1. Grob tells us: “Whatever its contradictory and tangled origins, deinstitutionalization had positive consequences for a large part of the nation’s severely and persistently mentally ill population.” (292) Is America still doing a good job with deinstitutionalization? Why are there an estimated 78,000 people living on the streets of NYC? (Statista.com – April 2021) This article addresses the relationship between homelessness and mental illness:
2. The 20th century developments reading mentions Alcoholics Anonymous as the “quintessential” self-help group. (373) Statistics show AA has a fairly high success rate.* Why do you think this program works?
3. Summers chapter nine does a terrific job of explaining the awful racism regarding the African American psyche and how this affected the treatment of those who were mentally ill. One key factor was social class and Summers illustrates this when he mentions the absence of mental health clinics in Black neighborhoods. (273) How much has really changed? Do the inner-city poor get access to the same mental health care available to Fredericksburg’s gentry?
Submitted by Bonnie Akkerman I pledge…
1.If the DSM had its origins in the military at what point did the insurances companies get involved in its establishment?
2. It is talked about that St. Elizabeths suffered from a lack of funding during the Vietnam war era leading to a shift to non-profits and private organizations to provide community mental health care. Do you think in the modern day that this is still the case or has it returned to the government based care system as seen before?
1. The DSM-III introduced the diagnosis of post-traumatic stress disorder (PTSD). Why do you think this was such a crucial moment in the history of mental health? Why is the DSM-III itself so important?
2. What is Feminist Therapy and how does it apply to existing social and gender norms? Would you say feminist thought has had an critical impact in the field?
– Lyndsey Clark
1. In Summers it is stated that there was a belief that Americans developed mental illness due to not being able to adapt to their environment. Why do you think this was linked exclusively to America’s wartime experiences?
2. In what ways do you think the location of Saint Elizabeth’s in the nation’s capital effects the way it is not only perceived but how it changed over time? Would Saint Elizabeth’s have developed differently if they did not have to live up to the ideals and images the country wished to portray of the nation’s capital?
Submitted by Jack Kurz
1. Why is the trend for mental hospitals to get worse rather than better? Institutionalization itself could be a beneficial and safe alternative for mentally ill patients and yet it almost never is.
2. Does the military focus on psychiatry from a warfare lens in that there is more research being done for how to harm the enemy then to help their own soldiers? This is certainly true for before the Vietnam War but how has this perspective changed?
- Janis Shurtleff
1. In From Madness to Mental Health we read about PTSD as it was conceived according to the DSM-III, which came out in 1980 (402). DSM-III’s description of the disorder begins “The essential feature is the development of characteristic symptoms following a psychologically traumatic event that is generally outside the range of usual human experience.” The phrase “that is generally outside the range of usual human experience” is deleted in the DSM-IV TR (2000). I’m wondering if omission of this phrase is due to soldiers and first responders developing PTSD when simply doing their jobs. What do you think?
2. Also from the edited volume From Madness to Mental Health is the piece “Psychiatrists Debate Osheroff vs Chesnut Lodge, which involves a debate between the psychiatrists Gerald Klerman and Alan Stone (405-20). Klerman, who testified for Osheroff, a doctor who sued Chesnut Lodge for inadequate treatment for his depression, supports treating mental disorders using drugs like any other disease. In Klerman’s view, the best way to advance psychiatric knowledge is by using clinical trials in establishing the efficacy of drug treatments. Klerman dismisses psychotherapy saying that it does not have a similar process to evaluate the effectiveness of its treatments. Alan Stone, who is a psychotherapist and lawyer answers back saying that drug treatments are riddled with problems and that if biological psychiatrists like Klerman want the courts to be brought into mental health cases, they better be prepared for a lot of malpractice suits. I find Stone’s rebuttal unconvincing. It seems to me that despite the fact that treating mental illness with medicine is not without its problems, for some people, it is the only answer. Discuss.
Submitted by Chris O'Neill
Question 1. Did the actions taken by the Reagan administration, even if they were ultimately reversed, towards mental health drastically impact mental health today? Or did they ultimately have little impact?
Question 2. Were there ever any issues with family members of white patients regarding integration in institutions, similar to certain reactions towards integration at schools?
submitted by Griffin Nameroff
1. Why did mental health reform take so long? Was it past prejudices about race and gender that prevented legislation from being passed? Was it intergovernmental relations? When reform happened, why did it not involve communities and hospitals? (Grob, 259)
2. Grob mentions that “disagreement over national mental health policy was but one development that had major repercussions on the mentally ill…” (Grob, 287) Summers also wrote about how the structural problems of Saint Elizabeths impacted patient experience. (Summers, 294) Do we think that mental health reform would have been more successful at a state level? Or would it only work on a national level? Has this approach changed today?
I pledge… - Submitted by Carson Berrier
As the 20th Century Developments reading explains, support groups like AA became prime examples of successful treatment options. Do you think its “community-based” style connects to the overall good, say, deinstitutionalization had on affected people during this time? Do you think AA's need for members to hold themselves accountable played/plays a role?
How would you lay out––or say Summers laid out––the major changes between the early to late 20th Century? Was there any “going backward,” per se? Were most of the issues during this time budget-based, or based on bad science?
Submitted by Theron Gertz. I pledge…