Mad in America Book

A historical account of how the mentally ill have been treated, with an emphasis on the treatment in America.

Rarely does a title describe a book so well. The treatment of the mentally ill has been marred by bad science throughout; historically plagued with abominable practices such as whipping and bloodletting, even in its golden hour in the 20th century, the mentally ill were "(being) described as a degenerate strain of humanity, "social wastage"..."defective germ plasm".." and in keeping with eugenics, that strangely flawed notion that refuses to go away, America's scientific elite, backed by the U.S Supreme Court, advocated policies that resulted in the mentally ill being prohibited from marrying, forcibly committed to state hospitals and sterilized against their will. Society's complicity, even if it was due to the then overwhelming role of newspapers in shaping the public discourse, should not be ignored: "In 1935, 83 percent of all Californians favored eugenic sterilization of the mentally ill." As a consequence, "asylums were increasingly run as places of confinement - facilities that served to segregate the misfits from society - rather than as hospitals that provided medical care.."

With the discovery that brain trauma could lead to altered behavior, another chapter in the saga of bad science and bad medicine began, with efforts made to willfully cause trauma in the form of a litany of "treatments" such as insulin-coma therapy - clinically inducing coma by injecting insulin, as many as 60 times in a few weeks; Metrazol injections, which, in less than a minute, would make the patient "arch into a convulsion so severe it could fracture bones, tear muscles and loosen teeth."; and electroshock therapy, which gained such widespread acceptance that it continues as a treatment even today. All were crude methods, with no control over the region of the brain they affected or the extent to which the brain is traumatized, and yet all accepted heartily by the psychiatric profession as miracle treatments.

Worse, unfortunately, was to follow, in the form of lobotomy; the deliberate inflicting of injury on the frontal lobes of the brain - the area that "gives us consciousness of the self, that allows us to experience ourselves and to project ourselves into the past, present and future..that allows us to care deeply about who we are and our fate..that stirs creative impulses, ambition, a capacity for love, and spiritual yearnings..(that) makes us uniquely human" - as a cure for brain disease. At its worst, lobotomy's greatest proponent, Walter Freeman would "use an ice pick to poke a hole in the bony orbit above each eye and then insert it seven centimeters deep into the brain. At that point, he would move behind the patient's head and pull up on the ice pick to destroy the frontal-lobe nerve fibers. With this new method, Freeman reasoned it wasn't necessary to sterilize the operating field and waste time with that "germ crap". The use of anesthesia could also be eliminated...To quicken the process, he would drive picks into both eyes at once, rather than one at a time...thereby shaving a few minutes off the operating time." The practice was widely adopted across the world, and continued to be used until the 1980's, despite poor results - in one major California hospital, Stockton, "twelve percent of the patients died from the surgery, mostly because of bleeding in the brain." And even in the best cases, it left the patients incapable of leading fulfilling lives: "The person who had once painted pictures, written poetry, or composed music was now "no longer ashamed to fetch and carry, to wait on tables or make beds or empty cans.""

Why did such inhuman practices continue for so long? Because there was bad science too, in judging the efficacy of the treatments. For instance, "At Winnebago State Hospital in Wisconsin, physicians used an outcomes scale (for lobotomy) that ranged from no change to slight improvement to being able to go home. They didn't even allow for the possibility that patients might become worse." Presumably, the situation of the mentally ill was so dire, that no outcome other than a positive one was possible. One wonders in what category patients who died following the treatments were placed.

The last part of the title emphasizes that the mistreatment of the mentally ill is enduring. The current trend in psychiatry is for the prescription of neuroleptics - drugs that essentially simulate the effects of prefrontal lobotomy without the surgery and which diminish the possibility "that a person, distraught in mind and soul when first treated, could ever return to a healthy, non-medicated life...(drugs such as) haloperidol could produce a "marked increase in violent behavior," even among those without any history of assault.. Little could the pulic have suspected that the madman of its nightmares, who kills without warning and for no apparent reason, was not always driven by an evil within but by a popular medication." Here too, bad science has again been used in the form of symtom-exacerbation experiments wherein a control group of patients is created by abruptly withdrawing their current medication, which makes them fare worse than the group treated with the new drug.

The author makes a long and convincing case of how the nexus of bad science and bad medicine has been forged stronger by a corporate greed for profit and by slack regulation that allows researchers conducting clinical drug trials to be funded by drug companies, thus perpetrating a moral hazard.

In most countries, the mentally ill can still be committed to mental institutions without their consent and any rights the law provides them are rendered meaningless through a lack of vigilance and lax implementation. The author contends that the outcomes of psychiatric care in the U.S. are poorer than in developing countries like India, and this too highlights just how bad the situation everywhere really is; for what little care is afforded to the mentally ill in a woefully ill-funded public health infrastructure in India is grossly inadequate, and grim stories often come to light about the mistreatment of the mentally ill in the badly regulated private sector.

Some of the case studies presented in the book illustrate how the line between the sane and the not-so-sane is increasingly being drawn in a way that penalizes even slight suggestions of idiosyncratic behavior and taken in a broader context, this is a synecdoche of society's demands of conformity - if you dress like a punk, put a turban on your head, a veil on your face or a tattoo on your back, you risk being labeled a subversive, your behavior considered deviant.

Our ethics and attitudes have changed considerably in the recent past; drawing and quartering would today be universally deplored, capital punishment itself is opposed by most, the prevention of cruelty to animals is sought, and yet we display a marked lack of empathy for those of us that like the very young, are the most vulnerable and should deserve it the most.

By highlighting the plight of those who fight a losing battle against their personal demons, this book does them an enormous service; it will likely not make any bestseller lists, but it truly deserves to be widely read.