Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, by Robert Whitaker, Cambridge, Mass.: Perseus, 334 pages, $27
ON JANUARY 18, 1959, 17-year-Old Jonika Upton was committed by her parents to the Nazareth Sanatorium in Albuquerque. They were sure she was tetched in the head; she had dated someone who seemed homosexual and carried around books by Proust. The final straw was Jonika's fleeing to Santa Cruz with her new boyfriend, a 22-year-old artist.
Her new caretakers ran high-voltage electric currents through Jonika 62 times in three months. Despite her doctor's expectations, this treatment did not heal her mental illness. The doctor lamented, "She has not become nearly as foggy as we might wish." It wasn't all bad news, though: "Of course, there is considerable confusion and general dilapidation of thought."
Even after two more weeks of the most sophisticated psychiatric treatment around--further electric shocks to a bound, usually terrified patient--the doctor could only note, regretfully, that "under this type of treatment a patient usually shows a great deal more fogging and general confusion than she has." By the end of April, Jonika's doctors couldn't hide their pride: She was pissing on herself and wandering around naked, and she didn't know if her father was still alive. Their mission completed, the doctors knew it was safe to send Jonika home.
How you react to Jonika's story is a good indicator of how you will react to Mad in America, the new book by award-winning science and medicine journalist Robert Whitaker. If you see the doctors of Nazareth Sanatorium as inhuman tormentors, you will see this book as a hideous history of unspeakable practices. If you think the doctors were honorable medical professionals providing the best available treatment to cure a bona fide mental illness caused by imbalances in the brain, you may think Whitaker has traduced the noble profession of psychiatry.
In his quietly intense history of the discipline's ever-shifting etiologies and cures, Whitaker sets out to show that psychiatric treatments cause more harm than good and that they are imposed, either through force or through subterfuge, on people who we have decided don't deserve or need respect. Psychiatrists would say these practices actually grant the mad the greatest respect we can give them: respect for their higher, sane selves--the selves they would want to be if only they weren't so desperately, sadly ill. Jonika, according to this view, would want to make sure she was never permitted to flaunt Proust or leave her parents' home in Albuquerque for Santa Cruz and her boyfriend. By the standards of that day, agreed upon by respected medical professionals, a young lady would have to be crazy to choose such a course.
Post-Nurse Ratched, it might seem a cultural commonplace that madhouses are mad and that institutional psychiatry has a lot of dehumanizing psychic (and physical) violence to answer for. As long ago as 1728, the novelist Daniel Defoe noted that life in a typical asylum is enough to drive anyone mad. As recently as 1946, Life magazine was exposing many of America's mental institutions as "snakepits." In his 1948 book The Shame of the States, Albert Deutsch wrote that public asylums reminded him of "Nazi concentration camps at Belsen and Buchenwald...buildings swarming with naked humans herded like cattle and treated with less concern, pervaded by a fetid odor so heavy, so nauseating, that the stench seemed to have almost a physical existence of its own."
Is this book just old news, then, a compendium of out-of-date horror stories from benighted days? Is it, in fact, an insult to the dedicated psychiatrists of today, who are doing their best to deal with the knotty mysteries of the human mind and how it can go awry?
It's easy to dismiss the critiques offered by Deutsch, Ken Kesey, and other such writers as irrelevant to contemporary psychiatry, which presumably has advanced beyond the primitive techniques they attacked (although electroshock has been making a comeback lately). What distinguishes Mad in America is that it draws a clear line from what everyone agrees were insane abuses of the past to the perfectly respectable "best practices" of today. Whitaker...