Jeffrey Scot Minch

A Great History but I Have One Big Reservation

Revisado: 08-02-22

This book is enlightening and, for the most part, engaging. The author, a sociologist who specializes in the history of medicine and psychiatry, really seems to know his stuff. I have one quibble however, and it's a pretty big one. When he recounts the history of deinstitutionalization in the 1980s the author paints it as a purely social and political move. States emptied mental hospitals to save money, or because of the stigma the hospitals had acquired. While that may have been true of the first wave of deinstitutionalization beginning in the 1950s, by the 1970s mental illness advocacy groups had won a number of court victories in America that gave the mentally ill new legal rights including right to refuse their medication and to not be involuntarily committed unless they were found to be a danger to themselves or others. Whether one agrees or disagrees with them these and a few other court decisions forced the deinstitutionalization of the 1980s onto the states. How states treated their severely mentally ill was now almost entirely out of their hands.

Also, toward the end of the book, Dr. Scull gives a rough outline of how he feels America should deal with our mentally ill citizens. And, while I agree with just about everything he says here, much of what he prescribes would be impossible given the court cases that I mentioned above. Does he not realize this?

The fact that Dr. Scull doesn't include these court cases in this history, but chooses instead to paint the deinstitutionalization of the 1980s as simply the product of hard-hearted policies created by an uncaring society gives me pause. Does this historian of psychiatry not know about the rulings of the 1970s that radically transformed how America has cared for its severely mentally ill for the past half-century? That seems like an awfully large gap in his education. Or did the author intentionally leave them out because it didn't fit a narrative he was creating? I don't know. Either way, the fact that he misrepresented this era that I happen to know something about makes me wonder if he did the something similar with eras about which I know less.

So, overall, four stars. Would have been five except for the above issue.

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