Abstract
Susan Bartlett Foote’s book, The Crusade for Forgotten Souls: Reforming Minnesota’s Mental Institutions, 1946–1954, describes the social and political factors that led to both the unprecedented investment and systematic divestment in mental health policy reform in Minnesota. The Mental Health Policy Act was passed into law in 1949; however, by 1953, much of the necessary funding had been stripped away from the monumental reform bill by the conservative majority in the state legislature. The path toward mental health reform in Minnesota is portrayed through the collaboration among a religious coalition, a healthy and respected press, and sustained political leadership. The overall portrayal appears to this reader to be uncritical about race, gender, class, diagnosis, and intervention as it pertains to mental illness and the broader mental health care system.
In the book’s 12 chapters, Bartlett Foote describes the various leaders of Minnesota’s mental health reform movement, and she describes in detail the political processes that impacted mental health reform in Minnesota. The book is primarily centered on the perspectives and actions of the religious Minnesota Unitarian Coalition (MUC) through three main voices: Engla Schey—an attendant who witnessed firsthand the horrific abuses at several of Minnesota’s mental institutions; Reverend Arthur Foote—leader of the MUC Committee on Mental Hospitals; and Genevieve Steefel—vice-chair of the MUC Committee on Mental Hospitals. In addition to the MUC, there is a strong focus on the perspective and actions of Governor Luther Youngdahl, Star Tribune reporter, Geri Hoffner (Joseph), and several leaders in the field of psychiatry.
The book documents the specific political processes and barriers that were initially overcome by the mental health reformers, namely securing better staffing standards, training, and compensation for both medical and nonmedical mental hospital staff, as well as improving the care and living conditions for those who were institutionalized. The subsequent divestment in the reformed mental health care system occurred following the loss of strong political leadership, bureaucratic mismanagement, and a calculated conservative effort to quell public concern by downplaying the abhorrent conditions at mental institutions in the press, or through the suppression of known facts in official legislative research reports.
Bartlett Foote managed to incorporate the voices of people who are often ignored or dismissed; such as a hospital attendant, Schey, whose selected diary entries also included the experiences of several people who were institutionalized. She was able to capture the dismissal of nonmedical mental health workers and “patients” by well-meaning psychiatrists and politicians within the coalition working for change. Further, she depicted the willingness of the legislature to eventually roll back much-needed protections for two frequently marginalized groups: those diagnosed with a mental illness and unlicensed health care workers.
Despite the inclusion of Schey, the voices of the forgotten, as referenced in the title, appeared largely absent throughout much of the text. For example, while three women were identified specifically for their leadership, the book predominantly focused on the activities and perspectives of men. Discrepancies in institutional treatment based on race and gender were briefly mentioned. However, there was no critical discussion about those disparities as they relate to diagnosis and institutionalization, nor was there any acknowledgment of how those issues were addressed or ignored during the reform effort in Minnesota. Bartlett Foote acknowledges the stigma, dehumanization, and criminalization of mental illness as perpetuated by the mental institutions, yet she repeatedly highlights the reduction of social stigma as a result of the reform process. The stigmatization, dehumanization, and criminalization of those diagnosed with mental illness in Minnesota were neither resolved nor eliminated with the reform effort or passage of the Mental Health Policy Act, which was not fully explained and could leave a novice reader with an inaccurate perception of the impact of mental health reform in Minnesota.
Overall, Bartlett Foote achieved her goal of highlighting the power and importance of interdisciplinary coalition-building, persistent outreach and education efforts, strong political leadership, and a powerful and independent press in garnering expansive public support for mental health reform on both state and national levels. She rightly asserts that much work remains.
