Mad in America

Mad in America (website) (2002) by Robert Whitaker is a controversial history of psychiatric treatment in the US. It’s a really startling read.

The book covers how mental illness has been treated in the since 17C. In part one the era from 1750 to 1900 is examined. Early treatments of essentially jailing and torturing people set the tone for the rest of the book. The ‘moral treatment’ of putting the mentally ill in small homes and treating them well is praised. Whitaker believes this led to outcomes that were superior to much later treatment. This sort of treatment was then adopted fairly widely. However, the treatment was expensive and soon the rising numbers of the mentally ill, partly due to syphilis, led to a decline in treatment and outcomes and the reintroduction of cruel treatments to subdue patients.

In Part 2 treatment between 1900 and 1950 is described. Here forced sterilization was implemented in part due to eugenic theories and psychiatrists started using insulin comas, electroshock treatment and lobotomies. The horrendous spectacle of unfortunate people presenting themselves as depressed and coming out with lobotomies is described in detail.

In part 3 which covers the treatment from the 1950s to the 1990s. Here the discovery and use of neuroleptic drugs like chlorpromazine is outlined. Whitaker states that the drugs were essentially chemical lobotomies. Whitaker believes that the drugs had far more serious side effects than the drug companies admitted. He goes on to say that these drugs just relieved symptoms but that they were later described by psychiatrists as healing drugs.

Whitaker writes about how modern attempts similar to the ‘moral treatment’ by the Quakers were torpedoed by the psychiatric establishment. He also cites a 1979 World Health Organisation report that found that schizophrenia patients had better outcomes in third world countries than in developed countries. Whitaker says this was because they didn’t use drugs as much as the developed world. Whitaker believes that the emptying of the asylums since the 1950s has not been the result of neurologics but a change in treatment and a push to emptyr asylums for cost reasons.

The book then looks at the period of the 1990s onward when atypical antipsychotics were developed. Whitaker says that the trials of these drugs were also manipulated in order to demonstrate their efficacy. Whitaker says that the main thing the trials were aimed at doing was showing that the side effects were less than earlier neuroleptics. He points out that in admitting the very serious side effects of earlier neuroleptics the drug companies were essentially admitting the problems of earlier drugs.

Whitaker rejects the theory that schizophrenics suffer simply from too much dopamine or seratonin. He believes that the causes of the disease are simply not known and that much drug treatment is not particularly effective. He also points out that the US is one of the few countries were high doses of drugs are used almost as a first response to mental illness and he is highly critical of this approach.

The book’s reception has been controversial. It’s hard to believe that the case advanced by the book is without merit. The descriptions of treatment up until the 1950s are largely accepted. Since then the description of mental illness drugs as not being effective and in fact being cruel and counterproductive has become very controversial.

The book is hard going. It’s well written and certainly makes valid and important points about treatment of the mentally ill before 1950. The drug chapters also clearly have something important to say. From reading the book and doing some research on the web and asking medical health professionals it appears the case Whitaker makes for treatment after 1950 also has considerably merit.  The book is very much worth reading though and would be well worth reading for anyone with an interest in science and medicine.





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