Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880-1940 (Cornell studies in the history of psychiatry) [Paperback]

Reading from a hardback first edition of Keeping America Sane: Psychiatry and Eugenics in the United States and Canada (KAS), 1880-1940 (Cornell Studies in the History of Psychiatry) by Ian Robert Dowbiggin (Author). Reading it is very enlightening about how the Holocaust and other 20th Century evil happened though it is not specifically about that evil. It discusses part of the reason for the death panel rumors about 21st Century healthcare, as it shows how the social elite influenced psychiatrist's ethics, putting money before science in the absence of morality. It is not a book on ethics or morality, it is a book about how the practices that are, came to be.

The book uses words of that time bringing understanding of their abuse today, vital information to understand why non-professionals react as they do to these words. These "old" words are useful in the book because it communicates the state of knowledge and practice at the time and the clash of ethics, morality, and practicality or practicability in the healthcare game today.

The current healthcare system makes care decisions in darkness, forbidden by a history riddled with professional named and unnamed death panels, from open discussion of medical practice issues. Such is the sad state of today's 21st Century end of life healthcare, still trapped in reality economics that were well understood by the end of the 19th Century in the United States and Canada as recorded in KAS. It was not written about healthcare and does not generalize from psychiatry's trials and tribulations in the Civil War to WWII era.

It is very readable, salted liberally with old terms like kith and kin (p128), intemperance (p194), or "chronic alcoholism" (p224, Is there another kind?). It is equally peppered with evidentiary reference notes to source material making it quite a scientific study on the early thoughts and motivation of the psychiatric profession in North America. The term "eugenics board" among whose goals was to eliminate "feebleminded" defectives (p165), ties the fear of the "defective and parasitic classes becoming a burden to the country" established on page 146 into the story web. "[Clarke's] experience trying to cooperate with federal and provincial governments between 1906 and 1910 reinforced the lesson that politics and effective mental health care did not mix; it also belies the popular notion that doctors, politicians, and bureaucrats formed a unified front conspiratorially dedicated to the xenophobic subordination of immigrants."(p149) The Christian justification (p154), belief in the fecundity (p164) "and sexual promiscuity of the feebleminded," left psychiatry to choose that better for humanity. The truths revealed make it well worth reading: "...a sober reminder of the all too-human propensity to follow intellectual fashion when it is in one's own interests to do so."(p234)

The book is very personal; "Clarke reacted with bitter pugnacity...to a struggle between the venality of politicians and self-interest groups and the disinterested humanitarianism and patriotism of [pre WWII] psychiatry."(p177) The vocabulary is only summary salt, easily understood in the context of the preponderance of much more familiar common words. The nation's first immigration law in 1882...excluded "any convict, lunatic, idiot, or any person unable to take care of himself or herself without becoming a public charge." (p194) It provided neither a definition of "lunacy" nor a means of enforcement. C. K. Clark concluded, "...reformers needed to employ alarmist rhetoric mitigated by references to impartial medical science."(p189)

It points out rational thinking, "Paton complained [of] too much attention being paid to `the so-called signs of degeneracy' [with] too little concrete knowledge about the distinctions between environmental and hereditary causes of insanity."(p223) "[Rosanoff] concluded that a neuropathic constitution was a recessive trait that conformed to Mendel's laws of genetics."(p223) Ian Robert Dowbiggen has documented in convincing language, supported by evidence, the slow progress of science in a political world of finance. The last sentence of his conclusion is worth generalizing, "...ideology has eclipsed historical understanding and overshadowed moral common sense as the twentieth century draws to a close."