Personal Accountability

As Rothman discusses in Strangers by the Bedside medical accountability and ethics is such a complex idea.  At first glimpse one would think judging ethics on medical procedures and experiments (do no harm) would be rather straight forward but this obviously couldn't be further from the truth.  As Jesse points out without medical oversight doctors can do whatever they want (a rather scary idea indeed), but by masking doctors and researchers behind lawyers and paperwork only seems to insulate them from their patients.  This seems a lot like the one premise from Freakonomics stating that incentives make people do strange things with often unforeseeable consequences.  The part I've found most interesting thus far is how doctors experimented on relatives or people close to the family (in-laws maybe?).  How best to ensure medical oversight then knowing that if any mistakes were made your sons/daughters life could depend on it.  Would BP have been willing to have their children work on their oil rigs?  Would people interested in Fracking be willing to drill in their own back yards?  Something tells me no and maybe that should be a telling indicator...

From Jessie

While reading chapter 3 of Strangers at the Bedside by David J. Rothman I was disturbed by “acceptable” research practices after WWII. In the chapter Rothman say’s “surveys revealed a widespread conviction that ethical judgments were best left to the judgment of investigators” (P. 60). I found this statement disturbing, because it brought to mind a sociology book I read in the last two years called “The Sociopath Next Door” by Martha Stout. In “The Sociopath Next Door” Stout describes how, as many as 4% of individuals are unable to feel empathy, compassion, or ability to relate to other humans or animals. Simply based on the findings of Stout, whether or not psychopaths actually account for 4% of the population, would render Rothman’s finding very disturbing. If we could imagine a doctor having unlimited capacity to run tests on an individual without oversight, from some board of ethics, it is disturbing to think what might be deemed acceptable practice by the doctor lacking a conscience. If such a person were to run medical experiments, it is unlikely they would have any sympathy/empathy for whatever pain, or even death they might deal their patients. Without moral/ethical oversight such individuals could potentially harm the lives of hundreds or even thousands of individuals, and have claimed it all to be in the name of science.

From James

Blog Post for “Strangers at the Bedside”

This book was certainly well written and a valuable contribution to health care and bioethics. I have not had a whole lot of experience in studying or learning about bioethics, including topics such as human experimentation and organ transplants. I think is tremendous ability to tell the history of bioethics starts with his research and profession as a professor of social medicine. His well written study goes further into the realm of the social ramifications bioethics had on society and the response people and the health care field had on these topics. The one thing that I want to also comment on was the extensive research Rothman accumulated for this book. His research extends to many different primary and secondary sources and I think that this really made his book that more convincing and valuable. In particular, I found it interesting that he included Congressional hearings and records on this topic. I think when something goes to Congress it is that much more controversial and interesting. I found his ability to incorporate these findings into the book that much better to his narrative. A well written and profound book.

Blog Post for “On Speed”

I found this book to be very well written and detail oriented. Rasmussen really gives a full description and analysis of the rise of amphetamines and the destructive power that they can have over patients and people. I think he did a great job at describing not only the historical perspective of amphetamines, but the current scene and how certain drugs are being consumed and discussed today. His particular discussion of Adderall and Ritalin are convincing and interesting. I never knew the type of impact these amphetamines had on people, and especially the youth. I know many people who take Adderall and they take it like a vitamin or something. It seems like it is a part of their everyday routine and it is like they have become so consumed with it that it becomes second nature. Being a prospective high school teacher and having some experience in classrooms, I have become familiar with the phenomenon of Attention Deficit Disorder (ADD) within students and the school’s effort to combat it. It seems as if more and more students are getting prescribed to Adderall and it is something that is alarming and concerning in my opinion.

From Brienne

The Impact of Health Insurance and Liability Insurance on Physician Autonomy

Although the book does not focus too much on the impacts of insurance on physician sovereignty, it is an important issue that has direct impacts on physicians’ practice. I know one physician who, in the course of his 40 year career, spent more and more time completing paperwork for health insurance companies, trying to meet the differing requirements of both health insurance and government regulations within Medicare and Medicaid. He experienced frustration over concerns about being audited by government agencies or of not receiving payment due to some bureaucratic requirement that he was not aware of. In the final year of his practice in 2010, as he attempted to cut back on patients, the chief determinant of the final day his office remained open was the annual cost of liability insurance. While he would have loved to care for his longtime older patients, the volume could not justify the insurance expense.

The book focuses mainly on direct medical decision making, but there is a vast array of issues that impact a physician’s autonomy.

Dan's blog

Rothman's boo seems to be an ideal companion to the Starr book we read earlier this semester. Where Starr's book was a somewhat exhuastive study, Rothman's is a bit more focused. However, both authors are primarily intested in specific shifts in medicine and why they took place. Rothman points out that the relationship between doctor and patient went from being one of trust to doubt to distant to the point of "strangers" intervening.

Like Lauren, I was intrigued by the implications (or lack thereof to be more precise) of the Nazi experiments of WWII. Once again the Nazi's excesses mark them as exceptional, thereby allowing American researchers to distance themselves from comparisons. That the interest of the "homefront" in medical research during the war excused many unethical procedures is not suprising at all. Still, Rothman's use of of context is very effective in helping the reader understand the the shifts toward greater regulation of medicine and research.

Stangers at the Bedside

I found Strangers at the Bedside to be very shocking and engaging. The section on Beecher’s article and all the human experiments done by clinical researchers was especially startling, particularly because of how recently they were done, particularly after WWII and all horror of the Nazi experiments was known. I was also kind of surprised by how cavalier researchers treated human experimentation. For example, in 1866 when J. H. Salisbury wanted to test swamps vapors as the cause of malaria, he filled tins with dying prairie bog and then placed the tins under the window of the bedroom of some men to see if they became sick. When the men become sick, Salisbury just notes that he had to stop the experiment because of “the difficulty of obtaining the consent of parties for examination.” It seems like the experimenters just took human experimentation so lightly. I can also see why this became more of a concern when the researchers were strangers. With Salisbury, it seems that the men knew who he was and told him to stop, but with the Beecher examples, the clinical researchers were testing people they did not know and who could not object. Also, today it is obvious that doctors are responsible so much more than just the individual patient, but I did realize how relatively quickly this transformation happened.

From Jessie

For
me the back-to-back chapters on Speed and Total War, and Bootleggers,
Beatniks, and Benzedrine Benders were amongst the most interesting from
Rasmussen’s book. When thinking of amphetamines, and particularly their
abuse “Meth” is the thing that most readily comes to mind, as a modern
symbol of amphetamine abuse. However I was unaware of the extent of the
drugs’ widespread use and abuse prior to the last 20 years. I had heard
about Nazis using the drug during WWII, however I was a bit shocked to
find that all the major powers were utilizing the drug, throughout their
war efforts.

Recently I have been reading Ian Flemings novels in the James Bond
series, which were written in the 50s and I was shocked while reading
“Live and Let Die” about a month ago, when the author casually describes
the protagonist downing Benzedrine before saving the world. In the
context of “On Speed”, accepted use of Amphetamines seems to have been
much more prevalent then we might assume based on current drug control
policy. In fact I was a bit shocked to read Rasmussen’s descriptions of
the drugs prevalence in bootleggers, beatniks, and Benzedrine benders.
In the chapter the author describes how many soldiers were admitted to
military service despite prior use of amphetamines, something that would
be unheard of today. Additionally it was interesting to hear that
Amphetamine use was considered a “social menace” as early as 1947 (p.
91), long before the U.S. government’s official crusade we now know as
“the war on drugs”.

America On Speed

I thoroughly enjoyed Rasmussen's account of amphetamines in American history. The way in which he writes paints a picture for the reader and allows us to see a fairly complete history of this drug. I was surprised to learn the impact of amphetamines in United States military history and it's overall impact on society. Having limited knowledge about this drug, I assumed it to be a 'street drug' used by addicts, etc., but it seems a great portion of Americans have used or are currently using some form of amphetamine. This is quite shocking. I was also interested in the trials and tests used to pinpoint it's most effective use when it was first developed; sort of trial by error.

On Speed

I thought this book was really interesting. I was really surprised to learn how many people currently use amphetamines and how long amphetamines have been in use. I though Rasmussen’s argument that people use amphetamines and other drugs in order to fit into the cheerful, thin, active image that society calls for is provocative. It is interesting to think that when society makes these impossible demands on people that they turn to medicine as a fix to these problems. I really liked how Rasmussen intertwined the history of amphetamines in the military with the history of amphetamines in society as a whole. I thought that there were some interesting parallels between both histories, particularly how the military gave amphetamines to the soldiers in order for them to fit the ideal image of a soldier. The military wanted the soldiers to be brave and continued to give the drugs to the soldiers despite the evidence that the drugs did not improve performance and could be harmful. I liked the similarity between this and how society takes the drugs in order to fit an ideal image even when to drugs can lead to serious problems.

From Jesse Dubrinski

I found Horwitz’s description of changing reimbursement schemes for psychiatrists as described from page 74 to be most interesting. Here Horowitz describes an important component to Psychiatry developing a more scientific face. It is interesting because as Horowitz shows dynamic psychiatry does not lend itself well to pay schemes used by insurance companies. Dynamic psychiatry seems to represent a personal journey between patient and psychiatrist, whereby the two parties work at deep-seated mental trauma, which may lead to revelations about a person’s mental state. Due to the way dynamic psychiatry works it appears that the healing journey was completely up to the progress of the individual and could be an indefinite and costly process. It is no wonder then why cost conscious insurance companies would back diagnostic psychiatry that attempted to put a specific label on peoples mental suffering and provide specific treatment plans for specific ailments. The changes backed by insurance companies seem to push towards a more concise doctor/ patient relationship, which would presumably cut costs as well.

I also wanted to mention that I found the dimensions of psychiatry and psychology to be a bit blurred in this book. Based on our in class description last week of the differences between psychology and psychiatry, it seemed like early psychiatry in particular may have looked a lot like psychology. Horowitz seems to do little to address the difference, and offers little explanation of drug-based solutions particularly in psychiatry’s earliest phases. Whether or not the two professions were once co-joined and have split or not, is not made clear, however I think even a brief discussion on the topic would be helpful.

Dan's Post: Because he is technologically inept

Allan Horwitz's book is eye-opening, a bit repetitive, but eye-opening. He seems to be spot on about the inherent weaknesses of the DSM. I found chapter 5 (The Structuring of mental disorders) particularly fascinating. the explosion of multiple personality disorder after people began to read about its symptoms is interesting. Horwitz also popints out in this chapter that if doctors didn't buy into a particular "mental disorder" then it essentially ceased to exist. The opposite is also true and leads to overdiagnosis. This leads me to question all kinds of mental health statistics over a long timeline. It also shows how cultural norms shape a lot of todays "diagnoses."

Horwitz's discussion of the transition from "dynamic" to "diagnostic" psychiatry is also well argued. It makes sense that once health care got involved more "accurate" and measurable diagnoses became necessary.

Shifts in Psychiatry

One of the overarching themes present in Horwitz's Creating Mental Illness is the way in which mental disease, illness, and disorders changed over (primarily) the 20th Century alongside changes within and without psychiatry. What is most interesting to me, as much of what Horwitz deals with has a lot to say about what we have read in the past weeks - the pursuit of professionals to maintain their legitimacy and status amongst their peers and with society. Horwitz centers much of his discussions regarding mental health around the changing philosophies of psychiatry; the creation of the DSM is a focal point for his argument.

When looking at the history of psychiatrists, in and out of the institutions, the same story has been told by plenty of other historians - many of which are cited in Horwitz's monograph. So - we must ask what is different here? More importantly, why should the history of mental health be considered today, and how does it play into the history of medicine in general? Obviously, I'm just posing questions (not looking for any real answers), but these are questions I've tried to ask myself with each book.

Horwitz's analysis of particular "mental disorders" that were a part of the DSM-III and DSM-III-r is important to note - eating disorders, MPDs, substance abuse, hysteria, and depression. Statistics are abundant in many forms of media today. The mass media (i.e. magazines, newspapers, television ads, Internet websites/ads) is constantly bombarding consumers with statistics regarding the numbers of people that go without treatment for "depression" or "fibromyalgia" are apparently at an all time high...well, so is the price of gold - it's how the "chicken guy" stays open ;). But on a more serious note, there is money to be had by finding a drug that does something to people, and making a disease be the problem which the drug fixes. But, the "symptoms of most psychological dysfunctions are not direct indicators of discrete underlying disease entities" (p.108). In other words, Horwitz has a major issue in the way psychiatry was morphed from a dynamic to diagnostic model.

Horwitz doesn't go so far as some might to saying that the DSM is worthless (see L.J. Davis: "Encyclopedia of Insanity") for he does find it useful in categorizing the psychotic disorders. However, Horwitz's evidence from the DSM writers is also insightful into analyzing why psychiatry made such a drastic shift in publishing the DSM-III.

Overall, I find Horwitz's point of view helpful in that he is primarily analytical, objective, and stays away from the contemporary smarmy muckraking pieces one would find in a newspaper or journal article criticizing psychiatry and those who practice it as quacks.

Article Mentioned:
L.J. Davis. "Encyclopedia of Insanity: A Psychiatric Handbook Lists a Madness for Everyone," Harpers Magazine. February 1997.

Medications

I was particularly interested in the medications and how they became mainstream. Horowitz talks about how people learn about medications from commercials and print media now, and that is true but this made me think of all the negative ad placement we see today. The ones that law firms put out saying if you have had such and such a symptom you can sue. It seems that so much information these days comes not from doctors, but from TV. Prozac of course, is mentioned quite a bit as it is a popular medication. I was also interested in the placebo trials because they show how the brain works and how much a given medication can affect people. The way that a medication can effect someones brain when that is not the intended response is both interesting and scary. It also shows how some medications today are used for multiple diseases, sometimes both mental and physical ailments.

I just began to get into the book and I was immediately reminded of a lesson of a class I took years ago.

We read this article (hopefully the link works)

http://oak.cats.ohiou.edu/~thompsoc/Body.html

I find the idea of cultural relativity an how it relates to mental illness very interesting. I recalled this article when reading the introduction and the Dobuans were mentioned. My favorite thing about the article i linked here is that it makes you think how strange those Naciremas are, until you realize who this "odd" tribe really is.

Hi everyone. I agree with Sam, I thought Metzl did really creative work writing this book - it was really refreshing and made the book really compelling. However, sometimes I think it also took away from his argument. He spent so much time talking about the woman at the beginning at the book that he almost loses the reader - it's still interesting, but it sort of made me confused about his argument. Once he tied it together, I understood, but it was an odd choice. I was also interesting in something that I saw as perhaps a hole in his argument. While I find his argument compelling, I noticed that he did not directly address the 'sexual psychopath' fear that was an its height in the 40s and 50s, perhaps into the 60s. I'm not by any means an expert in this topic area or era, but I know that George Chauncey points to a moral panic in this time period that revolved around psychologists and the creation of 'sexual psychopaths,' and that this lead to many people seen as 'deviants' were pathologized. How much of this fear was perhaps responsible for the shift from white housewives to African American men? Overall, I was fascinated by Metzl's argument and his use of evidence. I particularly enjoyed his use of material like movies, ads, and other visual sources. I found the pharmaceutical ads totally shocking.

Protest Psychosis

I found this book to be a fascinating and engaging read. Metzl did a great job interweaving archival sources, interviews and a historical timeline for schizophrenia. I particularly liked the way he wrote the book in such an engaging way that allowed the reader to absorb these complex ideas and want to continue reading.

I have always found histories of institutions to be interesting (probably stemming from too many ghost stories as a child). In a middle school english class we read "The Yellow Wallpaper", a short story about a woman who goes insane upon being confined to bedrest, and whenever this topic pops up in a class I am reminded of this story.

I thought that Metzl's focus on the changing definition and association of schizophrenia through the 20th century was very interesting. Extending his study to the wider context to such events as the Civil Rights movement was very educating for me because I had not been previously so well exposed to the history of schizophrenia.

Interesting read...

I think that Metzl's narrative, Protest Psychosis, was a more interesting read than the previous book...however I do not know if it is simply due to my own personal interests in terms of how history is written.

The eloquent prose of the case studies provides an insight into the institution but, more importantly, insight into the lives of a few patients. Metzl uses patient files, as well as documented interviews between patient/doctor to give the narrative a more personal theme. Writing patients back into the history of medicine is often something, until recently, which history has overlooked. However, providing a more personal touch, a reader is allowed to make a different judgment of a particular situation and how it changes over time. For example the first case deals with a woman placed in the institution for (basically) breaking down in a public place due to overwhelming stress in her life. However, without the creation of story within Metzl's narrative, we might not much of a story, or at least not one as compelling.

I enjoyed reading about schizophrenia's changing perspectives - the general public, those institutionalized, and those in power-positions within and without the institutions. Moreover, I feel like Protest Psychosis provides an interesting example of how a social history of medicine can be written.

The Protest Psychosis

The Protest Psychosis provides a rather in-depth look at the way schizophrenia has developed since it's development and how the disease reinforced racial stereotypes, especially in the 1960's and 1970's. Metzl takes an honest approach in his narrative and I appreciate that. His comprehensive and lengthy research could in no way be represented or reiterated in one book and he readily admits this. I liked his approach of citing specific case files, namely patients, to tell the story of how this disease changed over time and it's ramifications on society. Personally, I was very interested in the connection Metzl makes between the architecture of the institution and the activities that took place within. The fact that a hospital could easily transition and function as a prison, the way Ionia State Hospital morphed into Riverside Correctional Facility, is troubling. This aspect of the story alone provides insight as to what life was like for patients at the hospital. I would be interested in seeing additional photographs of the institution besides those included in the text.