Mental Health and American Society

Jessica Vinas-Nelson 

Welcome to History Talk the podcast that brings together a panel of experts to discuss current events in historical perspective. I'm your host, Jessica Vinas-Nelson.

 

Brenna Miller  

And I'm your other host, Brenna Miller. Recent mass shootings have turned American attention to mental health, and examining the shortcomings and successes of the mental health system. It seems clear though, that questions surrounding mental health are much broader than extreme cases of mass violence.

 

Jessica Vinas-Nelson 

The debate about how we care for and treat people with mental illness in the US are nothing new. America has a long history of locking people away in psychiatric hospitals, and an equally lengthy history of criticizing the treatment of those considered mentally ill. To discuss this longer history. We've invited two experts to discuss the history of mental health care. In the studio, we have Dr. Susan Lawrence, professor at The Ohio State University who focuses on the history of medicine.

 

Dr. Susan Lawrence  

Hello.

 

Brenna Miller  

Also in the studio, we have with us Zeb Larson, a PhD candidate at The Ohio State University, who recently wrote an article for Origins titled "America's Long Suffering Mental Health System".

 

Zeb Larson 

Hello.

 

Jessica Vinas-Nelson 

Thanks for joining us today. What is the current state of our mental health system?

 

Zeb Larson 

The current state of the mental health system in United States, I think suffers from a number of problems. And you can see where there are gaps in the system. For example, the largest mental health providers in the United States are prisons and jails at this point, respectively, Cook County prison, Rikers Island and the Los Angeles County prison or jail, I think are the three largest in the United States. People with severe and persistent mental illnesses live 15 to 20 years less on average than other Americans, usually from a variety of co-occurring other problems. There're problems in terms of access to mental health care, there're problems in terms of homelessness, but that's not why we're talking about this today, is it?

 

Jessica Vinas-Nelson 

No. Is the recent public attention on mental health and the mental health system warranted in the wake of recent shootings?

 

Zeb Larson 

From my perspective, no. There was a study done about a year ago that linked I think, 235 mass shootings over about a century, and it found that maybe just 22% of them could be in any way prescribed back to mental health as a factor. There was an APA study that was done in 2016, that estimated that maybe 1% of all gun homicides in the United States are related to mental illness. So there are instances in which mental illness plays a contributing factor to crime. But I think it's a mistake to paint, the epidemic of mass shootings in the United States as somehow connected to the mental health system.

 

Dr. Susan Lawrence  

And I'm going to agree with that entirely. I think in part because it's just so easy to want to try to find a simplistic solution to gun violence or to mass shootings in general, and the temptation to say, well, anybody who commits a mass shooting is clearly crazy. Therefore, the problem is our mental health system. If we had diagnosed that person, we could have prevented it. But that's extraordinarily difficult, not simply because of predictive, you know, behaviors, but also because of issues of civil rights. We cannot lock up people who are behaving strangely or even who make, you know, vague threats.

 

Zeb Larson 

And for people who talk about improving the mental health system to better catch shooters, I'm always, the civil rights piece, Susan, I think you're really right on with that, because I'm not sure exactly what they envisioned that they would actually be genuinely comfortable with. Most people probably don't want the kinds of psychiatric interventions that even they're sort of hinting at, to be able to prevent shootings, assuming that link was even substantive in the first place.

 

Dr. Susan Lawrence  

Right, because if you consider, you know, the problem of homelessness, and the problem of the homeless who are mentally ill, and the problem of helping people to be consistently, just consistently take their medications. Some people with mental illness do not want to be medicated. And it is not allowable to forcibly medicate people, unless there is a significant threat, you know, to themselves or others. But again, defining that threat to oneself or others, it doesn't count, that a threat to oneself is simply I do not want to live in a shelter. I do not want people to take care of me, I do not want to be medicated, because courts have decided that if that is what a person who seems reasonably able to make decisions, that's what they're allowed to do.

 

Brenna Miller  

Questions surrounding mental health and psychiatric care have always been with us. So as a group of historians, what are some of the challenges of looking at these issues from a historical perspective?

 

Dr. Susan Lawrence  

I think that the biggest this challenge I see and looking at it from a historical perspective, is the fact that we lumped together a wide range of psychiatric conditions under the term mental illness, because that encompasses everything from mood disorders, like depression, even mild depression, or anxiety, or, you know, many of the things that many people suffer from either chronically, or episodically all the way to people who are clearly delusional, clearly have broken with reality, and are simply unable to cope in any way with the normal functions of everyday life. And then there's a huge spectrum in between. The other thing that's hard historically, is that mental illness is defined in terms of what society considers to be normal behavior. And that normality changes over time, it changes with different cultures, it changes with the ways that people are willing to accept, you know, diversity, strange behaviors, it also varies considerably with the kind of social networks that existed at different times in places, especially things like the family, where you might have strange Uncle Al, or, you know, depressed Aunt Margaret. But that was okay. I mean, because they could function in daily life, surrounded by family. We talk often, as you did, in your introduction, that America has a long history of locking people away in psychiatric hospitals. But there were actually an equally long period when we didn't have psychiatric hospitals. So there were systems of community care. Every single community in the colonies in colonial America had the equivalent of the English poor law, which was tax funding to deal with people who were indigent, who could not otherwise take care of themselves. And one of the kind of responses in more urban areas was to create poor houses, or in slightly rural areas to create poor farms, those things were considered necessary at the community level. Were they nice, not necessarily, but they weren't necessarily in carceral either. The other way that people dealt with those individuals who fell out of the common social networks of family were, people would be paid to have those people board with them, and they would be responsible for taking care of them. Now, maybe that did sometimes mean that they would be locked in, if they were people who were seen as out of control. And that's one of the reasons that there was a movement in the 19th century towards psychiatric hospitals, is because there was seen by various reformers, the abuse of the seriously mentally ill, where people simply were taken to somebody's house, and locked up in a stable or kept with very, very few amenities. So in that sense, you know, we've, we've come from a kind of community system that then went to considering that an institution would be safer, cleaner, more, you know, run by experts. So this idea that people were locked up in these horrible asylums that that at one point was seen as progressive, that would, that was seen as, as helpful to those who, who society was failing.

 

Zeb Larson 

You know, the only thing I would maybe consider adding to that, too, is also just the transformation from rural to industrial.

 

Dr. Susan Lawrence  

Absolutely.

 

Zeb Larson 

How much that destabilizes what would just be considered an older conception of mental health care. I mean, there's a reason asylums were historically slow to develop in the United States. It was an overwhelmingly rural country. And to the extent that they did develop relatively quickly, in the 19th century, it was in the northeast, you don't start to see really organized asylums, I think explicitly for mental health, until the 1820s and 1830s, Massachusetts establishes the first one in 1830, then the 1840s, you get a bump in the number of them. And they were regarded, like Susan says, as a progressive way to deal with the fact that private institutions simply weren't able to keep up with the indigent mentally ill.

 

Dr. Susan Lawrence  

Right. Again, we're talking about the seriously mentally ill.

 

Jessica Vinas-Nelson 

So Susan, as you mentioned, we look to mental health as kind of a panacea for mass shootings, has there been a time in the past when mental health facilities or particular treatments been seen as quick fixes, if you will, for other problems in society.

 

Dr. Susan Lawrence  

I think that these large-scale asylums were seen as quick fixes, for those who are seen to be increasingly deviant, from normal standards. And some people argue that partly, it's the rise of a certain kind of middle-class white ethos, about manners and about appropriate behavior and appropriate hygiene. So that when people deviated from those in ways that made others uncomfortable, then they wanted them to disappear. So the asylum does have this later catch all function of removing those people who are seen as difficult. Now, one thing that I know, say, in Iowa, for example, or in Nebraska, in the mid-19th century, 1860s 1870s was the rise of what people saw as women especially, but also men being sort of beset by religious mania, by having these kind of serious delusions about their own kind of religiosity. And they behave badly, they behaved in ways that weren't considered appropriately, you know, feminine, appropriately female, appropriately maternal, whatever those particular roles should be. And so they were again seen as it's better to remove them as influences on other people, rather than to try to deal with them at home.

 

Zeb Larson 

It's also telling the different classes of people that start to be institutionalized, once that option is available too you already brought up the elderly people with dementia going into the poor houses, but they're going to eventually end up in the state hospitals over time too, or this problem has, has mostly disappeared from the present, but people suffering from late stage neurosyphilis, absolutely they have they wound up in institutions, because that was the best place they could care for them, even people with epilepsy for a long time, because the state hospital is the closest thing that they could be fit into easily.

 

Dr. Susan Lawrence  

You know, one of the things that's kind of related to your we'll talk about other comorbidities about the rise of, of, you know, drug abuse, of alcoholism, of the recognition of something like alcoholism as being a mental disorder, rather than simply a, you know, a failure of will, a failure of the ability to control oneself. That uncontrollable, you know, alcoholic, who is again is, can be seen as a danger, can be seen as a problem within the family. They began to have specific hospitals for inebriates. So you know, again, remove them, not necessarily for treatment, but to try to take care of them.

 

Brenna Miller  

How have the ways that we have thought about mental illness changed, and how does that relate to the types of treatments and care that are offered to them?

 

Zeb Larson 

There is an increasing sophistication, a diagnostic category that starts to go on from the from the 19th century onward that moves many of the people who initially get institutionalized, people with epilepsy, people with neuro syphilis, people suffering from dementia, they get moved into one category. So that we're increasingly looking at individuals with schizophrenia, individuals with bipolar disorder, individuals with major depressive disorder, or you brought up mood disorders, anxiety disorders, those and those even take longer to develop. So honestly, professionalization has a lot to do with this. Psychiatry is a new profession by just about any reckoning.

 

Dr. Susan Lawrence  

Right. Mental illness as a whole was taken care of by regular doctors. It was not a specialized field until, well, in Europe until the 18th century, when you start to have, yes, there, there were a couple of large asylums like Bedlam, in London, or Bedlam Hospital. But there were also private hospitals, where, again, now the upper middle classes, who did not want to cope at home, would send their family members. But there were then people who were in charge of those institutions, who were doctors who tried to begin the shift from just locking people up or treating them as if they had some kind of physical disease. And so using kind of regular medical methods to change their attitudes, which were often unsuccessful, to having what they called moral therapy, or work therapy, or ways of trying to distract people from their problems and giving them things to do giving them tasks, giving them recreation, giving them crafts, trying in that way to have this kind of moral reform, through teaching them over and over again, what was considered appropriate behavior.

 

Zeb Larson 

I mean, it's almost like an early form of occupational therapy.

 

Dr. Susan Lawrence  

 It is. It is.

 

Zeb Larson 

In a more rural society, you would expect that a large number of people would at least have some practice with agriculture. To go back again to this middle-class sort of white Protestant sensibility, it is telling that moral treatment, so often moves people from the city to the country.

 

Dr. Susan Lawrence  

 Yeah.

 

Zeb Larson 

Right? You take them out of the unhealthful surroundings of the city as a 19th century doctor might say, and you move them out into the country, and you give them some just honest labor to perform. And that's supposed to help regenerate them.

 

Dr. Susan Lawrence  

Right. Well, the cities were seen as corrupting. The idea that nature was, you know, soothing, calming, all those things that, because there was in the 19th century, the later 19th century, this sense that civilization itself created mental illness, that the stresses of, of modern life… There was a whole condition at the end of the 19th century called neurasthenia, which was particularly a mental disorder that affected middle class often men who were seen as you know, locked into desk work. They're now not out doing honest labor, they're in offices. And they're pushing papers, and they're stressed by business, especially this kind of competitive cutthroat sense of, you know, of capitalism out there. And they became anxious, they became incapable of managing those decision-making processes. So the rescuer, you know, was seen as an appropriate way of treating them.

 

Brenna Miller  

I'm kind of curious about like pharmaceuticals. And if you have a sense, you know, when does that kind of become popular?

 

Dr. Susan Lawrence  

Medical intervention into psychiatric disorders, again, I think, is as old as medical medicine itself. But those were often seen as way of attempts to change the physical body, because the mental disorder was seen as a physical disorder in many, many, you know, ancient systems. So the, but it was still extremely hard to treat. That's the problem. I mean, they would try various drugs, and they simply wouldn't work, you know. So that the kind of low level expectant, you know, simply managing that person's behavior, you know, was ultimately the key. I think, in the 18th century, there is more experimentation, as you start to have more work on isolating new chemical compounds, like the discovery of gases, and trying inhalation therapies. It was fascinating, you know, they knew that oxygen was necessary for health. So let's, you know, inhale oxygen and see what happens or, you know, inhale things. That's where we get anesthesia. The discovery of electricity. The idea that you shocked somebody was very early on applied to medical therapeutics, to cases of paralysis, you know, to cases of mental illness. Again, it didn't have many results. But doctors were constantly looking and trying new things. I think that things don't really take off until the early 20th century. But one of the examples I think of doctors trying to be extremely creative was what they called Malaria therapy for Neurosyphilis. Syphilis is a, you know, a bacteriological disease. The idea was that if you gave somebody malaria, and they had a high fever, it would actually kill the spirochetes in the body, because there's sound knowledge that that's what fever does is it kills bacteria in the system. So they tried that. And they also used Malaria therapy or insulin shock therapy for again, trying to shock people out of a mental state into a different state. So there's lots of experimentation going on. But the goal always was to try to relieve people's suffering.

 

Zeb Larson 

Yeah, what's interesting to me, at least in studying the American example is, on the one hand, beginning in the 19th century, you have psychiatrists or the people who will become psychiatrists sort of desperate to be taken seriously, too. Because they don't just want to be seen as caretakers of a custodial institution, they actually want to try to find a way to treat the people who are in their care. And that's, that I think, is in part where Malaria therapy comes in. And how you develop insulin therapy is they see something that seems to be working with people who are afflicted with Syphilis, we might as well try and extrapolate that to our own particular problem. So there was this doctor at New Jersey State Hospital, named Henry Cotton, and Cotton's treatment for people, he believed that mental illness was frequently a product of infection in the body. So he would, he would simply remove teeth or spleens, or a woman's uterus, he just sort of tried to find whatever he thought might be afflicting them. Now, of course, we know that this was wholly ineffective. But Cotton was a well-regarded doctor who in most other respects, acted humanely towards his patients. He was just in his own way desperately grappling with some kind of solution.

 

Dr. Susan Lawrence  

But we also have to keep in mind, I mean, to be fair, that is the standard of what it meant to help medicine to change, to find progress. It was done on an ad hoc individual practitioner level for thousands of years. Doctors did have this fundamental tension between trying to go with what was traditional practice and then not change anything. Those people who stepped outside of that norm and tried these new things, what else were they going to do, other than to give it a try? And so I don't think that they made these decisions lightly. And although we don't have a lot of information about the consent process, because there was no official informed consent that had to be documented, they were not doing this against the will necessarily of the patient or of the patient's guardian or family, you know. So, yes, we tend to go look back and be highly judgmental. But every time people want to do that, I keep wanting to say, well, you know, every bit of progress that has been made in the history of medicine, up to the mid-20th century, was done by doctors who just tried things.

 

Zeb Larson 

There is also a political dimension to this, too.

 

Dr. Susan Lawrence  

Of course.

 

Zeb Larson 

And as much as American mental health facilities and hospitals in the early 20th century, I mean, they're almost entirely funded by the public. They are answerable to state legislatures and governors, and those institutions are becoming alarmingly overcrowded in this period. So for the public good, there's an incentive to try to find cures. Because otherwise the prospect of these institutions is becoming so full, if all they can do is effectively warehouse people.

 

Dr. Susan Lawrence  

Yes.

 

Jessica Vinas-Nelson 

So how have public perceptions of the mentally ill changed over time? And how has that affected their care?

 

Dr. Susan Lawrence  

Wow, that's a hard one. Because I think, I guess, I think, in general, mental illness is now much, much more accepted as a legitimate medical problem, all the way from psychotic behavior to mood disorders. And people look to medicine for answers. They don't look as much as they certainly did in the past to the actual, say, sinful behavior of the individual, where one brings on one's own sort of mental illness by bad behavior. You know, so I think that people are more accepting, in general. They're accepting of it in the abstract. I think when it comes to individuals behaving differently, again, people who are not familiar with dealing with people with mental illness are still scared. And so the temptation to, again, not see them is one thing. And the temptation to say, "Well, I mean, how many people in the audience might have had this experience growing up?" You know, if you know, somebody who suffers from clinical depression, and people just say, "I don't understand why Joe just doesn't snap out of it." That kind of judgmentalism, I think, is still very strong.

 

Zeb Larson 

And I think, especially as mental illness was understood more and more as a medical phenomenon, and once you have psychiatric drugs, that while they vary in their effectiveness, they at least can credibly be effective at times. There's also a sort of demand that mental illness be increasingly treated as an acute phenomenon, and not a chronic phenomenon. I think you see this in Kennedy's message when he signs the Community Mental Health Act in November of 1963. That people because of these new drugs that are being developed, they're going to be able to go back to their communities and become productive citizens. I think he actually uses the expression productive citizens. Bam, this is it, we found the cure.

 

Dr. Susan Lawrence  

It's like antibiotics, right? You know, we have an infection, you give antibiotics. We have diabetes, you give insulin, you know. There is this, this sense that medication, I agree with you, is an easy solution. And we're talking here about post-war America. We're talking about the post-war world, when these drugs are really developed and spread. So we've only had, you know, 60-80 years of experience with a host of pharmacological inventions, developments, that still people are trying to process and to figure out, what is the best way of using some of these drugs? And are we overmedicating now?

 

Brenna Miller  

We talked about the introduction of asylums in the United States. And those increasingly became less and less popular. So why was that the case? And then what were the consequences of that?

 

Dr. Susan Lawrence  

From the work I've done on asylums in the Midwest or the Prairie States, but in Iowa, for example, in the 1850s, when the first asylum is approved by the legislature, again, this is seen as  progressive. This is seen as modern. What wasn't expected, what wasn't anticipated is number one, that these are chronic. Many people do have chronic conditions. They don't just go for a rescuer, and get better and come home. And so they become overcrowded. And then the problem is that they're expensive. And they keep getting more and more expensive as you have more professionalization. And then, you know, it happens in Iowa. It happens in other states. Well, we need another asylum, because this one's overcrowded. So they build another one. And the taxpayers look at this, and they say, well, it's too expensive cut back, you know, you can have three people to a room. You don't need to have two people to a room or one person to a room. And so I think that's when we start to see more and more abuses becoming public because then they say okay, you want to cut back on the quality of the staff. And so you hire a lot of people who have no training whatsoever. And so then end up abusing, you know, the patients, and there are just too many people, for there to be proper oversight.

 

Zeb Larson 

And part of the difficulty. This is where the people who founded the first institutions, they don't really anticipate how county governments are going to react, yes, especially in times of any economic downturn. A county government is going to try to shed expenses as much as possible. And when these state institutions are available, they will try to transfer as many people who might be in their care in one way or another over to the state hospitals. You see, this is especially pronounced during the Great Depression. And then the other phenomenon that undergirds this is just that states have different fiscal philosophies in the United States. So New York and Massachusetts tended to spend more per capita on mental health than other states did. Whereas the south, the American West, they tended to spend a lot less. Even within that though, you still get pretty striking examples of scandal, let's call it in the 1940s and 1950s. So it comes out and I think 1943 that Creedmoor hospital, which is in Queens, there's been an outbreak of amebic dysentery, which is not something that should be happening at a hospital in the United States. This points to really primitive levels of care. This is a major scandal at the time, despite the fact that New York is probably doing more than most other states to actually fund the systems it's built.

 

Brenna Miller  

How did they close down that is, when these sort of abuses are, become more public?

 

Zeb Larson 

I think scandal informs it to a certain extent, but it's striking to me that it's not the only reason that it happens. So in Oregon, in 1942, there's an accidental poisoning at the state hospital that kills 47 people and leaves another 400 people sick. But the state hospital grows for another 15 years, it doesn't actually reach its peak size until 1957. So to me, I don't look at that and see a eureka moment where everybody in the state goes, well wait, we need to dramatically think about the way that they're doing this. I think drugs were really the transformative effect. Once you had drugs like Thorazine that could actually meaningfully alleviate at least a large number of people’s symptoms, that helps. You also have a federal government that in the early and mid-1960s is suddenly much more willing to take on parts of the state's financial burden. And then the state can seriously look good at shedding their hospitals.

 

Dr. Susan Lawrence  

I also think that there's an element, at least by the early ‘60s, where there's a high level of intellectuals who start to criticize the mental health system as being, incarcerating people who are deviant, rather than people who are sick. And so this idea that mental illness is socially constructed, that mental illness is simply the way that mainstream society gets rid of the people who are creative and exciting and eccentric, and, you know, different because they're too uncomfortable, be it you know, gadfly women, or homosexual men, or, you know, all anybody who's seen, who was seen, as you know, kind of wow, you know, just challenging the norms. To what extent that represents the reality of asylum patients is a whole other question. But this sense that the story of punishing the different does become, I think, politically popular in some ways. And I think my speculation is it does by the mid-60s, fit into lots of issues of civil rights, that these are people who are being incarcerated against their will. That there's no good legal grounds for keeping some people in these institutions if they want to get out. And so there are legal challenges to the inpatient population that begin to undermine the legitimacy of these hospitals.

 

Jessica Vinas-Nelson 

And what happens to the populations of mentally ill as these institutions close?

 

Zeb Larson 

I think there are a lot of people who are, this is the tricky thing about this history, there are a lot of people who succeed in at least in the terms set by the people who wanted to close the hospitals and move them into the communities. They take medications. They live in the community. They live something like whatever a normal American life is. And their story is sort of invisible in this process. And I don't want to lose sight of the fact that a lot of people do benefit from these institutions being closed. But then there are patients whose symptoms, who are more difficult to treat, and they slip through the cracks. There's a reason that there's a large percentage of mentally ill homeless individuals living in the United States, partly because the social safety net wasn't really designed to take the hit when all of those individuals were discharged from their hospitals.

 

Dr. Susan Lawrence  

And families refused to take them.

 

Zeb Larson 

Mhmm.

 

Dr. Susan Lawrence  

You know, I think that there's, I think that there's part of, you know, some larger social, I don't know, unpleasantness that we want to, you know, call out here. It's again, yes, there are people who refuse to take their medications, and so wouldn't stay with their families. But there are also those whose families simply rejected them and they had no other place to go.

 

Zeb Larson 

Yeah, and it's striking, planners really didn't seem to anticipate this. So the commission that had been behind the Community Mental Health Act in 1963, they simply assumed that everybody would go live with their families. It never seems to have crossed their minds that somebody who was in their 40s, or 50s, might have elderly parents who would be unable to care for them in the community.

 

Dr. Susan Lawrence  

Or that people come from dysfunctional families, you know. That this is the time when I think the family is still being idealized rather than seen as a place where families do hurt each other.

 

Zeb Larson 

Or the reality that treatment is not as effective as everybody had hoped it would be.

 

Dr. Susan Lawrence  

And the treatment is not as effective.

 

Zeb Larson 

It's very effective for some individuals. It's somewhat effective for other individuals. And then there are people for whom the benefits are relatively marginal. And if it's somebody who for whom the benefits are marginal or they're not medication consistent, or whatever other factor intervenes, it might be very difficult for them to go live with their families, understandably, for everybody involved.

 

Jessica Vinas-Nelson 

Well, speaking of civil rights, and white middle class Protestants, how does race and gender affect issues of mental health and the treatment of mentally ill?

 

Zeb Larson 

Well, it's interesting, looking back at the eugenics movement, at least, and this is something we haven't discussed today. But sterilization of mentally ill individuals was very, very normal in the United States in the 1920s, 1930s, into the 1940s. And surprisingly, some of those institutions stuck around for a while, I think. I want to say Oregon performed its last sterilizations in 1981 that overwhelmingly tended to fall on people of color. Different states also perform them at different levels. I think California accounted for a third of all sterilizations in the United States.

 

Dr. Susan Lawrence  

Certainly in the south, and in certain other sort of large cities people of color were targeted more as being suitable for sterilization. But we have to remember that eugenics isn't just about mental illness. It's also about mental retardation and it's also you know…

 

Zeb Larson 

Epilepsy.

 

Dr. Susan Lawrence  

About epilepsy. And so other things that were considered inherited when it comes to the 1940s and 1950s. And people are looking at the argument about deviant women, you do have a lot of medications, things like barbiturates that are being prescribed more to women who present to their doctors as being unable to sleep, as being anxious, as being as wanting to do more, perhaps as wanting to do things. And they need to be kind of mellowed out, shall we say. Women who are dissatisfied, were seen that way. And so there are a couple of, uh, you know, very famous women like Sylvia Plath, you know, who are very outspoken, who are very, you know, engaging or very, you know, dynamic women, but who also ultimately end up committing suicide, because, you know, they just because, they have serious clinical depression. And so there's this sense that were they driven to suicide because they couldn't fit in? Or was it because they were mentally ill?

 

Brenna Miller  

What are some of the most important things that we should focus on that maybe are getting lost when we are so hyper focused on mass violence and mass shootings?

 

Zeb Larson 

To me, the problem with assuming that we're going to see meaningful, substantive reform because of violence, it seems to me to be that it doesn't guarantee a long-term funding stream that people are going to be really interested in sustaining. I think this is one of the problems with the community mental health advocates have tried to grapple with since the hospitals were largely done away with. At least when the hospitals existed, there were these brick and mortar institutions, and they had to get a set amount of money in a given year. Now, states would try to cut back that money as quickly as they could or keep it to a politically acceptable limit. But there were certain guarantees about what you could receive, and states in a given year now, depending on the federal government's relationship with Medicaid, or what's gone on recently, with Obamacare, those funding streams are always at risk of changing in some way or another. So paying attention, if we are going to actually reform how we're going to not just sustain it for a two year period, to me seems really critical. Americans seem disposed to see the world in terms especially social systems in terms of quick fixes. They don't like to deal with chronic issues, which I think partly accounts for the country is generally fraying social safety net, and Americans really haven't begun to grapple with this particular issue. And I also don't think violence and mass shootings are going to be the tipping point for this particular issue.

 

Dr. Susan Lawrence  

I don't either. I think that a lot is going to depend on how we deal in the long term with poverty, on how we're going to deal with the undermining of our education system. I think that a lot of the avenues for children's health and mental health of teenagers of early diagnosis is crucial for a lot of any kind of illness, but certainly for mental illness as well. The earlier that people can be understood and take part in their own self-care, the better off we're going to be.

 

Jessica Vinas-Nelson 

We'll wrap it up on that note, thank you to our two guests, Dr. Susan Lawrence and Zeb Larson.

 

Zeb Larson 

Thank you.

 

Dr. Susan Lawrence  

Thank you.

 

Jessica Vinas-Nelson 

Thanks, everyone. This episode of History Talk podcast was brought to you by Origins: Current Events in Historical Perspective, an online publication of the public history initiative and the Goldberg Center in the history department at The Ohio State University in Columbus and Miami University in Oxford, Ohio. Our main editors are Steven Conn, Nicholas Breyfogle. Our audio and technical advisor is Paul Kotheimer, our audio producers and hosts are Brenna Miller and Jessica Vinas-Nelson, song and band information can be found on our website. You can find our podcasts and more on our website origins.osu.edu on iTunes and on SoundCloud, and Stitcher. And as always, you can find us on Twitter and Facebook. Thanks for listening.