In a Darkness
by James A. Wechsler
Norton, 160 pp., $5.95
Recovered psychiatric patients don’t usually write about their experiences in and out of the hospital, but enough of them have done so to make a tradition of sorts. One thinks of A Mind That Found Itself, written by Clifford Beers in 1907; or Fight Against Fears, Lucy Freeman’s dramatic account of her troubles—a bestseller in the middle 1940s, when psychiatry was catching hold among the middle and upper American bourgeoisie; or more recently, Barbara Field Benziger’s The Prison of My Mind, from which the reader learns how the rich can be hoodwinked and devastated by the seamier side of medicine and its various specialties—all those “rest homes” and “sanitoria” with their pretty names, set up to fleece patrons, whom they insult and humiliate, then quickly discharge when cash runs out or suspicions (no doubt called “paranoia”) get dangerously active.
Then there are those who don’t recover. They start out with something that is called “anxiety” or a “phobia” by the family doctor. With his help they struggle against their symptoms for a time, only to feel worse and worse. If they are reasonably well-to-do and educated they are likely to take themselves to a private psychiatrist. If they have little money but are students or young professional men or women they may go to a clinic, where their youth and “promise” earn them favored status—”individual psychotherapy.” If they are poor or their parents are working people—mechanics, gas station attendants, waitresses, switchboard operators—the chances are that “medication” will be prescribed, infrequent and brief “follow-up” visits recommended, and maybe, under the best of circumstances, some “group therapy” made available.
In 1958, August Hollingshead and Frederick Redlich in their study Social Class and Mental Illness concluded that money commands attention from psychiatrists, among others; those who are relatively poor or uneducated (meaning millions and millions of ordinary working people, who can barely pay the baby doctor for the routine childhood illnesses that come up, let alone bills for psychotherapy) are commonly treated in ways that require much less of the doctor’s time. In the fourteen years since their book appeared, nothing has happened to change their description.
Yet here, as in so many other respects, psychiatry has to be distinguished from other branches of medicine. Nowhere in this country, or in any other country, do the rich and powerful fail to get better “care” than the poor. Hospitals vary, as does nursing care or the quality and quantity of medical attention, according to the patients’ pocketbooks or positions in society. (Since Hippocrates, the call for another, more equalitarian approach has been given unremitting lip service.) Yet whether a patient is rich or poor, penicillin is prescribed for bacterial pneumonia, surgery for an inflamed appendix; class barriers have nothing to do with the way children are protected from polio or tetanus—the same vaccine is used throughout the country.
In contrast, psychiatrists talk about various “modalities of treatment,” supposedly a rational response to separate …