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

JAMA. 2002;287(23):3149-3150. doi:10.1001/jama.287.23.3149-JBK0619-5-1.
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Robert Whitaker, an award-winning journalist, presents a caustic history of American psychiatry's treatment of schizophrenia. Starting with the Colonial era practice of spinning in a gyrator, the litany continues with chilling ice baths, dental extractions, therapeutic sterilization, malarial therapy, insulin coma, electroconvulsive treatment, and frontal lobotomy, and ends with the typical antipsychotics and their new generation cousins.

Each treatment, the author points out, was justified by a specific scientific hypothesis consistent with that era's broader theory of mental illness. In Colonial and post-Revolutionary times, insanity was seen as a loss of reason, a return to the bestial that required firmness and, at times, terror. Post-Darwin it was a product of faulty germ plasm, which required confinement and sterilization to protect the gene pool. Today, it is considered a biochemical abnormality that necessitates treatment with pharmaceutical agents, just as diabetes requires insulin. For Whitaker, the only bright spot in 200 years of mistreatment is the short-lived era of Moral Treatment. As he makes clear, it originated in a religious inclination to treat the mentally ill as brethren, which organized medicine subverted and then overthrew.

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