Journal of Substance Abuse Treatment, Vol. 15, No. 1, pp. 75–76, 1998
Copyright © 1998 Elsevier Science Inc.
Printed in the USA. All rights reserved
After the Madness: A Judge’s Own Prison Memoir
New York: Random House, 1997, $24.00, 369 pages.
This popular best-seller is being reviewed in this profes-
sional journal because Sol Wachtler’s experience very
much concerns the field. Although written for the lay
public, this book should be read by mental health profes-
sionals, particularly by physicians involved with sub-
stance abusing and dually diagnosed patients, who can
be iatrogenically made physically dependent on controlled
substances. Members of the legal community on both
sides of the plaintiff–defendant dyad would also profit
from hearing what a celebrated judge has to say about
humanism and the holistic understanding of humanity
from the vantage point of a newly released prisoner.
A distinguished professional jurist and Chief Judge of
the State of New York and the Court of Appeals, Wacht-
ler was able to manipulate the medical profession in or-
der to self-medicate his undiagnosed major depression.
He regularly obtained legal prescriptions for drugs which
he clearly abused and which markedly altered the course
of his psychopathology. Over a 4-month period, for ex-
ample, Wachtler took 1400 tablets of Tenuate
phetamine-like drug with high abuse potential), and 280
tablets of Halcion
(a Schedule IV Controlled Substance
that can not only worsen a depression but cause out-
of-character behavior and agitation, including delusions,
psychotic confusion, and mania). With Halcion
grade amnesia with or without apparent confusion is not
uncommon and withdrawal seizures can occur when the
drug is abruptly discontinued. None of the physicians he
consulted diagnosed his underlying psychiatric condi-
tion. Large doses of Tenuate
were prescribed to “elevate
the energy level” and in part the drug induced a manic
state with the resulting bizarre, inappropriate behavior
that has been well publicized and need not be repeated in
this review. Eventually, he was charged with violation of
federal laws stemming from his threats of kidnapping
and extortion. He was arrested on November 7, 1992,
and left prison on August 29, 1994 to serve a term of “su-
pervised release” until October 1996.
The bulk of the book is well written, crisp, and sharp
as to style and content. As the title suggests, its subject is
the author’s adaptation and survival with all types of fel-
low inmates and with hostile, often sadistic, prison au-
thorities. This once relatively liberal jurist now views the
treatment of prison inmates through different eyes. He
describes the medical and psychiatric care he and others
received in the federal prisons as grossly inadequate,
care that would readily be classified as malpractice if it
were administered in a private setting. Wachtler records
many instances of the lack of respect, the disenfranchise-
ment, and the loss of dignity imposed on prisoners for
the sake of compliance to a rigid standard of behavior.
He writes passionately about drug policy reform and the
futility of another “war on drugs,” making an elegant
plea for a more rational public health paradigm than the
current punitive paradigm. He also takes the judicial sys-
tem to task, particularly the role of the prosecutor, who
wields great power and often exercises it cruelly in pur-
suit of headlines and in the service of political ambition.
This is, however, a man who has regained his reason; no
rancor, anger, or rationalization dominate his narrative.
There is even a degree of humor. Wachtler appears at
this point to recognize and acknowledge that he and his
illness are responsible for his behavior.
Wachtler gives the reader glimpses into his early life,
suggesting that a primary mood disorder preceded the
onset of his substance use as a self-medication strategy.
He did not seek help for his affective disorder, probably
as a function of denial, and fear of the stigma involved
when a public official makes such an admission. He cites
several examples of public figures whose careers were
ruined by their honesty in this regard. When he did seek
medical help, he very likely presented himself as a dis-
tinguished colleague rather than a troubled patient. Ce-
lebrities are not easy to treat, perhaps because they have
a sense of entitlement and a grandiose desire to prescribe
for themselves. Physicians should beware of being “se-
duced,” counter-transferentially, by the “rich and famous”
patient. The reviewer completed the book feeling that it
is no credit to members of the medical community, un-
aware of the potential for dual diagnosis in the substance
abuser and apparently unable to see this impressive man
in a clear clinical light, that Wachtler ended a distin-
guished career by serving a federal prison sentence.