jo's Reviews > Mad in America: Bad Science, Bad Medicine and the Enduring Mistreatment of the Mentally Ill

Mad in America by Robert Whitaker
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's review
Feb 26, 2011

it was amazing
bookshelves: books-i-teach, psychic-pain, trauma, not-fiction, psychiatry-ugh
Recommended for: anyone who has to deal with their or others' mental issues
read count: 3

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.
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Comments (showing 1-5 of 5) (5 new)

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message 1: by Hazel (new) - added it

Hazel Thanks for this review, jo. I don't know much about the practice of psychiatry in the US, and nothing about your mental health legislation, but many of my colleagues here share your scepticism about the influence of big pharma, and the (ab)use of psychiatry as a form of social control.

message 2: by jo (new) - rated it 5 stars

jo are you a mental health professional, hazel? if you already told me, forgive my forgetfulness!

message 3: by Hazel (new) - added it

Hazel Guilty as charged, jo. I'm a psychiatrist. :-)

message 4: by jo (new) - rated it 5 stars

jo yay! go to know. you'll be my to-go person for questions about english psychiatry! (you are probably the best read psychiatrist in the world, hazel).

message 5: by Hazel (new) - added it

Hazel I wish!!! There are these great gaps in my knowledge and understanding, you know? And never enough time to learn all I'd like to. :-)

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