Mind Control

Later, the newspapers would describe the man as an eccentric, and so he probably was. But until he was arrested for panhandling in a Chicago bus terminal in early 1975, Robert Friedman had lived quietly for most of his life, supporting himself with jobs as a clerk-stenographer. What got him into trouble with the Chicago cops was the attaché case full of cash--nearly $25,000--that he was carrying when he was busted. The money was his own, savings that the frugal Friedman, a devout Jew, had hoped to use for a trip to Israel. Because of their suspicions of a panhandler carrying $25,000, the court immediately had Friedman locked up in a psychiatric ward, where he was heavily drugged with tranquilizers. Five days later, acting on the recommendation of a Cuban-born psychiatrist who spoke only broken English, a judge committed Friedman to a mental institution; in announcing the decision, he explained that the purpose was to protect Friedman from people who "might be after his money." Friedman begged the judge to release him and to order his money returned; he noted that he had worked steadily all his adult life until he was laid off a few months before, that the rent on his apartment was paid and that he had not been convicted of any crime. He even promised to stop panhandling and to put his savings into a bank. The judge paid no heed to these pleas. In committing Friedman, he said: "Letting you go would mean you would be unable to take care of yourself."

Never again would Robert Friedman be a free man; nor would he ever again see his money. When he died 14 months later, more than half of his fortune was gone--the state of Illinois having taken $800 a month to pay for his treatment (largely in the form of psychoactive drugs administered against his will) and $5000 having gone to a lawyer hired by relatives who wanted to have Friedman committed. More important, the drugging and routine brutality of hospitalization had turned Friedman into a pathetic semi-invalid who defecated on himself, ran naked through the hospital halls and no longer could understand what was happening to him.

When the judge who had committed Friedman learned of the inmate's condition, he expressed shock and allowed him to be released to a nursing home. By then, however, Friedman could no longer function as a human being; when he died a few months later, the official cause of death was listed as cardiac arrest brought on by pneumonia.

At the time of his death, Friedman was 44 years of age.

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The cases are commonplace:

In New York, a mother of three, desperate to find housing for her family, gets into a shouting match with a public-housing official; the police are called and the woman is shipped to a mental-health clinic, where she is diagnosed as paranoid schizophrenic and drugged; her children are sent to a juvenile home. In Southern California, a group of school children who disturb their teachers with their adolescent energy are sent to the school doctor, who instructs that they take the psychostimulant Ritalin to help them sit quietly in class. In San Francisco, an unemployed schoolteacher appears at a hospital personnel office looking for a job. "The next thing I knew," she says, "I was being held for observation because they decided I was dangerous to myself and others." The ex-teacher was given antidepressants and was allowed to go home three days later only after promising to continue to take her pills; she was also compelled to pay a $225 bill for her "treatment."

The San Francisco teacher was lucky to be alive. At least 5000 patients are killed each year by their "treatment."

The Men in the White Coats

In 1940, shortly before the outbreak of World War Two, there were approximately 3000 psychiatrists practicing in the United States; today there are approximately 30,000, nearly all of whose training was supported by National Institute of Mental Health (NIMH) grants. During the same period, there has been a corresponding growth in the number of psychologists, psychiatric social workers, technicians, nurses and orderlies who staff a national network of clinics, hospitals and nursing homes. Today this army totals 500,000 people and their bases of operation include some 1100 "freestanding" psychiatric outpatient clinics, 80 Veterans Hospital outpatient mental clinics, 300 general hospitals with psychiatric outpatient services, 500 Federally funded Community Mental Health Centers and tens of thousands of nursing homes, board-and-care facilities, behavior clinics, child-guidance clinics, alcohol-and drug-abuse centers and suicide-prevention clinics, all of them handling people who have been persuaded that they need help or who have become too annoying, difficult or assertive for welfare workers or public-housing authorities or relatives or the police to handle. There are more mental-health workers in the United States than there are police officers.

These workers form a vast and growing behavior-control network that regards nearly every form of personal deviance as a disease; consequently, the network has made mental health into a 15-billion-dollar industry "serving" some 6,000,000 to 8,000,000 Americans each year and prescribing psychoactive drugs to over 30,000,000 others. At the pinnacle of the network are the closed mental hospitals that have existed in this country for almost 200 years, and that have been under public attack almost since the day they opened. The psychic and physical brutality suffered by patients in these institutions has made them obvious targets for reformers, for muckraking chroniclers of the snake pits and for creators of "fictional" cuckoo's nests.

But during the past generation, the philosophy and practice of behavior modification and the new techniques of chemical behavior control have created methods of intervention in the lives of citizens that are so extensive and so pervasive that the classic mental hospital, for all its notoriety, is now only one small part of a complex system that includes organized psychiatry, the drug companies, state and local agencies, the private mental-health movement, medical schools, university research centers and a Federal Government that, in its support of mental health through subsidies and propaganda, has, more than any other element, been responsible for the network's phenomenal growth.

Underlying the network's operations, and those of the individuals and institutions of which the network is comprised, is a fundamental shift in the way by which the Government and powerful private-sector organizations control the lives and behavior of individuals: from punishment to "therapy," from direct to indirect controls, from the overt and crude methods of the traditional loony bin to the subtle and smooth techniques of the psychiatrist's office. This shift now affects nearly every American, even if he has never been inside a mental-health clinic or been to see a psychiatrist.

A judge who is reluctant to send a person to prison or to a closed mental hospital may consider himself to be a model of enlightened compassion in asking the same person to "volunteer" for psychiatric treatment. And the individual citizen who properly fears psycho-surgery or electroshock (still practiced on some 200,000 people a year) may think he is getting off easy by agreeing to undergo therapy with drugs--drugs that ultimately may be just as damaging to his brain and nervous system.

Since 1955, the number of Americans treated by an agency of the mental-health network has more than tripled, while the number of those subject to some form of psychological intervention on the job, in schools or through welfare agencies, delinquency- and crime-prevention programs and private offices of physicians has grown so rapidly that there is no way to estimate a total. According to a confidential 1976 industrial newsletter, over 30,000,000 Americans are given psychotropic drugs outside hospitals every year. This figure includes hundreds of thousands of old people tranquilized in nursing homes, more than half a million school children medicated with amphetamine-type drugs for "hyperactivity" and thousands of inmates drugged in prisons and mental hospitals. At any given time these days, some 2,000,000 nonhospitalized citizens are taking such mood-altering medication as the powerful tranquilizers Thorazine and Stelazine, sometimes called chemical strait jackets; and of those 2,000,000, more than a third are poor and/or black. Each year, an increasing number of people who are not formally inmates of any institution are treated--and taught to behave--as if they were.

Every day, hundreds of people are (continued on page 175)Mind Control(continued from page 138) induced to accept treatment, to take medication or to subject themselves to behavior-modification programs in schools or clinics, all on the promise that such treatment will prevent something worse. Every week, thousands of patients are released from hospitals on the condition that they continue their medication and that they report regularly--under what has been called psychiatric parole--to a therapist or a clinic. As the law makes it more difficult to arbitrarily lock up deviants, science makes it easier to define them as sick and to divert them into treatment programs--as outpatients of the criminal-justice system, the mental-health system or the social-service system. And as the law makes it more difficult to discriminate on the basis of race, class, age or sex, science finds new labels to replace the old--the parapsychiatric, the predelinquent, the potentially abusive or dangerous--and new ways to watch and control those so labeled.

The Marriage of Shrink and State

The classification of mental disorders embodied in the official diagnostic and statistical manual of the American Psychiatric Association has a curious history. During and after World War Two, the Army needed some method to screen candidates on a psychological basis, so there evolved a series of categories that would fill the military's neat bureaucratic forms. This system reduced what was patently unscientific and unsystematic--labels, theories, jargon--to something that was sufficiently precise to fill the operating manuals of large organizations. The bureaucratic nomenclature developed by Army doctors later became perfectly adaptable to insurance forms, hospital records, computers--all of the paper that fills Big Brother's files.

Its chief architect was the late Brigadier General William C. Menninger of Topeka's Menninger Foundation, who headed the psychiatric division of the Surgeon General's Office during World War Two; and the effect of Menninger's screening system, as psychiatrist Thomas S. Szasz has pointed out, was that "more civilians were declared mentally unfit, more soldiers were classified as mentally ill and more veterans now receive... 'treatment' for mental illness than ever before in history." (Of some 15,000,000 examined for induction during World War Two, nearly 2,000,000 were rejected for neuropsychiatric reasons.)

It never occurred to the Army professionals to examine the criteria on which their judgments were based. (The British army had a much lower rate of psychiatric rejections, though British soldiers were no more prone to psychological problems than their American cousins.) Instead, what General Menninger called "the lessons of war" became the foundation of postwar policy and the basis of a Federal mental-health program whose budget grew from virtually nothing to some $700,000,000 annually in 1977. The importance of the contribution to this growth made by Menninger and his Army cohorts cannot be underestimated; or, in the words of one Menninger fan: "The bitterly learned lessons of the war years, the startling and unexpected revelations of the mental health and weakness of our citizenry in a delicately balanced world, must bear fruit in the postwar life of our nation if we are to remain healthy, strong and preserve our way of life."

The war proved that one of ten Americans needed psychiatric treatment. "If these young men were representative of the nation," asked Robert H. Felix, who was to become the first director of NIMH, "what would be the absolute figures for the mental and nervous impairments of the entire nation?" Karl Menninger, probably the most influential American psychiatrist of this century, had long maintained that "all people have mental illness of different degrees at different times"; his brother William devised a system to prove it.

All Men are Created Equal--All Men are Mad

Once the formal definitions were established, thanks to the Army and General Menninger, the game was open to any physician, social worker, cop or bureaucrat who learned the rules and wanted to play. As a result, reputable surveys in the mental-health field regularly maintain that anywhere from ten to 60 percent of the American population can use psychiatric attention at any given time. There is Nathan S.Kline, the director of research at New York's Rockland Research Institute and one of the leading promoters of the "gentle restraints of tranquilizing medication," who claims that between 7,000,000 and 15,000,000 Americans are in need of treatment for depression but are not receiving it. New York psychiatrist Ronald Fieve, who believes that Abraham Lincoln, Theodore Roosevelt and Winston Churchill could have benefited from drug therapy and who estimates that between 18,000,000 and 20,000,000 Americans suffer from depression. Or the Midtown Manhattan Study, which in 1962 declared that 24.4 percent of adult Americans suffer from psychological disorders.

Uncle Sam is a Pusher

During the past generation, much of the mental-health network has become a drug-dispensing system in which medication is the basic, and often the only, mode of treatment. The Federal Government, though it collects data on the most minute details of the mental-health system, has strangely never gathered any information on the percentage of people drugged--even in Government-supported institutions--or on the kinds of drugs provided, their dosages or the diagnoses upon which they are administered.

But even with the paucity of Government statistics, there are some indications of the extent of patient drugging: At San Francisco's West Side Community Mental Health Center, regarded as one of the most enlightened facilities on the West Coast, 52 percent of the outpatients are on drugs; across the bay in Richmond, a local mental-health clinic was revealed in 1977 to have more than 80 percent of its outpatients on drugs; and in a group of 20 clinics associated with Los Angeles County Mental Health Services, enough money is budgeted to provide a bottle of pills for each client each time he or she goes into the clinic for a visit.

Psychiatric staffing within mental-health clinics is generally so low that the cheapest and fastest way to handle a difficult patient is to hand him a bottle of pills or a prescription, sometimes torn from a preprinted and pre-signed pad. The ramifications of such procedures are illustrated by the case of "Edna McGuire," a woman who had been hospitalized several times after making obvious but ineffectual suicide gestures in the presence of her boyfriend. Discharged from the hospital, she is enrolled in a local outpatient clinic, where she sees a therapist once a month, or once every other month, and where on each visit she gets another set of refill prescriptions for her tranquilizers and for a drug that is supposed to control the twitches, rigidity, dry mouth and other side effects of the tranquilizers. The clinician's notes for each visit generally consist of one-or-two-line entries: "Doing OK--needs appt."; "Doing well--saw son after two years--thinks she has diabetes--will call for appt."; "In for meds--getting nervous again"; "Worried about everything but life has never been better"; "In for pills--doing OK." And after each visit, the clinician records, "Meds refilled" or "Meds."

During three years of treatment, Edna McGuire has consumed nearly 8000 pills; she has not had a medical examination during this time and no serious attempt has been made to help her change her dreary life. After one of her suicide gestures landed her in the hospital, the physician who prescribed most of the pills outlined his "plan" for her treatment: "Medicate, and hope for the best."

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Medicate; above all, medicate. Concurrent with the postwar growth of the mental-health network was the emergence of behavior-control drugs. While amphetamines and barbiturates, the classic uppers and downers, had been standard pharmacology items for a number of years, the real breakthrough in this area came in the early Fifties, when a group of French physicians and pharmacologists stumbled onto the chlorpromazine today known as Thorazine.

The French group had been searching, one of them would later say, for a drug that might produce the "cold-bloodedness, 'indifference' or ataraxia extolled by the Stoics," and they found that Thorazine "reproduced in warm-blooded animals conditions existing in cold-blooded or hibernating ones." While Thorazine was originally intended for use in surgery to slow heart rate, pulse and other organic functions, in 1951, French psychiatrists tried the drug on manic hospital patients--only to find its effects "interesting but not strong enough." The next year, doctors tried it on schizophrenics, with somewhat better "effects," and by 1954, physicians on both sides of the Atlantic were administering it to thousands of institutionalized patients with what Thorazine advocates, then and now, regarded as near miraculous results. As Frank J. Ayd, Jr., a Baltimore psychiatrist and one of the most vocal American advocates of psychotropic medication, said recently, "You will be impressed by the serenity [in mental hospitals]. You will sense the attitude of realistic optimism that predominates. Flowers, curtains, paintings, music, fresh air and comfortable, tidy lounges make a pleasant environment for clean, tranquil patients."

Predictably, the mental-health profession and the drug industry promised not only to remedy such formal categories of mental illness as schizophrenia and depression but also to cure a long list of maladies that had never been regarded as diseases. The result can be seen in the medical and psychiatric journals of the past two decades, journals whose pages are laden with advertisements showing women with anxious faces and disheveled hair standing in front of stacks of dirty dishes, or women cowering behind prisonlike bars, holding mops and brooms; and under the photos are the reassuring messages: "You can't set her free, but you can help her feel less anxious"; "In premenstrual tension, your prescription of Equanil can help ease his wife's anxiety, thus reducing her irritability and nervousness"; "She has insomnia, so he's awake. Restless and irritable, she growls at her husband. How can this shrew be tamed?"

Women are not alone in this mélange. The pharmaceutical house Hoffman-LaRoche conjured up an anxious college student for whom "exposure to new friends and other influences may force her to re-evaluate her goals" and for whom Librium might be a savior. Meanwhile, McNeil Laboratories checked in with a picture of a swarthy, thick-lipped young man who, fist clenched, is snarling at the camera. "Assaultive and belligerent?" asks the text. "Cooperation often begins with Haldol. Acts promptly to control aggressive, assaultive behavior."

The message is clear: If you can't cure, control.

Medicate. The patients walk in or are coaxed in or are dragged in: the 65-year-old woman whose eccentricity has been an embarrassment to her suburban children and who thinks that the injections she gets at the clinic are for her back pains; the student drugged with tranquilizers after a Saturday-night brawl; the housewife dosed with Elavil after her doctor convinces her that she is having a breakdown because she refuses to cook her husband's breakfast; the kid on Ritalin because he--like most kids--can't sit still in school; the black teenaged girl who "assaulted a ten-year-old boy for calling her names" and who, after five days in a locked ward, is dosed with four different drugs, including a tranquilizer that is given in amounts roughly double the maximum recommended in the medical manuals.

The patients are labeled depressed or hyperactive or schizophrenic, sometimes at random and often with only the most cursory examination. They are drugged accordingly and, if they continue to misbehave, they are drugged some more.

The majority of the over 30,000,000 Americans who are regular users of prescription psychoactive drugs have never visited a psychiatrist or had any other formal contact with the mental-health network. They get their prescriptions from internists, gynecologists, pediatricians and general practitioners who know even less about the drugs than do the psychiatrists. Most of the drug users are women and the heaviest users of all are women in the lowest quarter of the economic scale--women in tract houses going "crazy" trying to take care of three or four young children without help, sympathy or day care. But they have lots of company, these "crazy" ladies, including hundreds of thousands of office, farm- and factoryworkers, truck drivers, airline stewardesses, telephone operators, waitresses and students who use tranquilizers, amphetamines or other drugs to get them through the day (or night) and who often take them right on the job.

What these people and millions of others have learned--what the drug industry and the mental-health profession have taught them--is that they have not only a right but an obligation to be free of "anxiety," "tension" and other forms of "psychic distress"; that there is no difference between being bad and being sick; and that things such as character, responsibility and behavior are themselves only vestigial words that actually describe chemical and mechanical effects of the brain.

In the process, the professionals have medicalized--and thus legitimized--mood and behavior control for everyman. Beyond the Valium is the nervous breakdown and beyond the breakdown is the Thorazine, the hospital and the shock treatments. What's illegal when it's bought on the street is blessed when held in the ministrating hands of the man in the white coat.

Psychotropic drugs, including hallucinogens, have been used for thousands of years, but the drug revolution that began with Thorazine in the Fifties democratized an idea that, until then, had been regarded as the exclusive province of totalitarian societies and futuristic novels: Virtually everyone is out of control; virtually everyone is to some extent the unaccountable victim of his own chemistry; and virtually everyone's mind can be regarded as a proper object of manipulation.

The drugs involve everyone in the ideology of mental health, whether he is formally a part of the network or not; we all help transform every physician into a parapsychiatrist and he, in turn, imposes on us a reconformation of the normative standards that the dominant culture imposes. It is a closed loop: Mental health legitimizes the drugs; the drugs legitimize mental health. In traditional psychiatry, the subject of mental health largely consisted of speculative chatter and was therefore subject to debate; with the advent of behavior-control drugs, however, mental health became a specific "scientific" discipline, one whose power increases daily and which tolerates no debate.

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Philadelphia, Nov. 19--Wearing a blue delegate's ribbon and a tiny gold peanut pinned to her blue dress, Rosalynn Carter announced today that her husband had promised to establish a President's commission on mental health after he takes office.

The announcement drew prolonged applause. Her listeners were some 500 delegates to the annual meeting of the National Association for Mental Health.

The majority seemed to share the view of the South Carolina delegate who said... "Rosalynn's interest in mental health will give our organization a tremendous boost."

Mrs. Carter told the delegates here that her interest in mental health dates from Jimmy Carter's 1970 campaign for the Georgia governorship. Mrs. Carter said that as she traveled around the state, she was amazed at the number of people who told her of mental-health problems in their families.

"I began to realize that something had to be done," she said, "and that we were the ones that had to do it."--The New York Times, November 20, 1976

For all the medical hazards, the most dangerous effect of the ideology of drugging as a means of behavior control lies in what it teaches us about the right and duty to be normal. Such an ideology creates the illusion that it is science, not the uncertain standards of politics and culture, that determines normative behavior; that to be a good patient is to be a good citizen; and that the presence of an arbitrary social authority is part of the natural order.

The historic American faith in human transformation and social betterment was not the exclusive possession of a single class or caste of experts, nor was it in any sense manifested in a technology or in a policy of government--other than the policy of nonintervention itself. As a practical matter, this faith therefore devolved to individual responsibility, to such hoary personality qualities as character, will and ambition. The original American mystery was, at least in theory, and at least for white men, a celebration of the ability of everyman to cope for himself and of the society to create conditions--mainly by leaving him alone--in which he could successfully do so.

Under the new mystiques and techniques of mental health, that faith is rapidly being replaced by an ideology that teaches the individual that he is a victim of his own chemistry and neurological circuits, a mechanical device to be tuned, repaired and pacified by experts who know more about him than he does. If he rebels or deviates from social norms, therefore, it is not because he has chosen to do so, or because there is something wrong with the norms, but because he is sick. Not culpable, not malfeasant, not criminal--but sick. And each instance of intervention narrows the bounds of acceptable behavior for the rest of the population; each person formally declared deviant brings the next person closer to the margin.

The ideology and the propaganda that condition people to accept mental-health services are themselves reinforced, at least for the moment, by the Government's need to control the growing number of superfluous people--the young, the old, the unemployed--who are no longer subject to the conventional controls of the market or who, because of changing standards of community acceptability and social hygiene (standards themselves promulgated by the new industries of intervention), have been declared presently or potentially deviant. For these citizens, medical and behavioral sciences cancel the protections of due process and make unnecessary the overtly invidious (therefore more resistible) distinctions of class, race, age or sex.

Slowly, subtly, humanely, science repeals the Constitution. Eventually--tomorrow, 50 years hence--we and our progeny will no longer know or care whether we are being served or controlled, treated or punished, or whether we are volunteers or conscripts. The distinctions will have vanished.

"There evolved a series of categories that would fill the military's neat bureaucratic forms."