The Shame of the States is not the book I’d pictured it to be. Having come across a reference to it in Edward Shorter’s A History of Psychiaty, I’d imagined it as a kind of proto-gonzo journalism in the vein of Black Like Me, where Deutsch would masquerade as someone with mental health issues in order to expose the deplorable conditions of insane asylums. To be sure, there is an exposé element to The Shame of the States, but it is not one reach through duplicity. Deutsch announced his intentions to every one of the asylums he visits, and stresses that in the majority of cases he was welcomed with open arms.
That is not to say that the conditions he saw were favorable, or that he pulled any punches in his reporting. Rather, it speaks to the desperation in which asylum administrators found themselves—hopelessly underfunded and overworked, with barely trained staff and annual turnover rates approaching 100%—that they willingly exposed the foetid underbellies of their institutions in the hopes that learning of their appalling conditions would shock the public out of complacency, and that their outrage would trickle down to the politicians holding the purse strings.
I can’t say whether Deutsch’s book was successful in that regard, though I can say the picture he paints is vivid and heartbreaking, full of people in restraints or slumped in chairs, of beds filling a room so completely there is no space left to walk around them, of crumbling walls and ceiling bubbling with rot. Deutsch brought a photographer with him to every asylum he visited, and the photos he captured further underscore the squalid conditions of most of these institutions.
Though writing with the restrained, clinical prose of a seasoned journalist for most of his observations, Deutsch cannot restrain his seething anger at the state of affairs he witnesses, and the book contains a number of passages in which he allows himself the freedom to editorialize. The case studies make up the bulk of the text, but the book has other facets as well, making it part history, part journalism, part treatise.
Deutsch’s compassion for his subjects cannot be denied, though the age of the book means that some of the language he uses can be jarring to a modern reader. He refers to people with mental disabilities as “mentally defective” and “feeble-minded,” and regularly throws about the term idiot as a descriptor. People with Down Syndrome are referred to as “Mongolian Idiots.” I admit I cringed a bit at some of these passages, though it’s worth reiterating that Deutsch employs these terms without malice, and that the phrases he uses were at the time blandly clinical. He even makes a point of distinguishing between morons, imbeciles, and idiots, terms that signified increasingly severe levels of cognitive delay. “Idiot” and “moron” have been so thoroughly expunged of their clinical roots, that it is almost impossible to hear them as anything other than insults. Seeing them presented this way is an interesting reminder of how language changes over time.