Book Review: Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

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The front cover of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*), by Lynn Nanos, featuring a police car shining its headlights on a sleeping homeless person wearing a green hoodie. Credit: Lynn Nanos.

*Disclosure: Some of the links below are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase. Thanks for supporting the work at The Bipolar Parent!

America’s mental health system is broken. It has failed millions of people suffering from mental illness and will continue to do so unless sweeping changes are made. That’s the premise of Lynn Nanos’ Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*).

I was offered a copy by the author in exchange for an honest review, which after reading the book, I am thrilled to provide. Nanos is a clinician in the field of emergency psychiatry in Massachusetts with over twenty years of experience in the field. She is uniquely qualified to write this book, having spent much of her life caring for the sickest of the sick.

According to Nanos, there are three core problems in the broken psychiatric system: a lack of inpatient beds due to deinstitutionalization; malingerers, who falsify claims of mental illness to request inpatient treatment; and that patients are “dying with their rights on.” The latter means that a prioritization of patients’ rights causes people suffering from psychosis who refuse treatment due to a lack of insight into their mental illness to be discharged from hospitals too early. These patients are often homeless and vulnerable to being attacked on the streets. Nanos’ solution to these problems is to promote a program called Assisted Outpatient Treatment (AOT), a court-ordered program which forces patients suffering from psychosis to comply with treatment when living in the community.

Nanos describes a condition called ansognosia, where patients have a lack of insight into their mental illness. This book has special significance for me because I have bipolar and have endured psychosis, like the patients in the many case studies Nanos covers in Breakdown. When I suffered a psychotic break, I had no insight into my mental illness, like many of the patients suffering psychosis that Nanos describes. I was fortunate in that, as I complied with treatment, I gained such insight and was able to take steps towards recovery before I left the hospital. Like Nanos points out, this is not the case with the majority of others.

What Doesn’t Work Well in Breakdown

Because I don’t want to end on a negative note, I’ll start with one item that didn’t work well for me in Breakdown.

  • Disclaimers: The opening chapter is full of disclaimers about what the book does and does not cover. These disclaimers are vital to understanding how the rest of the book works, but they make for dry reading, especially for a first chapter. However, I don’t know how else Nanos would have structured this. These disclaimers are necessary, and they need to be placed upfront.

That’s it. That’s all I didn’t like. If a reader can get past the tedious first chapter, the meat of Breakdown is brilliant.

What Does Work Well in Breakdown

As promised, here’s what does work well in Breakdown:

  • Fulfilled Promise: In the opening chapter, Nanos promises a solution to the issues she raises later on, and she delivers on this promise. The writing is accurate and engaging, with case studies of patients offering an emotional look into people who suffer psychosis and their mental illnesses. The book is a blend of clinical information and painfully personal writing, which is another part of what Nanos promises and delivers.
    Research-Backed Opinions: Nanos’ commitment to scientific research is admirable. She cites approximately 300 studies, and the last chapters of Breakdown are especially filled with mental health statistics, which back up her claims.
    Professional Formatting: Despite being self-published, Breakdown is professionally formatted. The cover, featuring a presumably homeless man being confronted by police while lying on a sidewalk, is well-drawn and fabulous. Not that I’m saying to judge a book by its cover, but Breakdown is visually pleasing inside and out.
    Case Studies: The most arresting parts of Breakdown are the case studies. Nanos demonstrates why psychotic patients need treatment through the examination of her encounters with them in a clinical setting. Some examples are: a woman who traveled from Maine to Massachusetts because a spirit called “Crystal” ordered her to, a man who smeared dead insects on his neighbors’ doors to help purify toxins in their apartments, and Lily, a woman who delivered dead dogs to strangers, among other stories. Most of these people refused adequate treatment due to ansognosia. A great number of them bolted before Nanos was able to arrange for transportation to hospitals. Some of them were violent, and a few went on to assault their loved ones, with two specific cases ending in death. The case studies are the most effective parts of Breakdown, and demonstrate why the AOT program is so important.

Final Thoughts

Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*) is a fascinating book. It’s professionally written and formatted, research based, and effectively delivers its message. The case studies were especially enlightening, and are the heart of Breakdown.

Mental health issues affect all of us, whether we suffer from mental illness, have loved ones who do, or are impacted by the mentally ill people all around us. Read this book and see how you, too, can join the mental health discussion.

*Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase.

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Author: Cassandra Stout

Freelance writer Cassandra Stout blogs at the award-winning Bipolar Parent, a comprehensive resource for parents with mental illnesses. Cassandra holds degrees from the University of Arizona in Creative Writing and Journalism. She has been a judge for the Pacific Northwest Writers' Association literary contest for nine years, where her memoir, Committed, recently placed as a finalist. She balances her literary work with raising her children, feeding her cat, and managing her bipolar disorder.

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