♪
(indistinct chatter)
CATHRYN JOHNSON: What were you
diagnosed as having?
JEREMIAH ROBINSON: Anxiety
JOHNSON: Mm-hmm.
ROBINSON: PTSD.
JOHNSON: Mm-hmm.
ROBINSON:
Depression,
bipolar, and schizophrenia.
JOHNSON: Wow.
ROBINSON: I've been in
state penitentiary two times.
And I've been locked up in here,
in Cook County,
I can't even count how many
times.
Not too long ago,
I was diagnosed with all those
different type of illnesses.
I really didn't buy it at first
because I was just thinking,
like, maybe the feeling
that I was having
was more, like,
from me being incarcerated.
And when a psychiatrist
was asking me personal questions
like, what I've been exposed to,
what type of drugs I was using,
like, how many people
I know had been m*rder*d
They were explaining to me
that those are the reasons
that I probably have
the illnesses that I have today.
When I don't medicate,
I don't be in my right state
of mind.
So it's like, you know,
having that good angel and
that bad angel on your shoulder.
I wonder, like,
where does it come from?
I don't even know where to find
help out there in the world.
♪
♪
NARRATOR: Mental illness
is rife with mysteries.
After centuries of searching,
there are still
no reliable cures.
and even diagnoses change
over time.
The one constant;
those labeled mentally ill
have always faced stigma.
♪
ASHWIN VASAN: Stigma is about
otherizing people
that are different to yourself.
We've done that
from time immemorium
for people with mental illness.
We have never seen them
as fully human,
and therefore fully deserving
of all of the menu of rights
of a human being.
And so the systems we have
are simply a result of that.
♪
(bird squawking)
NARRATOR: Today, America's
largest mental health facilities
aren't hospitals, they're jails.
TOM DART: When I first became
sheriff here in Cook County,
I honestly didn't truly
understand
what I was getting myself into.
INTAKE SCREENER:
Have you ever been diagnosed
with any mental illnesses
or any mental health issues?
Bipolar 1 disorder.
INTAKE SCREENER:
When you felt depressed,
has it lasted every day,
for two weeks,
or longer?
- Give or take.
- Give or take?
Yeah.
INTAKE SCREENER:
What diagnosis
qualified you for that care?
- Bipolar.
- Okay
- Interpersonality disorder.
- Okay.
DART: Entire divisions
were filled with people
who were mentally ill.
Our population pretty
consistently is
40% with a diagnosed mental
illness.
(indistinct chatter,
cell door creaking)
NARRATOR:
About 50,000 people pass through
Chicago's Cook County jail
each year.
Over 90% are people are color.
♪
SIDNEY HANKERSON: As a result
of institutionalized racism,
and the legacy of mass
incarceration in this country,
we know that Black men
with mental health problems
are more likely to be
brought in by police compared
to white men.
Now there is
an increased awareness
of the racial injustice
that our country is facing,
and the field of psychiatry is
at the center of this reckoning.
♪
NARRATOR:
Like many here,
Jeremiah Robinson grew up on the
south side of Chicago.
ROBINSON: It was a pretty okay
neighborhood for me,
but as I got a little older,
it started to be a little bit
dysfunctional.
♪
A lot of drug dealing,
people getting hurt, violence.
I was an A and B student.
But I kind of messed up
a little bit in high school.
I was fighting a lot.
NARRATOR:
In high school,
Jeremiah was twice referred
to a mental hospital.
ROBINSON: They figured that
I had a behavior problem,
but I didn't realize that
I was having a mental problem.
(people speaking indistinctly)
NARRATOR: Jeremiah is awaiting
trial for parole violation
and weapons possession.
This is his 15th arrest.
Past charges include drunk
driving and drug possession.
ROBINSON:
I definitely know that there's,
there's some type of problem
that's affecting me.
(people speaking indistinctly)
NARRATOR: Jail and prison
psychiatrists diagnosed him
with schizophrenia, anxiety,
bipolar,
and post-traumatic
stress disorder.
ROBINSON:
This, this picture right here,
it's like of my daughter,
it's just a off-the-head
type of sketch.
I ain't finish it up though,
I just, kind of get a little
My anxiety kick in a little bit
and, you know,
and I don't want to
I tend to, like I say,
I can't stay focused on one
thing for too long,
so I wind up
doing something else.
So that's why I didn't
complete the drawing though.
♪
JOHNSON:
I kind of think of the jail
as almost the emergency room;
here's where we stabilize you,
right?
So you're going to need some
long-term care
after you're stabilized.
There isn't any one place
that we can send them to,
to make sure that they're
cared about
once they leave the jail.
It just doesn't exist anymore.
♪
NARRATOR:
How did this happen?
How did prisons and jails
become a front-line treatment
for the mentally ill?
♪
"What to do with
the mentally ill?"
is not a new question.
Cures have always been elusive,
and societies have often viewed
those living with mental illness
as a burden and treated
them as disposable.
For centuries, families paid to
confine relatives to "madhouses"
which provided shelter
but little treatment,
while prisons and hospitals
like the infamous
Bedlam in England
locked them in cells.
GEORGE MAKARI:
Bedlam was a tourist attraction.
Patients were gawked at.
They were treated in deeply
inhumane ways
As deviants,
and morally deficient.
Essentially like
they're criminals.
NARRATOR:
The line between treatment
and punishment often blurred,
with exorcisms,
blood-letting,
and even extreme mechanical
devices.
ANDREW SCULL: They're two
different moral universes.
One sees this as entirely
appropriate,
exactly what you need to do
with violent madness.
And the other sees it as, as we
might, as intolerable cruelty.
♪
NARRATOR: One American woman
who found it intolerably cruel
was schoolteacher Dorothea Dix.
ANNE HARRINGTON: Dorothea Dix
was a very unlikely reformer.
She wasn't highly educated.
She was a woman
in a time when women
had very little,
if any political power.
NARRATOR:
In early 19th century Boston,
Dix founded a school for girls.
She taught the poor for free.
But her own struggles with
depression
eventually led her to England
and a new kind of treatment.
HARRINGTON: She made
the acquaintance of Quakers.
They created the first
alternative to the madhouses
called the Tuke's Retreat,
the place where benevolence
as opposed to harsh treatment
predominated.
SCULL: It's a very different
kind of approach
known as moral treatment, which
tries to coax the madmen
back into reality, tries to
encourage his or her ability
to control themselves rather
than be externally coerced.
♪
NARRATOR: Inspired by this idea
of "moral treatment,"
Dix returned to the U.S.
She taught at a women's prison
and saw mentally ill inmates
chained to walls,
in unheated cells.
Her outrage earned her
the nickname
"Angel of the Madhouses."
MATTHEW GAMBINO: She saw it as
very much her moral mission
to petition local legislatures,
state legislatures,
and ultimately the federal
government to create facilities
that drew from the
United Kingdom,
where patients would be treated
as human,
and would be brought into
a small social order.
ROBERT KIRKBRIDE: But she was
not permitted as a woman
to debate or present her ideas.
It had to be men representing
her arguments among other men.
NARRATOR: On June 27, 1848,
Dix sent a proposal to Congress
requesting a vast system
of federally funded asylums.
It concluded:
"May it not be demonstrated
"as the soundest policy for
the federal government
"to assist in diminishing and
arresting widespread miseries
"which mar the face of society,
and weaken the strength
of communities?"
After much debate,
the government rejected Dix's
appeal for national reform.
(projector whirring)
But many states were drawn
to her compassionate approach.
RALPH DIDLAKE: Dorothea Dix
visited Mississippi
as she did many states,
and she was successful
in getting the Mississippi
legislature
to appropriate money to build
an asylum.
And it was indeed,
in 1855 when it opened,
a state-of-the-art facility,
a so-called Kirkbride structure,
using what was then
state-of-the-art care
for the mentally ill.
NARRATOR: Thomas Kirkbride
A Quaker doctor
laid out detailed plans
that were the basis
for the Mississippi asylum and
many others across the country.
Dix embraced his belief
architecture could support
moral treatment.
Robert Kirkbride is
Thomas' distant relative.
KIRKBRIDE:
Kirkbride built these structures
as places for people
who had no other place.
These were castles
that were built
for those who are not
aristocracy.
They were intended for people
who were dispossessed.
MAKARI:
The notion of asylum,
of a retreat from the world,
was not just, like,
a place to rest.
It was a place to be cured.
The idea was if you had a
curative environment,
you could actually
cure mental illness.
NARRATOR: The buildings had a
distinctive bat wing formation.
KIRKBRIDE: The further you went
out into the wings,
the more extreme the cases
became.
The cases that
were the most likely
to return soon to the world
were closest
to the central main
administrative building,
where often
the superintendent lived.
NARRATOR:
Kirkbride believed
natural light encouraged
healing,
so there were large windows
and high ceilings,
wide hallways for socializing,
and large rooms
for occupational therapy.
KEITH WAILOO: Dorothea Dix
and hospital reformers
saw these institutions
as places of moral order
where the new regimens
that could be created
for the mentally ill
were themselves therapeutic.
DIDLAKE: There was not a lot of
specific treatments,
certainly not
pharmacological treatments,
other than calming the patients,
and occupational therapy,
allowing them to walk
on the grounds.
NARRATOR: Kirkbride's asylums
were to be set off
from the rest of society,
so quiet and nature could
calm the mind.
JEFFREY LIEBERMAN:
Even the term that was used
to describe the doctors
who were responsible
for these places,
they were called alienists,
because they were alien
to society.
And people with mental illness
were alien to society.
They existed
in this other world.
♪
NARRATOR: The goal was
to rehabilitate patients
and send them back to society
as productive citizens.
VASAN: The history
of moral treatment
is grounded in that
intrinsic human truth,
which is that people need
things to do that are
of their own choice
in places where they feel safe
and to build up experiences
that help them
overcome their disability,
or at the very least,
manage the disability
that arises
from chronic serious
mental illness.
NARRATOR: Dix's call
for compassionate care
swept America.
But her utopian vision soon
collided with harsh realities.
♪
Across the country,
ruins are among
the last remnants
of these palaces
for the dispossessed,
designed to cure mental illness
a century and a half ago.
♪
What happened
to these places of healing?
KIRKBRIDE:
Kirkbride was specific.
From the very beginning,
he said 250 patients
at a time in a state hospital,
and do not go above that.
That almost immediately
was outstripped.
♪
NARRATOR: Just as moral
treatment took hold,
the Civil w*r ravaged America.
♪
It siphoned resources
and drove thousands of
traumatized people
to asylums like the one
in Mississippi.
DIDLAKE: Like many institutions
in the state,
it suffered in
the immediate postwar period.
There was overcrowding
and under-resourcing.
And it was almost immediately
overwhelmed by the need
to care for the mentally ill.
NARRATOR: After the w*r, in
Mississippi's segregated wards,
Black patients were often forced
to sleep on the floor,
and they died at twice
the rate of whites.
♪
Over decades, some 30,000
patients came through.
Many never left.
The asylum's cemetery
was only recently discovered.
♪
MOLLY ZUCKERMAN:
In the fall of 2012,
construction work was happening
on the University of Mississippi
Medical Center's campus.
And they stumbled upon a burial.
♪
In total, 68 human skeletons
were excavated from the site.
So we used
ground-penetrating radar
to map out where burials might
be in the remainder of the area.
We've estimated approximately
7,000 burials on the site.
There are no institutional
records that allow us
to determine with any certainty
who is buried in what particular
part of the cemetery.
NARRATOR:
Of the 7,000 burials,
not a single one has been
identified.
(birds chirping)
And there's no trace
of the grand Kirkbride asylum
that once stood here.
♪
But records in the
state archives
reveal why many were admitted
and how many died.
LIDA GIBSON: You have
to be careful with them.
ZUCKERMAN: Yes
Do you want to follow this one?
GIBSON: Yeah, sure
so let's see who this is.
This would be John Ross,
and he was a farmer from
Holmes County.
Chronic mania and then
ZUCKERMAN:
Is the form of mental disorder?
GIBSON: Is the form of mental
disorder.
ZUCKERMAN (voiceover):
The assumption was that people
would recover quickly
and be able to be released.
GIBSON:
Here's a dementia praecox,
which is now called
schizophrenia.
Epileptic mania, acute mania,
recurrent mania,
depressive mania.
ZUCKERMAN (voiceover): But there
were extremely limited
treatment options,
so a lot of these people
were going to be there
for the rest of their lives.
GIBSON: Here's a man named
Willis Barnes,
and, my goodness,
he had 20 kids.
And the reason he was admitted
was worry.
NARRATOR:
Hardships outside the asylum
often led people to its doors.
And poor nutrition was one
common culprit.
ZUCKERMAN: A lot of people
who were involved
in cash crop agriculture,
so primarily cotton production,
were not able to produce
agricultural products
on their farms
that they could eat
and instead they were dependent
on what they could buy,
which was primarily
processed corn meal.
Those really protein-deficient
diets resulted in
pellagra, which is
a vitamin B deficiency.
"Pellagral insanity."
GIBSON: Mm-hm.
ZUCKERMAN:
Died from pellagra.
GIBSON:
Huh.
NARRATOR:
Pellagra could led to dementia,
and was a common cause
of admission and death.
ZUCKERMAN: Everybody on this
page died of pellagra.
(voiceover):
It wasn't known exactly
what caused pellagra,
and so it wasn't something
that could be
effectively treated.
GIBSON:
So this is quite a run here.
We have, syphilis, syphilis,
unknown,
TB tuberculosis
And syphilis.
NARRATOR: Nearly a quarter of
asylum patients had syphilis
the sexually transmitted
bacterial disease
a leading cause of psychosis.
GIBSON: Then their form of
mental disorder is acute mania.
ZUCKERMAN (voiceover): The
increase in cases of syphilis
into the early 1900s
is really, really dramatic.
And you would not have recovered
from this disease.
So we have kind of burgeoning
populations
in all of these asylums and an
inability to provide caretaking
that is necessary for them.
GIBSON: Here's a teacher
from Warren County,
which is Vicksburg,
and her form of mental disorder
was nymphomania.
NARRATOR:
Patients could be admitted
if a family member merely
claimed they were insane,
and two physicians backed it up.
GIBSON: She was there for 11
years, six months, and 20 days,
and then she died.
♪
WAILOO: The idea that people
could die
in institutions
and just be buried there
without any public accounting,
without any public awareness,
and that these stories
could be unearthed
many, many decades later
highlights one of
the fundamental problems
with asylums.
People were literally
out of sight, out of mind,
and in many instances,
forgotten.
(film music playing)
FILM NARRATOR:
Sanctuary,
refuge, hospital
This is no snake pit.
The doors are locked, but
it's not a prison that we enter.
For these locks
are meant to protect patients.
WAILOO:
One of the major problems
was that there
was this sense that they were
evolving outside
of any public view,
outside of
any political oversight,
and in a world by themselves.
The practices
there were unaccountable.
NARRATOR:
By the early 20th century,
asylums overflowed
with patients.
Some Kirkbride facilities housed
nearly ten times more
than originally planned,
with only one doctor
for hundreds of residents.
♪
And these doctors
understood little
about how to cure
mental illness.
LIEBERMAN: We didn't know very
much about the brain,
how it worked,
and what happened to cause
someone to become mentally ill.
I mean, we knew that
the brain was an organ,
and we knew it resided
inside the skull,
and we knew it was really
an amalgam of many, many cells
called neurons
that were wired together.
But we didn't know
how they fit together,
we didn't know
what functions they served.
And so, we could do nothing
to really treat people
with severe mental illness.
NARRATOR: To handle the
ever-growing patient population,
states expanded
Kirkbride buildings
and constructed
new, giant asylums
including the world's largest
hospital of any kind
"Pilgrim State" in Long Island,
which held more than
13,000 patients.
Out of view from the public eye,
desperate doctors experimented
with new treatments.
SCULL: There are a lot
of experimental therapies
that now strike us as quite
bizarre, even sadistic.
It's important
to understand that
the people doing these things
were very often true believers
in what they were doing.
They sincerely thought
that their interventions
were therapeutic
and well-motivated.
♪
LIEBERMAN: The treatments
that were attempted
were based on speculations.
And in most cases,
they proved to be wrong.
♪
NARRATOR:
In 1927,
an Austrian doctor
won a Nobel prize
for his radical approach
to treating patients
with psychosis
so-called "malaria therapy."
LIEBERMAN:
He had observed that
when patients in his asylum
developed a fever,
it often made them better.
So he thought,
"If I induce a fever,
this will be therapeutic."
So he would take
the blood of malaria victims
and inject it
into mentally ill persons.
But he wasn't actually
alleviating
the psychotic
symptoms of schizophrenia,
he was curing
or improving people
who had syphilis of the brain,
and the high fever
was k*lling the microorganism.
NARRATOR:
While "malaria therapy"
did help treat some
psychoses caused by syphilis,
the treatment didn't work
for other ailments,
and could be deadly.
SCULL: When they had to explain
away the fact that
they'd originally promised
they'd cure all these people
they put into asylums
and then they couldn't,
they said, "Well, really,
"that was because they were
biologically defective.
They weren't fully human,
they were degenerates."
The language became extremely,
extremely harsh.
GIBSON: "It is for the best
interest of the patients
"and of society, that
any inmate of the institution
"under his care should
be sexually sterilized.
"Such superintendent
is hereby authorized
"to perform the operation
of sterilization
on any such patient
confined in the institution."
DIDLAKE:
In 1928,
the Mississippi
legislature passed a law
allowing sterilization of the
mentally ill without consent.
NARRATOR: Similar laws swept
the nation, fueled by eugenics
a theory that categorized both
the mentally ill
and the mentally deficient
As inferior.
MAKARI:
Eugenics is a kind of discipline
that was founded
by Francis Galton,
who was related
to Charles Darwin,
where the idea was that the
genetically feeble
should in some way be winnowed
out of the population.
♪
That was an idea that was
favorable to both conservatives
as well as progressives
who really looked forward
to a bright future.
♪
NARRATOR:
Over decades,
tens of thousands of men
and women
in state-run institutions were
sterilized against their will
often without their knowledge.
ANGELA COOMBS: You go in for
a different procedure,
you come out, and
you're not able to reproduce.
So this was happening
in the context of eugenics
being looked at as
some legitimate science,
so that you could then justify
not allowing people
to reproduce.
(man in film speaking German)
MAKARI: This eugenics program
in the United States
kind of looped back to
n*zi Germany,
where the Nazis oversaw
the m*rder of over
200,000 psychiatric patients
in what was considered
to be a prelude to
the m*rder of then the disabled,
and then of course the Jews.
NARRATOR: Why were the ideals
of moral treatment
set forth by Dorothea Dix
no longer upheld?
♪
While American eugenicists
didn't go as far as the Nazis,
psychiatrists
were desperate to control
the number of mentally ill.
After World w*r II, asylums
were reaching their peak,
housing more than
half a million patients.
MAKARI: The notion that these
were curative places
transformed into the notion
that they were hellholes,
that they were huge institutions
that warehoused people.
SCULL: People condemned to the
back wards of a mental hospital
were going to be there for life.
And it was an almost
inhuman existence.
So anything you might do
that would rescue them
was perhaps worth trying.
MAN: Six centimeters
above the zygoma,
in the coronal suture,
the opening is made.
Turning now to the brain,
the frontal lobe is bounded by
the Sylvian fissure
NARRATOR: The workings of
the brain remained mysterious,
but after observing patients
with head injuries or strokes,
a theory emerged that damage
to an area of the brain
called the frontal lobe
altered personality and
behavior.
Some wondered, could surgically
severing the frontal lobe
cure mental illness
and possibly even
make asylums obsolete?
SCULL: The idea
was that madness emerged
because the frontal part
of the brain,
the most distinctively human
part of the brain,
had somehow gone awry.
And the connections between
the front and the back
of the brain
had become twisted
and distorted.
And if we could somehow
interrupt some of them,
we could interrupt the madness.
NARRATOR: In 1936, Washington,
D.C., neurologist Walter Freeman
performed the first lobotomy in
the United States.
SCULL: It was widely seen as a
kind of miraculous intervention
in the course of psychosis.
There were some patients
who were clearly damaged,
but nonetheless
had lost their obsessions
and their involvement with
hallucinations and delusions,
and were able to function
more or less,
perhaps even be discharged
from the hospital,
as quite a number of them were.
Many of them became
vaguely happy all the time.
And so,
in the context,
some people saw that as
a trade-off worth making.
♪
There was a huge
lobotomy program at Harvard,
at Yale, at Columbia.
It spread everywhere.
NARRATOR:
Even far outside the asylums.
In 1941, 23-year-old
Rosemary Kennedy
younger sister of
future president John
Became one of
Walter Freeman's patients.
Rosemary was developmentally
challenged from birth.
HARRINGTON: She had been
very carefully trained
and kept on a
very, very tight leash,
but there was growing concern,
particularly by Joseph Kennedy,
the father,
that Rosemary
was starting to rebel.
She wanted to be
like everyone else
and have a life.
It was felt that, you know,
she could end up pregnant.
And this would be
a great embarrassment.
It was suggested to
Joseph Kennedy
to lobotomize her.
It would make her docile.
MAN: The first mark is made
three centimeters behind
the lateral rim of the orbit.
NARRATOR: Rosemary would be
unable to walk or speak
after her psychosurgery.
MAN: Another mark
is made in the midline,
13 centimeters
from the glabella.
NARRATOR:
Her parents would send her
to a privately run institution
and keep the details
of her procedure secret,
even from her siblings.
MAN: Operations can be performed
under local anesthesia
if the patient is
sufficiently cooperative.
ANDREA TONE: Women tended to
be lobotomized more than men.
In part because
husbands reported back
saying how happy they are
that their wife has been
restored
and will now do housework
and leave their home
cleaner than it ever was.
SCULL: Because each operation
took an hour or two
and involved a very scarce
commodity, a neurosurgeon,
well, you know, this was not
good.
NARRATOR: So Freeman found a way
to streamline the operation.
Instead of accessing
the frontal lobe
by drilling holes in the skull,
he took a shortcut
through the eye socket
using a tool modeled
after an icepick.
SCULL: That enabled lobotomy
to be done very fast.
Most patients were confined
in mental hospitals
against their will.
When that happened,
they lost their civil rights,
they lost any access
to the outside world.
Their wishes
were considered to be
the product of their psychosis.
So doctors certainly
performed many lobotomies
on patients who
had no say whatsoever.
♪
NARRATOR:
But by the early '50s,
a new revolution would end
the lobotomy craze
and change asylums forever.
MAN:
This real chance for many of us
to get well again is
due to research
in mental illness.
And one of the most hopeful
contributions of that research
is new drugs.
It says over here you
heard voices is that true?
- Yes.
- Hm?
ALLEN FRANCES: All of the drugs
in psychiatry
were discovered serendipitously
by accidental clever
clinical observation.
SALLY: This is me
when I came to the hospital.
I was very upset
from many worries.
What did the voices say
to you, Sally?
(unintelligible)
FRANCES: Thorazine,
the first antipsychotic,
was discovered because
it was being used by surgeons
as an antiemetic,
so people wouldn't throw up
during operations,
and it calmed the patients down.
SALLY: This is me
after the doctor gave me
some medicine to help me.
DOCTOR:
And you were telling me
there was something wrong
with the neighborhood,
- is that right?
- Mm-hmm.
Now I'm not so mixed up.
I talk to him okay.
LIEBERMAN:
There's no question that
in the scope of history,
when it comes to
understanding mental illness,
the real turning point
came with the introduction
of Thorazine.
NARRATOR: The effects
of these drugs on Sally
and patients like her
led scientists to a new theory:
that antipsychotics alter levels
of a chemical in the brain
called dopamine.
Dopamine was one of
dozens of neurotransmitters
discovered over time.
LIEBERMAN:
In identifying these,
seeing what parts of the brain
those were operative in,
we developed drugs
and used them to treat
various types of
neuropsychiatric conditions.
NARRATOR:
To this day, how exactly
changes in brain chemistry
lead to changes
in thought and behavior
remains unknown,
but in the 1950s,
antipsychotics let asylums
do the unthinkable:
send patients home.
DOCTOR:
What's the difference?
I feel like I talk just to myself.
I don't feel like talking
to nobody else,
just to myself.
Patients who were hitherto
unmanageable
or untreatable
or who had resisted
all other forms of treatment
now have been helped.
SALLY:
I am very happy to go home.
TONE: When Thorazine first
came onto the market,
it was advertised as
a chemical lobotomy.
The idea that patients
who may not have had
much hope before
could take a pill
and be discharged
from a hospital,
it was quite miraculous.
NARRATOR: Antipsychotics had
serious side effects,
but almost immediately
reduced the need for
mass institutionalization
just as it reached its height.
SUSANNAH CAHALAN: The height
of the asylum population
was about 1955.
And at that point,
I think 550,000 people
were, were hospitalized.
This was a major part
of the fabric of society.
You probably knew
multiple people
who had been hospitalized.
NARRATOR:
The advent of pharmaceuticals
fueled deinstitutionalization.
But as patients left the asylum,
they also left
the institutional safety net
Dix's moral treatment
had provided.
GAMBINO: One of the things
that we often overlook
is how much agency
patients themselves had
about their lives
and creating the world
in which they lived.
They formed relationships.
They wrote
institutional newspapers.
They found forms of
self-expression
in an otherwise impoverished
and brutal environment.
MAN: But suddenly now,
there is new hope for all.
For you, the public,
who pay the bills,
and for us, the mentally sick.
VASAN: People
with serious mental illness
who were leaving
psychiatric hospitals
said to themselves,
"We need a place to go.
"No one really wants us.
"No one will employ us.
"Where can we go that's safe,
"and actually rebuild
our lives in some fashion,
to whatever degree
we can do that?"
NARRATOR: Patients and
advocates worked to build
a patchwork system of
locally based community care.
Some leaders paid attention,
and looked for alternatives
to institutionalization.
MAN: John Fitzgerald Kennedy,
do solemnly swear
KENNEDY:
I, John Fitzgerald Kennedy,
do solemnly swear
NARRATOR: When John F. Kennedy
became president in 1961,
he'd only recently learned about
the disastrous outcome
of his sister
Rosemary's lobotomy.
FRANCES: Kennedy himself
had a strong, I guess, guilt
and desire to
improve the life of
the mentally ill in the country.
So help me God.
(applause and cheers)
NARRATOR: Like Dorothea Dix
more than a century before,
he called for America
to treat the mentally ill
with greater compassion.
KENNEDY: The mentally ill and
the mentally Ret*rded
need no longer be alien
to our affections
or beyond the help of
our communities.
Under this legislation,
custodial mental institutions
will be replaced
by therapeutic centers.
♪
NARRATOR: Congress passed
the Community Mental Health
Act of 1963
to fund the alternative programs
patients and advocates
had initiated.
This was Kennedy's
last legislative victory.
He was assassinated
three weeks later.
KENNEDY: I think that
in years to come,
that those who've been
engaged in this enterprise
can feel the greatest source
of pride and satisfaction
and that they will
recognize that there were
not many things that they did
during their time in office
which had more
lasting imprint on
the well-being and happiness of
more people.
So I express all
of our thanks to them,
and I think it's
a good job well done.
CAHALAN: In that speech,
JFK saw a vision of the future
where 50% of the population
would no longer need
to be hospitalized.
FRANCES:
The promise was great.
It was an era
of democratization.
The patients
were very much involved.
We were not only going to be
changing the world
for the severely ill
who were discharged,
but we also had high hopes
that we could help improve
the whole mental health
of the communities.
♪
NARRATOR:
Then, in 1965, President Johnson
signed Medicaid into law
to cover medical costs
for low-income Americans.
But psychiatric hospitals
with more than 16 beds
were not covered.
One goal was to steer money
into community care
and away from asylums.
♪
These castles,
optimistically built
to cure the mentally ill,
hadn't fulfilled their promise,
and opposition to them
reached a crescendo.
DOCTOR: When were you
admitted to the hospital?
WOMAN: It was
about five weeks ago.
DOCTOR: And who actually
brought you to the hospital?
My husband.
And six policemen
in three police cars.
FRANCES: It began
to be expressed that
any form of
involuntary hospital commitment
was a crime of the state
against individual liberty.
SCULL: And then
came the Hollywood movie
"One Flew Over
the Cuckoo's Nest."
Did Billy Bibbit leave
the grounds of the hospital,
gentlemen?
SCULL: Which really
portrayed psychiatry
in an extremely negative light.
I want an answer to my question.
SCULL: As fools
or villains or both.
NARRATOR:
The film captivated America
in 1975, the same year
the Supreme Court ruled
the mentally ill could not
be forcibly committed
unless they posed a danger
to "self or other."
WARREN BURGER:
There is no constitutional basis
for confining such persons
involuntarily if they
are dangerous to no one
and can live safely in freedom.
NARRATOR:
This landmark victory
allowed patients to refuse care,
but in many ways backfired.
♪
WAILOO: The
deinstitutionalization movement
was driven by a true and
beneficent, progressive ideal
for providing a better
chance at life and health
for people who had been
locked away.
To the extent that
many of those people were freed
and have gone on to live full
and complete lives, right?
Those were
really progressive developments.
But this is difficult,
because to refuse care also puts
the onus on you
to care for yourself.
And society has to figure out
a way to deal with that.
NARRATOR: The 1970s brought
new freedom for patients,
but also a
financial crisis that drove
a conservative backlash
against social programs.
WAILOO: The history of
American mental healthcare
is a history of
liberal, expansive projects
to provide progressive care,
and recoiling against the costs
and the nature of
the social commitment.
CAHALAN: This dream of
being treated in the community
never came to fruition
because the money
did not follow the patients.
VASAN: You've got the federal
government basically saying,
"We're going to
close down a system
"that is pernicious
and punitive and inhumane,
"but we're not gonna make
enough of a durable investment
into communities."
RONALD REAGAN: We'll
continue to search for ways
to cut the size of government
and reduce the amount
of federal spending.
WAILOO: The Community Mental
Health Act hits the rocks
with the Reagan-era
conservative revolution,
which argues that,
you know, government
isn't the solution to
your problem.
Government is the problem.
He took the money
that had been allocated
specifically for the
mental patients in the community
and instead gave them to
the states as a block grant,
which the state could use
for the mentally ill,
or use to reduce taxes,
or increase other programs,
and eventually to build prisons.
♪
NARRATOR: At the same time
community care was defunded,
money for prisons flowed.
And the treatment of
the mentally ill
began to resemble the
punitive systems of the past.
MAN:
Go tell it on the mountain
(indistinct chatter)
COOMBS: You have people
being incarcerated
at rates that are surpassing
other nations during this time.
Such that you get
the mass incarceration
of folks with mental illness.
This is happening
at the same time as
mass incarceration of
people of color.
So, if you have both
a serious mental illness
and you are a Black American,
that risk of you
being incarcerated
is that much higher.
FRANCES: The irony was
that the mentally ill
were not really
deinstitutionalized.
They wound up in nursing homes
or in prisons, or homeless.
Next two gentlemen, step up.
CAHALAN: Today,
90% of the beds available
with JFK's Community Care Act
are no longer available.
As bad as many of
these institutions were,
I can't think of
a worse place to be
than a prison or a jail
when you are acutely psychotic.
LIEBERMAN: States
by and large have reduced
the number of
state hospitals they have
and reduced
the number of beds they have,
and made it more difficult
to admit people to.
MR. BO: Who's been diagnosed
with PTSD?
Okay.
Depression?
Okay.
Anxiety?
Bipolar?
- MAN: Yeah.
- Okay.
And schizophrenia?
VASAN: Black Americans
are three times
more likely to be diagnosed
with schizophrenia
or bipolar disorder,
but only one out of three
Black Americans
actually get access to
mental healthcare
that they need once they
receive a diagnosis.
Share will you share with me,
my brother?
Since I've been
coming out of the jail system,
I never had no type of help,
no type of support
or nothing, but
NARRATOR: Untreated,
mental disorders can worsen,
and those with mental illness
are more likely to enter
the criminal justice system.
Once there,
they accumulate diagnoses.
They diagnosed me with
bipolar and schizophrenia.
FRANCES: The more
psychiatrists you meet,
the more likely you are
to get a new diagnosis.
Then it's so easy
to write a diagnosis,
so hard to erase it.
My mother for my father,
to her mother and her father,
this, they have bipolarness,
PTSD, and anxiety.
DART: In the
criminal justice system,
we're supposed
to incarcerate people
because they present a danger
to us and to society.
In grade school, like,
I always had a short
attention span.
I was always, like
DART: But I cannot tell you
how many detainees
said to me,
"I just can't believe
I had to go to a jail
to have this help."
MR. BO: Mr. Robinson,
I've been working with you
for a while.
Can you share
one of the diagnoses
that maybe, that you
struggle with the most?
I would say the PTSD.
(voiceover):
In a group session,
it's kind of hard for me
to expose myself
like I can talk to you
right now, in a one-on-one.
And if I'm in a more of a group,
I don't really
want the next person
to know the type of problems
that I'm having, you know?
I kind of feel ashamed of them.
Because I've been around
certain type of environments
and violence,
been exposed to it, and
It was just,
it became the norm to me
after just dealing with it
for so long.
MR. BO:
Thank you for sharing that,
because so many men
do the same thing.
NARRATOR: Jeremiah was diagnosed
with several disorders,
including PTSD and
schizophrenia.
His most consistent
mental health treatment
has been in jail,
including these group sessions,
counseling, and medication.
The pharmacy at Cook County
distributes thousands of doses
of psychiatric medication
every day.
ROBINSON:
They got me a pill called
Buspirone, Zyprexa,
- and Remeron.
- Mm-hmm.
So that's three different
medications that I take.
When I first began speaking
with a psychiatrist,
they told me
the symptoms I was giving
of schizophrenia, they say,
- was me hearing voices.
- Mm-hmm.
Like, feeling as if
I'm always triggered
to do something wrong
to somebody,
and me having to tell myself,
"No, that ain't
That ain't how
I need to go about it."
Okay, this medication,
is it helping to give you
the strength to
not listen to the voices?
- Yeah, most definitely.
- Most definitely?
- Yeah.
- Okay.
JOHNSON:
The vicious thing
about mental illness
and medication is,
as long as
I take the medication,
I don't have the symptoms.
Get your I.D.
Sign your name.
NARRATOR:
Detainees are not allowed
to leave the jail
with medication in hand,
so on their way out,
they're given prescriptions.
WOMAN: As far as
the psych medication,
do you know you can
go to Stroger?
Oh, I don't,
I don't take psych medication.
- You don't?
- No, ma'am.
They just legalized weed.
(chuckling):
Well, just in case,
you know it's West Harrison,
to the pharmacy
on the first floor.
Okay.
JOHNSON: When I leave here,
there is nobody
to make me take the medication
or no one to check up.
If I'm not
taking the medication,
the symptoms reappear,
then the behaviors
that accompany the symptoms
also reappear.
WOMAN: What were you
charged with?
Uh, domestic battery.
JOHNSON:
And it's a vicious cycle.
It is vicious.
GUARD: Next man who
needs a jacket.
Sometimes you get locked up
when it's hot outside,
and you get out,
and it's the winter.
Thank you.
♪
NARRATOR: In America, the
treatment of the mentally ill
has always swung between
compassion
and punishment.
But future approaches
may emerge,
as new tools provide
greater insight into the brain.
RACHEL YEHUDA:
What these tools can do is
help us move the needle forward
in terms of telling us
that we're on the right path
with our understanding of
what the fundamental disease
processes are.
♪
NARRATOR: To unravel
the roots of mental illness,
scientists look to genetics
and brain imaging.
And find evidence Dorothea Dix
and Thomas Kirkbride
may have been right:
environment and experience
are key.
YEHUDA: Every experience puts
some kind of an imprint on us,
and then we walk around
as a collection
of those experiences,
and that collection
is encoded in a biology.
And what we've come to
understand is that
environmental events can
really change gene expression
and contribute to why people
feel so utterly transformed
by a traumatic experience.
NARRATOR: Genetics do play
some role in mental illness,
and recent studies suggest
experiences can switch
key genes on or off,
affecting who
actually develops disease.
YEHUDA: So you don't
even have to worry only about
your own trauma history
The experience of
your parents and your ancestors,
this whole chain of
intergenerational responses
contribute to how you approach
your current life circumstances.
♪
NARRATOR:
After six months behind bars,
Jeremiah Robinson
has been released
for the 15th time.
He's living with his
four children and fiancée.
ROBINSON:
It's been kind of rough,
trying to take care of the kids,
you know,
trying to find me
a source of income, but, um,
I've been maintaining,
you know, staying focused.
♪
MAN: What's
your dream for her?
To
Put her in a better environment.
That's my dream, man.
Have her grow up
with some stability, you know?
Not as many worries
and problems that I've had.
(children calling)
COOMBS: What would it
look like if we lived in
a world where fewer people
are traumatized,
where fewer people
have to live in a way
that continues to propagate
a lot of suffering?
Will we see serious mental
illness at the same rates?
Maybe not.
♪
ANNOUNCER: Next, on "Mysteries
of Mental Illness."
MAN: The neurosurgeon is going
to implant
two electrodes in my brain.
MAN: People might say
it's a little creepy
that we're actually going to
manipulate someone's brain,
but these are very ill patients.
I'm so desperate at this point.
TIMOTHY LEARY: Turn on, tune in,
drop out.
WOMAN: After taking a
psychedelic,
people didn't want to go to w*r.
It is a tool that facilitates
healing.
MAN: E.C.T. is by far
the most effective treatment
in psychiatry.
MAN: You're introducing
electricity into the brain.
MAN: For people who have very
severe depressions,
it's a lifesaver.
WOMAN:
It's critically important
to give people a choice.
MAN:
Surgery, it's a gamble.
This is the final frontier
in psychiatry.
It's my best and last hope.
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01x03 - The Rise and Fall of the Asylum
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The attempts across generations to unravel the mysteries of mental illness, including its causes and treatments.
The attempts across generations to unravel the mysteries of mental illness, including its causes and treatments.