Sadia Ashraf

May 8, 2020

Mad in America

SWRK 151 Health Services + Systems - Section 5

Introduction:​ Robert Whitaker wrote Mad in America to highlight the dark history

regarding mental health in America. People are ignorant of the atrocities that occurred to the

patients in mental hospitals and the amount of abuse they faced. For example, doctors and

psychiatrists would promise cure to any type of mental issue, ranging from schizophrenia to mild

anxiety. Yet, the treatment plan would be the same, which would be way overdosage of drugs

and torture, leaving patients worse than before. Society might believe that we have made great

progress in the expense of the people who suffered, however Whitaker would argue otherwise,

“our society believes that psychiatry has made great progress in treating schizophrenia, and yet

this book tells of a modern therapeutic failure and the “enduring mistreatment” of the seriously

mentally ill” (xv). Mad in America is a phenomenal book that shows the stigma regarding mental

health, the dehumanization of the patients, how racism against African Americans was

weaponized to put them in asylums, as well as how vulnerable parts of society such as minorities

were targeted for this scam. People did not receive the treatment they were promised. They were

lied to, tortured, manipulated, all for the means to make more profit. This is the definition of a

scam, yet for decades it was sugarcoated to be called “treatment”.

1) There’s a lot of themes present within the book, but the two that stand out the most is

dehumanization of mentally ill patients and targeted racism. In the beginning, the mentally ill

were treated like wild, savage animals. The common conception was “​like all wild animals,

lunatics needed to be dominated and broken.” (7)​ That all changed when Rush came along, who

was a Quaker and a reformist, and he treated the mentally ill patients with kindness. He saw

great improvement when he simply treated the patients as equal and kept them in humane
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conditions. The patients lived in a comfortable house-like area with others and were fed and

dressed properly, the staff was trained to be respectable, and there were many activities the

patients could partake in. However, throughout the years since, psychiatry changed for the worse

again. There was a deep bias against the patients within psychiatry, since the field itself was not

seen as a respectable career. It was low paying, there was lack of funding by the government, and

lack of proper training to treat the patients. However, new innovative surgeries and treatment

plans would garner a lot of attention and support from the public, which in turn would earn them

more revenue. For example, “​they [surgeons] could hope to earn fees ranging from several

hundred dollars to $ 1,500 for performing a lobotomy, attractive sums to surgeons whose annual

salaries at that time might not exceed $ 5,000.” (130) Surgeons had a lot of financial incentive

from performing such horrific surgeries like lobotomy, which left patients in a vegetable state.

This was seen as a success, since they were no longer being “disruptive”. What constituted as

being disruptive one might ask. One horrific example is that of a 17 year old girl named Jonika

Upton who had no signs she was mentally ill, she was simply a rebellious teenager who ran away

with her boyfriend. Her parents did not want her to be with him or have friends who were

homosexual. Thus, she was sent to the hospital to receive the electroshock treatment which left

her in an incontinent state, “by the end of April, Jonika Upton had finally deteriorated to the

desired “confusional” point. She was incontinent, walked around naked”. She was deemed to be

a success and was discharged, upon which she “did not seem to recognize her parents,” the

nurses observed… her memory of her boyfriend had been erased, and certainly she was no

longer carrying Proust under her arm. Upton’s physician chalked her up as a therapeutic

success”. (101) This is not the only time this happened. These disgusting and horrific stories
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were extremely prevalent, upon which there were numerous studies conducted to show how

eager the psychiatrists were to make the diagnosis of a mental illness, admit them to the hospital,

torture them, and return them back home in a worse shape they came in. Whitaker states, “a

researcher who reviewed Manhattan State Hospital’s 1982 case records determined that 80

percent of the “schizophrenic” patients there had never exhibited the symptoms necessary to

support such a diagnosis. Nationwide, it was estimated in 1978 that more than 100,000 people

had been so misdiagnosed.” (169) Psychiatrist at the time believed that the way to cure patients

was through removal of the “frontal lobes which made us uniquely human. And that’s what

needed to be taken from the mentally ill. This mental activity, Freeman and Watts explained, was

the source of their suffering. Disconnecting the frontal lobes freed the mentally ill from

“disagreeable self-consciousness.” (127) So not only was there misdiagnosis, but there was

repeated abuse and dehumanization of the patients who were seemingly normal. Freeman and

Watts even had the audacity to say that having an imaginative mind was to blame for the

mentally ill. And if the removal of the frontal lobe destroyed their sense of self, it was a much

needed sacrifice in order to cure them of such a disease. Why was there so much unneeded

cruelty presented? Were the staff and doctors simply just evil? Well yes, simply because they

were prejudiced against the patients who were for the most part, unfavorable members of society.

Asylums included all types of people, alcoholics, drug users, schizophrenics, depressed patients,

women left behind by their families, and also African Americans. Freed slaves in the North were

at a high risk of being placed in asylums simply because they dared to seek freedom from their

masters. F​or an african american person to be seen as normal, they would have to be docile and

submissive to their master. Anything other than that would be rebellious and they risked being
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put in asylum hospitals. Whitaker states, “nationwide, the incidence of “insanity” among

Negroes rose fivefold between 1860 and 1880 , and once again, such statistics were seen by

many Southern doctors as evidence that the “colored race” simply couldn’t handle freedom.”

(172) Anything out of line as seen by society at the time was seen to be abnormal and deserved

to be fixed. It speaks volume how extreme Americans view were at the time, when Nazi

Germany was inspired by America in its eugenics to get rid of the mentally ill, “America’s

eugenicists even encouraged Nazi Germany in its massive sterilization of the mentally ill, a

program that led directly to the crematoriums of the Holocaust.” (42) None of this should have

occured if people were more open minded and empathetic to others. Ignorance and lack of

willingness to learn led to many innocent peoples death.

2) The evolution of mental health care is fascinating to say the least. How the mentally ill

were treated was dependent on the mental health care which reflected the underlying societal

values at the time. For example, in the 1700s, European societies believed that the mentally ill

were simply animals, and they developed harsh therapies to “tame” and cure them. In the 1800s,

the Quakers in York, England viewed the mentally ill as equals who deserved empathy and

respect, which reflected on the care that they provided. They were provided a comforting home

and treatment plans which were gentle. In the 1900s, Americans viewed the mentally ill as

“hereditary defectives” without the rights of “normal citizens” (136). Thus, the care Americans

provided was mostly set to alter and cure who they were as a person, since it was wrong to be

that way. They had to be fixed, since there was no way otherwise. The way they did so was by

many types of treatments that came one by one through trial and error at the expense of many
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innocent people. ​Treatment ideas were often barbaric in nature, and in this following instance the

idea spurred from visiting a slaughterhouse of all places. This symbolizes very outright how the

scientist at the time viewed the mentally ill, nothing more than animals that needed to be tamed.

Whitaker states, ​“​The eureka moment for Cerletti, however, came in a much more offbeat

venue— a local slaughterhouse. Cerletti had gone there expecting to observe how pigs were

killed with electroshock, only to discover that the slaughterhouse simply stunned the pigs with

electric jolts to the head, as this made it easier for butchers to stab and bleed the animals. The

key to using electricity to induce seizures in humans, Cerletti realized, was to apply it directly to

the head, rather than running the current through the body.” (97) By observing pigs, Cerletti got

the idea to do the same on humans. While it’s normal to observe how animals will react to

certain medications or treatments, this particular instance was much more insidious in nature.

Some other treatments included were ​shock treatments, leading to prefrontal lobotomy. Whitaker

states, “insulin coma, metrazol, and electroshock had all appeared in asylum medicine within the

space of a few years, and they all “worked” in a similar manner. They all dimmed brain

function… with these three methods, there was no precise control over the region of the brain

that was disabled, nor was there control over the degree to which the brain was traumatized. The

approach, said one physician, seemed akin to “trying to right a watch with a hammer.” (107)

These treatments came for the benefit of the hospital staff, not the patients. Hospital staff and

administrators were struggling with inadequate budgets and overcrowded facilities. (146) These

drugs were introduced so that it could tranquilize “disruptive” patients, and it was welcomed

with open arms. Moral treatment was also looked down upon in the beginning because in the late

1800s, “psychiatry had vowed to turn itself into a scientific discipline, and for all intents and
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purposes, that meant finding physical, or somatic, treatments for psychotic disorders.” (74) Thus,

in order for it to be scientific, it had to be proven with surgeries, drugs, shock treatments, since

keeping the patients in a room with activities was not scientific enough regardless of the positive

results it brought. Physical health on the other hand was ignored for the mentally ill. While

physical health care was advancing fast for the general population, it was stagnant or even

declined within the mentally ill population. People did not view mental health parallel to

physical health, because mental health was “invisible” and the majority of society was not

affected by it. For example, people who suffered from schizophrenia, in addition to their mental

and emotional problems, they also “walked oddly and suffered from facial tics, muscle spasms,

and sudden bouts of sleepiness. Their pupils reacted sluggishly to light. They also drooled, had

difficulty swallowing, were chronically constipated, and were unable to complete willed physical

acts.” (167) These patients suffered mentally, emotionally, and physically as well. It was too

broad of an illness, thus psychiatry simply altered the diagnostic criteria. The physical symptoms

of the disease were dropped, and the only thing remained was “the mental symptoms:

hallucinations, delusions, and bizarre thoughts.” (167) Physical and mental health diverged from

this point forward. No longer people who suffered from mental health were also diagnosed with

issues relating to their physical health, since it was considered a separate diagnosis.

3) Americans definitely hold different beliefs and values when viewing physical vs.

mental health care. Americans were not innately born to be prejudiced against the mentally ill,

but rather society at large by many different institutions used their influence and power to instill

a specific image for the ill. For example, Whitaker states, ​“In the first decades of the twentieth
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century, the American public regularly heard the insane likened to “viruses,``''social wastage,”

and “melancholy waste products.” (56) Thus, many Americans started to view the mentally as a

plague on civilization, one that in nature would have been quickly eliminated. Scorn toward the

severely mentally ill became the popular attitude. In fact, in 1937, Fortune magazine poll found

that 66 percent of Americans favored sterilizing “defectives.” By the end of 1945, 127

Americans had been sterilized under such laws, 311 of whom were patients in state mental

hospitals. (60) The most surprising revelation came when researchers found that our perceptions

of how those ill with “schizophrenia” think, behave, and look are all perceptions of people

altered by medication, and not by any natural course of a “disease.” (164) The belief that

mentally ill were the epitome of what was wrong with society was a flawed thinking. When

someone breaks a bone, it is seen as natural that needs to be taken care of right away, and needs

to be treated gently. When someone has a mental breakdown, they are not taken seriously, but

even if they are, there is victim blaming and less support. Even now, while times are better, this

is still a common thinking a lot of people have regarding mental health.

4) ​Whitaker is critical of the use of pharmaceuticals in treating mental illnesses, and

rightfully so. Whitaker states, “in short, the California investigators determined that neuroleptics,

rather than speeding people’s return to the community, apparently hindered recovery.” (157).

This was done through many ways and by different groups who abused their power for profit. It

states after WWII, where drug development began to shift from Germany to the United States,

because there was much more profit to be had there. Drug manufacturers in the United States

could get FDA approval easily, and they also did not have to prove that their drugs were
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effective. The bar was set quite low as well, they only had to prove they weren’t too toxic. They

could also charge much higher prices in the United States than any other countries because of the

patent-protection laws that limited competition dearly. The pharmaceutical companies could also

count on the support of the American Medical Association, which was complacent with the

pharmaceutical industry due to the new laws that were set in place. (148) Pharmaceutical

companies also had reasons for protecting the image of drugs as being deemed safe to use.

Whitaker states, “the drugs had turned into cash cows, and drug companies were not just selling

them for use in the mentally ill.” This means that drug companies were selling them to people

who did not suffer from any mental illness. For example, by 1970, more than 50 percent of

mentally ill children in America were using drugs unintended for their use. Not only that, elderly

in nursing homes and juvenile delinquents were also using the drugs regularly. It was used so

much that the drugs were coined “zombie juice.” (205) How were they able to acquire such

medications that would otherwise not be meant for them? The only way to do so was by laws,

which were passed by Hubert Humphrey where he “expanded the type of medication that can be

obtained only by a doctor in order to protect patients and customers potentially buying drugs

they don't need.” (150) Not only that, pharmaceutical companies were also setting up programs

by the states to medicate discharged patients. The patients were now being told to take

medications that needed to be taken continuously, rather than short-term remedies as was

previously conducted. Now, “pharmaceutical firms had lifelong customers for their drugs, and a

society poised to insist that such drugs be taken.” (158) The criticism by Whitaker is warranted,

and it doesn’t only apply for mental health medications, but also for physical health as well.

Many doctors and pharmaceuticals are known to prescribe drugs and therapies that might not
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always work for the patient, but because they earn more revenue, they continue to prescribe it.

While there are differences between mental and physical health, it is much easier to abuse

medications for those who are mentally ill. With physical health, a lot of the problems are

apparent and can be diagnosed easily, but mental health is much more invisible and subjective in

nature.

5) ​Robert Whitaker writes a balanced account of mental health history, he acknowledges

that while there were advancements made in psychiatry, it was at a very big cost. He does not

have any inherent biases that could be presented in the book, since everything he states is based

on research and factual evidence. The only bias that can be noted is that of the medical

community in the past who wronged the people for selfish pursuits. The book received a lot of

criticisms from the medical community, yet it was factual. He revised the book to further debunk

all the critics he received from the first edition. One of his reviews of the book states, “Robert

Whitaker has written a fascinating and provocative book— a history of the way Americans

understand schizophrenia and attempt to treat it, each twist and turn of which is marked by the

hubris that at last we have the answer. And as he makes clear, we still do not, nor are we

anywhere near as humane in caring for the schizophrenics in our midst as we think we are.”

—Marcia Angell, M.D., Harvard Medical School, former Editor-in-Chief, New England Journal

of Medicine”. A lot of the critics dismissed him because he is just a journalist, but it does not

detract from the validity and accuracy of the information provided in the book. The strength of

this book is that it provides charts and other factual data to back up his claims, which makes him

credible. This book is a fantastic resource for anyone who wishes to learn more about how
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mental health care evolved throughout the United States history. The only weakness that can be

argued, although quite weak, is that he often villainized the people in the past. Although nothing

can be justifiable for the way medical staff and society treated the mentally ill, is it really their

fault since they are ignorant of the nature of different mental illnesses? While a lot of it was

simply because of selfish pursuits, other people genuinely believed that their actions were

beneficial for the mentally ill. Instead of giving benefit of doubt, he lumped together a lot of

medical professionals at the time who were simply trying their best, even though their actions

hurt a lot of people.

Conclusion:​ The evolution of mental health care in America is not streamline. There were

many different factors at play that led to where the state of mental health care currently lies. It

started off with providing the patients moral treatment, which was practiced by the Quakers who

believed in the patients deserving of respect and kindness. That practice as it spread through

different hospitals and asylums did not translate as well due to budget constraints and lack of

knowledge, leading to torturous treatment methods. From shock therapies to horrific surgeries

like lobotomy and later on with the invention of drugs, which chemically castrated people's

brains. If not for these “treatments”, many patients were outright tortured. Everything that was

done to them was inhumane. Patients for the most part were outcasts of society, and as such

societies value over them was very little. Many people in America believed that they should be

sterilized in hopes of preventing them from having any more offspring which would lead to more

“bad apples” in society. Everything was profit driven, from the doctors who earned a lot of

money and privilege by performing treatments to the pharmaceutical companies who lobbied
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with the government to put laws in place that would hurt the mentally ill even more, in hopes of

earning even more money. Robert Whitaker does an excellent job debunking a lot of the

criticisms he received from his first edition that he published, by providing factual data and

arguments. He leaves the reader in a solemn state, sobering up people with preconceived notions

that everything that occured back then was justifiable. America still has a long way to go before

it reaches a state where everyone receives proper, equal treatment.

Reference

Whitaker, Robert. ​Mad in America : Bad Science, Bad Medicine, and the Enduring

Mistreatment of the Mentally Ill​, Basic Books, 2001. ProQuest Ebook Central,

http://ebookcentral.proquest.com/lib/csus/detail.action?docID=515522.

Created from csus on 2020-05-06 00:01:34.