"He further characterizes Deutsch as familiar with “practical politics,” and thus accurate in his assessment that the system "can" change if the public knew what was going on and expressed their concern to legislators.Deutsch's goal in writing this book, he says, is to break the “conspiracy of silence”—to “inform the public and to make the public care.”

Deutsch supports this assertion in his preface, describing himself as a “part of the movement for civilized, humane, and scientific treatment of those who cannot speak for themselves,” a movement begun by Dorothea Dix in the early 19th century and continued by such figures as Nellie Bly and Clifford Beers, the latter of whom Deutsch had personally worked with.