As debates over national health care administration and affordable care continue to rage unresolved in the United States, it is salutary and timely to be thinking about the genesis of debates over the role of the state in taking care of its people. Therapeutic Revolutions provides an excellent starting point for thinking about these issues by offering a broad interdisciplinary assessment of the discourses surrounding mental health in the United States between 1945 and 1970. The book interrogates the realities and fantasies surrounding mental health and illness throughout that period and ties the shifting politics of diagnosis, treatment and health care provision to the cultural representations of mental health issues in cinema and literature.

The book is divided into three parts – “Fragmentation,” “Organization,” and “Reorganization” – in order to show the historical evolution of postwar American health care culture, with each part corresponding to the four presidential administrations covering the era. Part One spans Harry S. Truman's administration from 1945 to 1953; Part Two, Dwight D. Eisenhower's from 1953 to 1961; and Part Three, John F. Kennedy and then Lyndon B. Johnson's administration from 1961 to 1970. In a clear, vast and fast-paced tour through national trends in therapeutic ideologies and health care, the shifts and trajectories are loosely tied to each President's experience of therapeutic culture on both a personal and a political level (for example, Eisenhower's experience of war; Kennedy's own ill health and his sister's institutionalization and catastrophic lobotomy). As an organizing principle for what is shown to be a far more complex series of overlapping shifts, tensions and crosscurrents, this is an interesting way of tying national political history (and postwar “recovery” and rehabilitation) to often discrete and personal experiences of mental illness and treatment, or the creative responses to those experiences, in art and culture. The burgeoning of health care needs and provision is reflected in the multitudinous set of examples examined, as well as in the elision of physical therapies with psychological treatment. Therapeutic Revolutions draws on a wide variety of materials to make such connections, intersecting government memoranda, medical case studies, popular science, film and fictional narratives. While therapy and the therapeutic are never treated as singular or unified concepts, or as ideologies held in common, such broad discussion enables the key ambition of the book, which is to show how therapy exerted its multifaceted influence in every area of contemporary life and thereby constituted a “revolutionary” or paradigmatic shift in American culture.

Each of the three parts covers a growing trend in psychiatry alongside shifts in the definitions and politics of “mental health” and is subdivided thematically into three chapters. Chapter 1 begins with demobilization and the assessment and treatment of “war neurosis” as a national health issue. Halliwell argues that the postwar era saw a new relationship emerge between mainstream medical diagnosis and psychiatry as a result of returning “disabled” veterans. While the veterans needed rehabilitation (both mental and physical), the communities they returned to also needed to be guided towards a new understanding and acceptance of the mentally and physically wounded in their midst. Readjustment, then, involved changing attitudes towards “ableism” and the role of the state with regard to medical treatment, all of which became represented in a variety of feature films and educational features.

Such efforts to create a return to “normalcy” are shown to be in tension with a shift towards an increasingly complex understanding of psychopathology and the development of social and cultural critiques of standardized culture in the era. As chapter 2 shows, fears that “war neurosis” might lead to social breakdown and lack of productivity in the postwar era were reflected in film noir Hollywood features and demobilization films, which dealt with characters who no longer “fit in,” and yet such films offered limited understanding of war-related trauma and often sent out mixed messages about successful reintegration into civilian life. As this illustrates, the drivers of the film industry (a clearly understood narrative, entertainment and profit) and the medical profession (the diagnosis of complex conditions, alongside treatment and cure) diverged as much as converged at times, characterized by the “plundering” of clinical case studies by celebrated Hollywood directors to make their features more terrifying and exciting (67). Charting the numerous crossovers between postwar medical discourses and cinematic representations thereby raises many questions about the limits of the therapeutic cultural response.

While a cultural interpretation cannot show how such feature-film stories impacted on an audience's everyday perception or how they responded to mental illness as a result (the film is seen as the response), Therapeutic Revolutions does show that a number of bioethical issues were raised that continued to stimulate debates about alienation, authority, definitions of sanity and medical experimentation into the 1970s. As chapter 3 illustrates, during wartime – including the Cold War and the Korean War – the needs of the state and the needs of the individual were often pitted against each other whereby “maladaptive” responses such as aggression and obedience became peacetime conundrums for medical professionals to resolve. The needs of the state could thereby be confusing and contradictory and in conflict with individual health needs. The nuclear state, or the military–industrial complex, thus created its own neuroses, which scientists and psychotherapists responded to in a variety of ways: from critiques of authority and the overemphasis on averageness or normality leading to new patient-focussed therapies, to drugs, hypnosis and experiments with mind control that were more about enabling the individual to fit into “the organization” than about achieving mental health.

Chapter 4 charts the growing tension between the individual and the organization and shows how postwar prosperity and the huge growth in white-collar jobs led to an increase in psychotherapeutic theories to deal with the resulting health implications (such as workplace stress, alienation and automation) of such rapid changes in industrial culture. This is tied closely to the narratives of white-collar fiction produced in response to such organizational trends – there are a multitude of examples discussed, from Sloan Wilson's The Man in the Grey Flannel Suit (1955) to Richard Yates's Revolutionary Road (1961). The trajectory of the subsequent chapters moves from the role of the state, to the role of the corporation/organization, to the role of the family and then the grassroots community group. Like the state, the family played a mixed role in the culture of therapy over the 1950s – becoming the point of administration of individual health care regimes and a therapeutic space for curing societal ills (as manifested in child-rearing advice manuals and the growth of the field of child psychology), and a locus of new and previously undiagnosed neuroses and Cold War containment (“momism”). However, Halliwell shows that the search for mental health in America was often a negotiation and oscillation between oppositions – as rigid definitions of “normality” became entrenched in the Diagnostic and Statistical Manual of Mental Disorders (1952), opposing discourses (such as the Kinsey reports on human sexual behaviour) emerged to resist the “centripetal cultural pull” of the mid-1950s (193).

All of this highlights that the trends that defined the 1960s (a shift away from organizations, authority and institutions towards community care, existential psychology, experimentation with drugs and New Age therapies) had their roots firmly in the research of, and resistance to, psychotherapeutic culture in the 1950s. At the same time, studies examining the psychological stresses of both segregation and desegregation explored the health fears raised by the civil rights movement and underpinned new understandings of psychological health and well-being for minority subjects and victims of urban poverty. This latter section of the book examines some of the research and cultural representations that underpinned new understandings of the psychodynamics of class, race and gender that led to the emergence of grassroots therapy: community and free clinics and investigations into minority psychology – concluding with the anti-psychiatry movement that viewed psychiatry as a repressive practice and highlighted the dangers of “disciplinary” therapies. Such anti-institutional trends evolved in a number of different directions, most notably towards experimentation with drugs (Timothy Leary's “Politics of Ecstasy”), self-medication (Vietnam soldiers) and gestalt therapies or New Age trends (the Esalen Institute).

Therapeutic Revolutions finishes at the end of Johnson's administration and looks towards a new shift in health care policy under Richard Nixon, a period that was notoriously fragmented, divided and governed by a paranoid style of rule. Despite this, as Halliwell notes, “disability activism and identity politics based on gender, race, and sexuality were key social changes at the beginning of the 1970s, and they indicate that medicine, psychiatry and healthcare had become a more diffuse field than the two-cultures model credited” (292). The steps towards a healthier nation taken in 1945, however, are shown to have gone in some unforeseen and unwelcome directions – with inequality and discrimination in the treatment of different social groups remaining despite the psychological effects of inequality being increasingly under the spotlight. An endpoint scenario concurs with Halliwell's conclusion that his book shows that “the longer history of healthcare in the United States is shot through with moments of optimism and instances of deep pessimism” (299): as the rich and sexually liberated few “cure” themselves of an increasingly complex set of neuroses and mental illnesses in the New Age clinic at an indulgent Esalen Institute (represented on film in the 1969 movie Bob & Carol & Ted & Alice), the utopianism of the free health clinic and hippie movement on the West Coast is washed up in the image of a free clinic full of burnt-out drug users wrapped in blankets and bloodied bandages suffering from “chronic toxicity” and “Terminal Euphoria”, while the drug cartels and gangs start to operate in their formally bohemian communities (281–82). The growth of a vast and complex set of national mental health issues since 1945 that were inherited by Nixon could not be made more stark.

Therapeutic Revolutions offers a wide-ranging and well-written cultural and intellectual history of mental health discourses in the era and explores the intersection of intellectual currents and complex philosophical and medical theories with politics and culture. As such it raises further questions about the causes of the tensions and inequalities in the care provision that it unveils. As a cultural history it does not aim to answer these, but the reader is left thinking about the spectre of current health care debates and with questions such as why no national health service developed in the United States during this era, unlike in many other Western nations in the same period, despite the clearly stated case that public concern with psychiatric health and national well-being increased tenfold. The question remains concerning the extent to which neuroses and illnesses were seen as profits as well as problems by the growing and increasingly privatized therapeutic industries (therapy, self-help, self-medication). While this is, perhaps, asking questions beyond the remit of an already ambitious cultural history of the era, as Halliwell turns to research a follow-up volume (entitled Voices of Mental Health: Medicine, Politics, and American Culture, 1970–2000), we can perhaps look forward to a discussion of the voices and experiences of the treated and “therapized” subjects themselves, something not addressed in this first volume.

Even though health care is an arena fraught with political division and tension, both then and now, Halliwell's conclusion and overall assessment remain nonpartisan. While Therapeutic Revolutions covers some familiar examples from the era, it is particularly adept at bringing a wide range of ideas and discussions into conversation with each other. Halliwell thereby effectively explores the intersection of medical/scientific discourses with the fault lines of contemporary debates, alongside the wider disagreements or tensions between the medical needs of individuals, the growth of psychotherapeutic sciences and the sociopolitical needs of the nation in the postwar era. His book provides a hugely important survey of the development and popular dissemination of psychiatric health care that may serve to inform the health care debates that the United States currently faces.

What we might call the paradoxical idée fixe of Martin Halliwell's detailed and informative Therapeutic Revolutions appears as early as the first page of the preface, when the “oscillation between idealism and realism, dreams and pragmatism” – part of the “fabric of American life” – is put forth as the most edifying way of apprehending the story of health and illness in the United States for much of the second half of the twentieth century (ix). Oscillation or alternation becomes the main point of Therapeutic Revolutions. Throughout the book, this idea is slightly recoded, but the notion of fluctuation from one pole to another remains:

It is not surprising that Halliwell's concern with shifting priorities governed by appeals to idealism and realism, or the persistent interplay of optimism and pessimism, would make a term like “health sciences,” which might seem like a good way to characterize the overall subject of his book, less than satisfying. The term comes off as too polished, too much of a fait accompli for Halliwell, who wants to provide a more ragged and bumpy account of health care in the United States. Because the study is invested from the start both in the postwar history of health care and in narratives about health and illness, “medical humanities” serves as a better descriptor of the book's overall site of inquiry. Even more precise is a term that Halliwell invokes only sparingly: “health narrative” (199). His book is a marvellous crafting of the United States' “health narrative,” which is, of course, made up of many multiple and distinct narratives, often cinematic and literary, that Halliwell revisits and reinterprets, often with remarkable subtlety.

The searching exploration of the American health narrative that Halliwell provides invites further exploration of the main dynamic he identifies within that narrative: the jockeying of idealism and realism. The latter term is especially interesting, for realism is given a broadly pejorative meaning throughout the book and, as we have seen, is effectively made a synonym for pessimism, denoting a failure to advance or achieve greater health among Americans. Because of the importance given to the term throughout, one is obliged to at least think through the other “realism” of Halliwell's book, which is to say its methodological realism. If realism in literary studies refers to the accurate depiction of a place or period in a literary work, Halliwell brings a brand of historical realism to bear on the subject he investigates. Another way to say this is that presidential speeches and other official governmental pronouncements are located on the same plane as cultural discourses and cinematic texts, for instance, since all of these evoke some aspect of an actual place and time. Literary and cinematic texts, by virtue of Halliwell's realist approach, are all realist narratives. This makes the topic of “realism” more complex and much more interesting than a mere pole of a perpetual and repetitive history in which health care is buoyed by optimism only to be robbed of that same optimism by the return of “realism.” Although “realism” in this latter guise is significant and indeed key to the way Halliwell presents his claims, the realist orientation of his study is arguably the more decisive “realism,” for it furnishes the book's prevailing logic, or what literary critic Kenneth Burke might have called its “attitude.”

For Kenneth Burke, all terms, “even when they name a process or condition,” do so by naming it from a meditative, moralizing, or even hortatory point of view.”Footnote ¹ Thus do terms transmit their respective attitudes. In projecting a picture of the United States health narrative in which idealism and realism vie for ascendency, Halliwell relies on what I have called a methodological realism, corresponding to an emphasis on the objective presentation of details and events. If this attitude bears some relation to what Burke calls a meditative point of view, it surely also has moralizing inflections, for as we have seen idealism is ever on guard in the health care story, preparing itself for the inevitable reappearance of a morally taxing realism. We are primed to see idealism as an incessant movement toward laudable aims of expanded health and to recognize the intractability of realism as a moral conundrum that can take the form of confused priorities, poor implementation, or refusal to meet the challenges of illness. The reliance on the objective presentation of details and events most acutely invites questions about Halliwell's larger attitude at the points at which his realism encounters the imaginative text. The first thing to say about Halliwell's attitude and the framework that follows from it is that it produces one of the most capacious and enriching available accounts of health and illness in the United States. Yet the attitude is also one that endows the “humanities” in “medical humanities” with a kind of instrumental quality. For every cultural narrative that Halliwell treats must enter the frame of the study as a statement within the larger health narrative, which is to say as a health narrative. I'll return to this shortly.

But first it is important to see how Halliwell's postwar story makes masterful use of juxtaposition. He is, of course, right to see James Baldwin, for instance, not only in terms of his contributions to American and African American literature, but also as a writer “interested in conditions that are ontologically prior to accidents of birth” (256). Recognizing this dimension of Baldwin makes it possible to place him alongside psychologist Abraham Maslow, whose concept of “human diminution” serves as an analogue to Baldwin's literary and philosophical preoccupations. There are many other such moments of unexpected and revealing juxtaposition in Therapeutic Revolutions. In another instance, Halliwell links the work of such critics as Erich Fromm, David Riesman, and Norman Mailer not only to a general “loss of autonomy” or heightened susceptibility to “external influences,” but more specifically to postwar anxieties that pictured psychiatry and medicine as “increasingly locked into the military–industrial complex” and no longer “representing a set of ideas and practices designed to help individuals regain or sustain their autonomy” (80). The reading of Riesman leads into a consideration of a range of texts, including Sloan Wilson's novel The Man in the Gray Flannel Suit, which Halliwell describes as a narrative suggesting that “domestic and working life can be reconciled, and that business in the 1950s was not just about a duped workforce suffering from new forms of alienation and monotony” (134). Here the novel intersects with Riesman's “ambivalences.” Halliwell seems persuaded to a degree by the view expressed by Arthur Brodbeck, who argued that Riesman's The Lonely Crowd is “not a jeremiad or full-scale critique of industrial relations,” but instead a work in which the “theme of loneliness ‘haunts every page, like an insistent and sorrowful background music’” (110–11). The same could be said for Sloan's novel, though Halliwell does not pursue this particular angle. Perhaps the most basic and simultaneously most intriguing claim that Halliwell makes about Riesman's work is that it “pits humanistic forces against technology and tacitly associates health with personal autonomy” (110). Thus did Riesman's work become a key entrant in the postwar health narrative.

Halliwell's book is punctuated by evocative juxtapositions, but the realism of his book risks giving the texts he explores, and the imaginative works he treats in particular, a functional character. They each enter into the postwar health narrative with their position papers in hand. Here we might profitably return to Burke, who questioned the “kind of ‘one-to-one’ correspondence between stimulus and response which is assumed in much contemporary criticism.”Footnote ² Continuing along these lines, Burke asked, “Does anti-militarism produce anti-militarism, corruption corruption, quietude quietude, acceptance acceptance, individualism individualism, etc.?”Footnote ³ Finding one-to-one correspondence across social phenomena or texts at times narrowed criticism that otherwise might be “broadened considerably.”Footnote ⁴ Although Burke was writing about criticism his comments apply equally to the literary and historical imagination generally. We might ask, with Burke in mind, does the health narrative produce the health narrative? Or, does the health–illness dyad produce the health–illness dyad? These questions are relevant in reading Therapeutic Revolutions because of its historical–literary structure – working across time as it does, while also attending to storytelling practices. They can be explored more fully by way of an example: the book's reading of Ken Kesey's 1962 novel One Flew over the Cuckoo's Nest. Therapeutic Revolutions posits a necessary correspondence between the postwar health narrative as such and the novel. That is, while the story carries distinct traits, it is of primary interest as another instantiation of the health narrative. Halliwell finds that in Kesey's work “laughter and camaraderie are proposed as humane therapies, enabling patients to coexist in a community and find new ways of being” (216). But Kesey can also be faulted, for unlike the nonfiction work The Psychiatric Hospital as a Social System, which Halliwell places alongside the novel, Kesey's work “tends to elide conditions (he has just two categories, ‘chronics’ and ‘acutes’)” (216). Still, the former work mentions a technique – “permissiveness” – that we are told would have met with “Kesey's approval” (217). Because his work becomes another iteration of the health narrative, Kesey can be read as a commentator who dispenses or withholds approbation in relation to techniques described in a work about psychiatric hospitals. Moreover, Kesey's reluctance to present pictures of such hospital environments with adequate precision can be construed as a failing. But what kind of failing is this? It becomes a failing within the terms of a stringent methodological realism. Yet if, with Burke once more in mind, we say that the health narrative is not the health narrative is not the health narrative, figuring Kesey in the way Halliwell does becomes a perilous exercise, for it limits literary work to the province of empirical categories and techniques emanating from the “health sciences.” We are ushered too hastily into a world of one-to-one correspondences.

Another way to describe the problem demonstrated by the Kesey example is to say that Therapeutic Revolutions puts forth a specific formulation of the medical humanities, for the book sees it as a “version of ‘cultural science,’ which draws as much on professional science and medicine as it does on popular representation” (14). If it is fair to say that scientism holds a substantial place in such medical humanities, it also seems fair to note that the Kesey problem may recur in perpetuity. The literary or cinematic text will continue to be an iteration of the health narrative. But does the health narrative produce itself with variations ad infinitum? Does the health narrative produce the health narrative? Or does the interpretive ken need to be expanded? If, like Burke, one holds that “art is naturally antinomian,” then it becomes necessary to problematize formulas that rely on one-to-one correspondence.Footnote ⁵ For “art's very accumulation (its discordant voices arising out of many systems) serves to undermine any one scheme of living,” as Burke writes.Footnote ⁶ And it is that accumulation that cannot but snag Halliwell's aspirational cultural science, despite the myriad original insights that Therapeutic Revolutions delivers.

At the end of Therapeutic Revolutions I suggested that the framework for understanding the place of therapy in American life was more extensive in 1970 than it had been in 1945. This was, in part, due to the expansion of the diagnostics and practice of psychiatry, which was still in a relatively fledgling form when the United States entered World War II, and then developed quickly through the 1940s and 1950s. But the growth of the psychiatric profession in the United States is often overshadowed by a broader cultural trend to which Philip Rieff gave voice in 1966 when he coined the phrase “the triumph of the therapeutic.”

Despite the diffusion of therapeutic language between the mid-1940s and the late 1960s, though, therapy was frequently viewed in polar terms. On the one hand, especially when coupled with invasive procedures, it seemed to be what Louis Althusser in 1970 called an ideological state apparatus, the aim of which was to eradicate aberrancy in favour of normalcy; but, conversely, in its humanistic form it was a healing practice in which the therapist acted as a guide to help the patient regain or newly discover a sense of agency. This model of “bad” versus “good” therapy is a seductive one, but these two perspectives are at best broad tendencies and at worst caricatures of Cold War-era thinking. A more balanced view would recognize authority and liberation as different faces of a prism of postwar therapeutic thought and practice that extends far beyond the medical sphere.

The therapeutic cultures of 1970 look much more mobile, then, than they do when pushed into a static Cold War model. This is evidenced by the divergence of medical research fields and health practices across the following decade. In the conclusion of Therapeutic Revolutions I outline seven emergent trends at the beginning of the 1970s: (1) the fusion of aesthetic and medical modes of enquiry (this found its flowering in the “narrative-and-medicine” movement of the 1980s and a greater range of first-person illness stories); (2) an interest in comparative health studies that looked beyond specific communities and sometimes beyond the nation-state (although this trend did not develop as quickly or substantially as it might have); (3) an increasing interest in psychopathology and the psychology of violence (this deepened during the 1970s and 1980s); (4) a topical interest in drugs, both recreational (promoted within some alternative-therapy cultures) and prescription-based (in the light of the growing influence of the pharmaceutical industry), a trend that led to a complex narrative of addiction and cross-addiction in the following decades, and into the 2010s with opioid addiction on the rise; (5) the refinement of diagnostic terms that led in 1980 to more organically rooted (rather than psychoanalytically oriented) nomenclature in the third edition of the Diagnostic and Statistical Manual of Mental Disorders than in the earlier editions of 1952 and 1968; (6) the growing importance of biological and neurological models for understanding “mental illness” as “brain disease” (as inflected in President Bush's pronouncement that the 1990s would be the “decade of the brain”); and (7) the politicization of mental illness (this was kick-started by the new social movements of the 1960s, but it had its own agenda in the 1970s, often at the intersection of gender, sexuality and race).

One reason why this broad paradigmatic shift from “two cultures” to “pluralistic cultures” is difficult to date precisely is that the vocabulary of therapy quickly became part of the mainstream after World War II, fluctuating between myths and folklore at one extreme and hard medical language at the other. It was also inflected by the belief among some thinkers (not all of whom were versed in existentialist thought) that the language of authenticity was under siege and needed rescuing. What my comments in Therapeutic Revolutions on early 1970s medical research trends fail to offer a full account of, though, is the concern from some quarters that therapeutic practice often strayed far from the biomedical model. When taken in isolation the medical model is often seen as prescriptive and reductive, as we have seen in the critiques of disability studies scholars. But when taken out of the frame, the risk is that just about any practice and practitioner could be seen to be as authentic – or inauthentic – as the next, especially within a culture of self-seeking, of which Edwin Schur was suspicious in his 1976 book The Awareness Trap.

It is towards this more contested terrain that I gesture at the end of Therapeutic Revolutions, and which I address in a more sustained way in its forthcoming sequel, through a discussion of the politics of mental health from the Moon landing to the millennium. The policy angle (an aspect of what Jay Garcia calls my “historical realism”) is more pronounced in this second book, Voices of Mental Health: Medicine, Politics, and American Culture, 1970–2000 (2017), and so too is the story of decline from the high ideals of the 1960s during what Nixon called an “era of negotiation.” Within this context I begin Voices of Mental Health by reflecting on the fate of deinstitutionalization. This process began with the community health initiatives of the mid-1960s and Lyndon Johnson's promise to inject new funds into health services for local communities, but it gave rise to concerns that the federal government was committing far too many health dollars. Indeed, when medical historian Gerald Grob looked back at the 1970s he saw a patchwork system in which community health services were struggling from inadequate subsidies, especially because the Nixon and Ford administrations had scaled back on the promises of Johnson's Great Society reforms.

This did not stop health costs spiralling, though. And when Jimmy Carter entered the White House in early 1977 he was faced by a “crisis of confidence” (as he called it in a July 1979 speech) on at least two counts. First, his advisers pointed out that the medical system was neither responsive nor coordinated enough to deliver on its postwar promises, especially with a wave of Vietnam War veterans requiring both physical and psychological care. Second, a cultural malaise seemed to have taken hold of the nation, which the quest for authenticity expressed in New Age texts by the likes of Claudio Naranjo and Robert Pirsig did little to mask. So when, for example, Pirsig's narrator searches for “channel deepening” in his 1974 cult book Zen and the Art of Motorcycle Maintenance it speaks both to the quest for something personally authentic in a “age of fracture” (to borrow the title of historian Daniel T. Rodgers's 2011 book) and to the search for well-being that seems to have been eroded by the electroconvulsive therapy that he underwent as a young man. Pirsig's narrator begins his journey adhering to classical philosophy and practical reason, but he realizes en route that emotions and intuition cannot be denied without diminishing the self. This view that the practical side of life is a necessary counterpart to “channel deepening” echoes the oscillation between realism and idealism that I trace through Therapeutic Revolutions and into Voices of Mental Health.

Zen and the Art of Motorcycle Maintenance is very much a personal narrative despite its philosophical vignettes. It stands up in its own right as a creative and theoretical work, but in the mid-1970s it also captured a shared search for meaning in an age of fracture that implicates a moral realm in which questions of health – especially mental health – take centre stage. It is best read, then, as both an imaginative and a realistic text, grounded in the author's experience of medical intervention and the long (and arguably only partial) recovery that followed.

Pirsig's text prompts us to think that quite often idealist conceptions of health seem to be the most authentic, especially in the wake of health activism during the 1970s via ex-patient and disability movements. But, as Jimmy Carter showed in his major contribution to the national conversation on health, in the guise of his 1977–78 President's Commission on Mental Health, pragmatic action of the realist kind (a step-by-step approach, data collection to augment patchy health records, community initiatives for underserved groups) often seems more plausible than the idealistic clean sweep that Massachusetts Senator Ted Kennedy proselytized in the 1970s in his championing of comprehensive national health insurance (this influenced Bernie Sanders's emphasis on the 2016 campaign trail that health should be a right and not a privilege). If there is a story to tell that bridges the poles of realism and idealism, then, the 1970s – and their influence on mental health policy in the mid- to late 1990s (delayed by Reagan's dismantling of the Mental Health Systems Act of 1980 that stemmed from Carter's Commission) – offer an instructive historical example.

The methodological problem of how best to tell the story of mental health is a tricky one. Angela Woods addressed this in a 2011 article for Medical Humanities, “The Limits of Narrative,” by reminding us that we need to be attentive to who is speaking in health narratives and to understand what kind of story is being constructed before we can accurately test the boundaries between biomedical and cultural understandings of health. This also reminds us that “mental health” and “mental illness” are in themselves slippery terms that are often used as high-level concepts that hide personal stories beneath. The methodological difficulty, then, is how to link the macro and micro, from broad frameworks of understanding (at the level of policy, report or manual) to personal stories about health conditions, treatments and daily life that are often the most instructive for testing the usefulness (and the limitations) of language for describing often amorphous experiences – in imaginative as well as realistic ways. This means that cultural representations do not just play a secondary or illustrative role when we construct historical health narratives, but nor does it mean that “the personal” simply plays the authenticity card. As stories of addiction, dementia, anorexia and personality disorder attest, the individual is often too deeply immersed in his or her “condition” to retain a clear perspective; and lapses, interruptions and deceptions within health narratives pose fundamental questions about veracity and truth-telling.

But nor does that mean that medical and political discourse holds the aces. At root, mental health lies on the fulcrum of seemingly incommensurate ways of accounting for human life, posing the kinds of question that palaeontologist Stephen Jay Gould asks in his 1981 book The Mismeasure of Man about how much is left out when we turn abstract categories into entities and seek deterministic explanations for complex epistemological, ontological and cultural issues. We could use a similar argument to propose that health economics and the management of health care on a macro level – however well-meaning, such as the World Health Organization's Mental Health Action Plan, 2013–2020 to address the “disease burden” of mental health conditions – will always be at the expense of the felt, intimate experience of life, in which the personal drama of health and illness plays out. This is where narratives, particularly those born out of personal experiences, come in. But we cannot easily flee the world of health policy and provision to reclaim a romanticized conception of authentic experience that can only be witnessed and articulated by the sufferer. As a number of late-century theorists grasped, narrative and action language are essential therapeutic tools for bridging these two worlds, but so too is a sense of community, citizenship and social action in which the individual is rooted in a network of other lives.

With recent research showing that loneliness and isolation have corrosive effects on health and well-being, both Therapeutic Revolutions and Voices of Mental Health address a moral lexicon that often inflects discourses of mental health and that bridges its idealist and realist conceptions. Sometimes this unhelpfully introduces a moralistic agenda in which mental illness is viewed as a personal failing (such as in Ronald and Nancy Reagan's pronouncements on addiction as an aspect of the “war on drugs”), but at other times it reminds us of a broader social picture that links personal stories to ideas and institutions. In this respect, it feeds into the research of Berkeley sociologist Robert Bellah that led him in The Good Society (1991) to envision the relationship between individuals, groups and institutions as a “moral ecology” based on genuine caring – a view that Jimmy Carter tried to embody in the late 1970s, despite the economic realities that gave him less room for manoeuvre than his rival Ted Kennedy believed he had (Bellah's call to remake the social covenant directly influenced Carter's “Energy and the Crisis of Confidence” speech). Bellah's Christian perspective may have led him to underestimate (or overestimate) the gap between “is” and “ought,” which is always tricky to navigate in the sphere of health. But it signals that the health effects of an isolated voice are likely to be more limited, and possibly more deleterious, than a voice situated within a shared world of others.