 Taking an historically informed approach, he called for a public reform movement as the only way to enact significant change of the state mental hospital system, emphasizing lack of state funding as the cause of the problems he witnessed (mainly the "twin diseases" of overcrowding and understaffing), and pointing towards a lack of public pressure on state representatives as the ultimate reason for the hospitals' limited budgets.This book was originally published in 1948, after years of research by Deutsch on the history of public welfare, public care of the mentally ill, psychiatry, and public care of veterans in America, and after many other publications on those topics.Having worked the six years previous as a columnist for the "New York Post", writing about public health, he was able to use many of his earlier experiences in visiting mental hospitals and speaking with key figures there as source material for this newest book.