Break On Through: Radical Psychiatry and the American Counterculture (The MIT Press) [1 ed.] 9780262042826, 0262042827

Table of contents :
Contents
1 Changing Minds
2 Disruption
3 From Prevention to Activism and Radicalization
4 Breakthrough of the Mind: New Age Therapies in the Medical Marketplace
5 Knowledge of the Mind: DSM-III, Data, and Parapsychology
6 Mental Health and Substances in the Seventies
Afterword
Acknowledgments
Notes
Index

Citation preview

BREAK ON THROUGH

BREAK ON THROUGH RADICAL PSYCHIATRY AND THE AMERICAN COUNTERCULTURE

Lucas Richert

The MIT Press Cambridge, Massachusetts London, England

© 2019 Massachusetts Institute of Technology All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from the publisher. This book was set in Stone Serif and Stone Sans by Jen Jackowitz. Printed and bound in the United States of America. Library of Congress Cataloging-­in-­Publication Data is available. ISBN: 978-­0-­262-­04282-­6 10 9 8 7 6 5 4 3 2 1

For Elizabeth and my wee ones, Oscar and Lucy

Contents

1

Changing Minds  1

2 Disruption  13 3

From Prevention to Activism and Radicalization  37

4

Breakthrough of the Mind: New Age Therapies in the Medical Marketplace  71

5

Knowledge of the Mind: DSM-­III, Data, and Parapsychology  91

6

Mental Health and Substances in the Seventies  115 Afterword  149 Acknowledgments  155 Notes  159 Index  203

1  Changing Minds

Canst thou not minister to a mind diseased, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain And with some sweet oblivious antidote Cleanse the stuff’d bosom of that perilous stuff Which weighs upon her heart?1 —­William Shakespeare, Macbeth

“We need you more than ever,” Vice President Joe Biden told an appreciative crowd of nearly 15,000 mental health professionals at the American Psychiatric Association’s annual meeting in 2014. “And, quite frankly,” he continued, “we need more of you than exists today.”2 Speaking in the Javits Convention Center in New York City, Biden highlighted a lack of Veterans Affairs and child psychiatrists as particularly acute problems in the twenty-­ first-­century mental health marketplace. The rise of post–traumatic stress disorder (PTSD) and an uptick in mental illnesses, including depression, in younger age cohorts worried him. For Biden, American psychiatry stood as a model for the world, and more psychiatrists, as well as more mental health professionals, were desperately needed. Biden was not alone in thinking about mental health in the United States. In recent years American mental health has seized the spotlight, for a number of reasons. Whether the issue under discussion concerns the mental health of active shooters or other kinds of assailants, the persistent rise in depression diagnoses, the relationship between marijuana use and psychosis, or the return of the use of psychedelic agents in psychiatric treatments, the public’s familiarity and fluency with mental health issues has

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burgeoned. Recent TV series, such as Maniac and Mindhunter, and major motion pictures, including Side Effects and Silver Linings Playbook, have introduced stories about people struggling with mental health problems and with prescription drug use. An unexpected and controversial sensation in 2017 was 13 Reasons Why, which focused on the assault, trauma, and suicide of a high school girl, bringing to viewers’ attention the complex mental health issues that teens and young adults may face. This book hopes to advance the discussion by placing the histories of American mental health, pharmaceutical use, and intoxicant use in dialogue with one another, all within the context of mainstream and fringe therapies. While definitions vary, counterculture in this book refers to theological, political, attitudinal, or material positions that departed from common and accepted societal standards. By tracing these histories, the book seeks to provide a more expansive outlook on and interpretation of mental health. My first book, Conservatism, Consumer Choice, and the Food and Drug Administration during the Reagan Era: A Prescription for Scandal, explored multiple aspects of pharmaceuticals in the United States from the 1970s to the 1990s. In it I maintained that consumer protections, product innovation, and freedom of choice in the American marketplace were challenged by competing ideologies and principles. My second book, Strange Trips: Science, Culture, and the Regulation of Drugs, moved beyond the pharmaceutical industry and the U.S. Food and Drug Administration (FDA). I argued for a more robust understanding of the porous boundary between legal and recreational drug use and examined the back-­and-­forth struggles over the regulation of pharmaceuticals and recreational substances in scientific circles, with an eye on culture. This book reviews the ministrations provided to “diseased minds” during a countercultural climate in the 1960s–1970s, including “sweet oblivious antidotes,”3 in Shakespeare’s words, and other sorts of therapies. It is still far from clear how best to “raze out the written troubles of the brain,” a task Macbeth asked of his wife’s physician. But a fuller understanding of the American mind and of mental health practices of the past, especially during an era that saw a major rewriting of treatment paradigms, should help place the U.S. vice president’s comments in context. Perspectives from the past might also forestall reactions like Macbeth’s to his wife’s doctor. When the doctor seemed incapable of helping her mental trouble, Macbeth suggested that the practice of medicine was fit for the dogs.

Changing Minds 3

Everyday people, just as much as government, medical authorities, and policymakers, must take into account commercial matters and cost-­ effective mental health strategies, and in this post-­deinstitutionalization era, scholars have a unique opportunity to shape the contours of mental health policy.4 I hope that Break On Through plays a part in this discussion. Whether the topic is activism and radicalism, shifting diagnostic criteria, or lysergic acid diethylamide (LSD) for the treatment of depression or end-­of-­ life pain, there is always space for more information, including historical examinations. The major pendulum swings and struggles in modern mental medicine have often been described by the term “radical.” The introduction of Freud’s ideas into psychiatry, for instance, was viewed as a “radical act” and one that bestowed “radical gifts” on contemporary culture and social life.5 I believe it is important to unpack the idea of mental health radicalism in a comprehensive way. Issues Present-­ day discussions surrounding mental health often center on the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual: Mental Diseases (DSM-­5), released to much fanfare, as well as considerable criticism, in 2013. Arbitrating the line between illness and normality, the 947-­ page book governs many Americans’ mental health treatments, and critiques of DSM-­5 often revolve around how it—­and, by extension, the pharmaceutical industry—­ wield far too much influence. That too many psychiatrists are operating in the United States (contrary to Biden’s view) and too many prescriptions are being written is a hard-­ and-­fast belief for many. In 2012 the APA’s annual meeting was held at the Philadelphia Convention Center, in the heart of the city. High-­profile comments on the profession that year, coming from such insiders as Drs. Marcia Angell, Allen Frances, and Robert Whitaker, to name just three, galvanized conversations about the expanding influence of the pharmaceutical industry and the imminent release of DSM-­5. Frances, for example, took the opportunity to praise DSM-­III, first published in 1980, in a New York Times article. It had, he said, “stirred great professional and public excitement by providing specific criteria for each disorder.” That meant everyone was using the “same playbook,” which in turn “facilitated treatment planning and revolutionized research in psychiatry and neuroscience.” But in his

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opinion, the APA had since overreached. The “times have changed, the role of psychiatric diagnosis has changed, and the association has changed.” The APA was no longer capable of being the sole professional arbiter of what constituted mental health.6 Another common refrain heard from opponents of the DSM and the mental health establishment is that Americans have experienced a revolution in psychopharmacology and witnessed tremendous advances in mental health care, yet the number of people plagued by chronic mental problems continues to grow. Depression, social anxiety disorders, and PTSD all appear to be on the rise. The economists Anne Case and Angus Deaton have advanced our understanding of “deaths of despair”—­those due to alcohol, drugs, and suicide—­as resulting from the merging of geographic and economic factors, with an increasing role for inequality. “Gilded” Zip Codes, for instance, are associated with a higher life expectancy, lower crime rates, and less morbidity. Long commutes to work, such as those faced by service workers who cannot afford to live in the locale of their employment, are associated with higher rates of obesity, stress, insomnia, loneliness, and divorce. These issues connecting economic status and the DSM diagnoses, which also played out in the pages of the New York Times, the London Review of Books, and the New England Journal of Medicine, were given greater force by the energy and fury of the Occupy protestors. A sociopolitical movement against social inequality and a deficit of “real democracy,” Occupy had as its primary goal advancing socioeconomic justice and new forms of democracy. The Great Recession of 2008–­2009 crystallized inequalities in American society, and by 2011 Americans were holding demonstrations, flash mobs, and sit-­ins to promote social justice. The movement spread beyond the borders of the United States, blossoming into a “global howl of protest,” as the Guardian put it.7 The convergence of socioeconomics, substance use, and mental health, as will become clear in the chapters of this book, has both parallels and roots in the 1970s. Illicit drug use and the use of psychopharmacological agents are vital parts of the discussion. Prominent psychiatrists have begun suggesting that mental health specialties need reining in, what one critic has called ­“taming, pruning, reformulation, and redirection.”8 Often such assessments of mental medicine are mounted on opposition to “disease mongering, its overuse of polypharmacy,” and knee-­jerk medicating for reasonably minor

Changing Minds 5

difficulties in adults as well as children and adolescents.9 David Healy has labeled the overprescribing of drugs as Pharmageddon, a mental health apocalypse that manifested after World War II.10 In the immediate postwar years, the dominant notion that a biochemical imbalance could be the cause of mental illness led psychiatrists to turn to drugs like Miltown, Prozac, or Xanax for treatment.11 A readiness to prescribe for any ill has recently been turned on its head as Americans have been afforded a sometimes frightening look at the role of the pharmaceutical industry in creating a sick society. They have received “the truth about the drug companies,” as the title of Marcia Angell’s book has it, and have become increasingly aware of the evolution in disease diagnoses and definitions in the United States since the 1950s.12 Drug companies allied with physicians and used the political climate of the Cold War to influence public opinion, shape legislative reform and the regulatory architecture of the country, and ward off damning charges made by congressional investigations.13 And what of psychedelic medicine and its role in the mental health treatment armamentarium? LSD initially was the subject of basic scientific research for mental illness and addiction. For supporters, psychedelic psychiatry held tremendous therapeutic potential for individuals diagnosed with schizophrenia and alcoholism, yet the promise of this research was never realized because of its nationwide ban in 1968. In the 1980 publication LSD: My Problem Child, the Swiss biochemist Albert Hofmann reflected in an honest and incisive manner on the drug he had first synthesized in 1938.14 The book describes psychiatry’s combination of excitement and joy over the “powerful ‘new’ technology,” as the medicinal chemist David Nichols described it to Hofmann in 1993.15 LSD attracted researchers working in the fields of psychiatry, psychotherapy, and psychoanalysis, although its unconventional status meant it rapidly became both revered and reviled.16 By the early 1960s, more than a thousand scientific articles had appeared by investigators who had used LSD in a wide variety of settings and administered it using diverse methods and instruments. The conclusions they drew were equally diverse,17 but several promising applications emerged. Principal among these was the use of LSD for treating alcoholism; LSD was also tested in clinical settings as treatment for a range of issues, including homosexuality, depression, aggression, dysfunctional interpersonal relations, end-­of-­life pain, and in a model of psychosis.18 As

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Hofmann noted, “LSD was discovered at a time when our society was not yet advanced enough to be able to integrate in a meaningful manner.”19 Carl Jung, by contrast, argued that it was “quite awful that the alienists” had discovered a new “poison to play with,” even though they weren’t entirely sure how to use it.20 By 2013–­2014, however, when the DSM was the subject of intense debate and Biden was reaching out to U.S. psychiatrists, the tide appeared to be turning. Articles began appearing in the popular press—­the New Yorker, the Atlantic, Scientific American, and other major periodicals—­suggesting a return of LSD from the wilderness—­indeed, a psychedelic rebirth or “renaissance.”21 An indication of the resurgence of interest in psychedelics within the scientific community was the 2013 Psychedelic Science conference, held in Oakland, California, under the aegis of the Multidisciplinary Association for Psychedelic Studies. The conference brought together close to two thousand professionals, including psychiatrists, psychologists, anthropologists, and physicians, from around the world to discuss the medical use of psychedelic drugs. These issues were elucidated in PBS NewsHour’s January 2017 report on the renewed interest in research on psychedelic drugs. But participants did not want viewers to get the wrong idea. Dr. Stephen Ross of New York University’s School of Medicine asserted: “We’re following the data. We don’t think that this is going to cure anything or change the world. We are focused on helping sick people and just doing more science and following the data, seeing where it leads.” Dr. Michael Mithoefer was even more circumspect: “This seems to be a very powerful tool, but it is only a tool. . . . I think there is the danger of people thinking of it as a magic bullet.”22 Design of the Book This book explores the relationships among the American mind, Americans’ mental health, and psychiatry in the late 1960s and 1970s from a broader vantage point and an eye on countercultural trends. How was the American mind twisted and turned in the 1970s? What was the role of psychiatry and psychology? Who were the major actors shaping mainstream and alternative views of mental health therapy? How did intoxicants simplify or stymie therapies? Topics range from cults to cannabis, data-­driven diagnoses, the DSM, and the importance of New Age therapies. The book

Changing Minds 7

unpacks responses to and the regulation of American mental medicine in light of long-­standing economic and political interests related to medical science. It tracks the discordant threads of the late 1960s and 1970s understanding of madness and mental medicine to help illuminate the present. In an overarching sense, the period of the 1970s was a shakeout moment in which radical ideas either matured, faded away, or became mainstream. If the period 1945–­1970 could be described as “magic years,” as onetime APA president Daniel Blain wrote, the years following proved equally mysterious but far more fragmented.23 These were explosive times. Psychoanalysis, Sigmund Freud’s therapy to unlock the unconscious mind, was struggling against a “challenge to the couch,” a war fronted by proponents of biological psychiatry.24 Social psychiatry and deinstitutionalization movements were reforming traditional mental health services as more and more patients emerged from asylums. Community mental health clinics popped up around the country, based on breakthroughs in psychopharmacological research and treatment. Powerful new antipsychotic drugs enabled a transformation in mental health service models. Entirely affirmative accounts of psychiatry and psychology began to give way to increasingly critical approaches. Many people felt that American psychiatry was at a confusing crossroad, and psychiatrists themselves became ever more “skeptical about the goals, methods, and achievements of their professions.”25 It was “a time of rapid professional upheaval” and forces emanating from multiple directions “compromised the credibility of psychiatry.”26 Headlines showed feminists pushing back against pharmacology and the U.S. Supreme Court turning against psychiatry. 27 This book tackles these ideas. It deals with radicalism in the profession, drugs, prescribed or used recreationally, and the American mind. According to historian Stephen Tuck, while it was perhaps once “tempting to dismiss” the era of the 1970s, it has recently “come into fashion as unexpectedly as a disco craze.”28 Writers and historians no longer apologize for carefully scrutinizing the period.29 Still, the view that the decade of the seventies was a unique period of sustained upheaval is flawed. Neither political nor economic nor cultural events transcended similarly critical (and interesting) moments in the 1950s, 1960s, or even the 1980s. The 1970s were special, to be sure. Yet the period manifested both continuity and “a crucial [time] of change and adjustment that has shaped the contours of U.S. history and global history.”30

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The decade began with several essential scientific breakthroughs and institutional changes that impacted mental health practice and perceptions. In 1970 Dr. Julius Axelrod, a researcher with the National Institute of Mental Health (NIMH), won the Nobel Prize in Physiology or Medicine for his groundbreaking work on an enzyme that stops the action of the nerve transmitter noradrenaline in the brain. His work set the stage for breakthroughs in drug design for psychiatric disorders. That same year the FDA approved the use of lithium as a treatment for mania, based on NIMH research. A significant change for people with manic-­ depressive illness (bipolar disorder), the therapy led to abrupt drops in inpatient days and suicides among people with this serious mental illness. Economically, the therapy laid the foundation for immense reductions in the costs associated with bipolar disorder. A third important initiative in 1970 was passage of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act, which established the National Institute on Alcohol Abuse and Alcoholism within the NIMH. Two years later, the National Institute on Drug Abuse within the NIMH was created following passage of the Drug Abuse Office and Treatment Act. Fourth, Kenneth Donaldson was released from Florida State Hospital in 1971. No longer deemed incompetent, he was awarded nearly $48,500 in damages and wrote about his committal in a memoir. Several years later the U.S. Supreme Court, in a hotly anticipated decision based on Donaldson’s case, declared unconstitutional the involuntary custodial confinement of admittedly nondangerous persons.31 The beginning of the decade, in short, heralded scientific promise and marked new legal and institutional approaches to mental health. The mental health establishment also underwent both strong reconsideration and demonization, a trend that gained momentum throughout the late 1960s and 1970s. At different times, various commentators suggested that mental health professionals needed to modify service models. In 1961 the Harvard-­trained psychiatrist Robert Coles, writing in the Atlantic Monthly, suggested that psychiatrists “try to hide behind our couches, hide ourselves from our patients,” and prolong “the very isolation often responsible for our patients’ troubles.”32 According to Frank Riessman and S. M. Miller, writing in the American Journal of Orthopsychiatry, psychiatrists shunned the possibility of “broad social change” and “passionate political involvement” for various reasons, including professional insulation, considerations of prestige, and infatuation with methods.33 Bruno Bettelheim

Changing Minds 9

characterized psychiatrists as “a rather conservative group” that, in his estimation, tended to avoid “radical analysis” of society’s problems, let alone entertain “radical solutions.”34 “I think it is very true in psychiatry,” a London-­based psychiatrist wrote in a letter to R. D. Laing, “more than in other branches of medicine that orthodoxies are inclined to be transmitted from generation to generation without criticism and . . . it is only by devastating attacks such as yours that knowledge can be gained.”35 Others, such as President Richard Nixon, were even harsher, as he remarked: “You know, psychiatry is a God damned racket.”36 Psychology, whose history during this period was closely interwoven with that of psychiatry, was affected by the war in Vietnam and the heightened demand for treatment services. Psychology underwent its own transformation, shifting from its more academic and laboratory-­based research traditions (psychometrics, personality testing) to clinical practice. And, like psychiatry, the discipline of psychology professionalized. It also received major investments in training and research opportunities, which rivaled those of its psychiatric sibling and led to competition between the two fields.37 By 1968, Abraham Maslow was the world’s most famous psychologist, with tremendous crossover appeal. As the cofounder of humanistic psychology and coiner of the term “hierarchy of needs,” he ushered in biological essentialism, drawing linkages between healthy individuals and a healthy society. Even more important, his work challenged Freud and behaviorism. He remained highly influential throughout the 1970s. The rest of this book investigates mental health practices, radicalism and intoxicants, and government policy and popular culture from different perspectives. Instead of focusing on a single substance or class of drugs, a single psychiatrist, a single program, or a single patient activist organization, the book explores intersecting histories. The mental health arena witnessed new entrants with the rise of patient groups, the availability of new therapies tailored to mass consumption, the acceptance of parapsychology as a legitimate field of study, and the renewal of psychedelic-­based psychiatry. Options abounded. Patient consumers could dip their toes into New Age medicine, draw from the font of naturopathy and homeopathy, or explore Eastern-­influenced medicine and teachings through venues such as the Esalen Institute in California. They might sample alternative mental health therapies, including primal scream therapy or transactional analysis, or find psychic comfort in participating in new religious movements.

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The source materials used to construct this book include archives and government documents, medical journals, newspapers, histories of the field, and a select number of interviews. While the book is mostly a narrative work, Michel Foucault’s formulation of power-­knowledge (le savoir-­ pouvoir) underlies my treatment of medical practices, psychiatry, and culture. According to Foucault, humans are made “subjects” and “psychiatric identities” are created, and these identities then fluctuate over time, influenced by myriad factors.38 The goal of the book is to offer a reinterpretation of medical and mental health knowledge in American society during the 1970s. Break On Through, however, is not a microhistory of an era, nor does it argue against the “fall” of psychoanalysis or in favor of biological psychiatry’s heroic emergence. The book is not about federal mental health policy, and it does not prioritize ex-­patient movements and antipsychiatry. Such narratives have been presented very well elsewhere. At certain points, the book reaches further back in time than the 1970s. Though the book is not strictly a cultural history, it seemed worthwhile noting the movies and music of the period, along with other cultural forms of expression. To understand the American mind during the 1960s and 1970s and beyond, it is important to have at least some sense of the era’s cultural and countercultural attributes. Cultural references thus cross historical documentation. Cultural influences on the development of the psychiatric profession are important as well (another example of the Foucauldian underpinnings of the book). Bodies of psychiatric knowledge should not be regarded as “universal, atemporal and objective.”39 Psychiatrists and their knowledge have not emerged from a “neutral space” beyond the history of a particular culture and society. Rather, the people who deploy psychiatric knowledge are products of, and thoroughly imbricated in, a social and cultural history.40 American culture—­its characteristics and knowledge, encompassing language, religion, social habits, and artistic expression—provided both the matrix in which psychiatry, its practitioners, and its clients grew up as well as a determinative influence on the further development of the field. As the sociologist Claude S. Fischer noted in 2010, “Understanding the cultural and psychological path Americans have taken not only satisfies our curiosity, it helps us think about the path Americans should take.”41 The path Break On Through takes may not appear to the reader to be clear-­ cut. The book does not proceed chronologically or employ straightforward argumentation. Instead, the narrative is predicated on intersecting stories.

Changing Minds 11

Chapter 2, “Disruption,” presents a general overview of the decade of the seventies and seeks to descry a big picture of American society and mental health care. It concentrates on how the American mind was disrupted in the late 1960s and 1970s. What were the drivers of this disruption? How did science and technology influence working life? What role did responses to the Vietnam War play in altering the social paradigm? Adopting a broad perspective, this chapter explores how the American mind was reshaped by a topsy-­turvy climate. Chapter 3, “From Prevention to Activism and Radicalization,” examines the rise of radical psychiatry in the 1960s. Who were the radical psychotherapists? Where did they come from? What did they believe in? Self-­described radicals were not always at the forefront of reformist agendas and were not the only health care providers to conceptualize American society as sick. Liberals, as opposed to “radicals,” also contributed to restructuring mental health care services in the 1950s and 1960s. Even as the self-­described radicals fought the system and “the man,” they also fought each other. They argued that the field of psychiatry (and all other mental health professions) needed to modify training methods and service delivery models. Mental medicine had to throw off neutrality and embrace individual and collective sickness, which, the radicals contended, were natural by-­products of militarism, alienation, and endemic racism. Chapter 4, “Breakthrough of the Mind,” examines new types of therapies deployed in the 1970s that straddled the line between science and religion. As psychoanalysis declined in popularity, substitutes emerged: the human potential movement, for example, furnished an outlet for Americans seeking therapeutic solace. New religions, such as Scientology, garnered greater attention. It soon became clear that, even as mental health practitioners, including the APA’s Radical Caucus, interpreted, reformulated, and transmitted psychiatric, psychological, and antipsychiatric ideas, troubled Americans were certainly not lacking for therapeutic choice in the 1970s. In a laissez-­faire therapeutic marketplace, much more was available than just the approaches proffered by the Esalen Institute and the Erhard Seminars Training, better known as EST. Chapter 5, “Knowledge of the Mind,” seeks to answer some important questions. What was the context in which the DSM-­III was developed? How important was radicalism in the discussion of data? This chapter shows countercultural psychiatrists struggling for and against a more quantitative

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approach to psychiatric diagnoses and the DSM-­II. What does this suggest about pendulum swings in psychiatry during the 1970s? The return of the biomedical model in the mid-1960s was the result of several factors, though the issue was fundamentally about knowledge production in mental health at a unique moment in American history. This was vital, and social and political evaluations supplemented ongoing debates within the field about the validity of psychiatric diagnostics and struggles among psychodynamic and biological psychiatry. The chapter also takes up parapsychology. As many mental health professionals rebelled against the use of psychological adjustment or the weaponization of psychiatry in any form during the 1960s, how did others explore fringe claims about mental spoon bending or remote viewing? Chapter 6, “Mental Health and Substances in the Seventies,” examines the roles of LSD, cannabis, and 3,4-­ methylenedioxymethamphetamine (MDMA, ecstasy) in psychoanalysis. How did researchers explore the end-­ of-­life use of LSD? To what extent should government limit and control access to a drug that might induce psychosis? These questions drove discussions about cannabis in the 1970s and stalled policy change; they are still with us today. Some mental health radicals argued in favor of closer engagement with prevailing issues of the day, saying it was time to get angry, to shout and press for action, while others examined anxieties around the process of dying. The discussion of MDMA, a main topic of this chapter, highlights that California in particular was a hotbed of health activism and medical entrepreneurship, a place where contested medicines collided with various economic and political ideologies.

2 Disruption

Times of crisis, of disruption or constructive change, are not only predictable, but desirable. They mean growth. Taking a new step, uttering a new word, is what people fear most.1 —­Daniel Levinson, 1974

In June 1969, mental health practitioners gathered in psychiatrist Eric Berne’s home in Carmel, California. The pipe-­smoking founder of transactional analysis held a weekly meeting to discuss important cases and offer an intellectual environment for other therapists. Partly jam sessions and partly training exercises, the meetings were smoke-­filled and loud. On this occasion, Berne’s protégé, Claude Steiner, who would go on to shape radical psychiatry, gave a presentation on the topic of being HIP—­high and proud—­and other struggles faced by the counterculture. In offering strident views about repression and violence in the United States, Steiner clashed with Berne. “I don’t think this should be a political forum,” Berne said at the start of the meeting, though it quickly became just that. After interrupting Steiner several times, Berne said, “What I’m trying to do here is keep this on some sort of . . . scientific basis, so it’s legitimate for this seminar.” Steiner kept up his political commentary, however. The 1970s, he asserted, would witness a dark revolution. “Since the Age of Aquarius is here, and there’s no stopping it, there’s going to be one confrontation, one situation, after another—­changes are going to occur.”2 The clash between Berne and Steiner encapsulated some of the struggles within radical mental health in the 1970s. It foreshadowed debates around the scientific legitimacy of the field and the roles of objectivity and spirituality. It also raised questions as to whether the 1970s really represented

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a “new age.” Would the era be one of violence, as Steiner foretold? Would changes occur? This chapter provides snapshots of the era, including the law and the American workforce, sex and electronics, Vietnam and punk rock, to help answer these questions. Vietnam By 1969, the Nixon administration had complicated the conflict in Southeast Asia and was employing—­suitably—­a “madman theory” to frighten the enemy.3 “I want the North Vietnamese to believe I’ve reached the point where I might do anything to stop the war,” Nixon suggested.4 He wanted his enemies to believe he was no longer a rational political actor, to use the language of geopolitics. He had concluded that angry threats, especially when uttered by a leader perceived as unstable and unpredictable, might coerce the North Vietnamese to settle the war on the United States’ terms. To this end, Nixon carefully cultivated the image of a mad bomber. According to one historian’s account, the policy was not a stretch, insofar as Nixon exhibited characteristics that could be described as “paranoid, antisocial, narcissistic, and passive aggressive.”5 He shifted from stages of depression and mania to fits of apoplexy, and then to paralyzing uncertainty.6 By November 1971, when Elton John’s studio album Madman across the Water hit record stores, negotiations between the United States, China, and North and South Vietnam had reached an impasse, which set the stage for Nixon’s Operation Linebacker, a colossal bombing campaign conducted against North Vietnam from May to October 1972. On the one hand, Nixon intensified hostilities in Vietnam with Linebacker, initiated incursions into Cambodia, and played the madman. On the other, he deescalated the American on-­the-­ground participation in the conflict by relying more on South Vietnamese forces and participated in the Paris peace talks; and these actions suggested rationality.7 As was the case with other American conflicts in the twentieth century, the fallout from the Vietnam War helped redefine the role of psychiatry and society’s perception of mental health. A mere five years after the fall of Saigon a new psychiatric term was introduced, tailored to the needs of veterans—­ post–traumatic stress disorder (PTSD). Psychiatric counseling was made available on an unparalleled scale, paid for by the U.S. government. From the inception of the Vietnam War, moreover, extensive and

Disruption 15

well-­ equipped psychiatric services were available to treat mentally distressed soldiers. As well, the tour of duty was limited to one year, with frequent periods of rest and relaxation. Military psychiatrists believed that both factors, the availability of psychiatric services and the limited tour of duty, would decrease the incidence of mental breakdown. Still, those psychiatric services required that soldiers be told to return to the front lines. Just as significant, Vietnam contributed to a new “consciousness of trauma” in Western society.8 A cultural emphasis on Vietnam’s trauma reveals ’Nam’s much greater level of strain relative to that of the Korean War, World War II, or other conflicts. In part, the emphasis on war-­induced mental disturbances reflected the spirit of the times and mythmaking on the part of television, movies, and the news. Platoon, China Beach, and Apocalypse Now, not to mention Missing in Action and Rambo: First Blood and Rambo: First Blood, Part II, underscored the fracturing of the soldier’s mind. Nearly every episode of Miami Vice, according to one tongue-­ in-­ cheek report, featured a psychotic vet. Put another way, Vietnam helped reconstitute psychiatry and mental health, in addition to reconfiguring ideas about trauma. But this did not occur in a vacuum, and the process was abetted by popular culture. Assessments of military psychiatry from front-­line service providers—­ that is, from individuals working in the field on a daily basis, as opposed to outsiders—­helped shed light on mental health. Michael S. Perlman challenged his fellow military psychiatrists to recognize acute combat reactions in Vietnam veterans. A psychiatrist in the U.S. Naval Disciplinary Command, a maximum-­security prison in Portsmouth, New Hampshire, Perlman was exposed to the manifestation of “chronic psychiatric symptoms as a result of traumatic situations peculiar to the Vietnam War.”9 Perlman sought advice from his colleagues after his initial encounters with such reactions, but he was surprised to find that “almost from the beginning, I was given the impression that I had poked my nose into something forbidden.” He was told he was “being conned” by those he treated or that his “antiwar sentiments” were overly influencing him. Perlman was bewildered by such a response and came to the conclusion that a “definite syndrome was being overlooked” on a broad scale.10 Perlman proved to be a disruptor. He argued that the psychiatrist’s proper role was to “recognize and communicate hard reality, however painful that truth” happened to be. Yet this basic premise was placed in danger when a

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given psychiatrist allied him-­or herself with an institution, whether it was an outpatient psychiatric clinic, a private office, or the military, rather than with the patient. While Perlman rejected the idea of any conscious pressure in the Navy to subvert psychiatry, he nevertheless concluded that the “pressures to compromise professional integrity” were more “subtle, unconscious and related to a naturally adopted character styles and defenses.” The outcome was that hard reality was often obscured, which was harmful to the “patient, the psychiatrist, the military establishment, and to society itself.”11 In chronicling his experiences in Portsmouth, New Hampshire, Perlman also offered a tangible first-­person account of the behavior of military psychiatrists. It was vastly more complicated. Americans’ experiences during the Vietnam War between 1965 and 1967 registered few mental breakdowns among soldiers. The rate of five per one thousand troops—­compared with about fifty at the beginning of the Korean War—­convinced military psychiatrists that they “appeared to have licked the problem” of mental trauma.12 This confidence was confirmed by psychiatrist Peter Bourne’s 1970 book, Men, Stress, and Vietnam. Bourne, a team member of the Walter Reed Army Institute of Research and a veteran of the Vietnam War, attributed the initially low rate of breakdown among American troops in Vietnam to empirically grounded ideas of war neurosis and the implementation of forward—­ interventionist—­psychiatry.13 Supposedly, the field had interceded early and often enough to prevent trauma. Bourne was so positive about these early successes that he thought there was “reason to be optimistic that psychiatric casualties need never again become a major cause of attrition in the United States military in a combat zone.”14 This type of reasoning turned out to be misguided. Fifteen years after the United States withdrew from Vietnam, an epidemiological survey concluded that 480,000 (15 percent) of the 3.15 million Americans who had served in Vietnam were suffering from service-­related PTSD. In addition, between one-­fourth and one-­third (nearly one million ex-­service personnel) displayed symptoms of PTSD at one time or another.15 The Vietnam War, then, proved instrumental in sparking a new level of awareness regarding mental health during times of war and led as well to fresh diagnostic approaches to mental trauma, specifically in the designation of PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-­III), which was released in 1980.16

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Hostilities in Vietnam and the struggle for rights at home were also essential to the formation of radical psychiatry and antipsychiatry—­and these remained crucial after 1969. Phil Brown, a self-­professed radical psychiatrist, described the evolution this way: With the growth of the antiwar movement, many changes occurred in American society. The black revolutionary movement developed out of the old civil rights struggle; new tendencies were unleashed in the antiwar movement as people took on a wider range of issues. … People began to question seriously more aspects of their lives—­while other third world groups in this country developed liberation movements, so did sexual groups—­women and gays.17

For Brown, the Vietnam War functioned as one bond for radicals in mental health, as well as a host of other activist groups. As the bombings increased and South Vietnamese forces burgeoned, radicals in the psych disciplines charged some of their peers with collusion. Some argued that psychiatrists and psychologists “polish the machinery of U.S. imperialism in Indochina and elsewhere.” These collaborators (meant negatively) counseled “bomber pilots so they won’t feel guilty about napalming Vietnamese.”18 They inured Americans to the violence, and offered psychic salves for the occasional festering guilt. A panel on military psychiatry particularly incensed the Radical Caucus of the American Psychiatric Association (APA) during the organization’s 1969 annual meeting. The panel included topics with titles such as “Conditioning Therapy Ward for Ineffective Soldiers,” and “several Radical Caucus members walked in with signs denouncing the war and APA complicity with the military. The disruption occurred when they came to the front of the room and attempted to engage the audience in conversation.”19 Radicals were asserting, in essence, that mainstream psychiatrists were legitimizing the war in Southeast Asia. As the Vietnam War drew to a close in 1975, the rise of veterans’ groups such as Vietnam Veterans Against the War highlighted the troubled socioeconomic milieu in the United States. Unlike their World War I and World War II counterparts, many servicemen returned to the States to find protests and civilian disgust at their participation, and the “therapeutic power of work was not automatically available, as it had been in 1945.”20 In 1969 military psychiatrists estimated that roughly 30 to 35 percent of American GIs likely used marijuana, an observation that in turn served to exacerbate popular anxieties over drug use in the United States.21 Powerful psychedelic

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substances such as lysergic acid diethylamide (LSD) offered the pharmacological sacrament for pacificism, while marijuana, by contrast, provided the threads to stitch together a countercultural movement.22 Such ideas—­ about unhappiness on the home front and drug use—­have become well-­ worn tropes and are deeply embedded in popular conceptions of the war. They appear in Oliver Stone’s Born on the Fourth of July and in the rock band Alice in Chains’s song “Rooster,” for example, in which a veteran is spat on

Figure 2.1 Military police in gas masks, New Jersey. Radicals in mental health were deeply involved in antiwar activities.

Disruption 19

in his homeland. Because of the resilience of such tropes, it is worthwhile asking questions about the relationship between the Vietnam conflict and psychiatry. What if the Korean War or World War I was equally, if not more, traumatizing—­and what if the 1980s zeitgeist merely overinflated the subsequent perception of Vietnam’s trauma? How true was it that Vietnam vets were regarded with civilian disgust? How often, in fact, were vets spat on? It might (or might not) have been the case that social and psychiatric radicals required Vietnam to appear morally reprehensible since it suited their ideological as well as professional needs. From Politics to Work and Work-­Life Balance Widespread dissatisfaction with the American government in the 1970s began with the reactions to abhorrent behavior in the executive branch and was worsened by the perception that America was losing the Cold War. Following the Watergate cover-­up, President Nixon resigned in August 1974 and was subsequently pardoned by his successor, President Gerald Ford. (The decision to issue an immediate pardon was, according to various reports, based on Nixon’s emotional state, particularly depression. Nixon’s mental health was “very bad and getting worse.”23 After a prolonged delay, presidential advisers told Ford that continued inaction would damage the country and the former president’s mind.) Many disgusted Americans concluded that a corrupt deal had been struck and that the government was broken. For his part, Ford proclaimed the national nightmare was over, but this hosanna proved less than uplifting. The erosion of faith in the presidency and in the U.S government continued unabated. Abroad, American supremacy was challenged. Though the reality was far more complicated, it appeared that the United States had exhausted itself in the global struggle against communism in such far-­flung places as Angola, Ethiopia, Laos, Mozambique, and Vietnam. These were parts of the world that occupied remote spaces in the minds of most Americans, and now the country was losing armed conflicts there. The future certainly looked dimmer, as “Americans came increasingly to lose their traditional faith in the future.”24 Jimmy Carter’s famous “malaise” speech on July 15, 1979, summarized the nation’s sentiments. He said the country was experiencing “a crisis of confidence” that was more dangerous than the threat from energy insecurity or inflation.25 Scarcity was on every American’s mind. The postwar affluence of the fifties and sixties

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was replaced by fears of natural resource exhaustion, unheated houses, and waiting in lines at gas stations. The prices of groceries rose 60 percent in five years, and oil prices increased fivefold. Unemployment skyrocketed. A diverse consumer movement flourished in the early 1970s.26 Some commentators argued that the failure of liberalism to acknowledge its own limitations and make important sacrifices was leading the nation down a path of economic ruination.27 The 1970s saw a robust and long-­standing industrial capacity undermined as the United States was remade into a haven for financial headquarters. It was a jarring conclusion to a golden age of postwar capitalism. And the end of this supposed halcyon era had its foundation in American willingness to provide open access to U.S. markets, numerous trade concessions, and tax incentives for foreign competitors—­in essence, the prioritization of neoliberalism and globalization at the expense of American workers and industry. American leaders reputedly failed to understand the new European and Japanese industrial competition and consequently were unable to generate policies that protected labor or enabled growth.28 Between 1947 and 1973, the average annual increase in output per worker had been roughly 3 percent. For the period 1973–­1979, it dropped to 0.8 percent. By the time of the 1980 presidential election, which saw the former actor and governor of California, Ronald Reagan, voted in to the highest political office in the land, inflation had reached 12 percent. It would later reach an inconceivably high 18.5 percent. One outcome of this combination of high unemployment and inflation, dubbed “stagflation” by presidential staff economist Arthur Okun, was widespread discouragement with the established Keynesian doctrine, and a sort of collective nervous breakdown. While baffled economists bickered over the microeconomic causes of stagflation,29 issues of much older economic debate, such as the proper amount of social and economic regulation, gained traction.30 Theories of deregulation and regulatory reform materialized in the 1970s as bromides for the nation’s economic woes and unhappy consumers, essentially policy salves for the bewildered Homo economicus. While the Club of Rome and E. F. Schumacher advocated restraint and proposed that a threshold had been reached, and as Greenpeace railed against environmental degradation, the result of a lightening of the regulatory burden, theories of deregulation offered hope of a rosier, richer future that included a return to economic growth and more hiring.31

Disruption 21

Women entered the workforce in greater numbers during the 1970s. The steady rise in female employment, particularly of wives and mothers, was met with questions about women’s mental health relative to men’s. Research throughout the decade and beyond produced ambiguous results. Some studies reported no marked difference between employed wives and homemakers; others showed that employed wives were significantly less distressed than unemployed or stay-­at-­home women. Tangible differences were found, however, between men and women. Many studies reported that women suffered more symptoms of psychological distress and higher rates of diagnosed mental health disorders. Beginning in the early 1970s, a number of factors were proposed to explain the disparity, including women’s lower incomes, the lack of high-­quality childcare, and the unwillingness of men to contribute to work in the home. Even more studies suggested women’s diminished sense of agency had led to a gender gap in the presentation of depressive symptoms. In short, emotional well-­being was unequal between the sexes.32 Ideas from the field of mental health also influenced conceptions of work and work-­life balance, and vice versa. A younger generation of employees began to question the authority of companies and organizations. This stimulated interest in democracy and self-­sufficiency in the workplace. The drive for more autonomy and personal gratification in one’s working life, combined with the pressures of declining productivity, forced companies to reevaluate employee relations. The changes introduced into the workplace through automation and early advances in digitization led to “dislocation and alienation of employment, education, and leisure time,” the activist physician Paul Lowinger wrote. New uses of automatic machinery, computers, and technicians in the workplace were, as he put it, a “considerable source of human suffering though it is less obvious than a mushroom cloud.”33 Such ideas proved prescient in anticipating how the workplace would change. Business psychologists and organizational theorists insisted that a new consciousness had emerged, and employers sought to get a handle on it. Society had changed by the 1970s. The new constituencies included the following: •

Activist shareholders

•

Antiwar activists

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•

Aroused regulatory agencies

•

Black (brown, and red) militants

• Conservationists •

Enlightened consumers

But workers themselves had also developed a fresh awareness, and outdated management styles were unsuitable for the 1970s. Business administration programs and business schools at Harvard, MIT, and UCLA, for example, quickly latched on to and helped popularize Abraham Maslow’s brand of humanistic psychology. In a reasonably satisfied person, Maslow held, discontent would set in if the person was not doing what “he is fitted for.” “A musician must make music, an artist must paint, a poet must write, if he is to be ultimately happy,” is how Maslow put it.34 This type of psychological theory bled into the working world. Self-­sufficiency, self-­exploration, and personal growth as nonmaterialistic endeavours eclipsed the hypercompetitive status seeking that had its roots in outmoded forms of capitalism. A study conducted in 1974 found that workers with socially isolated jobs had difficulty integrating into community life.35 “A new model is called for,” wrote the business management expert Laurence Foss. “Not man as acquisitive animal, but man as quiescent reed. Not predation, a non-­ cyclical activity, but photosynthesis, a cyclical activity, may have highest survival value in the ensuing decades.”36 He suggested that the young generation—­ the counterculture—­was personal, communal, existential, nonmaterialistic; found that good lay in giving; and was focused on the present. The counterculture elevated style over content, aesthetics over morality, irony over tragedy. Foss was wrong in several ways about “the psychedelic seventies,” as he called the period, yet he was also on to something: business practices and work would undoubtedly transform to meet the era’s demands. The cold, impersonal technologization of the workplace would be modified to align with the psychic needs of workers. Here Foss’s theories and recommendations supported what radical psychotherapists had argued for some time: mechanization, though it limited mistakes, dissipated creativity and engendered alienation. Individual workers in such a work environment considered themselves expendable parts of an interminable assembly line, holding little or no decision-­making power. Foss’s solution, which he sold to various companies across the United States in the 1970s, was sensitivity

Disruption 23

training, group dynamics training, and interpretation of the counterculture’s workplace desires.37 Disruptions in business practices during the 1970s were not driven solely by changing societal values and the consciousness of the counterculture. Other major factors, such as the growth of technology, economic globalization, the changing demographics of the workforce, changing customer demands, increased competition, and a tightening regulatory environment, compelled organizations to reexamine underlying assumptions, structures, and systems and to reposition themselves to succeed in a turbulent marketplace. For some commentators, tying benefits to employment magnified fears of job loss, fears that were already considerable owing to the relative lack of a social safety net in the United States. Worries about unemployment, reinforced by the capital-­labor accord that unions bought into practice after the late 1940s, persisted, contributing to the decline of unions and worker militancy. To maintain or increase profits, U.S. capitalists cut their workforces, lowered wages, and whittled away at benefits.38 The revolution in Japanese manufacturing procedures in the 1960s and 1970s dramatically highlighted fundamental weaknesses of the U.S. mechanistic model—­of Taylorism and the alienation it provoked. When Japanese-­ manufactured products hit the world market, they were noted for their exceptional quality. Furthermore, several quality techniques integral to the modern high-­performance organization were popularized by the Japanese revolution: quality circles, statistical process control, total quality management, Six Sigma, just-­in-­time inventory management (kanban), continuous improvement (kaizen), and lean production. All part of the “lean enterprise” philosophy promoted by Toyota in the 1970s, some of the common elements included working in teams; changes in titles and roles; increased employee involvement, participation, and empowerment; a focus on the market and customers; vision-­driven, innovative human resource and production practices; and flexibility and adaptability.39 It was the beginning of a new, informal “psychological contract” between workers and employers that concentrated on competency development, continuous training, and work-­life balance. In contrast, the stale psychological contract was all about job security and steady advancement within the firm. U.S. workers grew increasingly invested in what researchers later called “psychological self determination.”40 They desired participation, expression, identity, and quality of life. Contemporaneously, there was an

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increased need for job analysis and test validation to defend the tools and techniques used in making personnel decisions. Cognitive-­based theories emerged, especially in such areas as motivation and leadership. Because of the changing nature of the field, the APA’s Industrial and Business Psychology division changed its name in 1973 to Industrial and Organizational Psychology to better reflect the evolving science and practice. Other developments included the creation of consulting firms such as the Foss Consulting Group, Development Dimensions International, and the Center for Creative Leadership; the implementation of teams in the business environment; and the development and use of social learning theory, which combined cognitive learning theory and behavioral learning theory.41 Business leaders drew on Carl Jung’s personality theories, though in modified form. Isabel Myers and Katherine Briggs commoditized and popularized the Myers-­Briggs Type Indicator (MBTI) in the 1940s, for example. The MBTI, a psychometric questionnaire that operationalized Jung’s personality constructs, grew out of Myers’s and Briggs’s belief that Jungian theory provided a structural framework for linking personality and job performance. Between 1943 and 1957, Myers and Briggs used their multiple-­ choice test on a relatively limited basis. The test, which used four separate indices (extraversion, intuition, feeling, and judgment), assessed and ultimately classified an individual’s personality. It classified a given individual into one of two preferences on four different indices and offered scores to a respondent of eight dimensions. The MBTI, though, was not uniformly positively received. In 1957 the Educational Testing Service reviewed it, found the instrument lacking, and did not pursue its further implementation. Nonetheless, the first MBTI Manual was published in 1962, and the test was resurrected in 1975 when Consulting Psychologists Press acquired the right to sell the MBTI as a proprietary tool. It was the same year that the Vietnam War came to an uneasy conclusion, and a full two decades after Jung had graced the cover of Time magazine as one of the most important public intellectuals of modern times. It was also a year after the DSM-­III task force, formed by the APA in 1974, began exploring new approaches to the classification of personality disorders. To be more empirical, the task force members separated personality structure from distinct symptoms. It soon became clear, however, that theoretical considerations, such as psychoanalytic ideas concerning narcissism and borderline conditions, were unavoidable. While the personality classification of the two systems diverged in

Disruption 25

several ways, it “is evident that the similarities clearly outnumber the differences.”42 By the early 1990s, and despite criticism of the tool’s validity, the second edition of the MBTI Manual was published, and more than two million copies were sold on an annual basis.43 Its popularity has not flagged since. As recently as December 2012, the Washington Post journalist Lillian Cunningham wrote, “It has become the gold standard of psychological assessments, used in businesses, government agencies and educational institutions. . . . Corporate America has its own religions, and one of them is Myers-­Briggs.”44 Science and Technology Practitioners of the psych disciplines also challenged and shaped dominant ideas about the elevated position of science and technology in the United States. Some sought to influence the ways in which Americans adjusted to the fast-­paced technologization and mechanization of daily existence, while others hoped to influence business practices, create more marketable products, and make work-­life balance more manageable. Another group of researchers and therapists hoped to trigger widespread transformation through new therapies and thinking. Television, interstate highways, computers, and the contraceptive pill were some of the forms of technological innovation that heralded a better human existence and offered proof of human progress. Yet for some, these innovations signaled a growing divide between technologically advanced and less advanced countries, an increasingly hectic pace of life, and an uptick in consumerism. “The bourgeois class bias of psychiatry, medicine, and science must be constantly analyzed in order to make these systems beneficial to all the people,” radical psychiatrists wrote in 1980. Science was not “value-­ free.”45 And “automation-­cybernation with its human obsolescence, unemployment, dehumanization, and educational crisis has a direct effect on the health of the family,” Paul Lowinger wrote.46 The 1970s saw the resurrection of certain antiscience ideas that had long lain dormant. The origin of this rebirth could be attributed to various interlocking philosophies. Ecologists such as Robert Hunter and the group Greenpeace raised awareness of industrial pollution, the loss of biodiversity, and, later, acid rain and global warming.47 A renewed interest in Karl Marx’s ideas also drove discussions around environmentalism,

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capitalism, and antiscience. According to Marxist thought, the impetus behind capitalism’s focus on research and development was to cut costs, increase productivity through technical innovation, particularly mechanization, and underprice other capitalists (or capitalist firms). Successfully doing so should enable a firm to expand its market share, increase profits, and ensure its survival. A knock-­on effect was that competitors were forced to adopt innovative production methods that might dehumanize workers or do away with them altogether. While critics from the ecological side saw environmental degradation as a perverse and natural outcome of this dynamic, critics from the psych disciplines viewed the industrialization of such goods as health care as contributing to mental health problems. Indeed, such concerns led various radicals in mental medicine and other medical specialties to advocate on behalf of a guaranteed annual income as a means of alleviating health problems and improving population health. Antiscience ideas, including terms such as technologization, dehumanization, and alienation, suffused radical mental health literature in the late 1960s and then the early 1970s. A focus on these terms was not novel. During his 1912 visit to New York, Carl Jung suggested how technology wove its way into the unconscious. “America does not see that it is in any danger. It does not understand that it is facing its most tragic moment; a moment in which it must make a choice to master its machines or be devoured by them.” The danger was that the more humans tried to master the machines, the more one “must be savage to” one’s “own unconscious self.”48 More so for Jung than for Freud, particular machines and structures—­the chariot, cog, engine, lever, tower, and automation in general—­were primal, shaping “intuition and apperception to forms specifically human.”49 The Frankfurt School, which included Theodor Adorno, Max Horkheimer, and Herbert Marcuse, presented challenges to Western society’s faith in scientific reasoning and industrial-­capital. In the 1950s, Jacques Lacan and Erich Fromm argued that patients’ experiences and the insanity of an industrial-­capitalist society were inextricably linked. Jacques Ellul, who coined the term technological society, argued that, yes, technology catered to society, but also enslaved it. Indeed, a number of ominous-­ sounding antiscience and antitechnology books were published after World War II, such as Sigfried Gideon’s Mechanization Takes Command (1948), Harold Innis’s Empire and Communications (1950), Abbott Payson Usher’s A History of Mechanical Inventions (1954), Jacques Ellul’s

Disruption 27

The Technological Society (1954), Marshall McLuhan’s The Gutenberg Galaxy (1962), and Leo Marx’s The Machine in the Garden (1964). As the ethnobotanist and self-­described psychonaut Terence McKenna put it, “In an electronics society there gradually occurs a reversal of the traditional relationship between man and the matter with which he forms his physical world.”50 Arguments of this kind were taken a step further by the widespread critique of certain fields in science and technology such as cybernetics, which was often portrayed in the mass media as an effort to mechanize all human activity. It did not help that cybernetics was often conflated with Dianetics, a “new science of the mind”51 created by L. Ron Hubbard, the founder of the Church of Scientology. Dianetics: The Modern Science of Mental Health conjured notions of wacky scientific fads and strange approaches to the brain. Cybernetics, also rooted in science fiction and fantasy, had been under fire since it first appeared on the scene in the early 1940s, especially from members of the Frankfurt School of neo-­Marxist social theory. As Herbert Marcuse, a philosopher and political theorist argued, “cybernetics and computers” would inevitably “contribute to the total control of human existence.”52 Cybernetics was clearly an issue for mental health radicals. According to Readings in Radical Psychiatry, a 1975 compilation of writings by Claude Steiner and others associated with the Radical Psychiatry Center, a sense of alienation was a natural side effect of an automated, technologically driven, compartmentalized society. Just as A-bombs and advanced warplanes alienated civilians at home (not to mention creating devastation abroad), assembly lines and automated devices in factories alienated labor and managers. Such alienation, noted the radicals, was “a feeling within a person that he is not part of the human species, that she is dead or that everyone is dead, that he does not deserve to live, or that someone wishes her to die.”53 Besides sexism, racism, militarism, schooling, environmental degradation, bureaucracy, and the consumer economy, developments in science and technology thus contributed to mental distress in modern America.54 As a result, there was a significant need to help people prepare for the rapid, all-­pervasive scientific and technological character of the times. This was because, compared with earlier ages, Americans were living through the equivalent of centuries of change.55 As the noted social thinker Christopher Lasch has argued, modern communications technology affected culture and production by asserting

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managerial control over the labor force. Industrial society may have been sick, but it gave way to a postindustrial society that solidified the achievements of industrialism. Much like mechanization in the workplace, the media formed a one-­way system of management and communication, serving to concentrate economic and political control in a small group of elites: corporate planners, market analysts, and social engineers. Technology, in this rendering, was an instrument of social control. Instead of creating a false consciousness, it sickened the collective mind.56 In 1970 McLuhan penned From Cliché to Archetype, which suggested that satellite technology might somehow “program” human beings. The ring of satellites circling the planet signaled the end of a natural environment, and this shield produced a global theater. Of course, the internet had not yet reached its troubled teens, let alone a midlife crisis. But McLuhan’s virtuosity lay in his forecasting the ways consciousness, awareness, and autonomy—­or cognitive shifts—­would be affected by communications technology and the changing natural environment. To many of his critics, McLuhan played with Freudian and Jungian psychological concepts too freely and loosely to be taken as a serious commentator on mental health.57 That he used the terms “subliminal,” “subconscious,” and at times “unconscious” synonymously, for example, detracted from his credibility among some psychiatrists and other professionals. It marked a lack of basic knowledge about the founders of the psych disciplines. McLuhan, who argued that the “electric media created the effect of bringing the unconscious level of the psyche to the surface where it could become conscious,” found it hard to gain traction precisely because of imprecision in his use of terminology.58 Feminism and Sex Throughout the 1970s, patient activism took various forms and continued to evolve in myriad ways. Women proved highly influential. Feminism and sexuality, more particularly, were crucial. In Washington, D.C., for example, near the home of the APA and the seat of political power in the United States, radical feminists conflicted with moderates and liberals. Liberal feminists wanted legal and statutory reform and exhibited a “fundamental faith in the soundness of America’s economic and political institutions,” whereas radical feminists, often far more bellicose, wanted to free women “within both personal and public realms,” as Anne Valk has written.59 These

Disruption 29

“radical sisters”—­Valk’s term—­in some instances advocated the toppling of America’s capitalistic economy to terminate patriarchy, racism, and imperialism, which they hoped would create the conditions in which an inclusive democracy could blossom. In other cases, pugnacious radicals established shelters for battered women, children’s programs, rape crisis centers, and feminist publications, such as Aegis and Quest. Yet the distinctions between radical and liberal can be misleading and somewhat overplayed. Within the District of Columbia, Valk notes, “The line separating liberals and radicals often blurred.”60 Conflict was certainly present among these reformers, but flexibility and adaptation also characterized interactions between groups like the Washington Area Women’s Center and National Black Feminist Organization. The tensions and negotiations, the push and pull among Washington’s radical sisters were typical of the dynamic and protean feminism of the 1960s and 1970s. They were also a feature of reformism among mental health activists. In Phyllis Chesler’s Women and Madness (1972), Chesler wrote of intellectual women who had spent time in psychiatric hospitals, such as Zelda Fitzgerald and Sylvia Plath. She discussed how questionable diagnoses of madness in rebellious—­if not wholly radical—­women, particularly nonwhite women, were a means of control. She also discussed exploitation at the hands of male therapists, especially sexual exploitation. Chesler’s argument was unique. It was a viewpoint that became characteristic of second-­wave feminist evaluations of psychiatry, as well as of women’s autobiographical reflections surrounding madness in the 1970s and 1980s. Chesler also pushed the limits of the conventional patient-­ therapist relationship. “Are you sure you want to sleep with your psychotherapist?” she asked New York magazine readers in 1972, a time when none of the major American mental health associations had enacted ethical codes disallowing sexual encounters on the treatment couch. The subject obviously needed more exposure, and the cover of the June 19, 1972, issue of New York Magazine did just that. It featured a distinguished, silver-­haired older man embracing a young, attractive woman as they reclined together on a leather couch. The accompanying article by Chesler, “The Sensuous Psychiatrist,” illuminated the often unspoken, exploitative aspects of therapy in the 1970s. It underlined the potential abuse of authority, gender inequalities, and the need to think more critically about the ways in which patients interacted with service providers. Chesler wrote that “most doctor-­patient

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Figure 2.2 Vietnam veterans protest the war in Boston in 1971. In the background, the State Theatre was screening an adult movie.

sex” was a “psychological form of such ‘incest’ as well as being medically unethical and legally questionable.”61 Whereas Sigmund Freud, according to Chesler, saw sexual encounters in therapy as a pitfall, a hazard to be avoided, numerous psychoanalysts believed a turn-­on might actually have therapeutic uses. Indeed, many regarded sex with patients—­a romp on the

Disruption 31

couch—­as neither an irregularity nor a blunder but rather as a “productive element of the therapeutic process.”62 In 1972, a time that saw the widespread theatrical release of Deep Throat, starring Linda Lovelace, and then, a year later, The Devil in Miss Jones, some therapists actually believed that sexual activity with clients was a legitimate part of therapy. The “golden age of porn” and “porno chic”63 saw films containing explicit sex explode into the cultural mainstream, to be later referenced by such icons as Jimmy Carson and Bob Hope. Everything You Wanted to Know about Sex but Were Afraid to Ask (1969), Human Sexual Inadequacy (1970), and The Joy of Sex (1972) also represented America’s booming interest in topics of sexuality. Picking up where Alfred Kinsey left off, these highly popular books reflected liberating attitudes toward relations between men and women and helped drive and inform the decade’s sexual revolution. The appearance of such popular books and movies occurred in parallel with institutional changes in the psych sciences. The APA declared sexual activity with patients unethical in 1973, followed thereafter by the American Psychoanalytic Association; the American Association of Sex Educators, Counselors, and Therapists trailed in 1975. The American Psychological Association followed suit in 1977, the same year the surrealistic adult film Barbara Broadcast was released in select theaters across the United States. Pornography, in various forms and going by numerous names, had always percolated beneath the surface of American society, but it was not until the mid-­1970s and the rise of feminism and patient activism that the porous line separating seduction and sexual exploitation in the therapy hour was interrogated far more closely. Apart from Chesler and sexual relations between the patient-­therapist, works like Betty Friedan’s The Feminine Mystique suggested that mass tranquilizer use during the 1950s had pacified women into acceptance of thwarted dreams and had facilitated women’s assenting to the limits imposed on them. For antipsychiatrists, humanistic concerns about feelings and emotion in American society were vital issues, and clearly intersected with the politics of feminism and sexuality. Other books besides The Feminine Mystique criticized the complicity—­or, worse, the willing participation—­of mainstream psychiatry in disciplining women and placing constraints on unfettered emotional, sexual, and artistic activity. Sylvia Plath’s The Bell Jar, published in the United States in 1971, and Virginia Woolf’s five-­volume diary, published in 1977–­1984, both underlined the dangers

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women faced at the hands of the mental health system. Later, the work of the feminist sociologist Kate Millett became a significant element in the antipsychiatry and patient power movements. In 1970 Millett published a scholarly study of patriarchy in Western literature, Sexual Politics, but she later offered memoir-­style works focusing on her relationships and sexuality throughout the decade, such as Flying (1974) and Sita (1977). In 1990 she became a dominant figure in the American antipsychiatry movement with her memoir, The Loony-­Bin Trip. It chronicled her harrowing psychiatric experiences, including her diagnosis of bipolar disorder, her struggle with the deadening lithium, and her psychiatric confinement.64 Women and sex were directly taken up in the DSM-­III, which saw a shift from a primarily psychoanalytic psychiatry in the DSM-­II. DSM-­III marked an increasing detailed differentiation of sexual problems encountered in American psychiatry, reflecting not only the influence of such thinkers on gender as John Money, Robert Stoller, and Richard Green but also the impact of the work of William Masters and Virginia Johnson. Masters and Johnson were certainly not the first to approach sexual problems with a form of behavioral conditioning or to emphasize the clitoris in female sexual pleasure. Still, their detailed physiological studies heralded the professionalization of a behavioristically inflected sex therapy. They were not directly involved in the DSM-­III, though. One result of the book’s attention to sex was the widespread acceptance of a condition dubbed “female sexual dysfunction.” According to the gender and sexuality scholar Katherine Angel, the “legacy of both the scientific and cultural critique of psychodynamic psychiatry in the postwar period, as well as that of the feminist critique of psychotherapy and psychiatry . . . converged to create a heated contemporary debate about sexuality, pleasure, psychiatry, and technology.”65 To conclude, feminism and sexual politics in the 1970s led to a reassessment of gender-­based hierarchies in the mental health establishment. In particular, psychoanalysis and psychopharmacological interventions were criticized strongly; both Freud’s focus on sexual fantasies and the use of “mother’s little helpers” (benzodiazepines) came under fire.66 Individuals such as Chesler and others drew from second-­wave feminism to refocus on the role of women in mental health. They criticized psychiatry for reinforcing notions of the dutiful mother and obedient housewife, suggesting psychiatry was a means to control women. Those women who did not behave “properly” risked ending up in psychiatric care. This critique wasn’t new.

Disruption 33

Throughout the twentieth century, psychiatrists sought to determine actual biological differences between men and women. This issue heightened in the 1970s, even as critics and physicians tried to illuminate some of the interwoven biomedical and sociocultural relationships 67 Punk Culture Popular culture reflected the ups and downs of the era, as music, television, and film turned from the hopeful currents of the 1960s toward a different type of message. In music, Bruce Springsteen (the Boss), along with other artists such as the Ramones, the Sex Pistols, and Merle Haggard and the Clash, played a huge role in interpreting anger-­plagued and angst-­ridden working-­ class sentiments. Punk rock in both the United Kingdom and United States advocated “naughtiness and disobedience,” to be “yourself, no matter how untidy or gauche.”68 Disco dancing also provided a basis to illustrate working-­class transformation. So much more revealing than one enormously successful film (John Travolta’s Saturday Night Fever) and its smash hit soundtrack, disco exposed “much about class and the cultural shifts of the decade”—­with all its angst and anger.69 While disco proved to be one of the few integrated working-­class cultural movements, the antidisco movement was a catch-­all for disenchanted white, blue-­collar males who collected slights—­real or perceived—­based on economics and sexuality, region and race, and fears of environmentalism limiting even more jobs. In 1976 the Ramones released their debut album. It was a concise, thirty-­minute album, and the group, along with the Dictators and Patti Smith, among others, showed a different side of American music. Writing in Rolling Stone, Paul Nelson suggested that the Ramones’ album exhibited “an exhilarating intensity rock & roll has not experienced since its earliest days.”70 The album “has to be heard to be understood. Heard, not read about or synopsized.”71 The sensibility was brutal, even as it symbolized a sort of rock austerity. A simplicity, perhaps—­or earthiness. The music was loud, hard, and fast. Production values were nonexistent, while costumes consisted of jeans and t-­shirts, often carefully unwashed. No fancy light shows entranced the audience. No gaudy song-­and-­dance acts distracted from the music. The genre of punk rock emerged at a time of economic and political worry and division, not only in the United States but in the United

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Kingdom as well. British punk espoused a tangible political agenda, and the Sex Pistols shouted there was “no future” rather than no limits.72 With respect to mental health in the United States, punk arose as deinstitutionalization gained momentum and provided “a youth-­friendly optic of mental illness as societal exposure to individuals with mental illness increased.”73 Even more, punk offered a voice to a “previously excluded community—­ reaching out to those stigmatised by prevailing values while rejecting self-­ stigma.” Mental health issues could not be ignored. Through punk, that is, “negative stereotypes of mental illness were thrust back into society’s face, reframed as desirable characteristics, all the while lampooning prejudice and discrimination.”74 This was the other side of stigma, a term that Erving Goffman so eloquently challenged in the early 1960s. The Ramones were especially important in interpreting debates in mental health, according to psychiatrist James McDonald. The lead singer, Joey Ramone (real name Jeffrey Ross Hyman), had Marfan syndrome, and later in life he was diagnosed with obsessive-­compulsive disorder. As a teenager he experienced a psychotic episode and was treated in hospital, a visit that informed many of the band’s songs. The group referenced asylums, padded cells, electroconvulsive therapy, and psychosurgery. As McDonald put it: No band is as rich in references to psychopathology . . . as original 1970s New York punks The Ramones. Songs such as ‘Psychotherapy’, ‘Gimme Gimme Shock Treatment’, ‘I Wanna Be Sedated’ and ‘Teenage Lobotomy’, although playing fast and loose with DSM criteria, are punk rock classics, mini case-­vignettes with a savage, knuckle-­headed wit lying behind the buzz saw guitar attack.75

In this way the group helped showcase common discussion points in the arena of mental health. Activists used the songs to illustrate the darker, “other” side of treatment methods. In a physical sense, too, the Ramones exemplified crossing boundaries. The Ramones toured Germany in 1973 and grew increasingly interested in passing through (or over) the Berlin Wall, into East Berlin. The band recounted how one evening, after dark, they had found stairs leading upward. Did they make it across? No. Through barbed wire, though, they could see “the other side,” which was “bleak,” “sterile,” and “ominous.”76 Spotlights found them, however, and they realized they were human targets, so retreated to a bar. Amsterdam was the next destination on the European tour and, according to Marky Ramone, they eagerly anticipated more highs.

Disruption 35

Concluding Thoughts While the seventies may not have been an entirely new epoch, change abounded, as Claude Steiner argued during the meeting at his mentor Eric Berne’s house. Transformations occurred in work-­life balance and the family, in government and business, in science and technology. The Vietnam War provided a volatile background for the rapidly moving reconstructions of society and culture. These developments in all facets of Americans lives had an impact on perceptions of the country and the American mind-­set. The next chapter takes up some of the era’s eddies and currents.

3  From Prevention to Activism and Radicalization

Conflict is the essential core of a free and open society. If one were to project the democratic way of life in the form of a musical score, its major theme would be the harmony of dissonance.1 —­Saul Alinsky, 1971

In 1969 the American Psychiatric Association (APA), the country’s most powerful mental health group and the umbrella organization for the nation’s shrinks, held its annual meeting at the posh Americana Hotel in sunny Miami, Florida. As participants registered on Sunday and early Monday, the temperature hovered benignly around 25 degrees Celsius, but there was some tension in the air. A few lone protestors were walking along Miami Beach or relaxing outside the hotel, while some licensed and more militant members of the APA were gearing up to make waves during the conference. The activists’ aspirations, and the radical psychiatrists who pushed for change in Miami, varied considerably in their goals and focus. Some were critical of militarism, of external social and political forces that traumatized people, and above all of oppression, elitism, and alienation. Solidarity against U.S. involvement in the Vietnam War brought them together, as did issues of recreational and pharmaceutical drug use and how to ameliorate an unequal economic structure. Other protestors were fixated on promoting social progress and human rights in American mental health services, as well as beyond the shores of the United States. Even more protestors were dedicated to advancing single issues, including gay rights, feminism and civil rights. With all these swirling and questing energies concentrating on the rise of science and technology, powerlessness, rights, and

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discrimination, the pressure for change at the APA conference was enormous. These agitators and radicals were asking questions of the organization, and of society more generally. They sought to redress mental illness at the individual and collective levels, and they wanted more refined practices to do so.2 The venue was hardly a suitable incubator for change. Originally built by the Tisch chain for $17 million, the 475-­room Americana Hotel in Miami opened on December 1, 1956, as a luxury hotel. By 1968, French showgirls were performing the “Toujours Paris Revue” in the Americana’s Carioca Lounge. Some of the protestors at the APA meeting criticized the venue as elitist, tactless, and out of touch, suggesting it represented persistent inequalities in society and, as the site of the 1968 Republican National Convention, alignment with the party of Richard Nixon. For many of the psychiatrist-­activists at the conference it was no longer tenable to take a casual approach to society’s problems, let alone problems in mental health and the allied sciences. The time for nonchalance had passed. Years earlier, it might have been possible to turn a blind eye, but not at the climax of the 1960s. Only a year before a mix of liberals and socialists, hippies and outsiders, had talked politely to colleagues about confronting racism, foreign policy, and the failures of their profession. They were content with such civilities and with incrementalism. In 1969, though, the liberal caucus in the APA decided to rebrand itself as the Radical Caucus and adopted a defiant style that targeted the major paradigms of the profession. In doing so, it also affixed bull’s-­eyes to such American institutions as police forces and government, the medical profession and the military, arguing for the closer engagement of these institutions and the psychiatric profession with the prevailing issues of the day. The radicals were no longer merely parroting the tenets of community psychiatry, nor was there any identification with the APA’s institutional leadership. It was time to get angry, to take action. This was the means to achieving better health and an improved society. The Radical Caucus cautioned psychiatrists and others in the mental health field against hiding “behind the couch” and demanded “bold new leadership.”3 Starting May 5, the Radical Caucus voiced its displeasure with the establishment in a very visible way. The group circulated pamphlets indicting APA members for persecution of “black and Puerto Rican mental health workers” and “complicity with the military.”4 The Radical Caucus supported

From Prevention to Activism and Radicalization 39

the APA’s Black Caucus, which had existed since 1965, and the Women’s Caucus. The former held up racism as the essential mental health problem in the United States and stated that black psychiatrists were systematically barred from positions of influence and authority. Demanding more participation in the management of the APA, total desegregation of mental health facilities, and more training for black psychiatrists, the Black Caucus was another powerful faction advocating for change.5 The Women’s Caucus, a wing of the Radical Caucus, announced its own independent doctrine in 1969 and articulated certain core elements. Some specific issues of concern, identified in their documents, were (1) total control over our [women’s] own bodies, (2) male supremacy in psychiatry, and (3) the politics of housework. The Women’s Caucus concluded its manifesto by urging the APA to support the women’s liberation movement and to begin listening to women as the real experts on the problems of women’s mental health.6 Overall, the Radical Caucus endorsed a bold set of policies and plans. It supported a comprehensive health care system that would be federally financed and controlled by local communities. It called for the repeal of all legislation that made the use, possession, or sale of any drug a criminal offense. The caucus denounced the war in Vietnam and demanded an end to the draft. And it called for abortion services to be freely available and provided by the state.7 Minor protests held outside the hotel by gay rights activists themselves bolstered the rights agenda at the conference. Angry gay activists, the Radical Caucus, and other more mainstream members helped drive debate about the politics and science of homosexuality’s classification as a mental disorder. This led, later, to a referendum on the matter, changes in the DSM, and ultimately the establishment of a Committee on Gay and Lesbian Issues in the APA’s Council on National Affairs. (Nearly two months after the APA conference in May, the gay rights movement would receive national attention with the Stonewall riots in New York City.) Miami was deemed a triumph by a number of protestors. The radical psychiatrists—­ composed of feminists, African Americans, and others—­ attracted up to two hundred persons at their meetings, and the group’s message was communicated energetically. As Tom Harper, one of the participants, wrote, the group triumphed in “dispensing a vast quantity of radical literature and leaflets” and “engaging in dialogues with hundreds of people at the literature table and informational meetings.”8 The caucus publicly demanded that the APA end all complicity with the military as

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long as the war in Vietnam continued. It called for all psychiatrists engaged in military training or war research to face expulsion. It proposed that the APA take a stand against the repression of youth. It demanded the APA censure all health institutions across the country that restricted community or political involvement.9 These matters did not move forward with any kind of tangible success and, to be sure, were not always expected to, but the radicals were satisfied that they had raised awareness among their colleagues and forced discussion. Hence protestors and radical participants left the meeting in Miami with a sense of purpose. The final APA meeting of the 1960s was, at least from the radicals’ perspective, a measured success in promoting its agenda. It was anyone’s guess what the 1970s might hold. Background The collection of radical psychiatrists at the 1969 APA meeting exemplified tensions within the mental health field, but they also typified divisions in American society, as well as the vicissitudes of the American mind. Even as they joined together in fighting the system and “the man,” the radicals also fought each other. They argued that the field of psychiatry (and all other mental health professions) needed to modify its training methods and service delivery models.10 According to the former head of the APA, Dr. John Talbott, the radicals were a “disparate amalgam of people.” They were “everything from Marxist-­Leninists to anarchists to people like me who were antiwar and were very upset about Kent State.”11 Many of them believed that the mental health establishment had to cast off neutrality and recognize the individual and collective sickness that was a natural by-­product of militarism, alienation, and endemic racism. “Therapy means political change,” the radical psychiatrists declared at the end of the 1960s, not simply “peanut butter,” which meant—­in a very sixties kind of way, and depending on how you interpret peanut butter—­that mental health was intimately tied to societal changes.12 Indeed, “a common sense that things needed to change” was what brought them together, Talbott said, although there was no unity on “any one way to change or how to change.”13 Self-­described radicals were not always at the forefront of reformist agendas and were not the only health care providers to conceptualize society as sick. Liberals (as opposed to “radicals”) also contributed to restructuring

From Prevention to Activism and Radicalization 41

mental health care services in the 1950s and 1960s. After World War II, social psychiatry and preventive psychiatry grew in strength.14 Adherents of both sought to locate the mental patient and his or her symptoms within a broader sociopolitical context. As well, both strains questioned the fundamental health of American society. In light of the two world wars and a history of slavery and discrimination, it was worthwhile reevaluating psychiatry’s traditional role and thinking more critically about a “sick society.”15 Such beliefs were by no means new to health care, and health activism in the 1960s was not a historical outlier. Medical students in the 1930s created the Association of Interns and Medical Students, which lasted until 1951, when “anti-­communist hysteria” helped extinguish the organization.16 Then, in 1964, Los Angeles and Boston-­based health students laid the foundation of a national movement called the Student Medical Conference (SMC), a multischool student organization.17 Certain SMC members worked alongside the Medical Committee for Human Rights (MCHR) in Mississippi in 1965, whereas other health care students contributed to pilot projects in Mexican American communities in East Los Angeles or clinics in Mission Hill, a black neighborhood in Boston. These groups, to varying extents, hoped to cure society and the individual. Students had long been attracted to careers in medicine, nursing, dentistry, pharmacy, social work, education, and psychology for the purpose of making a difference in society. With the creation of groups like the Student Health Organization, for example, principled and passionate individuals might now have an avenue to change the system by offering idealistic approaches to American medicine. The aim of the program, established in 1966, was to collaborate with the underprivileged and address the problems that standard medical school curricula formal education did not prepare health care workers for.18 Dr. Mike Michaelson, a graduate of the University of Pennsylvania Perelman School of Medicine, wore his long curly hair down to his shoulders. He was tall and lanky, bespectacled, and often wore a button on his jacket that read “Caution: AMA May Be Dangerous to Your Health.” He felt the medical system—­the establishment—­posed a threat to American health, not just at the individual level but to all of society. He was upfront and unflinching in his views. And he unquestionably considered himself a radical. As a member of the MCHR, Michaelson was far from an isolated figure. By 1971 the MCHR’s national membership had grown to 10,000 health workers across

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the country, and one of the foundational principles of the group was that health activism—­and not just mental health activism—­was a vital national concern. The organization had formed in 1964 after an enhanced “medical presence” was requested by activist organizations in Mississippi following the murder of three civil rights volunteers. Two psychiatrists from Massachusetts, Drs. Robert Coles and Joseph Brenner, who had been volunteering in Mississippi, responded by challenging physicians in the state to provide “the best of medical care,” no matter how they felt about the issues.19 That same year saw an influx of “good doctors” into the state, in addition to short-­term health student volunteers and professional nurses.20 The grassroots activist and writer Saul Alinsky also wrote Rules for Radicals in 1971. Over a lifetime of agitation, protesting, and community organizing, Alinsky had developed some strong ideas about best practices in pursuit of societal reform. True progress, in his view, could only be achieved through organized conflict. Time magazine called him a “prophet of power” who had possibly “antagonized more people—­regardless of race, color or creed—­than any other living American.” He believed strongly that a given community should determine its own direction, and that the “enemy” should be defeated through direct but nonviolent action. Alinsky placed tremendous importance on empowering the impoverished and underrepresented. A few of his thirteen rules included (1) never go outside the expertise of your people; (2) ridicule is man’s most potent weapon; and (3) the price of a successful attack is a constructive alternative. Besides this, an enemy had to be selected carefully, or, as he framed it, “Pick the target, freeze it, personalize it, and polarize it.” Here he counseled against choosing institutions and organizations as targets, since individuals were much more vulnerable. Massive national bodies, such as the American Medical Association or the APA, were far more insulated, far more resilient, than single entities.21 Important in their own right, the rules for radicals and Alinsky’s own system of beliefs help us understand mental health activism. In Alinsky’s writings, it is possible to detect inconsistencies that would ultimately hinder radicals in the psych disciplines and beyond. As he said in an interview with Playboy magazine, “I’ve never joined any organization—­not even the ones I’ve organized myself. I prize my own independence too much. And philosophically, I could never accept any rigid dogma or ideology, whether it’s Christianity or Marxism.”22 Intellectual autonomy was vital; he would

From Prevention to Activism and Radicalization 43

not prostrate himself before a predetermined set of principles. Alinsky taught how power ought to be challenged, channeled, and implemented, yet he could not submit himself to a collective aim. He offered advice to activists seeking to influence public policy and dealt with such topics as class differences and tactics, how to disrupt meetings, and how to attract media attention. Still, he was also contradictory about the community’s autonomy, agency, and ultimate goals. This too would play out in health care politics and struggles over the correct approaches in mental medicine.23 Radical Genesis In 1968 the radicals first coalesced as a group at the APA’s annual meeting in Boston under the rubric “Psychiatrists for Action on Racism and the Urban Crisis.” During the May meeting, as the Bill Russell–­led Celtics competed for their eighth championship of the decade and eleventh in thirteen years, concern “about the grave social conditions in the nation,” the “danger of riots,” and “the effects of racism and poverty on the social and emotional well-­being of the entire country” resounded.24 According to most participant accounts, the group was finding its feet and brainstorming about goals. On May 15, a group of radical psychiatrists supportive of “social action” in “urban and racial” relations met to discuss how to improve American communities, specifically the city of Boston. Four key topics were addressed: (1) working with grassroots groups, (2) the provision of emergency care in violent outbreaks, (3) changing white racism, and (4) providing education and career ladders. Part laundry list of member activities and part how-­to training in engaging with the critical issues of social movements and racism, records of the meeting show that its aim was to create awareness of the practicalities involved in psychiatric activism. For instance, in San Francisco, psychiatrists had developed a working relationship with the Black Panther movement. This took the form of political support for Black Panther candidates running for office. It also took the form of medical and psychological support during demonstrations. The practical lesson to be drawn was that mental health providers should “make [themselves] available and open up contacts with these local groups.” For greatest success in interactions with grassroots groups, it was “best to let the initiative come from them as to the role to be played by the medical or psychiatric personnel,” according to a note-­taker for the Ad Hoc

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Committee for Social Action. This would allow “maximum autonomy and power” to “remain in the hands of the community group.”25 The radical psychiatrists at the APA meeting also argued that they had opportunities to strengthen race relations in Boston and elsewhere. This would be a difficult task, since racism took “different forms and guises” and did not lend itself to a “specific activity [intervention] with a short range goal.” It was agreed that various strategies targeting institutions and individuals had borne fruit. One such strategy was to recruit medical students from the “negro ghetto,” thereby boosting the numbers of “racial and ethnic minorities” in hospitals and medical schools. Another strategy was to organize “programs to increase constructive contact between the races” through small “tea parties” or “more prolonged intensive mixed T-­group” gatherings. (“Tea” was a common euphemism for marijuana in the 1950s and 1960s). In each case, the idea was to foster discussion and underscore that there were “human beings behind the stereotypes.”26 The concern for diversity in psychiatry has certainly not receded, and efforts to improve the “cultural validity” of the DSM-­III are still being undertaken. The DSM-­5 Cultural Issues Subgroup, for example, criticized the “rigidity” of the DSM-­ IV’s diagnostic criteria and for that edition’s discounting “context in the emergence and characteristics of psychopathology.”27 This first moment of organized radical psychiatry engaged the issues of social justice and American militarization but avoided direct criticism of the profession and did not adopt a revolutionary ethos. Instead, the philosophy emphasized the need for increased education at the grassroots level and more work “within communities, unions, professional associations, [and] fraternal organizations,” according to the 1968 recording secretary, a psychiatrist from Boston. Though the liberal caucus demanded more APA involvement in the contemporary issues of the day, the debate was relatively polite, and no one displayed overt hostility. As the recording secretary noted, “Two directions of action were agreed on: a petition at the convention to give immediate expression to the opinions of many attending, and long term activities within the APA itself.”28 As finally constituted, these opinions included an endorsement of Benjamin Spock’s efforts to find a peaceful solution to the Vietnam War, more funds and interventions for the underserved, support for Martin Luther King’s Poor People’s March on Washington, and further social action by the APA. In other respects, much was left up in the air: the following year’s

From Prevention to Activism and Radicalization 45

convention was not planned for, and no definite decisions were made about the direction of the group. A lot of loose ends resulting from the fast pace of the radicals’ meetings were left untied.29 “There was no confrontation by this liberal caucus of the larger APA organization for its complicity with the American racism, militarism, and imperialism which are responsible for the ghetto and Vietnam,” an attendee noted.30 Strangely enough, the radicals’ opinions merely reflected the philosophy underpinning social psychiatry while paraphrasing the words of APA president Howard Rome, who that year had urged psychiatrists to become more engaged in foreign affairs and issues of poverty, violence, and unemployment. “If psychiatry is to move into the avant-­garde of meaningful social reform,” Rome pointed out, it would have to “greatly extend the boundaries of its present community operations,” which was precisely the point of the liberal caucus.31 According to Scripts People Live, written by therapist Claude Steiner, “Alienation is a feeling within a person that he is not part of the human species, that she is dead or that everyone is dead, that he does not deserve to live, or that someone wishes her to die.”32 The phrase was then reprinted in the introduction of Readings in Radical Psychiatry, a collection of articles published in 1975 under the editorship of Claude Steiner and others in the Radical Psychiatry Center.33 Yet the radicals also pulled from such thinkers and practitioners as Carl Rogers, Abraham Maslow, and others, who privileged the patient’s “unique life-­world instead of adhering to rigid scientific frameworks.”34 Radicals wanted to reconceptualize the ways in which new bonds could be forged within communities. The thrust of the idea was that the individual and community might mutually reinforce each other, rather than stand in opposition.35 Dr. Paul Lowinger was a good example. Born in Chicago in 1923, Lowinger served in World War II before earning his medical degree from the State University of Iowa in 1949. In the early 1960s, after moving to Wayne State University’s Department of Psychiatry, he grew more and more involved in liberal movements and groups, including Physicians for Social Responsibility and the MCHR. Mustachioed and with a shock of wild hair reminiscent of Albert Einstein, he participated in the Selma to Montgomery march in 1965, attended many marches in Washington, D.C., and served as the national chairman of the MCHR. Yet he was not simply a marching protestor and personal physician for the civil rights movement. He was also a prolific researcher and writer, an organizer and an advocate. Along with

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other self-­proclaimed radical psychiatrists, Lowinger helped strengthen the position of his peers. Over the course of his career he wrote on eclectic but unsurprising topics: including doctors as political activists, lysergic acid diethylamide (LSD), marijuana, psychosurgery, prison reform, and the features of radical psychiatry. However, it was a focus on grander “social forces of progress” and what he perceived as “independence of thought and action” that underpinned much of his work.36 Unlike many of his counterparts, throughout his career he largely avoided talk of violent revolution and tearing down existing structures. Striking a middle-­ground approach, Lowinger proclaimed in 1967 during a wide-­ranging Conference on Radicals in the Professions that his fellow psychiatrists “need not be reactionary, conservative or passive in the face of revolutionary social change.”37 Lowinger’s views at times fit within the unstructured antipsychiatry camp, though he did not refer to himself as an antipsychiatrist. This movement, which incorporated disparate positions, confronted the legitimacy of psychiatric categories, diagnostic practices, and mainstream forms of treatment. It was “motivated by anger” with, on the one hand, the “arbitrariness of psychiatric diagnostic practice” and, on the other, inhumane treatments, including electroconvulsive therapy, insulin therapy, and long-­ term involuntary hospitalization.38 In the early 1960s, the principal drivers of the movement were psychiatrists themselves, many of whom, like Lowinger, avoided the term “antipsychiatry” and emphasized that they sought reform, not revolution. Psychiatrists such as R. D. Laing and Thomas Szasz, whose views differed strikingly in other ways, came together in pursuing the concept of antipsychiatry.39 Erving Goffman’s Asylums, Laing’s The Divided Self, and Szasz’s The Myth of Mental Illness helped set the stage for the subsequent attack on psychiatry.40 As early as 1964, the radical Lowinger, who would prove so influential in 1968–­1969, sought to locate his profession’s practices within larger societal changes, intellectual transitions, and notions of American exceptionalism. He participated in numerous marches for social justice during the early and mid-­1960s and witnessed firsthand the violence and racism that were leveled against African Americans. He treated cuts and bruises, broken bones, and the emotionally traumatized. By 1964, Lowinger had begun thinking more universally, and started to identify with signatories to the “Triple Revolution” memorandum, individuals like Linus Pauling, Robert Theobald, and Tom Hayden. The memo touted how developments in weaponry,

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human rights, and automation undercut social and economic progress and were ultimately detrimental to human civilization.41 Lowinger, although not a futurist as many on the Ad Hoc Committee on the Triple Revolution were, agreed with these positions. In addition, he believed strongly that his contemporaries, as well as the APA more broadly, ought to be cognizant of how breakthroughs in military hardware, advances in human rights activism, and the rising automation of Western civilization affected the field of psychiatry. “Health and mental health,” Lowinger wrote to his fellow radicals, “are issues inherent in each of these revolutions.”42 In 1969 the newly named Radical Caucus circulated a pamphlet that was titled “A Call to Psychiatrists, Medical Students, and Others in Mental Health,” the aim of which was to get the mental health establishment, and society at large, to contemplate the pressing issues of the day. On the heels of President Rome’s speech the year before, which called on psychiatrists to take a larger view of the world in which they practiced, radicals asked how mental health professionals had conditioned Americans during the 1960s. According to the document, were they “misusing their energies adjusting people to our oppressive society?” Was it feasible to alter “concepts and practices to make them relevant to needed radical social change?” And why did mental health professional continue to “cling to class and generation biases, deny external social reality, and blindly identify with the entrenched establishment?” In discussing whether psychiatrists bolstered such oppressive, authoritarian institutions as “schools, colleges, armed forces, courts, prisons, industrial concerns, and welfare agencies,” the radicals conceptualized psychiatry as capable of solving society’s ills, as a liberating force rather than a tool of oppression. They intellectualized psychiatry as a potential source of energy and emancipation rather than a “sedative-­tranquilizing” medical discipline that ensured “the survival of a social order and its failing health care system.”43 Radicals in the APA latched on to notions of parochialism and conservatism even as they addressed concerns about how mental health professionals ignored racism, sexism, militarism, and other societal ills. These were concepts anathema to traditional ideas about prevention and intervention, yet the radicals were not lone wolves howling in the wilderness. By 1969 the American Orthopsychiatric Association, the American Academy of Psychoanalysis, and the Group for the Advancement of Psychiatry had already exhibited some sensitivity to pressing social problems. The same was true

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of the APA and American Psychoanalytic Association, as both organizations were growing more attuned to politically and socially important issues. Wider engagement with society’s problems was palpable in the pages of the American Journal of Psychiatry and Psychiatric News, as well as in the formation of standing committees on such topics as aggression, foreign affairs, and poverty. One American Journal of Psychiatry article, written by Walter E. Barton, argued that while the landscape in which psychiatry operated was different, not all psychiatrists wished “to participate in the social evolution and revolution that are today’s reality.” He cautioned against overenthusiasm for “new fashions” in psychiatry, even as he remarked that a number of vital issues, including gun violence, needed much more attention.44 Esquire magazine commented in a piece headlined “Psychoanalysis Must Go” that “too much of the twentieth century has been wasted on the couch.”45 Wedged between articles by William F. Buckley Jr., “On the Politics of Assassination,” and Kenneth Tynan, “How Dirty Books Can Stay,” the piece posited that it was time to rise from the couch—­“to get up and try something else.”46 The American Psychoanalytic Association, for its part, established a Standing Committee on Social Psychiatry in 1969, something that had not interested practicing analysts in the past. Inaction, it seemed, was no longer an acceptable approach for psychiatry. And the concept of neutrality—­of remaining clinically objective in the face of major crises in the United States—­was increasingly viewed as anachronistic and a possible cause of the field’s decline.47 Raymond Waggoner, the new head of the 16,000-­member-­strong APA, was certainly in touch with the times. “Change,” he asserted in 1968, was “a catchword in American life,” and his aim as president was to oversee “healthy and wisely determined progress.” He suggested that it was time for psychiatrists to take a more active and diversified role in social problems outside the organizational structure. Psychiatrists and mental health organizations had to accept responsibility for and concern themselves with social change and social problems. It happened that the APA was in the process of modifying its constitution, with amendments that called for a more “action-­oriented role” for psychiatrists. To wit, psychiatrists changed the language of their guiding document so that it reflected advancement. Instead of “furthering the study of the nature, treatment, and prevention of mental disorders,” the new language indicated efforts “to improve the treatment, rehabilitation, and care of the mentally ill” and to promote

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“research, professional education, and the prevention of psychiatric disabilities.”48 Waggoner also sought to redress inequities in the organization, offering black minority members a greater voice in the policymaking process when he designated observer-­consultants to APA committees to remedy disparities.49 Overall, he felt, “as psychiatrists, we should not be afraid to be social activists,”50 and that it was “time to make concrete plans for psychiatry’s more constructive role in our future society.”51 This was the voice of the establishment? The establishment’s leader was using language from the anti-establishment? Radicals in the APA, as well as in the mental health professions more generally, engaged in debates over the utility (and decline of) psychoanalysis. Terms like “mystification” and “elitism” typified psychoanalytic practice for many radicals. They questioned how it might be possible to “progress from Freud’s one-­dimensional psychology to new concepts.”52 They asked how mental health professionals, who had themselves undergone psychoanalysis and psychotherapy, could not view the individual patient as a part of a dynamic, variable social structure. In their raising these points, it was clear that the radicals were acutely aware of the biomedical and psychodynamic debate within the field. Not simply evaluating the situation, though, certain radicals crafted a vision of therapy that transcended the rift. This excerpt from a pamphlet, which was developed by participants at the 1969 meeting, highlighted some of the problems facing radicals in mental health: Some psychiatrists have reacted to the dilemma by stressing adherence to “neutrality” of the traditional clinical role. But the psychiatrists’ role has never been value free. If he uses electroshock and drugs to suppress symptoms he is telling his patient in effect that he must adapt himself to whatever environment exists, however oppressive. On the other hand, if he leans toward Freudian interpretation, the effect can be much the same. By interpreting the patient’s reactions only in terms of inner conflicts established in early childhood, he implies that examining oppressive social and cultural conditions and choosing among alternative roles in society, including that of revolutionary struggle, are not important in the solution of his problems.53

According to the pamphlets circulated in Miami, Freud (and his medico­ philosophical ideas) had once been radical. His theorizing of the individual as a dynamic entity was cutting edge—­ahead of its time. Yet Freudian theory held social structures to be fixed entities, whereas the Radical Caucus members viewed these structures as mutable—­indeed, even as tools of

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repression. “The traditional ideology that views a given society as static rather than dynamic,” the logic in the pamphlet went, “can be attributed to powerful forces operating within that society.” In trippy-­sounding language, the Radical Caucus argued in favor of a new system of psychology “based on the interaction of the individual with a modifiable total at a success of points in time and space.”54 The radical psychiatrists put forth an alternate view of the much-­discussed schism within psychiatry. If unquestioning loyalty to the biomedical model was to be avoided, so too was excessive introspection based on the work of Freud and others, since both approaches ignored larger societal problems.55 In 1969 the Radical Caucus staked out a third way in the biological and psychodynamic rift. For the more than two hundred radical psychiatrists in Miami, smashing the walls of neutrality in the psych sciences and mental health professions meant various things to various people. But a real problem was the method by which the radical message was to be agreed on, organized, and distributed. How the knowledge was articulated and presented meant a great deal to conflicting constituencies. A “radical style” was ultimately adopted, which meant cribbing from the New Left and taking operational and aesthetic cues from other parts of the counterculture, including the student activist organization Students for a Democratic Society, the Black Panthers, and even the Weather Underground. Scatalogical language, cartoons, psychedelic imagery, and position papers—­these were all part of the new radicalism methods espoused by the New Left. Leaflets were handed out. Meetings were held. Yet the demonstrations and disruptions, sit-­ins and theatrics were used to generate publicity and force discussion of the value of new mental health approaches in 1969 and beyond. All this was done in an effort to overturn the overwhelming apathy of the mental health establishment, which many radicals in psychiatry deemed to be populated by hide-­bound traditionalists. After the steamy May meeting in Miami, the self-­ described radicals dispersed and planned for the future. One of the participants, Dr. Claude Steiner, returned to California to teach his version of radical psychiatry at the Free University at Berkeley and established a RaP (Radical Approach to Psychiatry) Center at the Berkeley Free Clinic. The bearded and bespectacled Steiner, a prolific writer, was born in Europe, relocated to Mexico, and then moved to California in 1952 to study physics. In the aftermath of

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World War II, he quickly rejected the idea of bomb-­making. Transferring to psychology and eventually obtaining his PhD in clinical psychology from the University of Michigan in 1965, he became a close associate of Eric Berne and a practitioner of transactional analysis. In 1970, with the death of his colleague and mentor, Berne, Steiner threw himself into crafting radical mental health positions. At the RaP Center, Steiner put together an amalgamation of his and Berne’s vision. “We offered drug, welfare, and draft counseling services, group psychotherapy, and some individual one-­ to-­ one therapy to the young people who were crowding the streets of Berkeley,” he wrote in a look-­back article reviewing his work.56 Over the course of 1969, radical psychiatry in Berkeley expanded. Feminist psychiatrists such as Hogie Wyckoff and Joy Marcus added their energy and intellectual imprint to the crusade. Wyckoff turned a harsh spotlight on the multiple ways in which women were alienated, including through coercive or unsatisfactory sexual experiences, withholding of recognition for and minimization of their work, and the induction of self-­contempt for themselves and their bodies. At the same time, she rejected individual therapy, writing, “There are no individual solutions for oppressed people,” and described the shape and outcomes of radical feminist therapy.57 In 1969 to 1970, Steiner began to take on a clear leadership role in radical psychiatry. In anticipation of the next APA meeting, which would be held on his home turf, in San Francisco in 1970, he developed the Radical Psychiatry Manifesto. One of the first expressions of radical psychiatry’s main precepts, it was a compilation of assertions and presumptions drawn from Laing, Szasz, Fanon, Marcuse, and Marx. Foucault was built into the mix, as was Timothy Leary. The basic formula of radical psychiatry, best practiced in groups, was as follows: Oppression + Deception = Alienation Oppression + Awareness = Anger Liberation = Awareness + Contact Steiner also drew from his peers in the field and from discussions with other radicals. “Psychiatry, Steiner asserted, “was a political activity,” and neutrality was not an option.58 Adopting neutrality in an oppressive situation meant psychiatrists were buttressing troublingly unequal laws and

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outdated values. Individual psychotherapy was an “elitist, outmoded, as well as nonproductive form of psychiatric help,” he wrote.59 In these declarations he was asserting not theoretical positions but rather the language particular to arguments in favor of social psychiatry and group psychiatry, especially after the passage of the Community Mental Health Act in 1963. More than that, the manifesto’s declarations about neutrality and the politicization of the psychiatric profession echoed those of institutional leaders at the NIMH and the APA. While there was alignment between the self-­described radicals and proponents of social psychiatry, Steiner also proclaimed, in what was clearly a reference to sociologist Thomas Scheff’s work on mental illness, stigma, and labeling, that “psychiatry must return to its non-­medical origins” and psychiatrists should repudiate the use of such words as “patient,” “illness,” and “treatment.”60 Deliberately inflammatory, Steiner asserted: “Paranoia is a state of heightened awareness” and “Psychiatric mystification is a powerful influence in the maintenance of people’s oppression.”61 In retrospect, the manifesto, which circulated during the 1970 annual meeting, gave voice to an unmistakable sense of dissatisfaction and anti-­authoritarianism. Even so, while the manifesto provided a concrete expression of radical psychiatry, it also encapsulated dilemmas and contradictions that would lead eventually to a split among the radicals. Steiner was not the only radical voice. Radical feminist psychiatry grew in potency, and Dr. Phyllis Chesler was especially persuasive. In 1969 she established the Association for Women in Psychology, completed her PhD at the New School for Social Research, and became a practicing psychotherapist in New York City. In Miami that same year, the Women’s Caucus, a subgroup of the Radical Caucus, had advocated that birth control information and devices be made freely available to women of all ages. It wanted to undercut “male supremacy” in the field; the year before, the May 9, 1968, “Resolution” stated that the “biological and psychiatric imperialism of women must end.”62 The means to ending male supererogation in the field of psychiatry was by acknowledging the unequal power relationship between men and women, women’s position as a legal domestic in the home, and the woman as an exploited worker. Recognizing these issues was the first step toward psychiatry becoming more progressive. In 1972 Chesler, drawing on these ideas, delivered the first critical evaluation of sexism and psychiatry, which would prove highly influential. By then, according

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to historian Andreas Killen, “the American psyche [had] received a jolt in its sex stereotypes,” and this would drive mental health conversations and practice for years to come.63 Chesler’s work provided an important foundation for future feminist writings in psychiatry, including Judi Chamberlin’s On Our Own: Patient-­Controlled Alternatives to the Mental Health System (1977) and Marge Piercy’s Woman on the Edge of Time (1976). The politics of housework had been addressed during the 1969 meeting, and the Women’s Caucus emphasized that household labor was unevenly distributed. This element of radical mental health would resonate throughout the 1970s. Psychiatry had to cease regulating the oppressed women by labeling them in various ways and it needed to recognize women’s objective conditions.64 The Women’s Caucus back in 1968 had concluded its “Resolution” by urging the APA to implement its demands, support the women’s liberation movement, and begin listening to women as the real experts on the problems of women.65 Chesler’s pioneering book, Women and Madness (1972), was grounded in many of the Women’s Caucus claims; it would sell over three million copies. She indicted psychiatry for its “marked sexism” and how this, in turn, played out in the construction and eventual assignment of pathological behaviors. According to Chesler, women were “especially liable to be deemed disturbed” and, following this, were far more likely to be “treated unfavorably in comparison to men.”66 Also in 1972 the establishment leadership convened at the APA’s headquarters to discuss the doctor-­patient relationship. In a committee meeting on May 17 that focused on the involuntary commitment of political dissenters, former APA chief Raymond Waggoner, the well-­known judge David Bazelon, and others questioned how mental health practitioners might readjust with the times. In the APA headquarters, however, the attitude of the committee’s members was far from conservative. A former judge on the U.S. Court of Appeals and a national spokesperson for the mentally ill, Bazelon was considered a radical by many. Waggoner, the former head of the APA, was himself a maverick, having noted on various occasions that “rebellion is not always necessarily undesirable” and “our institutions must recognize the errors which have been perpetrated and perpetuated.”67 Proceedings began with an avowed aim to better understand the factors involved in the forcible commitment of patients to mental hospitals. Waggoner opened with ideas about how the psychiatrist was no longer only the agent of the patient, that there was ambiguity that arose over the

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psychiatrist’s primary alliance, and that conflicts of interest had to be made explicit to the patient. In short, the meeting took on a far-­reaching tenor, a more radical sheen. The attending members agreed To look at, examine and make recommendations about possible conflicts and abuse which may arise in any situation in our society in which the psychiatrist is not functioning directly and solely in the interests of the patient (the traditional doctor/patient relationship), but rather his responsibility is more or less divided between the interests of the patient and various other institutions in our society; i.e. mental hospitals, prison, the military, etc.68

The core idea, then, was to examine how the psychiatrist-­patient relationship might be compromised. What conflicts, if any, were inherent in the relationship of the psychiatrist to the institutions of society that commit people? Staff were hired, grants were written, a methodology was decided on, and subjects were recruited to survey how clinical relationship could be modified. Still, roadblocks prevented progress. The APA Board of Trustees disapproved of the committee’s focus and of the Princeton-­based researchers the committee had selected to conduct the research. The team of researchers, it seemed, was too radical, the questions were too jarring. Judge Bazelon lamented that the APA trustees—­the real establishment—was so frightened of uncovering hard truths. Drs. Visotsky and Visher, two other members of the committee, questioned whether the APA leadership could tolerate the study at this time—­whether it could handle troubling findings. Visotsky, in particular, made clear that it was “always painful to look at ourselves.”69 Waggoner resigned from the committee.70 Within the APA’s upper echelon, struggles were manifest, just as they were among the radical practitioners. Publication Record After the APA’s 1969 meeting in Miami, radicals in mental health were provided a forum to discuss their principles and practices in 1970 when Michael Glenn, a U.S. Air Force psychiatrist based in Minot, North Dakota, initiated the Radical Therapist Collective and started a journal called Radical Therapist. An idea spawned during the frigid North Dakota winters, the new publication was intended by Glenn to be a fiery “rallying ground” to help develop a therapy “that serves the people.”71 However, it was aimed mostly at professionals. After twelve issues were published between 1970

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and 1972, the journal’s title was changed to Rough Times, reflecting the members’ broadening interest and evolving doctrine. There were tensions among the loose coalition of radical psychiatrists. Some in the wider radical therapy movement expressed displeasure with the Radical Therapist Collective. Many ex-­patient groups, deinstitutionalization advocates, and mental health workers felt the group had been “coopted by those who can publicize themselves,” namely through the Radical Therapist and other radical psychiatrists. The backlash was essentially a by-­product of the dominance of certain groups that had “the resources and know-­how” but did not necessarily represent the totality of the movement.72 As John Talbott observed in 1974, “The Radical Therapist may not have exhibited all or even the most important segments of opinion held by radical psychiatrists, radical therapists, or radical mental health workers,” but because of the journal’s wide distribution, “it constitutes their newspaper of record.”73 The journal served as the primary forum for interpreting, reformatting, and broadcasting antipsychiatric and radical theories to a larger audience, and because it grew into the chief voice of the radicals, it also took on the role of their establishment. Because its members were operating within the field of mental health, they represented elitism.74 The Radical Therapist dealt with breathtakingly complex topics, capturing the diversity of radical thought, and provided a snapshot of radical psychiatry’s intricacy. Its fire did not last long, but it certainly burned brightly, just as Michael Glenn had hoped. Power and the medical model, mental health services delivery, the psychiatric oppression of minority groups, and psychiatry and the individual patient were all addressed. Without deviation, authors framed the goal of traditional psychiatry as “the maintenance of personal and professional power and prestige, economic well-­being, and control over others.” And articles in the Radical Therapist also identified the wide-­ ranging etiological factors that contributed to mental distress in modern America. The list included not just the expected sexism, racism, militarism, and the consumer economy but also the American educational system, environmental degradation, bureaucracy, and technological growth.75 Society truly was sick. The eventual buckling of the radical movement was caused by various pressures and tensions. In general, some radicals craved wholesale commitment to macro social revolution at the expense of basic psychiatry, while others wanted to focus on reforming psychiatry itself, rather than

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sidelining it in favor of political action. At a more micro level of analysis, different approaches to psychiatry and the individual patient exemplified the strains within radical psychiatry—­between the kinds of therapy practiced—­and often revealed ties to other organizations. While most of the Radical Therapist’s authors deplored the overuse of such enforced therapies as drugs, electroconvulsive therapy, and insulin shock, division still characterized attitudes toward patients’ specific rights. Several articles written in support of a proposed patient bill of rights agreed with the Insane Liberation Front, a patient-­led organization that formed part of the psychiatric survivors’ movement. The authors of these articles called for the comprehensive dismantling of the capitalist system, mental institutions, mental commitments, and the practice of psychiatry more broadly. Other articles in the Radical Therapist, by contrast, concurred with the moderate Mental Patients’ Liberation Front, another patient organization that pushed back against abuses in the mental health arena, and advocated a less extreme platform that underlined reform of mental psychiatric and psychological practices.76 While there may have been agreement among professional psychiatrists, psychologists, and patient groups, there was little uniformity about the appropriateness of a formal association. Some believed that former “mental patients and professional therapists” should “participate in the same organizations and work together,” while others felt that they could “work together but not in the same organization.” Similarly, most radicals considered “involuntary hospitalization, psychoactive drugs, electroshock, behavior modification, and psychosurgery as harmful,” yet, once again, others regarded such treatment activities “as useful in specific instances.”77 In the case of community-­based psychiatry, there was significant departure on—­ or, rather, radicals squabbled over—­ consultation and control. According to Michael Staub’s 2011 Madness Is Civilization, initially “community mental health programs represented a great step forward, especially in light of the evidence . . . that persons from economically depressed backgrounds suffered far higher rates of psychiatric disorders than persons from affluent communities.”78 This type of service delivery, at once touted as a positive outgrowth of liberal Great Society thinking and a move away from what Erving Goffman had in 1961 deemed oppressive asylums, now came under fire from a segment of radical psychiatrists. In fact, shots across the bow had been fired as early as 1969 in Miami.

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Figure 3.1 Elderly patient watching television in Belchertown State School, Massachusetts, 1972. Belchertown was one of many mental health institutions criticized for the poor treatment of patients.

Deinstitutionalization was predicated on improving patients’ health through more interaction with the community and greater reliance on antipsychotic drugs, though ultimately it was a means to transfer mental health care costs to the federal government. But in a clear allusion to Szaszian theory—­specifically, Szasz’s recommendation to separate psychiatry from

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the state—­such Radical Therapist articles as “Radical Overview of Community Psychiatry” and “Community Mental Health as a Pacification Program” argued that the average community mental health center was a weapon of the establishment. It acted as a means to pacify angry communities and promote harmony rather than work toward social change.79 Szasz believed that the state, even outside the confines of large asylums, corrupted psychiatry for its own purposed and might twist the profession in ways similar to what had happened in Nazi Germany or the Soviet Union.80 Community consultation and community clinics, which sounded innocuous enough, garnered considerable attention and grew as a point of contestation among radicals. Some authors suggested totally abandoning community mental health center consultation altogether (since it served institutions, including prisons, the police, corporations, schools, and universities) and focusing exclusively on social activism. Other Radical Therapist writers proposed working within the system to achieve their ends. Szasz, for his part, called for a full-­scale halt to “government-­psychiatry mind control operations.”81 The three-week takeover of the Lincoln Hospital Mental Health Clinic in the South Bronx in 1968, for instance, embodied the diverse approaches to community clinics that were high-­minded and publicly funded; the Black Panthers that displaced the well-­meaning and award-­ winning therapists certainly had different views from the psychiatrists. All of the squabbling led to a rupture in 1971. The fundamental problem dividing the radical therapists was the legitimacy of the psychiatric profession, and of mental medicine more generally. Theoretical differences were vital. John Talbott, who led the APA for a time and wrote about radicalism, described having an “affinity” for the Radical Caucus because of social psychiatry and social causes, because income and health disparities needed addressing. Where he differed from them, he mentioned in an interview, was in their “love of people like Tom Szasz and R. D. Laing and people like that, who I felt were very destructive.”82 More particularly, the break among radicals was precipitated by disagreement over support for patient activism, accusations of elitism, and a lack of authentic revolutionary action on the part of reluctant mental health practitioners. Some members of Michael Glenn’s Radical Therapist Collective refuted psychotherapy as a valid activity and repudiated the various professions entirely. Psychiatry, in such renderings, was incompatible with societal change and political change. This

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Figure 3.2 Community mental health clinics emerged around the United States after 1963 and were contested within the psychiatric field and without. The government sponsored image demonstrates how patients would improve in a community setting. Image from around 1964.

truly was the radicals splintering. Already by 1967–­1968, radicals in mental health had questioned the oppressiveness and mystification of mental health therapies. These were the outstanding critiques of radical psychiatry and were not going away anytime soon; now, though, the argument was taken even further. Proponents of alternative therapy and ex-­patients (aka psychiatric survivors) “eyed each other with suspicion,” as a historian of the era has written, and the latter came to “bar professionals from participating in [their] conferences, newsletters, and self-­help centers.”83 The therapists’ rejoinder was that mental patients’ liberation groups ignored the broader goals of the Left and were too narrowly focused.84 A chasm soon separated California radical therapists, in particular, and others in the movement, which duly influenced the publications. Acrimony spread, and the Berkeley-­based Radical Psychiatry Center, located

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in the core of psychedelic psychiatry and the emerging New Age mental health environment, was singled out as entitled, elitist, and the very picture of weekend radicalism. Claude Steiner had morphed into a persona non grata for several reasons. Amid bitterness over the Californians’ “middle-­class emphasis on groovy fun and individual solutions,” Michael Glenn left the journal he had helped found. The last issue of 1971 printed a critique of the journal’s title, and the publication was subsequently renamed Rough Times. “We participate in the world-­wide revolutionary force,” the newly administered journal held, “not within the confines of ‘radicals in the professions.’”85 Total revolution was the aim, not simply reforms. In addition, the journal’s content became increasingly globalized, drawing more and more on the works of the mental health reformer in Italy, Franco Basaglia, among others. Claude Steiner, author of the original Radical Psychiatry Manifesto, started another journal, Issues in Radical Therapy.86 The breakup was not entirely clean, though, and a degree of animus remained. Rough Times critiqued the break-­away therapists thusly: Most of them are too comfortable in their professionally detached attitudes, pseudo-­hip life-­styles, and removed position from world revolution as well as personal change. We began to see our position in terms of being part of a revolutionary movement. Our goals were more linked to a broad-­based socialist movement than to a radical caucus at a professional convention. We began to reassert, with more force and conviction, that RT should be part of a movement to build a revolutionary new world.87

The original radicals in mental health were supplanted. Joy Marcus, who had established herself as a leading radical feminist therapist while in Berkeley, offered a bracing retort. She attacked the change at her former journal as “depressing, destructive, a rip-­off and a cop-­out.”88 The publications continued along divergent pathways. In successive years, both Rough Times and Issues in Radical Therapy published articles. Issues in Radical Therapy, although a by-­product of discord, regarded itself as constituting part of the same movement; that said, it conceptualized itself as a practically oriented and prescriptive publication even as the editors, including Steiner, made clear that any liberal co-­optation would be repelled vigorously. Rough Times, for its part, eventually changed its name again, this time to State and Mind. In doing so, the journal completed a journey into the realm of self-­help and pop psychology.89 It ceased publication in

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1976. Carrying on, Issues in Radical Therapy offered dense academic articles and came to represent the movement of radical and alternative mental health therapy. Its circulation was largely restricted to the Bay Area, and the journal completed its run in 1983. A third publication, Madness News Network, further complicated the picture. Also based in San Francisco’s Bay Area, Madness News Network gave voice to ex-­ patients and promoted the intersecting threads of mental health liberation groups. Madness News Network was founded in 1972 as a newsletter and, while also an outgrowth of the political activism and countercultural strains of the 1960s, it possessed an explicit agenda: to tackle the legacy of deinstitutionalization, address the failures of community care of the mentally ill and the lack of mental health services more broadly, and offer a safe “therapeutic space” for the recipients of services in the system. In essence, the editors encouraged readers to give voice to their experiences, to demolish the mystique and fear that often accompanied mental illness. Madness News Network gradually grew from a community-­ based newsletter and provided a forum for members of New York City’s Mental Patients’ Liberation Project, Portland’s Insane Liberation Front, and San Francisco’s Network Against Psychiatric Assault, among others. Unlike its counterparts, Madness News Network tracked closely with developments in civil rights activism, gay activism, and women’s liberation magazines. In aiming to protect the “rights and dignity of those people labelled crazy,” Madness News Network advertised in other like-­minded anti-­establishment magazines. More than this, and perhaps not surprisingly, Madness News Network leaned heavily on Thomas Szasz’s ideology. Whereas Rough Times and Issues in Radical Therapy amalgamated an eclectic group of thinkers, Szasz was preeminent at Madness News Network. His strident refusal of “madness” and his casting of psychiatry as a modern religion was apparent in the journal from its inception. Indeed, this outlook—­the promotion of individualism and the denial of mental illness—­underpinned much of the political activity that flowed from the pages to the streets, including sit-­ins and celebrations, rallies and lawsuits.90 After analyzing the Radical Therapist and alternative mental medicine more broadly, the psychiatrist John Talbott suggested that members of the collective, as well as contributors to the journal, were divided into those “who want to effect change and those who are nihilistic ‘neo-­Dadaists.’”91 To be sure, radicals in the field of mental health had always demonstrated

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a multifaceted ideology, and the brief history of the Radical Therapist not only exemplified the difficulties in harmonizing such a broad set of ideas but also tested the limits of the radicals’ tolerance for each other. They called each other names. They accused one another of capitulation. These radical psychiatrists, in short, represented the complications inherent in negotiating a mishmash of theories and ideas. Even the heavy-­hitting radicals weren’t simpatico. “I guess we both needed a little time to break the ice,” Erich Fromm wrote to R. D. Laing, “and I was sorry that we had to separate when I thought a good deal of fruitful conversation would have begun.” In 1979 Michel Foucault wrote to Laing and continued to press for more work from his colleague, while the latter kept his distance. “I am truly sorry you won’t write the article we spoke about. I do understand your reasons. I want you to know that if any idea comes to you . . . we will be very pleased of it.”92 They were friendly, but perhaps less than friends.93 It was the same within the Radical Caucus and the Radical Therapist Collective. Contending with and reconciling concepts about the politics of experience, the dangers of asylums, and the myths of mental illness and state control could not have been a simple task. Difficulties in streamlining radical theory were also present in the association with patient survivors. The belief in professional boundaries between physician and patient prevented some psychiatrists, even though they considered themselves radical, from working in the same organization. By contrast, other psychiatrists felt those boundaries were artificial, injurious to the patient, and required total demolition.94 Likewise, involuntary hospitalization and the use of psychoactive drugs, electroshock therapy, behavior modification, and psychosurgery all served to split the radical psychiatrists. From its inception in 1968, radical psychotherapy proved to be an intricate and incompatible mixture of ideas; a straightforward “antipsychiatry” designation does not adequately encapsulate the complexity of the movement. It sought social transformation, but it also unwittingly contributed to popular self-­help psychology, a blending with New Age ideas of the mind and body, of relationships between individuals and government. More than this, alternative therapists—­ radicals—­ drove discussion about the gathering and use of data to understand the mind, to overcome mystification and elitism. To be sure, antipsychiatric views were firmly established at the Radical Therapist, and certainly constituted part of the Radical Caucus’s philosophy; still, self-­described radical psychiatrists were divided

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over both principles and practice.95 For such radical psychiatrists as Paul Lowinger and Claude Steiner, the field of psychiatry needed an intellectual overhaul and had to drastically modify its training methods and service delivery models. The profession, though, did not need to be torn down brick by brick. Rather, a refurbishment was necessary. In trying to explain the incongruity of radicalism—­essentially, why the rupture occurred—­it is not necessary to stray far from the incompatibility of the big thinkers. The leaders, such as Laing, Szasz, and Berne, held different views and were different individuals.96 Some of the radical psychiatrists, therefore, deemed it vitally necessary to dismantle the domineering psychiatric profession, a monolithic, conservative structure, and to impose constraints on the imperialistic expansion of psychiatry; others regarded a more moderate reform of the profession as the ultimate goal. Sometimes radicalism meant participating in the Vietnam War protests, the civil rights movement, and early women’s liberation groups and contesting the APA’s established power structures; at other times it meant embracing the rhetoric of anti-­establishment, anti-­social control, freedom of self-­ expression—­ a belief in antipsychiatry—­ and pushing for deinstitutionalization and the dismantling of asylums. The radical psychiatry ideology, in short, embodied both positive and reformist sentiments and anarchistic and nihilistic viewpoints. Patient Power The patients’ rights movement also emerged in this milieu, and the foundational moment often referenced was the drafting in 1970 of twenty-­six such rights by the National Welfare Rights Organization, which later led to the American Hospital Association’s Patient’s Bill of Rights in 1973. These proposals were momentous in that they declared unequivocally that a patient has the right to refuse treatment, but also the right to “obtain from his physician complete current information concerning his diagnosis, treatment, and prognosis, in terms the patient can be reasonably expected to understand.”97 As the patients’ rights movement grew in size and strength, the 1970s saw the beginnings of a change in the amount of medical information available to citizens in the medical marketplace. In Berkeley, where the radical psychiatry movement had become tremendously influential and where Steiner had created his RaP Center, the

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radical and activist psychiatrists remained politically engaged and watchful of psychiatric abuses in 1974 and after. The Committee Opposing the Abuse of Psychiatry (COAP), for instance, a group affiliated with the Berkeley Radical Psychiatry Collective and composed of professionals, lawyers, and concerned citizens, fiercely resisted Governor Ronald Reagan’s 1973 plans to establish a center for the study and reduction of violence. Widely circulated pamphlets censured Governor Reagan’s proposed research center, calling it “a Clockwork Orange for California’s minorities” and warning that “psychosurgery” would be used to effect “behavioral modification.”98 Much as the earliest mental health activists had in the mid-­1960s, the COAP joined other concerned stakeholders, including the Black Panther Party, the National Organization for Women, the United Farm Workers Organizing Committee, the California Mental Health Coordinating Council, and the Committee for Prisoner Humanity and Justice.99 The COAP’s brand of radical psychiatry was interested in constructive reform, not in an across-­the-­board revolution. Governor Reagan’s project was to be avoided because it was an initiative that maneuvered psychiatrists into the position of being used as agents of social control, which would allow them to devise ways of managing violent individuals.100 For COAP members, this was anathema to their beliefs about the practices and principles of psychiatry, and their rhetoric and actions in response to Reagan’s proposal reflected not nihilistic dogma but a reform-­oriented ideology aimed at preventing patient abuse, elevating patients’ rights, and operating within the biomedical model. Psychiatric survivor movements, according to the historian Geoffrey Reaume, did not achieve the same level of support as did black civil rights or anti-­Vietnam protestors; however, they did exert a tangible influence on mental health policy and terminology.101 Ex-­mental patients’ interest groups organized protest demonstrations, circulated petitions, conducted lobbying activities, and initiated legal actions against psychiatrists and institutions.102 The Insane Liberation Front, established in Portland, Oregon, in June 1970, lasted only six months, but its principal objective—­to disassemble the psychiatric institution—­can be found in the pages of radical psychiatry articles. A second group, the Mental Patients’ Liberation Project, was founded in New York City in 1971 by a former Insane Liberation Front member, and it also opposed involuntary treatments, including forced hospitalization, electroshock treatment, aversive behavior therapy, and

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psychosurgery. That same year the Mental Patients’ Liberation Front was established in Boston, and a year later San Francisco saw the founding of the Network Against Psychiatric Assault. Many ex-­patient members of these separate organizations believed that mental illness was a social construct, but clearly different views about the field of psychiatry were manifest.103 The ex-­patients’ movement was far from static, and the groups involved adopted various terms, including “antipsychiatry,” “mad liberation,” “mental health consumers,” and “psychiatric survivors,” to describe the movement and its participants. The term “inmate” was used, as were “clients” and “consumers.” Nomenclature mattered: the use of certain terms signified progress and a break with orthodoxy. Overall, the movement eschewed a distinct leadership, specific objectives, and formal membership. Empowerment was what mattered, in addition to protecting those individuals who had experienced—­or been changed by—­the mental health establishment; members often militated against oppression, and actions took the form of forums, protests, press conferences, and publications. Judi Chamberlin’s On Our Own: Patient-­Controlled Alternatives to the Mental Health System, first published in 1978 to much acclaim, helped connect a diverse and loose collection of organizations spread across the country, as well as members (who were not really members) who communicated mostly through Madness News Network. In addition, the first annual Conference on Human Rights and Psychiatric Oppression was held in 1973; subsequent conferences continued to bring people together. Chamberlin was a powerful voice in the ex-­patient movement, a survivor of the mental health treatment system with a serious bone to pick. In 1971 she joined the Mental Patients’ Liberation Project in New York after gut-­wrenching personal experiences in the mental health system. One of the first patient-­run advocacy groups in mental health, the organization gave Chamberlin a sense of liberation and empowerment. She later moved to Vancouver, Canada, Bellingham, Washington, and, at the end of 1973, Boston, where she joined the Mental Patients’ Liberation Front. Chamberlin was active. She testified before Congress, vowed to smash psychiatric oppression, and sought to challenge the mainstream portrayal of mental illness. She wrote to the Village Voice, the Nation, and the New York Times to challenge their coverage of psychiatric survivors and the positive advancements mental health more broadly. In 1977, for example, she questioned the New York Times about its uncritical treatment of the mental health

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system. It lauded a progressive “revolution” in treatment facilities and Chamberlin did not agree.104 She suggested to the Village Voice that “negative stereotyping” in its pages had the potential to “inflame a public already hostile to mental health patients.” She added, “There are serious problems caused by the concentration of former patients on the upper west side. But name-­calling and stigmatization are not contributions to a solution.”105 In 1974 Chamberlin helped organize the second national Conference on Human Rights and Psychiatric Oppression, which took place in Topeka, Kansas, the “Psychiatric Capital of the World,” according to ex-­patients. Home to the Menninger Foundation and Topeka State Hospital, not to mention Leavenworth Prison, the state was considered by activists to be brutal and repressive. The conference itself was deemed action-­oriented, meaning the goal was to facilitate communication. Workshops were proposed, but no formal conference schedule was established. Participants were free to explore what was “rotten in the institutions of psychiatry.” They might attend informal gatherings with titles such as “Community Mental Health—­ Help or Oppression?” or “Ripoffs in Private Practice.” People could pop into other workshops, including “Alternatives to Psychiatric Institutions” and “Alternatives to the Medical Model.” Other topics focused on unlearning brainwashing, diagnosing schizophrenia as a means of control, and working with the mass media. No “big names” were invited as keynote speakers, and this was deliberate, because the organizers felt the event should remain “a grassroots movement, not one controlled by a few superstars.”106 Fittingly, the egalitarian meeting prompted by a “groundswell of concern” about oppression was held at the Forest Park Campground of the United Methodist Church.107 The conference attendance fee was set at $15 for the three days, but no one was turned away for lack of funds. Inclusivity was important for the organizing committee as well as Chamberlin and her peers. In San Francisco, the Network Against Psychiatric Assault (NAPA) constituted the biggest wing of the movement; after its formation in 1974, NAPA targeted the Langley Porter Hospital at the University of California, San Francisco, Herrick Memorial Hospital in Berkeley, and the McAuley Neuropsychiatric Institute at St. Mary’s Hospital in San Francisco. NAPA opposed the use of electroconvulsive therapy involuntarily or without informed consent in each of these institutions. Moreover, NAPA members invaded locked wards at McAuley to protest involuntary drugging. They

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also opposed the startling practice of “sheeting,” wherein uncooperative patients were tightly swaddled—­ or mummified—­ as a means of punishment. They targeted specific psychiatrists who frequently used electroconvulsive therapy and proceeded to protest and disrupt the offices even as they organized a sleep-­in (rather than a sit-­in) at Governor Edmund G. Brown Jr.’s office in Sacramento.108 Patient activists, as distinct but interconnecting groups, displayed the same sort of squabbling that troubled radical mental health practitioners. In 1975 many ex-­patients united over the contrived relationship with mental health professionals. The Third Annual Conference for Human Rights and Against Psychiatric Oppression, held in San Francisco, proved to be the breaking point. It began on July 1, 1975, a day on which the Defense Department launched ARPANET, the precursor to the internet, and a day when New York City officials sacked 37,000 employees. Instead of an open format, as at the previous two iterations of the conference, the 1975 program had “resource people” present topics and “facilitators” to guide the discussions. The format failed. Offenses were taken. Slights were perceived. In particular, there was a noticeable lack of discussion about mental patients’ liberation—­the core of the movement. With one party made to feel marginalized, allies quickly became enemies.109 Sick of elitism, tired of being second-­class participants in the movement, ex-­patients held protests at St. Mary’s Hospital, then gathered in San Francisco’s Union Square. They roared “Smash the Therapeutic State!” They yelled “What do you want? Freedom!” Such emotion was a powerful force in the fight against psychiatry. Describing the 1975 conference in San Francisco, one participant said: No, anger is not “nice,” but it’s real, it comes from the gut, and not to be angry at being shit upon is being dead—­which is what shrinks and their kind what [sic] us all to become. That’s why they lock us up, drug us, cut into our brains with electricity and with knives . . . because our anger is POWER, and THEY ARE AFRAID OF US. And anyone who is not angry at what they do to us is as much our enemy as the shrinks themselves.110

On the final day of the conference, a full-­on fracture occurred, which carried over into subsequent years. The ex-­patients secluded themselves. In 1976, during that year’s conference, ex-­patients held meetings apart from the other participants, mainly the mental health professionals, posting “Keep Out” signs on the doors. If one had not spent some time in a mental institution, then stay away.

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Professionals like the Radical Caucus members from Berkeley were consequently put in a position of self-­justification, even wounded. According to Judi Chamberlin, the separation led to “noisy confrontations.” She also noted, however, that this signaled a missed opportunity to confront the “hip professionals,” to discuss “real alternatives” and challenge the “those who made money off human suffering while presenting themselves as radicals.”111 The limits of this partnership between patients and mental health practitioners had stretched to the breaking point. The simple act of slamming the door on outsiders—­especially professionals in the psych sciences, even if they did call themselves radical—­ was a means to empower ex-­patients and enable them to embrace their own expertise. Slamming the door likewise signaled recognition of the divide between service providers and patients; it signaled recognition of entrenched inequalities. Many ex-­patients felt they were the true authorities on mental health and derided the hip professionals, an epithet that gained momentum in 1975—which was, coincidentally or not, the same year that One Flew over the Cuckoo’s Nest hit theaters. Drawing on Black Power and radical feminism strategies, some ex-­patient activists felt separation was often the best way to advance their goals. Breaking away from the mental health system’s agents, in short, would create a space to achieve ends. Did it make sense to ally with psychiatrists or psychologists when the aim was a complete abolition of therapeutic intervention? Many thought not. One clinical psychologist, Michael D. Galvin, was “hurt and angry” at being excluded, but wanted to be informed about future events.112 Judi Chamberlin of the Mental Patients’ Liberation Front replied, “The presence of someone who presents himself as superior, detached, and professional (as you do) would be most unhelpful.” The conference was for “former mental patients” who “want to fight back,” not professionals “with the full intention of being leaders.”113 Galvin was indignant: Your letter was a perfect example of the zeal found in the early phases of liberation movements. It enhances cohesion and the general energy level, but unfortunately seems to go hand in hand with a non-­differentiation of targets of anger. . . . You called me “superior, detached, and professional.” . . . I think I am superior in my clinical abilities . . . and I am professional in the best sense of the word.114

He still believed some good could come of the conference, but did not understand why he should be barred. After all, he wrote, “I do subscribe

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to the R.T. [Radical Therapist] and have long been a member of the ACLU which both do support your cause.”115 Madness News Network communicated to readers many of the ideas above, and more. It grew stronger, and its reach widened. Interactions between American and global patient activist groups increased, with the likes of Franco Basaglia and Frantz Fanon featuring more prominently. In 1979 the National Alliance for the Mentally Ill (NAMI) was established and slowly evolved into a largest interest group that spoke for patients. At the same time, NAMI supported the genetic and biochemical explanations that were gaining traction in psychiatry. Mental health was hotly contested throughout the 1970s by both mental health professionals and activists on the outside looking in. The APA’s Radical Caucus did not perish entirely in the 1970s. It merely fragmented and weakened, as the zeitgeist of the era overwhelmed social movements of multiple shades and varieties. The Radical Caucus and, later, the Radical Therapist were “no more an attack on psychiatry than religious Protestantism was an attack on religion.”116 The movement condemned the arrogance of mental health practices not because of objections to therapeutic conceptions of reality but because it wanted to diffuse them more widely than ever, rooting them in popular understanding and daily practice. Expansion, not reduction. Growth, not limitation. Instead of confining therapy to medical practice, radical therapists proposed to import it into every activity: model education, law enforcement, and the like. They also sought to level the playing field and break down barriers between elites with specialized knowledge and the mainstream. The logical extension of this was a move toward standardization and the use of models aimed at reproducibility, and that move has echoes in the present. In 2018, this manner of argument remained important; the Wellcome Trust Foundation, for example, advocated on behalf of a “radical new approach” to mental health treatment because “different disciplines use different measurement scales, there are inconsistent approaches to diagnosis and treatment, and there’s a lack of shared data.”117 The radicals of the 1960s and 1970s served as agents of change and renewal, and they often forced others to confront unpalatable truths and question conceptions of normality and acceptability in mental health circles.118 The next chapter explores some of the alternative therapies and ideas that emerged contemporaneously with the radical therapists’ efforts to change the profession.

4  Breakthrough of the Mind: New Age Therapies in the Medical Marketplace

To men and women who have had direct experience of self-­transcendence into the mind’s Other World of vision and union with the nature of things, a religion of mere symbols is not likely to be very satisfying.1 —­Aldous Huxley, 1958

With the decline of the dominant psychoanalytic paradigm in the United States during the 1960s, the correct pathway for the psych sciences proved twisted, complicated, and divisive. The traditional psychotherapies, as exemplified by analysis, failed to address the demands of the public. They were gradually “rejected for their technical inefficiency as well as their inadequacy in providing a philosophy of life for contemporary society.” Standard practices did not offer enough of an emotional appeal in the way that alternative therapies did.2 And as psychoanalysis declined in popularity, the Esalen Institute and the human potential movement, for example, furnished an outlet for Americans seeking therapeutic solace. It soon became clear that troubled Americans were not lacking for therapeutic choice in the 1970s. In a laissez-­faire therapeutic marketplace, as the Radical Caucus and activists struggled to reform the mental health establishment, there was so much more available than Erhard Seminars Training (EST). The seventies were dubbed the Third Great Awakening because of the surge in religious and spiritual revivals throughout the country. A variety of Jesus movements, Oriental cults, and gurus spread across America.3 Reverend Sun Myung Moon drew 20,000 spectators—­“Moonies”—­to Madison Square Garden in September 1974. A backlash from the Right criticized the shortcomings of postwar liberalism and awoke Christian movements during the late 1960s and early 1970s. Many southern U.S.–­based groups, such as Jerry Falwell’s Moral Majority, sought to bring America back to “biblical

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principles.” As well, televangelism and the ascendance of the Moral Majority movement found strong support toward the end of the decade. Similarly, there were alternatives to faith-­based religions for people to cope with personal problems. Therapeutic movements began displacing orthodox religions throughout the period. Gallup reports indicate almost 20 million Americans practiced a variety of Eastern philosophies and disciplines.4 Former radicals of the counterculture such as Jerry Rubin exchanged political slogans for therapeutic ones during the 1970s. Rubin grew increasingly obsessed with mental health, turned to therapists instead of priests, and looked for peace of mind, or mindfulness, rather than LSD-­fueled spiritual transcendence. One study concluded that nearly all of American society became involved in some form of therapeutics by the end of the decade. “It is as if tens of millions of people had decided simultaneously to conduct risky experiments in living, using the only materials that lay at hand . . . their own lives,” the social scientist Daniel Yankelovich wrote.5 The churning crosscurrents of politics and economics accelerated the merging of the specialized language of therapists with popular culture. Observers as diverse as the novelist Tom Wolfe, the historian and social critic Christopher Lasch, and the psychoanalyst Heinz Kohut explored mental health and so-­called New Age therapies to reevaluate the role of American narcissism (for example). Such critics probed concepts of independence, inaccessibility, and identity, as well as vanity and gratification; they discussed how the American psyche was repackaged and reconstituted—­in an age when a mass audience had been conditioned for bastardized Freudianism. Lasch, for his part, was a jarring interpreter of the American mind and mental health. An iconoclast and public intellectual, Lasch blended a peculiar mix of cultural conservatism with Marxist anticapitalism. His approach in the best-­selling The Culture of Narcissism suggested that the average American was a narcissist, obsessed with external approval, material acquisition, and, yes, power. Any outward-­facing charms masked a desperate core. America’s wider “culture of narcissism” fostered this orientation because narcissism’s unyielding cycle of need and fulfillment was fuel for the consumer economy fire. The Washington Post’s Henry Allen also pushed “the new narcissism” message after watching John Travolta’s white-­ suited strutting in Saturday Night Fever (1977). Allen’s article describes the emergence of a unique male narcissism in American culture.6 Lasch wrote that Americans at the tail end of the twentieth century were overwhelmed by anxiety, depression, and a sense of inner desolation, and

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that the “psychological man” of the twentieth century sought neither individual self-­aggrandizement nor spiritual transcendence; instead, the goal was peace of mind, the modern equivalent of salvation, “mental health.” In this milieu, Lasch argued, “therapists, not priests or popular preachers of self-­help or models of success like the captains of industry, had become his [the average American’s] principal allies”—­that therapy had established itself as the heir both to Teddy Roosevelt’s rugged individualism and to conventional religious practices. Crucially, Lasch did not suggest that the “triumph of the therapeutic” embodied a new American religion. Rather, he saw it as representing an antireligion, a vacuum, insofar as most mental health therapies were predicated on rational explanation and tried-­and-­ tested scientific methods of healing.7 In assessing the mental health landscape and primal therapy technique, which was popular in the 1970s, Alfred Yassky, executive director of the American Psychotherapy Seminar Center in Manhattan, held that the tectonic plates of mental health had shifted. Americans were different. The therapeutic geography had perceptibly altered. He wrote: As a larger number of [Americas] are becoming alienated and are hungering for a sense of meaning, identity, happiness, and even salvation, we are wanting more from therapies and therapists. One way of putting it is that in many ways psychotherapy has taken over the function of religion. Therefore, the therapist is supposed to take over the function and roles of shaman, guru, wiseman, minister, rabbi, or priest. We are expected to help with spiritual matters on the one hand and scientific on the other.8

There were, of course, myriad other reviews that involved mysticism, spirituality, and mental health in the late 1960s and 1970s, emerging from figures like Thomas Szasz, Phillip Rieff, and E. Fuller Torrey. This chapter explores some of the alternative and complementary therapies in mental health during the 1970s; at the same time, it examines mainstream and fringe groups that emerged to cater to the mental and spiritual well-­being of Americans. Were there major breakthroughs for the American mind? Esalen and the Human Potential Movement In 1962, on an exquisite stretch of land bordering the Pacific Ocean in Big Sur, California, two Stanford graduates named Michael Murphy and Dick Price established a small retreat and workshop center called the Esalen

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Institute. Adjacent to the vast and unrelenting ocean, Esalen created a safe space where individuals could explore what Aldous Huxley called “human potentialities”—­and all that this included. Murphy and Price envisioned the integration and expansion of humanistic psychology alongside Eastern philosophies, an environment in which holistic approaches to wellness and personal transformation that involved the body, mind, and spirit might thrive. Murphy, a well-­heeled Californian with an undergraduate degree in psychology and an interest in Indian mysticism, found a friend in Price, who felt strongly about exploring alternative therapies for psychiatric patients, having been one himself for a short time. Nestled along the coast and close to hot springs and majestic redwood trees, Esalen soon established itself as the bastion of New Age therapy and a place where examining the limits of the mind was an everyday occurrence. With the creation of Esalen came the birth of the human potential movement. It attracted all manner of thinkers, artists, psychologists, and philosophers, including Erik Erikson, Ken Kesey, Buckminster Fuller, Aldous Huxley, John Lilly, Abraham Maslow, Linus Pauling, Fritz Perls, Arnold Toynbee, and Alan Watts. Musicians showed up, including Joan Baez, Bob Dylan, George Harrison, Joni Mitchell, and the members of Crosby, Stills, Nash & Young. Some called the institute and its ideas radical, yet “all therapeutic approaches are anchored in Zeitgeist and therefore reflect many aspects of the time and culture,” as Alfred Yassky wrote at the time.9 The end of the 1960s and the 1970s seemed an especially propitious moment for the emergence of Esalen. Liberated from any university, think tank, or religious organization, Esalen offered an extensive mix of workshops by experts in the psych sciences and various other authors, scholars, and shamans. For instance, the highly regarded psychologist Carl Rogers added to and reinforced the human potential movement as practiced at Esalen. His theories of the self, predicated on humanism, existentialism, and phenomenology, were highly influential. Fritz Perls, a German-­born psychiatrist, taught Gestalt therapy, which emphasized the value of enhanced awareness of sensation, perception, bodily feelings, emotion, and behavior in the present moment. He lived at Esalen for more than five years. Abraham Maslow, a world-­ famous psychologist, proponent of self-­actualization, and founder of the frequently cited hierarchy of needs, gave lectures, and provided guidance. Both Perls’s Gestalt therapy and Maslow’s humanistic psychology were

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among the foremost trends in popular mental health practices in the 1960s and beyond. Esalen’s practices, according to historian Nadine Weidman, were initially broken into three main types. The “hot seat” was a form of Gestalt therapy during which the patient recounted feelings and dreams and told stories of relationships and events. As part of therapy, the imposing and bearded Fritz Perls tore down the patient, deconstructing language, movement, and so on. He would then rebuild the subject, reconstituting the individual in a sort of creative destruction process. (Perls jumped ship in 1969 and went to Vancouver Island to form his own retreat.) A second practice was the T-­group, or group therapy for the purposes of sensitivity training. Verbal sparring and violence were always potentially in the cards, and vicious honesty was a common feature of these sessions. From smooching to slapping, the thrust of the exercise was emotional release. Getting loud or physical was considered important for a breakthrough. Body work was the third type of practice at Esalen and included just about anything: meditation and massage, tai chi and yoga, hitting the hot tub naked.10 More broadly, Esalen promoted an approach that emphasized a melding of Eastern and Western practices and philosophies, meditation, yoga, life coaching, encounter groups, and personal and spiritual development as a form of lifelong learning. Christian evangelicalism intersected with Protestantism, essence faiths, and gnosticism. Psychological and paranormal phenomena were accepted, while Tantric philosophies and yoga were highlighted. The traditional dichotomy of mental health and illness was rejected at Esalen and a spotlight was placed on helping individuals create more vital and meaningful lives. Dualism in general was rebuffed, while the concept of holism was embraced. Besides encounter groups and a variety of nontraditional therapies (including Gestalt therapy, psychodrama, transactional analysis, primal scream therapy, and Morita therapy), the human potential movement also included several disciplines and practices involving self-­ healing, self-­ improvement, and self-­ awareness; Zen Buddhism; astrology; art and dance; and various systems of body movement and manipulation. Drug use was also pervasive. The Esalen Institute, perched precariously on cliffs above the Pacific Ocean, gradually expanded to become the leading venue for New Age approaches committed to self-­transformation. The human potential movement was the rubric under which these approaches gathered. According to

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Stratton Caldwell, something of a hippie intellectual himself, the human potential movement focused “not upon meeting the social, political and economic wants and needs of the disadvantaged and disposed, but rather the psychological/sociological/spiritual hunger of many affluent and advantaged citizens.”11 The movement brought novel individual and group psychotherapies together. It placed attention on improving relationships rather than on healing old psychic wounds. Human potential psychology, according to its adherents, attracted Americans because it fundamentally redefined psychotherapy. It provided a context for personal growth instead of recovery from mental illness, and it provided group experiences that were not as time-­or money-­consuming as traditional therapies.12 At the same time, public service and support for liberal social reform constituted another area of interest at Esalen, and the institute’s political attitude bridged spiritual privilege and worldly activities beyond the confines of Big Sur. True self-­actualization—­authentic fulfillment of human potential—­ had to include the pursuit of social justice and peace. Actualized individuals were compassionate toward those who were less fortunate and were as a result obligated to support others to lead improved lives. By 1971, Esalen had become the model for more than ninety similar centers, known informally as “Little Esalens.” They were large and small, rural and urban, with the majority located in California or in or near major cities such as Chicago, Boston, and New York. Most survived for less than a decade. By the early 1970s, there were an estimated 150 to 200 growth centers modeled after Esalen throughout the United States. Most of these centers highlighted, in the argot of the time: “humanness, wholeness, the integrated totality of the person, providing experiences for individuals valuing sensing/ feeling varied ways of knowing as means of personal/interpersonal/transpersonal/organizational facilitation of growth/change in awareness, consciousness, behaviour.”13 Publicity for Esalen and these growth centers, in Life, Newsweek, Ramparts, Look, and Time, contributed to the institute’s reputation as a catalyst for individual psychological transformation, improved intimate relationships, and new social arrangements. Seventeen books by authors directly associated with the institute were published between 1969 and 1975, all as part of the short-­lived Esalen/Viking series. While Esalen was the institutional pioneer of the human potential movement, if it had a single avatar, a solo travelling salesman, it was Werner Erhard. Drawing in equal parts from Zen Buddhism and Dale Carnegie’s

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methods, Erhard created and sold a program called EST (short for Erhard Seminars Training) in hotel ballrooms across the country, a sort of cultish offshoot of Esalen practices. These combative training sessions, aimed at businesspeople and government employees, had clients take responsibility for their lives and “get it” by discovering there was actually nothing at all to get. Some of the celebrities who participated included Diana Ross, Joe Namath, Yoko Ono, and Jerry Rubin. With more than 100,000 clients, Erhard was anointed by Newsweek as “a celebrity guru who retails enlightenment.” There were numerous cynics, not surprisingly: individuals who believed human potential and self-­actualization could be reached neither quickly nor easily. To the New York Times Magazine, the dapper, trench-­ coat-­wearing peddler of self-­help was “the king of the brain snatchers.” The criticism intensified as EST continued to grow. It was labeled a cult that practiced mind control (through verbal abuse and sleep deprivation), a smoke-­ and-­mirrors grift that exploited its followers (through heavy recruiting and endless “graduate seminars”).14 The ideas and practices behind Esalen have since been absorbed into the cultural mainstream. While the glitzier and more unconventional features of the human potential movement, such as EST, have largely been relegated to fads of the 1960s and 1970s, the movement has endured in other forms. The American Society of Humanistic Psychologists remains active. Journals in the field include the Journal of Humanistic Psychology, the Journal of Creative Behavior, and the Journal of Transpersonal Psychology, among others. Popular culture abounds with references to Esalen and its hybrid philosophy, from Mad Men to Madonna to allusions to New Age spirituality in politics and films, including The Sixth Sense. “Esalen can best be located and understood as a utopian experiment suspended between the revelations and promises of religious tradition and the democratic, scientific, and pluralist revolutions of modernity and now postmodernity,” as later commentators have noted.15 And as Robert Fuller observed, Esalen “helped put into circulation” a metalanguage that “has contributed to a new cultural and religious outlook.”16 New Ideas Even as he shaped radical psychiatry in Berkeley, protested at APA meetings, contributed to the Radical Therapist Collective, and typified divisions

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within the radical mental health movement, Claude Steiner published a short children’s story, called The Warm Fuzzy Tale, an introduction to transactional analysis lite for young people, in 1969, and Games Alcoholics Play in 1970. In 1974 he came out with Scripts People Live, which was a national best-­seller, and thereafter compiled a collection of essays with the Radical Psychiatry Center, Readings in Radical Psychiatry, which was published in 1975.17 Steiner fully embraced the “radical” moniker and also assigned the label to his mentor, Eric Berne, who had developed his own school of behavior therapy, called transactional analysis. Whether Berne considered himself radical remains an unanswered historical question, but the label was certainly significant for Steiner, since he believed that “a radical psychiatrist is a person who has been personally, intensively, trained by another radical psychiatrist.”18 Transactional analysis was promulgated as a theory and a practice that were essentially psychodynamic but that could be verified through “real-­world observations.” Berne absorbed concepts that other writers and practitioners had used in the abstract and retooled them so they could be identified in therapeutic settings. This approach was important because he offered a new language for therapists, one that blended social and personal psychology but was also relatively easy to replicate. Where Freud had written of transference and countertransference, Berne suggested that there were patterns in communication—­transactions. Where Adler had used life-­style, Berne employed script, and provided ways of recognizing several different kinds. The basis of transactional analysis was a heady mix of empiricism, phenomenology, and existentialist thought, and Berne drew from Søren Kierkegaard, Rollo May, and others.19 Berne’s approach was significant for a number of reasons. It was based on John B. Watson’s theory of behaviorism, which emphasized objectivity as well as a focus on an external analysis of actions, and advanced a “distinctly non-­Freudian idea” that individuals were the products of their environments—­that they were “conditioned.”20 Steiner met Berne in 1958 and trained with him, on and off, until Berne’s death. According to Steiner, Berne was “a far-­reaching pioneer” and “a radical scientist” who reexamined the “basic assumptions held by psychiatry.”21 Transactional analysis was formulated between 1956 and 1969, after the San Francisco Psychoanalytic Institute suspended Berne’s training and he cemented the separation with an extraordinary parting letter to the educational committee that ousted him.22 Arguably, Berne’s most

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impressive success was Games People Play: The Psychology of Human Relationships, which sold more than 650,000 copies by 1967. Also—­and this should not be underestimated in a new therapeutic marketplace of ideas—­Berne’s books were user-­friendly and offered a straightforward guide to operating in everyday life. The accessibility of his ideas ­departed from conventional wisdom and practice in psychoanalysis. They were more palatable than Freud’s. During an intense question-­and-­answer session after Claude Steiner’s presentation of a “boring” case history in May 1970, Berne inadvertently confused Freud with fraud, bringing the entire room of therapists to laughter. Steiner, after he convinced his mentor to see his troublesome and “boring” patient, joked that Berne wasn’t allowed to call him Dr. Fraud.

Figure 4.1 Eric Berne (right), the founder of transactional analysis, and Claude Steiner challenged the status quo in mental health. Photograph from around 1968.

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Steiner chimed in that Berne’s slip-­up was “really one of the best things I’ve ever heard.” Within moments, he added that “only history could tell” whether Berne’s approach was superior to Freud’s.23 Berne passed away two months later from a heart attack. After Berne’s death, transactional analysis moved on. In January 1971, the first edition of the Transactional Analysis Journal appeared. In a tribute that sounded vaguely religious, one colleague wrote: “Our lives have been touched and been touched potently by Eric, and in turn we have carried him along to a position of Euhermerus, as was Freud before him, and Moses before him.”24 Others forecast great things for transactional analysis —­that it would not be “possible for medical, psychological, behavioral science historians to ignore his contribution.”25 For Steiner, psychoanalytically trained mental health professionals were challenged—­even threatened—­by Berne’s three transformative concepts: (1) people are born okay; (2) people in emotional difficulties are nevertheless full, intelligent human beings; and (3) all emotional difficulties are curable, given adequate knowledge and the proper approach.26 Steiner also feared that transactional analysis would evolve into a “consumer item, sold at every counter, plasticized, merchandized, and made more and more palatable to larger and larger crowds of consumers.”27 Besides Berne’s and Steiner’s transactional analysis, other relatively new therapies permeated mass culture in the 1970s and acted as legitimate alternatives to mainstream psychoanalysis. Arthur Janov, for instance, pioneered and championed primal therapy with his 1970 book, Primal Therapy: The Cure for Neurosis. It was a form of therapy in which patients entered extreme emotional states to allow the jettisoning of any deep-­rooted “primal pain” experienced in childhood. The method was often accompanied by shouting and screaming—­the primal scream. The California-­based Janov had worked as a psychotherapist for the Los Angeles Children’s Hospital and Veterans Administration, among other places, when in 1967 he developed his theory. In a series of books published between 1970 and 1972, Janov contended that patients who concluded his therapy effectively would overcome the diseased state common to most people. These “post-­primal” patients would attain a genuine normality, thereafter occupying healthy, neurosis-­ free bodies.28 What’s more, he suggested that his therapy offered physical cures. Repression, in Janov’s estimation, stunted physical development, but

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successful primal therapy would enable the natural growth of breasts, hair, and hands.29 Janov’s therapy struck a chord with the countercultural set and other Americans hungry for alternative approaches to mainstream psychoanalytic practices. He cagily teased out and played around with themes of intergenerational antagonism, repression caused by postwar society, and the ways in which physical experiences and emotions trumped neutral reasoning; more than that, he touted altered states of consciousness and the more specific view that personal (and perhaps national) liberation depended on the violent overthrow of corrupt systems. These altered states did not include pot, LSD, or MDMA (3,4-­methylenedioxymethamphetamine, ecstasy), and had to be reached without any artificial aids. Janov fully rejected the use of illegal intoxicants, uninhibited sexual activity (“free love”), and transcendental meditation. These were not pathways to fulfillment, in his view, but rather the unconscious compulsions of an unwell mind. John Lennon and Yoko Ono, who experimented with many substances, underwent primal therapy in 1970 after the Beatles disbanded—­and, along with a “primal concept album,” John Lennon/Plastic Ono Band (1970), helped popularize the therapy.30 Transactional analysis and primal therapy resonated with Americans. First, the concept of “cure” had become so alien within the field of psychiatry and psychology that to make such a claim was to invite professional incredulity.31 Both Berne’s transactional analysis and Janov’s primal therapy promised a fix, not just continuing therapy sessions. Even as the theories leveled criticisms at the “medical model” of mental illness and departed from standard psychotherapy, Janov and Berne steeped their therapies in the terminology of disease and cure. Second, the divergent approaches became hallmarks of the “feeling” and encounter group movement or the humanistic/experiential movement therapies popular during that era. These were not the value-­free, one-­on-­one, neutral methodologies that radicals in the APA had critiqued. Rather, they were full-­on sessions, both draining and loud, honest and difficult. This lent them authenticity—­ legitimacy for a new age. Third, transactional analysis and primal therapy represented for many Americans innovation, the avant-­garde, a break from the tired pointy-­ bearded therapists of the 1950s. Their success, though brief, was tantamount to harnessing the fierce energy of the counterculture

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and about appealing to American minds with a mental health product that was fresh. Religion as Therapy: From Shamans to Cults Spirituality and mysticism were prevalent in discussions surrounding mental health practice in the 1970s. While many of the radicals drew on the work of Thomas Szasz, his appraisal of psychiatry as a religion unto itself was not uniformly accepted. Some psychiatrists, specifically E. Fuller Torrey, took up Szasz’s approach and made the case that psychiatrists were nothing more than witch doctors, shamans, or priests. All were prescientific, and much of the vision of mental health derived from religious beliefs and the unquestioning acceptance of current mores.32 By the 1960s, though, some critics were arguing that “the monolithic belief in the psychiatrist, the mental hospital, the university department and community center is under attack. This means that the institutional, military, school, and academic and private psychiatrist is no longer to be believed on training and faith alone.”33 Faith in psychiatry was waning. Organized religion began to undergo change, too. “Strange things seem to be happening to man’s religiousness in our time,” wrote Huston Smith, “especially among the young. . . . Students are making a left end run around the prophetic (this-­worldly) wing of institutional religion to tackle directly such issues as Vietnam, racial justice and the problems of poverty. This has been evident for several years.”34 The Radical Caucus and other radicals in the psych sciences did not explicitly criticize religious institutions in their literature. Religion was not singled out in the same way that the military-­ industrial complex was highlighted, or that schools and colleges, courts and prisons were critiqued. These were regarded as “authoritarian institutions” and the “entrenched establishment,” according to pamphlets handed out in Miami.35 Christianity and Judaism, as well as all other organized forms of worship, were not. The relationship between psychiatry and religion may have been “adversarial,” but the latter escaped demonization.36 Certainly, Sigmund Freud had asserted that belief in a single God was delusional and that all religion was a mass neurosis. Psychoanalysis was partially in conflict with traditional religious attitudes; many churches identified Freud, psychoanalysis (with its emphasis on sex and materialism), and by

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association the whole of psychiatry with atheism, antagonism to religion, and a challenge to conventional morality.37 As late as 1961, for example, the Vatican prohibited priests from practicing psychoanalysis. In 1967 this approach loosened, and Pope Paul VI reversed the ban, enabling the future Pope Francis, then in Argentina, to undergo analysis with a Jewish doctor during the 1970s.38 Freud’s successors ultimately modified his ideas. Alfred Adler largely divested Freud’s theories of their sexual content, reinterpreting libido as the “will to power” rather than the Oedipus complex. Adler’s emphasis on interpersonal relations and competition, his social-­democratic sympathy with the underclasses, and his identification of will and the striving for moral perfection resonated with many Americans. Many former Freudians, such as Eric Berne, moved away from psychoanalysis and developed altogether new approaches. Carl Jung’s mysticism, on the other hand, promised relief from another contemporary malaise. Jung viewed the unconscious as a reservoir of collective experiences, of saving myths. The task of therapy was to bring to consciousness the buried imagery, the archetypes. Jung’s cultural shoplifting and Adler’s self-­improvement, as Christopher Lasch put it, though radically different in tone and content, shared one thing: both replaced insight with ethical teaching, transforming psychotherapy into “a new religio-­ethical system.” For all his despair of science and rationality, Jung shared Adler’s confidence that psychotherapy could achieve a spiritual transformation of the individual and even of society.39 Drugs mattered as well. At times, they acted as the connective glue between therapeutic and religious practices, between science and spirit. At other times, not. Drugs have played a vital role in the practice of many religious groups and have retained an important place in mental health treatment. As early as 1874 the psychologist and philosopher William James published The Anesthetic Revelation and the Gist of Philosophy, a paper that suggested the riddles of religion and philosophy were discoverable through nitrous oxide intoxication. James’s drug use, particularly nitrous oxide, helped alter the beliefs that science had given him, and it helped him experience, if only for a fleeting moment, certain pleasing illusions of the religious visionary. Moreover, in 1964 the California Supreme Court held that members of the Native American Church, an association of Native American groups all of which use peyote in their religious rituals, had a First Amendment right to use the drug. In subsequent years the Native American

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Church obtained religious exemption from peyote restrictions in twenty-­ seven other states, though in a few instances, notably in a case before the Oregon Supreme Court, its arguments were rejected. Meanwhile, non-­ Native American requests for religious exemption from drug statutes have repeatedly been denied—­ including those of the Neo-­ American Church, which in 1968 had 20,000 members. Similarly, the Universal Church of Christ Light’s use of cannabis was rejected, as were claims by the Church of the Awakening, the Native American Church of New York, and the Ethiopian Zion Coptic Church. In 1990 the U.S. Supreme Court rejected the claim that the First Amendment protected the Native American Church’s use of peyote, but Congress fought back and passed the Religious Freedom Restoration Act, thereby reinstating the Native American Church’s right to use drug in its religious rituals. A notable example was the Psychedelic Venus Church in California, which incorporated drug use (and explicit sexual practices) in all its religious activities. Promotional materials called it a “pantheistic nature religion of hedonism” and in an ironic message deemed “Official Dogmatic Bombast,” declared that “Cannabis sativa is the preferred sacrament of this church; though psychedelics (and even wine) may sometimes be used.”40 To achieve greater peace of mind and enlightenment, church rituals included blind meditation and touch, nude group sensitivity encounters, cannabis communions, and om chanting. The church’s manifesto was a tangle of positions and ideas. It stated that members, including the founder, Jefferson Fuck Poland, did not “commit ourselves to one creedal formula of words,” that Venus-­Aphrodite served as lead god, and that mental tranquility would be achieved through sexual freedom. Social issues of the day were paid lip service; the manifesto noted that “we will do what we can to prevent warfare, racism, sexism, and ecological disaster” but that “most of our activities will be on the level of personal liberation.”41 One scholar of psychedelics and religion, Thomas Roberts, sought desperately to reconcile the rise of new movements focusing on wellness with mysticism, the immune system, and mind-­body dualism. As a psychologist, he aimed to understand the holistic health benefits of certain substances. He recounted the characteristics of psychedelic experiences and connected them to possible gains in psychotherapy, religion, creativity, psychology, and related fields. The characteristics he identified were:

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•

a feeling of oneness; ego transcendence;

•

objectivity and reality: noetic quality or sense of truth;

•

a transcendence of time and space;

•

a feeling of sacredness;

•

deeply felt positive mood;

•

an awareness of paradoxicality—­an awareness that is often anomalous in the Western scientific paradigm;

•

a feeling that experience is ineffable;

• transiency; •

positive changes in attitude and/or behavior.42

Along with other scholars, Roberts acknowledged a longer tradition of hallucinogen use that connected with traditional healing practices among indigenous people or was linked with non-­Christian religions.43 Indeed, the literature on psychedelics and mystical experiences occurs predominantly in two disciplines, religion and psychotherapy. The word “entheogen” comes from the religious literature and means “realizing the divine within” or “generating the experience of god within”; it was coined in 1979 specifically to denote the religious experiences of psychedelic use.44 In the 1970s, many Americans increasingly found political and spiritual solace in other therapeutic and religious movements, just as they had in previous periods of unrest and social protest. “Cults” reputedly grew in scale and scope during the 1970s. Some of them included the Children of God, Moon’s Unification Church, and the People’s Temple; transcendental meditation (or TM) also became popular around this time. With the decline of psychedelia, followers “drifted away from psychedelics to follow Meher Baba or embrace some other form of occultism.”45 Each of these cults had a charismatic leader, or guru, at its head. They often demanded money and obedience, isolation from friends and family, and the adoption of communal living. The groups also provided, for some participants at least, a kind of psychological and psychiatric treatment—­a sense of belonging to counterbalance alienation, for example.46 Cults have played various therapeutic roles, and they should be understood as serving a number of functions for its members. Heinz Kohut argued, for example, that cult involvement and activity, whether radical or not, has normally been underpinned by a need “to restore self-­cohesion.”47 Yet, as has been

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well documented in the case of the followers of Jim Jones, David Berg, and later David Koresh, the result of this effort has sometimes been self-­ destruction instead of self-­cohesion.48 Scientology offered an alternative mix of spiritual and therapeutic solace. It challenged Christianity and various other mainstream American religions, but it also sought to replace psychiatry and psychology. At the end of the 1940s, L. Ron Hubbard, a pulp writer and former naval officer, hatched a plan to revive his stuttering fortunes. “I’d like to start a religion,” he is reported to have declared. “That’s where the money is.”49 This effort began with Dianetics: The Modern Science of Mental Health, published in May 1950, which became a smash hit in the United States. It occupied the New York Times best-­seller list for twenty-­eight consecutive weeks, and Walter Winchell wrote at the time that Dianetics was a “new science” that would “prove to be as revolutionary for humanity as the first caveman’s discovery and utilization of fire.”50 As Hubbard put it, his creation inaugurated a “new science of the mind.”51 Scientology leadership also called the “first precision science of mind.” In pamphlets it promised freedom from “loneliness, guilt, feelings of inferiority, depression, nervousness, inhibitions, impulsiveness, alienation, repressions, compulsions,” and so on. With enough time and energy, one might achieve a state of nirvana known as “Clear,” which represented “a higher evolution of man.”52 Hubbard promised, first, that by practicing Scientology’s techniques one could transcend negative mental states, harness a superior memory, and achieve greater overall intelligence. He maintained that the foundation of mental and physical illness lay in so-­called engrams that were set in early, even prenatal, experiences and remained protected in a person’s subconscious, or “reactive mind.” To overcome the reactive mind, Dianetics, and later Scientology, used a mental therapy technique called auditing, which, similar to primal therapy or LSD therapy, involved reexperiencing incidents in one’s past life in order to erase their engrams. In practice, auditing was based on the use of the electropsychometer, or E-­meter. Most often compared to lie detectors, E-­meters purportedly measured changes in electrical currents in the body in response to questions posed by an auditor, all in an effort to uncover unconscious lies. Auditing was part therapy and part confession, and it was the only way to move upward in the church. One had to pay fees for the sessions, achieve a sort of psychic revelation (or breakthrough), and thereafter elevate to a higher “grade” in the organization. All

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this auditing, of course, led one to being in a state called Clear. “For more than 2500 years man has dreamed of this goal,” but only through Scientology and E-­meters would such a breakthrough of the mind be possible.53 In 1963, the year Kennedy signed his Community Mental Health Act and JFK and Aldous Huxley died (on the same day, November 22), the Food and Drug Administration confiscated hundreds of E-­meters from the Church of Scientology’s Washington, D.C., offices. In doing so, the FDA accused the church of making false claims about its physical and mental healing powers. In Berkeley, California, the church’s congregants advertised the various strengths of the new religious movement. “Super Scientology Party Tonite,” one poster blared, while a second exhorted “Scientology Works!” A third poster noted that “Scientology is a way to increase your self-­respect.” Another suggested “You can be freer and more aware of life around you than you ever dreamed possible.”54 In February 1970, a pamphlet was circulated that knowingly appealed to the counterculture: Is Scientology just another trip? Are all trips equal and all you have to do is be on one? Can a trip be “more equal?” Scientology, like knowledge, works. Every time. No exceptions. It is needed, now not later. It is openly communicable. And it is open and available to everybody. The east has given the west much here on the border of Berkeley and elsewhere. Discover what the west gives in return. Really blow your mind.55

Many of the church’s publications, including Freedom and The Auditor, castigated the mental health establishment—­not to mention institutions like the FDA and the U.S. Congress. Yet most of the promotional materials were largely encouraging, drawing on celebrity culture to make Scientology’s case. Figures from the world of music, such as Leonard Cohen and the Grateful Dead’s Tom Constanten, offered positive accounts, while the writer William Burroughs did the same. In an era when the psych sciences and mental medicine were undergoing change, Hubbard wanted to legitimize and professionalize his pseudoscientific creation in various ways. “It’s been a consistent shock,” he wrote in 1974, that the psych disciplines and mental health practitioners considered him an interloper. While he may not have attended medical school or trained as a psychologist, Hubbard stated, “I had the good fortune not to be entirely a stranger to training in the field of the mind.”56 For critics, Hubbard was the “embodiment of a peculiar and not unimpressive kind

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of American dynamism: a Barnum-­like huckster, confidence man as philosopher, the quack who would be king.”57 The first Church of Scientology was formally established in February 1954, with more than a dozen new churches springing up over the next decade.58 Hubbard advanced his church with bravado, false credentials, prolific writings that cut across the political, religious, and medical spectrums, and bold claims. In his view, “Dianetics is not psychiatry. It is not psycho-­analysis. It is not psychology. It is not personal relations. It is not hypnotism. It is a science of mind.”59 Hubbard believed he had bettered mental health orthodoxy, and his followers, Dianeticists and Scientologists, assumed they were on the cutting edge of mental health knowledge.60 Scientologists have often considered many illnesses psychosomatic and hence have disregarded standard medical treatments. Psychiatry, in particular, was singled out as abhorrent. Psychiatrists, when combined with the pharmaceutical drug industry, created a “front group,” Hubbard wrote in a 1969 essay titled “Today’s Terrorism.” The average psychiatrist, he contended, a mere two months before the APA meeting in Miami, constituted part of a group that made “the Mafia look like a convention of Sunday school teachers.” Hubbard accused psychiatrists of kidnapping, torturing, and murdering with impunity—­all without the “slightest police interference or action by Western security forces.” “A psychiatrist,” he wrote, “kills a young girl for sexual kicks, murders a dozen patients with an ice pick, castrates a hundred men.”61 Such rhetoric was not entirely unusual; it constituted part of the “war over mental health professionalism,” as Stephen Kent and Terra Manca have written, a war in which Scientology sought to “eradicate psychiatric practice (especially psychiatrists’ use of pharmaceuticals) from the planet and replace it with Scientology’s own techniques.”62 Substance abuse treatment provides a telling example. In an interview with former Cheers actress and talk show host Kirstie Alley, author Jane Reitman revealed Scientology’s “antitherapy” ethos. According to Alley, a practicing Scientologist and former participant in the organization’s Narconon program, therapy was “based on some guy analyzing you, and what he thinks is going on with you. And when he can’t quite figure it out, he makes up a disease and gets a drug for that. If that doesn’t work, he shocks you. And then surgery. . . .” Scientology, she said, used a holistic detoxification program known as the “purification rundown,” which employed heavy doses of vitamin supplements, primarily niacin, in conjunction with

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exercise and long hours in a sauna. Many addiction specialists have pointed to the lack of evidence behind such practices, yet Scientology claims that the “purif” cleanses the body of impurities. “I can get someone off heroin a hell of a lot faster than I can get somebody off a psych drug,” Alley told Reitman. “The guy on heroin’s not being told daily, ‘This is what you need for your disease, and you’re gonna have to take this the rest of your life.’”63 Kirstie Alley, an actor and talk show host with no medical training and a former cocaine addict herself, was arguing on behalf of an eclectic, unquantifiable method—­one that was both naturopathic, quasi-­scientific, and antipsychiatric. If the New Age promised “tranquillity, wellness, harmony, unity, self-­realization, self-­actualization, and the attainments of a higher level of consciousness,” then Scientology, as therapy and religion, cribbed and echoed New Age language, even as it provided an alternative to mainstream psychiatry.64 The New Age, holistic movements, and Scientology were theoretically separate, yet they shared features with each other in the 1970s.

5  Knowledge of the Mind: DSM-­III, Data, and Parapsychology

For I am actually not at all a man of science, not an observer, nor an experimenter, not a thinker. I am by temperament nothing but a conquistador—­an adventurer . . . with all the curiosity, daring, and tenacity characteristic of a man of this sort.1 —­Sigmund Freud, February 1900

The biomedical model in mental health underwent change during the seventies. Various alternative approaches to health and well-­being, including ideas from Sigmund Freud, the Frankfurt School, and the antipsychiatric movement, put pressure on the model. Psychiatrists, patients, and critics subsequently disputed the validity and consequences of all manner of treatments (including lobotomies, popular in the 1930s, and electroshock therapy, popular in the 1940s and 1950s) and contested the use of new drugs in psychiatric patients. As Gerald Grob has cleverly put it, over the years psychiatrists have “vacillated between emphasizing curability and chronicity, between extreme optimism and a more fatalistic pessimism, and between a commitment to deal with the severely mentally ill and search to find other kinds of patients.”2 These struggles have overlapped with efforts to understand and legitimize—­that is, quantify—­fringe elements in the psych sciences, including parapsychology. This chapter explores how radicalism intersected with a new mental health orthodoxy, one based on the scientific method, quantification, and the diminishing authority of psychodynamic approaches. Between the 1920s and the 1960s, the pendulum swung away from biological conceptions of mental illness, and psychoanalysis emerged as the number one treatment method in the United States. “Like a giant

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mesmerist’s watch” swinging unrelentingly at the 1751 Paris World’s Fair, the pendulum as metaphor has been deployed to encapsulate changes in mental health, including Soviet abuses of psychiatry, struggles within psychoanalysis, and the rise of the antipsychiatric movement in the 1970s.3 Phillipe Pinel helped create a “clinical medical gaze” in the early nineteenth century that viewed both the disease and the individual patient as subjects of consideration. He thereby offered a “first salvo in the still-­recognizable dialectic in medical psychiatry,” or the first swing of the pendulum.4 “Concepts such as repression, resistance, mental conflict, ambivalence, unconscious, conversion, free association, libido,” among many others, “became the lingua franca of not only psychiatry but also the era.”5 Alfred Hitchcock drew on discoveries in psychoanalysis to make his films, especially Spellbound. Surrealist art, such as that by Salvador Dalí, was heavily influenced by Freud. Modern marketing drew on psychoanalytic theory, and mental health recovery was associated with lying on the leather couch. Eric Caplan’s excellent 1995 book, Mindgames: American Culture and the Birth of Psychotherapy, charts the origins, ascent, and acceptance of mental therapeutics in the late nineteenth century and early twentieth century. As Caplan suggests of the shifts in the somatic paradigm and changing medical attitudes: “Psychotherapy emerged at considerable odds and in the face of considerable opposition—­much, indeed most, of which was generated by the medical profession itself.”6 Its arrival, and later its begrudging acceptance by both medical elites and rank-­and-­file physicians, marked a recognition of the need to compete effectively in a rapidly expanding mental health marketplace.7 The pushback against psychotherapy came from various sources, including contributors to the Atlantic Monthly. With “The Americanization of the Unconscious,” as one article title had it, the power of psychoanalysis to create “a distinctly American unconscious” was lamented, which is reminiscent of critiques of modern psychiatry, psychopharmacology, and the DSM.8 Antipsychiatrists in the late 1950s and early 1960s were deemed radical, as we saw earlier, though the movement drew in an ideologically and politically diverse group of critics. Former patients organized, lobbied, and protested against mainstream psychiatry in one of the earliest patient survivor movements.9 Similarly, the publication of DSM-­III in 1980 was also a “radical shift.”10 The first DSM, published in 1952, and its successor, DSM-­II, published in 1968, were heavily influenced by the psychoanalysis

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then dominant in the United States. With the appearance of DSM-­III in 1980 a new leaf was turned over. The book was radical in that it adopted “a descriptive symptom-­based approach that was essentially theory-­neutral regarding underlying etiology.”11 It was also radical because it ushered in a “second biological era” at the expense of an “icon,” psychoanalysis, that had begun falling into disfavor.12 The factors responsible for this trend were manifold. Some chalked up the fall to internal squabbling and that it had been “mismanaged by its adherents.”13 Others noted that psychoanalysis was scientifically deficient and needed to modernize.14 Additional problems dragged down the icon, including the exclusivity and insularity of analysts, the inaccuracy or downright irrelevance of Freudian theories, and the inefficiency of psychoanalytic methods, which were considered time-­intensive and offering few cures. Radicals and antipsychiatrists flagged these problems in their critiques of the profession’s methods. As one icon began to fall, another, in the form of the DSM, began to ascend, marking a swing of the pendulum from one extreme to another. The golden age of American psychoanalysis was in the 1940s and 1950s; thereafter a “biological revolution pulled down the psychoanalytic apparition,”15 marked by a turn toward quantification in psychiatry during the mid-­1960s.16 In 1968, even the psychoanalysts who were fighting against the pounding tide of biological psychiatry used the term. Leo Rangell, the former president of the American Psychoanalytic Association, noted that “there are always fashions, fads, and pendulum swings” in mental health and that analysts, with their couches and pipes, were still very much in demand.17 The return of the biomedical model in the 1960s was founded on several factors, although at its most elemental the issue was about knowledge production in mental health at a unique moment in American history.18 Social and political critiques supplemented ongoing debates within the field about the validity of psychiatric diagnostics and the contest between psychodynamic and biological psychiatry. Schizophrenia, in particular, drove discussions about altering the DSM approach to diagnosis. Psychologists and psychiatrists had long disagreed about the phenomenology, etiology, and therapeutic course of schizophrenia. Certain mental health specialists rejected the label “schizophrenia” altogether. Recognition of the disease dated to 1908, when Eugen Bleuler coined the term to replace “dementia praecox,” and the concept of schizophrenia was introduced into the literature in 1911.19 Thereafter, numerous

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theories were put forth to explain the pathology of the disease and allow (it was hoped) effective treatments. Writing in 1961, Dr. August Hollingshead recounted that six major etiological theories existed: a pathological lesion on the brain; a biochemical origin, such as Emil Kraepelin’s notion of a metabolic imbalance; a congenital cause; a psychogenic cause, based on psychoanalytic thought; a sociogenic cause; and finally a biopsychosocial (holistic) cause, an idea endorsed by Adolf Meyer.20 Indeed, much about schizophrenia was contested. Barry Gurland’s cross-­national study of hospitals in New York and London at the end of the 1960s focused exclusively on the diagnosis of schizophrenia, and this proved a deal-­breaker. It found that schizophrenia was diagnosed about twice as frequently in New York as in London. Yes, symptoms were agreed on, but not the final diagnosis. Essentially, “operational” criteria had to be set. At its core, this study concluded that there was a noticeable lack of consensus—there were major discrepancies—­in determining which patients suffered from schizophrenia and which did not. According to the paper, the difference “appears to be primarily a result of differences in the way the two groups of hospital psychiatrists diagnose patients” and not the result of any differing psychopathology exhibited by patients.21 By the late 1980s, the “schizophrenia controversy” was still perplexing mental health researchers. This controversy was certainly damaging, and, when combined with the now famous paper by David Rosenhan, it brought into focus the unreliability of psychiatric assessment and the need for more data.22 Rosenhan’s study used “pseudopatients,” who faked hallucinations, to examine the admissions and diagnostic process in a well-­known mental hospital. Pharmaceuticals also influenced the discussion surrounding modification of the DSM. Relatively efficient medications discovered in the 1950s and 1960s (lithium in 1949, chlorpromazine in 1952, imipramine in 1957, haloperidol in 1958, and diazepam in 1963) for treating various mental disorders became major pillars of psychiatric treatment and underpinned the decline of large mental asylums in the second half of the twentieth century.23 The discovery of a genuinely effective drug for controlling mania also proved significant. The Australian researcher John Cade proved that lithium was effective, and after a great deal of skepticism and dispute, the Food and Drug Administration (FDA) approved its use in 1970; in 1974 it was approved for the treatment of manic depression. This stamp of approval was very important, insofar as previously there was really no effective

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chemical treatment for any mental illness. Now there was a treatment—­and one based on data—­that worked, even though clear behavioral criteria were still necessary to identify who would benefit from lithium. In 1970 the radicals also exerted influence over diagnostics and data and moved the pendulum through confrontational tactics, demonstrations, and threats. After the meeting in Miami in 1969, such cities as Ann Arbor, Atlanta, Chicago, New York, New Haven, Portland, and Seattle, among others, established radical psychiatry RaP Centers to offer an unconventional and progressive kind of therapy, while the radicals insinuated themselves into various political events. They now had a manifesto, written by Claude Steiner. In the Radical Therapist they had a journal to refer to. The Kent State shootings in May 1970 galvanized the group, sparked marches, and brought the radical psychiatrists closer together; they also forced the issue of oppressiveness in society and in the mental health arena. During the 1970 annual meeting, the Radical Caucus, now larger and louder than ever, protested what it deemed abusive and violent therapies. Dr. Nathaniel McConaghy’s “aversive therapy” to “treat” homosexuality, for example, enraged radical psychiatrists, who were making common cause with gay rights demonstrators. This had also occurred the year before and had led to a larger discussion in the American Psychiatric Association (APA) about the politics of homosexuality. McConaghy described his clinical trials on gay men, which included electric shocks and induced nausea. He revealed the ostensible “conditionability” of homosexuality. At this point in his presentation the radicals interrupted him.24 Shouts of “Barbaric!” and “Gay is good!” filled the room, and McConaghy was yelled down as a “tool of fascist psychotherapy.” For apoplectic radical therapists, this type of research was the quintessence of brutal, old-­school psychiatric repression. It was one thing to assist in the adjustment of a patient’s mental health issue, such as homosexuality as a condition, but far more invasive to “alter the sexual orientation” of the patient. Such research was intolerable to radicals, especially when various levels of electric shocks were administered to test subjects via a small battery according to erectile responsiveness to homosexual imagery.25 McConaghy’s research, and the resistance to it, was both intriguing and important. He represented a dying breed, one of the last gasps of legitimized psychiatry to try to treat homosexuality in a scientific if unseemly manner. Of course, he was not the only researcher exploring the conditionability

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of homosexuality through aversive therapy and psychoanalysis. Interventionist research had shown a degree of promise—­a term to be used carefully—­as early as 1962. Within that milieu and under those circumstances, the pathological definition of homosexuality—­on which McConaghy based his therapy—­was subjective, to be sure. It was also predicated on observable correlations with mental illness or negative mental outcomes for homosexual men. It had been agreed on by mainstream mental health leaders. Did that make it right? No. Were the data influenced by long-­standing ideas about sexuality and morality in American society? Absolutely. Yet the definition was based on years of studies and, it must be stated, was not entirely arbitrary. The causes were unidentified; yet the “Gay is good!” shouts in 1969 were also subjective, and this message became the orthodoxy not because the message was evidentially valid at the time but because radicals (rightfully?) yelled at and intimidated colleagues who pathologized homosexuality. The demonstration against McConaghy’s presentation and research suggested a lot more about radicals in the field of psychiatry than one might at first assume. The placards and sit-­ins, the shouting and the interrupting jibes, were not just about supporting gay rights advocates and were not simply about rejecting invasive therapies. They went deeper than that, harking back to the radicals’ views that magic, superstition, and mysticism—­as well as a dearth of empiricism—­typified mental health therapies. Because the DSM-­II classification of homosexuality as a mental disorder was so problematic in itself, McConaghy’s research project highlighted the nonscientific, nonquantifiable element of psychiatric diagnosis. His testing on gay men was predicated therefore on a subjective pathological definition of homosexuality, which, by extension, strengthened radical psychiatrists’ argument that the field was contingent on mystification and elitism. This idea was not always made explicit, but it remained as an undercurrent of criticism. These kinds of ideas would be given greater expression and would take on a clearer shape two years later when an expert in schizophrenia and a rabble-­rousing product of such elite institutions as Princeton, McGill, and Stanford universities, E. Fuller Torrey, published a fire-­breathing book called The Mind Game. It was highly critical of mental health practice. Torrey, a one-­time special assistant to the National Institute of Mental Health director, had become disenchanted during the late 1960s and early 1970s. He described psychiatrists specifically as akin to witch doctors, or shamans:

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“The techniques used by Western psychiatrists are, with few exceptions, on exactly the same plane as the techniques used by witchdoctors. If one is magic then so is the other. If one is prescientific, then so is the other.”26 The only exceptions to the “magical” techniques were certain physical therapies, in particular some drugs and electroshock therapy, which, Torrey argued, had been shown conclusively to be effective in producing psychiatric change.27 In his view, the data underpinning mental health were lacking. The rhetorical use of religion and alternative medicine conjured images of Timothy Leary, cults, and gurus. It also conjured the spirit of Freud, who had once casually described himself as a conquistador and adventurer.28 Torrey’s language called into question the dangers of unverifiable mental health practices based not on evidence and replicability but on tradition, on knowledge passed from generation to generation. The term witch doctor, moreover, raised ideas about the progressive and positivist nature of mental health therapy. Was it primitive? Was it based on mysticism and credulity? The book slotted mostly easily into the antipsychiatry genre, although Torrey did not classify himself as such a practitioner. Many radicals fully rejected his views on electroshock therapy. Torrey in 1974 wrote a second, withering book titled The Death of Psychiatry. He proposed that the demise of his own medical specialty was not a “negative event,” since much of the work he performed on a daily basis was “fraudulent.”29 This volume built on The Mind Game, his earlier book, and formed part of a larger iconoclastic body of research and advocacy in the field of mental health, particularly in the area of schizophrenia. Indeed, Torrey acted as a rebel in the field. Most interestingly, Torrey’s views, as well as the radicals’ views decrying homosexuality experimentation in Miami, aligned with those of critics of psychodynamically oriented psychiatry who sought “narrow, symptoms-­ based definitions” that “could make diagnostic criteria seem more objective.”30 His was an argument about the creation of medical and mental health knowledge, and how to use that knowledge in 1972 and beyond. The proponents of biological psychiatry often espoused the rectitude of the biomedical paradigm, scientific inquiry, and clarification of mental disorders—­ much as Torrey did in The Mind Game and, to a certain extent, just as Steiner did in his manifesto. The debate over homosexuality contributed to psychiatry’s “crisis of legitimacy” and acted as a catalyst for the “cataclysmic” change in nosology used by the landmark DSM-­III, released in 1980.31

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R. D. Laing, another radical psychotherapist, also weighed in on the pathologization of homosexuality and schizophrenia. In 1978 he told a reporter that “the American Psychiatric Association convention took a vote to vote out homosexuality as a disease.” While a positive development, the fluctuating nature of diagnostic categories and ultimately the reevaluation of behaviors that constituted mental illness was deeply troubling for him—­and for the American mind. Such shifts encapsulated many of the problems with mental health practices: its bureaucracy, subjectivity, and politics. “What are we to make of a system,” he queried, “that asks the public to take it seriously as a medical diagnostic system and then votes diseases in and out? One year it’s one thing, the next year something else.”32 With schizophrenia, he voiced many of the same concerns. He questioned whether “mental illness (typically, schizophrenia) was indeed an illness at all,” according to the historian Paul Laffey.33 “Schizophrenia,” he argued, was a “special strategy a person invents in order to live in an unlivable situation,” and he pushed back against genetic theories of the mental disorder.34 He critiqued the institutional power of psychiatry, as well as the early work of Emil Kraepelin, and offered a sociological interpretation of schizophrenia that avoided biological reductionism or biological determinism. Laing emphasized that the “behaviors and thought patterns of the schizophrenic patient were actually understandable when interpreted in context.”35 More than that, he highlighted Fromm-­ Reichman’s “schizophrenogenic families” theories. Just as in the case of LSD, Laing served as knowledge-­maker and power broker; his papers and other writings (published and unpublished) on the hotly contested nature of schizophrenia were thoughtful but not altogether well regarded, or definitive. “I am sure,” wrote one professional colleague of Laing’s “there are some people who regard your [schizophrenia] paper as having demolished all arguments for a genetic factor completely as a kind of decisive battle in a Holy War. This is an attitude I regard with distaste and, I judge from your own remarks, that you see the matter in proper perspective.”36 Radical psychiatrists were clearly engaged in debates about diagnoses and data at the theoretical level and through tangible reform. Many found in attempts to alter someone’s sexuality, for example, a type of vicious psychiatric despotism, a throwback to an earlier era of leather mitts, camisoles, and horrific asylum practices. The protests against McConaghy’s work, then, were based on puncturing the mysticism of the field, but also on exercising

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a social responsibility. In 1969–­1970, radicals played a role in prompting a revolutionary shift toward a biological framework of mental health that incorporated neuroscience, brain chemistry, and pharmaceuticals. Even as they accomplished this, radicals and protestors also maintained faith with the idea of progressive advances in human rights and the need to protect the patient from the dominance of outdated practices. This political and professional controversy, to which the APA’s Radical Caucus contributed, was resolved in 1973 when the APA Board of Trustees agreed to remove the “disease” from its manual. As one commentator put it, the gradual move toward the acceptance of homosexuality within the fields of psychiatry and psychology represented a “radical shift from the past.”37 Data-­Driven Mental Health The state of affairs that brought psychotherapy to its nadir was tied to the development of health care—­including mental health care—­as a tremendously profitable industry in the United States. During the 1950s and 1960s, unions demanded and often won health insurance benefits from their employers, including mental health services. These and other victories were generally passed on to the nonunion workforce as well. Yet there were limits to these victories. In 1946 the United Auto Workers, led by Walter Reuther, signed an agreement with General Motors instituting company-­ sponsored health insurance, which effectively undermined the more progressive demand of the Congress of Industrial Organizations (CIO) for a national health insurance covering organized (as well as nonorganized) workers. Similarly, the Taft-­Hartley law of 1947 had mandated that workers obtain health benefits only through collective bargaining with their employers, rather than through government programs. During this period, too, “psychoanalysis in the United States saw an accelerated growth” and the movement continued to establish itself.38 By the early 1960s, the psychoanalysis movement’s “institutionalization within the psychiatric community, and its full incorporation in academia and hospital training” was largely complete.39 It would not begin to lose its foothold until the mid-­1970s and early 1980s. In 1963, David Beres, the president of the American Psychoanalytic Association, confidently told his colleagues that their field had established itself as “a member of the scientific community.”40 He was also confident enough to suggest, much as

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Felix and Yolles later would, that it was a favorable moment to engage with social problems in American society. The immense influence of psychoanalysis did not go unchallenged. Many within the psychiatric and psychological communities contested its authority, insisting that it was both dogmatic and scientifically bankrupt. Sir Karl Popper, a world-­renowned authority on scientific knowledge, stated that, when it came to “Freud’s epic of the Ego, the Super-­ego and the Id, no substantially stronger claim to scientific status can be made for it than for Homer’s collected stories from Olympus.”41 Psychoanalysis was deeply affected by capitalistic trends, scientific paradigms, and government initiatives like those mentioned above. Debates continued over its suitability in the profession and, more particularly, whether it was more than a product of its times.42 For many, psychiatry had functioned outside the measurable parameters of traditional science; for too long it had operated without the hard data needed for policymaking and insurance purposes. In the face of advances, it met, as one scholar put it, “strong competition from cost-­effective psychopharmacologic and behavior-­ focused treatments, which could indeed be easily offered to masses of the public sector and monitored by the expanding power of an industrialized health care machine.”43 As Allan Horwitz, a historian of psychiatry, writes (and has been chronicled by many others), “A huge cultural transformation in the construction of mental illness” occurred “in a relatively short time.” It essentially moved “from an ideological to a scientific discipline.”44 There was a slow but definite shift away from psychoanalysis. Mental health care was deliberately transformed. “Until 1980,” argued Allen Frances, a former chair of the DSM Task Force and a critic of diagnostic inflation, “DSMs were obscure little books that no one much cared about or read.” But then DSM-­III “burst” on the scene, and it suddenly acquired the status of “a very fat book that became a cultural icon, a perennial bestseller, and the object of undue worship as the ‘bible’ of psychiatry.”45 Partly this was a product of reformers in the APA, who perceived upheaval in the profession during the 1970s as an outgrowth of diagnostic unreliability, both in treatment and in research.46 This was partly driven by economic imperatives or, rather, cold hard cash, since it facilitated “cost-­effective psychopharmacologic and behavior-­focused treatments” that could be “easily offered to masses of the public sector and monitored by the expanding power of an industrialized health care machine.”47

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Money and data deficiencies were certainly factors related to community-­ based psychiatry. It is no secret that both the return of biological psychiatry and the negative interpretations of the mental health field in popular culture were partially driven by significant changes in how medical services were paid for. With the passage of President Johnson’s Medicare and Medicaid amendments to the Social Security Act in 1965, the “demand for cost-­ effective services based on objective criteria increased steadily” throughout the 1960s.48 This Great Society initiative, in other words, amplified the move toward increased quantification of mental health. And “non-­ medically licensed competitors (e.g.-­ psychologists, social workers, and counselors) were offering psychodynamically-­based therapeutic services at significantly less expensive rates.” Economic pressures thus “challenged the psychiatric community to prove that its diagnoses and therapies were (more) efficacious and represented treatment of legitimate medical diseases.”49 The decline of working-­class fortunes, the failing American war in Vietnam, and the subsequent disintegration of carefully built Cold War dichotomies all informed the ongoing debates about DSM-­III. It was a time, in the mid-­1970s, “when so much was up in the air and unsettled.”50 A mod subculture had fully revived, while the rise of punk continued unabated. A running craze had gripped the country, and an estimated 15 million Americans jogged on a regular basis; Runner’s World, a magazine for joggers, increased its circulation more than 400 percent between 1977 and 1978.51 People were collecting pet rocks, wearing leisure suits, and making love in their state-­of-­the-­art waterbeds surrounded by lava lamps. APA chair Dr. Robert Spitzer placed an emphasis on scientific objectivity and method, empirical research, and the construction of stronger psychiatric classifications and nomenclature in the manual. A member of Columbia University faculty, he had played an instrumental role in eliminating homosexuality from the manual by ridding the gay community of its out-­and-­out sickness label. After changes in 1973 and 1974, homosexuality was removed from the DSM-­III classification of mental disorders and replaced by the category Sexual Orientation Disturbance, which, according to Spitzer, represented a compromise between the view that preferential homosexuality was invariably a mental disorder and the view that it was merely a normal sexual variant.52 During the 1970s, Spitzer was placed in charge of revising the DSM. The New York Times described him as “the keeper of the book, part headmaster,

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part ambassador, and part ornery cleric, growling over the phone at scientists, journalists, or policy makers he thought were out of order.” The role seemed to suit him: he methodically brought order “to a historically chaotic corner of the science.”53 Spitzer was extremely influential in propelling the pendulum’s swing toward empiricism, which was just another example of the “cyclical nature of psychiatric progress.”54 Objectivism was back. The move came to guide and mold how many within the psychiatric and psychological communities would see clinical practice and research. Subjective bias was one of the core problems in psychiatry and demanded eradication. According to Seymour Kety, a neuroscientist and one of the dons of empiricism in mental health, writing in the 1970s, “Carefully controlled and ‘double-­blind’ experimental designs . . . can help to minimize this bias.”55 Likewise, among psychologists, the argument that the discipline “should study human behavior scientifically,” with its “observation, and whenever possible, measurement,” was steadily growing.56 Spitzer largely agreed. He proved an important figure in driving the paradigmatic shift, striving to move beyond “public embarrassments” relating to schizophrenia and Rosenhan’s study, homosexuality, and the perceived failures of social psychiatry in the community, which only added to difficulties in mental health.57 He was vital in the making of the DSM-­III, in the course of which Spitzer had to contend with a polarized profession and widespread upheaval in society. DSM-­III marked a “paradigm shift” and a “turning point,” to be sure, a point confirmed by psychiatrists and scholars alike, although the DSM project on the whole has remained a work in progress, always undergoing change, forever fluid.58 And it’s crucial to recognize that this was a product of the times, and how “features of culture which usually count as non-­scientific greatly influence both the creation and the evaluation of scientific theories and findings.”59 One of the most telling features of this trend was the official removal of the psychodynamic term “neurosis.” In the face of outcry from psychodynamically oriented psychiatrists, the decision to ban the term from the DSM was only slightly corrected, and DSM-­III’s Nomenclature Task Force eventually decided to include the term parenthetically as “Neurotic Disorder” after renaming mental disorder categories that corresponded to the earlier “Neurosis” classifications. The increased number of mental disorder categories (from 182

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in DSM-­II to 265 in DSM-­III) was intended to reflect the increase in psychiatric knowledge accrued since the DSM-­II, as well as a greater specificity of diagnosis sought by the DSM-­III Task Force. The latter often entailed the organization of previous, more broadly construed categories into several individual “subtypes,” each considered a separate and discrete mental disorder. For instance, the number of disorders under the umbrella of schizophrenia changed from fourteen categories in the DSM-­II to eighteen in the DSM-­III. Additionally, many novel disorder categories (absent from the DSM-­II) were formalized as mental illnesses in the DSM-­III. These included Post– Traumatic Stress Disorder, an array of childhood and adolescence disorders (such as three categories of Attention-­Deficit Disorder), seven classes of Psychosexual Dysfunctions, and four Disorders of Impulse Control Not Elsewhere Classified (such as Pathological Gambling). Controversy has arisen over the legitimacy of several of these categories as “true illnesses” since their inclusion in the DSM-­III and then perpetuation in successive editions of the DSM. Besides such content modifications, several other novel features of the DSM-­III merit mention. Elaborate and more explicitly defined operational criteria for inclusion and exclusion were formulated for each disorder. These included standards for the differential diagnosis of several categories of disorder that shared similar characteristics, and the minimum duration of signs and symptoms required for a clinical diagnosis to be made. Another unique feature of the DSM-­III was the adoption of a “multi-­axial system” of diagnosis to account for patients’ multifactorial presentation and multidimensional experience of mental illness, and to facilitate a more comprehensive depiction of the patient’s condition. Within mere weeks of the appearance of DSM-­III in 1980, people were discussing what DSM-­IV should look like. After DSM-­III came DSM-­IIIR (for “revised”) in 1987, then DSM-­IV in 1994, followed by DSM-­IV TR (for “text revision”) in 2000. In 2013, DSM-­5 was released to tremendous publicity.60 The DSM project has always been about the creation and dissemination of mental health knowledge; it’s been about how Americans “understand ourselves” and “relieve suffering.” It has also been framed in terms of progressivism—­the triumph of “science over ideology” or as a “victory for science.”61 To some detractors of the book, which was once obscure and relatively small, it now represented the “desire to control, to manipulate, to

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turn others’ vulnerabilities to our advantage” And the consequence of these impulses meeting each other was that “commerce—­and often bullshit—­ will prevail.”62 Various individuals and institutions argued for a “rebiologization” of psychiatric thought, which germinated slowly in the 1960s and 1970s, culminating in publication of the DSM-­III in 1980. Discussions over data and the DSM in the 1970s were a “fateful point” in mental health. They were a move toward a “standardized nosology of fixed disease categories” to be derived from a research-­based medical model63 that all but swept away psychodynamic and other alternative theories from the APA’s official manual.64 The multiple amendments introduced to the DSM-­III demonstrated a shift in the conceptualization of mental disorders from psychological “states” to discrete, operationally defined disease categories and a return to a descriptive, symptom-­based classification. In essence, the DSM-­III inaugurated an attempt to “remedicalize” American psychiatry. Contemporaneously, the federal government sought to get a better grasp of the organization of mental health services through various commissions. Reports As the APA debated the DSM, President James Earl Carter, elected in 1976, initiated a program to better understand and improve mental health services in the country. By then a significant number of mental health experts, from health care economists to physicians, recognized the system was in need of reorganization and rationalization, a problem President Carter had to address. To this end, Carter, who embodied for many the limits and austerity of the era, initiated a presidential commission to investigate mental health in the United States.65 Passage of the Community Mental Health Centers Act in 1963 offered federal subsidies for the construction of local clinics, which were intended to be the foundation of a “radically new policy.” Retrospectively, CMHCs have been criticized—­often justifiably, sometimes not—­as placing ideology over reality. Medicaid, Social Security Disability Insurance, Supplementary Security Income, food stamps, and housing supplements also provided resources that enabled persons with serious mental disorders to reside in the community, so there were certain redundancies. To be sure, hospital populations dropped swiftly in a process known as deinstitutionalization.

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Yet the states’ policy decisions to reduce their public mental hospital populations made admission to such hospitals more problematic. Inflation did not help, nor did the decreasing number of psychiatrists who wanted to work in community-­based operations. By the 1970s, then, the U.S. mental health system consisted of multiple institutions with overlapping functions and authorities: short-­term mental hospitals, state and federal long-­term institutions, nursing homes, residential care facilities, CMHCs, outpatient departments of general hospitals, community care programs, community residential institutions for the mentally ill with different designations in different states, and client-­run and self-­help services, among others. Several government reports assessed and undercut confidence in the American mental health apparatus, thereby adding more impetus for change. The U.S. Department of Health, Education, and Welfare and the Government Accountability Office both recommended efforts to redress problems in the system.66 Inside the Beltway, Ralph Nader’s public policy research group produced The Madness Establishment, published first as a report and then as a book in 1974. It found that many of the country’s CMHCs were inefficient, psychiatrists could be self-­interested, and services were unequally distributed between socioeconomic groups.67 President Carter’s Commission on Mental Health, akin to the discussions of the DSM led by Spitzer, attempted to offer evaluations and reforms; the psychiatrist Peter Bourne called Carter’s commission “new and creative leadership” in the treatment of the nation’s mentally ill.68 Structures and legislation at the federal level, in other words, interfaced with mental health ideology and practice.69 Carter was complex. The journalist James Fallows in May 1979 remarked that President Carter was “perhaps as admirable a human being as has ever held the job.”70 According to Philip J. Hilts, Carter was a political hybrid, the precursor to President Bill Clinton’s centrist Democratic model because he held strong democratic tendencies and fierce antigovernment attitudes simultaneously.71 Carter was an economic conservative in that he promised to balance the budget in four years and eliminate unnecessary bureaucracy and government regulations.72 Much like President Barack Obama, Carter also vowed to fix Washington and provide change—­and the electorate either believed him or gave him the benefit of the doubt. Carter was not a product of the tightly interwoven Washington establishment. When he narrowly won the presidency, many pundits and commentators argued that his victory was based on the merits of his outsider status, his distrust of

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government, and his castigation of the status quo in Washington. The sentiment predictably left a sour taste in the mouths of many career employees in government and elsewhere in the nation’s capital. “Mr. Carter,” according to one senior regulator, “came into the presidency running, at least in my view, on a very strong anti-­federal-­government platform. . . . You’ll recall that this was the post-­Nixon era; there was still a major concern over the possibility of wrongdoing within government.”73 Carter tried to set things right in mental health. The creation of the President’s Commission on Mental Health on February 17, 1977, however, marked a recognition of difficulties in a system that was fragmented, lacked organization, and sadly failed to meet the requirements of many groups in the United States. Just as Carter sought to move on from the recent (toxic) events in Washington, D.C., the name of the commission itself marked a break from the past. Nearly two decades earlier, the Joint Commission on Mental Illness and Health (1955–­1961) had focused largely on the problems faced by individuals with serious and persistent mental disorders, many of whom were institutionalized. Hence the decision in 1977 to use “mental health” rather than “mental illness” in the commission’s name indicated a policy shift—­indeed, a shift in the times—­even though there was virtually no explicit recognition of its implications. The change in terminology was founded on a “public health model that emphasized the role of the environment, social services, and prevention rather than the traditional psychiatric focus on the diagnosis and treatment of severe and persistent mental disorders.”74 The Carters had long demonstrated a commitment to addressing problems facing the mental health system in the United States. For Rosalynn Carter in particular, the issue was significant: as early as 1974 she promised to tackle mental health if her husband was elected to the highest office. In Georgia, as the wife of a governor, she had achieved some minor victories, and was intent on seeing more Americans deinstitutionalized and community-­ based clinics strengthened. Unfortunately, the effort to get patients out of hospitals caused a variety of problems. The community-­ based mental health system was not meeting the needs of many deinstitutionalized populations, and local mental health programs were severely underfunded. For many, the community mental health services could not meet the array of psychiatric, social, and economic needs of individuals with mental illness. Gerald Klerman, the head of the U.S. federal Alcohol,

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Drug Abuse, and Mental Health Administration, was brutally honest in 1977 when he pointed out that the practice of deinstitutionalization had the potential to lead to a 1984 or A Clockwork Orange society. “The fear is that drugs and other behavior control technologies,” Klerman asserted, “if not controlled and regulated, combined with the anomie and isolation of urban life, will convert our communities into the ultimate total institution, a totalitarian society.”75 When President Carter announced the establishment of the commission he opined that addressing mental health in the United States was the moral equivalent of war, a battle that needed to be fought for the sake of all Americans.76 The commission was given no small task. In an era of struggle between biological psychiatry and psychodynamic psychiatry, in which facts and figures were deemed acutely necessary for the legitimacy of the field, government officials were charged with providing further information about the system of mental health. The commission was asked, in essence, to deliver more information—­more data—­on several issues: •

Were the “mentally ill, emotionally disturbed, and mentally retarded” being served or underserved?

•

What were the projected needs for dealing with emotional stress during the next twenty-­five years?

•

What was the proper role of the federal government?

•

How could a “unified approach to all mental health and people-­helping services” be developed?

•

What kind of research was needed?

•

How could the educational system, volunteer agencies, and other institutions minimize “emotional disturbance”?

•

Finally, how much would it cost to change the system, and how might the expenditures be allocated among the three levels of government?

In seeking to answer these grandiose questions and develop a fuller knowledge of the mental health ecosystem, the subsequent reports and deliberations demonstrated that the commission’s members were dealing with amazingly complex issues. The problems emerged from a global mental health agenda, a domestic rights revolution, and the involvement of multiple interest groups, including remnants of the radical psychiatrists and psychiatric survivors. By early 1978 the commission’s separate panels had

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completed their work, and their reports filled 2,140 pages in three large volumes. Their statements were far from compatible, representing a “multiplicity of voices,” and were clearly agenda-­driven. Overall, it was debatable whether any group, professional or lay, could assess the contradictory recommendations of the two dozen individual mental health panels and then fashion an intelligible final report. But an effort was made.77 The commission was instructed to produce a final report by April 1978. The result was a hodgepodge. Carter called it a “superb analysis of the problems that we still have in the adequate delivery of mental health care to the people of our country.” He praised the report for not calling for major spending increases and acknowledged the trouble in bringing together “widely and disparate groups . . . interested in mental illness of all kinds.”78 Carter agreed with the report’s recommendations that federal policy ought to inspire mental health specialists to work in underserved areas, increase the number of minority personnel, and ensure that the skills and knowledge of such personnel were suitable for the needs of those they served. In calling for reform in both the public and private financing of mental health services, the report dealt with legal and human rights. How could it not? In light of the social upheaval of the 1960s and 1970s, this subject, the rights revolution, was inescapable. Concern with race, ethnicity, and gender issues permeated the document. The mental health of children was emphasized, as was a greater understanding of “the nature of social environments.” As part of this general orientation, the commission supported a series of actions to better represent mentally disabled individuals, eliminate discrimination, and ensure that the states reviewed their civil commitment and guardianship laws. In addition, it affirmed the right to treatment in the least restrictive setting, rehabilitation, and protection from harm. The report advanced more than one hundred other recommendations, prompting critics to charge it was so broad and so inclusive as to be meaningless. In seeking consensus, or the much sought-­after middle ground, the report offered something for everyone, the optics of which were far from ideal. At best, it seemed a dithering effort difficult to translate into a tangible piece of legislation; at worst, it came off as hollow political posturing and a waste of time and resources. Creating legislation proved difficult. Years later, though, the spirit of the report could be found in the provisions of the Mental Health Systems Act of 1980. The act reaffirmed the priority of community mental health services,

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particularly for such underserved groups as individuals with chronic mental illnesses, children and youth, the elderly, ethnic and racial minorities, women, the poor, and rural residents. Yet it also emphasized planning and accountability, mandated “performance contracts” as a condition for federal funding, and called for new intergovernmental relationships and closer links between the mental health and general health care systems. In its emphasis on ties to existing institutional structures, it was not quite radical. Parapsychology Researchers of an altogether different sort similarly explored the limits and power of the mind in the 1970s. Some were legitimate researchers, others were not. All sought to improve and legitimate their knowledge of the brain. The last section of this chapter examines parapsychology as a means to broaden the conception of mental health debates, the use of data, and radicalism. Early psychical research focused on spiritualist cults, mediums, ghost hunters, mind readers, levitators of tables, and mystics of all sorts. By the 1930s, excitement in the United States attracted the interest of some serious scholars and institutional support, and a newer and more sophisticated investigation of the paranormal got under way. Various groups ran experiments on paranormal subjects, testing everything from precognition, remote viewing, and metal bending to animal communication and energy field projection. Ghosts and extraterrestrial beings were explored as parapsychologists engaged with the military and with fringe groups. Amid Cold War tensions, the Soviet and U.S. governments invested in efforts to develop “psychic spying.” The American program was tasked and funded by the Department of Defense, as well as by the CIA, the Drug Enforcement Administration, the National Security Agency, the National Security Council, and the Secret Service. During the 1970s a number of organizations dedicated to exploring the parapsychological came into being, including the Academy of Parapsychology and Medicine (1970), the Institute of Parascience (1971), the Academy of Religion and Psychical Research, the Institute for Noetic Sciences (1973), and the International Kirlian Research Association (1975). Major American universities began running experiments throughout the decade. Duke, Princeton, Stanford, and Virginia, among others, all embarked on

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mind-­ blowing research with cool-­ sounding names. Stanford’s secretive CIA-­funded project, called Project Stargate, sought to examine people from afar through “remote viewing.” In New Jersey, the Princeton Engineering Anomalies Research project investigated extrasensory perception and telekinesis. The University of Virginia’s Division of Perceptual Studies, meanwhile, researched reincarnation and near death experiences, in addition to other altered states of consciousness, while Duke University’s Parapsychology Laboratory—­the birthplace of modern parapsychology in the United States—­was operating all manner of tests. Parapsychology had a foundation in numerous intellectual traditions, research fields, and several institutions and organizations. But experiments by the botanist Joseph Rhine at Duke University are rightly regarded as the beginning of parapsychology’s rebranding as a science. By 1935, several years before the rise of cybernetics as an area of growth in science and around the time that sociology consolidated as a discipline, Rhine had coined the term extrasensory perception (ESP). A well-­worn story is that Sir Arthur Conan Doyle turned Rhine on to parapsychology during a 1922 tour-­ de-­ force lecture in Prohibition-­ era Chicago. After teaming up with his mentor, William McDougall, Rhine went on to establish himself as a parapsychological pioneer. He delineated different forms of ESP, including telepathy (mind-­to-­mind communication without known physical means), clairvoyance (seeing things not present), precognition (knowing things before they happen), and psychokinesis (mind over matter). Rhine believed that by incontrovertibly establishing ESP as reality-­based, and by showing that it operated independently of the physical and mortal body, he might also discover something about humans that could survive the death of the body. It was nothing less than a life-­after-­death thesis. Proving this—­ quantifying it—­was another matter. The “Rhine revolution” encompassed several elements. Rhine attempted to provide parapsychology with a systematic program of experimentation, to quantify the conditions and extent of psi phenomena, meaning ESP but also skills, rather than merely trying to prove their existence. In this way he sought to give the field of parapsychology academic and scientific legitimacy. He used card-­guessing and dice-­rolling experiments, for example, all in an attempt to verify statistically—­scientifically—­that ESP existed. He wanted to prove that the mind had far fewer limits than we could imagine. Besides the Duke University Parapsychology Laboratory, he also founded

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the independent Rhine Research Center. Further, Rhine cofounded the Journal of Parapsychology in 1937 and then the Parapsychological Association in 1957, the mission of that association being, as stated in its constitution, “to advance parapsychology as a science, to disseminate knowledge of the field, and to integrate the findings with those of other branches of science.” Under the direction of the cultural anthropologist Margaret Mead, the Parapsychological Association took a large step in advancing the field of parapsychology in 1969 when it became affiliated with the American Association for the Advancement of Science, the largest general scientific society in the world. This link gave even more credence to, and fostered general openness toward, psychic and occult phenomena in the 1970s. As the university-­based research got under way, the influx of spiritual teachers from Asia, and their claims of abilities produced by meditation, led to research on altered states of consciousness. Parapsychologists used ganzfeld tests to measure ESP ability, as one example. Ganzfeld tests sought to quantity telepathy by separating two individuals in isolated rooms and having one attempt to send a telepathic image to the other. Researchers found, too, that ESP abilities heightened under hypnosis. Since hypnosis typically involved relaxation and suggestion in a comfortable atmosphere, researchers suggested that perhaps one of these factors, or a combination thereof, was responsible for heightened psi scores.79 Uri Geller, an Israeli illusionist, proved an intriguing case study that served to divide the scientific community. He popularized paranormal activity during the mid-­1970s with his claims of mental spoon-­bending ability and telepathy. He was significant enough, and his supercharged mind was sufficiently powerful, to prompt articles in Nature magazine, among others, and serve as a basis of study at Stanford. Considerable debate followed. In 1972–­1973, researchers worked with Geller to examine his reputed ability to bend metal and his ESP. The results were favorable to Geller, and they demonstrated the limitless power of the mind, but the New Scientist was far from sympathetic. “The SRI paper simply does not stand up against the mass of circumstantial evidence that Uri Geller is simply a good magician.”80 Also in 1972, the noted writer and intellectual Arthur Koestler published The Roots of Coincidence, which linked hard science and the paranormal, and critiqued Carl Jung. Koestler’s long-­standing beliefs in mysticism and powers of the mind led him to partner with Sir Alister Hardy at Oxford University; together they worked to promulgate both “sensational”

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and critical accounts of ESP, believing they were on “the fringe of something very important.”81 In 1972, and later in the decade, lessons could be drawn about the American mind and the state of science in the United States more generally. First, the potency of suggestibility was crucial in thinking about beliefs in the paranormal. Far too many individuals were caught up in the TV circus and newspaper headlines and had lost perspective. Second, scientists were not nearly as “critical, sceptical, and observant” as they ought to have been. The standards of judgment and the responsibility of scientists appeared to be compromised during the episode. Third, historical perspective mattered. Claims of clairvoyance and other powers about the mind have long histories, stretching back to the late nineteenth century and earlier.82 The swell in paranormal research continued throughout the 1970s and carried into the 1980s. It was reflected in popular culture, with the author Stephen King, for example, establishing an empire based on novels featuring paranormal activity. Telekinesis, telepathy, and the like featured in the King-­inspired films Carrie (1976), The Shining (1980), The Dead Zone (1983), and Firestarter (1984). But ghosts and ghouls, angels and the afterlife, were far more popular than just King properties. According to one account, the official forces of science and society—­usually marked as skeptical and white male—­no longer had the power to “battle evil.” The heroes of such new films, whether in The Exorcist (1973) or Ghostbusters (1984), had to struggle against these forces, or the establishment, in addition to evil, paranormal, mind-­controlling, Satanic bad guys.83 Horror films, suggested the New York Times, entered a cycle of unparalleled carnage during the late 1960s and 1970s that has often been explained in psychological terms, such as family dynamics or the workings of the subconscious. Science fiction and paranormal trends also met in the 1970s, particularly at the cultural intersection of Close Encounters of the Third Kind (1978), a film that represented for many critics not only the genius of Steven Spielberg but the New Age beliefs of the era.84 The film articulated the post-­Watergate mistrust of government. “In many ways, this movie is a cosmic Watergate,” Spielberg explained. “Hopefully people will experience something very much like a real U.F.O. experience.”85 By the end of the 1980s, the Parapsychological Association reported members were working in more than thirty countries. Additionally, research not associated with the association was being conducted in Eastern Europe

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and the Soviet Union. With the increase in parapsychological investigations, structured opposition also grew—­to the findings of parapsychologists and the granting of any formal recognition of the field. This was not science, the detractors argued. This was hokum. Geller, with all his reputed powers, was a chiseler, while parapsychology was flimflammery. The founding of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP) in 1976, which was later renamed the Committee for Skeptical Inquiry, provided a forum for critics to push back against the rise of parapsychology. It was established on April 30, 1976, at an international symposium held on the campus of SUNY-­Buffalo under the title “The New Irrationalisms: Antiscience and Pseudoscience.” “There has been an enormous increase in public interest in psychic phenomena, the occult, and pseudoscience,” held the cofounder of the organization, Paul Kurtz. “Radio, television, newspapers, books, and magazines are presenting the case of psychic healing, psychokinesis, immortality, reincarnation, Kirlian photography, orgone energy, psychic surgery, faith healing, astrology, the chariots of the gods, UFOs, dianetics, astral projection, exorcism, poltergeists, and the ‘talents’ of Uri Geller,” among others.86 The aim of CSICOP was to examine these in detail.87 Among the more prominent CSICOP fellows were the astronomer Carl Sagan, the biophysicist Francis Crick, the evolutionary scientist Stephen Jay Gould, and the zoologist Richard Dawkins. Besides these academic heavyweights, the science writer Isaac Asimov and the psychologist B. F. Skinner acted as fellows. At the founding of the organization, Kurtz, the editor of Humanist magazine, spoke passionately on the scientific attitude versus antiscience and pseudoscience. He referred to “cults of unreason” and “nonsense” that inundated supposedly advanced societies like the United States. He made clear, though, that the organization would not cold-­heartedly and reflexively reject all amazing claims. It wouldn’t automatically take the other side. Rather, the organization would seek to verify—­to confirm—­claims about metal bending or reincarnation.88 Final Thoughts “We invented the fantasy-­industrial complex,” wrote the cultural critic Kurt Anderson. “Almost nowhere outside poor or otherwise miserable countries are flamboyant supernatural beliefs so central to the identities of so many

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people.”89 Many of these same people thought that they might break on through to this alternative existence or unlock the door to otherworldly powers. This state of affairs did not occur by accident, nor did it happen overnight. By the mid-­1970s, scientists felt it necessary to organize against the rise of such fantastical beliefs. The massive expansion of belief in psychic phenomena, the occult, and pseudoscience, as well as a rise in religiosity, prompted the founding of new groups to explore the trends.90 Deliberations and disputes within the field of mental health during the 1960s and 1970s did not occur in isolation, and protests were far more than an intraprofessional or multiprofessional scuffle. Quarrels over the characterization of homosexuality, the use of drugs, and whether replicable drug trials were ethical constituted elements of a political, economic, and cultural landscape in transition. The aftermath of the Vietnam War, the rights revolution, and greater drug use across the spectrum of society, to take just a few examples, helped shape mental health discussions and the ways in which psychiatrists and psychologists addressed each other and their patients.91 The gay rights movement in America ran parallel with discussions about homosexuality as a mental health disorder; meanwhile, arguments about drug trials and disease categories occurred alongside debates related to science and the validity of parapsychology. The course of mental health history shows that many questions have been asked about proper practices—­and the use of data to justify actions. The development of moral treatment methods in the late nineteenth century forced reflection on caging and charging admission to observe the mentally ill. Physicians questioned the use of canvas jackets and cages, leather harnesses and locked wooden beds. The ensuing “great restraint controversy,” which focused on whether a patient’s ability to move should be limited, marked an early struggle in the field of mental health and elicited an early example of reformist impulses.92 Somewhat later, William Menninger wrote of psychiatry’s “great awakening” during World War I and suggested that trauma endured on the front lines prompted changes, though slow, to the status quo, specifically an increased acceptance of psychoanalysis.93 The skeptics of parapsychology were cut from the same cloth as those who drove the return of the biological model in mental health. It is an interesting historical intersection that parapsychology angled for legitimacy at roughly the same moment as the DSM underwent basic changes and the mental health establishment began to demand more quantification.

6  Mental Health and Substances in the Seventies

It is quite awful that the alienists have caught hold of a new poison to play with, without the faintest knowledge or feeling of responsibility.1 —­Carl Jung, April 1954

Alternatives to the medical mainstream, including lysergic acid diethylamide (LSD), cannabis, and MDMA (3,4-­methylenedioxymethamphetamine, ecstasy), are often deemed radical, and their use has been debated heavily within American medical circles. The use of these substances in relation to mental health is the subject of this chapter. They are important in helping determine the complex line that separates consumer safety from market innovation, where the right to choose one’s therapy ends and the state’s responsibility to defend citizens from spurious drugs begins, and what constitutes appropriate mental health care. During the 1970s, California acted as an incubator in which the use of contested medicines met various economic and political perspectives, and in which new treatment methods were developed. As LSD research waned in the 1960s, that on MDMA briefly waxed. Mentions of marijuana, meanwhile, often conjure ideas of the 1936 film Reefer Madness, Harry J. Anslinger, or, later, Cheech and Chong’s Up in Smoke or Bob Marley. As more U.S. states either decriminalize or legalize cannabis, it’s useful to reflect on mental health and the so-­ called radical drugs of the 1970s. To what extent should government limit or control access to an intoxicant that might induce psychosis? Was LSD or MDMA effective? What are the boundaries of legitimate and illegitimate use in the laboratory and on the street? These questions drove discussions about drugs in the 1970s stalled policy changes; they are still with us today.

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LSD and the “Other Side” On November 22, 1963, Aldous Huxley, author of The Doors of Perception and Brave New World, passed away peacefully in his California home. Mere hours separated Huxley’s death and the assassination of President John F. Kennedy, who one month earlier had signed the Community Mental Health Act. Suffering through the late stages of laryngeal cancer, Huxley was unaware of Kennedy’s trip to Dallas, but was still conscious enough to request a dose of LSD from his psychotherapist wife, Laura. Having lost the ability to talk, he scribbled the message, and she administered the drug by needle. Three years had passed since Huxley’s initial diagnosis of cancer. During that time he had been far from idle. He lectured at the nascent Esalen Institute on human potential, occasionally even delving into transhumanism. He wrote Island, his gloomiest novel, and delved further into mysticism, parapsychology, and universalism.2 Throughout his life, he had poked and prodded at the edges of magic and death. As author Steven Johnson put it in his book on neuroscience, Huxley sought to live with a mind wide open.3 Near the end of his life, Huxley examined the “other side,” as he had in many of his earlier writings. “Peyote produces self-­transcendence in two ways,” he had written in 1958. It introduced “the taker into the Other World of visionary experience, and it gives him a sense of solidarity with his fellow worshipers, with human beings at large and with the divine nature of things.”4 In January 1963, Huxley sent a prodigious number of letters to all sorts of researchers, including Sanford Unger, who was experimenting with LSD treatment for the terminally ill. Huxley was clearly impressed with how Unger provided a balanced account of the drug and wanted to thank him for the “remarkable achievement,” as he put it. It was quite a letter: You have really succeeded, it seems to me, in that most difficult and most necessary of tasks—­the task of making the best of both worlds; the world of science and the world of immediate experience; the world as it is observed through the various frames of reference appropriate to bio-­chemistry, physiology, etcetera and the world actually perceived and felt as beautiful or ugly, divine or diabolic, senseless or significant; the world as it is analysed and simplified by the various scientific disciplines, as it is described in the aseptic language of the scientific paper, in which each word stands for one thing and one thing only, and the world as it is

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integrally experienced and as it is described by poets in words that stand, not for one aspect of reality, but form many aspects simultaneously.5

Ten years before that, in 1953, Humphry Osmond and Aldous Huxley had begun a friendship that led to their impish fashioning of the word “psychedelic” out of the whole cloth of classical educations and an intermingling of Greek and Latin. In the spring of 1953, Osmond connected with Huxley at an American Psychiatric Association (APA) convention in Los Angeles, which in turn led to the Saskatchewan-­based psychiatrist administering the world-­famous author his first taste of mescaline. Huxley documented this journey rather eloquently in The Doors of Perception, in which he drew on William Blake’s imagery and lyrical views on limits and infinity. Osmond had long suggested that psychedelic drugs might be of use in terminally ill cancer patients to aid them in the process of dying, and Huxley applied the treatment to himself prior to his own death. Various researchers later picked up on this psychedelic therapy. Among them were Sanford Unger, Walter Pahnke, Charles Savage, Stanislav Grof (after his arrival in the United States from his native Czechoslovakia), and Eric Kast, whose extensive work with LSD and cancer patients ultimately revealed a “lessening of the patients’ physical distress and a lifting of their mood and outlook that lasted about ten days.”6 Grof was based at Spring Grove, a state mental hospital in Maryland, when he sought to “transform the agony of terminal cancer” and “map the seas and craters and peaks of the unconscious.”7 He wanted to examine the journey, “under LSD, through death to the beginning of life.” And his research program was aimed at studying the effects of certain psychedelic drugs on the mental and physical states of patients with terminal cancer. Grof and his colleagues at the Maryland Psychiatric Research Center used LSD as an adjunct to psychotherapy, and they emphasized that the patient had to be fully prepared for the drug experience. He was certainly not the first in the United States to perform such experiments. In 1963, Eric Kast at the University of Chicago noted that LSD relieved depression, improved sleep, and lessened anxiety about death in patients at the end of life. According to Grof, the goal of the Maryland study was to reduce physical pain, but also to “relieve the emotional suffering of the patient and influence favorably his attitude toward death.”8 In Grof’s view, drugs altered the depression and anxiety of dying. “Most dramatic changes occur after

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sessions that have mystical and religious elements,” he suggested. These often involved “changes in the concept of death itself and transformation of the attitude toward the process of dying.” Grof added that experiencing “death in a very realistic way in the LSD session” was then “followed by the experience of rebirth and opening up of an endless cosmic panorama.” It was profound and convincing—­and the patients could thereafter “apply that experience to the process of actual death.”9 Grof and his colleagues sought to place patients in a comfortable frame of mind before a therapeutic session. Flowers were arranged in a private room. A record player spun the classics—­Vivaldi, Brahms, Beethoven. Specially trained nurses attended the sessions. Props were used, including eyeshades and sometimes headphones. As Tom Huth reported in the Washington Post, such sessions were an effort to overcome the fear and depression associated with death—­indeed, a method of distilling some meaning and enjoyment from one’s last few months.10 Mental health treatment for the dying was at a crucial stage of development in the 1960s and early 1970s. The movement and the testing of LSD were outgrowths of the failed system. The earliest impetus for humane hospice programming in the United States can be traced to the famous British physician and spokeswoman Cicely Saunders, who in the early 1960s embarked on “an exhausting schedule of speaking and teaching engagements” that saw her encourage the development of new hospice programs.11 Meanwhile, Saunders open-­ mindedly explored and experimented with alternative therapies for the dying. She read widely and deeply on the use of LSD as a pain reliever and adjunct to talk therapy, for instance. She largely agreed with Kast and Collins, who argued that “an ideal analgesic” had not yet been discovered, the criteria of which included relief from pain, minimal “impairment of the sensorium,” and no damage to “interest in life.”12 Yet LSD was not a top priority. “I hope you’ll forgive me,” she wrote Stanford University’s Willis Harman in 1965, “if I leave the question of using LSD on one side because I think it needs a lot of consideration.”13 Saunders was reluctant to implement LSD as part of palliative therapy at St. Christopher’s, and this was based clearly on a lack of evidence, though she remained open to a partnership with Spring Grove.14 Still, she would later offer criticisms of the treatment. “I have met Dr Grof for an afternoon,” she recounted, “he is a good doctor, with very good psychotherapy and spends

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10 hours at a time with a patient if necessary.” However, his methodology was flawed since no control groups had been established to evaluate patient responses. For her, this was troubling. “He totally believes in the LSD. Basically, I think it’s a gimmick.” The drug was valuable, yes, but the fact that he gave his patients so much one-­on-­one attention, or, as she put it, “intense personal interest,” was just as important.15 Grof saw his psychotherapeutic LSD research as helpful and pioneering. He had witnessed more than two thousand LSD sessions, about which he said, “I see my own role in terms of trying to collect these new observations and incorporating them into the body of accepted psychological and psychiatric knowledge.”16 Saunders, for her part, also investigated the use of hypnotherapy as an end-­of-­life treatment, if not to eliminate pain, then to heighten the patient-­ caregiver relationship and address the patient’s mind rather than the body at the end.17 She received practitioners of hypnosis at her hospice from several universities in the United States. Their visits were intended to help her learn about developments in the field and update best practices in pain management and end-­of-­life treatments. “Personally,” one hypnotherapist told Saunders after visiting, “I doubt if I could help anyone with progressive pathological pain . . . but no doubt this good doctor-­patient relationship developing through its use would be helpful.”18 Dr. David Ryde sent as much material to Saunders as he could. Other hypnotherapists went much further than Ryde in their pronouncements. According to Bertha Rodger, an American anesthesiologist and hypnotist, the practice was often misunderstood and misrepresented. It generated strong feelings and even more questions about its viability. Yet hypnotism “was well worth the time and effort entailed to use . . . as an adjunct to drug sedation or chemo-­anesthesia, or as hypno-­analgesia or anesthesia to whatever degree circumstances permit.” In short, hypnosis diminished “significantly the amount of medication or anesthetic agent” that was needed; it allowed for a “mastery of pain.”19 Hypnosis fostered, Rodger argued, “a relationship between two people, built on trust and confidence.” It used both “psychological and physiological principles with a resulting increase in comfort and efficiency.”20 How? Hypnotism enabled the patient to utilize his or her potentialities and allowed the physician to communicate more adequately with the patient. The enhanced communication, though, was not always based on conversation. With skilled hypnotists, “there is far

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less need of words. . . . Reliance is placed upon joint participation and inner attitudes that are transmitted by gesture, tone of voice, rhythm, warmth, inflection, muscle tension, and a thousand subliminal cues. These indicate a sort of tuning-­in on the situation, a receptiveness to communication.”21 Following her instrumental tour in the late 1960s and early 1970s, the hospice movement slowly gained momentum in an unstructured and unplanned manner throughout the decade, and by the mid-­1980s the number of hospices had ballooned, to roughly 1,500.22 A hospice, according to the American National Hospice Organization, is “a medically directed multidisciplinary program providing skilled care of an appropriate nature for terminally ill patients and their families to live as fully as possible until the time of death.” As well, the hospice “helps relieve symptoms during the distress (physical, psychological, spiritual, social, economic) that may occur during the course of the disease, dying, and bereavement.”23 Even more famous was Elisabeth Kübler-­Ross, who produced the bestselling On Death and Dying in 1969. According to the British Medical Journal, the book “rocked the medical profession and at the same time also resulted in a public outcry for compassionate care of the dying.” Like Foster, Kübler-­Ross emphasized communication, holding that through dialogue, wherein patients could review “their lives, their deterioration, and imminent death . . . a good death could be achieved.”24 Kübler-­Ross promoted the five-­stage framework of death and dying, which included denial, anger, bargaining, depression, and acceptance, and she pressed the medical community to employ it.25 In broad terms, the hospice was originally designed as a refuge or a “way station” for terminally ill patients and their families. Not only was it to provide more patient-­centered holistic and humanistic care, but the goals of the hospice required a reevaluation of existing modes of care for dying patients.26 The movement in the United States emerged as a reaction to the depersonalized care the dying received from the traditional medical system, which often failed to relieve the psychological and physical pain associated with cancer and cancer-­related treatment. LSD, Laing, and Leary The LSD, Laing, and Leary trifecta captured all the religious-­scientific contradictions of the late 1960s and the 1970s. For the therapist and guru

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Timothy Leary, if society was sick, LSD offered an antidote for the collective. Devotees were drawn to the mysticism of Leary, who rejected religious dogma and contended that ultimate reality and meaning would be found with LSD, not in scripture. Leary proclaimed “Start your own Religion!” and “Your Brain is God!” In this rendering, God was everywhere, acid was holy, and alienated hippies were potential worshippers. Psychedelic drugs such as mescaline and LSD, which had the power to alter the senses, loosen the ego, and promote introspection, were a boon for therapists.27 On the one hand, some citizens opted for this type of therapy because of the real or perceived failures of other, orthodox methods. LSD therapy, in short, was avant-­garde, perhaps like primal therapy or transactional analysis. On the other hand, under the drug’s influence, many LSD users arrived at a conclusion about the bankruptcy of the American Dream and formed a counterculture that advertised the drug as an altogether different kind of godsend, one that had the power to bring about peace and love on a global scale.28 “In each generation,” according to Leary’s promotional literature, “a few men stumble upon the riddle of consciousness and its solutions.”29 He, of course, pronounced himself such an individual, promoting his religion vigorously.30 As originally conceived, LSD therapy, whether it was offered in California or Canada, was often driven by the set-­and-­setting paradigm. “Set” included a willingness to move toward uncomfortable thoughts and images rather than avoid them—­either by leaving the room or by emotional avoidance. Part of the set-­and-­setting equation required phases to develop trust in the guides and therapists—­or shamans or gurus—­who would remain throughout the session. Or, as researcher Roland Griffiths put it (in rather familiar terms), subjects needed to have a “radical curiosity . . . that’s how you have to approach this.”31 Some of the problems associated with LSD psychotherapy included occasional adverse reactions and flashbacks, loss of emotional control, and the eight-­to twelve-­hour duration of the drug action.32 Beyond Leary, however, LSD also cemented R. D. Laing’s presence in popular culture. He may or may not have been the high priest of acid or a therapist rock star, depending on one’s perspective, but many in the field expected, even demanded, the Glaswegian’s advice and support. From 1964 to 1970, R. D. Laing, along with his associates in the Philadelphia Association, ran Kingsley Hall in London. It offered a space for patients to take a metanoic expedition, absent standard treatment methods. Besides

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acting as an alternative treatment facility, Kingsley Hall played host to leftist activists, the avant-­garde in the arts, and celebrities from academia. Standard mental health drugs, including major tranquilizers, were largely shunned, but cannabis was unquestionably present, as was LSD. By 1970 Laing had risen to international superstardom himself, morphing into a heavyweight of the Left and the type of public intellectual whose ideas became cotton candy for college campuses. Posters of Laing hung in dorm rooms. Some young women described themselves as “chicks who dig Coltrane, The Dead, and R. D. Laing.”33 Laing carried on long-­distance conversations with Leary about the power of acid. For a time, Laing acted as an, if not the, medical authority on LSD, and was asked about the political climate, as well as the drug’s therapeutic applications. “There seem to be fewer and fewer psychiatrists using LSD in psychotherapy,” wrote a colleague at the University of London. “One feels that the present climate of opinion, helped perhaps by the Government’s rather difficult restriction on supplies, might be frightening people off, particularly the younger and more adventurous psychotherapists.”34 Canadian researchers and clinicians based at Hollywood Hospital in British Columbia also inquired after Laing, requesting information in his possession. We have amassed a considerable volume of papers relating to work with the psychedelic (psychodelytic) chemicals. We would appreciate receiving copies of any papers you may have written—­published or unpublished—­on this subject for our library. We will shortly be entering our ninth year here working with LSD-­25 and Mescaline, and naturally are interested in anything you are doing in this field.35

Ronald Sandison, a pathbreaker in LSD therapy, wrote to his Scottish compatriot in June 1970, a moment when the Beatles’ “The Long and Winding Road” and Jerry Mungo’s “In the Summertime” were wafting over the airwaves and Myra Breckinridge and Catch-­22 were showing in theaters. Sandison had distanced himself from the drug in the mid-­1960s after it had garnered negative media attention, but by 1970 he was aiming to reevaluate it, even though he believed it was not fully rehabilitable. Hence his correspondence with Laing. “I feel that it is time to make a reassessment of the extent to which LSD is being used in this country for clinical purposes and also to take a look at some of the adverse reactions,” he wrote. He added that it was his goal to survey the “present status of LSD in relation to its use and therapy.” He enclosed a questionnaire to this end. Whether Laing

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sat down, leafed through that document, ticked the boxes of the form, and sent it back, remains unknown.36 In addition to these requests, Laing communicated with the BBC regarding its treatment of LSD in films, and he carried out peer reviews of LSD-­based research. In doing so, he was always cautious about the use of evidence and the potential demonization of the hallucinogen. “LSD appears to be neither a drug of addiction nor a drug of habituation,” Laing suggested to one author after peer-reviewing a manuscript. However, he was far from laissez-­faire in its use. “I agree of course that it should not be employed irresponsibly.”37 If anything, the comments held that LSD ought to be treated as a viable therapeutic modality and that criticisms of its suitability for use in the clinic or treatment room necessitated a foundation of evidence. But by 1970 Laing had grown weary, prompting him to leave the United Kingdom for India and Ceylon. It was a personal journey of metanoia, and it was partly about escape: from his self-­stylized image and detractors, from debates about Vietnam, and his role in countercultural movements. Alone in South Asia, a world away from the questing energies of the mainstream society and politics, he took up Buddhist meditation more regularly and practiced yoga for a year and a half. It was an interval of contemplation and recharging. As one writer artfully put it: The far east. Ceylon was Oriental in the last measure of completeness—­utterly Oriental, also utterly tropical, and indeed to one’s unreasoning spiritual sense . . . lovely spot it must be: the garden of the world, big lazy leaves to float about on, lily pads sans logic, snaky lianas they call them.38

After the conclusion of Laing’s idyllic exile, he returned transformed. He was by various accounts softer around the edges, though he still imbibed frequently, and matter-­ of-­ factly distanced himself from various far left positions. He forcefully rejected the term antipsychiatry. He no longer demonized the nuclear family. And, lo and behold, he supported the use of psychotropic medications as long as they were administered voluntarily, with proper accompanying information. This was a major change for him. As a response to these changes, the Left gradually and inexorably deserted Laing in the 1970s. Many of his former comrades, such as Peter Sedgwick, censured him. Prominent feminists, such as Phyllis Chesler, dismissed and undermined his ideas. In particular, Chesler, who had rightfully

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critiqued the sexual aspects of the patient-­therapist dynamic, argued that Laing ignored the operation of gender roles within the family and women’s oppression more generally. This perception was compounded by other critiques of Laing, which persuaded feminist theorists to discard existential psychiatry in favor of the psychoanalytic model of gender differentiation.39 Yet Laing still drew crowds. After he embarked on a U.S. speaking tour in November 1972, the month of Richard Nixon’s reelection, it quickly became clear that Laing’s star had only slightly diminished. Crowds flocked to his talks. Students screeched. His schedule included stops on campuses and hospitals on an itinerary that stretched from New York, Boston, Philadelphia, Baltimore, and Virginia to New Orleans, Chicago, Salt Lake City, Los Angeles, and San Diego. The trip—­ a grueling one—­ concluded on December 8, the day after Apollo 17 was launched into orbit and its crew members captured the iconic “Blue Marble” photograph, a truly trippy and mind-­blowing image. Much attention has been paid to Laing over the years, and new historical treatments continue to emerge. The reason for the reconsiderations of Laing has to do with his contradictions, with his embodying so many of the conflicts in mental health, the psych sciences, and the era. He inhabited the mainstream and the counterculture alike. Laing was a figure of prestige and paranoia. He demonstrated, too, how psychiatrists could inhabit various roles simultaneously, for he was at once a scientist, guru, mystic, and cultural critic. For Abram Hoffer, who, along with Humphry Osmond, was a pioneer of LSD testing in Saskatchewan, Laing represented regression. “Physicians are qualified to treat diseases,” Hoffer wrote him, and “society expects us to use a medical model and to act as physicians. We have no special training, nor competence, nor licence to deal with all of man’s problems.” He added that the Laings and Berkes of the world ought to give up their medical licenses and admit they were counselors, like priests. “I object to a masquerade (game) in which my colleagues take every advantage of their M.D. and comport themselves like non doctors.”40 The Madness of Cannabis Policy On March 22, 1973, windstorms over the Atlantic Ocean caused chaos and death in the shipping lanes between the United States and Great Britain. Vessels carrying coal or ferrying passengers foundered and ran aground.

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One ship, the MV Norse Variant, which had left Virginia the day before, sank and lost all but a single member of its crew. Another cargo ship, Anita, took on water and its entire crew perished. A political storm was also ripping through Washington, D.C. and the rest of the country in late March. President Nixon, fully entangled in and confused by the Watergate scandal, was battening down the hatches in the Oval Office, desperately seeking to minimize the damage to his sinking presidency. John Dean’s upcoming televised testimony against Nixon at the Sam Ervin committee hearings would be another tempest. This testimony would take place relatively soon, in June, and Nixon felt it crucial to get his entire crew working in accordance with each other. On March 22, the beleaguered president instructed his aides to ensure that the nation never learned of the political and financial machinations that surrounded the Watergate burglary. “And, uh, for that reason,” the president insisted rather unpoetically, “I am perfectly willing to—­I don’t give a shit what happens, I want you all to stonewall it, let them plead the Fifth Amendment, cover-­up or anything else.”41 Judge John Sirica, who presided over the Watergate trials, professed astonishment at Nixon’s measures to weather the storm.42 He would later write, “A lifetime of dealing with the criminal law, of watching a parade of people who had robbed, stolen, killed, raped, and deceived others, had not hardened me enough to hear with equanimity the low political scheming that was played back to me from the White House offices.”43 That same day, March 22, Nixon was clattered by other political developments. The final report of the National Commission on Marihuana and Drug Abuse was released, and the findings aligned neither with his goals nor with his political beliefs. Also known as the Shafer Commission, after its chair, Raymond P. Shafer, the body had been appointed by Nixon in 1970 as a response to a substantial increase in drug-­use patterns in American society during the 1960s, and a swirling controversy over changing the marijuana laws. Nixon had appointed Shafer, the former Republican governor of Pennsylvania, and eight other members. A final four members of the commission were senators and members of Congress, and the congressional leadership had appointed them. The thirteen members employed a staff of seventy-­six. From 1970 to 1973, the Shafer Commission issued numerous reports and technical papers, totaling over 3,700 pages, which were published in four volumes with appendices. A year earlier to the day, on March 22, 1972, the

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commission had rocked Washington with the controversial Marihuana: A Signal of Misunderstanding, which departed from Nixon’s stated agenda of eradicating drug use in the United States.44 Now the final report, Drug Use in America: Problem in Perspective, was issued at a blustery moment in Nixon’s presidency, and the 500-­page report was supplemented by 1,000 pages of appendices. The Shafer Report observed that “no conclusive evidence exists of any physical damage, disturbances of bodily processes or proven human fatalities attributable solely to even very high doses of marihuana.”45 Together, the Shafer Commission reports acknowledged that, decades earlier, “the absence of adequate understanding of the effects of the drug,” combined with “lurid accounts” of certain “marijuana atrocities,” had greatly affected public opinion about the drug’s impact on physical and mental health. Users were described as “physically aggressive, lacking in self-­control, irresponsible, mentally ill and, perhaps most alarming, criminally inclined and dangerous.” Yet the Commission found that the drug typically inhibited aggression “by pacifying the user . . . and generally produc[ed] states of drowsiness, lethargy, timidity and passivity.” With respect to mental health, it found anything but medical and scientific consensus. It was far from clear that marijuana use contributed to temporary psychosis, let alone full-­blown insanity, as many accounts suggested.46 Historically, cannabis possession and transfer were legal in every American state until 1915, when Utah enacted the first state prohibition statute. By 1937, all forty-­eight states had adopted laws relating to cannabis. That same year, Congress entered the field of cannabis proscription with the Marihuana Tax Act, which required persons to expose themselves to state prosecution in order to comply with federal tax law. Though federal marijuana prohibition began in 1937, strict enforcement and stiffened penalties began in earnest during the 1950s. The Boggs Act and the Narcotics Control Act established mandatory sentencing guidelines for many offenses, including first-­time marijuana possession. Penalties ranged from two to ten years in prison and fines of up to $20,000. As young, white, middle-­class offenders entered the criminal justice system, there was a strong outcry to temper the stance on marijuana. This self-­incriminatory aspect of the statute resulted in its being declared unconstitutional in 1968. Two years later Congress reinserted itself into the cannabis controversy with the Comprehensive Drug Abuse Prevention and Control Act of 1970.47

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This was the legal reality of a unique moment in politics and culture, following the act’s passage. In June 1971, Nixon officially declared a war on drugs and called drug abuse “enemy number one in America.” In the postsegregation era, the language resonated with many fearful Americans. With so much social turmoil, here was a leader standing up to the forces of darkness. That same year, Nixon created the Special Action Office for Drug Abuse Prevention within the Executive Office of the President as a “dramatic way to highlight the problem.” By 1972 Nixon’s ally, Attorney General John Mitchell, had placed cannabis on Schedule I, and then he resigned to head Nixon’s reelection committee. In 1974 the National Institute on Drug Abuse was established.48 Thousands of publications over the past 150 years have discussed cannabis, many being dubious scientific analyses of its societal and physiological effects. The Indian Hemp Drugs Commission Report of 1894, established by the colonial government of India, is noteworthy because it rejected contentions that cannabis was physically dangerous, criminogenic, or morally debilitating, and anticipated the claim of modern drug law reformers that cannabis was a relatively benign intoxicant. Fifty years later the LaGuardia Report (report of the New York Mayor’s Commission on Marihuana) echoed the hemp report’s general conclusions about cannabis and additionally found no significant evidence that cannabis use causes progression to the use of other drugs.49 With recreational drugs, users, regulators, physicians, researchers, and law enforcement officials negotiated the conditions under which the evidence shaped policy. Here a “consumer protection” model often conflicted with a “social control” model, and proponents of each sought to mediate the evidence.50 With cannabis, the medical and scientific knowledge was often contested around the boundaries of madness: To what extent should government limit and control access to a drug that might induce psychosis? What are the boundaries of legitimate and illegitimate use in the laboratory and on the street?51 These unanswered questions stalled policy change, and remain fixtures in twenty-­first-­century politics and policy.52 The link between marijuana use and psychosis has been a matter of debate in the scientific community since the 1930s. Researchers in and outside mental health have argued that there are sufficient grounds to doubt this link—­and that more evidence is

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needed. Two possibilities have emerged: a predisposition to schizophrenia may increase the likelihood of cannabis use, or a third variable may make it more likely for people to use marijuana and develop schizophrenia. For example, previous studies have suggested that schizophrenia and cannabis share both genetic and demographic risk factors, including low socioeconomic status. The year 1934 was an inflection point for cannabis and mental health in the United States. This was the year that Harry Anslinger and the Federal Bureau of Narcotics turned their attention to the marijuana menace and in so doing inaugurated the reefer madness era. It was also the year that Dr. Walter Bromberg, senior psychiatrist at Bellevue Hospital in New York, published the first in a series of articles about his examinations of cannabis users in New York. While his research contained less fearful accounts of drugs use—­particularly cannabis—­than most others, he nonetheless did much to foment ideas about how the substance “released inhibitions” and “stimulated impulsive actions.” Even if cannabis did not drive one into the depths of lunacy, it still fundamentally altered the user’s psychological makeup and was a factor in lawbreaking behavior, he intimated.53 From the 1930s on, crime and madness lined up neatly with cannabis. It was framed as an “addictive drug” that produced “insanity, criminality, and death.”54 The rhetoric, well chronicled by proponents of cannabis, grew increasingly shocking and helped normalize the causal links between the substance and mental illness. Disgusting criminal acts and irrevocable madness went hand in hand, portrayed as two likely outcomes of consuming cannabis. The medical community contributed to the debate in the 1930s and 1940s.55 According to a typical sensationalistic account: “How many murders, suicides, robberies, criminal assaults, holdups, burglaries and deeds of maniacal insanity it causes each year, especially among the young, can only be conjectured. . . . No one knows, when he places a marijuana cigarette to his lips, whether he will become a joyous reveller in a musical heaven, a mad insensate, a calm philosopher, or a murderer.”56 Anslinger fueled much of this language and the attendant policy consequences. He redeployed ideas of nonsensical violence, sexual perversion, racial fears, and infected American values in articles in popular magazines. As a propagandist, Anslinger was first rate; as a critical thinker, he was far less impressive. With “Marijuana: Assassin of Youth” in 1937, co-­written with Courtney Ryley, Anslinger recounted Victor Licata’s marijuana-­ induced

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axe-­ murder spree. Left unreported was the fact that Licata, who subsequently committed suicide, suffered from schizophrenia. According to Licata’s psychiatrists, he had not gone spontaneously insane with a puff or two.57 Besides being an official in the Treasury Department and the Bureau of Narcotics, Anslinger held consular posts in The Netherlands, Germany, Venezuela, and the Bahamas, in addition to serving as U.S. representative at League of Nations conferences on narcotics and as part of the UN Narcotic Drugs Commission. As the commissioner of the Bureau of Narcotics from its inception in 1930 until his retirement in 1963, Anslinger was the American government’s chief law enforcement officer in the fight against illegal drugs—­before there was an actual stated “war on drugs” in the 1970s. Anslinger, sturdy, weathered, and often wearing a trench coat and stiff-­ brimmed fedora, firmly believed that cannabis represented an existential threat to the “safety and well-­being of the country.”58 The threat was both physical and psychological. Along with the psychiatric community, Anslinger proved highly influential in crystallizing the connection among mental health breaks, the predilection for criminal behavior, and cannabis use. He wholeheartedly supported lurid and overblown claims, such as the one put forth by the International Narcotic Education Association: Prolonged use of Marihuana frequently develops a delirious rage which sometimes leads to high crimes, such as assault and murder. Hence Marihuana has been called the “killer drug.” The habitual use of this narcotic poison always causes a marked deterioration and sometimes produces insanity. While the Marihuana habit leads to physical wreckage and mental decay, its effects upon character and morality are even more devastating. The victim frequently undergoes such moral degeneracy that he will lie and steal without scruple.59

In an early attempt at using pharmaco-­scientific prestige to justify prejudicial policy, he brought forth a so-­called “scientific expert” to testify before Congress. In Temple University pharmacology professor James C. Munch, who had previously worked for the Food and Drug Administration (FDA), Anslinger had identified an instrument. The tall, mustachioed Munch argued that, based on his experimental research in dogs, the use of cannabis for as little as three months resulted in insanity, including a temporary insanity that Professor Munch himself affirmed, after having conducted experiential research with cannabis. Munch described the fear and temporary

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madness he had personally suffered. “After two puffs on a marijuana cigarette,” Munch said in all seriousness, “I was turned into a bat.” Fluttering around the room for several minutes, he finally settled in a two-­hundred-­ foot high vat of ink, another product of his delusional mind. The testimony proved compelling and ignited a storm of media sensationalism.60 By the end of the 1960s, the link between addiction, mental health, and marijuana was being evaluated more rigorously. In 1969 the WHO Expert Committee on Drug Dependence announced it “strongly reaffirms the opinions expressed in previous reports that cannabis is a drug of dependence, producing public health and social problems, and that its control must be continued” and that “medical need for cannabis as such no longer exists.” After discussing a draft of what would eventually become the 1971 Convention on Psychotropic Substances, the WHO Expert Committee suggested a division of five categories and recommended the inclusion of tetrahydrocannabinols in the strictest category. This group was reserved for “drugs recommended for control because of their liability to abuse constitutes an especially serious risk to public health and because they have very limited, if any, therapeutic usefulness.”61 Drugs—­and the attendant war on drugs—­also mattered to the radicals in psychiatry. In 1969 to 1972, Paul Lowinger began conducting research on the perceptions and use of recreational drugs in medicine and society, focusing on such topics as marijuana legislation and use, chronic LSD use, and medical student drug usage. Operating in a climate in which illicit drug policy grew more restrictive, Lowinger was concerned not only with evaluating these drugs on their own but also with psychiatry’s role in shaping the wider understanding of drugs.62 In Lowinger’s estimation, too much “rhetoric” outweighed “quantitative data.” He was apprehensive about psychiatry being used to justify the war on drugs, just as he was concerned about psychiatry’s legitimization of the Vietnam War. At the American Orthopsychiatric Association’s annual meeting in 1970, Lowinger noted that “health professionals have a responsibility to speak to the public on issues which involve freedom, health, and human behavior.” Besides issues of access to services and more comprehensive health care for the general public, he was specifically referring to the “voluminous rhetoric” around such drugs as marijuana, amphetamines, and LSD, which had become “emotionally charged issues.”63

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Green Rebellion The Nixon administration was concerned with the politics of pot and the Left. In particular, Nixon was wary of the Green Rebellion, a movement seen as a mutiny against institutionalized and governmental violence, war, power struggles, cutthroat competitiveness, aggressive materialism, and the various forms of dehumanization found in modern society. Green, for critics, symbolized naïve idealism, the love of nature, and, of course, “grass.” Drugs like cannabis—­which had “green” as a slang name—­played a critical role in this rebellion. Other powerful psychedelic substances such as LSD offered the pharmacological sacrament for a pacifist mystique, whereas marijuana provided the cement that held the movement together, giving it a social ritual, a camaraderie of guiltless lawbreaking, an endless topic of conversations.64 Alcohol stood for decadent tradition and induced violent behavior. In John Charles Chasteen’s Sacred Bliss: A Spiritual History of Cannabis, marijuana, the Green, acted as connective tissue for a specific group: “Marijuana was the drug of our tribe, the cool, long-­haired, rock-­music-­ listening, faded-­blue-­jean-­wearing tribe. Pot, as we called it most often, made people peaceful. Alcohol belonged to the other tribe, exemplified by hard-­hat construction workers who drank beer and threatened to beat up ‘long hairs.’”65 The Nixon campaign in 1968 and, later, the Nixon White House, had two enemies, according to insider John Ehrlichman: “the antiwar left and black people.” As he put it for news reporters, the struggle against cannabis was a struggle against these opponents. “We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities.” This would enable law enforcement officials to “arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”66 Whether one can take Erhlichman at his word, especially forty years later, is questionable; but numerous historians, political scientists, and water-­cooler pundits have argued that Nixon clearly sought to capitalize on cultural turmoil and racial division to create wedge issues and then split and segment the South as a discrete voting bloc. It was vital to overcome the “progressive” middle

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class, which favored issues like environmentalism, consumer protection, scaling down hostilities, and the decriminalization of cannabis.67 Trumping up cannabis as a dangerous drug, for various commentators, was about winning elections. The Nixon tapes, which recorded private conversations in the Oval Office, also captured Nixon periodically associating cannabis and other

Figure 6.1 Medical and wider societal debates about cannabis use, psychosis, and wider health issues are of long standing. Image from around 1940.

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psychoactive substance use with a host of bugbears: antiwar protesters, Jews, psychiatrists, homosexuals, and passivity. In Nixon’s view, the use of cannabis signaled a particular moral and social decay, a wasting away of American grit, a swing away from hard-­ working, upstanding values. During the seventeen-­month period between the time Congress passed the Controlled Substances Act, on October 27, 1970, to March 22, 1972, when the congressionally mandated Presidential Commission on Marihuana and Drug Abuse issued its report and policy recommendations, Nixon found ways to complicate the marijuana policy review process. These interventions, however trifling, helped ensure there would be political momentum to continue to maintain a policy of criminalization of cannabis use, even when the presidential panel went on to recommend the opposite. After watching the flabby, racist, and yet beloved Archie Bunker on All in the Family in May 1971, Nixon revealed strong beliefs on cannabis and the Cold War. Dope? Do you think the Russians allow dope? Hell no. Not if they can allow, not if they can catch it, they send them up. You see, homosexuality, dope, immorality in general: these are the enemies of strong societies. That’s why the Communists and the left-­wingers are pushing the stuff. They’re trying to destroy us.68

The tenuous relationship between insanity and cannabis abetted this belief. In 1968, a series of articles in mainstream psychiatry journals reasserted the dangers of cannabis. The American Journal of Psychiatry and Psychiatric News disapproved of its use because a dearth of evidence did not allow an informed decision to be reached about the drug’s dangers. These publications also suggested there was enough evidence to suggest its dangers. Some of these accounts were related to schizophrenia. Others centered on potential harms to the lungs from inhalation. Two anticannabis writers and physicians made such cases forcefully. For Donald Louria, “Those of us who oppose legalization are  .  .  . implacable in insisting that all cannabis preparations are potentially dangerous. The potential dangers, to our minds, are severe.”69 According to Henry Brill, “There is overwhelming consensus that this drug [marijuana] should not be legalized, and no responsible medical body in the world supports such action.”70 (More recently, such sentiments have echoed in the work of former New York Times reporter Alex Berenson, who underlined the mental health and violent crime dangers associated with the drug.71) Cannabis,

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in these renderings, produced psychological dependency, panic and psychosis, motor function impairment, and diminished ambition and productivity. But cannabis use was also detrimental to adolescent personality formation, and cannabis served as a potential gateway to other drugs. On occasion, the propaganda and objective scientific research were obviously fuzzy. When asked about the purpose of his research into the physiological effects of marijuana, Dr. Vincent de Paul Lynch, chairman of the Pharmacology Department of St. John’s College of Pharmacy, commented, “Our purpose is to establish scientific proof of marihuana’s ill effects.”72 The literature chronicled cases of full-­blown acute psychotic episodes precipitated by marijuana use. Other cases were reported in individuals with histories of mental disorders, with marginal psychological adjustments, or with poorly developed personality structures and ego defenses.73 Conventional wisdom held that cannabis intoxication hindered the ability of such individuals and that psychotherapy and antipsychotic medications proved useful in controlling and preventing this reaction. Such issues remain. As Scientific American reported in September 2014, multiple studies have shown that teens who use marijuana face a greater risk of later developing schizophrenia or symptoms of it, especially if they have a genetic predisposition. One study, for example, followed more than 45,000 Swedes who initially had no psychotic symptoms. The researchers determined that subjects who smoked marijuana by age eighteen were 2.4 times more likely to be diagnosed with schizophrenia than their non-­marijuana-­smoking peers, and this risk increased with the frequency of cannabis use. Remarkably, the connection still held when the researchers accounted for participants’ use of other drugs.74 Yet despite these results and an uptick in marijuana use in the 1970s and 1980s, other researchers have not uncovered an increase in the incidence of schizophrenia in the general Swedish population—­suggesting that perhaps people who were going to develop schizophrenia anyway were more likely to use marijuana.75 According to the psychiatrist Ben Sessa, “For the majority of adults cannabis is a relatively benign drug,” but “for a small section of people it is a really dangerous drug.” He emphasized that “we need to be clear if we are making stigmatizing judgments.”76 While mainstream medical opinion in the late 1960s regarded cannabis as harmful, potentially dangerous, and undesirable, a minority of doctors pushed back. David E. Smith, a physician, toxicologist, and pharmacologist,

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was director of the Haight Ashbury Free Medical Clinic, which treated a heavy drug-­using population. He claimed to have never witnessed a “primary psychosis” among his 30,000 patients; outside the confines of his clinic, he maintained that he had seen only three cases of marijuana-­ induced psychosis—­“extreme paranoid reactions characterized by fear of arrest and discovery.”77 Other medical figures modified their position from the “pathology” model to one that minimized the actual or potential hazards of cannabis. Dr. Stanley Yolles, for instance, director of the National Institute of Mental Health (NIMH) and a mental health professional who once stood for aspects of the “antipot pathology argument,” testified before the Senate Judiciary Subcommittee on Juvenile Delinquency in 1969 about marijuana’s minor medical dangers. He later wrote an article for the Washington Post titled “Pot Is Painted Too Black.”78 In a 1969 hearing before Congress, a year before he left his position, Yolles spoke even more candidly of the total disregard for scientific and medical facts when it came to marijuana laws, stating: “I know of no clearer instance in which the punishment for an infraction of the law is more harmful than the crime.”79 He was replaced shortly thereafter by Bertram Brown, who also proved a thorn in the side of the Nixon administration. Richard Nixon was driven to fits of pique–­madness?—­by mental health professionals and marijuana. In a meeting with H. R. Haldeman, the president was visibly angry about the lack of condemnation concerning cannabis. RN:  Now, this is one thing I want. I want a Goddamn strong statement on marijuana. Can I get that out of this sonofabitching, uh, Domestic Council? HRH:  Sure. RN:  I mean one on marijuana that just tears the ass out of them. I see another thing in the news summary this morning about it. You know it’s a funny thing, every one of the bastards that are out for legalizing marijuana is Jewish. What the Christ is the matter with the Jews, Bob, what is the matter with them? I suppose it’s because most of them are psychiatrists, you know, there’s so many, all the greatest psychiatrists are Jewish. By God we are going to hit the marijuana thing, and I want to hit it right square in the puss, I want to find a way of putting more on that. More [unintelligible] work with somebody else with this.80

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Men like Yolles, the top mental health official in the United States during the 1960s, represented how physicians’ opinions were in flux, and the contested nature of mental health knowledge. Many doctors, not just psychiatrists, were becoming aware of its vast use. Data on the effects of marijuana use were beginning to refute many of the common antimarijuana arguments that harked back to the 1930s and 1940s, and physicians sufficiently respected the empirical tradition to be influenced by the new findings. Radicals in mental health contributed to this debate. At the American Orthopsychiatric Association’s annual meeting in 1970, Paul Lowinger noted that “health professionals have a responsibility to speak to the public on issues which involve freedom, health, and human behavior.” Besides issues of access to services and more comprehensive health care for the general public, he was specifically referring to the “voluminous rhetoric” around such drugs as marijuana, amphetamines, and LSD, which had become “emotionally charged issues.”81 In his view, it was vital for American medical practitioners to contribute to the discussion in a reasonable way to help produce evidence-­based drug policy. He also thought it crucial to provide a view of the “prevalence and rationale of drug-­usage or abuse within the medical profession, especially among medical students.”82 Invoking the common parlance of the day, Lowinger sought to answer how and why medical students would “turn on.” This, he felt, was a means to better understanding broader “cultural change” and the “student power movement.”83 After surveying nearly one thousands participants from 1968 to 1970, Lowinger and a colleague, Philip Polakoff, reported that despite the “archetypal example of the conservative conscientious [medical] student,” many responded in a “more radical manner than other student populations on the issues of drug usage.”84 This might have been predicted, insofar as the Student American Medical Association in 1968 had invited the jazz poet, socialist, and White Panther Party founder John Sinclair to deliver the keynote lecture at its meeting. Yet Lowinger and Polakoff’s findings also indicated that the “attitudes of medical students toward drug use were,” not surprisingly, “heavily influenced by their own experiences.”85 John Sinclair, the Michigan-­based poet of the counterculture, was referred to in radical physicians’ pamphlets and documents as “a political prisoner on a marijuana conviction” and commended for his message about the value of “rock and roll, dope and fucking in the streets.”86

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While the authors’ answer to why medical students decided to take drugs, particularly marijuana, was ultimately unsatisfying, the research nevertheless underlined that medical students were participating in the countercultural trends in American society. If nothing else, the results of Lowinger and Polakoff’s work proved that medical students were far from uniform in their beliefs about the recreational use of drugs or legalization initiatives during the late 1960s. At the same time, one of Lowinger’s conclusions—­ that “a continuing health education program must present facts and varying opinions to adults and children and avoid moralizing, hypocrisy, and falsehood”—­seems rather far from radical.87 The radicals’ criticism of mainstream psychiatry’s role in the Vietnam War and in promoting militarism more broadly was also tangentially related to cannabis. Many mental health figures rebelled against the use of psychological adjustment or the weaponization of psychiatry in any form. All that talk of mind control. LSD brainwashing. Telepathy. The Manchurian Candidate. That psychiatry was a tool of the military-­industrial complex. Therapy for soldiers was criticized so heavily, so repetitively, that when it was revealed that the Bureau of Narcotics was involved in highly classified psychological research, various younger radical psychiatrists and antipsychiatrists reacted with a mixture of fury and astonishment. Anslinger himself, it was revealed, conducted experimental research with narcotics that focused on ways to control human behavior and break down psychological defenses in enemy agents. “We are trying to discover a truth drug,” Anslinger admitted in 1968, “by using peyote and sodium amytal.” He and his fellow brain-­busters and deprogrammers/reprogrammers resorted not just to these substances but also to LSD and marijuana, the latter of which Harry had called the “killer weed.”88 In 1977, the same year Carter announced his mental health commission, the full extent of the CIA-­ sponsored program of mind control, which lasted for nearly two decades, became known. More than eighty public and private research institutions soaked up public funds through the MKUltra project as foundations, universities, hospitals, prisons, and pharmaceutical companies contributed to the national interest. The effort might be called the militarization of the mind, all in an attempt to win the Cold War. The project included groovy research on behavioral therapy, chemically induced brain concussions, brain wiping, hypnosis, extrasensory perception, cutting-­edge polygraph techniques, sleep research, and on and on and on. The CIA destroyed much

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of the data in 1973 but failed to get the job done completely. Separate government hearings in 1975 and again in August 1977 uncovered the magnitude of the MKUltra effort—­including its work with cannabis.89 As mental health officials reeled from the MKUltra blowback, some government officials pushed back against the antimarijuana agenda in the mid-­1970s. As chronicled by Edward Epstein, the NIMH, which employed psychiatrists in detoxification programs called “farms,” was unwilling, for a variety of reasons, to use treatment as part of a law-­and-­order campaign; in particular, mental health professionals resisted targeting minorities. The “primary orientation of NIMH” was toward professionals and psychiatrists, wrote Emil Krogh to John Ehrlichman, and “philosophically, NIMH orientation could not accommodate non-­mental health approaches.”90 NIMH director Bertram Brown went even further when he was quoted in the Washington Post suggesting that cannabis violations in the United States ought to be treated no more seriously than traffic violations. Nixon was livid. He “hit the ceiling.” He insisted “that clown Brown” be fired immediately, and then furiously reiterated this call a few days later while in a meeting with Ehrlichman, Krogh, and Krogh’s assistant, Jeffrey Donfeld.91 Nixon, in discussing how to best address the situation, had much to say about Brown and mental health professionals more broadly. RN:  Don’t go to HEW. Well we might, we might have big problems with HEW too. The difficulty that, that, well, Bureau, as an old prosecutor, and, uh, as an old prosecutor, I, I, I don’t mind somebody putting in J. Edgar Hoover’s hands, but, the, I, I come down very hardly on the side of putting in, uh, hard-­headed doctors, rather than a bunch of muddle-­headed psychiatrists. RPS:  Well you’ve, you’ve hit on—­ RN:  They’re all muddle-­headed. You know what I mean? RN:  I know those people over there, doc—­ RN:  Too many of them are, I mean, their, they get so that their hearts run their brains, and it should be the other way around, most of the time. RN:  . . . I am a hardliner. I am a hardliner on the drug thing. I mean, this whole Brown over here. HEW. Remember? Who comes out and makes a speech on marijuana as the same as a traffic ticket and we should pay no attention to it. The hell with him!92

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Brown was far from an outsider or radical. Only the third director of the NIMH, he served from 1970 to 1977, succeeding Stanley Yolles, who had shown a measure of independence himself. Brown received his M.D. degree from Cornell University Medical College, held a pediatrics internship at Yale, and completed a psychiatry residency at the Massachusetts Mental Health Center. He had also earned an M.P.H. degree from the Harvard School of Public Health. And he went beyond his traffic violation statements. By December 1970, Brown secured control of an interagency study group that was tasked with formulating national goals for the war on drugs. He influenced the group into recommending NIMH as the tip of the spear—­to take the lead in efforts to minimize addiction in the United States. It proposed, for instance, that community mental health centers act as the main “focal point” of drug rehabilitation projects, and the White House staff were suspicious. Many regarded this as a means to increase the NIMH’s budget, to widen its scope and expand its power. Krogh, among others, counseled that this would strengthen the NIMH “to the detriment of the administration’s law-­and-­order programs.”93 Ultimately, an evidence-­based approach to cannabis gave way to a “law-­ and-­order” attitude that highlighted the drug menace in American society.94 As David Musto and Grischa Metlay have separately argued, the war on drugs had progressed from a means to decrease crime to the mass provision of treatment to street-­level enforcement by federal agents wielding new and powerful tools against drug traffickers and users. Moreover, with the creation of the National Institute on Drug Abuse, strategy shifted from direct oversight of mental health and addictions treatment to a decentralized system of drug treatment run at the state level.95 The National Commission on Marihuana and Drug Abuse had, of course, insisted on an evidence-­based approach. The Shafer Report, for example, insisted that alcohol be recognized as the major drug problem in the United States, and it recommended that the term “drug abuse” be replaced with more descriptive terminology concerning drug-­using behavior. The terminology was especially problematic because it implied there was consensus on the term “drug abuse” and an agreed-­upon standard for what constituted drug use. The APA in the first edition of the DSM, published in 1952, grouped alcohol and drug abuse under Sociopathic Personality Disturbance; however, subsequent editions distinguished substance abuse with physical

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dependence from substance abuse alone. A stronger argument, in short, could be made for tobacco or alcohol as a “gateway drug.”96 In response, the Shafer-­led commission—­taking input from physicians, mental health professionals, and addiction specialists—­developed a typology of drug-­using behavior (experimental, recreational, situational, intensified, and compulsive use) and emphasized the need for a range of social responses for different patterns of use. Yet change seemed afoot in the 1970s. The editors of both the New York Times and the National Review called for the decriminalization of pot in 1972. Between 1973 and 1978 twelve states, encompassing more than a third of the nation’s population, legalized or decriminalized possession of up to an ounce. Pot activism gained steady momentum. The United States had successfully poisoned cannabis plantations in Mexico and Jamaica, but Colombia stepped in and acted as the willing supplier. According to one scholar, the American middle class had fully embraced cannabis by 1975, and the pot paraphernalia sector of the U.S. economy grew. 97 The ranks of those who had tried illegal drugs grew—­in 1973, 12 percent of respondents to a Gallup poll said they had tried marijuana. That number had doubled by 1977. In 1978, 66 percent of Americans said marijuana was a serious problem in the high schools or middle schools in their area, and 35 percent said the same of hard drugs.98 In January 1977, President Jimmy Carter was inaugurated on a campaign platform that included marijuana decriminalization, and eight states had already decriminalized marijuana by then. He also called for a major report on mental health in the United States, but legalizing pot, well, that was something altogether different. Still, Carter sounded rational. It sort of made sense. In a speech before Congress, Carter declared, “Penalties against possession of a drug should not be more damaging to an individual than use of the drug itself.” In October 1977 the Senate Judiciary Committee voted to decriminalize possession of up to an ounce of marijuana for personal use. In 1979 marijuana use among adolescents peaked—­or, perhaps more appropriately, reached its high.99 MDMA: From Adam to Evil In 1960 Alexander Shulgin had his first psychedelic experience. At the time he was a PhD candidate in biochemistry at the University of California,

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Berkeley, while working at Dow Chemical. Before that, he had served in the U.S. Navy and had briefly attended Harvard University. Always interested in playing around with chemicals, ever curious about pharmacology and “interested in the machinery of the mental process,” when Shulgin was presented by a friend and colleague with mescaline, the active ingredient in peyote, he seized on it as an opportunity to explore his own mind. It was a revelatory experience. Shulgin spent the afternoon transfixed by his swirling surroundings, deep in thought. Afterward he recorded the experience, writing: “I understood that our entire universe is contained in the mind and spirit.” Accessing this vast expanse and untold reaches of his mind was not straightforward, but “there are chemicals that catalyze its availability.”100 Following this trip, Shulgin continued to work at Dow, designing chemicals and drugs of various kinds, often testing on himself. He made Zectran, one of the world’s first biodegradable insecticides; Aleph-­1, which produced a mix of “paranoia and selfishness”; and Ariadne, later patented and tested under the name of Dimoxamine as a psychopharmaceutical for geriatric patients. The aim of Dimoxamine was to stimulate activity in senile or unmotivated older patients. There were other drugs, including DOM, MEM, and DIPT, as well as close to two hundred other psychedelic compounds, including stimulants, depressants, and aphrodisiacs.101 But MDMA proved to be Shulgin’s pièce de résistance. One of his students first mentioned the drug to him in a seminar, and she claimed stridently that it had cured her stutter, forever altering her life for the better. This triggered Shulgin’s curiosity and sent him down a path to dig out of obscurity a long-­lost and forgotten compound and reintroduce it to both the mental health community and the underground. MDMA was first synthesized in 1912 by the German pharmaceutical company Merck as it sought to create a hemostatic medication called hydrastinine. Merck patented it in 1914, but further research was for the most part halted. During the 1940s, discussions of the therapeutic use of psychedelic substances began to surface in the psychiatric literature, and in the 1950s therapists and researchers in the United States and Europe began to experiment with psychedelic substances as an adjunct to the psychotherapeutic process. The psychedelic drugs most commonly used as aids included LSD and psilocybin. In such places as Saskatchewan and Quebec, Canada, and Baltimore, Maryland, researchers, clinicians, and

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others in the mental health field experimented with schizophrenic and alcoholic patients.102 MDMA research was reignited in the 1970s. Adding a methyl group to the side chain of MDA and of amphetamine creates MDMA and methamphetamine. So it was. On September 12, 1976, Shulgin synthesized and ingested MDMA in increasing doses to investigate its effects on humans. After taking it himself, he memorably described the experience as a “low-­ cal Martini.”103 Shulgin, who would become deified within the psychedelic community, nevertheless found that “much of the scientific community” viewed him as “a curiosity and at worst a menace,” in the words of his biographer.104 He was an iconoclast naturally, a rebel and a radical—­much like his contemporary, Timothy Leary. Yet it was far from that simple. Shulgin was more than a mad scientist, with beakers and dissected cacti strewn about his lab. He was more than a countercultural maven, with tubes and mangled posters of the periodic table hanging on the walls. Shulgin consulted for the Drug Enforcement Administration and counted high-­ranking officials within the agency as close friends, even as he maintained a membership with San Francisco’s Bohemian Club, an über-­exclusive male-­only society for the wealthy and influential. In 1976 MDA (not MDMA) was called the “Mellow Drug of America” or the “love drug,” and it was a darling on the psychedelic scene. It broke down barriers, improved the experience of music and art, and enhanced trust and sexual experiences, but did not necessarily hinder one’s ability to distinguish reality from fantasy. It intensified perception, cognition, and feelings of disengagement. Shulgin, among others in the “Boston Group,” which included MIT’s Artificial Intelligence Lab, immediately recognized the therapeutic potential of the substance he synthesized. He introduced his findings to a pensioner psychologist named Leo Zeff, who was equally enthralled with the drug’s prospective effectiveness in therapy, so much so that he ended his retirement to advocate—­to evangelize, even—­on its behalf. Zeff had always been interested in the “mysteries of healing,” and MDMA helped. “All I know,” he told a crowd, “is that I present myself, do certain things, and changes occur.”105 MDMA’s psycholytic (mind-­ loosening) effects were perfect for psychosomatic or neurotic disorders and in nurturing change during therapy sessions. “Zeff was so enthusiastic about the compound” that he traveled “across the country introducing MDMA to

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hundreds of his fellow therapists.” And in doing so, he also provided the drug with its first street name, “Adam,” because he believed it “stripped away neuroses and put users in a primordial state.”106 Zeff sought to “free himself” from the “buzzing” and “mind-­fucking” of everyday life, which meant jettisoning “opinions, judgments, preconceptions, prejudices, and all other kinds of things,” as he put it.”107 MDMA was a tool to help others do the same. Leo Zeff, already familiar with LSD therapy, championed MDMA and used it in the treatment of hundreds of patients. According to Myron Stolaroff’s The Secret Chief, Zeff administered MDMA to about four thousand people and trained more than 150 therapists over the following dozen year.108 His instructions for individual sessions were straightforward, but often included this: “If you don’t know what to do and your mind wanders, then listen to the music. If you go into heavy judgements against yourself, then listen to the music.”109 Zeff, a Jungian psychotherapist and a former lieutenant colonel in the U.S. Army, proved a hidden persuader, and MDMA-­assisted psychotherapy grew in popularity up and down the West Coast of the United States, eventually spreading to the East Coast and Europe. According to the National Institute on Drug Abuse, some psychiatrists and psychologists called it “penicillin for the soul” because it was perceived to enhance communication in patient sessions and reportedly allowed users to achieve insights about their problems.110 At a 1985 conference on MDMA held at the Esalen Institute in Big Sur, California, one researcher and psychotherapist estimated that the thirty-­five participants combined (mostly psychiatrists, psychotherapists, and researchers) had conducted over a thousand MDMA-­assisted sessions. This clinical work went on secretively and mostly underground in an attempt to avoid the fate of LSD, which was criminalized and popularized recreationally. The term “Adam” was used to surreptitiously describe the drug by this group of practitioners.111 In the first published study of the effects of MDMA in humans, co-­ written with medicinal chemist David Nichols in 1978, Shulgin described the MDMA experience as “an easily controlled altered state of consciousness with emotional and sensual overtones.”112 Within a psycholytic therapeutic setting, under supervision, the use of MDMA was aimed at breaking “logjams” and “healing fear.” It helped explore feelings, but not alter

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perceptions. It was used for couple and group therapy, but also in one-­on-­ one psychotherapy sessions. For the loquacious Ralph Metzner, MDMA was revelatory, virtually holy, and certainly quite beneficial: Teachers and practitioners of meditation and related forms of spiritual work describe the experience as being fundamentally an opening of the heart-­center—­ which is considered in most systems to be the foundation for all further psychospiritual growth and practice. One teacher suggested that the Adam [MDMA] experience facilitates the dissolving of barriers between body, mind, and spirit: one senses the aware presence of spirit infusing the structures of the body and the images and attitudes of the mind. Awareness expands to include all parts of the body, all aspects of mind, and the ‘higher’ reaches of Spirit—­thus permitting a kind of re-­connecting, a re-­membering of the totality of our experience, an access to forgotten truths.113

If one believed the accounts, MDMA produced that all-­important and transforming element, the X factor, in psychiatric sessions—­honesty. Such insights, moreover, would be recalled afterward. Consequently MDMA’s proponents in the psychiatric field realized that if they were not careful, they might have their wonder drug spirited away and placed under lock and key, as had happened with LSD. One government employee, the psychiatrist John Docherty, felt that MDMA represented trends in the field. As chief of the Psychosocial Treatment Research Center at NIMH, he noted that a major development in psychotherapy was the gradual alignment of “psychopharmacology and psychotherapy and their combined use to relieve psychiatric problems.” MDMA, he felt, helped point the field in the direction “it ought to be headed.” He added: “a drug that could particularly enhance the psychotherapeutic process is the next stage from a scientific development point of view.”114 What did treatment actually look like? Before therapy sessions began an extensive preparatory session was held to establish a close relationship with the subjects, who were instructed that they should not take MDMA unless they were certain they were willing to talk through disturbing experiences, including their psychological difficulties. The locations of the setting varied, as did the tools involved and the number of participants. A six-­hour fast was instituted to ensure quick absorption of the medicine, as well as to prevent nausea. During individual sessions, the subjects listened to instrumental music, with or without headphones, to encourage an internal experience. Music, usually classical, was also played in the background during

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interpersonal or group sessions. Props, including pictures or eyeshades, were often used. As the psychotherapy sessions progressed, and when subjects noticed that the effect of MDMA was subsiding, they were offered a second dose, ranging from 50 to 75 mg. Other subjects had the option of diazepam (Valium) or 1-­tryptophan to reduce physical and emotional side effects, such as muscle tension. The average session lasted approximately five to eight hours and an oral follow-­up session was conducted soon afterward, followed later by a written questionnaire.115 Initially, the life histories of the subjects were discussed, as well as their intentions and goals for the sessions. This was done to optimize the “therapeutic alliance” and mind-­set of all participants. This was part of a concept—­“set and setting”—­that also derived from Timothy Leary, who had described the ideal scenario for using different hallucinogens as therapeutic adjuncts. Setting, by contrast, referred to the physical environment and the individuals present during the experience. What was necessary, therapists and researchers agreed, was openness. Other agreements were made, including promises that all parties would remain on the premises until the session was over, there would be no destructive behavior or sexual activity, and subjects would follow instructions given by a therapist when stated as part of the structure of the session. A dose of 75 to 150 mg was then administered orally.116 Because locations varied, there was no uniform décor or architectural template that characterized the sessions. One account described the model setting as “quiet, comfortable, tastefully decorated, and furnished in a homelike fashion. . . . Attention should be paid to choice of fabrics, pictures and flower arrangements.”117 Another account held that the ideal location was “serene” and “simple,” one in which the subject could recline and therapist could “sit nearby.” “Elements of nature,” such as plants, water, and fire, were also regarded as highly beneficial. The best locations for sessions were those in the out-­of-­doors, where patients could be surrounded by natural beauty.118 Leo Zeff, Stanislav Grof, and their successors did not refer to themselves as shamans, but in using MDMA to alter the state of a subject’s consciousness during therapy they were drawing on a long tradition. Zeff, for example, “conducted sessions for personal and spiritual development.”119 Shamanic practices have taken a number of forms but share universal aspects, including transcendence, spirituality, recognition of a higher power, and

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involvement of community relations. A new literature, sometimes popular, sometimes more obscure, emerged in the 1970s. Such authors as Joan Halifax, Michael Harner, Peter Furst, and Terence and Dennis McKenna chronicled shamanic practices and traditions. At the same time, there was increasing openness toward traditional healing practices. This new openness was exemplified in the World Health Organization’s declaration at the 1978 International Conference on Primary Health Care in Alma Ata, where the ‘‘Health for All by the Year 2000’’ program was initiated to incorporate traditional healers into primary health care.120 In promotional material for MDMA, the drug was described in language that aligned with holistic and alternative health. Ecstasy . . . empathy . . . openness . . . compassion . . . peace . . . acceptance . . . being . . . forgiveness . . . healing . . . rebirth . . . unity . . . emotional bonding . . . caring  .  .  . celebration  .  .  . these are some of the terms and phrases people use to describe their experiences with a new class of substances, of which MDMA (“Adam”, or “XTC”) has become best known.121

Therapists in California, while far from uniformly conservative in their political views, were certainly positive about MDMA, so much so that many obtained their medicine from an underground manufacturer in Berkeley and sought to keep their activities under wraps. Just as in the case of LSD, and much to the chagrin of the DEA and mental health professionals, the recreational use of MDMA, under the name of Adam, ecstasy, and a variety of other street names, gradually grew. MDMA leaked into the nonmedical market. “The street kids of San Francisco” figured out early how to abuse it, noted the director of the Haight Ashbury Free Medical Clinic.122 It was a pattern familiar to anyone who had worked with LSD. The seventies witnessed a division of interests as “psychotherapists and spiritually inclined individuals began to explore its possible applications” while another group began using it socially to get a high “comparable in some respects to cocaine.”123 By the early 1980s, MDMA was a purported hit in Texas nightclubs, and the DEA started paying closer attention to the substance. Then in 1984 the open and legal sales in the Lone Star State prompted the ten-­gallon-­ hat-­wearing and one-­time presidential nominee Senator Lloyd Bentsen to request MDMA’s scheduling as a controlled substance. The DEA dutifully complied, thereby setting off a major battle. How could the DEA have known of the widespread support for MDMA in the psychiatric community? Should it come as a surprise that the strong opposition surprised

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the DEA?124 According to one official, “We had no idea psychiatrists were using it.”125 Wrap-­up Debates about drugs in the present moment have a legacy in the past. Physicians, regulators, and psychiatrists often urge caution to drug-­takers and are frequently concerned that evidence buttress the management of a given substance, either therapeutically or recreationally. At other times the waters are muddied, and it is precisely the health authorities that advocate on behalf of illicit substances. All parties desire facts—­more knowledge—­before sanctioning or outright snubbing any particular medicine or intoxicant. The science may be far from settled, but this has not prevented individuals from demanding access to and consuming untested and unconventional substances. Those involved in these debates will continue to push the limits, resist change, and attempt to revolutionize medicine, rendering some drugs legitimate, others illegitimate, and many contested. R. D. Laing, for example, reanalyzed psychiatry, medicine, and science. His use (and perhaps misuse) of LSD paralleled struggles for legitimacy in the realm of psychedelic medicine. His questioning of psychiatric diagnosis and the psychiatric establishment can be seen in changes to the DSM nosology in the mid-­1970s, culminating in a biological shift in 1980. Laing’s experimentation with alternative approaches, mysticism, and Eastern religions also dovetail with the reemergence of parapsychology in the 1970s. These investigations, coupled with an outsider status, invite comparisons with the rise of Scientology, a relatively new religion that emphasized the failure of orthodox psychiatry and novel ways of understanding the mind. Before 1972, close to seven hundred studies with psychedelic drugs took place, not including the MKUltra program research. The research suggested that psychedelics offered significant benefits: they helped recovering alcoholics abstain, soothed the anxieties of terminally ill cancer patients, and eased the symptoms of many difficult-­to-­treat psychiatric illnesses such as obsessive-­compulsive disorder. For all the testing, however, LSD, to take one example, had not insinuated itself into a specific disease category or sought-­ after psychopharmaceutical niche to warrant further evaluation in this context. The capacity of researchers to establish quantifiable and verifiable results accordingly became ever more challenging.126 As Sanford

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Unger, the noted LSD researcher, said, “Good research takes time.” It would likely be “several years” before “hard and secure” evidence was available.127 MDMA was banned in the late 1980s. By 2016, MDMA was legitimized. In November, the FDA gave permission for large-­scale, Phase 3 clinical trials of the drug—­the final step before the possible approval of ecstasy as a prescription drug for treating PTSD. Indeed, researchers proved so optimistic that they applied for and were granted breakthrough therapy status with the FDA, which would accelerate the approval process. If accepted, the drug could be available by 2021.128 In other words, the drug had come full circle. More than a century after its patenting by Merck in 1914, MDMA was on the cusp of being an authorized, evidence-­based mental health therapy.

Afterword

To be a “radical” one must be open to the possibility that one’s own core assumptions are misconceived.1 —­Christopher Hitchens, 2001

The history of mental health remains “a minefield.” Interpretations—­old and new—­are constantly being “blown up” by fresh evidence and “many surprises may lie in store for us all.”2 Personally, I can’t wait for these revelations. According to Mark Micale and Roy Porter, writing in the mid-­1990s, “The past thirty years have brought an outpouring of original scholarship—­ often passionate, partisan, and polemical.”3 The last several years, for instance, have seen the publication of even more monographs on Sigmund Freud. Books have addressed the asylum, made audible the voices of mental health activists, and positioned madness against the backdrop of the Cold War and in far-­flung, less researched regions of the world. Yet more needs to be written. Intoxicants have gradually featured more centrally in histories of psychiatry and psychology, while contested science and medical knowledge have been brought into the fold as well.4 The study of global psychopharmaceutical advertising, meanwhile, has arisen in recent years as a means of examining mental illness and pharmaceutical use.5 Additionally, I echo several of my colleagues who urge acceptance of “opportunities for cross-­fertilization” and seize chances to engage with policymaking.6 As I wrote in Medical History in 2014, the history of psychiatry and mental health is constantly shifting, and a diversity of distinctive approaches is readily apparent.7

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This book is an attempt to add a new and broader perspective. There are manifold ways to approach mental health and the 1970s. The radicalism of the era was surely unique, yet it resonates in the present moment. Today, many Americans are dealing with a massive divide between rich and poor in society. Wars in Syria, Afghanistan, Iraq, and elsewhere have left a psychological and fiscal mark on the nation. The #MeToo movement, which began in Hollywood, then moved to government, has helped shine a spotlight on gender relations. There’s still a lot of experimentation with drugs. Microdosing in California has definitely captured attention recently through being popularized in best-­selling books and magazines and on television shows. Mental health continues to be an intractable problem for regular people and for policymakers and practitioners, just as it was in the 1970s, while racism, poverty, and colonialism, which helped create mental health problems, persist in the present. Thinking about the 1960s and 1970s probably conjures up images of Bobby Seale and Huey Newton’s Black Panther Party. The 1970s also call to mind the Weather Underground, a homegrown terrorist organization intent on fomenting revolution, which detonated a series of bombs in 1970. Left-­ wing-­ inspired violence continued throughout the decade as police precincts, prisons, and government buildings were targeted from New York City to San Francisco. Gay rights activists, second-­wave feminists, and opponents of busing all drew lessons from their protest movement predecessors in the 1960s. The era saw a mix of bra burning and Bible-­thumping, sit-­ins and jogging fads, a crumbling consensus, and the emergence of a “new world order . . . built on the rubble.”8 A constellation of so-­called radical movements with multiple influences vied to reengineer the shifting landscape and redress historical inequities in the United States. Psychiatry and psychology felt the effects of the radical movements strongly.9 Whatever one’s feelings about the era, it is difficult to argue that any other moment in American history “witnessed as much critical attention and cultural energy lavished on issues relating to madness as the 1960s and 1970s.”10 The psychiatrist Walter Barton has said that unraveling the impact of the forces in motion at that time is a task for historians.11 The 1970s left a lasting impression. After the decade of the 1960s, it had become more commonplace for professionals in the psych sciences to get “involved in community affairs” and “denaturalize” therapeutic culture.12 Mental health professionals of all varieties took on greater social

Afterword 151

responsibility and rejected cultural dissonance. Ex-­ patients mobilized. Breakthroughs in military hardware, increasingly conspicuous human rights activism, and the rising automation of Western civilization all affected the collective mental health—­and left their imprint on psychiatry and the other psych disciplines. “Health and mental health are issues inherent in each of these revolutions,” wrote Paul Lowinger, a radical psychiatrist.13 These developments ran in parallel with challenges to mental health expertise.14 Debate was rife. It took place over psychiatric nosology (the classification of illnesses), scientific legitimacy, and the value of evidence-­ based diagnosis. It focused on the forces of modernization, psychopharmacology, (de)institutionalization, and social psychiatry. Debate crystallized around the rise of the antipsychiatry movement and the ascendancy of ex-­patient groups, whose members referred to themselves as “survivors” or freed “slaves.” All this tumult was regarded as a “child of its rebellious, anti-­establishment times.”15 The shifting of plates within the mental health establishment were felt far beyond the profession of psychiatry. Ideas about drugs, Marxism, anti-­ authoritarianism, Eastern philosophy, and mysticism entered the national conversation and served to twist impressions of the Vietnam War, technology and science, and religion. The economy mattered, as did the opinions in mental health expertise. In establishing an agenda that discussed whether the field of mental health bolstered such institutions as schools and churches, colleges, armed forces, courts, prisons, industrial concerns, and welfare agencies, prominent agitators of the day shook society’s bedrock. In targeting issues like pollution, overpopulation, racism, and nuclear war, mental health providers moved beyond the health of the individual and reconceptualized mental health as a national and global concern.16 As part of this reorientation, psychiatrists and psychologists prepared a new version of the DSM, which was released in 1980 as the DSM-­III and marked the continuing struggle between biological and psychodynamic psychiatry. California, as a space and place, has occupied a large part of the narrative of this book. It was a conservatory of health activism and medical entrepreneurship in the 1960s and 1970s, providing a hothouse climate in which strange medicines could be cultivated alongside various ideas, ideologies, and new therapies. The state was home to radical psychiatry in Berkeley, Berne’s transactional analysis, the Esalen Institute, and drawn-­out disputes over the use of therapeutic LSD and MDMA, along with a robust

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libertarian and conservative ethos. Dr. Sidney Cohen, among others, agitated against the use of MDMA, while Zeff and Shulgin helped spread the word of its potential. In Berkeley, patient groups rose up against “coercion as cure,” a phrase popularized by Thomas Szasz. And all this activity was about patient-­consumer agency and a struggle against the establishment over the best scientific evidence. Finally, the state was the home of the provocative rock band the Doors, which released the popular song “Break On Through” in 1967. Several figures also emerged that straddled the line dividing mainstream from radical, establishment from counterculture, legitimacy from illegitimacy, prestige from paranoia. Phyllis Chesler questioned the gender-­based pyramids in the mental health establishment. In doing so, she drew on second-­wave feminism to refocus the role of women in mental health. Cicely Saunders, based in the United Kingdom, explored alternative end-­of-­life therapies and tried to understand more clearly the value of LSD, even as she sought to provide the best possible experience for terminally ill patients and offer psychological solace. Eric Berne, rejected by the Psychoanalytic Institute, set out on his own and reconstituted psychodynamic concepts to create and popularize transactional analysis. Alexander Shulgin, meanwhile, recreated potent new substances for therapists in the United States. His synthesis of MDMA propelled the use of a new generation of psychoactive substances in clinical settings, substances that have since become more legitimate in contemporary society. These individuals sparked all manner of discussions about the American mind that are relevant in the present. They challenged scientific orthodoxy and the status quo even as they adapted and contributed to new methodologies and ideas. They personified some of the transitions and limits in the mental health field and helped push the boundaries of traditional mental health concepts and practices. In doing so, they reshaped and were shaped by American culture. During a 1977 interview, Michel Foucault wondered whether psychiatry was perhaps not on “good terms with its own history.” He suggested that many mental health professionals regarded his Madness and Civilization as an “attack on present-­day psychiatry,” when it was merely meant to narrate an untold story.17 In the years ahead, I recommend a greater global focus on radicalism in psychiatry, as well as in the wider mental health arena. Such scholars as John Foot, Sarah Marks, Karen Minikin, Camille Robcis, and Oisin Wall have advanced British, Czech, French, German, and Italian

Afterword 153

histories at the nation-­state level and it would be worthwhile to further develop understandings of the circuits through which radicalism traveled across time and space. I hope that some of my colleagues target the root causes of mental health problems and economics. At the same time, it is vital to push ahead with interdisciplinary accounts of personalized neuroscience treatments that are culturally diverse, translational in nature, and actively involve patients. In doing so, American psychiatry and culture will be better served.

Acknowledgments

This book project began with an unsuccessful grant application in 2008. While a PhD student based in London, I applied for a Walter J. Lear Fellowship to visit the University of Pennsylvania’s special collections related to health activism. In retrospect, the application wasn’t well-­executed but Mr. Lear took the time to ring me (he was in his mid-­80s!) and talk about my project. I remember being tongue-­tied and impressed that he would reach out like that. As I mentioned above, the application was not funded; however, the conversation with Mr. Lear, and the encouragement I took from it, was enough incentive for me to press ahead. His kindness has stuck with me. I am extremely grateful for the fabulous communities of scholars and friends that have supported me over the years and in the writing of this book. Early on in my academic career, Iwan Morgan and Robert Mason fostered my passion for American history. My studies in the United Kingdom, at both the University of Edinburgh and the University of London, were enriched by their stewardship and backing. I keep thanking them for their support at the beginning of my career, and I will continue to do so! Recently, I have weathered many storms with the aid of Nancy Campbell and David Herzberg; they are terrific colleagues and I am delighted we have become such good friends since we took up the role of Co-­Editors in Chief at Social History of Alcohol and Drugs. Matt Smith and Jim Mills, meanwhile, deserve huge thanks for their support of me while I lived in Glasgow and worked at the University of Strathclyde; while there, I was privileged to be a part of the Centre for the Social History of Health and Healthcare in the School of Humanities, administered in part by my friend and colleague Laura Kelly. Caroline Marley was a fulcrum at CSHHH, and I will

156 Acknowledgments

miss working with Patricia Barton, Matt Eisler, and Emma Newlands. Ann Bartlett, Margaret Jolly, Margaret Keoghan, Mark Law, Maureen McDonald, and Maureen Noor must be acknowledged. At the University of Wisconsin–­ Madison, my new institution, I am deeply appreciative of colleagues in the School of Pharmacy, particularly Dave Mott and Michelle Chui. Both of them have been generous with their time and have offered amazing mentorship. I would also like to acknowledge Olufunmilola Abraham, Betty Chewning, James Ford, Kevin Look, and Olayinka Shiyanbola, my splendid colleagues in the Social and Administrative Sciences Division. Meanwhile, Kristen Huset does a masterful job of keeping us on track. Thanks are also owed to the School of Pharmacy Dean, Steve Swanson. The American Institute of the History of Pharmacy likewise is home to some tremendous people, including Dennis Birke, Greg Bond, Greg Higby, Beth Fisher, and President Bill Zellmer. Erika Dyck is an excellent friend whose support has been crucial over the years. Ross MacFarlane was instrumental in helping me in the early stages of this project. Others that I’m grateful to, though they may not know it, include Dorian Deshauer, Timothy Hickman, Wendy Kline, Emma Long, Sarah Marks, Mat Savelli, Brandy Schillace, and Jon Sutton. Matthew DeCloedt offered essential research support. Parts of chapter 3 appeared in slightly different forms in the edited collection, Preventing Mental Illness: Past, Present and Future, and in the pages of Social History of Medicine. The writing of the book would not have been possible without the informative and engaged archival doorkeepers, including Diana Bachman, Jessica Borge, Sam Maddra, Anne Moore, Sarah Hepworth, David Ulrich, and Stephanie Schmitz. If I am missing anyone, I extend sincere apologies. My research was conducted using various archives in the United States, Canada, and the United Kingdom. The archivists named above made this process immeasurably better. Adam Montgomery and Mark Polachic read through early drafts. Other early readers, including Jonathan Sadowsky and Edward Shorter, commented on draft versions of Break On Through. Matt Browne at the MIT Press offered calm and clever guidance. He has been superb in guiding me through the process. Also at the MIT Press, thanks to the Editorial Board and specifically to Deborah Cantor-­Adams and Marjorie Pannell, who both proposed erudite suggestions that undoubtedly improved this book. Cheers! Finally, I thank the external reviewers for taking the time to read and make beneficial suggestions to upgrade the manuscript.

Acknowledgments 157

I appreciated the opportunities to test drive this material at scholarly meetings, such as those of the Alcohol and Drugs History Society, the American Association of the History of Medicine, the Canadian Society for the History of Medicine, Historians of the Twentieth Century United States, Queen Mary’s Biennial Symposium in American History, and the History of Science Annual Conference. I am also grateful for the chance to speak with radical librarians at the University of London’s Radical Collections symposium and the Glasgow Skeptics participants. Finally, this project would not have been possible without the generous support of various institutions, and here I would like to highlight the Scottish Crucible and The Royal Society of Edinburgh. The Social Sciences and Humanities Research Council provided funds in 2011–­2013 that set this project in motion. It has been my pleasure to be associated with these groups. Nine years after I spoke with Mr. Lear, I completed the initial draft of this book in mid-­May 2017 at my home in Glasgow. A bomb had just detonated at the conclusion of a pop music concert in Manchester, the terror threat level had been raised to critical, and security personnel had been dispatched to key sites across the United Kingdom. Since then, similar attacks, some with guns or knives or vans, have harmed many innocent people. This state of affairs has reaffirmed to me that kind conversations and a willingness to reach out are needed more than ever.

Notes

Chapter 1 1.  William Shakespeare, Macbeth, edited by E. R. Branmuller (Cambridge: Cambridge University Press, 1997), 225. 2. Deborah Brauser, “‘Desperate’ Need for More Psychiatrists, VP Joe Biden Says,” Medscape Medical News, May 6, 2014, http://www.medscape.com/viewarticle/824691 #vp_1. See also David Levine, “VP Biden Addresses 15,000 Psychiatrists at #APA2014 Meeting,” Elsevier Connect, May 8, 2014, http://www.elsevier.com/connect/vp-joe -biden-addresses-the-american-psychiatric-association. 3. Shakespeare, Macbeth, 225. 4.  Deborah Doroshow, Matthew Gambino, and Mical Raz, “New Directions in the Historiography of Psychiatry,” Journal of the History of Medicine and Allied Sciences 74, no.1 (2018): 17. 5.  Sara Matthews, “The Freudian Legacy Today,” in The Freudian Legacy Today, ed. Dina Georgis, Sara Matthews, and James Penney (Toronto: Canadian Network for Psychoanalysis and Culture, 2015), 1, http://www.cnpc-rcpc.ca/wp-content/uploads/ 2014/05/CNPC-Intro.pdf. 6. Allen Frances, “Diagnosing the D.S.M.,” New York Times, May 11, 2012, http:// www.nytimes.com/2012/05/12/opinion/break-up-the-psychiatric-monopoly.html. 7.  Esther Addley, “Occupy Movement: From Local Action to a Global Howl of Protest,” Guardian, October 18, 2011, https://www.theguardian.com/world/2011/oct/ 17/occupy-movement-global-protest. 8.  Allen Frances, Saving Normal: An Insider’s Revolt against Out-­of-­Control Psychiatric Diagnosis, DSM-­5, Big Pharma, and the Medicalization of Ordinary Life (New York: William Morrow, 2013), xix. For Frances, who helped write DSM-­III, psychiatry should avoid overreach and stay within its competence. See also Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (New York: Broadway Books, 2010), 4–­5.

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9.  Bradley Lewis, Narrative Psychiatry: How Stories Can Shape Clinical Practice (Baltimore, MD: Johns Hopkins University Press, 2011), 63–­64. 10.  David Healy, Pharmageddon (Berkeley: University of California Press, 2012), 12. 11.  David Healy, The Creation of Psychopharmacology (Cambridge, MA: Harvard University Press, 2002); David L. Herzberg, Happy Pills in America: From Miltown to Prozac (Baltimore, MD: Johns Hopkins University Press, 2009). 12. Marcia Angell, The Truth about the Drug Companies: How They Deceive Us and What to Do about It (New York: Random House, 2004). 13. Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definitions of Disease (Baltimore, MD: Johns Hopkins University Press, 2008), 139–­ 140; Dominique A. Tobbell, “‘Who’s Winning the Human Race?’ Cold War As Pharmaceutical Political Strategy,” Journal of the History of Medicine and Allied Sciences 64, no. 4 (2009): 429–­ 473; Erika Dyck, Psychedelic Psychiatry: LSD from Clinic to Campus (Baltimore, MD: Johns Hopkins University Press, 2008); Herzberg, Happy Pills in America; Eric Schneider, Smack: Heroin and the American City (Philadelphia: University of Pennsylvania Press, 2008). 14. Albert Hofmann, LSD: My Problem Child: Reflections (New York: McGraw Hill, 1980), republished as LSD: My Problem Child and Insights/Outlooks, trans. Jonathan Ott (Oxford: Oxford University Press, 2013). Citations are to the Oxford edition. 15.  Albert Hofmann letter, April 19, 1993, David Nichols Papers, MSF 468—­ Correspondence, box 1, folder 14, Psychoactive Substances Collection, Archives and Special Collections, Purdue University [hereafter PSC]. 16.  See, for example, Hofmann, LSD, 42, but also Dyck, Psychedelic Psychiatry. 17. Michael Pollan, “The Trip Treatment: Research into Psychedelics, Shut Down for Decades, Is Now Yielding Exciting Results,” New Yorker, February 9, 2015, http:// www.newyorker.com/magazine/2015/02/09/trip-treatment. 18.  For one example of the diversity, see Harold A. Abramson, The Use of LSD in Psychotherapy: Transactions of a Conference on d-­Lysergic Acid Diethylamide (LSD-­25) (New York: Josiah Macy Jr. Foundation, 1960). See also Nicolas Langlitz, Neuropsychedelia: The Revival of Hallucinogen Research since the Decade of the Brain (Berkeley: University of California Press, 2013); and David J. Nutt, Drugs without the Hot Air: Minimizing the Harms of Legal and Illegal Drugs (Cambridge: UIT, 2012). 19.  Albert Hofmann letter, June 16, 1993, 468—­Correspondence, box 1, folder 14, PSC.

David

Nichols

Papers,

MSF

20.  “C. G. Jung Letter to Victor White,” April 10, 1954, in C.G. Jung Letters, vol. 2, 1951–­1961, trans. Jeffrey Hulen, edited by Gerhard Adler (Princeton, NJ: Princeton University Press, 1975), 172.

Notes to Chapter 1 161

21.  See Ben Sessa, The Psychedelic Renaissance: Reassessing the Role of Psychedelic Drugs in 21st Century Psychiatry and Society (London: Muswell Hill Press, 2012). 22. Interview by Miles O’Brien, “Why Psychedelic Drugs Are Having a Medical Renaissance,” PBS NewsHour, January 25, 2017, http://www.pbs.org/newshour/bb/ psychedelic-drugs-medical-renaissance. 23.  Matthew Smith, “The Magic Years: The History of Psychiatry from the Horse’s Mouth,” Psychology Today, April 28, 2015, https://www.psychologytoday.com/blog/ short-history-mental-health/201504/the-magic-years. 24.  Lawrence Samuel, Shrink: A Cultural History of Psychoanalysis in America (Lincoln: University of Nebraska Press, 2013), 128. 25. Tom Harper and Bob Boone, “The Dilemma of American Psychiatry in the 1960s,” May 9, 1968, MS Coll. 635, box 6, folder 86, Walter J. Lear Health Activism Collection, Annenberg Rare Book and Manuscript Library, University of Pennsylvania; Arnold A. Rogow, The Psychiatrists (New York: G. P. Putnam’s Sons, 1970), 15. 26.  Laura Hirshbein, “The American Psychiatric Association and the History of Psychiatry,” History of Psychiatry 22, no. 3 (2011): 302–­313; Owen Whooley, “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manuals of Mental Disorders,” Sociology of Health & Illness 32, no. 3 (2010): 452–­469. 27. Elaine Shannon, “Feminists Denounce Tranquilizer Ads,” Newsday, October 1975, 17; Wade Hudson, “The US Supreme Court versus Psychiatry,” Daily Californian, July 17, 1975, 5; Ronald Sullivan, “Disgrace of the State Mental Hospitals,” New York Times, October 9, 1977, 5. 28. Stephen Tuck, “Introduction: Reconsidering the 1970s—­The 1960s to a Disco Beat?,” Journal of Contemporary History 43, no. 4 (2008): 617–­620, 618. 29.  See Peter N. Carroll, It Seemed Like Nothing Happened: The Tragedy and Promise of America in the 1970s (New York: Holt, Rinehart and Winston, 1982); and Edward D. Berkowitz, Something Happened: A Political and Cultural Overview of the Seventies (New York: Columbia University Press, 2005). Finally, see Lucas Richert, “Surveying the Seventies: Something’s Still Happening,” Canadian Journal of History 46, no. 3 (2011): 649–­654. 30.  Niall Ferguson, Charles S. Maier, Erez Manela, and Daniel J. Sargent, eds., The Shock of the Global: The Seventies in Perspective (Cambridge, MA: Belknap Press of Harvard University Press, 2010), 352. 31. The unanimous ruling ultimately held that the confinement of Donaldson was a denial of his “right to liberty.” The decision reflected a growing grassroots movement across the country, as well as the rise of antipsychiatric sentiment in the United States. Critics from both the right and the left of the political spectrum denounced the ways in which the Soviet Union and other Eastern bloc countries

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used psychiatry as a tool of repression. Right-­wingers in the John Birch Society, for instance, had demonized the field of psychiatry throughout the 1950s and 1960s for just this reason. One often cited example was the case of Vladimir Bukovsky, who was forcibly hospitalized in Moscow for anti-­Communist and anti-­establishment activities. He became a poster child for Americans railing against psychiatric persecution and oppressive activities in society. For the American Association for the Abolition of Involuntary Mental Hospitalization’s George Alexander, an attorney and spokesperson, there were thousands of Bukovskys in the United States. Donaldson’s case in the Supreme Court was just one example of the changing legal landscape and shifting mental health climate in the 1970s. George J. Annis, “Medicolegal #11: The Non-­Dangerous Mentally Ill Person’s Right to be Free,” Orthopaedic Review 4, no. 10 (October 1975): 59–­60; Hudson, “The US Supreme Court Versus Psychiatry,” 5; Sullivan, “Disgrace of the State Mental Hospitals,” 5; Alan Meisel, “The Rights of the Mentally Ill under State Constitutions,” Law and Contemporary Problems 45, no. 3 (1982): 7–­40, 7–­9. 32.  Robert Coles, “A Young Psychiatrist Looks at His Profession,” Atlantic Monthly, July 1961. 33.  Frank Riessman and S. M. Miller, “Social Change versus the ‘Psychiatric World View,’” American Journal of Orthopsychiatry 34, no. 1 (1964): 29–­38. 34.  Bruno Bettelheim, “Review of Committee on Social Issues, Psychiatric Aspects of the Prevention of Nuclear War,” Bulletin of the Atomic Scientists 21, no. 6 (1965): 55–­56. 35.  Letter from John Roy (St Nicholas Hospital) to R. D. Laing, undated, MS Laing DR65, R. D. Laing Collection, Special Collections, University of Glasgow. 36.  “March 21, 1972, 1:00 pm–­2:15 pm—­Oval Office Conversation No. 690-­11—­in this segment, the President is meeting with H. R. (‘Bob’) Haldeman.” Quoted in Sunil Kumar Aggarwal, “Health Scientist Blacklisting and the Meaning of Marijuana in the Oval Office in the Early 1970s,” CASP Communications, July 1, 2015, https://medium. com/@ReachCASP/health-scientist-blacklisting-and-the-meaning-of-marijuana -in-the-oval-office-in-the-early-1970s-71ea41427b49. 37. For a thorough discussion of the psychological profession during this period, see James H. Capshew, Psychologists on the March: Science, Practice, and Professional Identity in America, 1929–­1969 (Cambridge: Cambridge University Press, 1999). 38. Marc Roberts, “The Production of the Psychiatric Subject: Power, Knowledge and Michel Foucault,” Nursing Philosophy 6 (2005): 33–­42. 39.  Roberts, “The Production of the Psychiatric Subject,” 12. 40.  Roberts, “The Production of the Psychiatric Subject.” 41.  Claude S. Fischer, Made in America: A Social History of American Culture and Character (Chicago: University of Chicago Press, 2010), 2 [italics mine].

Notes to Chapter 2 163

Chapter 2 1.  Quoted in Gail Sheehy, “Catch-­30 and Other Predictable Crises of Growing Up Adult,” New York Magazine, February 18, 1974, 30. See also Stuart Whatley, “Disrupt Yourself (and Do Us All a Favor),” Los Angeles Review of Books, March 28, 2014, https://lareviewofbooks.org/article/disrupt-us-favor. 2.  “High and Proud and the Cultural Revolution,” recording, box 1, folder 44 (June 24, 1969), MSS 2013–­18, Eric Berne Collection, Archives and Special Collections, University of California, San Francisco. 3.  See William H. Chafe, The Unfinished Journey: America Since World War II, 5th ed. (New York: Oxford University Press, 2003), 38. 4. Chafe, The Unfinished Journey, 38. 5. Jeffrey Kimball, Nixon’s Vietnam War (Lawrence: University Press of Kansas, 1998), 12. 6. Kimball, Nixon’s Vietnam War, 204–­205. 7.  Stanley Karnow, Vietnam: A History (New York: Viking Press, 1983), 567–­610. 8. Ben Shephard, A War of Nerves: Soldiers and Psychiatry in the Twentieth Century (Cambridge, MA: Harvard University Press, 2001), 340. In 1969, military psychiatrists estimated that roughly 30 to 35 percent of American GIs likely used marijuana, a figure that in turn served to exacerbate popular anxieties over drug use in the United States. See also Kathleen J. Frydl, The Drug Wars in America, 1940–­1973 (Cambridge: Cambridge University Press, 2013), 395. 9.  Michael S. Perlman, “Basic Problems of Military Psychiatry: Delayed Reactions in Vietnam Veterans,” International Journal of Offender Therapy and Comparative Criminology 19, no. 2 (1975): 135. 10.  Perlman, “Basic Problems of Military Psychiatry,” 135–­136. 11.  Perlman, “Basic Problems of Military Psychiatry,” 135–­136. 12.  Wilbur J. Scott, “PTSD in DSM-­III: A Case in the Politics of Diagnosis and Disease,” Social Problems 37, no. 3 (1990): 294–­310, 297. See also Herbert C. Archibald, Dorothy Long, Christine Miller, and Read D. Tuddenham, “Gross Stress Reaction in Combat: A 15-­Year Follow-­Up,” American Journal of Psychiatry 119, no. 4 (1962): 317–­ 322; and Herbert C. Archibald and Read D. Tuddenham, “Persistent Stress Reaction after Combat: A 20-­Year Follow-­Up,” Archives of General Psychiatry 12, no. 5 (1965): 475–­481. 13. Peter G. Bourne, Men, Stress, and Vietnam (Boston: Little, Brown, 1970). See Scott, “PTSD in DSM-­III,” 296.

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Notes to Chapter 2

14.  Quoted in Shephard, A War of Nerves, 340. 15. Richard A. Kulka, William E. Schlenger, John A. Fairbanks, et al., Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study (New York: Brunner/Mazel, 1990); Richard A. Kulka, William E. Schlenger, John A. Fairbanks, et al., The National Vietnam Veterans Readjustment Study: Tables of Findings and Technical Appendices (New York: Brunner/Mazel, 1990). 16. Adam Montgomery, The Invisible Injured: Psychological Trauma in the Canadian Military from the First World War to Afghanistan (Montreal: McGill-­Queen’s University Press, 2017), 94–­95. 17.  Phil Brown, ed., Radical Psychology (New York: Harper Colophon Books, 1973), xiii. 18. Brown, Radical Psychology, xv–­xvi. 19. Tom Harper, “Radical Caucus at the American Psychiatric Association Annual Convention,” Ripsaw Magazine, December 1968, 20. 20. Shephard, A War of Nerves, 358. 21. Frydl, The Drug Wars in America, 1940–­1973, 395. 22.  James R. Allen and Louis Jolyon West, “Flight from Violence: Hippies and the Green Rebellion,” American Journal of Psychiatry 125, no. 3 (1968): 364–­370. 23.  Lou Cannon, “Fear of Nixon Depression Key to Ford Pardon Move,” Des Moines Register, September 9, 1974, 3. 24. Robert M. Collins, Transforming America: Politics and Culture During the Reagan Year (New York: Columbia University Press, 2007), 14. 25. Jimmy Carter, “Energy and National Goals: Address to the Nation, July 15, 1979,” in Public Papers of the Presidents: Jimmy Carter, 1979 (Washington, DC: Government Printing Office, 1980), book 2, 1235–­1241, quoted in Bruce J. Schulman, The Seventies: The Great Shift in American Culture, Society, and Politics (New York: Free Press, 2001), 141. 26. Jeremy A. Greene, Prescribing by Numbers: Drugs and the Definitions of Disease (Baltimore, MD: Johns Hopkins University Press, 2008), 139–­140. 27. Daniel Bell, The Cultural Contradictions of Capitalism (New York: Basic Books, 1976), 25–­26. 28.  Judith Stein, Pivotal Decade: How the United States Traded Factories for Finance in the Seventies (New Haven, CT: Yale University Press, 2010), ix–­x. 29.  Andreas Killen, 1973 Nervous Breakdown: Watergate, Warhol and the Birth of Post-­ Sixties America (New York: Bloomsbury, 2006).

Notes to Chapter 2 165

30.  For a fuller, more comprehensive account of the political economy during the 1970s, see Robert M. Collins, More: The Politics of Economic Growth in Postwar America (Oxford: Oxford University Press, 2000); James T. Patterson, Restless Giant: The United States from Watergate to Bush v. Gore (Oxford: Oxford University Press, 2005); John Sloan, The Reagan Effect: Economics and Presidential Leadership (Lawrence: University Press of Kansas, 1999); and Michael J. Boskin, Reagan and the Economy: The Successes, Failures, and Unfinished Agenda (San Francisco: Institute for Contemporary Studies, 1987). 31.  D. H. Meadows, Dennis L. Meadows, Jørgen Randers, et al., The Limits to Growth: A Report for the Club of Rome’s Project on the Predicament of Mankind (London: Pan, 1974); E. F. Schumacher, Small Is Beautiful: A Study of Economics As If People Mattered (London: Blond & Briggs, 1973). 32.  Robin W. Simon, “Twenty Years of the Sociology of Mental Health: The Continued Significance of Gender and Marital Status for Emotional Well-­ Being,” in Sociology of Mental Health: Selected Topics from Forty Years, 1970s-­2010s, ed. Robert J. Johnson, R. Jay Turner, and Bruce G. Link (New York: Springer, 2014), 21–­53, 25–­27. 33.  Paul Lowinger, “Radical Psychiatry,” International Journal of Psychiatry 9 (1970): 659–­668, 661–­662. 34.  Nadine Weidman, “Between the Counterculture and the Corporation: Abraham Maslow and Humanistic Psychology in the 1960s,” in Groovy Science: Knowledge, Innovation, and American Counterculture, ed. David Kaiser and W. Patrick McCray (Chicago: University of Chicago Press, 2016), 121–­122. 35.  Stephen P. Miller, The Seventies Now: Culture as Surveillance (Durham, NC: Duke University Press, 1999), 98. 36. Laurence Foss, “The Psychedelic Seventies: New Life Styles for Those in Business?,” Management of Personnel Quarterly 9, no. 2 (1970): 2–­10, 3–­5. 37.  Foss, “The Psychedelic Seventies,” 3–­5; Rosabeth Moss Kanter, “The New Workforce Meets the Changing Workplace,” in The Nature of Work: Sociological Perspectives, ed. Kai Erikson and Steven P. Vallas (New Haven, CT: Yale University Press, 1990). See also Committee on Techniques for Enhancement of Human Performance et al., The Changing Nature of Work: Implications for Occupational Analysis (Washington, DC: National Academy Press, 2000). This report called attention to the importance of relational and interactive aspects of work, just as Foss had done in 1970. As collaboration and collective activity become more prevalent, workers need well-­developed social skills—­what the report calls “emotional labor.” 38. David Noble, America by Design: Science, Technology, and the Rise of Corporate Capitalism (New York: Knopf, 1977); Ernest Mandel, Late Capitalism (London: Verso, 1978); Karl Marx, Grundrisse (New York: Random House, 1973), 704; Karl Marx, Capital, vol. 1 (New York: International Publishers, 1967 [1867]), 361.

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39. Jeffrey K. Liker, The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer (New York: McGraw-­Hill, 2003); Leslie A. Perlow, “The Time Famine: Toward a Sociology of Work Time,” Administrative Science Quarterly, 44, no. 1 (1999): 57–­81; Arlie R. Hochschild, The Time Bind: When Work Becomes Home and Home Becomes Work (New York: Metropolitan Books, 1977). 40.  Shoshana Zuboff and James Maxmin, The Support Economy: Why Corporations Are Failing Individuals and the Next Episode of Capitalism (New York: Viking Press, 2002). 41.  Zuboff and Maxmin, The Support Economy. See also James H. Capshew, Psychologists on the March: Science, Practice, and Professional Identity in America, 1929–­1969 (Cambridge: Cambridge University Press, 1999); Ernest R. Hilgard, Psychology in America: A Historical Survey (San Diego: Harcourt Brace Jovanovich, 1987). Work-­life policies and programs were grounded in governmental policy aimed at supporting working families with children. Policies, including the 1978 passages of the Pregnancy Discrimination Act, set a precedent for the flexibility issue. 42.  S. R. Ekstrom, “Jung’s Typology and DSM-­III Personality Disorders: A Comparison of Two Systems of Classification,” Journal of Analytical Psychology 33 (1988): 329–­344, 339. 43. For a more comprehensive description of the MBTI and how its classification diverges from Jung’s original theories, see David J. Pittenger, “The Utility of the Myers-­Briggs Type Indicator,” Review of Educational Research 63, no. 4 (1993): 467–­488, 468; and Frazier M. Douglass IV and Robin Douglass, “The Validity of the Myers-­Briggs Type Indicator for Predicting Expressed Marital Problems,” Family Relations 42, no. 4 (1993): 422–­426. 44.  Lillian Cunningham, “Does It Pay to Know Your Type?,” Washington Post, December 14, 2012, https://www.washingtonpost.com/national/on-leadership/myers-briggs -does-it-pay-to-know-your-type/2012/12/14/eaed51ae-3fcc-11e2-bca3-aadc9b7e29c5 _story.html?utm_term=.ea1e4905933e. 45.  “Letters to the Editor,” February 9, 1980, MS Coll. 635, box 6, folder 90, Walter J. Lear Health Activism Collection, Annenberg Rare Book and Manuscript Library, University of Pennsylvania. 46.  Lowinger, “Radical Psychiatry,” 662. 47.  James E. McClellan III and Harold Dorn, Science and Technology in World History: An Introduction (Baltimore, MD: Johns Hopkins University Press, 2006), 434. 48.  Carl Jung, “America Facing Its Most Tragic Moment,” New York Times, September 29, 1912, SM2. 49.  Carl Jung, “Instinct and the Unconscious,” British Journal of Psychology 10, no. 1 (1919): 15–­23, 19. See also Carolyn Thomas, The Body Electric: How Strange Machines Built the Modern American (New York: New York University Press, 2005).

Notes to Chapter 2 167

50. Terence McKenna, “The Future of Magic in Electronic Societies,” manuscript, 1966, Dennis J. McKenna Papers, MSP 213, box 2, folder 10, Psychoactive Substances Collection, Archives and Special Collections, Purdue University. 51.  Ronald R. Kline, The Cybernetics Movement: Or Why We Call Our Age the Information Age (Baltimore, MD: Johns Hopkins University Press, 2015). 52.  Henry A. Nasrallah, “The Anti-­psychiatry Movement: Who and Why,” Current Psychiatry 10, no. 12 (2011): 5–­7; Herbert Marcuse, Marxism, Revolution and Utopia: Collected Papers of Herbert Marcuse, vol. 6 (New York: Routledge, 2014), 252. See also Andrew Pickering, The Cybernetic Brain: Sketches of Another Future (Chicago: University of Chicago Press, 2010). 53.  Claude Steiner, “Principles,” in Readings in Radical Psychiatry, ed. Claude Steiner, Hogie Wyckoff, Daniel Goldstine, et al. (New York: Grove Press, 1975), 11. 54. Nathan Hurvitz, “The Status and Tasks of Radical Therapy,” Psychotherapy: Theory, Research and Practice 14, no. 1 (1977): 65–­73, 67. 55.  Humphry Osmond and Bernard S. Aaronson, “Psychedelics and the Future,” in Psychedelics: The Uses and Implications of Hallucinogenic Drugs, ed. Bernard S. Aaronson and Humphry Osmond (Garden City, NY: Doubleday, 1970), 473. 56. Christopher Lasch, The Minimal Self: Psychic Survival in Troubled Times (New York: W. W. Norton, 1984), 16. 57.  Adriana Braga, “Mind as Medium: Jung, McLuhan and the Archetype,” Philosophies 1, no. 3 (2016): 220–­227. 58.  Braga, “Mind as Medium.” 59. Anne M. Valk, Radical Sisters: Second-­ Wave Feminism and Black Liberation in Washington, D.C. (Urbana: University of Illinois Press, 2010), 4. 60. Valk, Radical Sisters, 8. 61.  Phyllis Chesler, “The Sensuous Psychiatrist,” New York Magazine, July 19, 1972. 62.  Susanna Kim and Alexandra Rutherford, “From Seduction to Sexism: Feminists Challenge the Ethics of Therapist-­Client Sexual Relations in 1970s America,” History of Psychology 18, no. 3 (2015): 283–­296. 63.  Ralph Blumenthal, “Porno Chic: ‘Hard Core’ Grows Fashionable and Very Profitable,” New York Times Magazine, January 21, 1973, 28–­34. 64.  Heather Murray, “‘My Place Was Set at the Terrible Feast’: The Meanings of the ‘Anti-­ Psychiatry’ Movement and Responses in the United States, 1970s–­ 1990s,” Journal of American Culture 37, no. 1 (2008): 37–­51, 44–­47. See also Nancy Tomes, “Feminist Histories of Psychiatry,” in Discovering the History of Psychiatry, ed. Mark S. Micale and Roy Porter (Oxford: Oxford University Press, 1994), 348–­83; and Lisa

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Appignanesi, Mad, Bad, and Sad: A History of Women and the Mind Doctors from 1800 to the Present (London: Virago, 2008). 65.  Katherine Angel, “The History of ‘Female Sexual Dysfunction’ as a Mental Disorder in the 20th Century,” Current Opinion in Psychiatry 23, no. 6 (2010): 536–­541. 66.  Andrea Tone, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (New York: Basic Books, 2012). 67.  Laura Hirshbein, “Sex and Gender in Psychiatry: A View from History,” Journal of Medical Humanities 31, no. 2 (2010): 55–­70, 57. 68.  David Meagher, “Punk Rock Made Me Psycho-­therapissed,” British Journal of Psychiatry 211 (2017): 395. 69.  Meagher, “Punk Rock Made Me Psycho-­therapissed,” 319. 70.  Paul Nelson, “The Ramones: Ramones,” Rolling Stone, July 29, 1976, https://www .rollingstone.com/music/albumreviews/ramones-19760729. 71.  Nelson, “The Ramones.” 72.  Matthew Worley, No Future: Punk, Politics and British Youth Culture, 1976–­1984 (Cambridge: Cambridge University Press, 2017). 73.  Meagher, “Punk Rock Made Me psycho-­therapissed,” 395. 74.  Meagher, “Punk Rock Made Me psycho-­therapissed.” 75. James McDonald, “Psychiatry Rocks,” British Journal of Psychiatry 200, no. 6 (June 2012): 453. 76.  Marky Ramone and Richard Herschlag, Punk Rock Blitzkrieg: My Life as a Ramone (New York: Simon and Schuster, 2015), 150–­151. Chapter 3 1.  Saul Alinsky, Rules for Radicals: A Practical Primer for Realistic Radicals (New York: Random House, 1971), 62. 2.  Walter E. Barton, The History and Influence of the American Psychiatric Association (Washington, DC: American Psychiatric Press, 1987), 297–­299. 3. Robert Coles, “A Young Psychiatrist Looks at His Profession,” Atlantic Monthly, July 1961, 108–­111. 4. Tom Harper and Bob Boone, “The Dilemma of American Psychiatry in the 1960s,” May 9, 1968, MS Coll. 635, box 6, folder 86, Walter J. Lear Health Activism Collection, Annenberg Rare Book and Manuscript Library, University of Pennsylvania [hereafter WJLHAC].

Notes to Chapter 3 169

5. Paul Lowinger, “Radical Psychiatry,” International Journal of Psychiatry 9 (1970): 659–­668, 660. 6. “Resolution of the Women’s Caucus, APA,” May 9, 1968, MS Coll 635, Box 6, Folder 86, WJLHAC. 7.  Harper and Boone, “The Dilemma of American Psychiatry in the 1960s.” 8. Tom Harper, “Radical Caucus at the American Psychiatric Association Annual Convention,” Ripsaw Magazine, December 1968, 20. 9.  Lowinger, “Radical Psychiatry,” 665. 10.  One example was social psychiatry, which had grown by leaps and bounds in the 1950s and continued growing throughout the 1960s. This movement, based on the work of Robert Felix and William Menninger, among others, concerned itself with the social environment, the community, and cultural factors that influenced mental illness. Placing socioeconomic factors at the center of psychiatric theory and practice, this was no less than preemptive psychiatry—­tackling mental illness in the United States before it manifested. The founding of the National Institute of Mental Health in 1946, the Mental Health Study Act of 1955, and the Joint Commission on Mental Illness and Health reflected and strengthened the movement both intellectually and politically. President John F. Kennedy reinforced the move toward preventive psychiatry in 1963. “We must,” he proclaimed, “seek out the causes of mental illness and of mental retardation and eradicate them.” He added, “Prevention will require both selected specific programs directed especially at known causes, and the general strengthening of our fundamental community, social welfare and education programs.” Unsurprisingly, many mental health practitioners, including future radicals, were overjoyed at the affirmation of the new approach in psychiatry. See Dennis Doyle, “‘Where the Need Is Greatest’: Social Psychiatry and Race-­Blind Universalism in Harlem’s Lafargue Clinic, 1946–­1958,” Bulletin of the History of Medicine 83, no. 4 (2009): 746–­774; Matthew Smith, “Mixing with Medics,” Social History of Medicine 24, no. 1 (2011): 142–­150; and Vicky Long, “‘Often There Is a Good Deal to Be Done, but Socially Rather Than Medically’: The Psychiatric Social Worker As Social Therapist, 1945–­70,” Medical History 55, no. 2 (2011): 223–­239. 11.  John Talbott, telephone interview by author, November 22, 2017. 12. Jerome Agel, ed., The Radical Therapist: The Radical Therapist Collective (New York: Ballantine Books, 1971), viii–­xi. Therapy, in other words, required social, political, and personal change. Achieving mental health was a struggle and was “bullshit unless it involves changing this society which turns us into machines, alienates us from one another and our work, and binds us into racist, sexist, and imperialist practices.” 13.  Talbott, telephone interview by author, November 22, 2017.

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14.  Melvin Sabshin, Changing American Psychiatry: A Personal Perspective (Washington, DC: American Psychiatric Publishing, 2008), 266. 15.  Sandra L. Bloom, Creating Sanctuary: Toward the Evolution of Sane Societies (New York: Routledge, 2013), 114. 16. William Bronston and Michael McGarvey, “A Treatise on Reformation: The Student Health Movement,” paper presented at the Conference on Radicals in the Professions, Ann Arbor, MI, July 14–­16, 1967, MS Coll. 592, box 63, folder 806, WJLHAC. 17. Naomi Rogers, “‘Caution: The AMA May Be Dangerous to Your Health’: The Student Health Organization (SHO) and American Medicine, 1965–­1970,” Radical History Review 80 (2001): 5–­34, 6. Information and quotations in this paragraph and the next are from this source. 18.  The Student Health Organization (SHO) was created in California in 1966 when medical students at the University of Southern California organized a summer program aimed at aiding Spanish-­speaking migrant workers. See “Students to Aid Doctors Help the Poor,” Los Angeles Herald-­Examiner, August 7, 1966. See also Rogers, “‘Caution: The AMA May Be Dangerous to your Health’”; Jane Banaszak-­ Holl, Sandra R. Levitsky, and Mayer N. Zald, eds., Social Movements and the Transformation of American Health Care (New York: Oxford University Press, 2010); Sandra Morgen, Into Our Own Hands: The Women’s Health Movement in the United States, 1969–­1990 (New Brunswick, NJ: Rutgers University Press, 2002); and Lily M. Hoffman, The Politics of Knowledge: Activist Movements in Medicine and Planning (Albany: State University of New York Press, 1989). 19. Leslie A. Falk, “The Negro American’s Health and the Medical Committee for Human Rights,” Medical Care 4, no. 3 (1966): 171–­177, 175. 20.  John Dittmer, The Good Doctors: The Medical Committee for Human Rights and the Struggle for Social Justice in Health Care (New York: Bloomsbury Press, 2009). 21.  Quotations in this paragraph are from “Essay: Radical Saul Alinsky: Prophet of Power to the People,” Time, March 2, 1970. 22.  “Playboy Interview: Saul Alinsky,” Playboy Magazine, March 1972, 78. 23. Nicholas Von Hoffman, Radical: A Portrait of Saul Alinsky (New York: Nation Books, 2010), 108–­109; “Playboy Interview: Saul Alinsky.” 24. Richard Morrill, “Ad Hoc Committee for Social Action,” May 15, 1968, MS Coll. 641, box 61, folder 735, WJLHAC; Richard Morrill, “Psychiatrists for Action on Racism and the Urban Crisis,” May 15, 1968, MS Coll. 641, box 61, folder 735, WJLHAC. 25.  Morrill, “Ad Hoc Committee for Social Action.”

Notes to Chapter 3 171

26.  Morrill, “Ad Hoc Committee for Social Action.” 27. Roberto Lewis-­Fernández and Neil Krishan Aggarwal, “Culture and Psychiatric Diagnosis,” Cultural Psychiatry 33 (2013): 30. 28. Nathan Hurvitz, “The Status and Tasks of Radical Therapy,” Psychotherapy: Theory, Research and Practice 14, no. 1 (1977): 65–­73, 70. 29.  Morrill, “Psychiatrists for Action on Racism and the Urban Crisis.” 30.  Lowinger, “Radical Psychiatry,” 660. 31.  Quoted in Torrey, American Psychosis, 70. See also Harry Oosterhuis, “Between Institutional Psychiatry and Mental Health Care: Social Psychiatry in The Netherlands, 1916–­2000,” Medical History 48, no. 4 (2004): 413–­428. 32.  Claude Steiner, Scripts People Live (New York: Grove Press, 1974), 16. 33.  Claude Steiner, “Principles,” in Readings in Radical Psychiatry, 11. 34. Martin Halliwell, Therapeutic Communities and Community Healthcare in 1960s America (London: British Library, 2013), 7. 35.  Halliwell, “Therapeutic Communities,” 7. 36.  Paul Lowinger, “The Doctor As Political Activist: A Progress Report,” paper presented at the Conference on Radicals in the Professions, Ann Arbor, MI, July 14–­16, 1967, MS Coll. 592, box 63, folder 806, WJLHAC. 37.  Lowinger, “The Doctor As Political Activist.” 38.  Rob Whitley, “The Antipsychiatry Movement: Dead, Diminishing, or Developing?,” Psychiatric Services 63, no. 10 (2012): 1039–­1041, 1039. 39.  L. Clarke, “Sacred Radical of Psychiatry,” Journal of Psychiatric and Mental Health Nursing 14, no. 5 (2007): 446–­453, 446. 40.  Clarke, “Sacred Radical of Psychiatry,” 451. 41. Paul Lowinger, “The Doctor as Political Activist? Progress Report,” American Journal of Psychotherapy 22, no. 4 (1968): 616–­625. See also Robert Perrucci and Marc Pilisuk, eds., The Triple Revolution: Social Problems in Depth (Boston: Little, Brown, 1968). 42.  Lowinger, “Radical Psychiatry,” 661. 43.  Quotations in this paragraph are from “A Call to Psychiatrists, Medical Students, and Others in Mental Health,” pamphlet, May 1969, MS Coll. 635, box 6, folder 86, WJLHAC. 44.  Walter E. Barton, “Prospects and Perspectives: Implications of Social Change for Psychiatry,” American Journal of Psychiatry 125, no. 2 (1968): 147–­150.

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45.  James V. McConnell, “Psychoanalysis Must Go,” Esquire, October 1968, 176–­177. 46.  McConnell, “Psychoanalysis Must Go.” 47. “The Death of Inaction,” Psychiatric News, October 1968. Some excellent examples of psychiatry’s engagement with the wider world include Bryant Wedge, “Training for a Psychiatry of International Relations,” American Journal of Psychiatry 125, no. 6 (1968): 731–­736; and Howard P. Rome, “Psychiatry and Foreign Affairs: The Expanding Competence of Psychiatry,” American Journal of Psychiatry 125, no. 6 (1968): 725–­730. 48.  Quotations from “Perspectives for the APA under the New Constitution, 1968,” Raymond Waggoner Papers, 1926–­1977, correspondence, folder 2, Bentley Historical Library, University of Michigan, 2, 15–­16, 13 [hereafter RWP]. See also “American Psychiatric Association: The Constitution,” American Journal of Psychiatry 125, no. 3 (1968): 434-­439. 49.  Walter E. Barton, The History and Influence of the American Psychiatric Association (Washington, DC: American Psychiatric Press, 1987), 296. 50.  Raymond W. Waggoner, “Facing the Challenge of Today,” Hospital & Community Psychiatry 20, no. 10 (1969): 295–­299, 298. 51.  Raymond W. Waggoner and Raymond Waggoner Jr., “Psychiatry in the Modern World,” Current Psychiatric Therapies 9 (1969): 1–­9. 52.  “A Call to Psychiatrists, Medical Students, and Others in Mental Health.” 53. Tom Harper and Bob Boone, “The Dilemma of American Psychiatry in the 1960s,” May 1969, MS Coll 635, Box 6, Folder 86, WJLHAC. 54. The block quotation and subsequent quotations are from Harper and Boone, “The Dilemma of American Psychiatry in the 1960s.” 55.  See Robert H. Dolliver, “Classifying the Personality Theories and Personalities of Adler, Freud, and Jung with Introversion/Extraversion,” Individual Psychology 50, no. 2 (1994): 192–­202, 193. 56.  Claude Steiner, “Radical Psychiatry,” in Handbook of Innovative Psychotherapies, ed. Raymond J. Corsini (New York: John Wiley & Sons, 1981), 571. 57.  Hogie Wyckoff, Solving Women’s Problems through Awareness, Action, and Contact (New York: Grove Press, 1977). 58.  Steiner, “Radical Psychiatry,” 571. 59.  Steiner, “Radical Psychiatry,” 571. 60.  Thomas J. Scheff, Being Mentally Ill: A Sociological Theory (Chicago: Aldine Press, 1966), and Thomas Scheff, Labeling Madness (Englewood Cliffs, NJ: Spectrum Books, 1975).

Notes to Chapter 3 173

61.  Steiner, “Radical Psychiatry,” 571. 62.  “Resolution of the Women’s Caucus, APA,” May 9, 1968, MS Coll. 635, box 6, folder 86, WJLHAC. 63.  Andreas Killen, 1973 Nervous Breakdown: Watergate, Warhol and the Birth of Post-­ Sixties America (New York: Bloomsbury, 2006), 26. 64. See also Banaszak-­ Holl, Levitsky, and Zald, eds., Social Movements and the Transformation of American Health Care; Nancy MacLean, The American Women’s Movement, 1945–­2000: A Brief History with Documents (Boston: Bedford/St. Martin’s, 2009); Morgen, Into Our Own Hands; and Hoffman, The Politics of Knowledge. 65.  “Resolution of the Women’s Caucus, APA,” May 9, 1968, MS Coll. 635, box 6, folder 86, WJLHAC. 66. Quoted in Joan Busfield, “Sexism and Psychiatry,” Sociology 23, no. 3 (1989): 343–­364, 344. 67. Raymond Waggoner, “Social Dissonance,” paper delivered at the conference “Freedom and Rebellion: Whither the Establishment,” 1969, Ad Hoc Committee on Conflicts in Society, 1972–­1973, box 11, folder 1, RWP. 68. “Meeting of the APA Ad Hoc Committee on the Use of Psychiatric Facilities for the Commitment of Political Dissenters,” May 17, 1972, Ad Hoc Committee on Conflicts in Society, 1972–­1973, box 11, folders 1–­3, RWP. 69.  “Summary of Meeting of Ad Hoc Committee to Study Conflicts Inherent in the Therapeutic and Institutional Roles of Psychiatry,” November 4, 1972, Ad Hoc Committee on Conflicts in Society, 1972–­1973, box 11, folders 1–­3, RWP. 70.  “Minutes of the Meeting of the Ad Hoc Committee to Study Conflicts Inherent in the Therapeutic and Institutional Roles of Psychiatry,” December 16, 1972, Ad Hoc Committee on Conflicts in Society, 1972–­1973, box 11, folders 1–­3, RWP. 71. Agel, The Radical Therapist, xiii. 72.  Quotations are from Hurvitz, “The Status and Tasks of Radical Therapy,” 67. 73. John A. Talbott, “Radical Psychiatry: An Examination of the Issues,” American Journal of Psychiatry 131, no. 2 (1974): 121–­128, 121–­122. 74. Lucas Richert, “‘Therapy Means Change, Not Peanut Butter’: Radical Psychiatry in the United States, 1967–1975,” Social History of Medicine 27, no. 1 (2014): 104–121, 106. 75.  Quotations in this paragraph are from Richert, “Therapy Means Change,” 106. 76.  Quoted in Talbott, “Radical Psychiatry,” 124–­125. See “Insane Liberation Front,” in Agel The Radical Therapist, 2, 15; “Mental Patients’ Liberation Front: Statement,” in Agel, The Radical Therapist, 2, 24.

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Notes to Chapter 3

77.  Hurvitz, “The Status and Tasks of Radical Therapy,” 68. 78.  Michael E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–­ 1980 (Chicago: University of Chicago Press, 2011), 123. See also Halliwell, Voices of Mental Health, 33. 79.  Carl I. Cohen, Joel S. Feiner, Charles Huffine, et al., “The Future of Community Psychiatry,” Community Mental Health Journal 39, no. 5 (2003): 459–­471, 460–­462. See Morton O. Wagenfeld and Stanley S. Robin, “Social Activism and Psychiatrists in Community Health Centers,” American Journal of Community Psychology 6, no. 3 (1978): 253–­264, 254; and Rodger Doyle, “Deinstitutionalization,” Scientific American 287, no. 38 (December 2002): 38. 80. David J. Rissmiller and Joshua H. Rissmiller, “Evolution of the Antipsychiatry Movement into Mental Health Consumerism,” Psychiatric Services 57, no. 6 (2006): 863–­866, 864. 81.  Rissmiller and Rissmiller, “Evolution of the Antipsychiatry Movement,” 864. 82.  Talbott, telephone interview by author, November 22, 2017. 83.  Alexander Dunst, Madness in Cold War America (New York: Routledge, 2016), 54. 84. In 1971, Steiner offered a breakdown and overview of squares and radicals in mental health. His taxonomy reduced the practitioners to distinct subsets and provided a means to understand the disputes. In one stratum were radicals absolutely certain of the need to modify official psychiatric policies yet who dealt with individual patients in a status quo fashion; another group pushed head-­on, full-­bore into political prescriptions. Certain strata wanted to practice psychiatry in innovative, avant-­garde ways but also desired new forms of political governance that might move the country away from militarism and the overwhelming dominance of corporations, finance, and economics. It was a mixed bag, where different priorities of race, class, and gender melted into and conflicted with one another—­then blended further with intraprofessional discussions of mental health practice. While it’s surely useful to have an insider—­a participant like Steiner—­seek to categorize the movement, the characterization must be treated carefully. In his estimation, Alpha psychiatrists, the largest segment in the profession, were either liberal or conservative in their “political consciousness” and in “practice and methods of psychiatry.” They constituted, in short, the establishment that Steiner wished to overthrow. Beta psychiatrists were similarly liberal or conservative in their politics but employed radical methods and techniques. This meant alternative methods of treating patients, which related to group counseling or the unsanctioned use of drugs. By contrast, Steiner’s third category, the Gamma psychiatrists, were radical in politics and then traditional in everyday practice and in the treatment of patients. The antipsychiatrists R. D. Laing and Thomas Szasz served as examples of this category since they employed “old, outmoded methods of therapy based on Freudian or neo-­Freudian therapy.” Steiner indicated a wholesale break from Sigmund Freud or Carl Jung and

Notes to Chapter 3 175

signaled a movement toward newer methods, including primal therapy or transactional analysis. It was also a declaration of support for Laing and Szasz. The fourth and final type of psychiatrist, a Delta, was radical in both politics and psychiatric practice. 85.  Quoted in Dunst, Madness in Cold War America, 54. 86.  Nick Totton, Psychotherapy and Politics (London: Sage, 2000), 28–­31. 87.  Jerome Agel, ed., Rough Times (New York: Ballantine Books, 1973), ix. 88.  Quoted in Totton, Psychotherapy and Politics, 28. 89. Dunst, Madness in Cold War America. 90.  Thomas Szasz, Coercion as Cure: A Critical History of Psychiatry (New Brunswick, NJ: Transaction Publishers, 2010). 91.  Talbott, “Radical Psychiatry,” 126. 92.  Letter from Michel Foucault to R. D. Laing , December 2, 1979, MS Laing GF35, and letter from Erich Fromm to R. D. Laing , December 20, 1969, MS Laing GF8–­10, R. D. Laing Collection, Special Collections, University of Glasgow. 93. Michael Guy Thompson, “R. D. Laing & Anti-­Psychopathology: The Myth of Mental Illness Redux,” Mad in America, October 26, 2013, https://www.madinamerica .com/2013/10/r-d-laing-anti-psychopathology-myth-mental-illness-redux. 94.  Hurvitz, “The Status and Tasks of Radical Therapy,” 68. 95. See Judi Chamberlin, “The Ex-­ Patients’ Movement: Where We’ve Been and Where We’re Going,” Journal of Mind and Behavior 11, no. 3 (1990): 323–­336, 324–­ 326; and Rissmiller and Rissmiller, “Evolution of the Antipsychiatry Movement,” 865. 96.  Talbott, “Radical Psychiatry,” 126. 97.  Lewis A. Grossman, “The Rise of the Empowered Consumer,” Regulation 37, no. 4 (Winter 2014–­2015): 34–­41, 36. 98.  “Committee Opposing Abuse of Psychiatry—­Pamphlet,” reel 80, folder 3, Social Protest Collection, Bancroft Library, University of California, Berkeley [hereafter SPC]. 99.  “Committee Opposing Abuse of Psychiatry—­Pamphlet.” 100.  “‘The Proposed Project on Life-­Threatening Behavior’ at the Neuropsychiatric Institute, U.C.L.A.,” reel 80, folder 3, SPC. 101.  Geoffrey Reaume, “Lunatic to Patient to Person: Nomenclature in Psychiatric History and the Influence of Patients’ Activism in North America,” International Journal of Law and Psychiatry 25, no. 4 (2002): 4-­5–­426, 415–­417.

176

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102.  Hurvitz, “The Status and Tasks of Radical Therapy,” 14, 65–­73, 67. 103.  Chamberlin, “The Ex-­Patients’ Movement,” 324–­326. See also Richert, “Therapy Means Change,” 104–121. 104. “Judi Chamberlin Letter to New York Times,” June 7, 1977, MS 768, folder A, series 4-­1975-­1978, DOC109, Judi Chamberlin Papers, Special Collections and Archives, University of Massachusetts, Amherst [hereafter JCP]. 105. “Judi Chamberlin Letter to Village Voice,” MS 768 Clippings, series 4-­1971-­ 2006, DOC36, JCP. 106. “National Conference on Human Rights and Psychiatric Oppression Pamphlet,” 1974, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, JCP. 107. “National Conference on Human Rights and Psychiatric Oppression Press Release,” July 1, 1974, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, JCP. 108. Patria Joanne Alvelo, “The Politics of Madness: The Women’s Liberation Movement in the 1970s,” (MA thesis, Sarah Lawrence College, 2009); Chamberlin, “Organizing,” 4, cited in Lenny Lapon, Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany and the United States (Springfield, MA: Psychiatric Genocide Research Institute, 1986), 170. 109. Lapon, Mass Murderers in White Coats, 171. 110. Anonymous to Tom, July 19, 1975, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, Third, 1975, JCP. 111.  Anonymous to Tom, July 19, 1975. 112.  Michael D. Galvin, PhD, to Judi Chamberlin, May 6, 1976, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, Fourth, 1976, JCP. 113.  Judi Chamberlin to Michael D. Galvin, PhD, May 14, 1976, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, Fourth, 1976, JCP. 114.  Michael D. Galvin, PhD, to Judi Chamberlin, May 19, 1976, MS 768, series 2, box 6, Conference on Human Rights and Psychiatric Oppression, Fourth, 1976, JCP. 115.  Michael D. Galvin, PhD, to Judi Chamberlin, May 19, 1976. 116.  Christopher Lasch, “Sacrificing Freud,” New York Times Magazine, February 22, 1976, 11. 117.  Wellcome, “Mental Health: Transforming Research and Treatments,” https:// wellcome.ac.uk/what-we-do/our-work/mental-health-transforming-research-and -treatments.

Notes to Chapter 4 177

118.  Helen Spandler, “The Radical Psychiatrist as Trickster,” in Being Human: Reflections on Mental Distress in Society, ed. Alastair Morgen (Ross-­on-­Wye: PCCS Books, 2008), 84–­99. Chapter 4 1.  Aldous Huxley, “Drugs That Shape Men’s Minds,” Saturday Evening Post, October 18, 1958, 111–­112. 2.  Alfred D. Yassky, “Critique on Primal Therapy,” American Journal of Psychotherapy 33, no. 1 (1979): 119–­127, 125. And see Joel Paris, The Fall of an Icon: Psychoanalysis and Academic Psychiatry (Toronto: University of Toronto Press, 2005) on the decline of psychoanalysis. 3.  Tad Szulc, Innocents at Home: America in the 1970s (New York: Viking Press, 1974), 324. 4. Peter N. Carroll, It Seemed Like Nothing Happened: The Tragedy and Promise of America in the 1970s (New York: Holt, Rinehart and Winston, 1982), 246. See also Douglas Osto, Altered States: Buddhism and Psychedelic Spirituality in America (New York: Columbia University Press, 2016). 5. Daniel Yankelovich, New Rules: Searching for Self-­Fulfillment in a World Turned Upside Down (New York: Random House, 1981), quoted in Peter Clecak, America’s Quest for the Ideal Self (New York: Oxford University Press, 1983), 152. 6.  Henry Allen, “The New Narcissism; ‘The Male Narcissist: He Walks in Beauty . . . and His Face Is His Fortune’,” Washington Post Magazine, June 10, 1978, 21. 7.  See Elizabeth Lunbeck, “Narcissm,” in Rethinking Therapeutic Culture, ed. Timothy Aubry and Trysh Travis (Chicago: University of Chicago Press, 2015). 8.  Yassky, “Critique on Primal Therapy,” 125. 9.  Yassky, “Critique on Primal Therapy.” 10.  Nadine Weidman, “Between the Counterculture and the Corporation: Abraham Maslow and Humanistic Psychology in the 1960s,” in Groovy Science: Knowledge, Innovation, and American Counterculture, ed. David Kaiser and W. Patrick McCray (Chicago: University of Chicago Press, 2016), 121–­122. 11.  Stratton F. Caldwell, “The Human Potential Movement: Forms of Body/Movement/Nonverbal Experiencing,” paper presented at the Forty-­Second Annual Conference of the California Association for Health, Physical Education, and Recreation, March 21–­24, 1975, Los Angeles. 12.  Marion S. Goldman, American Soul Rush: Esalen and the Rise of Spiritual Privilege (New York: New York University Press, 2012), 3–­5.

178

Notes to Chapter 4

13.  Caldwell, “The Human Potential Movement,” 1. 14.  Peter Haldeman, “The Return of Werner Erhard, Father of Self-­Help,” New York Times, November 28, 2015, http://www.nytimes.com/2015/11/29/fashion/the-return -of-werner-erhard-father-of-self-help.html. See also Jesse Kornbluth, “The Fuhrer over EST: Werner Erhard of EST—How the King of the Brain-Snatchers Created His Private Empire,” New York Times Magazine, March 19, 1976. 15.  Jeffrey J. Kripal and Glenn W. Shuck, eds., On the Edge of the Future: Esalen and the Evolution of American Culture (Bloomington: Indiana University Press, 2005), 5. See also George Burr Leonard, Walking on the Edge of the World (Boston: Houghton Mifflin, 1988); and Jeffrey J. Kripal, Esalen: America and the Religion of No Religion (Chicago: University of Chicago Press, 2007). 16.  Quoted in Kripal, Esalen, 219. 17.  Claude Steiner, A Warm Fuzzy Tale (New York: Jalmar Printing, 1969); Steiner, Games Alcoholics Play (New York: Ballantine Books, 1970); Steiner, Scripts People Live (New York: Grove Press, 1974); Claude Steiner, Hogie Wyckoff, Daniel Goldstine, et al., Readings in Radical Psychiatry (New York: Grove Press, 1975). 18.  Claude Steiner, “Radical Psychiatry,” in Handbook of Innovative Psychotherapies, ed. Raymond J. Corsini (New York: John Wiley & Sons, 1981), 570. 19.  Ian Stewart, Eric Berne (London: Sage, 1992), 21. 20.  Lawrence Samuel, Shrink A Cultural History of Psychoanalysis in America (Lincoln: University of Nebraska Press, 2013), 127. 21. Steiner, Scripts People Live, 1. 22. “Eric Berne Letter to the San Francisco Psychoanalytic Institute, 1956-­11-­01.” Eric L. Berne Papers, 1933–­1971, MSS 2003-­12, box 3, folder 12. Eric Berne Collection, Archives and Special Collections, University of California, San Francisco. 23. This incident’s quotations are from “Boring Patient, Voodoo Death,” box 1, folder 9 (1970), MSS 2013–­18. Eric Berne Collection, Archives and Special Collections, University of California, San Francisco. 24.  V. Callaghan, “A Living Euhemerus Never Dies: Section II,” Transactional Analysis Journal 1, no. 1 (1971): 68. 25. William Cheney, “Eric Berne: A Biographical Sketch,” Transactional Analysis Journal 1, no. 1 (1971): 22. 26.  Cheney, “Eric Berne.” 27. Steiner, Scripts People Live, 7–­8. 28.  Arthur Janov, The Primal Scream: Primal Therapy: The Cure for Neurosis (New York: Dell, 1970); Janov, The Anatomy of Mental Illness: The Scientific Basis of Primal Therapy

Notes to Chapter 4 179

(New York: G. P. Putnam, 1971); Janov, The Primal Revolution: Toward a Real World (New York: Simon and Schuster, 1972). 29. Paul Williams and Brian Edgar, “Tommy, Primal Therapy, and the Counter-­ cultural Critique of ‘Sick Society’ and ‘Cripple Psychology’,” Journal of Literary and Cultural Disability Studies 9, no. 2 (2015): 207–­223. 30. Williams and Edgar, “Tommy, Primal Therapy, and the Counter-­cultural Critique of ‘Sick Society’ and ‘Cripple Psychology’.” 31. Noreen Kerr, “Neuroses and Primal Therapy,” Nursing Forum 15, no. 1 (1976): 34–­46. 32.  Thomas Szasz, Ideology and Insanity (Garden City, NY: Anchor Books, 1970); E. Fuller Torrey, The Mind Game: Witchdoctors and Psychiatrists (New York: Emerson Hall Publishers, 1972), 8; Joan Sayre, “Radical Therapy—­A Challenge to Psychiatry?,” Perspectives in Psychiatric Care 12, no. 1 (1974): 27–­31, 30. 33.  “A Call to Psychiatrists, Medical Students, and Others in Mental Health,” pamphlet, May 1969, MS Coll. 635, box 6, folder 86, Walter J. Lear Health Activism Collection, Annenberg Rare Book and Manuscript Library, University of Pennsylvania [hereafter WJLHAC]. 34. Huston Smith, “Psychedelic Theophanies and the Religious Life,” Christianity and Crisis 27, no. 11 (1967): 144–­147. See also Smith, Cleansing the Doors of Perception: The Religious Significance of Etheogenic Plants and Chemicals (New York: Jeremy P. Tarcher/Putnam, 2000). 35.  “A Call to Psychiatrists, Medical Students, and Others in Mental Health.” 36. Harold G. Koenig, “Religion and Medicine I: Historical Background and Reasons for Separation,” International Journal of Psychiatry in Medicine 30, no. 4 (2000): 385–­398. 37. Chris Cook, Andrew Powell, and Andrew Sims, eds., Spirituality and Psychiatry (Glasgow: RCPsych Publications, 2009), 3. 38.  Dominique Wolton, Pope Francis: Politics and Society (Paris: Editions de l’Observatoire, 2017). 39. Andrew R. Heinze, Jews and the American Soul: Human Nature in the Twentieth Century (Princeton, NJ: Princeton University Press, 2004), 77; Pietro Castelnuovo-­ Tedesco, “Psychoanalytic Movement,” in The Freud Encyclopedia: Theory, Therapy, and Culture, ed. Edward Erwin (New York: Routledge, 2002), 445. See also Lasch, “Sacrificing Freud,” 11. 40. “Intercourse: Psychedelic Venus Church,” pamphlet, January 1970, reel 82, folder 36. Psychedelic Venus Church 1969–­70 Social Protest Collection, Bancroft Library, University of California, Berkeley [hereafter SPC].

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41.  “Everything You Always Wanted to Know (but Were Afraid to Ask) about Psychedelic Venus Church,” Nelly Heathen Magazine, August 12, 1973, 10, reel 82, folder 36. Psychedelic Venus Church 1969–­70, SPC. 42. Walter N. Pahnke and William A. Richards, “Implications of LSD and Experimental Mysticism,” in Altered States of Consciousness, ed. Charles T. Tart (New York: John Wiley & Sons, 1969). 43. See Abram Hoffer and Humphry Osmond, The Hallucinogens (New York: Academic Press, 1967). 44.  Historical, anthropological, and enthnographic evidence supported that many, possibly all, earlier cultures used hallucinogens such as mescaline, ayahuasca, and ibogaine. 45.  Lisa Bieberman, “The Psychedelic Experience,” New Republic, August 5, 1967. 46.  J. Hochman, “Iatrogenic Symptoms Associated with a Therapy Cult: Examination of an Extinct ‘New Psychotherapy’ with Respect to Psychiatric Deterioration and ‘Brainwashing’,” Psychiatry 47, no. 4 (1984): 366–­377; S. V. Levine, “Cults and Mental health: Clinical Conclusions,” Canadian Journal of Psychiatry 26, no. 8 (1981): 534–­539. 47.  Kohut’s ideas found in T. B. Feldman and P. W. Johnson, “Cult Membership as a Source of Self-­Cohesion: Forensic Implications,” Bulletin of the American Academy of Psychiatry and the Law 23, no. 2 (1995): 239–­248. 48.  Kelly Boyer Sagert, The 1970s (Westport, CT: Greenwood Press, 2007), 54–­56. 49.  Sukhdev Sandhu, “Going Clear: Scientology, Hollywood and the Prison of Belief by Lawrence Wright—­Review,” Guardian, February 2, 2013, https://www.theguardian .com/books/2013/feb/02/going-clear-scientology-wright-review. 50. Janet Reitman, Inside Scientology: The Story of America’s Most Secretive Religion (Boston: Houghton Mifflin, 2011), 23. 51.  Ronald R. Kline, The Cybernetics Movement: Or Why We Call our Age the Information Age (Baltimore, MD: Johns Hopkins University Press, 2015), 91. 52.  “Look: What Is Scientology?,” pamphlet. April 29, 1971, reel 83, folder 40. Scientology 1969–­77, SPC. 53.  “Look: What Is Scientology?” 54.  “Pamphlets,” reel 83, folder 40, SPC. 55.  “Promotional Material,” February 2, 1970, reel 83, folder 40, Scientology 1969–­ 77, SPC.

Notes to Chapter 5 181

56. L. Ron Hubbard, “Your Right to Greater Personal Ability,” The Auditor 11.97, March 1974, 1, reel 83, folder 40, Scientology 1969–­77, SPC 57.  Brian Stelter and Christine Haughney, “The Atlantic Apologizes for Scientology Ad, and Says It Will Rethink Its Policies,” New York Times, January 15, 2013, B3. See Lawrence Wright, Going Clear: Scientology, Hollywood, and the Prison of Belief (New York: Vintage Books, 2013). 58.  Janet Reitman, “Inside Scientology,” Rolling Stone, February 8, 2011, http://www .rollingstone.com/culture/news/inside-scientology-20110208. 59.  L. Ron Hubbard, Dianetics: The Modern Science of Mental Health, A Handbook of Dianetic Therapy (New York: Hermitage House, 1950), 168. 60.  Hugh B. Urban, The Church of Scientology: A History of a New Religion (Princeton, NJ: Princeton University Press, 2011), 63. 61. Urban, The Church of Scientology. 62. Stephen A. Kent and Terra A. Manca, “A War Over Mental Health Professionalism: Scientology versus Psychiatry,” Mental Health, Religion & Culture 17, no. 1 (2014): 1–­23. 63.  Reitman, “Inside Scientology.” 64. Hans A. Baer, “Partially Professionalized and Lay Heterodox Medical Systems within the Context of the Holistic Health Movement,” in Biomedicine and Alternative Health Systems in America: Issues of Class, Race, Ethnicity, and Gender, ed. Hans A. Baer (Madison: University of Wisconsin Press, 2001), 107. Chapter 5 1. Letter to Wilhelm Fliess, February 1, 1900, in The Complete Letters of Sigmund Freud to Wilhelm Fliess, 1887–­1904, edited by Jeffrey Moussaieff Masson (Cambridge, MA: Belknap Press of Harvard University Press, 1985), 398. 2.  Gerald N. Grob, The Mad among Us: A History of the Care of America’s Mentally Ill (New York: Free Press, 2011), 3. 3.  This should not be confused with another pendulum metaphor, specifically that used by Ingersoll and Rak to describe the spectrum of mood disorders. R. Elliott Ingersoll and Carl F. Rak, Psychopharmacology for Mental Health Professionals: An Integrative Approach (Boston: Cengage Learning, 2016), 188–­189. 4. Richard Lewis Holt, “Pinel and the Pendulum,” in Psychoanalysis and Narrative Medicine, ed. Peter L. Rudnytsky and Rita Charon (Albany: State University of New York Press, 2008), 62. For more on Phillipe Pinel and moral therapy, see Ian Robert Dowbiggin, Inheriting Madness: Professionalization and Psychiatric Knowledge in

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Nineteenth-­Century France (Berkeley: University of California Press, 1991); Jan Goldstein, Console and Classify: The French Psychiatric Profession in the Nineteenth Century (Chicago: University of Chicago Press, 2001); Philippe Pinel, A Treatise on Insanity (London: Messers, Cadell & Davies, Strand, 1806); and Patrick Vandermeersch, “‘Les mythes d’origine’ in the History of Psychiatry,” in Discovering the History of Psychiatry, ed. Mark S. Micale and Roy Porter (Oxford: Oxford University Press, 1994), 219–­231. 5.  Bradley Lewis, Narrative Psychiatry: How Stories Can Shape Clinical Practice (Baltimore: Johns Hopkins University Press, 2011), 61. 6.  Eric Caplan, Mindgames: American Culture and the Birth of Psychotherapy (Berkeley: University of California Press, 2001), 6. 7. Caplan, Mindgames, 6. 8. John R. Seeley, “The Americanization of the Unconscious,” Atlantic, July 1961, 68–­72. See Ethan Watters, Crazy Like Us: The Globalization of the American Psyche (New York: Free Press, 2010), 3. 9. Norman Dain, “Critics and Dissenters: Reflections on ‘Anti-­ psychiatry’ in the United States,” Journal of the History of the Behavioral Sciences 25, no. 1 (1989): 3–­25. See also Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: Anchor Books, 1961); Thomas J. Scheff, Being Mentally Ill: A Sociological Study (Chicago: Aldine, 1966); Thomas Szasz, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Harper & Row, 1961); and E. Fuller Torrey, The Death of Psychiatry (Radnor, PA: Chilton, 1974). 10. Michael B. First, “Paradigm Shifts and the Development of the Diagnostic and Statistical Manual of Mental Disorders: Past Experiences and Future Aspirations,” Canadian Journal of Psychiatry 55, no. 11 (2010): 692–­700, 693. 11.  First, “Paradigm Shifts,” 694. See also Anne Harrington, Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness (New York: W. W. Norton & Company, 2019). 12. Lewis, Narrative Psychiatry, 63; Joel Paris, The Fall of an Icon: Psychoanalysis and Academic Psychiatry (Toronto: University of Toronto Press, 2005), 3. See also Melvin Sabshin, “Turning Points in Twentieth-­ Century American Psychiatry,” American Journal of Psychiatry 147, no. 10 (1990): 1267–­ 1274. For the most part, Sabshin avoids terms like “radical” and, with a focus on the influence of Adolf Meyer, instead emphasizes four major turning points. 13. R. F. Bornstein, “The Impending death of Psychoanalysis,” Psychoanalytic Psychology 18 (2001): 7. 14.  J. Masling, “Empirical Evidence and the Health of Psychoanalysis,” Journal of the American Academy of Psychoanalysis 28 (2000): 682.

Notes to Chapter 5 183

15.  Jonathan Metzl, Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs (Durham, NC: Duke University Press, 2003), 31, 196. 16.  David Healy, Pharmageddon (Berkeley: University of California Press, 2012), 4. 17.  Paul Vitello, “Leo Rangell, a Stalwart of Freudian Talk Therapy, Dies at 97,” New York Times, June 4, 2011, http://www.nytimes.com/2011/06/05/us/05rangell.html?_r =0. See Jonathan Sadowsky, “Beyond the Metaphor of the Pendulum: Electroconvulsive Therapy, Psychoanalysis, and the Styles of American Psychiatry,” Journal of the History of Medicine and Allied Sciences 61, no. 1 (2006): 1–­25. 18.  Martin Halliwell, Therapeutic Revolutions: Medicine, Psychiatry, and American Culture (New Jersey: Rutgers University Press), 13. 19. August B. Hollingshead, “Some Issues in the Epidemiology of Schizophrenia,” American Sociological Review 26, no. 1 (1961): 5–­13, 6–­7. Although dated and somewhat guilty of being a “Whig” view of the history of psychiatry, Gregory Zilboorg’s 1941 work provides an excellent account of changes in psychiatric nomenclature in the nineteenth century and early twentieth century. See Gregory Zilboorg, A History of Medical Psychology (New York: W. W. Norton, 1941). 20.  Hollingshead, “Some Issues,” 7–­8. 21.  Barry J. Gurland, Joseph L. Fleiss, J. E. Cooper, et al., “Cross-­National Study of Diagnosis of Mental Disorders: Hospital Diagnoses and Hospital Patients in New York and London,” Comprehensive Psychiatry 11, no. 1 (1970): 18–­25, 24. 22. David L. Rosenhan, “On Being Sane in Insane Places,” Science 179, no. 4070 (1973): 250–­258. See also Bernard Dixon, “Schizophrenia Controversy,” British Medical Journal 298, no. 6668 (1989): 265. 23.  Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997), 246–­272. 24.  See Irving Bieber, Harvey J. Dain, and Paul R. Dince, et al., Homosexuality: A Psychoanalytic Study (New York: Basic Books, 1962); Desmond Curran and Denis Parr, “Homosexuality: An Analysis of 100 Male Cases Seen in Private Practice,” British Medical Journal 1, no. 5022 (1957): 797–­801; and M. J. MacCulloch and M. P. Feldman, “Aversion Therapy in Management of 43 Homosexuals,” British Medical Journal 2, no. 5552 (1967): 594–­597. 25.  John Bancroft, “Aversion Therapy of Homosexuality,” British Journal of Psychiatry 115, no. 529 (1969): 1417–­1431; Michael E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–­1980 (Chicago: University of Chicago Press, 2011), 124–­127. 26.  E. Fuller Torrey, The Mind Game: Witchdoctors and Psychiatrists (New York: Emerson Hall Publishers, 1972), 8.

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27.  A. C. Gibson, “How ECT Works,” British Medical Journal 4, no. 5989 (1975): 169; J. P. Kelly, “Fractures Complicating ECT,” British Medical Journal 2, no. 4888 (1954): 647–­648. See also Edgar L. Peasley, “For Patients Having Coma Shock Therapy,” American Journal of Nursing 49, no. 10 (1949): 623–­626. 28. Letter to Wilhelm Fliess, February 1, 1900, in Masson, The Complete Letters of Sigmund Freud to Wilhelm Fliess, 398. 29. Torrey, The Death of Psychiatry, 199–­200. 30.  Rick Mayes and Allan V. Horwitz, “DSM-­III and the Revolution in the Classification of Mental Illness,” Journal of the History of Behavioral Sciences 41, no. 3 (2005): 249–­267, 258–­259. 31.  Mayes and Horwitz, “DSM-­III and the Revolution in the Classification of Mental Illness,” 258–­259. 32.  Marc Barasch, “The New Age Interview: R. D. Laing,” New Age Journal, September 1984. 33. Paul Laffey, “Antipsychiatry in Australia: Sources for a Social and Intellectual History,” Health and History 5, no. 2 (2003): 17–­36, 17–­18. 34.  Barasch, “The New Age Interview: R. D. Laing.” 35.  Susie Scott and Charles Thorpe, “The Sociological Imagination of R. D. Laing,” Sociological Theory 24, no. 4 (2006): 331–­352, 332. 36.  Letter between Prof T. Ferguson Rodger and Laing, March 26, 1962, MS Laing DR65, R. D. Laing Collection, Special Collections, University of Glasgow. 37.  For more on this struggle, see Ronald Bayer and Robert L. Spitzer, “Edited Correspondence on the Status of Homosexuality in DSM-­III,” Journal of the History of the Behavioral Sciences 18, no. 1 (1982): 32–­52; Jack Drescher, “The Removal of Homosexuality from the DSM: Its Impact on Today’s Marriage Equality Debate,” Journal of Gay & Lesbian Mental Health 16, no. 2 (2012): 124–­135; G. Rubinstein, “The Decision to Remove Homosexuality from DSM: Twenty Years Later,” American Journal of Psychotherapy 49, no. 3 (1995): 416–­427; and Heather Wyatt Nichol, “Sexual Orientation and Mental Health: Incremental Progression or Radical Change,” Journal of Health and Human Services Administration 37, no. 2 (2014): 225–­241, 234. 38. Mario Rendon, “Psychoanalysis in an Historic-­ Economic Perspective,” in RoseMarie Pérez Foster, Michael Moskowitz, Rafael Art Javier, et al., Reaching Across Boundaries of Culture and Class: Widening the Scope of Psychotherapy (Northvale, NJ: Rowman & Littlefield, 2004), 57. 39.  Rendon, “Psychoanalysis in an Historic-­Economic Perspective,” 57. 40.  Ralph Schoenstein, “Merrily We Probe Along,” Saturday Evening Post, August 25, 1962, 10.

Notes to Chapter 5 185

41.  Karl Popper, Conjectures and Refutations: The Growth of Scientific Knowledge (New York: Basic Books, 1965), 33–­65. 42.  Arnold A. Rogow, The Psychiatrists (New York: G.P. Putnam’s & Sons, 1970), 15; T. M. Luhrman, Of Two Minds: An Anthropologist Looks at American Psychiatry (New York: Vintage Books, 2001), 225. 43.  Rendon, “Psychoanalysis in an Historic-­Economic Perspective,” 58. 44.  Allan V. Horwitz, Creating Mental Illness (Chicago: University of Chicago Press, 2002), 3, 5. 45.  Allen Frances, Saving Normal: An Insider’s Revolt against Out-­of-­Control Psychiatric Diagnosis, DSM-­5, Big Pharma, and the Medicalization of Ordinary Life (New York: William Morrow, 2013), xii. 46.  Stuart A. Kirk and Herb Kutchins, The Selling of DSM: The Rhetoric of Science in Psychiatry (New York: Aldine de Gruyter, 1992). 47.  Rendon, “Psychoanalysis in an Historic-­Economic Perspective,” 58. 48.  Sabshin, “Turning Points,” 1270. 49. Shadia Kawa and James Giordano, “A Brief Historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and Implications for the Future of Psychiatric Canon and Practice,” Philosophy, Ethics, and Humanities in Medicine 7, no. 2 (2012): 1–­9, 4. 50. Hannah S. Decker, The Making of DSM-­III: A Diagnostic Manual’s Conquest of American Psychiatry (New York: Oxford University Press, 2013), xxii. 51.  David Frum, How We Got Here: The 70’s, The Decade That Brought You Modern Life (For Better or Worse) (New York: Basic Books, 2000), 173–­175. 52.  Robert L. Spitzer, “The Diagnostic Status of Homosexuality in DSM-­III: A Reformulation of the Issues,” American Journal of Psychiatry 138, no. 2 (1981): 210–­215. 53.  Benedict Carey, “Psychiatry Giant Sorry Backing Gay ‘Cure,’” New York Times, May 18, 2012, http://www.nytimes.com/2012/05/19/health/dr-robert-l-spitzer-noted -psychiatrist-apologizes-for-study-on-gay-cure.html?_r=0. 54.  Carey, “Psychiatry Giant Sorry Backing Gay ‘Cure.’” 55. Seymour Kety, “The Academic Lecture: The Heuristic Aspect of Psychiatry,” American Journal of Psychiatry 118, no. 5 (1961): 385–­397. 56. Amedeo Giorgi, Psychology as a Human Science: A Phenomenologically Based Approach (New York: Harper & Row, 1970). 57. Mitchell Wilson, “DSM-­III and the Transformation of American Psychiatry: A History,” American Journal of Psychiatry 150, no. 3 (1993): 399–­410, 403.

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58. Seyyed Nassir Ghaemi, “Paradigms of Psychiatry: Eclecticism and Its Discontents,” Current Opinion in Psychiatry 19, no. 6 (2006): 619–­624; Alan A. Baumeister and Mike F. Hawkins, “Continuity and Discontinuity in the Historical Development of Modern Psychopharmacology,” Journal of the History of the Neurosciences 14, no. 3 (2005): 199–­209. 59. David Bloor, Knowledge and Social Imagery (London: Routledge & Kegan Paul, 1976), 2. 60. First, “Paradigm Shifts”; Kawa and Giordano, “A Brief Historicity of the Diagnostic and Statistical Manual of Mental Disorders.” See also Ian Hacking, “Lost in the Forest,” London Review of Books 35, no. 15 (August 8, 2013), http://www.lrb.co.uk/ v35/n15/ian-hacking/lost-in-the-forest. 61.  Sabshin, “Turning Points,” 1272; G. L. Klerman, G. E. Vaillant, R. L. Spitzer, et al., “A Debate on DSM-­III,” American Journal of Psychiatry 141, no. 4 (1984): 539–­553, 539. 62.  Gary Greenberg, The Book of Woe: The DSM and the Unmaking of the Psychiatry (New York: Blue Rider Press, 2013), 25. 63. Klerman, Vaillant, Spitzer, et al., “A Debate on DSM-­ III,” 539–­ 540; Owen Whooley, “Diagnostic Ambivalence: Psychiatric Workarounds and the Diagnostic and Statistical Manuals of Mental Disorders,” Sociology of Health & Illness 32, no. 3 (2010): 452–­469, 453. 64.  American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (Washington, DC: American Psychiatric Association, 1980). Edward Shorter summed up these changes by stating that “biological psychiatry came roaring back on stage, displacing psychoanalysis as the dominant paradigm and returning psychiatry to the fold of the other medical specialties.” See Shorter, A History of Psychiatry, 239. 65.  Gerald N. Grob, “Public Policy and Mental Illnesses: Jimmy Carter’s Presidential Commission on Mental Health,” The Milbank Quarterly 83, no. 3 (2005): 425–456, 427; Grob, “Mental Health Policy in the Liberal State: The Example of the United States,” International Journal of Law and Psychiatry 31, no. 2 (2008): 89–­100. 66.  Health: United States 1975 (Washington, DC: Department of Health, Education, and Welfare, 1975), and Health: United States, 1976–­1977 (Washington, DC: Department of Health, Education, and Welfare, 1976). 67. Franklin D. Chu and Sharland Trotter, The Madness Establishment (New York: Grossman, 1974). 68.  Quoted in Martin Halliwell, Voices of Mental Health: Medicine, Politics, and American Culture (New Brunswick, NJ: Rutgers University Press, 2017), 37. 69.  Grob, “Public Policy and Mental Illnesses.”

Notes to Chapter 5 187

70. James Fallows, “The Passionless Presidency: The Trouble with Jimmy Carter’s Administration,” Atlantic Monthly, May 1979, 33–­48. 71. Philip J. Hilts, Protecting America’s Health: The FDA, Business, and One Hundred Years of Regulation (New York: Alfred A. Knopf, 2003), 207. 72. John Sloan, The Reagan Effect: Economics and Presidential Leadership (Lawrence: University Press of Kansas, 1999), 37. 73.  Joseph Paul Hile interview, August 4, 1988, accession number 0756, FDA Oral History Collection, National Library of Medicine, Bethesda, Maryland, 52–­53. 74.  Grob, “Public Policy and Mental Illnesses.” 75.  Nicolas Henckes, “Magic Bullet in the Head?,” in Therapeutic Revolutions: Pharmaceuticals and Social Change in the Twentieth Century, ed. Jeremy A. Greene, Flurin Condrau, and Elizabeth Siegel Watkins (Chicago: University of Chicago Press, 2016). 76.  Jimmy Carter, “President’s Commission on Mental Health Remarks on Receiving the Commission’s Final Report,” April 27, 1978, in Gerhard Peters and John T. Woolley, The American Presidency Project, http://www.presidency.ucsb.edu/ws/ ?pid=30714. 77.  Grob, “Public Policy and Mental Illnesses,” 429. 78.  Carter, “President’s Commission on Mental Health Remarks.” 79.  A. Gauld, A History of Hypnotism (Cambridge: Cambridge University Press, 1995); Richard Kammann, The Psychology of the Psychic (Amherst, NY: Prometheus Books, 2000): 137–­187. 80. Joseph Hanlon, “Uri Geller and Science,” New Scientist 64, no. 919 (1974): 170–­190. Consulted in Papers of Arthur Koestler, MS 2407.3.114–­124, Centre for Research Collections, University of Edinburgh [hereafter CRC]. 81. Letter from Sir Alister Hardy to Arthur Koestler, January 29, 1973,MS 2344, folder 4, CRC; letter between Sir Alister Hardy and Arthur Koestler, March 29, 1972, MS2344, folder 4, CRC. 82. Bernard Dixon, “Comment: Lessons of the Geller affair,” New Scientist 64, no. 922 (1974): 379. Consulted in Papers of Arthur Koestler, MS 2407.3.103, CRC. 83.  David J. Hess, Science in the New Age: The Paranormal, Its Defenders and Debunkers, and American Culture (Madison: University of Wisconsin Press, 1993), 122. See also Shaila K. Dewan, “Do Horror Films Filter the Horrors of History?,” New York Times, October 14, 2000. 84. J. Hoberman, “‘Close Encounters’ Was When the Movies Got New-­Age Religion,” New York Times, August 31, 2017. 85.  Hoberman, “‘Close Encounters’ Was When the Movies Got New-­Age Religion.”

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86. Kurtz quoted in Kendrick Frazier, “Science and the Parascience Cults,” Science News 9 (1976): 346. 87.  Quoted in Gordon Stein, ed., The Encyclopedia of the Paranormal (Amherst, NY: Prometheus Books, 1996), 161–­180. 88.  Kurtz quoted in Frazier, “Science and the Parascience of Cults,” 346; see also J. McClenon, Deviant Science: The Case of Parapsychology (Philadelphia: University of Pennsylvania Press, 1986); J. W. Monroe, Laboratories of Faith: Mesmerism, Spiritism, and Occultism in Modern France (Ithaca, NY: Cornell University Press, 2008). 89. Kurt Anderson, Fantasyland: How America Went Haywire (New York: Random House, 2017), 4–­6. 90. Ingrid Kloosterman, “Psychical Research and Parapsychology Interpreted: Suggestions from the International Historiography of Psychical Research and Parapsychology for Investigating Its History in the Netherlands,” History of the Human Sciences 25, no. 2 (2012): 2–­22. 91. Caplan, Mindgames, 2–­3; Torrey, The Mind Game, x. See also Jack Pressman, Last Resort: Psychosurgery and the Limits of Medicine (Cambridge: Cambridge University Press, 1998). Here I am also referring to relatively new trends in the historiography. See Laura Hirshbein, Smoking Privileges: Psychiatry, the Mentally Ill, and the Tobacco Industry in America (New Brunswick, NJ: Rutgers University Press, 2015); Mat Savelli and Sarah Marks, eds., Psychiatry in Communist Europe (Basingstoke: Palgrave Macmillan, 2015); and Mimi Waltz, Autism: A Social and Medical History (Basingstoke: Palgrave Macmillan, 2013). 92. Nancy Tomes, “The Great Restraint Controversy: A Comparative Perspective on Anglo-­American Psychiatrists in the Nineteenth Century,” in Anatomy of Madness: Essays in the History of Psychiatry, Volume III, The Asylum and Its Psychiatry, ed. William F. Bynum, Roy Porter, and Michael Shepherd (London: Routledge, 1988), 190–­225. 93. William C. Menninger, Psychiatry in a Troubled World: Yesterday’s War and Today’s Challenge (New York: Macmillan, 1948), 558. See also Nathan G. Hale, The Rise and Crisis of Psychoanalysis in the United States: Freud and the Americans, 1917–­ 1985 (New York: Oxford University Press, 1995), 13. Hale argues that World War I provided psychiatrists with “a new sense of mission and an expanded role.” Chapter 6 1.  “C. G. Jung Letter to Victor White,” April 10, 1954, in C. G. Jung Letters, vol. 2, 1951–­1961, trans. Jeffrey Hulen, edited by Gerhard Adler (Princeton, NJ: Princeton University Press, 1975), 172.

Notes to Chapter 6 189

2.  Hal Bridges, “Aldous Huxley: Exponent of Mysticism in America,” Journal of the American Academy of Religion 37, no. 4 (1969): 341–­352. See also June Deery, Aldous Huxley and the Mysticism of Science (New York: St. Martin’s Press, 1996). 3.  Steven Johnson, Mind Wide Open: Your Brain and the Neuroscience of Everyday Life (New York: Scribner, 2004). 4.  Aldous Huxley, “Drugs That Shape Men’s Minds,” Saturday Evening Post, October 18, 1958, 111–­112, 112. 5.  Aldous Huxley letter, January 27, 1963, Sanford Unger Papers, MSP 69, folder 1, Psychoactive Substances Collection, Archives and Special Collections, Purdue University [hereafter PSC]. 6.  Eric Kast, “A Concept of Death,” in Psychedelics: The Uses and Implications of Hallucinogenic Drugs, ed. Bernard S. Aaronson and Humphry Osmond (Garden City, NY: Doubleday, 1970), 366–­381. 7.  Jerry Avorn, “Stanislav Grof: Beyond the Bounds of Psychoanalysis,” Intellectual Digest, September 1972, 86–­87. 8.  “A Trip Before Dying,” Newsweek, November 29, 1971, 67–­68. 9.  Avorn, “Stanislav Grof,” 86–­87. 10. Tom Huth, “Maryland Doctors Use LSD to Explore Minds,” Washington Post, November 19, 1972, A1. 11.  Paul R. Torrens, ed., Hospice Programs and Public Policy (Chicago: American Hospital Association Publishing, 1985), 8. See also Ann Neumann, The Good Death: An Exploration of Dying in America (Boston: Beacon Press, 2016). 12. Eric Kast and Vincent Collins, “Lysergic Acid Diethylamide as an Analgesic Agent,” Anesthesia & Analgesia 43, no. 3 (1964): 285–­291, 285. 13. Letter to W. Harman, December 16, 1965, K-­PP149-­2-­3-­29–­013, Dame Cicely Saunders Collection, Archives, King’s College London [hereafter DCSC]. 14.  Letter to C. Saunders, March 7, 1966, K-­PP149-­2-­3-­29–­013, DCSC. 15.  Renie Schapiro, “LSD for the Dying,” Sunday Times, August 31, 1975, 9. 16.  Avorn, “Stanislav Grof,” 88. 17. Drugs of Hallucination Notes, K-­PP149-­2-­3-­29–­011, DCSC; letter to Saunders from David Ryde, July 15, 1964, K-­PP149-­2-­3-­010, DCSC. 18.  Letter to Saunders from David Ryde, July 15, 1964, K-­PP149-­2-­3-­010, DCSC. 19.  Bertha Phillips Rodger, “Hypnosis: As an Adjunct to Delivery Room Anesthesia,” Anesthesia and Analgesia 40, no. 2 (1961): 206–­209. Found in K-­PP149-­2-­3-­20–­004, DCSC.

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20.  Bertha P. Rodger, “Magic or Medicine.” Found in K-­PP149-­2-­3-­29–­005, DCSC. 21.  Bertha P. Rodger, “Hypnosis in Anesthesia: Some Psychological Considerations,” American Journal of Clinical Hypnosis 4, no. 4 (1962): 237–­238. 22.  Lenora F. Paradis and Scott B. Cummings, “The Evolution of Hospice in America toward Organizational Homogeneity,” Journal of Health and Social Behavior 27, no. 4 (1986): 370–­386. 23.  Robert W. Buckingham, “Hospice and Health Policy,” Health Policy and Education 1, no. 4 (1980): 303–­315. 24.  Laura Newman, “Elisabeth Kübler-­Ross: Psychiatrist and Pioneer of the Death-­ and-­Dying Movement,” British Medical Journal 329, no. 7466 (2004): 627. 25. Cicely Saunders, “Hospice Pioneer: Interview by Gill Oliver,” Nursing Standard 13, no. 47 (1999): 18. 26.  Paradis and Cummings, “The Evolution of Hospice in America.” 27. Erika Dyck, Psychedelic Psychiatry: LSD from Clinic to Campus (Baltimore, MD: Johns Hopkins University Press, 2008). 28.  Martin A. Lee and Bruce Shlain, Acid Dreams: The Complete Social History of LSD: The CIA, the Sixties, and Beyond (New York: Grove Weidenfeld, 1992); David Farber, “The Intoxicated/Illegal Nation: Drugs in the Sixties Counterculture,” in Imagine Nation: The American Counterculture of the 1960s and ’70s, ed. Peter Braunstein and Michael William Doyle (New York: Routledge, 2002), 17–­40. 29. “Castalia Foundation: Experiential Workshops,” pamphlet, MS Laing GM139, R. D. Laing Collection, Special Collections, University of Glasgow [hereafter RDLC]. 30. Lisa Bieberman, who had been with the Leary-­ led Cambridge psychedelic movement since 1962, cautioned against those who thought a fake church was better than none. By 1967 Bieberman had had enough of the outlandish religious spectacle perpetrated by Leary and others. “Does the psychedelic experience really have to be offered to the public in the form of bizarre shows?” she asked. “Do the psychedelic people have to live in squalid ghettos?” she wondered. Furthermore, did “their conversation[s] have to be a rapid-­fire rap of slogans and meaningless declarations of ‘love’?” She warned of false prophets and peculiar religious retreats, such as Millbrook. In doing so, wittingly or not, she echoed many so-­called “conservatives” in medicine, who lamented the undermining of the drug. “If the utopian vision of 1962 was too good to be true,” she asserted, “it does not follow that what came out of that had to be this bad.” In making this argument, she also pushed back against the counterculture. See “Dr. Timothy Leary,” Harvard Law School Forum, November 4, 1966, pamphlet, William Richards Papers, MSP 67, folder 5, PSC; and Lisa Bieberman, “The Psychedelic Experience,” New Republic, August 5, 1967. See also Steven J. Novak, “LSD before Leary: Sidney Cohen’s Critique of 1950s Psychedelic Drug Research,” Isis 88, no. 1 (1997): 87–­110.

Notes to Chapter 6 191

31.  Erica Rex, “Calming a Turbulent Mind,” Scientific American 24, no. 2 (May/June 2013): 58–­66, 68. 32. Lester Grinspoon and James B. Bakalar, “Can Drugs Be Used to Enhance the Psychotherapeutic Process?,” American Journal of Psychotherapy 40, no. 3 (1986): 393–­ 404, 401. 33.  Alexander Dunst, Madness in Cold War America (New York: Routledge, 2016). 34.  Letter between R. D. Laing and Nicolas Malleson, MD, March 7, 1968, MS Laing GM139, RDLC. 35.  Letter between Hollywood Hospital (Dr Frank Ogden, Psychedelic Therapist and Laing), Hollywood Hospital, 515 Fifth Ave, New Westminster BC, 2–­8621 3 November 1965, MS Laing GM139, RDLC. 36. Letter between R. A. Sandison and Laing, June 18, 1970, MS Laing GM139, RDLC. 37. Comments on a provisional draft, “Lysergic Acid Diethylamide” (by Dr Herxheimer), for Drugs and Therapeutic Bulletin, April 9, 1965, MS Laing GM139, RDLC. 38.  Alexandra Chasin, Assassin of Youth: A Kaleidoscopic History of Harry J. Anslinger’s War on Drugs (Chicago: University of Chicago Press, 2016), 137. 39. Joan Busfield, “Sexism and Psychiatry,” Sociology 23, no. 3 (1989): 343–­ 364, 343–­345; Daniel Burston, The Wing of Madness: The Life and Work of R. D. Laing (Cambridge, MA: Harvard University Press, 1996). See also:Maggie K. Tonkin, “‘The Time of the Loony’: Psychosis, Alienation, and R.D. Laing in the Fictions of Muriel Spark and Angela Carter,” Contemporary Women’s Writing 9, no. 3 (2015): 366–­384, 373. 40.  Letter from Abram Hoffer to Ralph Metzner, January 9, 1967, MSP 88, folder 1, Hoffer correspondence, PSC. 41. U.S. House of Representatives, Committee on the Judiciary, Impeachment: Selected Materials (Washington, DC: Government Printing Office, 1998), 121; See also Douglas Brinkley and Luke Nichter, The Nixon Tapes: 1973 (Boston: Houghton Mifflin Harcourt, 2015), 368. See also Barry Werth, 31 Days: Gerald Ford, the Nixon Pardon, and a Government in Crisis (New York: Anchor Books, 2007), 131–­132. 42.  Jack Sirica, “A Father’s Reluctant Judgment on Nixon,” Baltimore Sun, May 2, 1994, http://articles.baltimoresun.com/1994-05-02/news/1994122182_1_nixon-water gate-father/2. See Laura Kalman, Right Star Rising: A New Politics, 1974–­1980 (New York: W. W. Norton, 2010); Andreas Killen, 1973 Nervous Breakdown: Watergate, Warhol and the Birth of Post-­Sixties America (New York: Bloomsbury, 2006). 43.  Sirica, “A Father’s Reluctant Judgment on Nixon.”

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44. National Commission on Marihuana and Drug Abuse, Marihuana: A Signal of Misunderstanding (Washington, DC: Government Printing Office, 1972). 45.  U.S. President’s Commission on Organized Crime, America’s Habit: Drug Abuse, Drug Trafficking, and Organized Crime: Report to the President and Attorney General (Washington, DC: Government Printing Office, 1986), 54. 46.  “A Puff of Logic: Correlation Is Not Causation,” Economist, June 28, 2014, http:// www.economist.com/news/science-and-technology/21605870-correlation-not -necessarily-causation-puff-logic. 47. Emily Dufton, Grass Roots: The Rise and Fall and Rise of Marijuana in America (New York: Basic Books, 2017). 48.  David Downs, “The Science behind the DEA’s Long War on Marijuana,” Scientific American, April 19, 2016, https://www.scientificamerican.com/article/the-science -behind-the-dea-s-long-war-on-marijuana. 49.  Marcel Martel, Not This Time: Canadians, Public Policy, and the Marijuana Question, 1961–­1975 (Toronto: University of Toronto Press, 2006); Montigny, ed., The Real Dope; Martin A. Lee, Smoke Signals: A Social History of Marijuana: Medical, Recreational, and Scientific (New York: Scribner, 2013). In the United Kingdom, James H. Mills has produced books that examine the global and British history of cannabis. See his Cannabis Britannica: Empire, Trade, and Prohibition 1800–­1928 (Oxford: Oxford University Press, 2005), and Cannabis Nation: Control and Consumption in Britain, 1928–­2008 (Oxford: Oxford University Press, 2013). 50. Erich Goode and Nachman Ben-­Yehuda, Moral Panics: The Social Construction of Deviance (Oxford: Wiley-­Blackwell, 2009), 81; Benjamin Cornwell and Annulla Linders, “The Myth of ‘Moral Panic’: An Alternative Account of LSD Prohibition,” Deviant Behavior 23, no. 4 (2002): 307–­330; Robert B. Horowitz, “Understanding Deregulation,” Theory and Society 15, nos. 1/2 (1986): 139–­174, 139–­140. 51. For a discussion of consumer protection in the realm of the pharmaceutical industry, see Lucas Richert, Conservatism, Consumer Choice and the Food and Drug Administration during the Reagan Era: A Prescription for Scandal (Lanham, MD: Lexington Books, 2014). 52. David J. Castle and Robin M. Murray, eds., Marijuana and Madness: Psychiatry and Neurobiology (Cambridge: Cambridge University Press, 2004). 53.  Walter Bromberg, “Marihuana: A Psychiatric Study,” in Drugs in America: A Documentary History, ed. David F. Musto (New York: New York University Press, 2002), 441. 54.  Quoted in Julia Buxton, The Political Economy of Narcotics: Production, Consumption and Global Markets (London: Zed Books, 2006), 49. See also Walter Bromberg, “Marihuana Intoxication: A Clinical Study of Cannabis sativa Intoxication,” American

Notes to Chapter 6 193

Journal of Psychiatry 91 (1934): 303–­330; Bromberg, “Menace of Marihuana,” Medical Record 142 (1935): 309–­311; and Bromberg, “Marihuana, A Psychiatric Study,” Journal of the American Medical Association 113 (1939): 4–­12. 55.  S. Allentuck and K. M. Bowman, “The Psychiatric Aspects of Marihuana Intoxication,” American Journal of Psychiatry 99 (1942): 248–­251; Bromberg, “Marihuana: A Psychiatric Study”; Bromberg, “Marihuana Intoxication”; H. C. Curtis and J. R. Wolfe, “Psychosis Following the Use of Marihuana with Report of Cases,” Journal of the Kansas Medical Society 40 (1939): 515–­517, 526–­528; A. T. Weil and N. E. Zinberg, “Acute Effects of Marihuana on Speech,” Nature 222, no. 5192 (1969): 434–­437; A. T. Weil, N. E. Zinberg, and J. M. Nelsen, “Clinical and Psychological Effects of Marihuana in Man,” Science 162 (1968): 1234–­1242. 56.  Quoted in David E. Newton, Science and Political Controversy: A Reference Handbook (Oxford: ABC-­CLIO, 2014), 87. 57. H. J. Anslinger and Courtney Ryley Cooper, “Marijuana: Assassin of Youth,” American Magazine 124, no. 1 (July 1937): 18ff. 58. Stephen A. Maisto, Mark Galizio, and Gerard J. Connors, Drug Use and Abuse (Stamford, CT: Cengage Learning, 2015), 263. See also Chasin, Assassin of Youth. 59.  Quoted in Matthew B. Robinson and Renee G. Scherlen, Lies, Damned Lies, and Drug War Statistics: A Critical Analysis of the Claims Made by the Office of National Drug Control Policy, 2nd ed. (Albany: State University of New York Press, 2014), 10. 60. Richard J. Miller, Drugged: The Science and Culture Behind Psychotropic Drugs (Oxford: Oxford University Press, 2014), 242–­243. 61. David R. Bewley-­Taylor, International Drug Control: Consensus Fractured (Cambridge: Cambridge University Press, 2012); Bewley-­ Taylor, The United States and International Drug Control, 1909–­1997 (London: Continuum, 2001); World Health Organization, WHO Expert Committee on Drug Dependence, Sixteenth Report (Geneva: World Health Organization, 1969), 19–­20, http://whqlibdoc.who.int/trs/WHO_TRS _407.pdf; World Health Organization, WHO Expert Committee on Drug Dependence, Seventeenth Report (Geneva: World Health Organization, 1970), 13, http://whqlibdoc .who.int/trs/WHO_TRS_437.pdf. 62.  David F. Musto and Pamela Korsmeyer, The Quest for Drug Control: Politics and Federal Policy in a Period of Increasing Substance Abuse, 1963–­1981 (New Haven, CT: Yale University Press, 2002), xviii. 63. Paul Lowinger, “Psychiatrists, Marihuana, and the Law: A Survey,” paper presented at the American Orthopsychiatric Association Annual Meeting, San Francisco, March 23–­26, 1970; Stanley P. Barron, Paul Lowinger, and Eugene Ebner, “A Clinical Examination of Chronic LSD Use in the Community,” Comprehensive

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Psychiatry 11, no. 1 (1970): 69–­79. See also Paul Lowinger and Philip L. Polakoff, “Do Medical Students ‘Turn On’?,” Comprehensive Psychiatry 13, no. 2 (1972): 185–­188. 64.  James R. Allen and Louis Jolyon West. “Flight from Violence: Hippies and the Green Rebellion,” American Journal of Psychiatry 125, no. 3 (1968): 364–­370. 65.  John Charles Chasteen, Getting High: Marijuana through the Ages (Lanham, MD: Rowman & Littlefield, 2016), 1. 66. Ehrlichman quoted in Tom LoBianco, “Report: Aide Says Nixon’s War on Drugs Targeted Blacks, Hippies,” CNN, March 24, 2016, http://edition.cnn.com/ 2016/03/23/politics/john-ehrlichman-richard-nixon-drug-war-blacks-hippie. See Dan Baum, “Legalize It All,” Harper’s Magazine, April 2016, http://harpers.org/archive/2016/ 04/legalize-it-all. 67. William C. Berman, America’s Right Turn: From Nixon to Bush (Baltimore, MD: Johns Hopkins University Press, 1994), 9; Jerome L. Himmelstein, To the Right: The Transformation of American Conservatism (Berkeley: University of California Press, 1990), 6–­10. 68. “May 13th 1971 between 10:30am and 12:30pm Oval Office Conversation 498-­5 meeting with Nixon, Halderman and Ehrlichman.” Quoted in Sunil Kumar Aggarwal, “Health Scientist Blacklisting and the Meaning of Marijuana in the Oval Office in the Early 1970s,” CASP Communications, July 1, 2015, https://medium.com/ @ReachCASP/health-scientist-blacklisting-and-the-meaning-of-marijuana-in-the -oval-office-in-the-early-1970s-71ea41427b49. 69.  Donald B. Louria, The Drug Scene (New York: McGraw-­Hill, 1968), 101. 70. Henry Brill, “Why Not Pot Now? Some Questions and Answers about Marijuana,” Psychiatric Opinion 5, no. 5 (1968): 16–­21, 19. See also Walter Bromberg, “Marijuana—­ Thirty Years On,” American Journal of Psychiatry 125, no. 3 (1968): 391–­393. 71.  Alex Berenson, Tell Your Children: The Truth about Marijuana, Mental Illness, and Violence (New York: Free Press, 2019). 72. Quoted in Lawrence A. Gooberman, Operation Intercept: The Multiple Consequences of Public Policy (New York: Pergamon Press, 1974), 162. 73. B. Defer and M. L. Diehl, “Les psychoses aigues: A propose de 560 Observations,” Annales Médico-­Psychologiques 126, no. 2 (1968): 260–­266; M. H. Keeler, “Alarihuana Induced Hallucinations,” Diseases of the Nervous System 29 (1968): 314–­315; M. H. Keeler and C. B. Reifler, “Grand Mal Convulsions Subsequent to Marihuana Use: Case Report,” Diseases of the Nervous System, 28 (1967): 474–­475; M. H. Keeler, “Adverse Reaction to Marihuana,” American Journal of Psychiatry 124, no. 5 (1968): 674–­677; H. S. Kaplan, “Psychosis Associated with Marihuana,” New York State Journal of Medicine 71, no. 4 (1971): 433–­435; John A. Talbott, “Pot Reactions,” USARMY

Notes to Chapter 6 195

Medical Bulletin, 1968, 40–­41; John A. Talbot and James W. Teague, “Marihuana, Psychosis: Acute Toxic Psychosis Associated with the Use of Cannabis Derivatives,” Journal of the American Medical Association 210, no. 2 (1969): 299–­302. 74.  Victoria Stern, “Can Marijuana Cause Psychosis?” Scientific American, September 1, 2014, 2017, https://www.scientificamerican.com/article/can-marijuana-cause -psychosis. 75.  Stern, “Can Marijuana Cause Psychosis?” Another study, conducted in Australia over a thirty-­year period, also found no increase in schizophrenia diagnoses among the general population despite rising rates of teen marijuana use. These authors concluded that although cannabis most likely does not cause schizophrenia, its use might trigger psychosis in vulnerable people or exacerbate an existing condition. 76.  Ben Sessa, interview by author, Bristol, October 31, 2017. 77.  David E. Smith, “Acute and Chronic Toxicity of Marijuana,” Journal of Psychedelic Drugs 2, no. 1 (1968): 37–­48, 41. See also Weil, Zinberg, and Nelsen, “Clinical and Psychological Effects of Marihuana in Man”; N. E. Zinberg and A. T. Weil, “Cannabis: The First Controlled Experiment,” New Society, January 19, 1969, 84–­86; N. E. Zinberg and A. T. Weil, “The Effects of Marijuana on Human Beings,” New York Times Magazine, May 11, 1969, 28–­29, 79ff; and A. T. Weil, “Marihuana,” letter to the editor, Science 163, no. 3872 (1969): 5. 78. Stanley F. Yolles, “Pot Is Painted Too Black,” Washington Post, September 21, 1969, C4. Compare this later statement with those Yolles made in the National Clearinghouse for Mental Health Information, NIMH pamphlet, published in part as “Authority on Drugs,” New York Times, March 7, 1968, 26, and the article “Before Your Kid Tries Drugs; Why Do Drug-­Taking Kids Ward Off Reality?,” New York Times Magazine, November 17, 1968, 124. 79.  Views on Marijuana: Hearings before the House of Representatives Select Committee on Crime, Crime in America, 91st Cong., 1st sess., October 14 and 15, 1969, 67, 50. Washington, DC. 80. “May 26, 1971, Time: 10:03 am–­ 11:35 am—­ Oval Office—­ Conversation: 505-­4—­Meeting with Nixon and HR ‘Bob’ Haldeman.” Quoted in Aggarwal, “Health Scientist Blacklisting.” 81. Lowinger, “Psychiatrists, Marihuana, and the Law”; Barron, Ebner, and Lowinger, “A Clinical Examination of Chronic LSD Use in the Community.” See also Lowinger and Polakoff, “Do Medical Students ‘Turn On’?” 82.  Lowinger and Polakoff, “Do Medical Students ‘Turn On’?,” 185. 83.  Lowinger, “Psychiatrists, Marihuana, and the Law,” 7. 84.  Lowinger and Polakoff, “Do Medical Students ‘Turn On’?,” 187.

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Notes to Chapter 6

85. Lowinger and Polakoff, “Do Medical Students ‘Turn On’?,” 188. For more on Sinclair, see John Sinclair, Guitar Army: Rock and Revolution with MC5 and the White Panther Party (Los Angeles: Process, 2007); and Nick Hefferman, “The Defeat of the Guitar Army: Don DeLillo, John Sinclair, and the Rock Revolution,” Comparative American Studies 10, no. 4 (2012): 338–­361. 86. “September 9, 1971, 3:03 pm–­ 3:34 pm—­ Oval Office Conversation No. 5684—­The President met with Raymond P. Shafer, Jerome H. Jaffe, and Egil G. (‘Bud’) Krogh, Jr.; the White House photographer was present at the beginning of the meeting.” Source available at CSDP.org and quoted in Aggarwal, “Health Scientist Blacklisting.” 87.  Lowinger, “Psychiatrists, Marihuana, and the Law,” 10. 88. John C. McWilliams, “Unsung Partner against Crime: Harry J. Anslinger and the Federal Bureau of Narcotics, 1930–­1962,” Pennsylvania Magazine of History and Biography 113, no. 2 (1989): 207–­236; James Sterba, “The Politics of Pot,” Esquire, August 1968, 118–­119. 89.  U.S. Project MKULTRA, the CIA’s Program of Research in Behavioral Modification: Joint Hearing before the Select Committee on Intelligence and the Subcommittee on Health and Scientific Research of the Committee on Human Resources, U.S. Senate, 95th Cong., 1st sess., August 3, 1977 (Washington DC: Government Printing Office, 1977). 90. Quoted in Edward Jay Epstein, Agency of Fear: Opiates and Political Power in America (New York: Verso, 1990), 120. See also Tim Weiner, One Man Against the World: The Tragedy of Richard Nixon (New York: St. Martin’s Griffin, 2016); and Evan Thomas, Being Nixon: A Man Divided (New York: Random House, 2015). 91. Epstein, Agency of Fear, 120. 92. “September 9, 1971, 3:03 pm–­ 3:34 pm—­ Oval Office Conversation No. 5684—­The President met with Raymond P. Shafer, Jerome H. Jaffe, and Egil G. (‘Bud’) Krogh, Jr.; the White House photographer was present at the beginning of the meeting.” Source available at CSDP.org and quoted in Aggarwal, “Health Scientist Blacklisting.” 93.  Quoted in Epstein, Agency of Fear, 121. 94. Epstein, Agency of Fear, 138. 95.  David F. Musto, The American Disease: Origins of Narcotic Control (Oxford: Oxford University Press, 1999); Grischa Metlay, “Federalizing Medical Campaigns against Alcoholism and Drug Abuse,” Milbank Quarterly 91, no. 1 (2013): 123–­162. See also Andrew B. Whitford and Jeff Yates, Presidential Rhetoric and the Public Agenda: Constructing the War on Drugs (Baltimore, MD: Johns Hopkins University Press, 2009), 48.

Notes to Chapter 6 197

96.  K. J. Sher and M. R. Lee, “Alcohol Use Disorders,” in Encyclopedia of Mental Health, 2nd ed., ed. Howard Friedman (San Diego: Academic Press, 2015), 40–­46. See also David A. Graham, “Are Pot Reformers Too Optimistic? The View from 1977,” Atlantic, April 4, 2014, https://www.theatlantic.com/politics/archive/2014/04/are-pot-reformers -too-optimistic-the-view-from-1977/360441. 97.  James D. Robinson, Colombia’s Narcotics Nightmare: How the Drug Trade Destroyed Peace (Jefferson, NC: McFarland, 2015), 29. 98.  Jennifer Robison, “Decades of Drug Use: Data From the ‘60s and ‘70s,” Gallup. com, July 2, 2002, http://www.gallup.com/poll/6331/decades-drug-use-data-from-60s -70s.aspx. 99. Kevin Mattson, “What the Heck Are You Up To, Mr. President?”: Jimmy Carter, America’s “Malaise,” and the Speech That Should Have Changed the Country (New York: Bloomsbury, 2008). See also Alice Echols, Hot Stuff: Disco and the Remaking of American Culture (New York: W. W. Norton, 2011). In the late 1970s, President Carter’s administration, including his assistant for drug policy, Dr. Peter Bourne, pushed for decriminalization of marijuana, with the president himself asking Congress to abolish federal criminal penalties for those caught with less than one ounce of marijuana. A grassroots parents’ movement responded by lobbying for stricter regulations and was instrumental in changing public attitudes. 100.  Quoted in Drake Bennett, “Dr. Ecstasy,” New York Times Magazine, January 30, 2005, http://www.nytimes.com/2005/01/30/magazine/dr-ecstasy.html?_r=0; A full account was published in Alexander T. Shuglin and Ann Shuglin, Pihkal: A Chemical Love Story (Berkeley: Transform Press, 1991). PiHKAL is short for “Phenethylamines I have known and loved.” 101.  William E. Fantegrossi, Aeneas C. Murnane, and Chad J. Reissig, “The Behavioral Pharmacology of Hallucinogens,” Biochemical Pharmacology 75, no. 1 (2008): 17–­33. 102. Dyck, Psychedelic Psychiatry, 16–­19; Janice Hopkins Tanne, “Humphry Osmond: Psychiatrist Who Investigated LSD, ‘Turned On’ Aldous Huxley, and Coined the Word ‘Psychedelic’,” British Medical Journal 328, no. 7441 (2004): 713; Matthew Oram, “Efficacy and Enlightenment: LSD Psychotherapy and the Drug Amendments of 1962,” Journal of the History of Medicine and Allied Sciences 69, no. 2 (2014): 221–­250. 103. Ben Sessa, “Continuing History of Psychedelics in Medical Practices: The Renaissance of Psychedelic Medical Research,” in The Psychedelic Policy Quagmire: Health, Law, Freedom, and Society, ed. J. Harold Ellens and Thomas B. Roberts (Santa Barbara, CA: Praeger, 2015), 62–­63. 104.  Bennett, “Dr. Ecstasy.”

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Notes to Chapter 6

105.  Leo Zeff, “Reflections,” MSP 74, folder 4, 6, PSC. 106.  Ethan Brown, “Professor X,” Wired, September 1, 2002, https://www.wired.com/ 2002/09/professorx; Myron J. Stolaroff, The Secret Chief Revealed: Conversations with Leo Zeff, Pioneer in the Underground Psychedelic Therapy Movement (Sarasota, FL: MAPS, 2004). Zeff’s experiences were chronicled in this book. In the first edition, his real name was not used because of fears that his past patients and associates might face legal sanctions. 107.  Zeff, “Reflections,” 5. 108. Stolaroff, The Secret Chief, 86. 109.  Quoted in Stolaroff, The Secret Chief, 138. 110.  National Institute on Drug Abuse, “MDMA (Ecstasy) Abuse: A Brief History of MDMA,” March 1, 2006, https://www.drugabuse.gov/publications/research-reports/ mdma-ecstasy-abuse/brief-history-mdma. 111. Sophia Adamson and Ralph Metzner, “The Nature of the MDMA Experience and Its Role in Healing, Psychotherapy, and Spiritual Practice,” ReVision: The Journal of Consciousness and Change 10, no. 4 (1988): 59–­72; Alexander T. Shulgin, “History of MDMA,” in Ecstasy: The Clinical, Pharmacological and Neurotoxicological Effects of the Drug MDMA, ed. Stephen J. Peroutka (Boston: Kluwer Academic, 1990), 105–­131; George Greer, “Using MDMA in Psychotherapy,” Advances 2, no. 2 (1985): 57–­59; Julie Holland, ed., Ecstasy: The Complete Guide: A Comprehensive Look at the Risks and Benefits of MDMA (Rochester, VT: Park Street Press, 2001). 112. Alexander T. Shulgin and David E. Nichols, “Characterization of Three New Psychotomimetics,” in The Psychopharmacology of Hallucinogens, ed. R. C. Stillman and R. E. Willette (New York: Pergamon, 1978): 74–­83. 113. Ralph Metzner, “Foreword” to Through the Gateway of the Heart: Accounts of Experiences with MDMA and Other Empathogenic Substances, ed. Sophia Adamson (San Francisco: Four Trees Publications, 1985), 2–­3. 114. “MDMA Transcript: Judge Considers History’s View,” Brain/Mind Bulletin, December 9, 1985, 3, http://www.maps.org/research-archive/hmma/brainmind12 .9.85.pdf. See David Kaiser and W. Patrick McCray, eds., Groovy Science: Knowledge, Innovation, and American Counterculture (Chicago: University of Chicago Press, 2016). 115.  George Greer and Requa Tolbert, “Therapeutic Uses of MDMA,” in Psychedelic Medicine: New Evidence for Hallucinogenic Substances as Treatments, ed. Michael J. Winkelman and Thomas B. Roberts, vol. 1 (Westport, CT: Praeger, 2007), 141–­153. See also George Greer and Requa Tolbert, “Subjective Reports of the Effects of MDMA in a Clinical Setting,” Journal of Psychoactive Drugs 18, no. 4 (1986): 319–­327; F. Di Leo, “The Use of Psychedelics in Psychotherapy,” Journal of Altered States of Consciousness 2, no. 4 (1975): 325–­337.

Notes to Chapter 6 199

116.  Rex, “Calming a Turbulent Mind,” 65. 117.  Sophia Adamson and Ralph Metzner, “Using MDMA in Healing, Psychotherapy, and Spiritual Practice,” in Holland, Ecstasy: The Complete Guide, 182–­207. 118.  Michael Mithoefer, “MDMA-­Assisted Psychotherapy for the Treatment of Post– Traumatic Stress Disorder,” in Winkelman and Roberts, Psychedelic Medicine, 155–­ 176, 163. Also see Stanislav Grof, LSD Psychotherapy (Sarasota, FL: Multidisciplinary Association for Psychedelic Studies, 2001). 119. Torsten Passie, “The Early Use of MDMA (‘Ecstasy’) in Psychotherapy (1977–­ 1985),” Drug Science, Policy, and Law 4 (2018): 2. 120.  Michael J. Harner, ed., Hallucinogens and Shamanism (Oxford: Oxford University Press, 1973); Joan Halifax, Shaman, Wounded Healer (New York: Crossroad, 1982); Peter T. Furst, ed., Flesh of the Gods: The Ritual Use of Hallucinogens (Prospect Heights, IL: Waveland Press, 1972); Peter T. Furst, Hallucinogens and Culture (San Francisco: Chandler & Sharp, 1976); Dennis J. McKenna and Terence K. McKenna, The Invisible Landscape: Mind, Hallucinogens, and the I Ching (New York: Seabury Press, 1975). 121. “‘Through the Gateway of the Heart’: Accounts of Experiences with MDMA and Other Empathogenic Substances by Sophia Adamson,” promotional material, MS Laing GW139, RDLC. 122.  “Through the Gateway of the Heart.” 123.  Ralph Metzner, “Molecular Mysticism: The Role of Psychoactive Substances in Shamanic Transformations of Consciousness,” Shaman’s Drum, Spring 1988, 15–­21, 16. 124.  Jerome Beck and Marsha Rosenbaum, Pursuit of Ecstasy: The MDMA Experience (Albany: State University of New York Press, 1994), 20. 125.  Jerry Adler, “Getting High on ‘Ecstasy,’” Newsweek, April 15, 1985, 96. 126.  Erika Dyck, “‘Just Say Know’: Criminalizing LSD and the Politics of Psychedelic Expertise, 1961–­68,” in The Real Dope: Social, Legal, and Historical Perspectives on the Regulation of Drugs in Canada, ed. Ed Montigny (Toronto: University of Toronto Press, 2011): 169–­196. 127.  Sanford Unger, “The Current Scientific Status of Psychedelic Drug Research,” unpublished paper, c1964, MSP 69, box 1, folder 1, PSC. 128. Dave Phillips, “F.D.A. Agrees to New Trials for Ecstasy as Relief for PTSD Patients,” New York Times, November 29, 2016, A11; Janet Burns, “FDA Designates MDMA As ‘Breakthrough Therapy’ for Post-­ Traumatic Stress,” Forbes, August 28, 2017.

200

Notes to Afterword

Afterword 1.  Christopher Hitchens, Letters to a Young Contrarian (New York: Basic Books, 2001), 102. 2. Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997), ix. 3.  Mark S. Micale and Roy Porter, eds., Discovering the History of Psychiatry (Oxford: Oxford University Press, 1994), 3. 4. Frederick Crews, Freud: The Making of an Illusion (New York: Macmillan, 2017); John Forrester and Laura Cameron, Freud in Cambridge (Cambridge: Cambridge University Press, 2017); Dagmar Herzog, Cold War Freud: Psychoanalysis in an Age of Catastrophes (Cambridge: Cambridge University Press, 2016); Eli Zaretsky, Political Freud: A History (New York: Columbia University Press 2015); Mike Jay, This Way Madness Lies: Asylums and Beyond (London: Thames and Hudson, 2016); Despo Kritsotaki, Vicky Long, and Matthew Smith, eds., Deinstitutionalisation and After: Post-­ War Psychiatry in the Western World (Basingstoke: Palgrave, 2016); Martin Halliwell, Voices of Mental Health: Medicine, Politics, and American Culture (New Brunswick, NJ: Rutgers University Press, 2017); Alexander Dunst, Madness in Cold War America (New York: Routledge, 2016); Laura Hirshbein, Smoking Privileges: Psychiatry, the Mentally Ill, and the Tobacco Industry in America (New Brunswick, NJ: Rutgers University Press, 2015); David Kaiser and W. Patrick McCray, eds., Groovy Science: Knowledge, Innovation, and American Counterculture (Chicago: University of Chicago Press, 2016). 5. Mat Savelli, Melissa Ricci, “Disappearing Acts: Anguish, Isolation, and the Re-­ imagining of the Mentally Ill in Global Psychopharmaceutical Advertising, 1953–­ 2005,” Canadian Bulletin of Medical History 35, no.2 (2018): 247–­277. 6.  Deborah Doroshow, Matthew Gambino, and Mical Raz, “New Directions in the Historiography of Psychiatry,” Journal of the History of Medicine and Allied Sciences 74, no.1 (2018): 33. 7. Lucas Richert and Frances Reilly, “Book Reviews: American Psychiatry Scholarship: The Pendulum Maintains Its Momentum,” Medical History 58, no. 4 (2014): 618. 8.  Sean Wilentz, The Age of Reagan: A History, 1974–­2008 (New York: HarperCollins, 2008), 1–­11; Steven Hayward, The Age of Reagan—­1964–­1980: The Fall of the Old Liberal Order (Roseville, CA: Prima Publishing, 2001), 612. See also Jefferson Cowie, Stayin’ Alive: The 1970s and the Last Days of the Working Class (New York: New Press, 2010), 17. 9.  Huey P. Newton, To Die for the People: The Writings of Huey P. Newton, edited by Toni Morrison (San Francisco: City Lights, 2009); Arthur M. Eckstein, Bad Moon

Notes to Afterword 201

Rising: How the Weather Underground Beat the FBI and Lost the Revolution (New Haven, CT: Yale University Press, 2016). 10.  Michael E. Staub, Madness Is Civilization: When the Diagnosis Was Social, 1948–­ 1980 (Chicago: University of Chicago Press, 2011), 3. 11.  Walter E. Barton, The History and Influence of the American Psychiatric Association (Washington, DC: American Psychiatric Press, 1987), 299. 12.  Quoted in Michael E. Staub, “Radical,” in Rethinking Therapeutic Culture, ed. Timothy Aubry and Trysh Travis (Chicago: University of Chicago Press, 2015), 97. 13.  Paul Lowinger, “Radical Psychiatry,” International Journal of Psychiatry 9 (1970): 659–­668, 661. 14.  Susan E. Cayleff, Nature’s Path: A History of Naturopathic Healing in America (Baltimore, MD: Johns Hopkins University Press, 2016), 275. 15. T. M. Luhrman, Of Two Minds: An Anthropologist Looks at American Psychiatry (New York: Vintage Books, 2001), 225. 16.  “A Call to Psychiatrists, Medical Students, and Others in Mental Health,” pamphlet, May 1969, MS Coll. 635, box 6, folder 86, Walter J. Lear Health Activism Collection, Annenberg Rare Book and Manuscript Library, University of Pennsylvania. See Adam Montgomery, The Invisible Injured: Psychological Trauma in the Canadian Military from the First World War to Afghanistan (Montreal: McGill-­Queen’s University Press, 2017). 17. Michel Foucault, Power-­Knowledge: Selected Interviews and Other Writings, 1972–­ 1977, edited by Colin Gordon (New York: Pantheon Books, 1980), 192.

Index

Academy of Parapsychology and Medicine, 109 Activism. See also Antipsychiatry; Feminism; Radical Caucus demonstrations, 4, 43, 50, 64, 95 environment, 20, 25–­27, 33, 55, 132 protest, 4, 17, 30, 37–­40, 42, 45, 63–­ 67, 77, 85, 92, 95, 98–­99, 114, 133, 150 psychiatric survivor movement, 56, 59, 64–­65, 107 students, 41–­42, 44, 47, 50, 82, 124, 130, 136–­37 Addiction, 5, 14, 88, 123, 130, 139–­40 Alcohol, 4–­5, 8, 78, 106, 131, 139–­40, 142, 147 Alcohol, Drug Abuse, and Mental Health Administration, 106 Alice in Chains, 18 Alinsky, Saul, 37, 42–­43 Alternative medicine, 9, 59, 61–­62, 97, 115, 118, 122, 146–­47, 174n84. See also Esalen Institute; Janov, Arthur; LSD; Primal scream therapy; Science; Scientology; Transactional analysis American Hospital Association, 63 American Journal of Orthopsychiatry, 8 American Journal of Psychiatry, 48, 133 American Medical Association, 42 American Psychiatric Association (APA), 1, 3–­4, 7, 11, 17, 24, 28, 31, 37–­40, 42–­45, 47–­49, 51–­53, 58, 63, 69, 77,

81, 88, 95, 98–­101, 104, 117, 139, 186n64 American Psychoanalytic Association, 31, 48, 93, 99 American Psychological Association, 31 Anslinger, Harry J., 115, 128–­129, 137 Antipsychiatry, 10, 17, 32, 46, 62–­65, 97, 123, 151 globalism, 60, 69 involuntary hospitalization, 8, 46, 53, 56, 62, 64, 66, 162 labeling, 52–­53 modernity, 77 political abuse, 37, 47, 51–­52, 65–­66 Anxiety, 72, 117–­118. See also Social anxiety disorder Asylum, 7, 34, 56, 58, 62–­63, 94, 98, 149 Atlantic Monthly, The, 6, 8, 92 Axelrod, Julius, 8 Basaglia, Franco, 60, 69 Behaviorism, 9, 78 Berne, Eric, 13, 35, 51, 63, 78–­81, 83, 151–­152 Bettelheim, Bruno, 8–­9 Biden, Joe, 1, 3, 6 Bipolar disorder, 8, 32 Black Caucus, 39 Black Panthers, 43, 50, 58, 64, 150 Blain, Daniel, 7 Bourne, Peter, 16, 105, 197n99 British Medical Journal, 120

204 Index

Bukovsky, Vladimir, 162. See also Involuntary commitment Business. See also Economy; Unions automation, 21–­22, 25–­26, 28, 47, 151 labor, 20–­21, 23, 27–­28, 41, 53, 165 manufacturing, 23 workplace psychology, 22, 24, 165n37 Cannabis, 84, 115, 122. See also Alternative medicine; Nixon, Richard culture war, 131, 135, 137 decriminalization, 138 insanity, 128–­29, 133–­134 prohibition, 126–­27 Carter, Jimmy 19, 104–­108, 137, 140, 197n99 Carter, Rosalynn, 106 Chamberlin, Judi, 53, 65–­66, 68 Chesler, Phyllis, 29–­32, 52–­53, 123–­124, 152. See also Feminism China, 14, 15, 17 Class, 25, 33–­34, 43, 47, 60, 67, 83, 101, 126, 131, 140. See also Activism; Business; Economy Cold War, 5, 19, 101, 109, 133, 137, 149 Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP), 113 Community Mental Health Act (1963), 52, 87, 116 Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act (1970), 8 Conference on Human Rights and Psychiatric Oppression, 65–­66 Conference on Radicals in the Professions, 46 Cybernetics, 27, 110 Dean, John, 125 Deinstitutionalization. See also Antipsychiatry; Asylum; Involuntary commitment

community clinics, 58 housing, 104 Rosenhan experiment, 94, 102 Depression, 1, 3–­5, 14, 19, 72, 86, 94, 117–­118, 120 Diagnostic and Statistical Manual of Mental Disorders DSM-­II, 32, 92, 103 DSM-­III, 3, 11–­12, 16, 24, 32, 44, 91–­ 93, 97, 100–­104, 151, 159n8, 186n64 DSM-­IV, 44, 103 DSM-­5, 3, 44, 103, 159n8 Drug Enforcement Administration (DEA), 109, 142, 146–­147 Economy, 27, 29, 55, 72, 140, 151. See also Business; Class globalization, 20, 23 oil prices, 20 stagflation, 20 women entering workforce, 21 Ecstasy, 115, 146–­148. See also MDMA; Shulgin, Alexander Ehrlichman, John, 131 Electroconvulsive therapy (ECT), 34, 46, 56, 66–­77 Environmentalism. See Activism; Greenpeace Erhard, Werner, 11, 71, 76–­77 Esalen Institute, 9, 11, 71, 73–­77, 116, 143, 151 Esquire (magazine), 48 Ethnicity. See Race Feminism, 32, 37, 68, 152. See also Activism; Business; Economy; Sexuality Aegis, 29 Friedan, Betty, 31 National Black Feminist Organization, 29 Plath, Sylvia, 31 Quest, 29

Index 205

Washington Area Women’s Center, 29 Film. See also Television Catch-­22, 122 drug films, 115 dystopia, 107 horror, 112 Myra Breckinridge, 122 One Flew over the Cuckoo’s Nest, 68 pornographic genre, 31 Side Effects, 2 Silver Linings Playbook, 2 Sixth Sense, The, 77 Spielberg, Steven, 112 Vietnam movies, 15 Food and Drug Administration (FDA), 2, 8, 87, 94, 129, 148 Ford, Gerald, 19 Foucault, Michel, 10, 51, 62, 152 Frankfurt School, 26–­27, 91 Freud, Sigmund, 3, 7, 9, 26, 28, 30, 32, 49–­50, 72, 78–­80, 82–­83, 91–­93, 97, 100, 149, 174n84 Fromm, Erich, 26, 62, 98 Gallup polls, 72, 140 Geller, Uri, 111, 113 Gestalt therapy, 74–­75 Goffman, Erving, 34, 46, 56 Government Accountability Office (GAO), 105 Great Recession, 4 Great Society, The, 56, 101 Greenpeace, 20, 25. See also Activism Grob, Gerald, 91 Grof, Stanislav, 117–­119, 145 Hoffer, Abram, 124 Hofmann, Albert, 5–­6 Hollywood Hospital, 122. See LSD Homosexuality, 39, 95–­98, 101–­102, 114, 133. See also Activism Hospice movement, 118–­119. See also LSD; Saunders, Cicely

end of life, 3, 5, 12, 117 Hubbard, L. Ron, 27, 86–­88 Human potential movement, 11, 71, 73–­77 Huxley, Aldous, 71, 74, 87, 116–­117 Hypnotism, 88, 119. See also Hospice movement Insane Liberation Front, 56, 61, 64 Institute of Parascience, 109 Insulin shock therapy, 46, 56 International Kirlian Research Association, 109 International Narcotic Education Association, 129 Involuntary commitment, 162 Issues in Radical Therapy, 61 James, William, 83 Janov, Arthur, 80–­81. See also Primal scream therapy Japan, 20, 23 John Birch Society, 162n31 Joint Commission on Mental Illness and Health, 106, 169n10 Journal of Parapsychology, 111 Jung, Carl, 6, 24, 26, 28, 83, 111, 115, 143, 174n84 Kennedy, John F., 87, 116, 169n10 Kent State shooting, 40, 95 King, Martin Luther, 44 King, Stephen, 112 Koestler, Arthur, 111 Kübler-­Ross, Elisabeth, 120. See also Hospice movement Laing, Ronald (R. D.), 9, 46, 51, 58, 62–­ 63, 98, 120–­124, 147, 174–­175n84 Lasch, Christopher, 27–­28, 72–­73, 83 Leary, Timothy, 51, 97, 120–­122, 142, 145, 190n30 Lithium, 8, 32, 94

206 Index

London Review of Books, 4 Lowinger, Paul, 21, 25, 45–­47, 63, 130, 136–­137, 151 Lysergic acid diethylamide (LSD), 3, 5–­6, 12, 18, 46, 72, 81, 86, 98, 115–­ 124, 130–­131, 136–­137, 141, 143–­ 144, 146–­148, 151–­152, 190n30 Macbeth, 1–­2 Madness News Network, 61, 65, 69 Marijuana. See Cannabis Maslow, Abraham, 9, 22, 45, 74 McConaghy, Nathaniel, 95–­96, 98. See also Homosexuality McLuhan, Marshall, 27–­28 MDMA, 12, 81, 115, 140–­146, 148, 151–­ 152. See also Alternative medicine; Ecstasy; Psychiatry; Science Medicaid, 101, 104 Medical Committee for Human Rights (MCHR), 41, 45 Medicare, 101 Menninger, William, 114, 169n10 Menninger Foundation, 66 Mental Health Systems Act (1980), 108 Mental Patients’ Liberation Project, 61, 65 Merck, 141, 148 Military-­industrial complex, 109, 137. See also Activism; MKUltra; Parapsychology; Vietnam coercion, 16, 38–­39, 82 military psychiatry, 15–­17 technology, 47, 151 Miltown, 5 Mitchell, John, 127 MKUltra, 137–­138, 147 Music, 22, 33, 142, 157 Cohen, Leonard, 87 Esalen guests, 74 EST sessions, 77 Grateful Dead, 87, 122 John, Elton, 14

Lennon, John, and Yoko Ono, 81 punk rock, 14, 33–­34, 101 used in treatment, 142–­144 Myers-­Briggs Type Indicator (MBTI), 24–­25 Nader, Ralph, 105 Narcissism, 24, 72 National Alliance for the Mentally Ill (NAMI), 69 National Commission on Marihuana and Drug Abuse, 125, 139 National Institute of Mental Health (NIMH), 7–­8, 96, 135 National Institute on Alcohol Abuse and Alcoholism, 8 National Organization for Women, 64 National security, 109. See also Activism; MKUltra; Vietnam National Welfare Rights, 63 Nature, 111 Network Against Psychiatric Assault, 61, 65–­66 New Age. See Alternative medicine; Science New Left, 50 New York (magazine), 29 New Yorker, 6 New York Times, 3–­4, 65, 133 Nixon, Richard, 9, 14, 19, 38, 106, 124–­ 27, 131, 133, 135, 138 Nobel Prize, 8 Occupy movement, 4. See also Activism Osmond, Humphry, 117, 124 Palliative care. See Hospice movement Parapsychology, 91, 109–­111, 113–­114, 116, 147. See also Science Patients. See also Activism, psychiatric survivor movement; Feminism; Psychiatric survivor movement; Radical Caucus; Sexuality

Index 207

as boring, 79 doctor-­patient relationship, 53 patient versus disease, 92 pseudopatients, 94 rights, 56, 63–­68 Perls, Fritz, 74–­75 Peyote, 83–­84, 116, 134, 141 Pharmaceutical industry, 3, 5. See also Economy; LSD; Psychedelic medicine; Science Phenomenology, 74, 78, 93 Physicians for Social Responsibility, 45 Playboy (magazine), 41 Post–Traumatic Stress Disorder (PTSD), 1, 4, 14, 16, 103, 148 Pregnancy Discrimination Act (1978), 166n41 President’s Commission on Mental Health, 106 Primal scream therapy, 9, 26, 73, 75, 80–­81, 86, 121, 174n84. See also Alternative medicine; Janov, Arthur Project Stargate, 110 Prozac, 5 Psychedelic medicine, 5–­6, 9, 17, 22, 50, 59, 84–­85, 117, 121–­122, 131, 140–­ 142, 147. See also Alternative medicine; LSD; Religion; Science Psychedelic Venus Church. See Religion Psychiatric News, 48, 133 Psychiatry American Psychiatric Association, 3, 7, 11, 17, 24, 28, 31, 37–­40, 42–­45, 47–­ 48, 51–­54, 58, 63, 69, 77, 81, 88, 95, 99–­101, 104, 117, 139 biological, 7, 9, 10, 12, 33, 50, 52, 91, 93, 97–­99, 101, 107, 114, 147, 151, 186n64 psychopharmaceuticals, 2, 88, 94, 99 Psychoanalysis, 5, 7, 10–­12, 32, 47–­49, 71, 79–­80, 82–­83, 91–­93, 96, 99–­100, 114

Psychology, 6–­7, 9, 12, 22, 24, 41, 49–­ 52, 60, 62, 74, 76–­79, 81, 84, 86, 88, 99, 149–­150. See also Parapsychology; Science Punk rock. See Music Race, 33, 42, 44, 108, 174n84. See also Black Caucus; Feminism; Radical Caucus Radical Caucus. See also Activism; Antipsychiatry; Economy; Social psychiatry; Steiner, Claude infighting, 55, 59–­62 manifesto, 51 Radical Therapist, The, 54–­56 Ramones, The, 33–­34. See also Music Reagan, Ronald, 20, 64 Reefer Madness, 115, 128 Religion cults, 6, 71, 82, 85, 97, 109, 113 Falwell, Jerry, 71 gurus, 71, 97, 121 Moon, Sun Myung, 71 mysticism, 73–­74, 82–­84, 97–­98, 111, 116, 121, 147, 151 Pope Paul VI, 83 Religious Freedom Restoration Act (1990), 84 shaman, 73–­74, 82, 96, 121, 145–­146 Third Great Awakening, 71 Universal Church of Christ’s Light, 84 Republican Party, 38, 125 Rome, Howard, 45, 47 Rosenhan experiment, 94, 102. See also Deinstitutionalization Rough Times, 55, 60–­61. See also Antipsychiatry San Francisco, 43, 51, 61, 65–­67, 78, 142, 146, 150 Saskatchewan, 117, 124, 141 Saunders, Cicely, 118–­119, 152. See also Hospice movement

208 Index

Schizophrenia, 5, 66, 93–­94, 96–­98, 102–­103, 128–­129, 133–­134, 195n75 Science. See also Alternative medicine; Parapsychology; Religion; Scientology antiscience, 25–­26, 113, 149 debate, 100, 103, 111, 113–­114 psych sciences, 50, 68, 71, 74, 82 Science fiction, 27, 112. See also Cybernetics Scientific American, 6, 134 Scientology, 11, 27, 147. See also Alternative medicine; Cybernetics; Hubbard, L. Ron; Religion; Science achieving clear, 86 addiction and recovery, 88 auditing, 86–­88 Berkeley, California, 87 Burroughs, William, 87 Dianetics, 27, 86, 88, 113 e-­meter, 86 Food and Drug Administration regulation, 87 Sexuality, 14, 17, 21, 27, 29–­32, 33, 51–­ 53, 55, 81–­84, 88, 95–­96, 103, 124, 128, 142, 145. See also Activism; Feminism; Homosexuality Sexual Orientation Disturbance, 101. See also Homosexuality Shafer, Raymond P., 125–­126, 139–­140. See also Cannabis Shulgin, Alexander (Sasha), 140–­143, 152. See also Ecstasy Social anxiety disorder, 3–­4 Social psychiatry, 7, 41, 45, 48, 52, 58, 102, 151, 169n10 Social Security Act (1965), 101 Soviet Union, 58, 92, 109, 113, 161 Special Action Office for Drug Abuse Prevention, 127 Spitzer, Robert, 101–­102, 105 Spock, Benjamin, 44

Spring Grove Hospital, 117–­118 State and Mind, 60. See Radical Caucus Steiner, Claude, 50, 59–­60, 63. See also Activism; Radical Caucus; Transactional analysis alienation, 27, 45 radicalism, 78, 95 with Eric Berne, 13, 35, 79 Student American Medical Association, 136 Suicide, 2, 4, 8, 128–­29 Szasz, Thomas, 46, 51, 57–­58, 61, 63, 73, 82, 152, 174n84 Taft-­Hartley legislation, 99. See also Business; Economy; Unions Television, 2, 15, 25, 33, 113, 133. See also Film Time (magazine), 24, 42 Torrey, E. Fuller, 73, 82, 96–­97. See also Antipsychiatry; Religion Transactional analysis, 9, 13, 51, 75, 78–­ 81, 121, 151–­152 Unions, 23, 44, 99. See also Activism; Business United Farm Workers, 64 U.S. Supreme Court, 7–­8, 83–­84 Vietnam, 9, 11, 14, 17–­19, 24, 30, 35, 37, 39–­40, 44–­45, 63, 82, 101, 114, 123, 130, 137, 151 Village Voice, 65–­66 Waggoner, Raymond, 48–­49, 53–­54 Washington Post, 25, 72, 118, 135, 138 Watergate, 19, 112, 125 Weather Underground, 50, 150. See also Activism Wellcome Trust, 69 Woolf, Virginia, 31 World Health Organization, 146

Index 209

World War I, 17, 19, 114 World War II, 5, 15, 17, 26, 41, 45, 51 Xanax, 5 Yolles, Stanley, 100, 135–­35, 139 Zeff, Leo, 142–­43, 145, 152