Mental Health Policy in America: Myths and Realities

Prologue: Before World War 11 the focus of America s efforts to treat its mentally ill citizens was on those individuals who suffered from the most severe and chronic problems. Since 1960 public policy has emphasized creation of a decentralized system of services. In the process, the target population became diffuse, and services were no longer focused on the most severely ill people. In this review Gerald Grob, Henry E. Sigerist Professor of the History of Medicine at Rutgers University, discusses this important policy shift and its consequences. Grob, who holds a doctorate in American history from Northwestern University, has devoted most of his career to an examination of the way America treats its mentally ill citizens. He was attracted to this subject thirty-two years ago while teaching at Clark University in Worcester, Massachusetts, where one of the state s mental hospitals was located. Grob learned that the hospital had maintained the case histories of every patient admitted to the institution since 1830. Exploiting this fascinating archive, Grob produced a book in 1966 that was a study of this state mental hospital from 1830 to 1920. Since then he has written a trilogy that serves as the definitive history of America s treatment of the mentally ill. His first work, entitled Mental Institutions in America: Social Policy to 1875 , was published in 1973. The second volume, Mental Illness and American Society, 1875-1940 , was published in 1983. The third volume, published in 1991, is entitled From Asylum to Community: Mental Health Policy in Modern America ; it is reviewed in this volume of Health Affairs . Because of his pathfinding work, Grob has garnered many honors, including a Guggenheim Fellowship, two fellowships from the National Endowment for the Humanities, election to the Institute of Medicine of the National Academy of Sciences, and the William H. Welch Medal of the American Association for the History of Medicine in 1986.