Product Description

A riveting social and medical history of madness in America, from the seventeenth century to today.

In Mad in America, medical journalist Robert Whitaker reveals an astounding truth: Schizophrenics in the United States currently fare worse than patients in the world's poorest countries, and quite possibly worse than asylum patients did in the early nineteenth century. With a muckraker's passion, Whitaker argues that modern treatments for the severely mentally ill are just old medicine in new bottles, and that we as a society are deeply deluded about their efficacy. Tracing over three centuries of "cures" for madness, Whitaker shows how medical therapies have been used to silence patients and dull their minds. He tells of the eighteenth- and nineteenth-century practices of "spinning" the insane, extracting their teeth, ovaries, and intestines, and submerging patients in freezing water. The "cures" in the 1920s and 1930s were no less barbaric as eugenic attitudes toward the mentally ill led to brain-damaging lobotomies and electroshock therapy. Perhaps Whitaker's most damning revelation, however, is his report of how drug companies in the 1980s and 1990s skewed their studies in an effort to prove the effectiveness of their products. Based on exhaustive research culled from old patient medical records, historical accounts, numerous interviews, and hundreds of government documents, Mad in America raises important questions about our obligations to the mad, what it means to be "insane," and what we value most about the human mind.

Product Details

• Amazon Sales Rank: #29778 in Books
• Published on: 2003-04
• Released on: 2003-04-15
• Original language: English
• Number of items: 1
• Binding: Paperback
• 352 pages

Features

• ISBN13: 9780738207995
• Condition: NEW
• Notes: Brand New from Publisher. No Remainder Mark.
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Amazon.com Review
Hot on the heels of an optimistic film about Nobelist John Nash's schizophrenic journey comes medical journalist Robert Whitaker's disturbing exposé of the cruel and corrupt business of treating mental illness in America. Mad in America begins by surveying three centuries of mental health treatments to discover why positive outcomes for schizophrenics in the U.S. for the last 25 years have decreased--making them lower than those in developing countries. Whitaker asks, "Why should living in a country with such rich resources and advanced medical treatments for disorders of every kind, be so toxic to those who are severely mentally ill?"

One of Whitaker's answers draws upon the historic and current assumptions of a physical cause for schizophrenia. This resulted in cruel and unusual physical treatments--from ice-water immersion and bloodletting to the more contemporary electroshock, lobotomy, and drug therapies with dangerous side effects. This physical cause model leads to Whitaker's more provocative explanation: that mental illness has become a profit center. He offers disturbing details about how good business for drug companies makes for bad medicine in treating schizophrenia. From drug companies skewing their studies and patient/subjects kept in the dark about experiments to the cozy relationship between the American Psychiatric Association and drug companies, Whitaker underlines the mistreatment of the mentally ill. This courageous and compelling book succeeds as both a history of our attitudes toward mental illness and a manifesto for changing them. --Barbara Mackoff

From Publishers Weekly
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.

Copyright 2002 Cahners Business Information, Inc.

From The New England Journal of Medicine
This book is more of an indictment than a historical account, in keeping with its subtitle. The author, a medical journalist, virtually equates mental illness with schizophrenia; depression and other psychiatric disorders are mentioned only parenthetically. The story starts on a positive note, with the establishment of proper medical wards for the insane in Pennsylvania Hospital, around 1800. This occurred in the wake of the work of Pinel, who in 1793 was the first to free psychiatric patients from their chains, in Paris. The medical approach, sometimes still harsh, was followed by the heyday of "moral treatment," between the 1840s and the 1880s, in Pennsylvania Hospital and elsewhere in the United States. It was modeled on the Quakers' retreat in York, England (in 1796), where patients were treated with compassion and respect. Alas, from there the road only went downward. The overcrowding of psychiatric hospitals with persons with syphilis, alcoholism, and dementia, as well as the lack of dedicated personnel, led to the departure of philanthropists and the restoration of the medical model, under the leadership of neurologists. Subsequently, the eugenics movement led to inhumane measures. The first was prohibition of marriage among the insane (in more than 20 states, between 1896 and 1914); the next was compulsory sterilization, performed in thousands of U.S. citizens between 1907 and World War II. Until the 1930s, psychotic behavior was most often treated with "hydrotherapy" (in fact, old-fashioned forms of restraint combined with the use of cold baths or wet packs). Other physicians acted on idiosyncratic theories and removed female organs, parts of the gut, or teeth, or they induced malarial fever. In the 1930s, new treatments followed each other in rapid succession: coma induced by insulin, seizures induced by pentylenetetrazol, electroshock treatment, and finally, prefrontal lobotomy. Moniz took the lead with this operation (in Lisbon, Portugal, in 1935) and was followed the next year by Freeman and Watts in the United States. It was especially in the decade after the war, after Freeman had introduced the transorbital technique, that more and more patients were regarded as candidates for prefrontal lobotomy. The state of lethargy in which most patients were left after this "minor operation" did not detract from its popularity. The fact that outcome assessment was so biased can be attributed not only to naive optimism; in addition, discharge from an institution was regarded as a success in itself. State asylums encouraged any measure that removed patients from their care, and reports of success would bring in new research money, especially from the Rockefeller Foundation. When the popularity of lobotomy waned, in the mid-1950s, more than 20,000 patients had undergone this procedure. One might think that the advent of antipsychotic drugs (starting with chlorpromazine, in 1954) would have marked the beginning of a more positive chapter in the history of American psychiatry. Not so, at least in the author's eyes. He regards American treatment regimens involving the use of antipsychotic drugs as no less disabling and brutal than the methods used in earlier times. Although there may be truth in the notion that dosages of antipsychotic drugs in the United States are higher than necessary, the author weakens his position by issuing continuous and unrelenting condemnations (for instance, "The Nuremberg Code doesn't apply here"), despite a dearth of evidence to support them. How can he be so certain that persons with Kraepelin's schizophrenia in fact suffered from encephalitis lethargica and that therefore today the outcome of the disease is seen in an unnecessarily gloomy light? Indeed, finding normal levels of dopamine in the cerebrospinal fluid of persons with unmedicated schizophrenia does not support the "dopamine hypothesis," but to call it "a bald-faced lie" is simplistic reasoning. It is true that blocking dopamine receptors often leads to akathisia (an irresistible urge to move), but what is proved by citing (without naming the authors) a study in which 79 percent of mentally ill patients who had tried to kill themselves suffered from akathisia? Or by citing one in which 50 percent of all fights on a psychiatric ward involved patients who suffered from akathisia? And what point is made by telling the sad story of a female patient who was eventually found murdered in Central Park? Or by recounting the story of fraudulent psychiatrists who made money by entering nonexistent patients into well-funded pharmaceutical trials? Such criminal behavior has occurred in other specialties and does not by definition disprove the efficacy of the drugs being studied. Similarly, the author tries to prove his point that neuroleptic drugs make patients worse, rather than better, by repeatedly comparing series of treated and untreated patients from different institutions, with inherent differences in referral patterns and severity of illness. It is precisely for such weaknesses of design that he chides the industry-driven clinical trials that introduced "atypical" antipsychotic agents such as risperidone and olanzapine. Rightly so, but by this time critical readers will have lost faith in the author's arguments. Although the author is widely read on the subject, the facts are largely arranged to suit his prejudice, especially in the chapters on drug treatment. American psychiatric institutions may have their failings in the current management of patients with schizophrenia, but they deserve better critics. J. van Gijn, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Customer Reviews

Quacks & Quakers
Imagine a doctor wearing the traditionally authoritative white coat walking into the local asylum with a baseball bat. He finds a couple of hyperactive patient-residents, clobbers them over the head with the bat and notices that they grow noticeably calmer when unconcious. The company that makes the bats funds the Doctor's subsequent research (which of course corroborates the earlier findings) and the bat is marketed to other psychiatrists as the "mood stabilizer." N years later the therapy of choice might be a stun-gun, a.k.a., the bio-consciousness transformer. Mad in America, as the title suggests, chronicles the history of a dysfunctional field, psychiatry, and the way it variously classified, misunderstood, mistreated and misled the most vulnerale of its patients, the schizophrenic. Psychiatry either failed to see what was happening to its patients or fabricated what it saw. Lobotomies, the so-called neuroleptics and the "atypicals" are all here on display in Whitaker's book as hyped and ineffective at best and, at worst, downright fradulent therapies. Taking a cue from Watergate's deepthroat, Whitaker almost always can explain why psychiatry went astray by "following the money."
This is a powerful book, but a problematic one as well. At least some of the drugs described by Whitaker remain in the standard PDR. Some fraction of patients may benefit from them, and benefit for reasons that psychiatry may not adequately understand. It's also valid that some fraction of patients benefit from placebos. Whitaker is surely right to put all of us on our guard, but few are willing to abandon entirely the hypothesis that bio-chemical imabalnces may be involved at some level as a causal agent in the overall manifestation of "madness." The theraputic approach of the early Quakers, with its emphasis on communities of caring, clearly desereve to be re-discovered and Whitaker does us a favor by reviewing this history, but so too we need to retain those pharmacological avenues that honestly show sound results, despite the possibilities for abuse, if only because the magnitude of the "madness" problem will invariably swamp any system that relies exclulsively on some combination of residential confinement, surgical procedures or out-patient psychotherapy.

Scathing Review of How the Mentally Ill are Treated
I normally never write review but feel as though this book is worthy of one. What the author does in this book is what journalists fail to do. He investigates the people in charge of taking care of the mentally ill in a way that makes the reader wonder who is the one that is really ill.
He starts out with a brief history of how mentally ill people have been treated throughout history. From hydrotherapy to metrazol, insulin coma, draining of blood, "tranquilizer chairs", etc. This progresses to the more recent introduction of neuroleptics in the 1950's and how they induce a sort of parkinsonism. What's most revealing about these drugs is how he points out that people who never take them are more likely to recover. In this part of the book, he also talks about Freeman's disgusting labotomy procedures in which he pokes the patient about the eye and places a stick in their head and wiggles it to destroy the frontal lobes. Patients then go on to act like children and even continue eating after vomiting in their own food.
With all that said, the most revealing aspect is the fact that people in less developed countries fare a lot better with schizophrenia than people in more developed countries. The introduction of atypical neuroleptics also reveal how "dirty" these drugs really are in that they target so many different neurotransmitters. He goes on to point so many conflicts of interest in regards to the reviews of drugs that it left me shocked.
The saddest part of the book is the story of various individuals. A young woman was taken off venlafaxine and given amphetamines to induce her psychosis to the point where they could experiment on her using brain scans. She then goes home for a day even though she isn't supposed to, does various household chores and leaves to go jump off a bridge. The greatest thing that can be taken from this book is not only how various doctors have experimented on the mentally ill with the so-called science of eugenics as well as the notion that mentally ill people are less human but the example treatment put forth by the Quakers as well as the Sorteria project. Mentally ill people deserve better treatment in this country as well as better healthcare overall. A WAKE UP CALL. HIGHLY RECOMMENDED

A Must-read for family members
This book is a must-read for anyone who cares about a person struggling with schizophrenia. As a former president of a county chapter of NAMI, I want to plainly state that Whitaker's charges of collusion between drug companies and institutions and organizations purporting to care for the mentally ill are not far-fetched. Some of his arguments are painted with a very broad brush, but that doesn't make them invalid.
The statistics involving mental illness in third-world countries simply can't be ignored. This book has altered my thinking regarding anti-psychotics. Family members who dismiss this book may be acting out of fear and unwillingness to change.
This book isn't the holy grail. But it provides startling information, and shouldn't be missed.