[1]: 12–13, 16 Whitaker then describes moral treatment, dating back to 1793 and the French Revolution and established in the U.S. by Quakers in 1817, in which lay superintendents treated the mentally ill in small homes with great kindness and had good outcomes: About 35 to 80 percent of patients were discharged within a year, the majority of them cured.
In Worcester State Hospital, 35 percent were chronically ill or had died while mentally ill.[1]: 36 Dr. George Wood, a visitor, reported in 1851: ...you encounter persons walking, conversing, reading or variously occupied, neatly and often handsomely dressed, to whom as you pass you receive an introduction as in ordinary social life; and you find yourself not unfrequently quite at a loss to determine whether the persons met with are really the insane, or whether they may not be visitors or officials in the establishment.
[1]: 136 Part Three describes the discovery of phenothiazines and the advent of the neuroleptic drugs that were derived from them, such as chlorpromazine (Thorazine) by Rhône-Poulenc in France, and its purchase by Smith, Kline & French (today known as GlaxoSmithKline).
[1]: 148–149 In Part Three, Whitaker also describes the American (but not for example British) propensity to classify patients as "schizophrenic", as well as the error (confusion of schizophrenia with the yet-to-be-discovered encephalitis lethargica) in the original classification by Emil Kraepelin, which psychiatry chose to not revisit and fix.
[1]: 199 Whitaker then criticizes some American studies, and points out the work of George Crane at the National Institute of Mental Health to get tardive dyskinesia recognized, which up to that point had largely been touted as a symptom of schizophrenia, and he contrasts the dosages that British doctors were comfortable in prescribing (300 milligrams per day of Thorazine) with what American psychiatrists prescribed (1,500 up to perhaps 5,000 milligrams per day).
[1]: 269–272 Whitaker calls it a type of medical fraud that schizophrenics are told that they suffer from too much dopamine or serotonin activity and that drugs put these brain chemicals back in "balance".
[1]: 291 Which in various parts of the book he claims or alludes to the drugs having this effect on all other fundamental aspects of personality and behaviors, including the ability to take care of oneself, a notion he later explores more critically in Anatomy of an Epidemic.
[4][5] Clinical psychologist Claudia Bukszpan Rutherford acknowledged that though the author holds an extreme position, the book's insight into many of the problems of clinical psychiatry over the years has good points: "While at times his lack of editorial restraint actually distracts from his message, and one may not agree with all of his arguments, his topic is a vital one that has needed to be raised for quite some time, and one which will hopefully be a catalyst for further discussion.
"[8] Psychologist Clare Mundell, PhD, writing for the Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry said Mad in America "should be required reading not only for mental health professionals, but also for those who still question whether profit has eclipsed patient care as the primary force in medicine in this country.
"[9] David Pilgrim, writing "News of scandal is a few decades too late" for Times Higher Education, focuses on the book's shortcomings, saying, "The semi-academic froth he generates distracts the reader from a legitimate outrage, which is not his alone.
Goldman concludes that the "overheated style" of the book "tends to undermine some of its more important points, such as the unhealthy symbiosis between the US pharmaceutical industry and much of the psychiatric research community and the ever-present miserliness of public mental healthcare systems.