The Mad Among Us Essay, Research Paper

To gain any sort of understanding of how mental healthcare and the care of the mentally ill progressed to the point it has, one must follow psychology s roots to its beginnings in the mental asylum. Providing a definitive history of the care of America s mentally ill, Gerald N. Grob s book, The Mad Among Us, traces the state of mental health care within the United States from colonial America to recent times. In our selected readings, the time period narrows to the late 19th century through the 1950 s. During the selected time period, mental health care underwent an extremely important and definite transition from widespread asylum care for our mentally ill to opportunities for psychological care outside the mental institution. The jurisdiction of the mental health professional also increased from strictly the care and treatment of the mentally ill with extreme disorders to providing service to people who had trouble with problems in everyday life. Marked by new theories and therapies, the psychology progressed as it did because of the introduction of medical science into psychiatry. Spurred by the widening gap between the efficacy of medical healthcare and mental healthcare, mental health practitioners strove to reform and improve the system and in so doing changed the basic foundation of their specialty. As the new generation of psychiatrists attempted to expand their scope outside the institution by examining the causes of mental disease, the managerial and administrative duties required for the long term care of the mentally ill lost its focus. While attempting to increase their scope outside the hospital, psychologists cut their links with the severely mentally ill and the mental institutions that supported them. A new government supported dedication At the end of the 19th century, mental healthcare practitioners and the institutions that employed them fell under extreme criticism. United in their condemnation of the system, former patients, charity reformers, and welfare officials attempted to expose the serious flaws that existed within the mental institution. Their criticism addressed social problems such as poverty and dependency; problems the institutional system never solved and sometimes exacerbated. Social reformers had mediocre success resolving these problems through administrative and bureaucratic solutions. However, the greatest catalyst for change of the mental institutions came from within the mental healthcare community. Intrigued by the newly emerging scientific medicine, neurologists attempted to introduce the ideals and techniques of scientific medicine into psychiatry. Inciting what would soon turn into a bitter conflict, neurologists such as Edward C. Spitka heatedly criticized asylum psychiatrists. Publicly charging the group with ignorance, charlatanism, insincerity, and neglect, Spitka labeled their practices and the group as unscientific and obsolete. Spitka and neurologist reformers like him proposed a mental care centered on the study of the brain and the central nervous system. The key difference that existed between the groups rested in asylum psychiatrists defense of traditional morality, free will and individual responsibility; opposed to neurologists heredity based, reductionist explanations of human behavior. The infighting among the mental health community threatened to de-legitimize the community as a whole and both sides understood the dire need for the mental institution. Undoubtedly affected by the harsh criticism, asylum physicians began the important transitional process that would continue for the next four decades. The first and most significant change occurred in the organizational structure of the mental health world. The foremost professional organization of the psychiatric community, the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), opened its membership to younger assistant physicians. The introduction of these new members represented the psychiatric community s new commitment to the medical and scientific aspects of mental disease. Immediately making their presence felt, these individuals introduced a new dynamic model of psychiatry that incorporated the patient s mental history into his analysis and treatment. Dynamic psychiatry expanded the jurisdiction of psychiatry, shifting the place of practice to beyond the asylum and hospital walls. Dynamic psychiatry s acknowledgement of past circumstances affecting current mental disorders paved the way for a new brand of preventive psychiatry. The mental hygiene movement s central concept was that the prevention of mental disorders was easier than the treatment of them. The new breed of psychiatrists were disillusioned with the asylums and their method of treatments and desired to widen professional boundaries so that the social problems that led to mental disease could be lessened by the application of preventive measures. Psychiatrists were also were aware that if they did not expand their jurisdiction beyond the asylum walls and close the gap between their rates of efficacy and those of scientific medicine, their inferior position in the medical community would continue.

Although early 20th century reformations changed and expanded psychiatry s reach beyond the mental hospital, the mental hospital remained the chief caretaker for the majority of mentally ill dependents. The growth and relative stability of large-scale mental institutions during the first half of the century obscured the problems that remained festering within them. As the costs of maintaining these facilities continued to mount and hospitals reached their maximum occupancy, mental health practitioners searched for viable alternatives for caring for mental dependents. Health practitioners experienced little success in their attempts to promote the expansion of home care, family care, and community placement. All progress derived from these plans was offset during the dark days of the Depression and World War II. Obviously, the mental hospital s financial problems greatly increased during this period. As appropriations fell due to economic decline, admissions increased due to the mental stress brought on by the Depression and mental health professionals decreased due to wartime service. As the quality of life and care plummeted within these large-scale facilities, psychiatrists struggled with the creation of a regulatory body that could maintain the delicate balance of professional autonomy and public accountability. Their efforts resulted in few definite resolutions and the mental health care community and the mentally ill struggled to keep their heads above water during this period. Although the quality of life and care experienced at the hospitals declined greatly during the Depression and World War II years, the period found its silver lining in what were considered at the time groundbreaking advances in therapeutic treatment. These radical therapeutic innovations provided hope for multitudes of seriously mentally ill patients. Although we now debate and often condemn the use of these innovations, the widespread use of fever therapy, insulin therapy, shock therapy, and the frontal lobotomy were the sole prospect of recovery for chronic patients who were seemingly destined to spend their lives in mental hospitals. Studies completed during this period reflect an overall improvement in the probability of release and the death rates within the institutions after the introduction of these somatic therapies. The effects that World War II had on psychiatry in America cannot be overestimated. During the War, the U.S. Army demanded thousands of psychiatrists to evaluate and ensure the mental fitness of soldiers. As a result, the years following World War II saw a significant increase in the number of psychiatrists. The knowledge psychiatrists gained from their wartime experiences proved to be beneficial on the home front. On the battlefield, psychiatrists gleaned a new understanding of how stress can lead to mental disorders and the way stress can be effectively combated. In addition, mental healthcare professionals observed the superiority of community based mental health systems over the traditional hospital system. The traditional mental hospital suffered additional condemnations when medical journalists such as Albert Deutsch exposed the terrible conditions that lie within. The government proved its dedication to improving these horrible conditions by its passage of the National Mental Health Act in 1946. The NMHA provided the impetus for research, training, and for the funding of efforts to improve the state of care for the mentally ill. The passage of the NMHA and postwar optimism in science and technology set the stage for what would be the one of the greatest periods of psychiatric advancement ever. The 1950 s saw the development and introduction of new theories accompanied by the simultaneous development of effective psychotropic drugs. The rise of the therapeutic community highlighted a period of rapid theoretical psychiatric advancement. Maxwell Jones, a British psychiatrist, brought the therapeutic community to life, providing the model for the rest of the psychiatric world. Jones model fostered the patient s active participation in the therapeutic process, thus negating much of the patient s dependency, a symptom of the traditional hospital setting. A series of influential studies backed the efficacy of Jones new model of treatment. With the spread of the public friendly community based model, psychiatrists began widen their professional boundaries to the general public. Mental health occupations such as clinical psychiatry and psychiatric social work spread to the public sphere.The psychiatric breakthrough with the most immediate impact of the 1950 s was the development and introduction of psychotropic drugs. These drugs treated and alleviated the symptoms of some of the most serious mental illnesses such as schizophrenia and manic depressive psychosis. Optimism brought on by these breakthroughs carried over to the policy makers of the time and furthered the cause of the mentally ill. Upgrades to the deteriorated mental facilities occurred and expansion of psychiatric services into the community spread.