Mental Health and American Society (a History Talk podcast)

Mental Health and American Society (a History Talk podcast)


Jessica Vinas-Nelson: Welcome to
History Talk the podcast that brings together a panel of
experts to discuss current events in historical
perspective. I’m your host, Jessica Vinas-Nelson. Brenna Miller: and I’m your
other host, Brenna Miller. Recent mass shootings have
turned American attention to mental health, and examining the
shortcomings and successes of the mental health system. It
seems clear though, that questions surrounding mental
health are much broader than extreme cases of mass violence. Jessica Vinas-Nelson: The debate
about how we care for and treat people with mental illness in
the US are nothing new. America has a long history of locking
people away in psychiatric hospitals, and an equally
lengthy history of criticizing the treatment of those
considered mentally ill. To discuss this longer history.
We’ve invited two experts to discuss the history of mental
health care. In the studio, we have Dr. Susan Lawrence,
professor at The Ohio State University who focuses on the
history of medicine. Dr. Susan Lawrence: Hello. Brenna Miller: Also in the
studio, we have with us Zeb Larson, a PhD candidate at The
Ohio State University, who recently wrote an article for
Origins titled “America’s Long Suffering Mental Health System”. Zeb Larson: Hello. Jessica Vinas-Nelson: Thanks for
joining us today. What is the current state of our mental
health system? Zeb Larson: The current state of
the mental health system in United States, I think suffers
from a number of problems. And you can see where there are gaps
in the system. For example, the largest mental health providers
in the United States are prisons and jails at this point,
respectively, Cook County prison, Rikers Island and the
Los Angeles County prison or jail, I think are the three
largest in the United States. People with severe and
persistent mental illnesses live 15 to 20 years less on average
than other Americans, usually from a variety of co-occurring
other problems. There’s problems in terms of access to mental
health care, there’s problems in terms of homelessness, but
that’s not why we’re talking about this today is it? Jessica Vinas-Nelson: No. Is the
recent public attention on mental health and the mental
health system warranted in the wake of recent shootings? Zeb Larson: From my perspective,
no. There was a study done about a year ago that linked I think,
235 mass shootings over about a century, and it found that maybe
just 22% of them could be in any way prescribed back to mental
health as a factor. There was an APA study that was done in 2016,
that estimated that maybe 1% of all gun homicides in the United
States are related to mental illness. So there are instances
in which mental illness plays a contributing factor to crime.
But I think it’s a mistake to to paint, the epidemic of mass
shootings in the United States as somehow connected to the
mental health system. Dr. Susan Lawrence: And I’m
going to agree with that entirely. I think in part
because it’s just so easy to want to try to find a simplistic
solution to gun violence or to mass shootings in general, and
the temptation to say, well, anybody who commits a mass
shooting is clearly crazy. Therefore, the problem is our
mental health system. If we had diagnosed that person, we could
have prevented it. But that’s extraordinarily difficult, not
simply because of predictive, you know, behaviors, but also
because of issues of civil rights. We cannot lock up people
who are behaving strangely or even who make, you know, vague
threats. Zeb Larson: And for people who
talk about improving the mental health system to better catch
shooters, I’m always, the civil rights piece, Susan, I think
you’re really right on with that, because I’m not sure
exactly what they envisioned that they would actually be
genuinely comfortable with. Most people probably don’t want the
kinds of psychiatric interventions that even they’re
sort of hinting at, to be able to prevent shootings, assuming
that link was even substantive in the first place. Dr. Susan Lawrence: Right,
because if you consider, you know, the problem of
homelessness, and the problem of the homeless who are mentally
ill, and the problem of helping people to be consistently, just
consistently take their medications. Some people with
mental illness do not want to be medicated. And it is not
allowable to forcibly medicate people, unless there is a
significant threat, you know, to themselves or others. But again,
defining that threat to oneself or others, it doesn’t count,
that a threat to oneself is simply I do not want to live in
a shelter. I do not want people to take care of me, I do not
want to be medicated, because courts have decided that if that
is what a person who seems reasonably able to make
decisions, that’s what they’re allowed to do. Brenna Miller: Questions
surrounding mental health and psychiatric care have always
been with us. So as a group of historians, what are some of the
challenges of looking at these issues from a historical
perspective? Dr. Susan Lawrence: I think that
the biggest this challenge I see and looking at it from a
historical perspective, is the fact that we lumped together a
wide range of psychiatric conditions under the term mental
illness, because that encompasses everything from mood
disorders, like depression, even mild depression, or anxiety, or,
you know, many of the things that many people suffer from
either chronically, or episodically all the way to
people who are clearly delusional, clearly have broken
with reality, and are simply unable to cope in any way with
the normal functionings of everyday life. And then there’s
a huge spectrum in between. The other thing that’s hard
historically, is that mental illness is defined in terms of
what society considers to be normal behavior. And that
normality changes over time, it changes with different cultures,
it changes with the ways that people are willing to accept,
you know, diversity, strange behaviors, it also varies
considerably with the kind of social networks that existed at
different times in places, especially things like the
family, where you might have strange Uncle Al, or, you know,
depressed Aunt Margaret. But that was okay. I mean, because
they could function in daily life, surrounded by family. We
talk often, as you did, in your introduction, that America has a
long history of locking people away in psychiatric hospitals.
But there were actually an equally long period when we
didn’t have psychiatric hospitals. So there were there
were systems of community care. Every single community in the
colonies in colonial America had the equivalent of the English
poor law, which was tax funding to deal with people who were
indigent, who could not otherwise take care of
themselves. And one of the kind of responses in more urban areas
was to create poor houses, or in slightly rural areas to create
poor farms, those things were considered necessary at the
community level. Were they nice, not necessarily, but they
weren’t necessarily incarceral either. The other way that
people dealt with those individuals who fell out of the
common social networks of family were, people would be paid to
have those people board with them, and they would be
responsible for taking care of them. Now, maybe that did
sometimes mean that they would be locked in, if they were
people who were seen as out of control. And that’s one of the
reasons that there was a movement in the 19th century
towards psychiatric hospitals, is because there was seen by
various reformers, the abuse of the seriously mentally ill,
where people simply were taken to somebody’s house, and locked
up in a stable or kept with very, very few amenities. So in
that sense, you know, we’ve, we’ve come from a kind of
community system that then went to considering that an
institution would be safer, cleaner, more, you know, run by
experts. So this idea that people were locked up in these
horrible asylums that that at one point was seen as
progressive, that would, that was seen as, as helpful to those
who, who society was failing. Zeb Larson: You know, the only
thing I would maybe consider adding to that, too, is also
just the transformation from rural to industrial. Dr. Susan Lawrence: Absolutely. Zeb Larson: How much that
destabilizes what would just be considered an older conception
of mental health care. I mean, there’s a reason asylums were
historically slow to develop in the United States, it was an
overwhelmingly rural country. And to the extent that they did
develop relatively quickly, in the 19th century, it was in the
northeast, you don’t start to see really organized asylums, I
think explicitly for mental health, until the 1820s and
1830s, Massachusetts establishes the first one in 1830, then the
1840s, you get a bump in the number of them. And they were
regarded, like Susan says, as a progressive way to deal with the
fact that private institutions simply weren’t able to keep up
with the indigent mentally ill. Dr. Susan Lawrence: Right.
Again, we’re talking about the seriously mentally ill. Jessica Vinas-Nelson: So Susan,
as you mentioned, we look to mental health as kind of a
panacea for mass shootings, has there been a time in the past
when mental health facilities or particular treatments been seen
as quick fixes, if you will, for other problems in society. Dr. Susan Lawrence: I think that
these large scale asylums were seen as quick fixes, for those
who are seen to be increasingly deviant, from normal standards.
And some people argue that partly, it’s the rise of a
certain kind of middle class white ethos, about manners and
about appropriate behavior and appropriate hygiene. So that
when people deviated from those in ways that made others
uncomfortable, then they wanted them to disappear. So the asylum
does have this later catch all function of removing those
people who are seen as difficult. Now, one thing that I
know, say, in Iowa, for example, or in Nebraska, in the mid 19th,
century, 1860s 1870s was the rise of what people saw as women
especially, but also men being sort of beset by religious
mania, by having these kind of serious delusions about their
own kind of religiosity. And they behave badly, they behaved
in ways that weren’t considered appropriately, you know,
feminine, appropriately female, appropriately maternal, whatever
those particular roles should be. And so they were again seen
as it’s better to remove them as influences on other people,
rather than to try to deal with them at home. Zeb Larson: It’s also telling
the different classes of people that start to be
institutionalized, once that option is available too you
already brought up the elderly people with dementia going into
the poor houses, but they’re going to eventually end up in
the state hospitals over time too, or this problem has, has
mostly disappeared from the present, but people suffering
from late stage neurosyphilis, absolutely they have they wound
up in institutions, because that was the best place they could
care for them, even people with epilepsy for a long time,
because the state hospital is the closest thing that they
could be fit into easily. Dr. Susan Lawrence: You know,
one of the things that’s kind of related to your we’ll talk about
other comorbidities about the rise of, of, you know, drug
abuse, of alcoholism, of the recognition of something like
alcoholism as being a mental disorder, rather than simply a,
you know, a failure of will, a failure of the ability to
control oneself. That uncontrollable, you know,
alcoholic, who is again is can be seen as a danger can be seen
as, as a problem within the family. They began to have
specific hospitals for inebriates. So you know, again,
remove them, not necessarily for treatment, but to try to take
care of them. Brenna Miller: How have the ways
that we have thought about mental illness changed, and how
does that relate to the types of treatments and care that are
offered to them? Zeb Larson: There is an
increasing sophistication, a diagnostic category that starts
to go on from the from the 19th century onward that moves many
of the people who initially get institutionalized people with
epilepsy, people, neuro syphilis, people suffering from
dementia, they get moved into one category, so that we’re
increasingly looking at individuals with schizophrenia,
individuals with bipolar disorder, individuals with major
depressive disorder, or you brought up mood disorders,
anxiety disorders, those and those even take longer to
develop. So honestly, professionalization has a lot to
do with this. Psychiatry is a new profession by just about any
reckoning. Dr. Susan Lawrence: Right.
Mental illness as a whole was taken care of by regular
doctors. It was not a specialized field until, well,
in in Europe until the 18th century, when you start to have,
yes, there, there were a couple of large asylums like Bedlam, in
London, or Bedlam Hospital. But there were also private
hospitals, where, again, now the upper middle classes, who did
not want to cope at home, would send their family members. But
there were then people who were in charge of those institutions,
who were doctors who tried to begin the shift from just
locking people up or treating them as if they had they had
some kind of physical disease. And so using kind of regular
medical methods to change their attitudes, which were often
unsuccessful to having what they called moral therapy, or work
therapy, or ways of trying to distract people from their
problems and giving them things to do giving them tasks, giving
them recreation, giving them crafts, trying in that way to
have this kind of moral reform, through teaching them over and
over again, what was considered appropriate behavior. Zeb Larson: I mean, it’s almost
like an early form of occupational therapy Dr. Susan Lawrence: It is, it
is. Zeb Larson: In a more rural
society, you would expect that a large number of people would at
least have some practice with agriculture. To go back again to
this middle class sort of white Protestant sensibility, it is
telling that moral treatment, so often moves people from the city
to the country. Dr. Susan Lawrence: Yeah. Zeb Larson: Right? You take them
out of the unhealthful surroundings of the city as a
19th century doctor might say, and you move them out into the
country, and you give them some just honest labor to perform.
And that’s supposed to help regenerate them. Dr. Susan Lawrence: Right. Well,
the cities were seen as corrupting. Yhe idea that nature
was you know, soothing, calming, all those things that, because
there was in the 19th century, the later 19th century, this,
this sense that, that civilization itself created
mental illness, that the stresses of, of modern life,
there was a whole condition at the end of the 19th century
called neurasthenia, which was particularly a mental disorder
that affected middle class, often men who were seen as you
know, locked into desk work, they’re now not out doing honest
labor, they’re in offices, and they’re, they’re pushing papers,
and they’re stressed by business, especially this kind
of competitive cutthroat sense of, you know, of capitalism out
there. And they became anxious, they became incapable of
managing those decision making processes. So the rescuer, you
know, was seen as an appropriate way of treating them. Brenna Miller: I’m kind of
curious about like pharmaceuticals. And if you have
a sense, you know, when does that kind of become popular? Dr. Susan Lawrence: Medical
intervention into psychiatric disorders, again, I think, is as
old as medical medicine itself. But those were often seen as way
of attempts to change the physical body, because the
mental disorder was seen as a physical disorder in many, many,
you know, ancient systems. So the, but it was still extremely
hard to treat. That’s, that’s the problem. I mean, they would,
they would try various drugs, and they simply wouldn’t work,
you know, so that the kind of low level expectant, you know,
simply managing that person’s behavior, you know, was
ultimately the key. I think, in the 18th century, there is more
experimentation, as you start to have more work on isolating new
chemical compounds, like the discovery of gases, and trying
inhalation therapies. It was fascinating, you know, they knew
that with oxygen was necessary for health. So let’s, you know,
inhale oxygen and see what happens or, you know, inhale
things. That’s what we get anesthesia. The discovery of
electricity. The idea that you shocked somebody was very early
on applied to medical therapeutics, to cases of
paralysis, you know, to cases of mental illness. Again, it
didn’t, it didn’t have many results. But doctors were
constantly looking and trying new things. I think that one of
the things don’t really take off until the early 20th century.
But one of the examples I think of doctors trying to be
extremely creative, was what they called malaria therapy for
neurosyphilis. Syphilis is a, you know, a bacteriaillogical
disease. The idea was that if you gave somebody malaria, and
they had a high fever, it would actually kill the spirochetes in
the body, because there’s sound knowledge that that’s what fever
does is it kills bacteria in the system. So they tried that. And
they also used malaria therapy or insulin shock therapy for
again, trying to shock people out of mental state into a
different state. So there’s lots of experimentation going on. But
But the goal always was to try to relieve people’s suffering. Zeb Larson: Yeah, what’s
interesting to me, at least in studying the American example,
is, on the one hand, beginning in the 19th century, you have
psychiatrists or the people who will become psychiatrists sort
of desperate to be taken seriously too, because they
don’t just want to be seen as caretakers of a custodial
institution, they actually want to try to find a way to treat
the people who are in their care. And that’s that I think,
is in part where malaria therapy comes in and how you develop
insulin therapy is they see something that seems to be
working with people who are afflicted with syphilis, we
might as well try and extrapolate that to our own
particular problem. So there was this doctor at New Jersey State
Hospital, named Henry Cotton, and Cotton’s treatment for
people, he believed that mental illness was frequently a product
of infection in the body. So he would, he would simply remove
teeth or spleens, or a woman’s uterus, you’ve just sort of
tried to find whatever he thought might be afflicting
them. Now, of course, we know that this was wholly
ineffective. But Cotton was a well regarded doctor who in most
other respects, acted humanely towards his patients, he was
just in his own way desperately grappling with some kind of
solution. Dr. Susan Lawrence: But we also
have to keep in mind, I mean, to be fair, that standards of what
it meant to help medicine to change to to find progress. It
was done on an ad hoc individual practitioner level, for
thousands of years. doctors did have this fundamental tension
between trying to go with what was traditional practice and
then not change anything, those people who stepped outside of
that norm, and tried these new things, what else were they
going to do, other than to give it a try? And so I don’t think
that they made these decisions lightly. And although we don’t
have a lot of information about the consent process, because
there was no official informed consent that had to be
documented, they were not doing this against the will
necessarily of the patient or of the patient’s guardian or
family, you know. So, yes, we tend to go look back and be
highly judgmental. But every time people want to do that, I
keep wanting to say, Well, you know, every bit of progress that
was has been made in the history of medicine, up to the mid 20th
century, was done by doctors who just tried things. Zeb Larson: There is also a
political dimension to this, too. Dr. Susan Lawrence: Of course. Zeb Larson: And as much as
American mental health facilities and hospitals in the
early 20th century. I mean, they’re almost entirely funded
by the public, they are answerable to state legislatures
and governors, and those institutions are becoming
alarmingly overcrowded in this period. So for the public good,
there’s an incentive to try to find cures, because otherwise
the prospect of these institutions that are becoming
so full, if all they can do is effectively warehouse people. Dr. Susan Lawrence: Yes. Jessica Vinas-Nelson: So how
have public perceptions of the mentally ill changed over time?
And how has that affected their care? Dr. Susan Lawrence: Wow, that’s
a hard one. Because I think, I guess, I think, in general,
mental illness is now much, much more accepted as a legitimate
medical problem, all the way from psychotic behavior to mood
disorders. And people look to medicine for answers. They don’t
look as much as they certainly did in the past, to the actual,
say, sinful behavior of the individual, where one brings on
one’s own sort of mental illness by bad behavior. You know, so I
think that people are more accepting, in general, they’re
accepting of it in the abstract. I think when it comes to
individuals behaving differently, again, people who
are not familiar with dealing with people with mental illness,
are still scared. And so the, the temptation to again, not see
them is one thing. And the temptation to say, “Well, I
mean, how many people in in the audience might have had this
experience growing up?” You know, if if you know, somebody
who suffers from clinical depression, and people just say,
“I don’t understand why Joe just doesn’t snap out of it.” That
kind of judgmentalism, I think, is still very strong. Zeb Larson: And I think I think,
especially as mental illness was understood more and more as a
medical phenomenon, and once you have psychiatric drugs, that
while they vary in their effectiveness, they at least can
credibly be effective at times. There’s also a sort of demand
that mental illness be increasingly treated as an acute
phenomenon, and not a chronic phenomenon. I think you see this
in Kennedy’s message when he signs the Community Mental
Health Act in November of 1963, that people because of these new
drugs that are being developed, they’re going to be able to go
back to their communities and become productive citizens. I
think he actually uses the expression productive citizens,
bam, this is it, we found the cure. Dr. Susan Lawrence: It’s like
antibiotics, right? You know, we have an infection, you give
antibiotics, we have diabetes, you give insulin, you know,
there is this, this sense that medication, I agree with you,
s an easy solution. And we’ e talking here about post w
r America, we’re talking about t e post war world, when these dru
s are really developed and sprea . So we’ve only had, you kno
, 60-80 years of experience with a host of pharmacologic
l inventions developments, th t still people are trying
o process and to figure out, wh t is the best way of using some
f these drugs? And are e overmedicating no Brenna Miller: We talked about
the introduction of _________ asylums in the United States.
And those increasingly became less and less popular. So why
was that the case? And then what were the consequences of that? Dr. Susan Lawrence: From the
work I’ve done on asylums in the Midwest or the Prairie States,
but in Iowa, for example, in the 1850s, when the first asylum is
approved by the legislature, again, this is seen as
progressive, this is seen as modern, what wasn’t expected,
what wasn’t anticipated is number one, that these are
chronic. Many people do have chronic conditions, they, they
don’t just go for a rescuer, and get better and come home. And so
they become overcrowded. And then the problem is that they’re
expensive. And they keep getting more and more expensive as you
have more more professionalization. And then,
you know, it happens in Iowa, it happens in other states, well we
need another asylum, because this one’s overcrowded. So they
build another one. And the taxpayers look at this, and they
say, well, it’s too expensive cut back, you know, you can have
three people to a room, you don’t need to have two people to
a room or one person to a room. And so I think that’s when we
start to see more and more abuses becoming public, is
because then they then Okay, you want to cut back on the quality
of the staff. And so you hire a lot of people who have no
training whatsoever. And so then end up abusing, you know, the
the patients, and there are just too many people, for there to be
proper oversight. Zeb Larson: And part of the
difficulty. This is where the people who who found the first
institutions, they don’t really anticipate how county
governments are going to react, yes, especially in times of any
economic downturn. A county government is going to try to
shed expenses as much as possible. And when these state
institutions are available, they will try to transfer as many
people who might be in their care in one way or another over
to the state hospitals. You see, this is especially pronounced
during the Great Depression. And then the other phenomenon that
undergirds this is just that states have different fiscal
philosophies in the United States. So New York and
Massachusetts tended to spend more per capita on mental health
than other states did. Whereas the south, the American West,
they tended to spend a lot less. Even within that though, you
still get pretty striking examples of scandal, let’s call
it in the 1940s and 1950s. So it comes out and I think 1943 that
Creedmoor hospital, which is in Queens, there’s been an outbreak
of amoebic dysentery, which is not something that should be
happening at a hospital in the United States, this points to
really primitive levels of care. This is a major scandal at the
time, despite the fact that New York is probably doing more than
most other states to actually fund the systems it’s built. Brenna Miller: How did they
close down that is that when these sort of abuses are, become
more public? Zeb Larson: I think scandal
informs it to a certain extent, but it’s striking to me that
it’s not the only reason that it happens. So in Oregon, in 1942,
there’s a accidental poisoning at the state hospital that kills
47 people and leaves another 400 people sick. But the state
hospital grows for another 15 years, it doesn’t actually reach
its peak size until 1957. So to me, I don’t look at that and see
a eureka moment where everybody in the state goes, well wait, we
need to dramatically think about the way that they’re doing this.
I think drugs were really the transformative effect. Once you
had drugs like Thorazine that could actually meaningfully
alleviate at least a large number of people symptoms, that
helps. You also have a federal government that in the early and
mid 1960s is suddenly much more willing to take on parts of the
state’s financial burden. And then the state can seriously
look good at shedding their hospitals. Dr. Susan Lawrence: I also think
that there’s a an element, at least in the by the early 60s,
where there’s a high level of intellectuals who start to
criticize the mental health system as being, incarcerating
people who are deviant, rather than people who are sick. And so
this idea that mental illness is socially constructed, that
mental illness is simply the way that mainstream society gets rid
of the people who are creative and exciting and eccentric, and,
you know, different because they’re too uncomfortable, be it
you know, gadfly women, or homosexual men, or, you know,
all anybody who’s seen, who was seen, as you know, kind of wow,
you know, just challenging the norms. To what extent that
represents the reality of asylum patients is a whole other
question. But this this sense that, that the story of, of
punishing the different does become, I think, politically
popular in some ways. And I think my speculation is it does
by the mid 60s, fit into, lots of issues of civil rights, that
these are people who are being incarcerated against their will.
That there’s no good legal ground for keeping some people
in these institutions, if they want to get out. And so there
are legal challenges to the inpatient population, that begin
to to undermine the legitimacy of these hospitals. Jessica Vinas-Nelson: And what
happens to the populations of mentally ill as these
institutions close? Zeb Larson: I think there are a
lot of people who are, this is the tricky thing about this
history, there are a lot of people who succeed in at least
in the terms set by the people who wanted to close the
hospitals and move them into the communities, they take
medications, they live in the community, they, they live
something like whatever a normal American life is. And their
story is sort of invisible in this process. And I don’t want
to lose sight of the fact that a lot of people do benefit from
these institutions being closed. But then there are patients
who’s symptoms who are more difficult to treat, and they
slip through the cracks. There’s a reason that there’s a large
percentage of mentally ill homeless individuals living in
the United States, partly because the social safety net
wasn’t really designed to take the hit when all of those
individuals were discharged from their hospitals. Dr. Susan Lawrence: And families
refused to take them. Zeb Larson: Mhmm. Dr. Susan Lawrence: You know, I
think that there’s, I think that there’s part of, you know, some
larger social, I don’t know, unpleasantness that we want to,
you know, call out here, it’s, it’s again, yes, there are
people who refuse to take their medications, and so wouldn’t
stay with their families. But there are also those whose
families simply rejected them. And they had no other place to
go. Zeb Larson: Yeah, and it’s
striking, planners really didn’t seem to anticipate this. So the
the commission that had been behind the Community Mental
Health Act in 1963, they simply assumed that everybody would go
live with their families, it never seems to have crossed
their minds that somebody who was in their 40s, or 50s, might
have elderly parents who would be unable to care for them in
the community, Dr. Susan Lawrence: Or that
people come from dysfunctional families, you know, that this is
the time when I think the family is still being idealised rather
than as seen as a place where families do hurt each other. Zeb Larson: Or the reality that
treatment is not as effective as everybody had hoped it would be. Dr. Susan Lawrence: And the
treatment is not as effective. Zeb Larson: It’s very effective
for some individuals, it’s somewhat effective for other
individuals. And then there are people for whom they the
benefits are relatively marginal. And if it’s somebody
who for whom the benefits and marginal or they’re not
medication consistent, or whatever other factor
intervenes, it might be very difficult for them to go live
with their families, understandably, for everybody
involved. Jessica Vinas-Nelson: Well,
speaking of civil rights, and white middle class Protestants,
how does race and gender affect issues of mental health and the
treatment of mentally ill? Zeb Larson: Well, it’s
interesting, looking back at the eugenics movement, at least, and
this is something we haven’t discussed today. But
sterilization of mentally ill individuals was very, very
normal in the United States in the 1920s, 1930s, into the
1940s. And surprisingly, some of those institutions stuck around
for a while, I think, I want to say Oregon performed, last
sterilization in 1981 that overwhelmingly tended to fall on
people of color. Different states also perform them at
different levels. I think California accounted for a third
of all sterilizations in the United States. Dr. Susan Lawrence: Certainly in
the south, and in certain other sort of large cities. People of
color were were targeted more as being suitable for
sterilization. But we have to remember that eugenics isn’t
just about mental illness, it’s also about mental retardation
and it’s also you know, Zeb Larson: Epilepsy. Dr. Susan Lawrence: About
epilepsy. And so other things that were considered inherited.
When it comes to the 1940s and 1950s. And people are looking at
the argument about deviant women, you do have a lot of
medications, things like barbiturates that are being
prescribed more to women who present to their doctors as
being unable to sleep, as being anxious, as being as wanting to
do more, perhaps as wanting to do things. And they need to be
kind of mellowed out, shall we say, women who are dissatisfied,
were seen that way. And so there are a couple of, uh, you know,
very famous women like Sylvia Plath, you know, who are very
outspoken, who are very, you know, engaging or very, you
know, dynamic women, but who also ultimately end up
committing suicide, because, you know, they, they just because
they have serious clinical depression. And so there’s this
sense that, were they driven to suicide because they couldn’t
fit in? Or was it because they were mentally ill? Brenna Miller: What are some of
the most important things that we should focus on that maybe
are getting lost when we are so hyper focused on mass violence
and mass shootings? Zeb Larson: To me, the problem
with assuming that we’re going to see meaningful, substantive
reform because of violence, it seems to me to be that it
doesn’t guarantee a long term funding stream that people are
going to be really interested in sustaining. I think this is one
of the problems with the community mental health
advocates have tried to grapple with since the hospitals were
largely done away with, at least when the hospitals existed,
there were these brick and mortar institutions, and they
had to get a set amount of money in a given year. Now, states
would try to cut back that money as quickly as they could or keep
it to a politically acceptable limit. But there were certain
guarantees about what you could receive, and, I, states in a
given year now, depending on the federal government’s
relationship with Medicaid, or what’s gone on recently, with
Obamacare, those funding streams are always at risk of changing
in some way or another. So paying attention, if we are
going to actually reform how we’re going to not just sustain
it for a two year period, to me seems really critical. Americans
seem disposed to see the world in terms especially social
systems in terms of quick fixes. They don’t like to deal with
chronic issues, which I think partly accounts for the country
is generally fraying social safety net, and Americans really
haven’t begun to grapple with this particular issue. And I
also don’t think violence and mass shootings are going to be
the tipping point for this particular issue. Dr. Susan Lawrence: I don’t
either. I think that a lot is going to depend on how we deal
in the long term with poverty, on how we’re going to deal with
the undermining of our education system. I think that a lot of
the avenues for for children’s health and mental health of
teenagers of early diagnosis is crucial for a lot of any kind of
illness, but certainly for mental illness as well. The
earlier that people can be understood and take part in
their own self care, the better off we’re going to be. Jessica Vinas-Nelson: We’ll wrap
it up on that note, thank you to our two guests, Dr. Susan
Lawrence and Zeb Larson. Zeb Larson: Thank you. Dr. Susan Lawrence: Thank you. Jessica Vinas-Nelson: Thanks,
everyone. This episode of History Talk podcast was brought
to you by Origins: Current Events in Historical
Perspective, an online publication of the public
history initiative and the Goldberg Center in the history
department at The Ohio State University in Columbus and Miami
University in Oxford, Ohio. Our main editors are Steven Conn,
Nicholas Breyfogle. Our audio and technical advisor is Paul
Kotheimer, our audio producers and hosts are Brenna Miller and
Jessica Vinas-Nelson, song and band information can be found on
our website. You can find our podcasts and more on our website
origins.osu.edu on iTunes and on SoundCloud, and Stitcher. And as
always, you can find us on Twitter and Facebook. Thanks for
listening.

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