Highlights From Residents’ Journal: June 2021

One Flew Over the Cuckoo’s Nest, The Snake Pit, The Shame of the States, “Titicut Follies,” and Life Magazine’s “Bedlam 1946.” These articles, films, and books—and books that were made into films—are cultural touchstones of the state mental hospital era. They epitomize a negativism—regarding insanity, imprisonment, terror, chaos, and disgrace—associated with life in American psychiatric institutions in the first half of the 20th century. Although critical attention has been paid to the relationship between publicized atrocities and the movement for state hospital deinstitutionalization, fewer efforts have highlighted the federal idealism underlying deinstitutionalization. The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963—more commonly known as the Community Mental Health Act (CMHA)—provides a critical historical lesson on the roles of optimism and structure in outpatient care for serious mental illness.

Today’s evidence-based medicine denotes alcohol addiction as a clinical disease, but medical literature from the 19th and 20th centuries was far less objective. Case reports from this period described alcohol addiction as a condition of moral compromise. Such claims masqueraded as public health concerns and contributed to a stigmatized view of alcohol addiction. Moral commentary aside, narratives of supernatural phenomena also appeared in case reports from this period. Dramatized reports of alcohol withdrawal served cautionary tales to readers and diluted clinical guidelines in the process.

The psychiatrist Frantz Fanon, best known for his works Black Skin, White Masks and The Wretched of the Earth, is a theorist famous for his impassioned writings on revolution and the psychological impacts of racial inequality and colonization. His writings have been touted by intellectuals from Jean Paul Sartre to Malcolm X and have inspired activists in the National Liberation Front, Black Panthers, and, more recently, Black Lives Matter. Fanon’s depictions of imperialist power are echoed by recent police killings of Black Americans, which have prompted public evaluation of privilege and culpability in perpetuating systemic racism. Within the field of psychiatry, there is renewed effort to explore how systemic racism affects our patients’ lives and to confront the national racial injustices that permeate our institutional practice. With this new focus, Fanon’s works merit revisiting because they are just as relevant today as they were 60 years ago.