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Robert Whitaker

Mad In America: Bad Science, Bad Medicine, And The Enduring Mistreatment Of The Mentally Ill Hardcover – January 1, 2002

by Robert Whitaker (Author)

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Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
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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.

Print length

304 pages
Language

English
Publisher

Basic Books
Publication date

January 1, 2002
Dimensions

6.25 x 1 x 9 inches
ISBN-10

0738203858
ISBN-13

978-0738203850
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Editorial Reviews

Amazon.com Review

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.

From The New England Journal of Medicine

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

Review

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

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

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

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

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

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

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

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

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

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.

Product details

Publisher ‏ : ‎ Basic Books; 1St Edition (January 1, 2002)
Language ‏ : ‎ English
Hardcover ‏ : ‎ 304 pages
ISBN-10 ‏ : ‎ 0738203858
ISBN-13 ‏ : ‎ 978-0738203850
Item Weight ‏ : ‎ 1.35 pounds
Dimensions ‏ : ‎ 6.25 x 1 x 9 inches

Best Sellers Rank: #917,944 in Books (See Top 100 in Books)
- #300 in Popular Psychology Mental Illness Books
- #415 in Schizophrenia (Books)
- #457 in Medical Psychology History

Customer Reviews:
378 ratings

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Robert Whitaker

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Robert Whitaker 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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1 star		4%

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Bethany Yeiser

Medications with terrible side effects can still improve your life.

Reviewed in the United States on February 26, 2019

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The facts in this book are true. Antipsychotics may come with side effects that may be as bad as chemotherapy for cancer. It is important for people, especially physicians, to not underestimate the suffering these medications can cause. But these medications can also radically change your life for the better.

Personally, the medication side effects I experienced on my first atypical (newer) antipsychotic were severe and consistent with the author’s desciption. There was no day that went by when I wasn’t acutely suffering.

However, my first medication did keep me out of the hospital, and allowed me to live in community rather than being perpetually restrained in an institution. Even with the horrific side effects, my first medication gave me a better life.

This book is so concerned with medication side effects that the author forgets to acknowledge these medications can improve a patient’s qualify of life. He also does not make a comprehensive distinction between the older antipsychotics which are neurotoxic and difficult to tolerate versus newer medications that have fewer side effects.

The author does not acknowledge that patients find medications that work well for them all the time. Eleven years ago, I found the medication that works for me, and I have lived a wonderful life with few side effects all these years, in full remission from schizophrenia.

Yes, I have experienced what this author describes. Antipsychotics may come with a high price to pay, but even then, they may drastically improve a patient’s quality of life. These medications may allow individuals who are a danger to themselves or others and used to always be institutionalized to recover, leave the hospital and live in the community.

43 people found this helpful

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Douglas Shoback

Important History, but Demonizes Psychiatry and Could be Harmful

Reviewed in the United States on March 15, 2019

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I picked up this book in hardcover while working in my university’s library back in the early 2000’s. I had just been diagnosed with bipolar and was seeking out whatever information I could on mental illness treatment.

Whitaker painstakingly takes us through the dreadful history of treating mental illness, focusing specifically on the late 19th century onward. From ice baths to isolation to the popularity of lobotomy from the 1920’s through the 50’s (doctors traveling across the country with an ice pick as their instrument; through the corner of the eye and removing a bit of the brain right in your home)—however, Whitaker does not explore how lobotomy was used mainly on women to control their emotions. There is an obviously sexist subtext to mental health treatment from the 50’s up to the 70’s: to control willful women.

Then Whitaker explores the creation and advances of psychopharmacology. And yes, early medication of schizophrenics and the mentally ill was disgusting and immoral. It led to sterilization and medicinal lobotomies. And pharmaceutical companies did hide harmful side-effects in order to get their drugs approved by the FDA.

But it’s nothing *new.* As we see in reports today, major pharmaceutical companies falsify or mask negative effects of their medication. In 2019, this still happens. Whitaker wants to lay the blame on psychiatry and the treatment of mental illness through medication. The problem isn’t psychiatry, the problem is Capitalism and for-profit health care.

To be honest, if I wasn’t treated by my psychiatric medication, I’d either be dead or an unproductive member of society. My medications allow me to exist in this culture.

So the case Whitaker makes is a good one, but it ignores the complexity and improvement modern mental health care deals with.

Just like modern medicine had to deal with bloodletting and leeches and mysticism, so, too, does psychiatry have to answer for its demons. But that does not mean psychiatry is bad science. It doesn’t mean it doesn’t help people. It’s evolving and will continue to evolve.

Just look at what has happened in all medical science in the 17 years since this book was published.

27 people found this helpful

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Andrea Stienkuller

the better.

Reviewed in the United States on April 10, 2018

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Read this book before stepping foot in a psychiatrist's office, or taking any medication for any kind of emotional distress. Psychiatry is nonsense, and the sooner it falls into the dustbin of history, the better.

28 people found this helpful

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Raptorduck

An important unfortunate history of mental health treatment

Reviewed in the United States on February 2, 2021

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I came at this from the perspective of somebody with PhD training in psychology who has worked in the pharmaceutical industry 36 years as a scientist and otherwise. I even studied schizophrenia in my PhD research. I found this book to be an excellent, if not alarming walk through the history of mental health treatment, particularly with schizophrenia. It takes you into your institutionalized America and now drugged America where many who would be erstwhile institutionalized are left to their own devices. Both did not work so great. While the book is dense and through, it offers few solutions other than revisiting old approaches from Quakers and some other countries. Sometimes it overgeneralizes the “bad” institutional pharmaceutical, mental health, and clinical psychology worlds. I assure you, I for one, want to find cures and effective treatments, not just make money off the mentally ill. I have seen mental illness first hand. That not notwithstanding, the author makes important points about institutional systemic bias that should not be lost on the reader. This is an important expose that should be read by all clinical psychologists and psychiatrists.

5 people found this helpful

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B. Hawkins

before I knew something was horribly wrong with the information perpetuated by the people I've ...

Reviewed in the United States on July 17, 2018

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Having dealt with the mental health system for years while caring for a schizophrenic son, words can't express my gratitude to this author. FINALLY, someone is telling the truth about the American mental healthcare system and psychiatry, which is fraught with outright deceit and callous indifference to the suffering of the mentally ill. I can attest to the ugly truth about antipsychotic medications, having witnessed it firsthand. I regret that I didn't read this book years ago, before I knew something was horribly wrong with the information perpetuated by the people I've relied on to "help" my son.

16 people found this helpful

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Top reviews from other countries

Rospo

A "Must Read."

Reviewed in the United Kingdom on August 2, 2015

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This book is a "must read" for all students of psychology/psychiatry. The writer gives an enthralling history of psychiatry and it use of medication.
It makes you question the impact of the drug companies on people's lives and the destruction they have left in their wake.
Every person who feels the need for medication, to help them through a depressive/anxiety episode, should read this book, before visiting a GP.

becky81

excellent read

Reviewed in the United Kingdom on February 9, 2012

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excellent detailed book, unlike many that are quick and vague this one took a while to read as was very detailed but has helped me a lot with my mental health studies. Definitly reccomend this book for anyone who is interested in mental health and its treatments, past and present. thoroughly enjoyed this book and was dissapointed when i has finished it!

DM Willcocks

Brilliant

Reviewed in the United Kingdom on March 27, 2013

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I very strongly recommend this book. its extremely well written and a real eye opener into how we have been failing people with mental health difficulties for years and how we are duped by the drugs companies and the powers that be. This book and Robert's other book on the subject An Anatomy of an Epidemic should be read by every prescriber of psychotropic medications. It is scary stuff and a massive issue. I do not usually do reviews but this is so important that the information and the facts that he presents need to be out there and to be acted on by policy makers and the profession as a whole. Go out and but theses books!!

3 people found this helpful

Simon H.

Excellent Book !

Reviewed in the United Kingdom on June 13, 2015

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Excellent Book must read for anyone who wants to know the myths associated with metal health systems of care & the drugs !

Amazon Customer

Five Stars

Reviewed in the United Kingdom on January 3, 2017

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Great book, well researched and presented.

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Robert Whitaker

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