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

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

by Michael E. Staub
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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Overview

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.


Product Details

ISBN-13: 9780226214634
Publisher: University of Chicago Press
Publication date: 10/10/2014
Pages: 264
Product dimensions: 6.00(w) x 8.90(h) x 0.70(d)

About the Author

Michael Staub is professor of English at Baruch College, City University of New York, and the author of Torn at the Roots: The Crisis of Jewish Liberalism in Postwar America.

Read an Excerpt

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

I

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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Table of Contents

List of Figures

Introduction

Part I: When the Diagnosis Was Social

Chapter 1: Society as the Patient

Chapter 2: Enough to Drive Anybody Crazy

Chapter 3: Suffering from Contingencies

Chapter 4: The Therapeutic State

Part II: The Revolution in Feeling

Chapter 5: The Insanity Trip

Chapter 6: Person Envy

Chapter 7: A Fashionable Kind of Slander

Epilogue

Acknowledgments

Notes

Index
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