Hot on the heels of an optimistic film about Nobelist John Nash's schizophrenic journey comes medical journalist Robert Whitaker's disturbing exposé of the cruel and corrupt business of treating mental illness in America. Mad in America begins by surveying three centuries of mental health treatments to discover why positive outcomes for schizophrenics in the U.S. for the last 25 years have decreased--making them lower than those in developing countries. Whitaker asks, "Why should living in a country with such rich resources and advanced medical treatments for disorders of every kind, be so toxic to those who are severely mentally ill?"

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


From Publishers Weekly
Tooth removal. Bloodletting. Spinning. Ice-water baths. Electroshock therapy. These are only a few of the horrifying treatments for mental illness readers encounter in this accessible history of Western attitudes toward insanity. Whitaker, a medical writer and Pulitzer Prize finalist, argues that mental asylums in the U.S. have been run largely as "places of confinement facilities that served to segregate the misfits from society rather than as hospitals that provided medical care." His evidence is at times frightening, especially when he compares U.S. physicians' treatments of the mentally ill to medical experiments and sterilizations in Nazi Germany. Eugenicist attitudes, Whitaker argues, profoundly shaped American medicine in the first half of the 20th century, resulting in forced sterilization and other cruel treatments. Between 1907 and 1927, roughly 8,000 eugenic sterilizations were performed, while 10,000 mentally ill Americans were lobotomized in the years 1950 and 1951 alone. As late as 1933, there were no states in which insane people could legally get married. Though it covers some of the same territory as Sander Gilman's Seeing the Insane and Elaine Showalter's The Female Malady, Whitaker's richer, more detailed book will appeal to those interested in medical history, as well as anyone fascinated by Western culture's obsessive need to define and subdue the mentally ill. Agent, Kevin Lang. Copyright 2002 Cahners Business Information, Inc.


From the New England Journal of Medicine, June 27, 2002
This book is more of an indictment than a historical account, in keeping with its subtitle. The author, a medical journalist, virtually equates mental illness with schizophrenia; depression and other psychiatric disorders are mentioned only parenthetically. The story starts on a positive note, with the establishment of proper medical wards for the insane in Pennsylvania Hospital, around 1800. This occurred in the wake of the work of Pinel, who in 1793 was the first to free psychiatric patients from their chains, in Paris. The medical approach, sometimes still harsh, was followed by the heyday of "moral treatment," between the 1840s and the 1880s, in Pennsylvania Hospital and elsewhere in the United States. It was modeled on the Quakers' retreat in York, England (in 1796), where patients were treated with compassion and respect. Alas, from there the road only went downward. The overcrowding of psychiatric hospitals with persons with syphilis, alcoholism, and dementia, as well as the lack of dedicated personnel, led to the departure of philanthropists and the restoration of the medical model, under the leadership of neurologists. Subsequently, the eugenics movement led to inhumane measures. The first was prohibition of marriage among the insane (in more than 20 states, between 1896 and 1914); the next was compulsory sterilization, performed in thousands of U.S. citizens between 1907 and World War II. Until the 1930s, psychotic behavior was most often treated with "hydrotherapy" (in fact, old-fashioned forms of restraint combined with the use of cold baths or wet packs). Other physicians acted on idiosyncratic theories and removed female organs, parts of the gut, or teeth, or they induced malarial fever. In the 1930s, new treatments followed each other in rapid succession: coma induced by insulin, seizures induced by pentylenetetrazol, electroshock treatment, and finally, prefrontal lobotomy. Moniz took the lead with this operation (in Lisbon, Portugal, in 1935) and was followed the next year by Freeman and Watts in the United States. It was especially in the decade after the war, after Freeman had introduced the transorbital technique, that more and more patients were regarded as candidates for prefrontal lobotomy. The state of lethargy in which most patients were left after this "minor operation" did not detract from its popularity. The fact that outcome assessment was so biased can be attributed not only to naive optimism; in addition, discharge from an institution was regarded as a success in itself. State asylums encouraged any measure that removed patients from their care, and reports of success would bring in new research money, especially from the Rockefeller Foundation. When the popularity of lobotomy waned, in the mid-1950s, more than 20,000 patients had undergone this procedure. One might think that the advent of antipsychotic drugs (starting with chlorpromazine, in 1954) would have marked the beginning of a more positive chapter in the history of American psychiatry. Not so, at least in the author's eyes. He regards American treatment regimens involving the use of antipsychotic drugs as no less disabling and brutal than the methods used in earlier times. Although there may be truth in the notion that dosages of antipsychotic drugs in the United States are higher than necessary, the author weakens his position by issuing continuous and unrelenting condemnations (for instance, "The Nuremberg Code doesn't apply here"), despite a dearth of evidence to support them. How can he be so certain that persons with Kraepelin's schizophrenia in fact suffered from encephalitis lethargica and that therefore today the outcome of the disease is seen in an unnecessarily gloomy light? Indeed, finding normal levels of dopamine in the cerebrospinal fluid of persons with unmedicated schizophrenia does not support the "dopamine hypothesis," but to call it "a bald-faced lie" is simplistic reasoning. It is true that blocking dopamine receptors often leads to akathisia (an irresistible urge to move), but what is proved by citing (without naming the authors) a study in which 79 percent of mentally ill patients who had tried to kill themselves suffered from akathisia? Or by citing one in which 50 percent of all fights on a psychiatric ward involved patients who suffered from akathisia? And what point is made by telling the sad story of a female patient who was eventually found murdered in Central Park? Or by recounting the story of fraudulent psychiatrists who made money by entering nonexistent patients into well-funded pharmaceutical trials? Such criminal behavior has occurred in other specialties and does not by definition disprove the efficacy of the drugs being studied. Similarly, the author tries to prove his point that neuroleptic drugs make patients worse, rather than better, by repeatedly comparing series of treated and untreated patients from different institutions, with inherent differences in referral patterns and severity of illness. It is precisely for such weaknesses of design that he chides the industry-driven clinical trials that introduced "atypical" antipsychotic agents such as risperidone and olanzapine. Rightly so, but by this time critical readers will have lost faith in the author's arguments. Although the author is widely read on the subject, the facts are largely arranged to suit his prejudice, especially in the chapters on drug treatment. American psychiatric institutions may have their failings in the current management of patients with schizophrenia, but they deserve better critics. J. van Gijn, M.D.Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


From Booklist
*Starred Review* American psychiatry has excelled throughout the nation's history, but doctors and drug manufacturers have profited far more than psychiatric patients. When the World Health Organization compared schizophrenics' recovery rates in the U.S and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity. Whitaker's articulate dissection of "mad medicine" in the U.S. explains why that dismaying contrast obtains. Assuming that insanity arises from identifiable physical causes, American psychiatry theorized about those causes and sought to find physical therapies and, later, drugs that attacked those causes. Accordingly, from being shocked with cold water and repeatedly nearly drowned, to suffering chemically and electronically induced grand mal seizures, to having the frontal lobes of their brains chopped off, to being drugged into parkinsonism (the preferred modus nowadays), the mad in America have suffered as essentially nonconsensual experimental subjects. Since World War II, drug companies have made continued testing increasingly worthwhile, despite the lack of encouraging results. This horrifying history is all the more discomfiting because another mode of treatment was successfully used from the late eighteenth century until the 1870s. Called moral treatment by its Quaker champions, it involved treating the mad with kindness and sympathetic companionship rather than drugs and machines. But it cost too much, and it wasn't professional. Ray Olson
Copyright © American Library Association. All rights reserved


From Book News, Inc.
Investigative journalist Whitaker tells the story of the treatment of schizophrenia in the United States from 1900 up until the present day. While many would recognize his tales of forced lobotomies, electroshock therapies, and other past "treatments" to be shameful reminders of an ignorant past, Whitaker saves his greatest outrage for the practices of the present. Noting the disturbing facts that outcomes for schizophrenics are worse today than they were 25 years ago and that outcomes are worse in the industrialized nations than they are in the developing world, he argues that the current regime of anti-psychotics (called "atypicals") is not based on good science and has been pushed by companies more concerned with raking in profits than with concern for patients.Copyright © 2004 Book News, Inc., Portland, OR


The Baltimore Sun
"The book's lessons about the medical dangers of greed, ego and sham are universal and couldn't be more timely."


South Florida Sun-Sentinel
"People should read this excellent book and learn which questions to ask before filling that "miracle" prescription."


Mother Jones
"Passionate, compellingly researched polemic, as fascinating as it is ultimately horrifying."


Kirkus
"An absorbing, sometimes harrowing history of the medical treatment in the US..."


In These Times, 6/7/02
"The most important bit of mental health muckraking since Deutsch's The Shame of the States was published in 1948."


Philadelphia Inquirer, 2/24/02
"[Mad in America] is mandatory reading and raises valid issues."


Seattle Times, 2/01/02
"[Whitaker] does an intelligent and bold job."


New Scientist, 7/27/02
"A humdinger of a book...an important book that every psychiatrist should be compelled to read."


American Scientist November / December, 2002
"Whitaker does not employ the exaggerated prose of the antipsychiatry movement...Serious and well-documented."


Book Description
A riveting social and medical history of madness in America, from the 17th century to today. In Mad in America, medical journalist Robert Whitaker reveals an astounding truth: Schizophrenics in the United States fare worse than those in poor countries, and quite possibly worse than asylum patients did in the early nineteenth century. Indeed, Whitaker argues, modern treatments for the severely mentally ill are just old medicine in new bottles and we as a society are deluded about their efficacy. Tracing over three centuries of "cures" for madness, Whitaker shows how medical therapies-from "spinning" or "chilling" patients in colonial times to more modern methods of electroshock, lobotomy, and drugs-have been used to silence patients and dull their minds, deepening their suffering and impairing their hope of recovery. Based on exhaustive research culled from old patient medical records, historical accounts, and government documents, this haunting book raises important questions about our obligations to the mad, what it means to be "insane," and what we value most about the human mind.


About the Author
Robert Whitaker's articles on the mentally ill and the drug industry have won several awards, including the George Polk Award for medical writing and the National Association of Science Writers' Award for best magazine article. He was named a finalist for the Pulitzer Prize for a Boston Globe series he co-wrote in 1998. Whitaker lives in Cambridge, Massachusetts.

FROM THE PUBLISHER

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

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

Author Biography: Robert Whitaker's articles on the mentally ill and the drug industry have won several awards, including the George Polk Award for Medical Writing and the National Association of Science Writers' award for best magazine article. A series he co-wrote for the Boston Globe was named a finalist for the Pulitzer Prize in 1998. He lives in Cambridge, Massachusetts.

FROM THE CRITICS

Baltimore Sun

The book's lessons about the medical dangers of greed, ego and sham are universal and couldn't be more timely.

Mother Jones

Passionate, compellingly researched polemic, as fascinating as it is ultimately horrifying.

South Florida Sun-Sentinel

People should read this excellent book and learn which questions to ask—before filling that "miracle" prescription.

American Scientist

Whitaker does not employ the exaggerated prose of the antipsychiatry movement...Serious and well-documented.

Seattle Times