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In a modern version of the 19th century reform movement that broke up the old bedlams, the state hospitals are now under attack from groups formed to defend the rights of mental patients, among them the California Parents of Adult Schizophrenics and the Advocates for the Adult Mentally Ill in Seattle. Such groups have filed class-action suits charging that the hospitals are little more than snake pits. Lawyer Robert Plotkin of the privately funded Mental Health Law Project in Washington, D.C., says that conditions in the hospitals are "universally shocking," with inadequately trained doctors prescribing drugs that they know about only through drug-company leaflets.
Like many others in the reform movement, Plotkin thinks patients should not be medicated, restrained or even touched without their consent—unless the courts appoint a guardian to protect the patient from his doctor. Psychiatrists do not look with favor upon a Miranda-type situation that would involve reading deranged patients their rights before throwing them into a straitjacket. Warns Harvard Psychiatrist Alvin Poussaint: "If a patient refuses medication and is violent and tearing up the place, you may be subject to a lawsuit if you medicate him properly, or even if you restrain him by putting him in a room alone. What do you do?" More optimistically, other psychiatrists think the gains won by the patients' rights movement will force the states to pump badly needed money into their mental hospitals. Says Miles Shore, superintendent of Boston's Massachusetts Mental Health Center: "The standard of care enforced by the courts is one of the few defenses we have against Proposition 13."
The most common complaint of psychiatry is that it is expected to do more and more with less and less. According to various estimates there are 4 million Americans who are afflicted by serious mental illness, and many of them are getting no treatment at all. Indeed psychiatrists have every reason to sound depressingly plaintive. "We need more money, and we're simply not getting it," says Talbott. "Every other disease—cancer, kidney disease, hypertension—has a constituency. But the chronically mentally ill have no constituency. Everybody would just like them to disappear, their families, the press, even the medical profession."
Confronted by such overwhelming burdens, psychiatrists often dream of an easy way out: the miracle cure, a cheap drug or chemical for every mental illness that ever plagued man. So far there has been no clear breakthrough, although the prospects are improving. Doctors are finding great success in the use of lithium for control, if not cure, of manic-depression, the classic disorder of wild mood swings from mind-racing euphoria to deep despair.