Managing Madness

Canadian Review of American Studies/ Revue canadienne d'etudes amencaines Volume 26, Number 1, Winter 1996, pp. 147-158 Managing Madness David L. Lightner 147 Lynn Gamwell and Nancy Tomes. Madness in America: Cultural and Medical Perceptions of Mental Illness before 1914. Ithaca, New York: Cornell University Press, 1995. Pp. 182. David Gallaher. Voice for the Mad: The Life of Dorothea Dix. New York: The Free Press, 1995. Pp. xi + 538. Gerald N. Grob. The Mad Anwng Us: A History of the Care of Arnerica1 s Mentally Ill. New York: The Free Press, 1994. Pp. xiii + 386. That American mental health policy is a shambles seems apparent to anyone who walks the mean streets of the nation's cities. The last time I was in Washington, I repeatedly skirted gingerly by a deranged man seated on the sidewalk outside the Library of Congress. The stench of his body wastes was overpowering. His face crawled with vermin and was contorted in rage, as he shouted an endless torrent of obscenities. I have not encountered the like here in Canada, but perhaps it is only a matter of time. The province of Alberta, where I live, is eliminating almost half of its acute-care psychiatric beds, and already horror stories are surfacing in the media. A professor at my university suffered from depression. Refused admission at a hospital, he shot and killed himself. More recently, a young woman tried to jump off a bridge near the university campus. Pulled to safety by passers-by, she was 148 Canadian Review of American Studies Revue canadienne d etudes americaines taken to hospital, examined, and released. She promptly returned to the same bridge and had to be rescued a second time. How did we get into this mess? More important, how do we get out of it? Recent studies on the history of mental illness in the United States have much to say in reply to the first question but provide no answer to the second. Gerald Grob is America's leading authority on the history of the care and treatment of the insane. His books include a pioneering account of the first state-funded hospital that treated rather than merely housed the mentally ill (Grob 1966), as well as broader histories of mental health policy (Grob 1973; 1991). In The Mad Among Us, Grob has drawn upon his own earlier work as well as the research findings of many other scholars to produce a work of synthesis that surveys American mental health policy from the seventeenth century to the present. At first, families mostly looked after their own but communities accepted responsibility for afflicted persons if kinfolk could not cope. When towns grew large enough to establish jails and almshouses, those facilities were used to house "distracted" persons who had nowhere else to live. More specialized institutions-madhouses and mad hospitals-appeared in the eighteenth century but remained almost purely custodial, supplying the bare necessities of life but offering no hope of cure. By the 1820s a few small private hospitals began providing the first significant therapy for mental illness, through the regimen known as "moral treatment," in which patients were removed from the environments that had driven them mad (hence the word "asylum") and were then cajoled and compelled into gradually altering their behaviour to conform to social norms. Practitioners claimed that most cases of insanity could be cured if treated promptly. Persuaded that early cure was cheaper than long-term care, states began establishing public asylums for the care of the insane. Those facilities eventually constituted "the single largest social welfare investment of states in the nineteenth century" (132). Unfortunately, the cure of mental illness often proved to be both more elusive and less permanent than the champions of moral treatment had hoped, and so the state mental hospitals became ever more crowded with chronic cases. David L. Lightner/ 149 The makeup of the mental hospital population varied over time. For example, patients suffering brain damage from tertiary syphilis made up close to ten percent of all admissions to mental hospitals in the 1930s, but their presence declined with the widening use of penicillin after the Second World War. In the nineteenth...