Ill-Treated: The continuing history of psychiatric abuses. - 'Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill' - book review

Reason, May, 2002 by Brian Doherty

Whitaker traces the turns in psychiatric theory and practice through American history, referring when necessary to European trends that were quickly imported here. We meet Benjamin Rush, a signer of the Declaration of Independence and the father of American psychiatry (whose image is still on the seal of the American Psychiatric Association). Rush, who thought mental illnesses were caused by circulatory defects, believed bloodletting (up to four-fifths of a patient's blood) and spinning patients on a board were appropriate treatments. He was also ahead of his time in concern for the rights of American Negroes, convinced that they were white under their disfiguring leprosy. (Whitaker, who assiduously avoids ad bominem attacks, doesn't mention this.)

Whitaker connects the craze for eugenics in early-20th-century America with a shift in cultural attitudes toward the mad. They went from people in deep distress, deserving of human sympathy and aid, to diseased carriers of inferior germ plasm who needed to be strictly and forcibly segregated from normal folk, prevented from reproducing, and perhaps even wiped out for everybody's good.

As this attitude grew, the percentage of Americans in asylums quadrupled from 1880 to 1929. Was mental illness really spreading so virulently, or were asylums merely becoming more popular as places for warehousing society's presumed inferiors? Whitaker reproduces the voice of, and thus gives moral witness to, one fellow trapped in California's sterilization-obsessed mental health system in 1918: "I shall ever bemoan the fact that I shall never have a son to bear my name, to take my place, and to be a prop in my old age."

As the 20th century dawned, dunking bound patients in water was still state-of-the-art treatment. Whitaker introduces a shifting set of cutting-edge psychiatrists on his tragical history tour of American psychiatry: Henry Cotton of Trenton State Hospital in NewJersey, who theorized that germs from tooth rot caused insanity and established a very respectable cure rate by pulling asylum inmates' teeth, then later other body parts he decided were breeding grounds for disease (thereby killing 43 percent of his patients); the SwissJacob Klaesi, who discovered that inducing deep sleep with barbiturates for weeks on end was an effective cure; Harvard men John Talbott and Kenneth Tillotson, who found that binding patients in freezing cold blankets until their body temperature fell 10 to 20 degrees below normal was quite therapeutic for the mentally ill; the Viennese Manfred Sakel, the father of induced insulin comas as therapy; and the Hungarian Ladislas von Meduna, who added metrazol to the psychiatric pharmacopoeia . It possessed the therapeutic property of inducing "a convulsion so severe it could fracture bones, tear muscles, and loosen Teeth.")

Then we reach the zenith of mid-20th-century psychiatric medicine: electroshock and lobotomy. Electroshock was based on the (now discredited) theory that seizures and mental illnesses were somehow opposite, so inducing one eliminated the other. Lobotomy derived from the notion that damaging the frontal lobes--the center of most higher human personality and mental functions--was the key to a happy cure for madness. Portuguese neurologist Egas Moniz, developer of the lobotomy, thought that mental illness resulted from fixed thought patterns and that "to cure these patients we must destroy the more or less fixed arrangements of cellular connections that exist in the brain." Moniz won the Nobel Prize for his innovation. He was also once shot by a disgruntled patient. (Brain damage as therapy, with chemicals instead of ice picks, dominates psychiatry to this day.) To the extent that they could reduce you to a characterless stupor, psychiatrists thought they were on the right track.