 He reiterates chapter ten, writing that the “real culprit” of the “chronic evils and abuses” present in state hospitals is not the individual scapegoat, responsible for some tale of “asylum horror,” but rather the state hospital system itself—a system which has allowed its institutions to become “principally custodial” rather than “hospitals in the true sense of the word.” He denies the claim that “such conditions are an inevitable part of a state care system,” pointing to the reformed VA as an example.He recapitulates his view that "the public is ultimately responsible for the inhuman conditions that exist on the wards of many mental hospitals.But an uniformed public cannot exercise that responsibility constructively...It is up to hospital officials, in possession of the facts, to share them frankly with the public."