The Mad Among Us: A History of the Care of America's Mentally Ill

A large proportion of today's mentally ill homeless are substance abusers, according to Rutgers University professor of history Grob in this comprehensive study which will be of interest to specialists. He outlines a ``cyclical pattern'' of mental health care ``that has alternated between enthusiastic optimism and fatalistic pessimism.'' Grob traces the growth of psychiatry as a medical specialty along with changes in public policy and social attitudes. In colonial times families and communities cared for their ``lunaticks''; with 19th-century urbanization, hospitals began assuming responsibility for the mentally ill, torn between custodial and therapeutic duties. Grob records a post-WW II trend toward de-institutionalization and treatment in outpatient or community centers staffed by psychiatrists trained in psychoneurology and a range of therapies, including electric shock, analysis and medication. Today, the author notes, general hospitals and local clinics, overloaded by both the chronically ill and substance-abuse cases, can assure little continuity of care. Illustrations not seen by PW. (Mar.)