The Mentally 111 in America
A History
of their Care and Treatment from Colonial Times. By Albert Deutsch. With an Introduction by William A. White, M.D., Sc.D. 530 pp. Doubleday, Doran & Co., Inc., N.Y., 1937.
It is characteristic of the American approach to social problems that it should be thought worth while for the American Foundation for Mental Hygiene to finance a survey of the treatment of the mentally ill. It is perhaps not so characteristic that the subject should be approached by a social historian from the standpoint of the gradual development of social attitudes and of the institutions through which these attitudes became shaped.
If proof were needed that the true understanding of social institutions, as of individuals, depends upon an appreciation of the influences which have combined to create them, it may be found in this interesting and intelligent study. As the author reveals the conflict of attitudes, the struggle between individual and social rights and duties, from ancient civilizations, through the barbarities of the Middle Ages, up to the theoretical and practical controversies of a society more self-conscious, if not more rational, the reader becomes aware of the presence of all these influences in his own and in other people’s lives. ” It is a fact that every stage in the long and painful history of the care of the insane from 1537 …. could be actually witnessed in some American community this afternoonsaid Thomas Salmon twentyfive years ago, and the author adds, “With some modification that sentiment might well be expressed to-day
Albert Deutsch has done for the United States what D. H. Tuke did for this country in 1882, in his History of the Insane in the British Isles. Whereas Tuke wrote with the intimate knowledge of the physician, drawing upon the remarkable annals of his own illustrious family, Deutsch claims no expert knowledge of mental disorder, and, as a social historian, is more interested in the influences which stimulated scientific discovery and which released the social effort necessary for its constructive use. This approach is amply justified since, as he Points out, ” Throughout the greater part of human history the role of the medical man in the care and treatment of the mentally ill has been a minor one “.
So many aspects of social life go towards the growth of care for the mentally disordered that the organisation of material is a difficult task. The author has shewn great thoroughness in his search for facts, and has, on the whole, succeeded in maintaining a proportion which makes for easy reading, while his ample references are unusually satisfying to the more scrupulous scholar. Starting with a chapter on “Prophets, Demons, and Witches”, he describes the early influence of magic and the ambivalence of attitude to which ideas of ” possession ” gave rise. Touching upon the stages of remarkable enlightenment in Babylonia, Greece and Rome, and among the Moslems of the 5th century, where a form of ” aftercare ” was already practised, he passes on to the crude witch-hunting phase of Colonial America, a stage which, under the influence of Puritanism, was even more prolonged than it was in the old world. It is interesting to find a parallel between the dramatic effects of the French and American revolutions, and also in the lead that was given by the Quakers in the reform of institutional care in England and in the United States. The 19th century produced in America as it did in this country, outstanding men and women who devoted their lives to the improvement of the care of the insane. Such leaders as Benjamin Rush and Dorothea Lynde Dix established in the United States some of the principles of justice with which the names of John Howard, Samuel Tuke, Lord Shaftesbury and Henry Maudsley will always be associated. It is interesting to trace the exchange of ideas between the two continents : the effect in America of the great experiment in Tuke’s “Retreat”, in spite of the claim that ” non-restraint might do for Englishmen, but it would never be tolerated by the red-blooded Americans” ; the stirring of popular imagination by Dickens and Charles Reade; the achievements in Scotland as well as on the continent of that remarkable middle-aged schoolteacher, Dorothea Lynde Dix. The author sees these pioneers as symbols of their age, harnessing the forces of social change which they would themselves have been powerless to create.
In America, as in England, the rationalism prevailing at the end of the 19th century was at the safne time destructive and creative of true justice. The very principles which found effect in elaborate procedures for protecting the individual from improper detention militated there as here against preventive and remedial treatment. Long after the concept of responsibility had been re-interpreted by psychology mental patients were given the right to meet the charge of insanity made against them, and the privilege of being tried by their peers. It is an astonishing fact that in some States a jury trial of the insane is still mandatory, and that in many others patients awaiting admission to hospitals are still cared for in jails and police-stations.
The development of the Mental Hygiene movement associated with the indomitable Clifford Beers, receiving its impetus from post-war psychiatry, child psychology and modern social case work, and finding its embodiment in the Child Guidance movement and in the treatment of voluntary mental patients, is vividly told, and the book includes a useful account of the care of mental defectives, of insanity and criminal law, and of modern theory and practice in medical and institutional treatment of mental patients.
This book is invaluable not only for the special subject which has been dealt with more comprehensively than in any other single work, but also as an illustration of the nature of social development. Students and practitioners concerned with mental health services will find it an essential addition to their libraries, and will be particularly grateful for the well chosen bibliography. S. Clement Brown.
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