PLANET MONEY – One of the most difficult and expensive questions that a society faces is how to care for those who cannot care for themselves, and how to pay for it.
Over the last century, the United States has radically changed how it answers this question when it comes to treating people with severe mental illnesses. Now we appear to be on the brink of another major change.
In the mid-to-late 20th century, America closed most of the country’s mental hospitals. The policy has come to be known as deinstitutionalization.
Today, it’s increasingly blamed for the tragedy that thousands of mentally ill people sleep on our city streets. Wherever you may stand in that debate, the reform began with good intentions and arguably could have gone much differently with more funding.
In October 1963, just weeks before he was assassinated, President John F. Kennedy signed into law landmark legislation that aimed to transform mental healthcare in the United States.
For decades, the United States had locked away people deemed to be mentally ill in asylums. At their height, in 1955, these state-run psychiatric hospitals institutionalized a staggering 558,922 Americans.
Investigative journalists, government officials, and heartbreaking books like 1962’s One Flew Over The Cuckoo’s Nest exposed Americans to the horrors of the asylum system and sparked a movement for reform.
Meanwhile, new pharmaceuticals like chlorpromazine (also known as Thorazine) burst onto the scene, holding the promise to treat people with mental afflictions without the need for around-the-clock supervision.
The asylum system was a massive cost to taxpayers, which helped reformers unite with fiscal conservatives to build a coalition for change.
For President Kennedy, the movement to reform mental healthcare was personal. His younger sister, Rosemary Kennedy, had been born with intellectual disabilities — and her treatment is illustrative of some of the horrors of the asylum era.
Kennedy’s parents had spent years sending Rosemary to special clinics and allowing doctors to subject her to experiments, like injecting her full of hormones as an adolescent.
In 1941, surgeons convinced the Kennedy patriarch, Joseph Kennedy, of the need for a newfangled medical procedure: a lobotomy. The procedure involved cutting out part of Rosemary’s brain.
Rosemary’s surgery went terribly wrong (even for a lobotomy, which is now a medically suspect and extremely rare procedure).
