American Notebook: Mental Hospitals and Social Theorists
Rosenberg, Bernard
A short time ago there appeared a 126-page monograph modestly entitled "Psychosis and Civilization" and written by Herbert Goldhamer and Andrew Marshall. This rather specialized statistical...
...one man's predispositions are not the same as another's...
...On the other hand, if psychosis is a personality problem ordinarily triggered by a crisis embedded in our tension-ridden society, then psychotherapy is surely indicated...
...I recently took a guided tour through one of Massachusetts' more "progressive" mental hospitals and was struck with the fact that nearly every other patient had a bandaged head...
...Given another twist of the Zeitgeist, the views I have quoted from Rosen may even gain general acceptance...
...If the former, then Goldhamer and Marshall must be taken with a grain of salt...
...A short time ago there appeared a 126-page monograph modestly entitled "Psychosis and Civilization" and written by Herbert Goldhamer and Andrew Marshall...
...The authors speak of a tendency, sometimes referred to as a law, according to which the probability that disturbed persons will be hospitalized is inverse to their distance from a mental hospital...
...I say, somewhat surprisingly, because Commentary in its "Study of Man" department often criticizes social science research and seldom applauds it...
...If severe mental disorder is nothing but a biological phenomenon, machines, pills, and surgical instruments are the appropriate means for dealing with it...
...In short a certain proportion of people are known to be psychotic and yet go Summer 1954 • DISSENT • 263 uncommitted...
...If this is so, I find it appalling that we should not have invested more heavily in research and treatment programs...
...S. Kirson Wineberg indicates that, "The standardized rates for schizophrenia during 1933, based upon the 1930 population, show 1.92 times more schizophrenics committed from urban than from rural areas...
...So long as we persist in denying this, it will be impossible to adopt a curative or a therapeutic program of any fundamental value...
...We have a middle class society, a middle-brow culture, and a middle-of-the-road government...
...and thereby does them an injustice...
...In each case, in accordance with well-known authors, I also found environmental factors of such distressing intensity that, if they could be duplicated, I believe they would produce the same type of psychosis in many other individuals as that which was produced in the unfortunate victims...
...A good many practitioners have finally felt some revulsion against this so-called therapy whose use causes quick remissions and quick readmissions...
...By now we are supposed to have progressed far beyond any theory of diabolic possession...
...if the latter then no genetic theory of psychosis can be seriously entertained...
...It remains unproved, not because they have failed to explore all the available data, but because it is an unprovable hypothesis...
...266 • DISSENT • Summer 1954...
...The above would seem to be a firm link in the chain of progressive approximations of the truth...
...Goldhamer and Marshall assert that, "The various conditions inhibiting admissions to mental hospitals were at least no less in Massachusetts of 1855-59 than they are currently in the United States as a whole...
...He writes: All we can conclude, they say, is that there has been no great change in the conditions causing psychosis in this country in the past hun dred years...
...How does one interpret such facts...
...This rather specialized statistical study, which would ordinarily be discussed only in the technical journals, was reviewed, somewhat surprisingly, in Commentary (December, 1953) by Nathan Glazer, who voiced an unqualified admiration for the work...
...If, however, you believe there is no essential difference between American society and, let us say Congolese Bantu society where Ellsworth Faris reports "the relative absence of insanity," then nothing needs to be reconstituted unless it be the body chemistry and the brain tissue of disturbed individuals...
...Laurence K. Frank has suggested, however, that society is the patient...
...Psychosis and Civilization" is, within limits, an admirable job...
...Landis and Page report that for the years 1915-20 rates of schizophrenia in New York State increased steadily with size of city...
...Leopold Bellak, in his comprehensive survey of schizophrenia, points out that it is a scourge more serious than cancer since it usually strikes in early adult life whereas the degenerative diseases commonly occur at an advanced age...
...Suppose all of it were spent on new institutions: there would be a sudden leap in the reported number of psychotics...
...It happens, however, that the hypothesis of its authors—that the rate of insanity is now no greater than it was a century ago—remains unproved...
...nothing could be done for them aside from the provision of more or less brutal custodial care...
...To misappropriate the Goldhamer-Marshall book in support of a genetic theory of psychosis, even one that reinforces our self-satisfaction, is to make an unwarranted deduction based on fragmentary evidence...
...Is all this irremediable...
...In Arkansas there are only two mental hospitals and in that state the official rate of psychosis is low...
...This is acadamese, of course...
...One cannot determine with any degree of accuracy the actual incidence of psychosis, and to be guided solely by the rate of first admissions to mental hospitals, as Goldhamer and Marshall have been, is nearly as misleading as to judge our crime rate by the prison population...
...It follows that any estimate of psychosis in the population at large is guesswork...
...For example the authors say, "Our findings give us warrant for emphasizing not that mental health is just as good today as it was in the past, but rather that mental health was just as bad in the past as it is now...
...Either the statistics are faulty and farmers are just as susceptible to schizophrenia as urban dwellers, or social conditions do affect sanity...
...The appeal that a highly vulnerable piece of social research has for the politically complacent is not hard to understand...
...None of this takes place in vacuo...
...In Massachusetts there are excellent facilities for mental patients and the records indicate a correspondingly high rate of psychosis...
...But this would tell us very little about the actual distribution of mental disease, except that many—an indeterminable percentage— of its victims go without professional care...
...Goldhamer and Marshall do say something like this, but they add something else which Glazer fails to mention: Theories that view the functional psychoses as resulting from repressions of basic human drives and as the consequence of trauma developing in early intimate personal and familial relationships, may possibly be thought of as being more especially consistent with our findings...
...Since approximately one-half of all hospital beds in the nation are occupied by mental patients, and schizophrenics constitute onehalf of these, Dr...
...Lobotomy, lobectomy, lately topectomy, and other forms of emotional decapitation which do not diminish intelligence (they merely take the spark out of life) have become increasingly common...
...However, when these findings are popularized and politicized the emphasis, especially in Commentary, is reversed...
...Another conclusion, they point out, is compatible with these results: that is, that in psychosis we deal with a condition which is independent of environmental circumstances, a condition depen dent on heredity or physiological aberration, which, like some physical diseases, strikes a certain proportion of the population...
...Full records of how many individuals apply for admission to mental hospitals are lacking, but if we could add those who do apply and are turned down for reasons of space to those who are accepted, the statistical picture would look quite different...
...Their presuppositions are perhaps more popular than ever...
...Ours is a middling age...
...Bellak suggests that every fourth or fifth bed available is occupied by a patient suffering from dementia praecox...
...Then it appears that since we will always have the mad with us, there is nothing so particularly stressful about our society as to derange a large percentage of Americans...
...It is relevant to consider the rural-urban differential...
...Rosen goes to the heart of the matter in "Direct Analysis" when he observes: Early years of training in pathology prompted me to describe the deteriorated schizophrenic in...
...About twenty years ago shock treatment was discovered and quickly swept the psychiatric field where, more often than not it continues to be used promiscuously...
...Yet it points clearly enough to environmental factors and away from hereditarianism...
...Those farthest removed from psychiatric centers are not necessarily the most immune to breakdown, but they are least likely to be institutionalized...
...It is no longer widely regarded as a panacea...
...That Glazer should have felt so enthusiastic about this little book is cause for a certain curiosity...
...One uses shock to establish rapport, to pierce the patient's gibberish, to bring him within reach...
...That the last answer should still be an unpopular one puzzles me a great deal...
...A false aura of Aristotelian wisdom has been cast over the whole civilization...
...and if writers in liberal journals such as Commentary prefer to suppose that psychosis is "independent of environmental circumstances" that may well be because they are committed to the view that American society—call it capitalism, socialism, what have you— is nearly the best of possible worlds...
...Governor Dewey has asked the New York State Legislature for an appropriation of $350,000,000 to be used for mental health...
...Does anyone care to argue that there is something about Arkansas—their physique, their hormonal balance, the amount of oxygen in their brains—which decisively differentiates them from residents of Massachusetts...
...The insane used to be doomed...
...Nevertheless, we are differentially endowed, perhaps from birth, surely thereafter...
...If X is unhinged he may become a paranoid while Y exhibits symptoms of cyclothymia...
...And when he relapses, one shocks him again...
...With all that, when a centrist position is really indicated those who embrace moderation in the abstract, choose this occasion to throw it overboard...
...262 • DISSENT • Summer 1954 Glazer paraphrases the authors—up to a point...
...With manic-depression the differences are less marked, but still plainly discernible...
...What harm this may do no one knows, but therapists who have had success in the direct analysis of psychotics contend that those who have been subjected to excessive shock are by far the hardest to cure...
...Psychiatrists are reported in the press to be working on a magic pill that, when consumed in the proper quantity, will restore the demented to health and happiness...
...organic terms, although at no point along the line have I ever been persuaded that there exists in these patients an organic or even a constitutional factor that could begin to fulfill the criteria of Koch's postulates...
...Nor would we have exhausted the possibilities...
...Clearly, we need not tamper with our sick society if psychosis—and who knows how many other forms of pathology?— are, as Glazer so happily puts it, "independent of environmental circumstances...
...For there are certainly psychotics who never apply or are never committed to mental hospitals...
...What may not be so obvious is that, within such a narrow framework, even intelligent therapy for indiSummer 1954 • DISSENT • 265 vidual patients, limited as its possibilities may be, is also very nearly blocked...
...All that Goldhamer and Marshall have really shown is that public and private expenditure for mental disorder is proportionately the same at present as it was a hundred years ago—at least in Massachusetts...
...2) No, because the whole phenomenon is biological and can be dealt with mechanically, through such means as shock treatment...
...Despite this chastening experience, the psychiatric Old Guard are undismayed...
...Practically all mental hospitals are crowded, many have long waiting lists...
...Our constitutions differ drastically, but any of us may become psychotic...
...It is still the devil, which smells as medieval by any other name, that needs to be exorcised...
...They have already been chided for confusing that New England state with all of civilization...
...Something precipitates the disorder: war, bereavement, guilt, conflict—something...
...If precipitating factors can be minimized by a reconstitution of the society that breeds them, it is safe to say that personality disorganization will decline...
...No one who takes 264 • DISSENT • Summer 1954 lysergic acid diethylanide at Boston Psychopathic Hospital fails to experience insanity...
...Short of Nazi-style eugenics, there are three possible answers: 1) Yes, because some people are just born that way...
...About fifty per cent of the total resident population of mental hospitals are schizophrenic...
...But social currents have a way of changing, and scientific evidence has a way of accumulating...
...Nevertheless, it often seems as if nothing except terminology has actually changed...
...The rates varied from 11.7 per 100,000 inhabitants in cities between 20,000 and 50,000 to 21 in New York City...
...Furthermore, practitioners like Johr Nathaniel Rosen, Frieda Fromm-Reichmann, and Harry Stack Sullivan have had success in treating schizophrenics without benefit of shock or tips from the pharmacopeia...
...3) No, because the problem is biosocial and where machines have failed other methods are beginning to work...
...But putting such objections to one side for a moment, and assuming that Goldhamer and Marshall do show that the frequency of psychosis is constant, it is worth our while to see how variously such a dubious conclusion can be interpreted...
Vol. 1 • July 1954 • No. 3
