Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally ill is not only well written, but eye-opening for the mentally ill patients and the general public. The mentally ill have had a constant history of mistreatment. From beatings, torture, drownings, sterilizations, lobotomies, electroshock, neuroleptics, the loss of civil liberties in general, and now atypical drugs, the severely mentally ill have been more of a scientific study for psychiatrists rather than patients. In the last half of the 20th century, the mentally ill became nothing more to the psychiatric industry than a means to make money. The greatest era of the treatment of psychiatric patients was the era of "moral treatment" in the midst of the 19th century, and recovery rates were much higher because instead of crowding the "mentally ill" into mental hospitals, the mental patients were treated with love and kindness. Robert Whitaker gives an in-depth review of the history of mistreatment within the psychiatric system, and this book should be required before anyone receives a doctorate in psychiatry.
As a former psychiatric patient, I am well aware of the the mishaps within the psychiatric system. I have entered a mental hospital twice voluntarily. The first time I went to get clearance to go back to school. I had a disturbing "feeling" that a fellow student was going to commit suicide, so I went to the school authorities warning that something was going to happen to this student. They thought I was, in layman's terms, going crazy, and they mandated a clearance from the mental hospital before I went back to school. I showed up to the mental hospital that night, and three days into the mental hospital, my mom received a phone call from the Vice President of Student Affairs that the student of whom I warned the school had his house burn down. Everyone was stunned, but I wasn't surprised. I don't know how exactly I knew something was going to happen to this student, but I did know. Regardless, my psychiatrist made me stay the entire two weeks within the hospital.
During the two weeks, I noticed how they were not willing to let me go. I had been taught to stand up to wrong opinions in college, and I felt that the psychiatrist's opinion on how I should think was wrong. Psychiatry taps into many civil liberties violations, and the 1st Amendment is one of those. Without freedom of thought, we do not have meaningful freedom of speech. With that said, they have to release patients after two weeks. Once I was released from the inpatient program, they made me attend the outpatient program before I would be cleared to go back to school.
The outpatient program was more of a classroom setting. Once again, I learned in the classroom to stand up to the head of the classroom when I believed that person was wrong. Needless to say, I actually caught myself debating with the psychologists and psychiatrists running the system. They had upped my dosage of Seroquel up to 400mg at night, my Abilify was upped to 30mg, I was on Klonopin, and I was also on the antidepressant Paxil. Yet despite all of this medication, I happened to still be thinking very clearly for someone in my position. The more I challenged their opinion, the more they resisted my opinion with coercion. Once the head psychologist within the outpatient program recommended that I go back inside the mental hospital, I denied. At this time, I had a 3.95 GPA with 107 hours complete for school, but I knew that psychiatry was wrong. I refused to go back into the hospital, and I did not receive clearance to go back to college.
I will explain my second institutionalization later, but first, I would like to touch on Whitaker's book. Whitaker most certainly puts up a legitimate argument that the psychiatric system should be reformed. My belief, however, is that psychiatry goes beyond that. Do psychiatric patients not have the right to be irrational? It is the basis of the First Amendment of the United States to have the freedom of thought. Without it, our speech is utterly meaningless. How do you decide what is "rational" and what is "irrational" when it comes to civil liberties? To be frank, there is no line for freedom of speech! No matter how irrational someone becomes, they have a right to speak. As John Stuart Mill said in On Liberty, "If all mankind minus one, were of one opinion, and only one person were of the contrary opinion, mankind would be no more justified in silencing that one person, than he, if he had the power, would be justified in silencing mankind." In essence, an opinion does not have to be respected nor appreciated, but a person has a right to believe and speak what he/she chooses.
As for the "pragmatic" solution, psychiatry does need to be reformed, and to do that, Whitaker explains in Mad in America the success of what was known as "moral treatment." Before physicians grabbed hold of the "mentally ill" after the Civil War to replace their war clients, the Religious Society of Friends took a new philosophy with how to handle the "mad," and in 1817, the Quakers opened the first moral-treatment asylum in America. America actually embraced this new idea for the humane treatment of the "mad" because it was a part of the newly formed ideal of liberty in America. In moral treatment, patients were treated with kindness and respect. Instead of the spinning board used by Benjamin Rush, patients attended plays, played games, and were given a sense as an equal human being (Granted, Benjamin Rush was a great pioneer for his time. He brought patients out of the chain links in the basements and allowed for much more freedom for those who "behaved"). Sadly, moral treatment lost it's prevalence in society when Dorthea Dix wanted to spread it to everyone. She had the most well intentions, but passing state legislation called for a much higher number of patients and less quality of faculty. Moral treatment worked because it gave each patient individual attention and individual care. The asylums that practiced moral treatment beforehand made sure that each and every member of authority was not inclined to overreact to the "craziness" of the patients, and that they were level headed. This sincere approach by Dix was the beginning of the end of "moral treatment" as we came to know it, but the final death of the system came when the Civil War ended. Physicians, needing to replace their former Civil War patients, began to once again use "medical" treatments on the insane.
The pragmatic solution is what we as a society need to embrace once again. To get rid of the psychiatric system is not pragmatic, nor is that what I want; however, it does need to change as we know it. As Whitaker mentions throughout his book, studies consistently show that those who never get on antipsychotics are the patients that are the least likely to relapse. After that, the relapse rate grows, and once you start taking antipsychotic medication, you are at a much higher risk of relapse. Patients should be admitted and attempted to be stabilized the first week (maybe the second), and if they cannot be stabilized, then medication should become the last option. It should not be the first option because of the dangers of going on and off of medication. Anyone who decides to get off of medication should always do so with a doctor. I, however, did not do this, and that led to my second stay in the mental hospital.
As I entered the mental hospital the second time, I was a complete mess. I not only stopped taking my medication abruptly, but I also got hooked on Adderall which I was buying off the street. I felt that Adderall would give me the energy that I had before I started antipsychotics, but it turns out that while it gave me energy, it also gave me delusions that I was speaking with Satan and God through means of other people. It took me a very long time to recover from my mistakes that I committed before I entered the mental hospital the second time, and I even drove up to the college and got arrested by campus police in that time. The most important fact in all of this is that none of mistakes nor my arrest would have happened if it wasn't for the malpractice of my first institutionalization. What they should have done was make sure I was stable the first time and then released me. As I said before, the issue of the psychiatric institution runs deep, and I was not about to back down from challenging authority when I felt they were wrong. Egos must be put aside if patients are to get truly "better."
Robert Whitaker also notes how all the studies shown to support a so-called "chemical imbalance" in the brain have been fundamentally flawed and propagandized to the public as fact. They are not fact. There has never been a study that didn't have the influence of drugs and shown any evidence of a chemical imbalance. As noted in the book, the studies of those who never took neuroleptics or atypicals in the first place are shown to not have any difference in dopamine receptors (Too high of dopamine flow is one "chemical imbalance" theory for the schizophrenics). After the introduction to the neuroleptics/atypical drugs, however, studies actually appear to show that an increase in dopamine receptors is caused by a reaction from the brain. The neuroleptics targeted dopamine and shut down the flow of dopamine receptors. The increase in dopamine has only been shown after the introduction of the drugs into one's system.
Pharmaceutical companies and their researchers also have never produced a sincere study; however, the FDA does not approve based on the sincerity of the study, but instead they approve based on if the drugs lower psychotic episodes. They base this on short-term studies, and if the antipsychotic does a "better" job than the placebo, then the drug is approved. The problem with the studies and why the studies are fundamentally flawed in the first place lies in that patients are never drug naive. Mental patients are abruptly withdrawn from the drugs they are on, and then placed on either the placebo, the new drug being tested, or the old drug they were initially on. Sudden withdraw of the psychiatric drugs I was placed on caused me to stare at the sun for 8 hours. To have a true, honest study, the pharmaceutical companies would have to include first time patients experiencing a psychotic episode whom have never been exposed to psychiatric medicine. Luckily, in Finland, they are doing these studies, and for the first time since "moral treatment," it is being shown that quality care is what works- not medication. Granted, there are some people that benefit from medication, but studies show that the majority of people experiencing psychosis are worsened by medication. As noted in the Afterword to the Revised Edition of Whitaker's book, Finland is beginning studies that promote doing what I said needs to be done in the United States. Finland is beginning to attempt to stabilize first, and drug later. If one is stabilized without psychiatric drugs, then they are not placed on the drugs. Studies have shown over and over that the unmedicated are the ones that truly "get better."
I really would have been homeless or dead if I did not enter the mental hospital the second time, but once I got out, I once again stopped taking my medication abruptly. I spent one day staring at the sun for eight hours which left my vision permanently damaged. If it were not for the care of my family (and eventually my best friend), I may be dead. Online socializing and online poker have also helped me recover. Luckily, I do not see any brain damage. I am actually accomplishing more voluntary reading than I ever have in my lifetime. I am truly happy. I don't have much money, but I have self-respect and love from others. I am drug free (outside of coffee, which is a drug) and ready to take on the world. I will pull a Diogenes of Sinope if I must to remain myself.
This review of this book was a review from my own personal perspective. I could not give a review without giving my personal experience. It is important to note how one reacts when a person believes he/she is falsely incarcerated or being treated disrespectfully. There are a lot of stigmatizing beliefs about how the "mentally ill" cannot help but act out of control, but those who say that should put themselves in the shoes of the mentally ill that are in a mental hospital. How would you like to be locked up and be trained like a pet on how to act? In essence, patients feel dehumanized a lot of times in mental hospitals, and I know firsthand why that is. Patients' opinions are virtually meaningless in a mental hospital, and it is more an issue on how the psychiatrist and the psychiatric staff want you to behave. They do not care about a patient's opinion! They care if the patient behaves accordingly or not.
