The mentally ill are no longer hounded as witches, no longer punished as criminals, no longer housed in prisons and poorhouses. They are treated less brutally than they were 100 years ago when Dorothea Lynde Dix began her 40-year crusade to better their lot. But their lot is still a wretched one, and the recovery rate in U.S. mental hospitals is not "appreciably higher" than it was 50 years ago. Albert Deutsch, medicine and social welfare columnist of the New York Star, has made an angry survey of state mental hospitals, The Shame of the States (Harcourt, Brace; $3). Deutsch gives most such hospitals big black marks: for neglect, overcrowding, inadequate treatment, lack of simple decencies.
None Measures Up. Most attendants, Deutsch complains, are not trained. The patients are too often merely guarded like prisoners, too rarely handled like patients. One attendant, at Napa (Calif.) State Hospital boasted cheerfully to Deutsch: "Who says we don't take good care of them? This man has been here for 40 years and he is still going strong."
The American Psychiatric Association has set minimum standards for mental hospitals: at least one psychiatrist for every 150 patients, one graduate nurse for every 40, one attendant for every eight, an outlay of at least $5 a day per patient for food, care and treatment. Says Deutsch: "Not a single state mental hospital in the U.S. meets, or has ever met, even the minimum standards set by A.P.A. in all major aspects of care and treatment." The current average in state mental hospitals, he says, is $1.25 a day per patient.
Deutsch found New York's Rockland State Hospital, the "Juniper Hill" of The Snake Pit (see CINEMA), one of the best, but even Rockland was 30% overcrowded, with 6,100 patients jammed into space intended for 4,700. "The hospital needed at least twice as many doctors, twice as many nurses, and three times as many attendants to provide adequate care and treatment . . . Often only one attendant watched over two wards for homicidal patients. There weren't nearly enough recreation workers or occupational therapy workers to help Rockland's patients on the road back to mental normalcy."
It was worse at Philadelphia State Hospital for Mental Diseases (Byberry): there were 6,100 patients, almost 80% more than the planned capacity of 3,400. "I was reminded of the pictures of the Nazi concentration camps at Belsen and Buchenwald ... I entered buildings swarming with naked humans herded like cattle and treated with less concern ... I saw hundreds of patients living under leaking roofs, surrounded by moldy, decaying walls, and sprawling on rotting floor for want of seats or benches."
Even Deutsch's statistics are horrifying: 125,000 persons enter mental hospitals in the U.S. every year; 1,000,000 children now in grade schools will spend some time in state mental hospitals before they die; the 190 state hospitals cost $200 million a year; total cost of mental illness in the U.S. (including loss of pay, services, etc.) is about $1 billion a year.