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The value and truthfulness of these reports is indicated in the Annual Report of the National Committee for Mental Hygiene for 1944. That report, made under the direction of Dr. George S. Stevenson, one of the nation's outstanding authorities on mental hospitals, stated:

"No one can deny that members of the Civilian Public Service Units -units of conscientious objectors working in hospitals- have first-hand knowledge of conditions in our mental hospitals. Since they know whereof they speak, their voices may well be hearkened to, and their influence in their communities may well break down the lethargy of the public in regard to present conditions in mental hospitals."

But not all the reports in the Foundation's collection, nor all the incidents presented in this book, have come from these conscientious objectors. Many doctors, nurses, attendants, former patients and other informed persona have added their reports and observations to the ever-growing collection.

From whatever source they have come, these reports have several things in common:

(1) They are accurate, first-hand reports, vouched for and signed by the observer.

(2) They have been submitted in a sincere effort to better the plight of mental patients in this country.

(3) They are to be used, not to point the finger of blame at one state, one hospital, one superintendent, one attendant, but rather to expose a general situation, and to show the public that the fault is ultimately its own. For this reason, names of persons and places and other identifiable details have been omitted or altered.

The validity and truthfulness of these reports, however, is not the only proof that these conditions exist, that they are true. Hardly a day goes by that some reliable newspaper somewhere does not report an incident or print a picture which shows conditions similar to those depicted in these pages. Albert Q. Maisels article in Life, May 6, 1946, and condensed in the July, 1946, Readers' Digest; Albert Deutsch's series of articles in the New York newspaper PM during the spring of 1946; and Mary Jane Ward's best-selling novel, The Snake Pit, provide undeniable evidence of intolerable conditions in mental hospitals. The official utterances of the American Psychiatric Association, the National Committee for Mental Hygiene, and the United States Public Health Service present the same facts, the same truth, in perhaps more prosaic but equally convincing form.

If anyone is still unconvinced -- if anyone still wants to escape the facts by asking "Is it true?" -- let him turn to the stable, undeniably accurate reports of the United States Bureau of the Census. There he will find statistical proof of facts which are best understood in terms of human misery, but which still lend themselves to quantitative analysis. Here are some facts from the year 1940, a pre-war year: (7)

Overcrowding -- State mental hospitals, on the average, had 10% more patients than they could normally accomodate. -sic-

Understaffing -- State mental hospitals, on the average, had one doctor (many of them not psychiatrists) for every 251 patients, and one nurse or attendant to care for every 28 patients (for three shifts).

Poverty -- State mental hospitals, on the average, operated on a budget of 82.1 cents per patient per day to buy all food, clothing and supplies, and to provide all medical care and personnel.

The accumulation of evidence is undeniable. The picture of mental hospitals presented herein is a true picture.

Is It Representative?

Granted that it is a true picture, perhaps it is a rare picture. Perhaps it exists in only a few backward states or in only a few backward hospitals. Perhaps incidents like those that have been described occur very rarely. Is it representative? Is it generally true?

A member of the Board of an eastern hospital, confronted with a general account of deplorable conditions in hospitals, immediately wrote a letter to the paper, assuring the citizens of his state that such conditions might exist in some places, but that they most certainly did not exist in their own state institutions. The editor of the paper received other letters guaranteeing that the conditions mentioned were actually quite characteristic of that state. A reporter was sent to visit the state hospitals and returned agreeing with the group of condemning letters.

We all wish this picture were not generally true. But the fact is that there is no hospital in any state where there is not room for improvement. In no case have we made a mental hospital live up to the best that we know.

This fact is confirmed conclusively by an informal survey of state hospitals recently conducted by the National Mental Health Foundation. A battery of thirty-two fact-finders was sent to each of forty-five mental hospitals throughout the country. The replies received indicated that:

95% were overcrowded, some by as much as 50%; patients of all kinds were thrown together on one ward in many of these hospitals.