Wayward Americans

Deinstitutionalization

Moving the mentally ill out of state-run psychiatric hospitals and into smaller, community health centers. Began in 1960s to improve treatment and cut spending.

What procedure was first done in 1936?

Lobotomies - first prefrontal lobotomy was done in 1936 by Freeman and Watts (standard vs. trans-orbital). By the late 1950s, 50,000 lobotomies had been performed.

What therapy/treatment was first introduced in 1938?

Electroshock therapy (ECT) used to treat schizophrenia and other chronic illnesses.

What drug was introduced in 1954?

Thorazine - became a staple in hospitals, eliminated the need for physical restraints and calmed outbursts.

When did the number of patients peak in hospitals?

Peaked in 1955 with 560,000 patients.

What 3 major changes lead to deinstitutionalization?

1. Science/medicine

2. Politics

3. Culture

How did science lead to deinstitutionalization?

Drugs such as thorazine got rid of restraints and made it easier to not have as many staff or facilities just to subdue patients.

How did politics lead to deinstitutionalization?

Federal funding was a big issue, as medicare/medicaid were introduced but funds were all going towards community centers. Made sense to shift to these facilities instead of state-run ones.

How did culture lead to deinstitutionalization?

People believed the mentally ill were being “warehoused” and felt better care would be given at smaller, local centers.

Thomas Szasz on mental illness:

Mental illnesses are seemingly scientific categories but are merely negative labels used to support the power that psychiatric authorities have. Focus on schizophrenia.

JFK Act to build community mental health centers

Community Mental Health Act - program was never funded due to Vietnam War and failing economy in 70s.

What did LBJ introduce?

Medicare & Medicaid - Medicaid did not cover mental patients so many moved into nursing homes/hospitals.

One Flew Over the Cuckoo’s Nest significance

Portrayed the distrust of how psychiatry was being used as opposed to how it was intended. Reinforced “social control” aspect of institutions.

1980 - Jimmy Carter signed what act?

Mental health Systems Act - funds more direct care and rehabilitation to ensure a healthy body, mind, and spirit while in a facility. Repealed by Reagan in 1981 and funding was shifted to states through block grants.

What problems does community care face today?

Limited funding and limited oversight for community care are a major problem, resulting in a shortage of proper facilities and reduced access to medication.

How many of inmates have a mental illness?

At least 400,000 inmates have a mental illness. Correctional facilities have inadvertently become a mental health care provider, though ill-equipped.P

Positives of deinstitutionalization?

Gave more rights to mentally challenged and reversed “send them away” mindset into a more reintegrative/rehabilitative one. Worked well for high-functioning people with mental health challenges.

Negatives of deinstitutionalization?

Severely mentally ill had few treatment options and could not go to community-based centers due to severity.

What was the opium influx in the 1800s due to?

Opium was being brought over by Chinese immigrants who came to work on railroads. Not a crime problem but a public health problem.

What was opium a common ingredient in?

Tonics and elixirs from the 1800s. However, this drug was highly addictive.

What did medicines with opium/cocaine do?

Relieved chronic pain and depression, and also worked as anesthetics/relief from intestinal disorders.

What soda was cocaine an ingredient in?

Coca-Cola (extract from coca leaf)

When was morphine developed and what did it do?

Developed in early 1800s - considered a wonder drug and eliminated severe pain/left the user in a euphoric state.

How did the morphine epidemic come about?

Thousands of soldiers in the Civil War were using it to relieve pain from war-related injuries and many of them became addicts. Medical professionals were concerned about an epidemic.

What was the biggest addiction problem in the 1800s?

Alcohol addiction

How did people initially try to fight alcohol addiction in 1874?

Heroin - invented in 1874 and imported into the USA after its invention to try and help with the alcohol addiction problem. Marketed as safe and non-addictive (as opposed to morphine).

What did drug companies start selling in the late 1800s and early 1900s?

Drug kits - contained a needle and a vial of opiates to treat a variety of illnesses. Marketed to kids and adults.

When did the use of narcotics (medical and non-medical reasons) peak?

It peaked in 1900; at the turn of the century, advertisements for these drugs were everywhere and the sale of them was booming. Regulation failed to curb this.

Harrison Narcotics Act of 1918

Required those who sold, transported, or possessed narcotics to report it to the IRS and pay tax. First measure to control trafficking. Shifted conversation from regulating legal drug activity to eliminating illegal drug activity.

When did cannabis start to be banned?

It started to be banned by state governments and other countries in the 1920s because therapeutic uses of it were still being explored and industry profited off of commercial applications of it.

1930s and marijuana

During the Great Depression, unemployment increased resentment/fear of Mexican immigrants and concerns about marijuana. Linked marijuana to being racially inferior and the lower class. By 1931, 29 states banned marijuana.M

Marijuana Tax Act of 1937

Importation, cultivation, possession, and distribution was regulated. Passed by Harry Anslinger, the first commissioner of the Federal Bureau of Narcotics.

What have advances in neurochemistry/imaging technology shown us about disorders?

Many disorders/violent, suicidal, or depressive behaviors result from disruptions in brain activity due to altered gene expression, chemical imbalances, and environmental factors.

Genetic essentialism

Tendency for people to believe that a person’s genes are the primary determinant of their traits and behaviors. Results in stereotypes and prejudices stemming from the belief that genes are a fixed and immutable factor that determines everything about us.

What are many neuroscientists concluding about morality?

Many believe that there is a biological basis to our morality.

Phineas Gage

Construction foreman that fell and got a pipe through his head. He suffered severe brain damage and his entire personality, reasoning, and sense of morality was offered. Raises the question of whether our morality is biological.

How does this relate to criminal activity?

If there is a biological basis for morality, personality, and reasoning, then it can argued that an affinity towards crime and deviant behavior is built in the brain or are genetic code, somehow. Should we think about this in the context of the individual (rehabilitative), or the welfare of all of society (incarceration)?