[Jim Noble]

The laws to close down mental hospitals were passed in the early 1960s. The Kennedy administration were huge proponents of “community mental health”.

But the old system (which I trained in) had a lot of momentum. By 1972, the doctors and nurses still were practicing Old Thinking and understood that the patients would suffer and die if they all hit the streets.

And, by the way - my only exposure to severe mental illness was in medical school (I didn’t become a psychiatrist) - and although public anger is rightly directed at the problem of psychotic criminals who prey on the innocent and commit terrible crimes, for every one of them there are 1000 tortured souls who suffer their delusions and who are constantly in danger of death, severe illness, rape, loss of body parts through negligence, etc and for whom there is no help.

The criminally insane are a big problem - but the lack of asylum for the poor people in the grip of mental illness who wander the streets defenseless and terrified is even worse.

All because of one stupid book and one stupid movie.

[ScaniaBoy]

Yes, for bad or good the medical profession is rather conservative, but eventually the "new thinking" will pervade, and in this case it has caused enormous suffering (not only in the US).

All because of one stupid book and one stupid movie.

BTW I did not know that the novel "One Flew Over the Cuckoo's Nest" was published in 1962, just as the big psychiatric deinstutionalization was being pushed through. I can just quote that wise Swedish statesman axel Oxenstierna:

"Do you not know, my son, with how very little wisdom the world is governed?"
(Count Axel Oxenstierna to his son a delegate to the negotiations that would lead to the Peace of Westphalia.)

[GOP_Party_Animal]

And I would imagine today’s America generates so many more mentally damaged people then the 1960s: broken families from no-fault divorce, the acceptance and prevalence of homosexuality, the sexualization of children, etc. Just a factory of mental illness.

[gundog]

People are surprised when I say that Ken Kesey was one of the most destructive influences in America in my lifetime. The Acid Tests, alone, could earn him that title.

[OldGoatCPO]

Tried to have a family member with a history of mental health and drug abuse committed in 2018. They told me they could only hold the person for 3 days unless a Judge intervened and no judge would unless suicide was involved. That family member may be alive today had long term in patient treatment been available. Courts do not want to intervene and hospitals will only do what the State will pay them for. Which as I understand it is 72 hours of in patient care.

[devere]

I think that Thomas Szasz was just as influential as Ken Kesey. De-institutionalizing the mentally ill was a movement of the times that took hold.

[Chickensoup]

No

there were a lot a levers.

Thomas Szasz and his idea that therw was no such thing as mental illness

[Sooth2222]

The Community Mental Health Act of 1963 deinstitutionalized the mentally ill, who were then supposed to have access to 2000 community mental health centers.

The gov't built a few hundred community mental health centers - and then repurposed them some years later.

The 2023 US mental institution population is roughly 1/20 the size that it was before the Act. Over the same time, the US population has roughly doubled.

Pharmacologic treatment of mental illness is (or can be) much more effective than it was in 1963, but it isn't at all effective if patients don't or can't comply with recommended treatments.

Rome wasn't burned in a day. (In this case, it's taken 60 years and Rome is still burning.)

Defining Deviancy Down - Daniel Patrick Moynihan (1992)

Moynihan wrote his essay 30 years after the Act was passed, it's now 30 years later, and things are much, much worse.

(Being a politician means never having to say you're sorry, or wrong.)