Mad In America

Mad In America

Robert Whitaker is a medical journalist who wrote an excellent book entitled Mad in America, published by Perseus Publishing (December 24, 2001). The following is a review of the book. Whitaker traces the treatment of depression in the United States. We learn of the tranquilizer chair, the proud 18th century invention of Dr. Benjamin Rush, the father of psychiatry. The patient was placed in a chair but was prevented from moving in any way, and a wooden hat was placed over the patient’s head to prevent sight.

A bucket was placed under a hole in the chair into which the patient defecated. Some doctors boasted that they kept patients in this chair for as long as six months. Some nineteenth century doctors believed that a valid medical treatment for depression was to strap the mentally ill in chairs that were lowered into water and kept submerged until just before they drowned. They were pulled out and then the process was repeated over and over. In contrast to this barbaric treatment, the Quakers established homes where the patients resided in pleasant surroundings, took frequent walks and were treated with dignity and respect.

The only “medical treatments” provided were warm baths. Mr. Whitaker tells us that people in these homes had a far greater chance of returning to their families and leading more normal lives than those who endured the treatments of Rush and his supporters. However, these humane and effective treatment methods were disliked by the medical community because they did not rely on medical treatments and were not supervised by medical doctors. Laws were passed requiring that the homes for the mentally ill had to be run by medical doctors. Mr. Whitaker attributes the increasingly inhumane treatment of the mentally ill in the nineteenth and twentieth centuries to this change.

Mr. Whitaker discusses the development of lobotomy (severing of the pre-frontal lobes of the brain) as a treatment that was heavily supported by funding from the Rockefeller Foundation. He quotes the disturbing findings published in their book, Psychosurgery. Written by psychiatrists Freeman and Watts, they set forth what they tell families to expect if a loved one undergoes a lobotomy. Whitaker states, “They say that in the first weeks following the operation, Freeman and Watts wrote, patients were often incontinent and displayed little interest in stirring from their beds. They would lie in their beds like ‘wax dummies’ so motionless that nurses would have to turn them to keep them from getting bedsores.

Relatives would not know what to make of their profound indifference to everything around them, Freeman and Watts said: ‘[The patient] responds only when they keep after him and then only in grunts; he shows neither distress nor relief nor interest. His mind is a blank…we have, then, a patient who is completely out of touch with his environment and to whom the passage of time means nothing.’” Mr. Whitaker traces the development of the “modern treatment” of mental illness through the use of drugs. He points out that in May of 1954, Thorazine was introduced as a treatment for schizophrenia. In the Journal of American Medicine, N. William Winkleman, Jr., stated “The drug produced an effect similar to frontal lobotomy.” Mr. Whitaker refers to the 1973 Science magazine article by psychology professor David Rosenhan. Rosenhan and seven others went to hospitals and exhibited symptoms typical of insane behavior.

They were admitted and ceased displaying the symptoms, but none of the hospital staff ever noticed. Rosenhan concluded,”We now know that we cannot distinguish insanity from sanity.” Mr. Whitaker discussed the close ties between the drug companies and the people being paid to do studies on the drugs developed by these companies. He also points out the consequences if anyone challenges the accepted “logic.” Loren Mosher, the director of the Center for Schizophrenia Studies at the National Institute of Mental Health, was concerned about the relationship between the doctors conducting studies of the effectiveness of different drugs and the drug companies. However, Mosher’s main concern was that the current drug treatment for schizophrenia did not seem to be effective. He decided to try to recreate the success enjoyed by the early Quaker facilities by setting up a treatment plan that didn’t use drugs but instead emphasized empathy and caring. Mosher named his study the Soteria Project. He had six patients, all of whom exhibited the classic symptoms like seeing aliens from Venus or spiders and bugs on all the walls.

The staff at Soteria listened to the patients and didn’t try to persuade the patients that what they said was wrong or irrational. The staff did let the patients know that they were expected to be clean and help with chores. Patients and staff played cards and there were no locks on the doors. Soteria was a huge success. However, Whitaker points out, “Soteria didn’t just question the merits of neuroleptics (tranquilizers). It raised the question of whether ordinary people could do more to help crazy people than highly educated psychiatrists.

The very hypothesis was offensive.” The funding for Soteria was eliminated and Mosher was pushed out of NIMH. As Whitaker says, “No one could have missed the message. American psychiatry and society had its belief system, and it was not about to suffer the fools who dared challenge it.” Whitaker then points to a World Health Organization (WHO) study that was launched in 1969 to compare outcomes (results of treatment).

He says, “At both two-year and five-year follow-ups, patients in three poor countries—India, Nigeria and Colombia—were doing dramatically better than patients in the United States and four other developed countries. “They were much more likely to be fully recovered and faring well in society—‘an exceptionally good social outcome characterized these patients,’ the WHO researchers wrote---and only a small minority had become chronically sick. At five years, about 64 percent of the patients in the poor countries were asymptomatic (without obvious signs or symptoms of disease) and functioning well.

Another 12 percent were doing okay, neither fully recovered nor chronically ill, and the final 24 percent were still doing poorly. In contrast, only 18 percent of the patients in the rich countries were asymptomatic and doing well, 17 percent were in the so-so category, and nearly 65 percent had poor outcomes.” When the results were attacked by psychiatry and the drug companies, WHO launched a follow-up study. As Whitaker notes, “No matter how the data were cut and sliced, outcomes in poor countries were much, much better.” He continued, “Even the statistics were much the same the second time around.

In the poor countries, nearly two-thirds of schizophrenics had good outcomes. Only slightly more than one-third became chronically ill. “In the rich countries, the ratio of good-to-bad outcomes was almost precisely the reverse. Barely more than one-third had good outcomes, and the remaining patients didn’t fare so well… The obvious place to look for a distinguishing variable, then, is in the medical care that was provided. And here there was a clear difference. Doctors in the poor countries did not keep their mad patients on neuroleptics, while doctors in rich countries did. In the poor countries, only 16 percent of the patients were maintained on neuroleptics. In rich countries, 61 percent of the patients were kept on such drugs. That is a statistically powerful correlation between drug use and outcomes.” Whitaker concludes, “In fact, if the past is any guide to the future, today we can be certain of only one thing: The day will come when people will look back at our current medicines for schizophrenia and the stories we tell to patients about their abnormal brain chemistry, and they will shake their heads in utter disbelief.”


In light of the recent very disturbing financial news, no one can read Whitaker’s well documented book and not ask why we don’t use non-drug and less expensive alternative treatments that seem to improve the quality of life for people with schizophrenia and other “mental ills.” Before we put anyone on a drug, let’s make sure that there is no physical cause that can be treated, and let’s treat all patients with respect and dignity. Why? Because this approach works.

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