THE MAD AMONG US

An informative survey of America's evolving responses to the question of society's obligation to the mentally ill and how best to meet that obligation. Grob (History of medicine/Rutgers) has previously published scholarly works on the history of the care of the mentally ill. Here, he reaches out to a larger audience with a highly readable account that begins in the colonial days. Back then, ``lunaticks'' were primarily a family responsibility, and those without families to care for them were seen as a social and economic problem, not a medical one. Public almshouses took them in, along with widows, orphans, and others needing public assistance. By the middle of the 18th century, the Enlightenment, with its faith in reason and science, gave rise to the idea of treating and possibly curing the mad, and insane asylums began to appear in cities. Grob recounts the efforts of Dorothea Dix to persuade state legislatures to set up mental hospitals, and by the middle of the 19th century, most states had at least one. But the 20th century found these optimistically founded institutions overcrowded and largely custodial in function. Exposure of conditions in these ``snakepits'' led to calls for new approaches, and the claim that community care and treatment were superior became an article of faith in the 1960's. The author points out that the federal government's current community mental-health policy has overlooked the need for supportive services to ensure proper housing, food, and social services, and he notes that since the 70's new problems have been created by a subgroup of the mentally ill—young, alienated substance-abusers. Grob's historical perspective gives him a balanced view that cautions against both unrealistic expectations and defeatist paralysis. Clear, engaging account of a persistent social problem, full of humanity and wisdom.