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Mental Health Policy in the United States since 1950
The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough. In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage. The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The "mainstreaming" of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.
Digitizing Life in the United States
Imagine biology and medicine today without computers. What would laboratory work be like without electronic databases and statistical software? Would disciplines like genomics even be feasible without the means to manage and manipulate huge volumes of digital data? How would patients fare in a world without CT scans, programmable pacemakers, and computerized medical records? Today, computers are a critical component of almost all research in biology and medicine. Yet, just fifty years ago, the study of life was by far the least digitized field of science, its living subject matter thought too complex and dynamic to be meaningfully analyzed by logic-driven computers. In this long-overdue study, historian Joseph A. November explores the early attempts, in the 1950s and 1960s, to computerize biomedical research in the United States. Computers and biomedical research are now so intimately connected that it is difficult to imagine when such critical work was offline. Biomedical Computing transports readers back to such a time and investigates how computers first appeared in the research lab and doctor's office. November examines the conditions that made possible the computerization of biology—including strong technological, institutional, and political support from the National Institutes of Health—and shows not only how digital technology transformed the life sciences but also how the intersection of the two led to important developments in computer architecture and software design. The history of this phenomenon is only vaguely understood. November's thoroughly researched and lively study makes clear for readers the motives behind computerizing the study of life and how that technology profoundly affects biomedical research even today.
There was a time when birth was treated as a natural process rather than a medical condition. Before 1800, women gave birth seated in birth chairs or on stools and were helped along by midwives. Then societal changes in attitudes toward women and the practice of medicine made birthing a province of the male-dominated medical profession.
In Birth Chairs, Midwives, and Medicine, Amanda Carson Banks examines the history of the birth chair and tells how this birthing device changed over time. Through photographs, artists' renditions of births, interviews, and texts from midwives and early obstetricians, she creates an evolutionary picture of birthing practices and highlights the radical redefinition of birth that has occurred in the last two centuries.
During the 1800s the change from a natural philosophy of birth to a medical one was partly a result of heightened understandings of anatomy and physiology. The medical profession was growing, and with it grew the awareness of the economic rewards of making delivery a specialized practice. In the background of the medical profession's rise was the prevailing perception of women as fragile invalids. Gradually, midwives and birth chairs were relegated to rural and isolated settings.
The popularity of birth chairs has seen a revival in the late twentieth century as the struggle between medical obstetrics and the alternative birth movement has grown. As Banks shows through her careful examination of the chairs themselves, these questions have been answered and reconsidered many times in human history. Using the artifacts from the home and medical office, Banks traces sweeping societal changes in the philosophy of how to bring life into the world.
A Comparative Study
Throughout the fourteenth century AD/eighth century H, waves of plague swept out of Central Asia and decimated populations from China to Iceland. So devastating was the Black Death across the Old World that some historians have compared its effects to those of a nuclear holocaust. As countries began to recover from the plague during the following century, sharp contrasts arose between the East, where societies slumped into long-term economic and social decline, and the West, where technological and social innovation set the stage for Europe’s dominance into the twentieth century. Why were there such opposite outcomes from the same catastrophic event? In contrast to previous studies that have looked to differences between Islam and Christianity for the solution to the puzzle, this pioneering work proposes that a country’s system of landholding primarily determined how successfully it recovered from the calamity of the Black Death. Stuart Borsch compares the specific cases of Egypt and England, countries whose economies were based in agriculture and whose pre-plague levels of total and agrarian gross domestic product were roughly equivalent. Undertaking a thorough analysis of medieval economic data, he cogently explains why Egypt’s centralized and urban landholding system was unable to adapt to massive depopulation, while England’s localized and rural landholding system had fully recovered by the year 1500.
Hemophilia and the Unintended Consequences of Medical Progress
By the 1970s, a therapeutic revolution, decades in the making, had transformed hemophilia from an obscure hereditary malady into a manageable bleeding disorder. Yet the glory of this achievement was short lived. The same treatments that delivered some normalcy to the lives of persons with hemophilia brought unexpectedly fatal results in the 1980s when people with the disease contracted HIV-AIDS and Hepatitis C in staggering numbers. The Bleeding Disease recounts the promising and perilous history of American medical and social efforts to manage hemophilia in the twentieth century. This is both a success story and a cautionary tale, one built on the emergence in the 1950s and 1960s of an advocacy movement that sought normalcy—rather than social isolation and hyper-protectiveness—for the boys and men who suffered from the severest form of the disease. Stephen Pemberton evokes the allure of normalcy as well as the human costs of medical and technological progress in efforts to manage hemophilia. He explains how physicians, advocacy groups, the blood industry, and the government joined patients and families in their unrelenting pursuit of normalcy—and the devastating, unintended consequences that pursuit entailed. Ironically, transforming the hope of a normal life into a purchasable commodity for people with bleeding disorders made it all too easy to ignore the potential dangers of delivering greater health and autonomy to hemophilic boys and men.
An American History of Intersex
What does it mean to be human? To be human is, in part, to be physically sexed and culturally gendered. Yet not all bodies are clearly male or female. Bodies in Doubt traces the changing definitions, perceptions, and medical management of intersex (atypical sex development) in America from the colonial period to the present day. From the beginning, intersex bodies have been marked as "other," as monstrous, sinister, threatening, inferior, and unfortunate. Some nineteenth-century doctors viewed their intersex patients with disrespect and suspicion. Later, doctors showed more empathy for their patients' plights and tried to make correct decisions regarding their care. Yet definitions of "correct" in matters of intersex were entangled with shifting ideas and tensions about what was natural and normal, indeed about what constituted personhood or humanity. Reis has examined hundreds of cases of “hermaphroditism” and intersex found in medical and popular literature and argues that medical practice cannot be understood outside of the broader cultural context in which it is embedded. As the history of responses to intersex bodies has shown, doctors are influenced by social concerns about marriage and heterosexuality. Bodies in Doubt considers how Americans have interpreted and handled ambiguous bodies, how the criteria and the authority for judging bodies changed, how both the binary gender ideal and the anxiety over uncertainty persisted, and how the process for defining the very norms of sex and gender evolved. Bodies in Doubt breaks new ground in examining the historical roots of modern attitudes about intersex in the United States and will interest scholars and researchers in disability studies, social history, gender studies, and the history of medicine.
The Medicalization of Reproduction in Greece
The author, a second-generation Greek American, returned to Greece with her young daughter to do fieldwork over the course of a decade. Focusing on Rhodes, an island that blends continuity with the past and rapid social change in often unexpected ways, she interviewed over a hundred women, doctors, and midwives about issues of reproduction. The result is a detailed portrait of how a longstanding system of “local” gynecological and obstetrical knowledge under the control of women was rapidly displaced in the period following World War II, and how the technologically-intensive biomedical model that took its place in turn assumed its own distinctive signature. Bodies of Knowledge is a vivid ethnographic study of how a presumably globalizing and homogenizing process like medicalization can be reshaped as women and medical experts alike selectively accept or reject new practices and technologies. Georges found, for example, that women in Rhodes have enthusiastically embraced some new technologies, like fetal imaging during pregnancy, but rejected others, like medical contraception. They are also avid consumers of popular childbirth manuals. This book is the recipient of the 2006 Norman L. and Roselea J. Goldberg Prize for the best project in the area of medicine.
The Surprising Career of the Spirometer from Plantation to Genetics
In the antebellum South, plantation physicians used a new medical device—the spirometer—to show that lung volume and therefore vital capacity were supposedly less in black slaves than in white citizens. At the end of the Civil War, a large study of racial difference employing the spirometer appeared to confirm the finding, which was then applied to argue that slaves were unfit for freedom. What is astonishing is that this example of racial thinking is anything but a historical relic.
In Breathing Race into the Machine, science studies scholar Lundy Braun traces the little-known history of the spirometer to reveal the social and scientific processes by which medical instruments have worked to naturalize racial and ethnic differences, from Victorian Britain to today. Routinely a factor in clinical diagnoses, preemployment physicals, and disability estimates, spirometers are often “race corrected,” typically reducing normal values for African Americans by 15 percent.
An unsettling account of the pernicious effects of racial thinking that divides people along genetic lines, Breathing Race into the Machine helps us understand how race enters into science and shapes medical research and practice.
The History of Coerced Sterilization in the United States
Most closely associated today with the Nazis and World War II atrocities, eugenics is sometimes described as a government-orchestrated breeding program, other times as a pseudo-science, and often as the first step leading to genocide. Less frequently is it depicted as a movement having links to the United States. But eugenics does have a history in this country, and Mark Largent tells that story by exploring one of the most disturbing aspects, the compulsory asterilization of more than 64,000 Americans.