A History of Stigma: Towards a Sociology of Mental Illness and American Psychiatry Joan Donovan A Thesis In the Department of Sociology Presented in Partial Fulfillment of the Requirements For the Degree of Master of Arts (Sociology) at Concordia University Montreal, Quebec, Canada September 2008 © Joan Donovan, 2008 Library and Bibliotheque et 1*1 Archives Canada Archives Canada Published Heritage Direction du Branch Patrimoine de I'edition 395 Wellington Street 395, rue Wellington Ottawa ON K1A0N4 Ottawa ON K1A0N4 Canada Canada Your file Votre reference ISBN: 978-0-494-45460-2 Our file Notre reference ISBN: 978-0-494-45460-2 NOTICE: AVIS: The author has granted a non­ L'auteur a accorde une licence non exclusive exclusive license allowing Library permettant a la Bibliotheque et Archives and Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par telecommunication ou par Plntemet, prefer, telecommunication or on the Internet, distribuer et vendre des theses partout dans loan, distribute and sell theses le monde, a des fins commerciales ou autres, worldwide, for commercial or non­ sur support microforme, papier, electronique commercial purposes, in microform, et/ou autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriete du droit d'auteur ownership and moral rights in et des droits moraux qui protege cette these. this thesis. Neither the thesis Ni la these ni des extraits substantiels de nor substantial extracts from it celle-ci ne doivent etre imprimes ou autrement may be printed or otherwise reproduits sans son autorisation. reproduced without the author's permission. In compliance with the Canadian Conformement a la loi canadienne Privacy Act some supporting sur la protection de la vie privee, forms may have been removed quelques formulaires secondaires from this thesis. ont ete enleves de cette these. While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans la pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. Canada ABSTRACT A History of Stigma: Towards a Sociology of Mental Illness and American Psychiatry Joan Donovan Using genealogical discourse analysis, this project examines how American psychiatrists utilized the concept of stigma in The American Journal of Psychiatry as it relates to illness and treatment from 1846-2007. Once historicized, stigma takes the form of four themes, i.e. the stigma of psychiatric practice, euphemistic stigma, the stigma of treatment, and the stigma of mental illness. These themes each result in numerous strategies to diminish their effects in the population and the individual patient through national campaigns to combat stigma. This thesis also identifies the role of an emerging medicalization of mental illness' stigma and how this medicalization has specific implications for psychiatric treatment and social inclusion. The alignment of stigma alongside particular diagnostic categories has far reaching consequences as it attempts to circumvent thj critical discourse which began with the anti-psychiatry movement in the 1960s. In this way, this thesis reveals American psychiatry's effort to de-stigmatize itself through campaigns to reduce the stigma of mental illness. in Acknowledgements I would like to express my gratitude to Dr. Shelley Reuter, Dr. Sylvia Kairouz, and Dr. Bart Simon for their expert guidance and tireless support throughout this project. I am grateful to my entire family because without them 1 may have never ventured into Canada in the first place. Thank you to Mary Donovan, Anne Fegan, Patrick Donovan. Debbie Donovan, Kathleen Donovan, William Donovan, and Tom Donovan for your willingness to listen and respond with thoughtful advice. To those that have taken me in and shown me their kindness, Nathalie Reid, Patricia Stewart, Charles Reid, and Pat Stewart-Reid, you are each valued for your unique contributions to this project. I must also thank and show appreciation to Sandra Smele, Rob Parungao, Kyle Zelmer, Janice Clarini, Dr. Beverly Best, Dr. Valerie de Courville Nicol, Dr. Penny Pasdermajian, Dr. Meir Amor, and Jody Staveley for their advice and encouragement along the way. I am indebted to Dr. Avi Goldberg who inspired me to attend graduate school and grow through this experience. There have been many others, too numerous to mention, who have inspired me throughout the course of my studies at Concordia and to them I would like to say: thank you, one and all. iv For my mother Kathleen F. Donovan many thanks for your encouragement. v Table of Contents List of Acronyms... vii Chapter 1 Introduction to the Research Problem...1 Chapter 2 Literature Review... 18 Chapter 3 Theoretical Framework...37 Chapter 4 History and Genealogy...67 Chapter 5 The Socio-historical Context of American Psychiatry: 1840-Present...85 Chapter 6 Genealogy of Stigma...] 31 Chapter 7 History of the Present... 173 Chapter 8 Conclusion...204 Bibliography of Primary Sources. ..216 Bibliography of Secondary References. ..262 VI List of Acronyms AAAIMH: American Association for the Abolition of Involuntary Mental Hospitalization AJI: American Journal of Insanity AJP: American Journal of Psychiatry AMA: American Medical Association AMSAII: Association of Medical Superintendents of American Institutions for the Insane AMPA: American Medico-Psychological Association APA: American Psychiatric Association CCHR: Citizen's Commission on Human Rights CMHC: Community Mental Health Center CSP: Community Support Program MNN: Madness Network News NAMH: National Association for Mental Health NCMH: National Committee for Mental Hygiene MHA: Mental Health America NAMI: National Alliance on Mental Illness NIH: National Institute of Health NIMH: National Institute of Mental Health NMHA: National Mental Health Association NMHCH: National Mental Health Clearing House SAMHSA: Substance Abuse and Mental Health Services Administration TAC: Treatment Advocacy Center WPA: World Psychiatric Association vii Chapter One Introduction to the Research Problem / live but for one thing; i.e. to have the stigma of insanity removed. -William Lee, Mental Patient, 19071 In 1902, William Lee was forty years old, owned a house and other property, married with three children and worked as an estimator at the iron works in New Jersey. He lost his job when the iron works was sold to the steel trust. He resumed work as a contractor and placed bids on constructing a new schoolhouse and making repairs to the heating system of the Statehouse. Lee lost both bids. When he found out that he had lost the bid for the schoolhouse, Lee broke all of the windows in the house owned by the architect who drew up the plans for the schoolhouse. The architect's brother, owner of the Trenton Trust and Safe Deposit Company, was the holder of Lee's bank accounts. Having lost the bid on the schoolhouse, Lee made an arrangement with the real estate agent who brokered the schoolhouse deal to buy the iron works for the sum of $12,000. Lee put down $2,000 towards this purchase and began repairs. The paperwork for this transaction was delayed by several months and when finally finished on July 17, 1902, Lee failed to pay the residual amount of $10,000. A month later on August 11, 1902, Lee was committed to the state hospital upon his arrest. In the interim period between the finished contract and the arrest, Lee had several altercations with other citizens. Several checks that Lee had written were not honored by 1 Lee as quoted in Hasbrouck 1911:121. All subsequent information about William Lee and his case has been taken from Hasbrouck (1911). 1 the bank, including two written to the Pennsylvania Railroad Company. These checks were drawn from his account at the Trenton Trust and Safe Deposit Company. As a result, the Pennsylvania Railroad Company rescinded all credit to Lee. When Lee met the state treasurer, Senator Briggs, who had turned down his bid on the repairs to the Statehouse, Lee insulted him publicly. After this meeting, Lee sent a letter to the Pennsylvania Railroad Company threatening to kill Senator Briggs because Lee believed that Briggs was involved in ruining his credit. Around the same time, Lee smashed the window of the Trenton Trust and Safe Deposit Company to retaliate against those he thought were trying to put him out of business. Lee had also been arrested on July 3, 1902 for shooting a gun off on his property and breaking the windows of a neighbor. Upon his arrest on August 11, 1902, Lee was examined by two physicians. Lee's wife was convinced by his attorney to petition for his committal. It was thought the ordeal would only last a few weeks if he was committed by a family member. One of the managers of the New Jersey Asylum who was responsible for Lee upon commitment was also the attorney that brokered the deal between Lee and the iron works on behalf of the elderly owner. This connection of the lawyer to the hospital bothered Lee as he suspected a conspiracy. Lee did not hold the other asylum manager, Dr. Garrett Vroom, as accountable for his commitment. Lee escaped the asylum in November and wrote several threatening postcards to those he thought responsible for his detention. In the twelve days he was free Lee procured a certificate of sanity from a physician in New York and returned to New Jersey to present the certificate to authorities. Despite having this document, he was remanded to the asylum immediately. Lee escaped two more times, finally settling in New York 2 where he resumed working as an estimator for several iron works companies. However, the mark of being labeled insane and being committed to the asylum weighed heavily on Lee. He continued to write letters to newspapers demanding the resignation of those he believed responsible for his unfair committal.