When the Diagnosis Was Social

Review of Michael E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948-1980 (Chicago: University of Chicago Press, 2011), ISBN 978-0-226-77147-2, 252 pages, Hardbound, $40.00.

As a convicted war-resister, in 1962 I arrived at the Medical Center for Federal Prisoners (MCFP) near Springfield, Missouri and was soon interviewed by a psychiatrist. I watched him write in his notes, “He is a martyr.” My mental state then received no further attention during my two years incarcerated there, but the mental state of many other inmates did. Several young staff psychiatrists at Springfield were interested in behavior modification and tested some of their ideas. One young inmate was jittery about his impending release and became reluctant to eat. He was placed in isolation, where he would eat only food handed to him by Morton Sobell, whose job as an inmate was medical technologist. The young psychiatrists then had Sobell excluded from the ward and predicted that the young inmate would eat when he got hungry enough. Instead, he died of starvation.

Those Springfield MCFP psychiatrists planned the behavior modification program at the new Marion Federal Prison, which opened in 1963, so I’m not surprised to learn from Michael Staub’s new book that by 1974, prisoners at Marion who openly objected to “inhumanities in the prison system” were being chained down in beds until they volunteered for behavior modification experiments (p. 127).

This Springfield memory came back to me before I actually reached page 127 in Michael Staub’s book. It came to mind at pages 124-125 where Staub describes a U.S. military psychiatrist in South Vietnam who liked B.F. Skinner’s “operant conditioning” and used prolonged food deprivation to convince Vietnamese patients at Bien Hoa mental hospital to grow vegetables for nearby Green Berets.

I didn’t know that, but so much else in Staub’s Madness Is Civilization intersects with my own life or reading in the 1960s and ‘70s that it’s often a stroll down memory lane. My own experiences

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and readings were hit-or-miss, however, whereas Staub’s account of the heyday of antipsychiatry is continuous. He identifies the main wellspring of antipsychiatry as rightwing conspiracy theories that likened psychiatric treatment in the U.S. to brainwashing in North Korea and China—especially to brainwashing as practiced in North Korean POW camps on American GI’s. So pervasive was apprehension in the 1950s about mental conquest that, as the ideological climate started shifting around 1960, the psychiatrist Thomas Szasz and others had little trouble convincing both rightists and leftists that something was often fishy about involuntary institutionalization for mental illness. Suspicion against insanity as a legal category had already been sown in 1958 by the thinly fictionalized bestseller Anatomy of a Murder (screened as a movie in 1959). So in 1961 when Thomas Szasz published The Myth of Mental Illness, he found a receptive audience, as did Erving Goffman’s exposé entitled simply Asylums, also published in 1961.

During the leftward-drifting 1960s, as Staub recounts, the Therapeutic State came to seem almost sinister, especially after social critics like the anthropologist Jules Henry, author of Culture against Man (1963), began saying that young people were dispirited and rebellious because “sham” (pretense) pervaded U.S. society from the micro level to the macro, from the family to the nation state. Meanwhile, the Scottish psychiatrist R.D. Laing and some colleagues had begun their micro diagnoses of dysfunctional families, their publications starting in 1960 with Laing’s The Divided Self, followed in 1964 by Sanity, Madness, and the Family. Soon Laing began defending the “psychotic episode” as a natural corrective entailing painful but desirable personal growth—unless one’s episode was derailed by prescription drugs. Anti-war and social-change advocates were increasingly receptive to such ideas and made Laing’s The Politics of Experience (1967) an alternative classic.

Meanwhile, popular psychology like Eric Berne’s Games People Play (1964) and his strategy of Transactional Analysis were tamer but often were equally “social” (non-medical) in their approach.

Staub gives excellent thumbnail sketches of these works and more, including their roles in shaping a radical viewpoint that by 1970 was sweeping the psychological professions—namely, that American society, if not necessarily mentally ill (whatever that even meant any more), was at least oppressive and in denial of many of its actions,

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fantasies, and impacts on others. This became axiomatic for the new feminism, which Staub describes in a chapter he titles “Person Envy,” because the new feminists tended to dismiss Freud in favor of the human potential movement with its celebration of personal and public self-actualization.

Without surveying everything in this book, I must at least backtrack to mention several pioneer theorists whom Staub acknowledges, such as Harold D. Lasswell and his 1948 study Power and Personality; as well as Theodor Adorno, et al., authors of The Authoritarian Personality (1950); and the 1954 formulation of the double-bind theory of schizophrenia explained by Gregory Bateson and several collaborators. Staub also broaches Erich Fromm’s thesis in Escape from Freedom (1941), but otherwise he doesn’t try to include the prewar theories of psychology vis-à-vis authority.

At the other end of the era, Staub doesn’t simply stop when the tide of antipsychiatry began to ebb. He chronicles psychiatry’s subsequent conservative backlash, which has reasserted that schizophrenia and other mental phenomena are indeed medical conditions—and are not caused by society or even significantly caused by family environments. This conservative backlash pervades the Diagnostic and Statistical Manual of Mental Disorders (DSM), beginning with its 3^rd edition (1985). Much research since the late 1960s has tried to find a genetic cause for schizophrenia, and Staub reports recent genetic research that suggests a genetic potential for schizophrenia exists in a major proportion of the U.S. population and, in fact, worldwide. Meanwhile, statistical researchers are busy, too, and are finding the incidence of schizophrenic diagnoses to be fairly comparable across all cultures, but also are finding the average duration of schizophrenia to be much shorter among members of less-developed societies than in developed societies like the U.S. (Staub, pp. 189-190). This in turn is reviving psychiatric interest in social environments. Some of the newest studies suggest that both genetic and social factors are involved in causing schizophrenia and other mental conditions. To quote: “In other words, a person may carry a particular gene, but if that gene is ‘silenced,’ the body may not make any protein from the gene and, in turn, may not present the related trait” (p. 190). “Persistent and uncontrollable stressful experiences interact with individual genetic susceptibility to alter synthesis, expression, and signaling in stress-related pathways…For example, genetic variation in the serotonin transporter gene interacts with early life stress, resulting in hyperresponsivity to

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stressors that increase vulnerability to psychiatric disorders such as major depression” (pp. 190-191).

This certainly sounds promising, and not just for therapies but for psychobiographical insights. Nonetheless, major social damage has resulted from “mental illness” becoming part of our country’s ideological struggles. A potentially benign release of 100,000s of mental patients into their pre-commitment communities was turned into a nightmare for many eleases when the Reagan administration suddenly cancelled mental patients’ disability benefits, thereby defunding out-patient treatment and other crucial support upon which deinstitutionalization had been predicated.

The subsequent rightwing synthesis came to be that 1960s radicals like Thomas Szasz, Erving Goffman, and R.L. Laing had brought about de-institutionalization, which then led to the homeless crisis of the 1980s. Distortions like that can make one hesitant to try anything—unless one remembers how many people still need help, and how urgently they need it.

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