I Never Promised You a Rose Garden (Historical Context)

Historical Context

Schizophrenia

The German doctor Emil Kraepelin (1856 – 26) classified mental disorders in 1887. What would later be called schizophrenia, Dr. Kraepelin lumped together with several other mental disorders under the term "dementia praecox," which can be translated as "early dementia." In 1911, Swiss psychiatrist Eugen Bleuler (1857 – 1939) further distinguished several forms of schizophrenia and asserted that some were treatable. The word schizophrenia comes from a Greek word and means a split or shattered mind.

In 1959, Kurt Schneider listed the symptoms of schizophrenia, which include psychotic episodes during which a patient has trouble differentiating between real and imagined experiences; delusions, which cause false judgments; and disorganized speech and behaviors. These symptoms, according to Schneider, would often cause social dysfunction, withdrawal, and a loss of motivation, concentration, and emotional reaction.

Debate persisted on the cause of schizophrenia, whether it had a biological or behavioral origin. But in the early 2000s common psychiatric understanding of the illness tends to suggest a combination of the two factors, with an emphasis on genetic and biochemical causes. In the early 2000s, schizophrenia is treated with a combination of antipsychotic chemicals and therapy. Hospitalization, in the more serious cases, may still be required. Despite these efforts, there remains, according to a 2003 survey taken by the Center for Disease Control, a high suicide rate (10 percent) among people suffering with the illness. There is also concern that heavy use of drugs, especially hallucinogenic drugs, can trigger schizophrenia in people who are predisposed to the illness.

Mental Illness and Therapy in the United States

Mental illness is described as a disorder in the brain that causes a dysfunction in the way a person thinks, communicates, and experiences emotion. Although mental illness has been observed and recorded as far back as ancient times, there is still a lot of controversy about its causes and possible cures.

The first U.S. Surgeon General's report on mental illness (1997) found that mental illnesses account for more disabilities in the United States than other physical illnesses such as cancer and heart disease.

In 1904, in the United States, two people out of a thousand were in mental hospitals. Fifty years later, around the time of Greenberg's stay, that number had doubled to four in every thousand. Before the 1950s, although Sigmund Freud's work was becoming more accepted and his principles of psychoanalysis more practiced, most mentally ill people in the United States were treated with shock therapy or otherwise just kept locked in hospitals, away from the general public.

Beginning around the 1950s, however, psychiatry changed and became more influential. Around this time, behaviorists, such as B. F. Skinner (1904 – 90), for example, sought to prove that doctors could help their patients to improve their mental health by teaching them different, and more effective, behaviors.

Another breakthrough occurred in the 1950s when pharmaceuticals were introduced. The drug chlorpromazine was approved in 1954 and given to patients who were housed in state mental institutions. Chlorpromazine calmed mentally ill patients and helped them to live normal lives.

Chestnut Lodge Hospital

Chestnut Lodge Hospital, located in Rockville, Maryland, is the site of Greenberg's story. It was built in 1886 as a hotel but was later turned into a psychiatric facility. The hospital consisted of twenty buildings situated on more than twenty acres of land, which were dotted with 125 chestnut trees.

The hospital was run by the Bullard family, three generations of medical doctors, and was considered a pioneering facility in the treatment of long-term, mentally ill patients. In 1994, when Dexter Bullard retired, Chestnut Lodge was sold to a nonprofit organization. However, due to financial problems, the hospital was closed in 2001.

Frieda Fromm-Reichmann

Frieda Fromm-Reichmann was the actual psychiatrist upon whom Greenberg's Dr. Fried was based. Fromm-Reichmann's work, along with that of Harry Stack Sullivan, in the interpersonal school of psychiatry, was world renowned. Rather than using shock treatment, which was the more popular therapy of the time, Fromm-Reichmann believed that her patients could regain their mental health by talking through their experiences. She stated that she wanted to treat her patients as she herself would have wanted to be treated if she had suffered from mental disease.

Greenberg remained in therapy with Fromm-Reichmann from 1948 to 1955 and was supposedly going to collaborate with Fromm-Reichman in the writing of her story. Unfortunately, the psychiatrist died in 1957, with Greenberg's portion of the book written but not the part to be written by Fromm-Reichmann. Greenberg, then, apparently, decided to complete the book as a fictional autobiography.

Compare & Contrast

• Early Twentieth Century: Clifford Beers spearheads the founding of the National Committee of Mental Hygiene, which eventually evolves into the National Mental Health Association.
  Mid-Twentieth Century: President Harry Truman signs the National Mental Health Act for research into mental illness. As a result, the National Institute of Mental Health is established.
  Today: President George W. Bush establishes the New Freedom Commission to conduct a comprehensive mental health service delivery system, which recommends mental health screening for all school children.
• Early Twentieth Century: Hospitals for the mentally ill become overcrowded. Added to the list of patients are soldiers returning home from World War I and, later, people suffering from the psychological effects of the Great Depression.
  Mid-Twentieth Century: In the United States alone, there are 560,000 people in mental hospitals. This number will be the peak of mental hospital populations.
  Today: Admittance to mental hospitals is low, but according to a 2005 statement from the National Mental Health Association, one-third of all homeless people suffer from a mental illness. Many of them are schizophrenics. Another report, this one from the Department of Justice (2001), claims that almost 300,000 people in prison are mentally ill.
• Early Twentieth Century: Electrical shock that induces convulsions, and lobotomy (a surgical procedure in which nerves connecting the frontal lobes to the thalamus are severed) are common practices in treating schizophrenia and other severe mental illnesses.
  Mid-Twentieth Century: The drugs lithium and thorazine are used in the treatment of schizophrenia and manic depression.
  Today: New lines of anti-psychotic and psychotropic drugs are used to control schizophrenia. Over 70 percent of patients using these drugs experience improvement.