In the first comprehensive one-volume history of the treatment of the mentally ill, the foremost historian in the field compellingly recounts our various attempts to solve this ever-present dilemma from colonial times to the present.
Gerald Grob charts the growth of mental hospitals in response to the escalating numbers of the severely and persistently mentally ill and the deterioration of these hospitals under the pressure of too many patients and too few resources. Mounting criticism of psychiatric techniques such as shock therapies, drugs, and lobotomies and of mental institutions as inhumane places led to a new emphasis on community care and treatment. While some patients benefited from the new community policies, they were ineffective for many mentally ill substance abusers. Grob’s definitive history points the way to new solutions. It is at once an indispensable reference and a call for a humane and balanced policy in the future.
A large proportion of today's mentally ill homeless are substance abusers, according to Rutgers University professor of history Grob in this comprehensive study which will be of interest to specialists. He outlines a ``cyclical pattern'' of mental health care ``that has alternated between enthusiastic optimism and fatalistic pessimism.'' Grob traces the growth of psychiatry as a medical specialty along with changes in public policy and social attitudes. In colonial times families and communities cared for their ``lunaticks''; with 19th-century urbanization, hospitals began assuming responsibility for the mentally ill, torn between custodial and therapeutic duties. Grob records a post-WW II trend toward de-institutionalization and treatment in outpatient or community centers staffed by psychiatrists trained in psychoneurology and a range of therapies, including electric shock, analysis and medication. Today, the author notes, general hospitals and local clinics, overloaded by both the chronically ill and substance-abuse cases, can assure little continuity of care. Illustrations not seen by PW.