Mad in America
| Company type | Book |
|---|---|
| Industry | Publishing |
| Founded | 2002 |
| Founder | Robert Whitaker |
Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill is a 2002 publication authored by medical journalist Robert Whitaker. The book critically evaluates the effectiveness, safety, and ethical considerations surrounding psychiatric interventions for severe mental illnesses, with a particular focus on antipsychotics. It traces a chronological history of treatment practices within the United States.
The work garnered favorable reactions from the general public, while responses from the medical field were more varied—some critiques pointed to potential source bias, yet many acknowledged the significant questions it raises about contemporary psychiatric care.
Part One: The Original Bedlam (1750–1900)
This section explores early therapeutic methods including a rapidly rotating chair reaching speeds of 100 revolutions per minute, the immobilizing Tranquilizer Chair, and various water-based treatments.[1] It also describes the advent of moral treatment, which originated during the French Revolution and was later embraced in America by Quakers in 1817. This humane approach emphasized compassionate care within small residential settings and yielded encouraging results: between 35 and 80 percent of patients were discharged within one year, most considered cured. At Pennsylvania Hospital, approximately 45 percent of patients were released as cured, with an additional 25 percent showing improvement; meanwhile, at Worcester State Hospital, roughly 35 percent either remained chronically ill or died while mentally unwell.[1] In 1851, Dr. George Wood observed that patients often appeared indistinguishable from visitors or staff members:
Part Two: The Darkest Era (1900–1950)
This segment addresses the rise of eugenics, which supplanted moral treatment by enforcing forced sterilization on individuals with mental illness and stimulated advances in psychiatry and neuroscience. During this period, practitioners employed severe interventions such as insulin-induced comas (Hypoglycemia), convulsions triggered by metrazol, compulsory electroshock, and lobotomy procedures.
Part Three: Back to Bedlam (1950–1990s)
The final part covers the introduction of phenothiazines and the development of neuroleptic medications like chlorpromazine (marketed as Thorazine), originally created by Rhône-Poulenc and later acquired by Smith, Kline & French (now known as GlaxoSmithKline). Initial accounts likened Thorazine's effects to those achieved through frontal lobotomy. Pharmaceutical marketing campaigns and media outlets portrayed Thorazine as a curative agent.
Following the 1951 Durham-Humphrey Amendment, which expanded categories of prescription-only drugs, pharmaceutical companies began directing promotional funds to the American Medical Association. Whitaker emphasizes America's propensity to label patients as "schizophrenic," highlighting inaccuracies in Emil Kraepelin's foundational classification system that psychiatry has largely failed to amend.
He discusses three dopamine pathways within the brain and incorporates direct testimonies regarding antipsychotic drug experiences. Whitaker condemns a 1996 New York Times advertisement sponsored by pharmaceutical companies that claimed psychosis results from abnormal dopamine activity and promoted their medications—a statement he deems a "bald-faced lie." He critiques American clinical studies and contrasts U.S. prescribing habits—sometimes reaching doses as high as 5,000 mg/day of Thorazine—with more moderate British dosing standards around 300 mg/day.
Whitaker points out the paradox wherein The New York Times criticized forced neuroleptic use in the Soviet Union while simultaneously endorsing their application in American patients. He recounts the erosion of moral treatment through Loren Mosher's Soteria Project, supported by NIMH funding, and references a 1979 World Health Organization investigation revealing superior schizophrenia outcomes in developing nations compared to developed countries—attributed to reduced reliance on pharmaceutical interventions.
Lastly, he scrutinizes five decades of American research that intentionally exacerbated schizophrenia symptoms for experimental purposes, contrasting this practice with ethical principles established after World War II through the Nuremberg Code.
Part Four: Contemporary Perspectives on Mad Medicine (1990s–Present)
This section explores clinical trials involving newer atypical antipsychotic medications, emphasizing how many studies favored these drugs by either omitting placebo groups or comparing various doses of the new drugs against a single high dose of older treatments. Whitaker criticizes both pharmaceutical companies and media outlets for endorsing claims—sometimes contrary to Food and Drug Administration recommendations—that medications such as Risperidone and olanzapine exhibit fewer adverse effects than first-generation antipsychotics. He also brings to light instances where patient fatalities during trials were not publicly disclosed.
Epilogue
Whitaker denounces the widely accepted theory that schizophrenia is caused by excess dopamine or serotonin as a form of medical deception, emphasizing that such misleading assertions would be unacceptable in fields like oncology or cardiology. He states, "The causes of schizophrenia remain largely unknown. Antipsychotic medications do not correct any identified brain abnormalities nor restore chemical balance in the brain. Instead, they modify brain function in ways that reduce certain hallmark symptoms..." Furthermore, he argues these medications affect core personality traits and behaviors, including the capacity for self-care—a topic he examines more thoroughly in Anatomy of an Epidemic.
Reception
A reviewer from the Chicago Tribune recognized Whitaker’s comprehensive documentation but felt his aspirations for humane treatment, though commendable, fell short. Critiques in The Baltimore Sun and In These Times lauded the work but questioned the absence of any reference to psychiatry critic Thomas Szasz.
Academic Journal Reviews
Clinical psychologist Claudia Bukszpan Rutherford acknowledged that although Whitaker adopts a radical viewpoint, the book provides important perspectives on persistent challenges within clinical psychiatry: "While his lack of editorial moderation can be distracting, his subject matter is crucial and stimulates necessary dialogue."
In JAMA, Daniel J. Luchins, MD, observed some partiality in the review of scientific literature but appreciated the emphasis placed on social dimensions of psychiatric care.
Physician J. van Gijn, writing for the New England Journal of Medicine, characterized the book more as a critique than a historical account, noting Whitaker primarily associates mental illness with schizophrenia. Van Gijn challenged Whitaker’s assertions regarding encephalitis lethargica and antipsychotic dosing, describing his condemnations as inadequately supported and his rejection of the dopamine hypothesis as overly simplistic. He concluded that although American psychiatric institutions have shortcomings, they warrant more nuanced evaluation.
Psychologist Clare Mundell, PhD, contributing to the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, recommended Mad in America as essential reading for mental health practitioners and those concerned about commercial interests overshadowing patient welfare in medicine.
Online Reviews
David Pilgrim, contributing to Times Higher Education, criticizes the book for containing "semi-academic froth" that detracts from a genuine outrage experienced by many prior to 1998, the year Whitaker began his writings on mental health.
In an article for WebMD's Medscape Today, physician Larry S. Goldman contends that Whitaker "throws the baby out with the bath water" by rejecting any biological abnormalities in schizophrenia, although he acknowledges that the definitive causes of schizophrenia remain elusive. Goldman points out that the book’s "overheated style" weakens important arguments concerning the problematic connections between the US pharmaceutical sector and psychiatric research, as well as the chronic underfunding of public mental health services.
Physician Nathaniel S. Lehrman, responding to these critiques, endorses Whitaker’s central assertions: that antipsychotic medications cause brain damage and do not restore brain chemistry but only modify brain activity to alleviate symptoms. Lehrman stresses that despite extensive neurobiological research, patient treatment has not seen meaningful improvement.
Later, Lehrman referred to Mad in America as "perhaps the most important psychiatric book of the 21st century" in the conservative publication Journal of American Physicians and Surgeons.
Christian Perring, editor of Metapsychology Online Review, commended the book’s well-reasoned critique of schizophrenia drugs, despite Whitaker’s sharply critical stance toward psychiatry.
On the other hand, E. Fuller Torrey from the Treatment Advocacy Center described it as "histrionic" and "deeply disappointing."
Physician Marcia Angell, MD, in a two-part analysis for The New York Review of Books, acknowledged this and related works as compelling indictments of contemporary psychiatry, underscoring issues such as overdiagnosis, excessive reliance on medications with serious side effects, and widespread conflicts of interest.
See also
- Liberation by Oppression (2002) by Thomas Szasz
- Big Pharma (2006) by Jacky Law
- Anatomy of an Epidemic (2010) by Robert Whitaker
- Mad Pride
External links
- Robert Whitaker's "Mad in America" a history of madness (25:40), Cambridge Community Television
- Mad in America, website inspired by the book