Madness Is Civilization: When the Diagnosis Was Social, 1948-1980

Madness Is Civilization: When the Diagnosis Was Social, 1948-1980

by Michael E. Staub

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In the 1960s and 1970s, a popular diagnosis for America’s problems was that society was becoming a madhouse. In this intellectual and cultural history, Michael E. Staub examines a time when many believed insanity was a sane reaction to obscene social conditions, psychiatrists were agents of repression, asylums were gulags for society’s undesirables, and

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In the 1960s and 1970s, a popular diagnosis for America’s problems was that society was becoming a madhouse. In this intellectual and cultural history, Michael E. Staub examines a time when many believed insanity was a sane reaction to obscene social conditions, psychiatrists were agents of repression, asylums were gulags for society’s undesirables, and mental illness was a concept with no medical basis.

Madness Is Civilization explores the general consensus that societal ills—from dysfunctional marriage and family dynamics to the Vietnam War, racism, and sexism—were at the root of mental illness. Staub chronicles the surge in influence of socially attuned psychodynamic theories along with the rise of radical therapy and psychiatric survivors movements. He shows how the theories of antipsychiatry held unprecedented sway over an enormous range of medical, social, and political debates until a bruising backlash against these theories—part of the reaction to the perceived excesses and self-absorptions of the 1960s—effectively distorted them into caricatures. Throughout, Staub reveals that at stake in these debates of psychiatry and politics was nothing less than how to think about the institution of the family, the nature of the self, and the prospects for, and limits of, social change.

 The first study to describe how social diagnostic thinking emerged, Madness Is Civilization casts new light on the politics of the postwar era.

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Editorial Reviews

Kim Hopper

“Fiercely argued and wide ranging, Madness Is Civilization revisits that much-reviled and much-celebrated period in US history, the sixties. But this view is through the looking glass of a cultural argument about psychosis as both indictment of and liberation from a repressive society. Sharply observed, reliably provocative, and tension-riddled to the last line, Staub’s reclamation of the unfinished legacy of a decade is sure to be widely read and debated.”

Mari Jo Buhle

Madness Is Civilization is a fresh and analytically stunning account of the critiques of psychiatry that prevailed in the decades after World War II. Staub explores the cultural and political meanings of the idea that insanity was a reasonable response to a society gone mad. Boldly, he revives the works of such luminaries as Theodor Adorno, Thomas Szasz, and R. D. Laing, and recounts the activism of such fascinating antipsychiatry movements as radical therapy and patients’ rights. In creating this exceptionally readable account, Staub utilizes a variety of sources ranging from medical to popular. Madness Is Civilization is a must read.”

David Herzberg

“Draws unexpected and fascinating connections between a host of important postwar thinkers, many of whom are often thought to have been at odds with each other but whom Staub persuasively depicts as having created and inhabited the same cultural moment. With creative new arguments about antipsychiatry and its connections to intellectual radicalism on both the left and the right, this is a valuable contribution to American intellectual history.”

Regina Morantz-Sanchez

“This lively examination of American therapeutic culture from the late 1940’s to 1980 examines how key events—fascism, the Cold War, the New Left, Civil Rights, feminism, Vietnam—shaped American psychiatry. The commitment to understanding an individual’s familial, social, and political contexts becomes in Staub’s hands a story of professional twists, turns, and unintended consequences. Humanistic therapies often failed to produce progressive outcomes, ushering in an age of biochemical solutions in psychiatric treatment. Wonderfully accessible and full of cultural irony, Madness Is Civilization is essential reading for scholars interested in the relationship between American culture and politics.”

Journal of American History

 “The author does a praiseworthy job of detailing the antipsychiatry battles of the 1960s and 1970s.”
The Sixties: A Journal of History, Politics and Culture - Sander L. Gilman

 “[A] new, readable, and extremely important book on post-WWII psychiatry and American culture. . . . Staub tells this American tale brilliantly.”
Contemporary Sociology

 “An interesting and accessible read, Madness Is Civilization sheds new light on the subject of mental health in the United States, while cohesively drawing together disparate intellectual elements under the rise (and fall) of the anti-psychiatry movement. . . . As such, any scholar with an interest in the changing dynamics of American culture and politics should include this book on their reading lists, as it provides both a unique and insightful analysis of the emergence of social diagnostic thinking and its importance in social change.”
History of Psychiatry

 “Critics of psychiatry had been around for over a century but nothing compared with the torrent of attacks on the field launched by individuals such as Michel Foucault, Erving Goffman, RD Laing, Ken Kesey and Thomas Szasz. Staub is to be commended for reconstructing this volatile, influential and largely neglected era in the history of psychiatry, as well as his coverage of research into the family origins of severe mental diseases during the 1950s.”
Social History of Medicine - Allan V. Horwitz

 “Madness Is Civilization makes a valuable contribution to the American intellectual history of the 1950s, 1960s and 1970s. For older readers, Staub provides a well-researched and insightful recreation of the debates that dominated a bygone period. For younger ones, he is a thoughtful guide to the general intellectual energy that the study of sanity and madness once provided. For both cohorts, he shows how much has been lost because of the absence of a genuinely social view of mental illness in current discourse about normality and abnormality. . . . Staub’s highly readable synthesis of a wide range of material is the single best source for a thoughtful discussion of the ‘anti-psychiatry’ movement that at the same time is so chronologically close yet so intellectually distant from our current era.”
American Journal of Psychiatry

 “In Madness Is Civilization, Michael E. Staub provides a clear perspective of the scrutiny of psychiatric disorders in the mid-20th century by broadly reviewing the clinical, political, sociological, and community work of the protesting intellectuals who propelled the antipsychiatry and countercultural movements from 1948 to 1980. . . . Psychiatrists and anyone else struggling to understand how large segments of society can angrily discount one branch of medicine should read this book to better understand the history of antipsychiatry groups and the current manifestations of the antipsychiatry movement.”

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University of Chicago Press
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Madness Is Civilization

When the Diagnosis Was Social, 1948–1980
By Michael E. Staub

The University of Chicago Press

Copyright © 2011 The University of Chicago
All right reserved.

ISBN: 978-0-226-77147-2

Chapter One

Society as the Patient

There is a growing realization among thoughtful persons that our culture is sick, mentally disordered, and in need of treatment. Lawrence K. Frank, 1948


The postwar era in the United States witnessed an extraordinary spike in attention given to the status of Americans' mental well-being. Debating what it meant to be mentally well and mentally ill became a national pastime as all things psychological became the focus for unprecedented fascination. This fascination took a myriad of popular forms. Magazines ran self-administered "diagnostic tests" to "determine how normal you really are." Articles advised anxious parents on how they might most effectively engage in "building" the "best possible mental foundation for mental health" of their children. There were nationally broadcast television programs on the subject of mental health, and there was the introduction of a Mental Health Week to publicize the message (and the dilemmas) of mental illness. The Basic Writings of Sigmund Freud appeared in a new edition in 1947 and, notwithstanding its unwieldy length of a thousand pages, sold over a quarter of a million copies. And syndicated columns with titles like "The Worry Clinic" or "Let's Explore Your Mind" drew readerships in the tens of millions. At the same time, and all through, there was a recurrent effort to theorize the deeper psychic illnesses that were said to course through American culture—efforts (as the title of a book published in 1948 put it) that conceived of "society as the patient."

This chapter explores how the postwar explosion of interest in all things psychological can be understood as rooted in lessons taken from World War II. In particular, the concern over traumatic experiences of soldiers in combat along with the attempts better to understand the "personality structure" of the Nazi opponents was to have tremendous consequences for the practice of psychiatry and for a social psychological analysis of U. S. domestic politics. During the war military psychiatrists witnessed the degree to which the onset of mental disorder represented a reaction to environmental stress; after 1945 these psychiatrists broadly applied their wartime observations of the impact that a conflict-ridden environment had on psyches to an exegesis of how the daily lives of average Americans probably also contained submerged pathogenic qualities. Moreover, psychiatric diagnoses of American society began increasingly in the postwar era to articulate moral and political values; for instance, "undemocratic" attitudes (such as antiblack racism or anti-Semitism) came widely to be interpreted by social psychologists and psychoanalysts as quite likely reflective of individual psychopathology or reactions to environmental influences—and the challenge was properly to identify this dynamic. If psychiatry was to be understood as a branch of medical science, it was additionally believed by many of its leading postwar practitioners to be a science with a social mission.

There was also increasing attention among researchers in the social sciences to the relationship between early experiences within the family and the later capacities of average Americans to develop properly beneficent and appropriately democratic personalities. "If men be good, government cannot be bad," William Penn had observed in 1693. This maxim rather remarkably came to be understood as so apt an expression of "the interlocking bonds of affection that give strength to social structure," as Harold D. Lasswell, a leading figure in the field of political psychology, wrote in 1948, that investigations into the possible connections between psychology and politics absorbed scholars across many disciplines. Americans, or so one line of argument went, had too often been inadequately nurtured as children, and thus grew to adulthood insufficiently affectionate and unable to maintain genuine and intimate personal relations. The grim news from psychiatrists and social psychologists by the early 1950s was that many Americans ran a high risk of developing mental illnesses because they had been raised in families that had not provided them enough warmth; and an interwoven argument was that many of these same persons were also at risk of being lured by right-wing ideologies. Indeed, as one theory had it—and as the authors of the massive social psychological tome on the origins of prejudice, The Authoritarian Personality, argued forcefully in 1950—the aggressions a person directed toward members of ethnic or racial minorities could be interpreted as the result of a frustrated search for affirmation. Drawing on wartime analyses of Nazi Germany, as well as on studies of race relations and the strong appeal of right-wing politics also in the United States, the authors dramatically concluded that a "failure in superego integration, inability to establish emotional relationships with others, and overcompensatory reactions to weakness and passivity are among the important sources of potentially fascist trends within the personality." While many scholars would soon reject the specific theses put forward in The Authoritarian Personality, the questions the book had raised about the psychic fragility of American democracy and the mechanisms of interaction between individual psychological development, familial dynamics, wider social environment, and ideological convictions would preoccupy the social sciences for many years to come. Most importantly, as with postwar psychiatrists' efforts to address not only psychosis but also a broader range of disturbances and maladjustments in daily American life, so also with the investigation into the connections between psychology and politics: the effect was to foreground just how indeterminate was the line between illness and health. This indeterminacy, far from inhibiting the growth of psychiatry's influence and prestige, instead facilitated it.

The dominant assumption in postwar American psychiatry was that society played a grievous role in the etiology—or "triggering off"—of mental disorders. This in itself was not a postwar innovation. As long ago as the late nineteenth century, French sociologist Émile Durkheim had analyzed statistical records and other data to explore how societal stresses (like the loss of social position) resulted in an elevated incidence of suicide; epidemiological research throughout the first half of the twentieth century continued to provide compelling evidence that environmental factors posed a risk in the etiology of mental illness. Social participation and social detachment were seen as especially important in this regard, with isolated individuals shown to be "much more likely to commit suicide than are persons who are closely integrated in group life." For related reasons persons who lived in the heightened anonymity of cities were found to run a higher risk of mental illness than persons who lived in rural areas. Nor were city dwellers all equally liable to go insane. In Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses (1939), medical sociologists Robert E. L. Faris and H. Warren Dunham had determined that the incidence of psychosis in Chicago was unevenly distributed across the strata of socioeconomic classes; the slum dweller ran a far greater chance of developing schizophrenia than persons who lived elsewhere in the city. Faris and Dunham could not settle the puzzle of whether individuals predisposed to mental illness were the most likely to "drift" to the poorer neighborhoods in urban centers or whether the slums produced psychosis. But their work nonetheless prompted research into causal links between the "social disorganization" of urban existence and heightened rates of mental illness; postwar epidemiological studies further confirmed at least partial aspects of what came to be called the "urban hypothesis" of mental disorders.

At the same moment a corollary hypothesis began to gain traction. It postulated that psychosis did not exist in "traditional" societies due to those cultures' social cohesiveness. Various anthropological researchers found that members of "primitive" cultures simply did not evince psychotic symptoms. If schizophrenia resulted from an inability to integrate oneself socially, scholars speculated that individuals in close-knit cultures were going to be far less susceptible to the emotional disorders of civilization; indeed, anthropologists also found that psychosis became a problem in traditional cultures only after members of those groups began to have extensive contact with Western peoples. As the writer of an article from 1942 in the American Journal of Psychiatry observed, there was no "schizophrenia among primitives" because mental illness represented "the peculiar curse of civilized man." Or as a medical sociologist summarized this view again with more measured phrasing a decade later in 1952: "It appears that schizophrenia is less frequent in cultures which are homogenous and have intimate contacts than in cultures which are heterogeneous and have impersonal and hostile contacts." Thus it was argued that the very fact of living in modern society effectively produced psychosis, though in truth much available evidence contradicted this conclusion. For instance, a historical review of mental hospital admission rates conducted in the late 1940s disclosed no increase in rates of mental illness since the nineteenth century despite industrialization and urbanization. Other researchers in the late 1940s concluded that schizophrenia was most likely ubiquitous in all human cultures. Nonetheless, the position that civilization promoted mental difficulties came to dominate postwar discussions. As one of the nation's foremost psychiatrists, Francis J. Braceland, declared in 1947, "it would not be surprising to see the incidence rates of psychoneurosis take an upward turn" in the years and decades ahead. In this fashion Braceland worked to position strategic arguments as though they were self-evident facts, noting how "civilization in its advance brings with it the seeds of neurosis."

The rising cross-disciplinary fascination with diagnoses of society's illnesses was not the only reason for the post–World War II decline in a biological disease model of mental illness that had been initially advanced in the early twentieth century by prominent German psychiatrist Emil Kraepelin. The biological model was also running into trouble because it had been unable to solve the problem of etiology. Indicative of the new hostility to biologism were the pronouncements of popular journalist Albert Deutsch, who wrote in his influential account, The Mentally Ill in America (1949), how Kraepelin had fallen "far short of his aim to create order out of the existing chaos in psychiatry" specifically due to the limitations of his neurobiological approach. According to Deutsch, while Kraepelin had "provided a valuable key to the understanding of the what and the how in mental disorder," the "greatest question—the why—still remained wrapped in deep mystery." This was, Deutsch asserted, because the disease model had resulted in "static conceptions of mental disorders," a problem only the investigation of social factors could begin finally to solve.

While some experts in American psychiatry remained committed to a Kraepelinean approach, increasing numbers of leading psychiatrists argued that a biological disease conception of mental illness was both unsatisfactory and inadequate. In 1948 psychiatrist Robert H. Felix—who would become the first director of the National Institute of Mental Health (NIMH) in 1949—summarized the postwar consensus of mainstream psychiatry when he proposed how "the impact of the social environment on the life history, and the relevance of the life history to mental illness are no longer in serious question as clinical and research findings." Also in 1948 Karl A. Menninger, one of the nation's most renowned psychiatrists, expressed comparable views, writing that there was "no proof" that "a special tendency to schizophrenia" was "transmitted by heredity." However, Menninger went on to remark that there existed "much proof" that "those individuals who later become schizophrenic" had suffered emotional "injuries" early in life. As Menninger outlined:

It may be the death of a mother, or neglect or harshness by the mother, incessant quarreling between the parents, hopeless rivalry with a much more popular or much more beautiful sister. Perhaps any, perhaps all of these things can do it. Some of them may occur even in the most gentle and kindly and affectionate of families.... The girl who is jilted by a lover at 21 and then develops schizophrenia may well have had a much more serious disappointment 18 years before that, and perhaps many others, but the final disappointment acts like the straw that broke the camel's back.

Likewise, psychologist Bruno Bettelheim, then director of the Sonia Shankman Orthogenic School in Chicago, a leading residential institution for the treatment of emotionally disturbed youth, underscored the social, not biological, sources of mental disturbance. Arguing that "certain factors originating in society interfere with our work and create specific emotional difficulties," Bettelheim further demanded that children at his school be kept as far removed from parents as possible because parents, in their confused desire to meet (often conflicting) social expectations, incoherently mixed intermittent indulgence with imposition of strict values and thus "may actually impede mental health" of children. As Bettelheim intoned: "The very fact that we had to try to create a total therapeutic environment is itself some reflection of recent changes in thinking on mental health within our society."

It was a widely promoted position, moreover, that psychiatry could play an essential role in healing the psychic wounds of postwar America. As William C. Menninger, brother of Karl and the first psychiatrist ever to serve as brigadier general in the United States Army, as well as president in 1946 of the influential Group for the Advancement of Psychiatry and president of the American Psychiatric Association in 1948, predicted in 1951, his profession "can and will make an important contribution towards the solution of some of our social problems." Such an expanded public role for psychiatry was especially vital at a historical moment when, as Menninger wrote to mark the first nationwide observance of Mental Health Week in May of that year, "the world could never before have had more grief and unhappiness and human turmoil than currently exists." As priorities Menninger named the desperate need "to find ways and means of more satisfactorily sublimating man's aggressive instinct," to diminish fear, superstition, and anxiety, to counteract impulses toward materialism and instead help people "gain greater satisfaction in life," and to teach young people "not only the facts about life, but a worth-while way of life." Thus, as Robert Felix wrote in 1947, having identified the roots of mental disorders in societal terms meant as well to interpret mental illness as preeminently constituting "a public health problem" for which preventive mental health treatment programs needed desperately to be made far more extensively available.

The conception of mental illness as a matter of considerable urgency developed further in direct relationship to lessons gleaned from the extensive firsthand experiences of American military psychiatrists during World War II. Already World War I had focused psychiatric concern on the problems of "shell shock" and "war neurosis." World War II presented exponentially larger problems. As an article in Mental Hygiene stated in 1947: "Never before were psychiatrists, psychologists, and psychiatric social workers employed on such a vast scale as members of neuropsychiatric teams as in the war recently won." World War II transformed the place of psychiatry within medicine as well as within American society. In early 1944 psychiatry became a division within the Office of the Surgeon General of the United States Army, and William Menninger was appointed its first director; the war also drew hundreds of physicians into psychiatry and greatly expanded the membership of the American Psychiatric Association. And as physicians who had examined soldiers with psychological disorders concluded, environmental stresses were the key to understanding the etiologies of mental maladjustment. Or as Albert Deutsch wrote, "the observations of military psychiatrists provided the basis for a remarkable stimulus to postwar study of the social aspects of mental disorders." (Continues...)

Excerpted from Madness Is Civilization by Michael E. Staub Copyright © 2011 by The University of Chicago. Excerpted by permission of The University of Chicago Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Meet the Author

Michael Staub

is professor of English at Baruch College and the author of Torn at the Roots: The Crisis of Jewish Liberalism in Postwar America (2002).

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