Mad in America

January 7, 2002
Tooth removal. Bloodletting. Spinning. Ice-water baths. Electroshock therapy. These are only a few of the horrifying treatments for mental illness readers encounter in this accessible history of Western attitudes toward insanity. Whitaker, a medical writer and Pulitzer Prize finalist, argues that mental asylums in the U.S. have been run largely as "places of confinement—facilities that served to segregate the misfits from society—rather than as hospitals that provided medical care." His evidence is at times frightening, especially when he compares U.S. physicians' treatments of the mentally ill to medical experiments and sterilizations in Nazi Germany. Eugenicist attitudes, Whitaker argues, profoundly shaped American medicine in the first half of the 20th century, resulting in forced sterilization and other cruel treatments. Between 1907 and 1927, roughly 8,000 eugenic sterilizations were performed, while 10,000 mentally ill Americans were lobotomized in the years 1950 and 1951 alone. As late as 1933, there were no states in which insane people could legally get married. Though it covers some of the same territory as Sander Gilman's Seeing the Insane
and Elaine Showalter's The Female Malady, Whitaker's richer, more detailed book will appeal to those interested in medical history, as well as anyone fascinated by Western culture's obsessive need to define and subdue the mentally ill. Agent, Kevin Lang.

Starred review from December 15, 2001
American psychiatry has excelled throughout the nation's history, but doctors and drug manufacturers have profited far more than psychiatric patients. When the World Health Organization compared schizophrenics' recovery rates in the U.S and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity. Whitaker's articulate dissection of "mad medicine" in the U.S. explains why that dismaying contrast obtains. Assuming that insanity arises from identifiable physical causes, American psychiatry theorized about those causes and sought to find physical therapies and, later, drugs that attacked those causes. Accordingly, from being shocked with cold water and repeatedly nearly drowned, to suffering chemically and electronically induced grand mal seizures, to having the frontal lobes of their brains chopped off, to being drugged into parkinsonism (the preferred modus nowadays), the mad in America have suffered as essentially nonconsensual experimental subjects. Since World War II, drug companies have made continued testing increasingly worthwhile, despite the lack of encouraging results. This horrifying history is all the more discomfiting because another mode of treatment was successfully used from the late eighteenth century until the 1870s. Called moral treatment by its Quaker champions, it involved treating the mad with kindness and sympathetic companionship rather than drugs and machines. But it cost too much, and it wasn't professional.(Reprinted with permission of Booklist, copyright 2001, American Library Association.)