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Gerald N. Grob's Mental Institutions in America: Social Policy to 1875 has become a classic of American social history. Here the author continues his investigations by a study of the complex interrelationships of patients, psychiatrists, mental hospitals, and government between 1875 and World War II. Challenging the now prevalent notion that mental hospitals in this period functioned as jails, he finds that, despite their shortcomings, they provided care for people unable to survive by themselves. From a rich variety of previously unexploited sources, he shows how professional and political concerns, rather than patient needs, changed American attitudes toward mental hospitals from support to antipathy. Toward the end of the 1800s psychiatrists shifted their attention toward therapy and the mental hygiene movement and away from patient care. Concurrently, the patient population began to include more aged people and people with severe somatic disorders, whose condition recluded their caring for themselves. In probing these changes, this work clarifies a central issue of decent and humane health care. Gerald N. Grob is Professor of History at Rutgers University. Among his works are Mental Institutions in America: Social Policy to 1875 (Free Press), Edward Jarvis and the Medical World of Nineteenth-Century America (Tennessee), and The State and the Mentality III (North Carolina). Originally published in 1983. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.

In mid-nineteenth century America the asylum became the foundation of public policy. This ubiquitous institution was regarded as a symbol of an enlightened and progressive nation that no longer ignored or mistreated its severely and chronically mentally ill citizens. The faith in an institutional policy was embodied in a vast and costly system of state mental hospitals that by 1940 had an inpatient population of about 450,000. Despite the presence of serious problems, there was little disposition to call into doubt the wisdom of institutional care and treatment. Even though mental health policy was formulated within a decentralized and divided political system, there was no doubt that a holistic and clear consensus prevailed.

Examines deinstitutionalization in the 20th century not as a single, consistent public policy, but as a result of unrelated, successively worsening developments in the mental health field. After 1945, inpatient mental hospitals were not as socially & medically endorsed because of such factors as the efficacy of outpatient treatments demonstrated by the experiences of WWII & journalistic exposes that showed the Depression's impact on mental hospitals. The introduction of Medicaid, which transferred the care of the elderly from mental hospitals to nursing homes, & Social Security Disability Insurance, which provided an income to those who were disabled & incapable of holding a job, also had significant effects on deinstitutionalization, since both shifted financial responsibility from state to federal governments & resulted in inpatients being discharged from mental hospitals. The effects of deinstitutionalization on the subgroup of young mentally ill adults with high rates of alcoholism & substance abuse, which led to high rates of homelessness, are also analyzed. Successful examples & suggestions for improving services for the chronically mentally ill are discussed. C. Haywood

AbstractBetween 1940 and 1963 mental health policy in the United States underwent a fundamental change as the legitimacy of institutional care was undermined by individuals and groups committed to an environmentalist psychodynamic psychiatry and to community‐oriented programs.

AbstractContrary to popular belief, the foundation for the attack on the legitimacy of mental hospitals was laid in the decades between 1890 and 1940; what occurred in the 1950s and after was a direct outgrowth of earlier developments.