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America's Care of the Mentally III: A Photographic History

Steven S. Sharfstein, MD
JAMA. 1995;273(8):676. doi:10.1001/jama.1995.03520320086051.
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This book, which was put together as part of the American Psychiatric Association's sesquicentennial anniversary (150 years), is a dramatic photographic testament to idealistic treatment philosophies, which were compromised by shaky science and the economics of"less is more." It is a moving portrait of the asylum era in American psychiatry, which initially attempted to provide individualized and humane "moral treatment" for the "insane" but rapidly deteriorated into the shame of the states, that is, huge understaffed warehouses for the mentally ill and brain damaged.

There are some extraordinary photographs of physicians and staff for the state and private hospitals and the patients who filled the beds and achieved the "economies of scale," the basis for financing care. The last ten pages show the next era of less is more, the homeless mentally ill and deinstitutionalization, which has replaced state hospitalization as mental health policy in the latter part of the


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