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Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
Schizophrenics in the United States currently fare worse than patients in the world’s poorest countries. In Mad in America, medical journalist Robert 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. The widespread use of lobotomies in the 1920s and 1930s gave way in the 1950s to electroshock and a wave of new drugs. In what is perhaps Whitaker’s most damning revelation, Mad in America examines how drug companies in the 1980s and 1990s skewed their studies to prove that new antipsychotic drugs were more effective than the old, while keeping patients in the dark about dangerous side effects.A haunting, deeply compassionate book—now revised with a new introduction—Mad in America raises important questions about our obligations to the mad, the meaning of “insanity,” and what we value most about the human mind.
348 pages, Paperback
First published January 3, 2002
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9622 people want to read
About the author
Robert Whitaker
9 books171 followersThere is more than one author in the Goodreads catalog with this name. This entry is for Robert {2^} Whitaker, medical and science writer.
Robert Whitaker, a journalist, writes primarily about medicine and science. He is the author of four books: Mad in America, The Mapmaker's Wife, On the Laps of Gods and Anatomy of an Epidemic.
His newspaper and magazine articles on the mentally ill and the pharmaceutical industry have garnered several national awards, including a George Polk Award for medical writing and a National Association of Science Writers Award for best magazine article.
A series he cowrote for the Boston Globe on the abuse of mental patients in research settings was named a finalist for the Pulitzer Prize in 1998.
Robert Whitaker, a journalist, writes primarily about medicine and science. He is the author of four books: Mad in America, The Mapmaker's Wife, On the Laps of Gods and Anatomy of an Epidemic.
His newspaper and magazine articles on the mentally ill and the pharmaceutical industry have garnered several national awards, including a George Polk Award for medical writing and a National Association of Science Writers Award for best magazine article.
A series he cowrote for the Boston Globe on the abuse of mental patients in research settings was named a finalist for the Pulitzer Prize in 1998.
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February 26, 2011
this is a grim but i think mandatory history of psychiatry in america. it seems to me that, at this time, the people we can truly trust when it comes to exploring mental health culture are investigative journalists. this book is not kind to psychiatry, and i think this is exactly as it should be. whitaker documents painstakingly every assertion he makes and shows us a discipline that was born wrongly and retains to this day the misguidedness of its roots. i don't know about other countries (there are shameful things described in this book that are solely and proudly american), but here in the US psychiatry has no chance to start doing good instead of harm if it doesn't scratch itself out and go back to square one.
whitaker describes the origins of american psychiatry as a debate between viewing the mentally ill (mostly people with psychotic symptoms, but also those suffering from melancholy and the plain wayward as assessed by doctors and families -- hence the disproportionate attack on women, whose societal roles were/are particularly burdensome and social influence correspondingly weak) as animals or as people. the mentally-ill-as-animal school of thought won and everything went downhill from there.
the eugenics movement gave a scientific veneer to this way of thinking by placing the mentally ill squarely into the domain of the sub-humanly defective, which gave license to psychiatrists of the time (second half of the 20th century) to do with them pretty much as they wished.
the advent of neuroleptics/antipsychotics (many of which are currently marketed as safe alternatives to run-of-the-mill antidepressants and quite liberally dispensed -- see Abilify) allowed doctors to "treat" the "mentally ill" (see definition above) in ways that look much less brutal but feel incredibly painful to those who have to endure them (ever wonder why keeping people on their drugs is such a problem?).
beside being mostly ineffective and painful (especially at large dosages and as maintenance drugs), antipsychotics can have a devastating effect on the brain, but you won't find many psychiatrists warning you of this, even though i believe state laws compel them to (not sure about this). to the contrary: medication can now be forced on patients via court injunction, and some insurance companies won't pay for therapy unless patients take their drugs. the same is true for electroshock (bet you thought we didn't do this any more), as a current case in minnesota outrageously confirms (the mindfreedom page could be better organized. make sure to click the various links for background pieces).
the main philosophical underpinning of all that is wrong with psychiatry (and a lot of modern medicine) is that, quite literally, patients have no voice. no one listens to the mentally ill. there is absolutely no recourse for psychiatric abuse in the justice system (which, as we can see from the minnesota case, is quite gleefully allied with doctors) and often even families will side with doctors. we all breathe the same cultural air.
if you show up in the emergency room in a state of acute distress, chances are no one will sit down and really talk to you. if they do talk to you, they’ll talk to you for 10 minutes and their only goal will be to assess whether to hospitalize you or not. once they decide you need to be hospitalized, you will have no appeal.
i am not blaming individual psychiatrists for this – especially, god knows, overworked and swamped ER psychiatrists. i am blaming a culture that has considered the “mentally ill” incapable of sound judgment and agency from the moment of its birth. i also blame the systematic weddedness of psychiatry to pseudo-science. whatever anyone tells you, our scientific understanding of why minds go awry and what makes them better is in its infancy. we know next to nothing. we are testing hypotheses. and we are testing them on the bodies of the mentally ill.
which brings me to current problem number one, the lovely friendship between psychiatry and pharmaceutical companies. it seems a no brainer to anyone who is capable of forming a simple thought that pharma money and the medical profession should be separated by an impenetrable barrier. what happens, instead, is that pharma money pretty much sustains and feeds our doctors. as consumers we must be savvy to this. doctors whose waiting rooms are plastered with pharmaceutical ads should be simply dumped. it can be hard because some of them are really nice, but there is no other way. similarly, health or mental health publications that carry pharmacological advertising (Psychology Today is one of those) belong in the trash can.
i read this book in class and it left my students frankly shell-shocked. even though it was published in 2002 and documents deceitful medical trials for psychiatric drugs occurring as late as 1997, my students hung on tooth and nail to the idea that “fortunately we don’t do this any more.” Unfortunately we do this more than ever.
whitaker describes the origins of american psychiatry as a debate between viewing the mentally ill (mostly people with psychotic symptoms, but also those suffering from melancholy and the plain wayward as assessed by doctors and families -- hence the disproportionate attack on women, whose societal roles were/are particularly burdensome and social influence correspondingly weak) as animals or as people. the mentally-ill-as-animal school of thought won and everything went downhill from there.
the eugenics movement gave a scientific veneer to this way of thinking by placing the mentally ill squarely into the domain of the sub-humanly defective, which gave license to psychiatrists of the time (second half of the 20th century) to do with them pretty much as they wished.
the advent of neuroleptics/antipsychotics (many of which are currently marketed as safe alternatives to run-of-the-mill antidepressants and quite liberally dispensed -- see Abilify) allowed doctors to "treat" the "mentally ill" (see definition above) in ways that look much less brutal but feel incredibly painful to those who have to endure them (ever wonder why keeping people on their drugs is such a problem?).
beside being mostly ineffective and painful (especially at large dosages and as maintenance drugs), antipsychotics can have a devastating effect on the brain, but you won't find many psychiatrists warning you of this, even though i believe state laws compel them to (not sure about this). to the contrary: medication can now be forced on patients via court injunction, and some insurance companies won't pay for therapy unless patients take their drugs. the same is true for electroshock (bet you thought we didn't do this any more), as a current case in minnesota outrageously confirms (the mindfreedom page could be better organized. make sure to click the various links for background pieces).
the main philosophical underpinning of all that is wrong with psychiatry (and a lot of modern medicine) is that, quite literally, patients have no voice. no one listens to the mentally ill. there is absolutely no recourse for psychiatric abuse in the justice system (which, as we can see from the minnesota case, is quite gleefully allied with doctors) and often even families will side with doctors. we all breathe the same cultural air.
if you show up in the emergency room in a state of acute distress, chances are no one will sit down and really talk to you. if they do talk to you, they’ll talk to you for 10 minutes and their only goal will be to assess whether to hospitalize you or not. once they decide you need to be hospitalized, you will have no appeal.
i am not blaming individual psychiatrists for this – especially, god knows, overworked and swamped ER psychiatrists. i am blaming a culture that has considered the “mentally ill” incapable of sound judgment and agency from the moment of its birth. i also blame the systematic weddedness of psychiatry to pseudo-science. whatever anyone tells you, our scientific understanding of why minds go awry and what makes them better is in its infancy. we know next to nothing. we are testing hypotheses. and we are testing them on the bodies of the mentally ill.
which brings me to current problem number one, the lovely friendship between psychiatry and pharmaceutical companies. it seems a no brainer to anyone who is capable of forming a simple thought that pharma money and the medical profession should be separated by an impenetrable barrier. what happens, instead, is that pharma money pretty much sustains and feeds our doctors. as consumers we must be savvy to this. doctors whose waiting rooms are plastered with pharmaceutical ads should be simply dumped. it can be hard because some of them are really nice, but there is no other way. similarly, health or mental health publications that carry pharmacological advertising (Psychology Today is one of those) belong in the trash can.
i read this book in class and it left my students frankly shell-shocked. even though it was published in 2002 and documents deceitful medical trials for psychiatric drugs occurring as late as 1997, my students hung on tooth and nail to the idea that “fortunately we don’t do this any more.” Unfortunately we do this more than ever.
March 8, 2009
A historical account of how the mentally ill have been treated, with an emphasis on the treatment in America.
Rarely does a title describe a book so well. The treatment of the mentally ill has been marred by bad science throughout; historically plagued with abominable practices such as whipping and bloodletting, even in its golden hour in the 20th century, the mentally ill were "(being) described as a degenerate strain of humanity, "social wastage"..."defective germ plasm".." and in keeping with eugenics, that strangely flawed notion that refuses to go away, America's scientific elite, backed by the U.S Supreme Court, advocated policies that resulted in the mentally ill being prohibited from marrying, forcibly committed to state hospitals and sterilized against their will. Society's complicity, even if it was due to the then overwhelming role of newspapers in shaping the public discourse, should not be ignored: "In 1935, 83 percent of all Californians favored eugenic sterilization of the mentally ill." As a consequence, "asylums were increasingly run as places of confinement - facilities that served to segregate the misfits from society - rather than as hospitals that provided medical care.."
With the discovery that brain trauma could lead to altered behavior, another chapter in the saga of bad science and bad medicine began, with efforts made to willfully cause trauma in the form of a litany of "treatments" such as insulin-coma therapy - clinically inducing coma by injecting insulin, as many as 60 times in a few weeks; Metrazol injections, which, in less than a minute, would make the patient "arch into a convulsion so severe it could fracture bones, tear muscles and loosen teeth."; and electroshock therapy, which gained such widespread acceptance that it continues as a treatment even today. All were crude methods, with no control over the region of the brain they affected or the extent to which the brain is traumatized, and yet all accepted heartily by the psychiatric profession as miracle treatments.
Worse, unfortunately, was to follow, in the form of lobotomy; the deliberate inflicting of injury on the frontal lobes of the brain - the area that "gives us consciousness of the self, that allows us to experience ourselves and to project ourselves into the past, present and future..that allows us to care deeply about who we are and our fate..that stirs creative impulses, ambition, a capacity for love, and spiritual yearnings..(that) makes us uniquely human" - as a cure for brain disease. At its worst, lobotomy's greatest proponent, Walter Freeman would "use an ice pick to poke a hole in the bony orbit above each eye and then insert it seven centimeters deep into the brain. At that point, he would move behind the patient's head and pull up on the ice pick to destroy the frontal-lobe nerve fibers. With this new method, Freeman reasoned it wasn't necessary to sterilize the operating field and waste time with that "germ crap". The use of anesthesia could also be eliminated...To quicken the process, he would drive picks into both eyes at once, rather than one at a time...thereby shaving a few minutes off the operating time." The practice was widely adopted across the world, and continued to be used until the 1980's, despite poor results - in one major California hospital, Stockton, "twelve percent of the patients died from the surgery, mostly because of bleeding in the brain." And even in the best cases, it left the patients incapable of leading fulfilling lives: "The person who had once painted pictures, written poetry, or composed music was now "no longer ashamed to fetch and carry, to wait on tables or make beds or empty cans.""
Why did such inhuman practices continue for so long? Because there was bad science too, in judging the efficacy of the treatments. For instance, "At Winnebago State Hospital in Wisconsin, physicians used an outcomes scale (for lobotomy) that ranged from no change to slight improvement to being able to go home. They didn't even allow for the possibility that patients might become worse." Presumably, the situation of the mentally ill was so dire, that no outcome other than a positive one was possible. One wonders in what category patients who died following the treatments were placed.
The last part of the title emphasizes that the mistreatment of the mentally ill is enduring. The current trend in psychiatry is for the prescription of neuroleptics - drugs that essentially simulate the effects of prefrontal lobotomy without the surgery and which diminish the possibility "that a person, distraught in mind and soul when first treated, could ever return to a healthy, non-medicated life...(drugs such as) haloperidol could produce a "marked increase in violent behavior," even among those without any history of assault.. Little could the pulic have suspected that the madman of its nightmares, who kills without warning and for no apparent reason, was not always driven by an evil within but by a popular medication." Here too, bad science has again been used in the form of symtom-exacerbation experiments wherein a control group of patients is created by abruptly withdrawing their current medication, which makes them fare worse than the group treated with the new drug.
The author makes a long and convincing case of how the nexus of bad science and bad medicine has been forged stronger by a corporate greed for profit and by slack regulation that allows researchers conducting clinical drug trials to be funded by drug companies, thus perpetrating a moral hazard.
In most countries, the mentally ill can still be committed to mental institutions without their consent and any rights the law provides them are rendered meaningless through a lack of vigilance and lax implementation. The author contends that the outcomes of psychiatric care in the U.S. are poorer than in developing countries like India, and this too highlights just how bad the situation everywhere really is; for what little care is afforded to the mentally ill in a woefully ill-funded public health infrastructure in India is grossly inadequate, and grim stories often come to light about the mistreatment of the mentally ill in the badly regulated private sector.
Some of the case studies presented in the book illustrate how the line between the sane and the not-so-sane is increasingly being drawn in a way that penalizes even slight suggestions of idiosyncratic behavior and taken in a broader context, this is a synecdoche of society's demands of conformity - if you dress like a punk, put a turban on your head, a veil on your face or a tattoo on your back, you risk being labeled a subversive, your behavior considered deviant.
Our ethics and attitudes have changed considerably in the recent past; drawing and quartering would today be universally deplored, capital punishment itself is opposed by most, the prevention of cruelty to animals is sought, and yet we display a marked lack of empathy for those of us that like the very young, are the most vulnerable and should deserve it the most.
By highlighting the plight of those who fight a losing battle against their personal demons, this book does them an enormous service; it will likely not make any bestseller lists, but it truly deserves to be widely read.
Rarely does a title describe a book so well. The treatment of the mentally ill has been marred by bad science throughout; historically plagued with abominable practices such as whipping and bloodletting, even in its golden hour in the 20th century, the mentally ill were "(being) described as a degenerate strain of humanity, "social wastage"..."defective germ plasm".." and in keeping with eugenics, that strangely flawed notion that refuses to go away, America's scientific elite, backed by the U.S Supreme Court, advocated policies that resulted in the mentally ill being prohibited from marrying, forcibly committed to state hospitals and sterilized against their will. Society's complicity, even if it was due to the then overwhelming role of newspapers in shaping the public discourse, should not be ignored: "In 1935, 83 percent of all Californians favored eugenic sterilization of the mentally ill." As a consequence, "asylums were increasingly run as places of confinement - facilities that served to segregate the misfits from society - rather than as hospitals that provided medical care.."
With the discovery that brain trauma could lead to altered behavior, another chapter in the saga of bad science and bad medicine began, with efforts made to willfully cause trauma in the form of a litany of "treatments" such as insulin-coma therapy - clinically inducing coma by injecting insulin, as many as 60 times in a few weeks; Metrazol injections, which, in less than a minute, would make the patient "arch into a convulsion so severe it could fracture bones, tear muscles and loosen teeth."; and electroshock therapy, which gained such widespread acceptance that it continues as a treatment even today. All were crude methods, with no control over the region of the brain they affected or the extent to which the brain is traumatized, and yet all accepted heartily by the psychiatric profession as miracle treatments.
Worse, unfortunately, was to follow, in the form of lobotomy; the deliberate inflicting of injury on the frontal lobes of the brain - the area that "gives us consciousness of the self, that allows us to experience ourselves and to project ourselves into the past, present and future..that allows us to care deeply about who we are and our fate..that stirs creative impulses, ambition, a capacity for love, and spiritual yearnings..(that) makes us uniquely human" - as a cure for brain disease. At its worst, lobotomy's greatest proponent, Walter Freeman would "use an ice pick to poke a hole in the bony orbit above each eye and then insert it seven centimeters deep into the brain. At that point, he would move behind the patient's head and pull up on the ice pick to destroy the frontal-lobe nerve fibers. With this new method, Freeman reasoned it wasn't necessary to sterilize the operating field and waste time with that "germ crap". The use of anesthesia could also be eliminated...To quicken the process, he would drive picks into both eyes at once, rather than one at a time...thereby shaving a few minutes off the operating time." The practice was widely adopted across the world, and continued to be used until the 1980's, despite poor results - in one major California hospital, Stockton, "twelve percent of the patients died from the surgery, mostly because of bleeding in the brain." And even in the best cases, it left the patients incapable of leading fulfilling lives: "The person who had once painted pictures, written poetry, or composed music was now "no longer ashamed to fetch and carry, to wait on tables or make beds or empty cans.""
Why did such inhuman practices continue for so long? Because there was bad science too, in judging the efficacy of the treatments. For instance, "At Winnebago State Hospital in Wisconsin, physicians used an outcomes scale (for lobotomy) that ranged from no change to slight improvement to being able to go home. They didn't even allow for the possibility that patients might become worse." Presumably, the situation of the mentally ill was so dire, that no outcome other than a positive one was possible. One wonders in what category patients who died following the treatments were placed.
The last part of the title emphasizes that the mistreatment of the mentally ill is enduring. The current trend in psychiatry is for the prescription of neuroleptics - drugs that essentially simulate the effects of prefrontal lobotomy without the surgery and which diminish the possibility "that a person, distraught in mind and soul when first treated, could ever return to a healthy, non-medicated life...(drugs such as) haloperidol could produce a "marked increase in violent behavior," even among those without any history of assault.. Little could the pulic have suspected that the madman of its nightmares, who kills without warning and for no apparent reason, was not always driven by an evil within but by a popular medication." Here too, bad science has again been used in the form of symtom-exacerbation experiments wherein a control group of patients is created by abruptly withdrawing their current medication, which makes them fare worse than the group treated with the new drug.
The author makes a long and convincing case of how the nexus of bad science and bad medicine has been forged stronger by a corporate greed for profit and by slack regulation that allows researchers conducting clinical drug trials to be funded by drug companies, thus perpetrating a moral hazard.
In most countries, the mentally ill can still be committed to mental institutions without their consent and any rights the law provides them are rendered meaningless through a lack of vigilance and lax implementation. The author contends that the outcomes of psychiatric care in the U.S. are poorer than in developing countries like India, and this too highlights just how bad the situation everywhere really is; for what little care is afforded to the mentally ill in a woefully ill-funded public health infrastructure in India is grossly inadequate, and grim stories often come to light about the mistreatment of the mentally ill in the badly regulated private sector.
Some of the case studies presented in the book illustrate how the line between the sane and the not-so-sane is increasingly being drawn in a way that penalizes even slight suggestions of idiosyncratic behavior and taken in a broader context, this is a synecdoche of society's demands of conformity - if you dress like a punk, put a turban on your head, a veil on your face or a tattoo on your back, you risk being labeled a subversive, your behavior considered deviant.
Our ethics and attitudes have changed considerably in the recent past; drawing and quartering would today be universally deplored, capital punishment itself is opposed by most, the prevention of cruelty to animals is sought, and yet we display a marked lack of empathy for those of us that like the very young, are the most vulnerable and should deserve it the most.
By highlighting the plight of those who fight a losing battle against their personal demons, this book does them an enormous service; it will likely not make any bestseller lists, but it truly deserves to be widely read.
March 21, 2011
This book was referenced by the author of "Shutter Island". It tells the history of mental treatment in America from the Quakers who tried to cure madness with gentle treatment to the drugs prescribed today. Some of it is frightening and terrible. Towards the end the author focused solely on schizophrenia and the drugs used to treat it. I would have found it more interesting if other psychiatric issues were addressed, but perhaps they're too many to mention. The author feels there is a vast conspiracy between pharmaceutical manufacturers and psychiatrists to keep the mental population medicated. He does offer evidence to support his view. I don't doubt there were and continue to be abuses of drugs. I think I would have found his information more believable if he hadn't painted both doctor and chemists so completely evil.
April 24, 2023
Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill [2002] – ★★★★1/2
Robert Whitaker opens his book with this quote by David Cohen: “We are still mad about the mad. We still don’t understand them and that lack of understanding makes us mean and arrogant, and makes us mislead ourselves, and so we hurt them”. His book is an engaging overview of the methods to treat mentally ill patients through centuries (starting in the pre-1750s period and continuing to the present day), and how changes in societal attitudes and perceptions, as well as in psychiatry politics and business considerations impacted the treatment. “Scientific” and “therapeutic” approaches to treating mentally ill had competed with each other for centuries, and Whitaker shows how politics of this or that time period ultimately dictated what mentally ill patients were supposed “to need”, with mentally ill people often caught in a trap of doctors and businesses’ ambitions to make a mark in science or earn money respectively.
The book is divided into four sections: (a) The Original Bedlam (1750 – 1900); (b) The Darkest Era (1900 – 1950); (c) Back to Bedlam (1950 – 1990s) and (d) Mad Medicine Today (1990s – present).
The Original Bedlam (1750 – 1900)
The story starts circa 1796, in a period when psychiatry was finally “waking up” from the “chain-the-mentally-ill” and “patients-as-a-spectacle” mentality and finally realising that patients in psychiatric institutions need a more humane medical treatment. Before that, mentally ill patients were held in terrible conditions, and Bethlehem (Bedlam) Hospital in London testifies to that. “Like all wild animals, lunatics needed to be dominated and broken” [2002: 7], was the opinion of that time. Unflinchingly, Whitaker goes through the horrific and shocking arsenal of “treatments” for the mentally ill at that time, talking about the Bath of Surprise, Spinning Therapy, and the Tranquiliser Chair. For example, the reasoning behind the Drowning Therapy was the following: “if a patient was nearly drowned and then brought to life, he would take a fresh start, leaving his disease behind” [2002: 17].
So, Benjamin Rush [1745 – 1813], “the father of American psychiatry”, was the proponent of a kinder treatment for the mentally ill at that time in Philadelphia, but even he thought that it was the circulatory disorder in the body that was the cause of all madness [2002: 17], and, accordingly, was in favour of bleeding his patients severely to “fix” that. A glimpse of hope at that time was the exemplary role of the Quakers in caring (gently and without medical intrusions) for the mentally ill in Philadelphia, as well as the influence of Philippe Pinel [1745 – 1826] and his promotion of “moral treatment” in Europe.
The Darkest Era (1900 – 1950)
Robert Whitaker states that “at the beginning of the twentieth century, the generous attitude towards the mentally ill disappeared in American society” [2002: 41]. The first half of the twentieth century was all about the rise of eugenics, segregation mentality and sterilisation efforts in psychiatry. The 1940s also saw the rise of shock treatments for mentally ill which were considered “quick, easy, reliable, and cheap” [Whitaker, 2002: 98]. However, it was also clear early on that these also produced “a more profound, lasting trauma” and “changes akin to suffering a concussive head injury” [2002: 102]. Whitaker writes: “[shock treatments were] a form of a brain damage, but that was not how [they] were presented to the public” [2002: 103]. The public were made to believe that the shock treatment was safe, effective and painless, and any memory loss was only temporary. However, they were anything but benevolent, and before the introduction of paralysing drugs, up to forty percent of all patients used to break bones in this treatment, and they were said to be used to “quieten the ward and insure good citizenship” [2002: 106].
If a shock treatment sounds awful, the rise of a procedure which became known as a prefrontal lobotomy may sound even more so. Dr Walter Freeman [1895 – 1972] and Dr James Watts [1904 – 1994] were neurosurgeons who were the pioneers of a method by which an instrument was drilled/inserted into a patient’s brain to cure them of disorders. Even though the procedure gained a “medical approval”, it was also deemed to be akin to a “partial euthanasia” and “the removal of a patient’s soul” because it induced the unprecedented state of passivity and regression to childhood.
Back to Bedlam (1950 – 1990s)
The latter half of the twentieth century was all about drugs as a cure for mentally ill patients, and a drug chlorpromazine (Thorazine or Largactil) had all the attention. That was a time when the shift occurred from the asylum to the community care, and schizophrenia was an illness of interest. Whitaker writes how pharmaceutical companies had the most to gain from promoting all sorts of antipsychotics as safe for consumption, and drugs were even prescribed for the elderly, for children with learning difficulties and simply for people who had mild stress in their daily jobs: “19 million prescriptions were written annually” [2002: 205]. And that was all happening at the time when the same patients were reporting dangerous side-effects from those drugs and immense addiction. A glimpse of hope in that period was probably a study conducted by American psychiatrist Dr Loren Mosher [1933 – 2004] who opened a house Soteria for mentally ill and had results that showed that a controlling atmosphere and over-use of drugs hindered recovery for patients and more attention should be paid to therapeutic and benign treatments, as well as to the atmosphere of kindness. However, Mosher’s results were generally ignored, and testing various drugs on patients without their consent continued to be a norm.
Mad Medicine Today (1990s – present)
“The transformation of chlorpromazine from a drug that induced a chemical lobotomy into a safe, anti-schizophrenic drug took a decade”, but “by the mid-1980s, it was no longer possible to ignore the many drawbacks of neuroleptics” [2002: 258], reports the author. So, what did pharmaceutical companies do? They invented new, “safer” drugs, and their prime goal was to outperform their business competitors. Whitaker talks in this section about the proliferation of drugs, such as risperidone, which causes mania where none was before, and about hasty and negligently conducted preliminary trials on those drugs [2002: 286].
“With the new drugs presented to the public as wonderfully safe, American psychiatrists [were] inviting an ever greater number of patients into the madness tent” and “evidence of the harm caused by the drugs was simply allowed to pile up, then pushed away in the corner where it wouldn’t be seen” [2002: 289], writes Whitaker. He convincingly shows how politics and business became the biggest winners in a game where patients’ care and needs were hardly prime considerations, and where corruption in the sector was ever-present (for example, see this documentary on corrupt mental hospitals of the 1990s).
💉 Robert Whitaker’s book may be too general for some and it does engage in some innocent “cherry-picking” of information, but it is still an engaging read and will be a very eye-opening read particularly for those who know little about the topic. The author provides testimonies from patients themselves, and demonstrates how “madness” is essentially a social construction and how the manipulation of public perception of the disease through the centuries gave medical professionals the licence to treat mentally ill patients in the most demeaning and horrifying way possible. It seems that those who benefited the most from all the alleged “treatments” and “cures” were medical professionals concerned with scientific progress and credentials as well as big businesses, with little attention being paid to the experience and needs of the actual patients.
Robert Whitaker opens his book with this quote by David Cohen: “We are still mad about the mad. We still don’t understand them and that lack of understanding makes us mean and arrogant, and makes us mislead ourselves, and so we hurt them”. His book is an engaging overview of the methods to treat mentally ill patients through centuries (starting in the pre-1750s period and continuing to the present day), and how changes in societal attitudes and perceptions, as well as in psychiatry politics and business considerations impacted the treatment. “Scientific” and “therapeutic” approaches to treating mentally ill had competed with each other for centuries, and Whitaker shows how politics of this or that time period ultimately dictated what mentally ill patients were supposed “to need”, with mentally ill people often caught in a trap of doctors and businesses’ ambitions to make a mark in science or earn money respectively.
The book is divided into four sections: (a) The Original Bedlam (1750 – 1900); (b) The Darkest Era (1900 – 1950); (c) Back to Bedlam (1950 – 1990s) and (d) Mad Medicine Today (1990s – present).
The Original Bedlam (1750 – 1900)
The story starts circa 1796, in a period when psychiatry was finally “waking up” from the “chain-the-mentally-ill” and “patients-as-a-spectacle” mentality and finally realising that patients in psychiatric institutions need a more humane medical treatment. Before that, mentally ill patients were held in terrible conditions, and Bethlehem (Bedlam) Hospital in London testifies to that. “Like all wild animals, lunatics needed to be dominated and broken” [2002: 7], was the opinion of that time. Unflinchingly, Whitaker goes through the horrific and shocking arsenal of “treatments” for the mentally ill at that time, talking about the Bath of Surprise, Spinning Therapy, and the Tranquiliser Chair. For example, the reasoning behind the Drowning Therapy was the following: “if a patient was nearly drowned and then brought to life, he would take a fresh start, leaving his disease behind” [2002: 17].
So, Benjamin Rush [1745 – 1813], “the father of American psychiatry”, was the proponent of a kinder treatment for the mentally ill at that time in Philadelphia, but even he thought that it was the circulatory disorder in the body that was the cause of all madness [2002: 17], and, accordingly, was in favour of bleeding his patients severely to “fix” that. A glimpse of hope at that time was the exemplary role of the Quakers in caring (gently and without medical intrusions) for the mentally ill in Philadelphia, as well as the influence of Philippe Pinel [1745 – 1826] and his promotion of “moral treatment” in Europe.
The Darkest Era (1900 – 1950)
Robert Whitaker states that “at the beginning of the twentieth century, the generous attitude towards the mentally ill disappeared in American society” [2002: 41]. The first half of the twentieth century was all about the rise of eugenics, segregation mentality and sterilisation efforts in psychiatry. The 1940s also saw the rise of shock treatments for mentally ill which were considered “quick, easy, reliable, and cheap” [Whitaker, 2002: 98]. However, it was also clear early on that these also produced “a more profound, lasting trauma” and “changes akin to suffering a concussive head injury” [2002: 102]. Whitaker writes: “[shock treatments were] a form of a brain damage, but that was not how [they] were presented to the public” [2002: 103]. The public were made to believe that the shock treatment was safe, effective and painless, and any memory loss was only temporary. However, they were anything but benevolent, and before the introduction of paralysing drugs, up to forty percent of all patients used to break bones in this treatment, and they were said to be used to “quieten the ward and insure good citizenship” [2002: 106].
If a shock treatment sounds awful, the rise of a procedure which became known as a prefrontal lobotomy may sound even more so. Dr Walter Freeman [1895 – 1972] and Dr James Watts [1904 – 1994] were neurosurgeons who were the pioneers of a method by which an instrument was drilled/inserted into a patient’s brain to cure them of disorders. Even though the procedure gained a “medical approval”, it was also deemed to be akin to a “partial euthanasia” and “the removal of a patient’s soul” because it induced the unprecedented state of passivity and regression to childhood.
Back to Bedlam (1950 – 1990s)
The latter half of the twentieth century was all about drugs as a cure for mentally ill patients, and a drug chlorpromazine (Thorazine or Largactil) had all the attention. That was a time when the shift occurred from the asylum to the community care, and schizophrenia was an illness of interest. Whitaker writes how pharmaceutical companies had the most to gain from promoting all sorts of antipsychotics as safe for consumption, and drugs were even prescribed for the elderly, for children with learning difficulties and simply for people who had mild stress in their daily jobs: “19 million prescriptions were written annually” [2002: 205]. And that was all happening at the time when the same patients were reporting dangerous side-effects from those drugs and immense addiction. A glimpse of hope in that period was probably a study conducted by American psychiatrist Dr Loren Mosher [1933 – 2004] who opened a house Soteria for mentally ill and had results that showed that a controlling atmosphere and over-use of drugs hindered recovery for patients and more attention should be paid to therapeutic and benign treatments, as well as to the atmosphere of kindness. However, Mosher’s results were generally ignored, and testing various drugs on patients without their consent continued to be a norm.
Mad Medicine Today (1990s – present)
“The transformation of chlorpromazine from a drug that induced a chemical lobotomy into a safe, anti-schizophrenic drug took a decade”, but “by the mid-1980s, it was no longer possible to ignore the many drawbacks of neuroleptics” [2002: 258], reports the author. So, what did pharmaceutical companies do? They invented new, “safer” drugs, and their prime goal was to outperform their business competitors. Whitaker talks in this section about the proliferation of drugs, such as risperidone, which causes mania where none was before, and about hasty and negligently conducted preliminary trials on those drugs [2002: 286].
“With the new drugs presented to the public as wonderfully safe, American psychiatrists [were] inviting an ever greater number of patients into the madness tent” and “evidence of the harm caused by the drugs was simply allowed to pile up, then pushed away in the corner where it wouldn’t be seen” [2002: 289], writes Whitaker. He convincingly shows how politics and business became the biggest winners in a game where patients’ care and needs were hardly prime considerations, and where corruption in the sector was ever-present (for example, see this documentary on corrupt mental hospitals of the 1990s).
💉 Robert Whitaker’s book may be too general for some and it does engage in some innocent “cherry-picking” of information, but it is still an engaging read and will be a very eye-opening read particularly for those who know little about the topic. The author provides testimonies from patients themselves, and demonstrates how “madness” is essentially a social construction and how the manipulation of public perception of the disease through the centuries gave medical professionals the licence to treat mentally ill patients in the most demeaning and horrifying way possible. It seems that those who benefited the most from all the alleged “treatments” and “cures” were medical professionals concerned with scientific progress and credentials as well as big businesses, with little attention being paid to the experience and needs of the actual patients.
July 12, 2011
Such an important book, that looks at how we have treated mentally ill folks through the centuries. An inside look at psychiatry's dirty secrets, and an exploration of where science, corporate interests (drug companies, doctors) and the mentally ill individuals intersect and interact. Whitaker has been demonized as a heretic for daring to question the efficacy of studies supporting the drugs we are increasingly ingesting and wonders why if they are effective relapse rates increase for those medicated, and why more and more American's are being diagnosed as mentally ill? Much at odds with the APA and the major pharma companies Whitaker asks why it is that those mentally ill in developing countries do better long term than those mentally ill in the developed world do (WHO studies). Well worth a read, heart-breaking, with enough positive side stories that shin a way forward for some, if not all affected.
October 28, 2016
The book “Mad in America” by Robert Whitaker is not Mad Science but an account of how science has been manipulated to serve the needs of pharmaceutical companies, medical and psychiatric associations as well as the reputations of countless medical experts, all at the expense of thousands of patients’ health and wellbeing. It’s a disturbing read. It makes the reader mad—angry at how we, the laypeople, have been fed the myth of the ‘broken brain’ that only medication can ‘fix’; medications like SSRIs which include Prozac, Paxil and Zoloft, and anti-psychotic drugs for so-called conditions of bi-polar and schizophrenia.
But to get a complete picture of how we’ve been duped and gain insight into why there’s been threefold increase in writing of prescriptions for depression and anti-anxiety drugs over recent years, Whitaker takes the reader through a history of insanity by writing a meticulously detailed account. He writes of the treatment methods for the insane, as they were called in the 1700’s, as well as the care and approach to patient treatment in asylums, the radical methods and surgical procedures such as the lobotomy used to cure insanity, to the introduction of prescription drugs—drugs that would cure and restore patients back to their ‘normal’ selves.
Whitaker also explores that various theories held by the medical community on the reasons for insanity, or what we now as a society refer to as ‘mental illness’. For instance madness was at one time considered a result of poor circulation specifically too little circulation to the head. Treatments in the late 1700’s included the ‘bleeding’ of patients where ounces of blood would be drawn from patients, in one case 200 ounces over a 2-month period and in another extreme case “of a manic patient, four-fifths of the blood in the body” (pg.14). Science moved forward with new rationale, as in the early 1900’s where insanity was deemed the fault of bad genes as Whitaker describes on page 44:
The insane patient “get it from where his parents got it—from the insane strain of the family stock: the strain which, as the old saying was, runs in the blood, but which we prefer now to describe as a fault or flaw in the germ-plasm passing by continuity of substance from generation to generation” – Henry Maudsley, The Pathology of the Mind – 1895.
Whitaker writes in detail about the disturbing methods in Part II, “The Darkest Era”, where treatments associated with the Eugenics movement and others are described, from shock therapy, to insulin treatments, to the "surgery of soul", the surgery as labeled by The New York Times in 1937, also known as the lobotomy.
It’s in Part III where we learn about the history of prescription drugs. It’s through this history where we learn about the business of clinical research, the motivations of pharmaceutical companies and the medical practitioners that conduct the trials, as well as the outcomes of the drugs and the effects on patients. Whitaker shares stories of patients whose voices and rights are rarely considered. One in particular was most distressful, a young woman who was admitted to hospital for anxiety and distress and was immediately included in a trial for a new drug where she was taken off her existing medication, denied it even when her condition deteriorated significantly and she spiraled into a state of despair, all for the reason of studying a new drug .
The science behind the so-called ‘mental illness’ our North American culture suffers from is exposed in Whitaker’s book—it’s based on not just bad science, but science that doesn’t explain or prove that mental illness is chemical imbalance, or a result of over active or under active dopamine systems as we’ve been led to believe. It’s the business of mental illness that has driven the theory forward, not science.
This book is an essential read for anyone looking to be informed about mental illness, schizophrenia in particular, or who is a consumer of medication prescribed for a so-called 'disease of the brain'.
But to get a complete picture of how we’ve been duped and gain insight into why there’s been threefold increase in writing of prescriptions for depression and anti-anxiety drugs over recent years, Whitaker takes the reader through a history of insanity by writing a meticulously detailed account. He writes of the treatment methods for the insane, as they were called in the 1700’s, as well as the care and approach to patient treatment in asylums, the radical methods and surgical procedures such as the lobotomy used to cure insanity, to the introduction of prescription drugs—drugs that would cure and restore patients back to their ‘normal’ selves.
Whitaker also explores that various theories held by the medical community on the reasons for insanity, or what we now as a society refer to as ‘mental illness’. For instance madness was at one time considered a result of poor circulation specifically too little circulation to the head. Treatments in the late 1700’s included the ‘bleeding’ of patients where ounces of blood would be drawn from patients, in one case 200 ounces over a 2-month period and in another extreme case “of a manic patient, four-fifths of the blood in the body” (pg.14). Science moved forward with new rationale, as in the early 1900’s where insanity was deemed the fault of bad genes as Whitaker describes on page 44:
The insane patient “get it from where his parents got it—from the insane strain of the family stock: the strain which, as the old saying was, runs in the blood, but which we prefer now to describe as a fault or flaw in the germ-plasm passing by continuity of substance from generation to generation” – Henry Maudsley, The Pathology of the Mind – 1895.
Whitaker writes in detail about the disturbing methods in Part II, “The Darkest Era”, where treatments associated with the Eugenics movement and others are described, from shock therapy, to insulin treatments, to the "surgery of soul", the surgery as labeled by The New York Times in 1937, also known as the lobotomy.
It’s in Part III where we learn about the history of prescription drugs. It’s through this history where we learn about the business of clinical research, the motivations of pharmaceutical companies and the medical practitioners that conduct the trials, as well as the outcomes of the drugs and the effects on patients. Whitaker shares stories of patients whose voices and rights are rarely considered. One in particular was most distressful, a young woman who was admitted to hospital for anxiety and distress and was immediately included in a trial for a new drug where she was taken off her existing medication, denied it even when her condition deteriorated significantly and she spiraled into a state of despair, all for the reason of studying a new drug .
The science behind the so-called ‘mental illness’ our North American culture suffers from is exposed in Whitaker’s book—it’s based on not just bad science, but science that doesn’t explain or prove that mental illness is chemical imbalance, or a result of over active or under active dopamine systems as we’ve been led to believe. It’s the business of mental illness that has driven the theory forward, not science.
This book is an essential read for anyone looking to be informed about mental illness, schizophrenia in particular, or who is a consumer of medication prescribed for a so-called 'disease of the brain'.
November 20, 2013
Great read. Whitaker digests a huge body of historical and scientific literature to produce this tragic, compelling story of schizophrenia in America.
The case Whitaker builds suggests that the majority of psychiatric patients in the United States have, for the past 50 years, been subjected to treatment that is detrimental to their recovery, as well as immoral and abusive. You'll question any faith you have in the moral infallibility of doctors. You'll be enraged at the corrupt, pseudo-scientific studies conjured up by pharmaceutical companies. You'll shake your head at the determination of smart medical professionals to tell themselves that they're providing the highest possible quality of patient care, even as the evidence provided by Whitaker so profoundly contradicts that story.
But the most surprising and most important aspect of this book is its relevance today. The misleading narratives woven by Big Pharma companies that paint their anti-psychotic medications as "miracle drugs" are still being told today. It's easy to keep blind faith in modern medicine that can seem miraculous, but the scene set by "Mad In America" is stark and unsensational. In psychiatry, at least, Whitaker is telling us, we understand far less than anyone likes to admit.
The case Whitaker builds suggests that the majority of psychiatric patients in the United States have, for the past 50 years, been subjected to treatment that is detrimental to their recovery, as well as immoral and abusive. You'll question any faith you have in the moral infallibility of doctors. You'll be enraged at the corrupt, pseudo-scientific studies conjured up by pharmaceutical companies. You'll shake your head at the determination of smart medical professionals to tell themselves that they're providing the highest possible quality of patient care, even as the evidence provided by Whitaker so profoundly contradicts that story.
But the most surprising and most important aspect of this book is its relevance today. The misleading narratives woven by Big Pharma companies that paint their anti-psychotic medications as "miracle drugs" are still being told today. It's easy to keep blind faith in modern medicine that can seem miraculous, but the scene set by "Mad In America" is stark and unsensational. In psychiatry, at least, Whitaker is telling us, we understand far less than anyone likes to admit.
January 29, 2017
Mental illness is one of the most complex struggles I can conceive. For the individual and society. For start, even calling it an “illness” suggests that we understand it primarily as a biological process; a subtle shift in terminology which may, ironically, impede recovery.
Whitaker focuses on the history of schizophrenia treatment in the United States. Beginning with the “moral treatment” the Quakers used in respite homes and, subsequently, employed at Pennsylvania Hospital. However, it did not take long for medical professions to modify the treatment methods. What began as a process of accompanying a person through their delusional break became a desperate struggle to impose reality. Immersion in cold water baths for days, electroshock therapy and lobotomies arose out of a medical attempt to cure. The lives of those treated secondary to the advance of scientific discovery. A subordination of personal dignity seeded by the eugenics movement in early 20th century America and reaching its reprehensible depths during the Holocaust.
However, Whitaker argues that this is not just some dark chapter in our history. It is an ongoing assault. The use of chemical agents to replace the brutish physical methods of prior treatments are similarly suspect. Excessive money flowing in and around the creation and marketing of neuroleptics make the pharmaceutical companies the biggest obstacle to uncorrupted research on schizophrenia. Psychiatrists, eager to have medical justification and a claim to treatment, are willingly (or even unwillingly) complicit in this model of treatment which does not cure. In fact, Whitaker’s research suggests the opposite. Medications actually make individuals chronically schizophrenic.
How, then, should society treat those afflicted with schizophrenia? Currently in America, after deinstitutionalization in the 1960s, the jails and prisons became the largest warehouses for those suffering from mental illness. Is that the goal? Or should we bring back asylums? Or will society actually invest the money and resources to recreate the facilities for “moral treatment” pioneered in the mid-19th century? Such treatment, as evidenced by the Soteria Project which (successfully) attempted to do the same in the 1970’s, is time intensive, costly and filled with risk. Until we can answer those questions, most likely the pharmaceutical companies will continue to be the sole purveyors of health for the mentally ill. And, if Whitaker is correct, history will judge us just as harshly as those who lobotomized and administered electroshock.
Whitaker focuses on the history of schizophrenia treatment in the United States. Beginning with the “moral treatment” the Quakers used in respite homes and, subsequently, employed at Pennsylvania Hospital. However, it did not take long for medical professions to modify the treatment methods. What began as a process of accompanying a person through their delusional break became a desperate struggle to impose reality. Immersion in cold water baths for days, electroshock therapy and lobotomies arose out of a medical attempt to cure. The lives of those treated secondary to the advance of scientific discovery. A subordination of personal dignity seeded by the eugenics movement in early 20th century America and reaching its reprehensible depths during the Holocaust.
However, Whitaker argues that this is not just some dark chapter in our history. It is an ongoing assault. The use of chemical agents to replace the brutish physical methods of prior treatments are similarly suspect. Excessive money flowing in and around the creation and marketing of neuroleptics make the pharmaceutical companies the biggest obstacle to uncorrupted research on schizophrenia. Psychiatrists, eager to have medical justification and a claim to treatment, are willingly (or even unwillingly) complicit in this model of treatment which does not cure. In fact, Whitaker’s research suggests the opposite. Medications actually make individuals chronically schizophrenic.
How, then, should society treat those afflicted with schizophrenia? Currently in America, after deinstitutionalization in the 1960s, the jails and prisons became the largest warehouses for those suffering from mental illness. Is that the goal? Or should we bring back asylums? Or will society actually invest the money and resources to recreate the facilities for “moral treatment” pioneered in the mid-19th century? Such treatment, as evidenced by the Soteria Project which (successfully) attempted to do the same in the 1970’s, is time intensive, costly and filled with risk. Until we can answer those questions, most likely the pharmaceutical companies will continue to be the sole purveyors of health for the mentally ill. And, if Whitaker is correct, history will judge us just as harshly as those who lobotomized and administered electroshock.
February 14, 2016
Although I consider myself fairly aware of the horrific historic and current state of mental health treatment in America, this book still left me shocked beyond words. I tried to tell myself that the abuse described in the text was and is born from a lack of understanding about how to engage with and treat this population. Yet, I could not keep myself from questioning how a society can act with so little compassion. This text is a reminder that when we are angry about something, it is our job not only to speak out, but to take action and begin working toward change.
October 22, 2010
A wake-up call to get as far away from psychiatric medications, they cause more problems than they help and leads to life-long dependence on them not to mention needing to take more insalubriuos meds to counter the health problem they create
June 1, 2011
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, by Robert Whitaker, Basic Books, 2010 Revised Edition. Originally published in 2002.
Mad in America is a searing indictment of our failure to relieve the suffering of the mentally ill and their families.
In the interest of fair disclosure, I am a psychologist and have spent much of my life studying mental illness, teaching about it, counseling, and writing, mainly in the areas of Death and Dying and other forms of loss. My aim has been to help those facing their own death, caregivers, and the bereaved and bereaving. Further, members of my family have suffered mental illness, and others of us have suffered from their afflictions.
Mad in America begins with a history of mental illness and attempts to alleviate it, in England with the original Bedlam, and here from 1750 to 1900. Recounted are the gentle “moral treatment” of the Quakers, and the more brutal treatment made famous by Benjamin Rush, including a bleeding regimen, blistering using major caustics, as well as emetics, purging, a dizzying gyrator, and the Tranquilizer Chair in which the patient was strapped immobile for days at a time. Also included are needle showers, ice baths, and wet packs. Historically, these were followed by insulin coma, convulsive therapy, electroshock and prefrontal lobotomy, as well as other creative solutions such as cliteroidectomy. Some treatments were chosen with eugenic goals in mind.
Major claims for cure, especially of schizophrenia, have been made on behalf of all these treatments, but the patients perceived them as forms of torture. We are now in the age of biochemical treatments beginning with chlorpromazine and other narcoleptics which are cash cows for the drug companies. Side effects are often undisclosed, such as tardive dyskinesia and parkinsonism and are rampant. Many patients were experimented upon without their knowledge. In fact, some of these treatments have been used as forms of torture in other countries.
There have been some heroic objections by psychiatrists and heroic efforts to better regulate the drugs and their application, or to do away with them entirely. Many studies have shown that the patients did better with placebos than with the antischizophrenic medications, abrupt withdrawal of which exacerbates the symptoms but has been done in the interests of trying out new drugs on people with flare-ups of their mental illness.
This is a brilliantly researched book. My one concern with it is that, with the exception of Moral Therapy, Emanon, and recent successful treatments in Finland, Mad in America doesn’t show the other positive side of treatment. The record set forth here is almost exclusively that of psychiatrists and the American Psychiatric Association or APA dealing with schizophrenia — the other APA, the American Psychological Association with psychologists who emphasize counseling is omitted. Psychologists can’t prescribe drugs themselves, but many have an arrangement with a psychiatrist who will prescribe for them; many psychologists treat Depression, “the common cold of mental illness” and numerous other afflictions using talk therapy or a combination of talk and drug, which takes longer and may be more expensive, but which often yields lasting relief.
I heartily recommend Mad in America as a study of the history of mental illness and its treatment, what works and what may destroy the mind and soul. It shows us where we have been, and where we need to move forward to relieve the massive suffering endured by so many mentally ill persons and their relatives.
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
-- Patricia Weenolsen
Mad in America is a searing indictment of our failure to relieve the suffering of the mentally ill and their families.
In the interest of fair disclosure, I am a psychologist and have spent much of my life studying mental illness, teaching about it, counseling, and writing, mainly in the areas of Death and Dying and other forms of loss. My aim has been to help those facing their own death, caregivers, and the bereaved and bereaving. Further, members of my family have suffered mental illness, and others of us have suffered from their afflictions.
Mad in America begins with a history of mental illness and attempts to alleviate it, in England with the original Bedlam, and here from 1750 to 1900. Recounted are the gentle “moral treatment” of the Quakers, and the more brutal treatment made famous by Benjamin Rush, including a bleeding regimen, blistering using major caustics, as well as emetics, purging, a dizzying gyrator, and the Tranquilizer Chair in which the patient was strapped immobile for days at a time. Also included are needle showers, ice baths, and wet packs. Historically, these were followed by insulin coma, convulsive therapy, electroshock and prefrontal lobotomy, as well as other creative solutions such as cliteroidectomy. Some treatments were chosen with eugenic goals in mind.
Major claims for cure, especially of schizophrenia, have been made on behalf of all these treatments, but the patients perceived them as forms of torture. We are now in the age of biochemical treatments beginning with chlorpromazine and other narcoleptics which are cash cows for the drug companies. Side effects are often undisclosed, such as tardive dyskinesia and parkinsonism and are rampant. Many patients were experimented upon without their knowledge. In fact, some of these treatments have been used as forms of torture in other countries.
There have been some heroic objections by psychiatrists and heroic efforts to better regulate the drugs and their application, or to do away with them entirely. Many studies have shown that the patients did better with placebos than with the antischizophrenic medications, abrupt withdrawal of which exacerbates the symptoms but has been done in the interests of trying out new drugs on people with flare-ups of their mental illness.
This is a brilliantly researched book. My one concern with it is that, with the exception of Moral Therapy, Emanon, and recent successful treatments in Finland, Mad in America doesn’t show the other positive side of treatment. The record set forth here is almost exclusively that of psychiatrists and the American Psychiatric Association or APA dealing with schizophrenia — the other APA, the American Psychological Association with psychologists who emphasize counseling is omitted. Psychologists can’t prescribe drugs themselves, but many have an arrangement with a psychiatrist who will prescribe for them; many psychologists treat Depression, “the common cold of mental illness” and numerous other afflictions using talk therapy or a combination of talk and drug, which takes longer and may be more expensive, but which often yields lasting relief.
I heartily recommend Mad in America as a study of the history of mental illness and its treatment, what works and what may destroy the mind and soul. It shows us where we have been, and where we need to move forward to relieve the massive suffering endured by so many mentally ill persons and their relatives.
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
-- Patricia Weenolsen
August 19, 2012
I'm completely over taken with the amount of information and its reliability. I studied psychology at Pitt, before I hit my breaking point. Do you know how many components can contribute to a nineteen year old girl whom gave up swimming, (she had a scholarship at her first college)the only thing that really mattered in her life. She used drugs and alcohol recklessly, she missed all of her classes because bulimia (when she wanted to photograph her puke as an art form), got more results than say, psychological stats. She walked the streets aimlessly and without any caution. Bottom line--hospital, sanitarium--whichever suits this purpose.
So I read this book years and years after all the above--I remember neuroleptics as well as the reassurance that I would feel better and gain perspective on my illness. Now I know why I never felt better, and I was to foggy for any kind of perspective;even if it be the girl in the chair with the big arms holding a book like she's reading it. Sentence after sentence I repeated in my reading. It took 5years to 1year to read an entire novel back then.
This book horrified my worst nightmares esp. about schizophrenia. If you ever doubted what you saw because you heard a different version: read this book. Mad in America should be a standard text for all programs.
So I read this book years and years after all the above--I remember neuroleptics as well as the reassurance that I would feel better and gain perspective on my illness. Now I know why I never felt better, and I was to foggy for any kind of perspective;even if it be the girl in the chair with the big arms holding a book like she's reading it. Sentence after sentence I repeated in my reading. It took 5years to 1year to read an entire novel back then.
This book horrified my worst nightmares esp. about schizophrenia. If you ever doubted what you saw because you heard a different version: read this book. Mad in America should be a standard text for all programs.
March 31, 2013
This work contains plenty of interesting facts about the advancements in the treatment of schizophrenics (in particular) in the U.S. health care system. That being said, the eventual condition of an all-encompassing "system" in the world of treatment was for these unfortunate souls a nasty development. It was enlightening to read that the treatment methods employed in the 19th century were much more closely related to those we now consider most humane and effective. (The "One Flew Over a Cuckoo's Nest" era was perhaps the worst -- 1950 to 1980. Overcrowding due to poor diagnoses, an utter dependence on big pharma zombie pills, and terribly incompetent staffing.) I love this type of non-fiction. And now I know all about Thorazine!
October 3, 2013
I am not sure how to rate this book honestly. The author did very well at putting this book together. However, I am not sure if I should "like" the book because I did not enjoy reading about the horrific treatment of people with mental illness. But I am grateful to have this knowledge about how these people were treated. It upsets me about what these people were put through, but on the other hand I am contemplating on whether or not I believe it was necessary in order to get to where we are today with the mental health system. The mental health system is MUCH different now, but there are still a lot of issues with it still.
I guess I will give it three stars. The book was good, but the information was almost incomprehensible.
I guess I will give it three stars. The book was good, but the information was almost incomprehensible.
July 3, 2017
Whitaker tells a chilling history of psychiatric medication in the United States that reminds us that we aren't nearly as advanced as we might like to think. Our advances have been in making our brutality only appear to be more humane. Now instead of attacking someone's brain with an ice pick, we charge them $900 a month for the privilege of using pharmaceutical ice picks on their own brain.
Of all the healthcare discussions our country needs to have, figuring out how to get medicine out of the profit mode and into the healing and care mode is critical. I wrote more about that here. Our mental health treatment is one of the largest areas of healthcare that needs to be thoroughly revamped.
Of all the healthcare discussions our country needs to have, figuring out how to get medicine out of the profit mode and into the healing and care mode is critical. I wrote more about that here. Our mental health treatment is one of the largest areas of healthcare that needs to be thoroughly revamped.
September 14, 2015
In the Preface to "Mad in America," the author points to a startling fact, that over the past twenty-five years, outcomes for people suffering with schizophrenia in the U.S. have worsened. More than 2 million Americans suffer with schizophrenia. Many end up homeless, in prisons, or in and out of psychiatric hospitals. Schizophrenia is estimated to cost the U.S. more than $45 billion annually. These facts led Whitaker to ask, "If the medications work so well, then why do 'schizophrenics' fare so poorly in the United States?"
Read
February 20, 2019This book changed my life. It is MUST READ. It is a shocking story that had a MASSIVE impact on me. It is about everything that is wrong with our mental health system and is a forerunner to a new form of care. Robert Whitaker, as medical journalist, has no bias but he speaks for generations of people who have been medicated against their will or consigned to a lifetime of drugs. Anyone who works in the mental health services, or who has been through them or watched a loved one go through them should DEFINITELY read this book. It should be on the reading lists of all medical courses.
April 6, 2012
This book gives an overview of some of the more horrific treatments for the mentally ill in America's history. It starts out with Benjamin Rush and his "gyrator", moving all the way to pharmaceuticals in present day. The eugenics movement of the 1930s is also covered (although not in depth). I have a fascination with the medical practices of the 18th and 19th centuries, and this work describes some shockers very well, indeed.
January 5, 2012
Basically the history of psychiatry in America. Shocking and gruesome and incredibly useful. I already think of psychiatrists as quacks, but I didn't know they had such a violent history of quackery. Wow.
December 22, 2015
Only got a few chapters in. This is a subject I'm passionate about as I had a brother who suffered from schizophrenia. This book should be take off shelves due to its antiquated and misguided information on mental illness.
March 15, 2017
An extremely interesting history of mental health in America, particularly noteworthy for its observations on how societal attitudes and economic factors influenced treatment.
May 6, 2024
Took me forever to finish but WHAT THE FUCK I’m literally about to start weening myself off my meds
June 1, 2022
Having worked in mental health and having been involved in clinical trials, from the 1970s to 1990s, I went into this book skeptical. But found that it reinforced much of what I observed. It also provides more information that I wasn't aware of about the FDA, for example, and the successes in mental health treatment in countries like Finland.
October 26, 2022
Wow I love being disillusioned
June 9, 2025
I went to medical school to become a psychiatrist before becoming disillusioned with the field, both through first-hand experience as a patient and through the medical curriculum I encountered. This book put into words what I, at the time, was not yet able to articulate.
"Those who do not learn from history are condemned to repeat it." There is no better illustration of this point than a deep dive into a shameful part of psychiatric history, which reveals that we are, shamefully, still repeating it.
This book is a compilation of historical practices that once gained worldwide traction despite little to no empirical evidence (hydrotherapy, lobotomies, insulin therapy, etc). Our current clinical guidelines, the overmedicalization of behaviors in the DSM, and the dominance of biological psychiatry along with its pharmacological treatment with little to no empirical backing, are direct consequences of that. The misleading and widely unethical research practices intentionally designed to push a certain narrative were disturbing at best and criminal at worst. Our patients deserve better.
Whitaker does not dismiss suffering. The symptoms and behaviors exhibited in the DSM are undeniably real and deeply valid; I know that first-hand. The way we conceptualize those behaviors and treat them, however, remains fundamentally flawed.
Everybody should read this book.
"Those who do not learn from history are condemned to repeat it." There is no better illustration of this point than a deep dive into a shameful part of psychiatric history, which reveals that we are, shamefully, still repeating it.
This book is a compilation of historical practices that once gained worldwide traction despite little to no empirical evidence (hydrotherapy, lobotomies, insulin therapy, etc). Our current clinical guidelines, the overmedicalization of behaviors in the DSM, and the dominance of biological psychiatry along with its pharmacological treatment with little to no empirical backing, are direct consequences of that. The misleading and widely unethical research practices intentionally designed to push a certain narrative were disturbing at best and criminal at worst. Our patients deserve better.
Whitaker does not dismiss suffering. The symptoms and behaviors exhibited in the DSM are undeniably real and deeply valid; I know that first-hand. The way we conceptualize those behaviors and treat them, however, remains fundamentally flawed.
Everybody should read this book.
June 26, 2016
A very interesting and shocking account of how psychiatry, more specifically the treatment of schizophrenia has changed over the years. This is a very important book about how the limitations in science and how the society has contributed to the mistreatment of the mentally ill.
Horrifying was the treatment of the mentally ill back in the day. Bleeding to the point of fainting; induced vomiting; swinging chairs; bath of surprise; drowning to the point of near death; removal of the uterus, ovaries and intestines; tooth extraction; hydrotherapy; induced malaria; electric shock therapy; insulin coma therapy; metrazol convulsive therapy; frontal lobotomy were all used to treat mental illnesses. Even the medical therapy with its many adverse effects is far from perfect.
The eugenics chapter was particularly horrifying to read about. The mentally ill were seen as unfit to breed, segregated and sterilized (in Germany even killed). Mental illness was seen to be especially common among immigrants and the lower class. They were seen as waste contributing defective genes to the society. And it was not just the mentally ill that were ill treated, even the black slave harboring any thought for freedom or someone having a dissenting political opinion was said to be insane.
I found the book to be a bit biased against the medical therapy and there was some repetition as the author was trying to stress the point he was trying to bring across. I really wish he had written about the other mental illnesses as well and something positive, perhaps what the developing countries were doing right. Are the medications when given in a low dose effective and what about when weaned off the medications? Did the benefits far outweigh the adverse effects? What of ECT used today?
All in all it was a very interesting read.
Horrifying was the treatment of the mentally ill back in the day. Bleeding to the point of fainting; induced vomiting; swinging chairs; bath of surprise; drowning to the point of near death; removal of the uterus, ovaries and intestines; tooth extraction; hydrotherapy; induced malaria; electric shock therapy; insulin coma therapy; metrazol convulsive therapy; frontal lobotomy were all used to treat mental illnesses. Even the medical therapy with its many adverse effects is far from perfect.
The eugenics chapter was particularly horrifying to read about. The mentally ill were seen as unfit to breed, segregated and sterilized (in Germany even killed). Mental illness was seen to be especially common among immigrants and the lower class. They were seen as waste contributing defective genes to the society. And it was not just the mentally ill that were ill treated, even the black slave harboring any thought for freedom or someone having a dissenting political opinion was said to be insane.
I found the book to be a bit biased against the medical therapy and there was some repetition as the author was trying to stress the point he was trying to bring across. I really wish he had written about the other mental illnesses as well and something positive, perhaps what the developing countries were doing right. Are the medications when given in a low dose effective and what about when weaned off the medications? Did the benefits far outweigh the adverse effects? What of ECT used today?
All in all it was a very interesting read.
July 25, 2011
This history of the treatment of madness in times leading up to our own backwards treatment of "mental illness" is a true wonder of scholarship and impartiality. True, the author shows science to be largely a sham concocted by those who speak and act "in the name of a science run amok," but he doesn't outright dismiss their findings-- he shows us the fairly obvious flaws and barbarism inherent in many acts perpertraited on the so-called "mad" in the name of progress and for anyone interested in the subject of "treatment" as it pertains to the "mentally ill," I recommend this book highly, as depressing and grim as it sometimes is as a cautionary tale when approaching curatives in their many variable guises. There's just so much history here it isn't possible to write a review as encompassing as this tome is. If you want REAL history and are open to the mythos that science or psychiatric pseudo-science sometimes is then you'll love this book. IF you are a secular despot of the ilk of some of these apparently well-meaning purists-- you may be less amused, if amused is even a fair term when more often than not I was naturally and fairly aghast. We'd do well to apply the Hippocratic oath twice as strongly perhaps when dealing with those who are for better or worse considered "Mentally ill," and amidst changing mores which brands more and less persons with the label "insane," or "mad." thought provoking and quite well-written...a very very intriguing read.
April 2, 2013
What did I think? I think the abuse that the mentally ill have suffered over the years is repulsive.
I bookmarked and highlighted many passages to share with my circle. To ignore the hell in which the mentally ill dwell is to turn your back on humanity. I can think of no worse life than that of a person who sought help and basically got turned into a vegetable for my troubles. And that is the least of the worries of those placed on neuroleptics or the "wonder drugs" of today. I am totally not knocking medicine in general for those in need. I am a happy consumer of Cymbalta, which I credit (along with therapy) as saving my metal well-being. However, if you want to know the real story behind the distribution of antipsychotics by individuals with no concern for the health of those they "serve", read this book. Just prepared to be shocked and dismayed.
Thank you, Mr. Whitaker, for writing a book allowing me to truly raise an educated voice in favor of helping this often ignored, yet often in need, portion of our population. Your passion is inspiring.
I bookmarked and highlighted many passages to share with my circle. To ignore the hell in which the mentally ill dwell is to turn your back on humanity. I can think of no worse life than that of a person who sought help and basically got turned into a vegetable for my troubles. And that is the least of the worries of those placed on neuroleptics or the "wonder drugs" of today. I am totally not knocking medicine in general for those in need. I am a happy consumer of Cymbalta, which I credit (along with therapy) as saving my metal well-being. However, if you want to know the real story behind the distribution of antipsychotics by individuals with no concern for the health of those they "serve", read this book. Just prepared to be shocked and dismayed.
Thank you, Mr. Whitaker, for writing a book allowing me to truly raise an educated voice in favor of helping this often ignored, yet often in need, portion of our population. Your passion is inspiring.
January 11, 2021
In clear, plain language, Whittaker chronicles the history of the treatment of schizophrenia in the Unites States and what happens when you let the “free hand” of the market design care. Spoiler alert: You snake snake oil. This is a history so dark, horrible, worse than any nightmare you can imagine, that I often felt a mixture of nausea and heartbreak, like I had just gotten the wind knocked out of me, while listening to it.
As a psychotherapist with patients that also see psychiatrists and as a professional that is “less than” a psychiatrist, it is a particular pain to know that the profession is mostly a steaming mound of bullshit wrapped in high end advertising. Psychiatrists are basically sea monkey salesmen except that sea monkeys don’t give you diabetes, tardive dyskinesia or make you die an early and unpleasant death.
We all know someone on mental health drugs so this book is for everyone. This is an injustice that makes the opioid epidemic look like the intermission act.
As a psychotherapist with patients that also see psychiatrists and as a professional that is “less than” a psychiatrist, it is a particular pain to know that the profession is mostly a steaming mound of bullshit wrapped in high end advertising. Psychiatrists are basically sea monkey salesmen except that sea monkeys don’t give you diabetes, tardive dyskinesia or make you die an early and unpleasant death.
We all know someone on mental health drugs so this book is for everyone. This is an injustice that makes the opioid epidemic look like the intermission act.
August 20, 2010
Details the treatment of mental illness for the past several hundred years. Interesting & sometimes shocking to read about some of the approaches that have been tried. I think one of the author's purposes was to make the psychopharmacological treatments of the last few decades seem just as ineffective and brutal as those from the past. Somewhat interesting, but got really boring/academic when it got to lobotomy & drug treatments.
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