The Shame of the States

Having worked the six years previous as a columnist for the New York Post, writing about public health, he was able to use many of his earlier experiences in visiting mental hospitals and speaking with key figures there as source material for this newest book.

The quote encapsulates one of Deutsch's main goals in writing The Shame of the States—that the public will come to understand that the mentally ill are no less human than themselves, and equally as deserving of basic dignities and care—and is as follows.

[9] In his preface, Deutsch frames his book as an account of conditions that have not essentially changed despite the months that have passed since his original research, and which have in fact worsened despite the “ambitious postwar planning programs.” Those programs, he writes, “have been blocked or dropped as a wave of budget retrenchment has hit one state after another, with resulting deterioration of services.

Though he acknowledges that already dire staff shortages were made worse by the drafting of hundreds of medical professionals, he characterizes accusations that hospital conditions were worsened because of the war, having previously been quite good, as simply false.

[11] Deutsch sets forth his main argument, which is that “real reform of our state hospitals hinges on acceptance of a single fundamental truth: mental patients are people, however sick they may be.”[12] He goes on to support the state as the “only public administrative unit able to provide adequate institutional facilities,” and having been initially charged with this task out of historical necessity, is therefore responsible for active care for the mentally ill regardless of their ability to pay.

[13] Deutsch describes how the bare minimum threshold of care, according to the APA, is not being met: state facilities are too small, tremendously overcrowded, and horrifically understaffed, they lack appropriate therapeutic equipment and are unable to engage in research or enact any possible new methods of care, and moreover foster an “atmosphere of defeatism.”[13] Ultimately, however, “the most serious defects arise from the deadly monotony of asylum life, the regimentation, the depersonalization and dehumanization of the patient…the contempt for human dignity.”[12] The system as it is now, he writes, costs us socially as well as financially: current patients have little to no chance of recovery and will probably be supported for the state for their entire life, with no chance to become contributing members of society.

[11] These sections are dedicated to descriptions of certain hospitals that Deutsch visited; he made a survey of over thirty psychiatric institutions nationwide, but featured a few in particular as representative of the general bad conditions.

He appeals to the public to stop "buck-passing the blame to institutional scapegoats" and act, asking "how much more documented detail must be dug up before a so-called civilized people can be galvanized into remedial action?

He also notes the following as contributing to reform of the old system: the new “open-door” policy of the APA, various “journalistic specialists” who value “institutional investigation” over condemning scapegoats, and the federal government's National Mental Health Act.

Reviews emphasize the shockingly vivid, sensational, and thought-provoking nature of the descriptions and photographs in the book, as well as the pervasiveness of the poor conditions uncovered and the fact that Deutsch can be considered a “lay expert” in this field.

In a New York Times article published only a year after the book, writer Lucy Freeman makes this comparison directly, describing mental hospital officials as operating “what have been called the country’s ‘snake pits’ and ‘shame of the states’.”[27] She also quotes Dr. George S. Stevenson, president of the APA and director of the National Committee for Mental Hygiene at the time, and a figure also quoted by Deutsch, on the reaction of the public.

Stevenson said that he did not believe that it was so much a matter of apathy, but of a feeling in people that makes them say, ‘I don’t want to see the movie, ‘The Snake Pit,’’ or, ‘It makes me sick just to think of a mental hospital.’ There is an aroused interest in mental hospitals, but it is shown mainly by ‘pointing a finger at a Governor or a superintendent,’ he said, so that an unsatisfactory situation can be explained in terms ‘outside themselves.’”[27] This was the very attitude that Deutsch was trying to counteract with The Shame of the States, and while the book did have a major effect on public opinion, it did not single-handedly galvanize a national movement.

[31] However, this shift in attitude, while helpful in moving patients out of the overcrowded state institutions and encouraging the development of centers for personalized treatment and rehabilitation, ultimately had mixed results.