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

The story of Walter Freeman, once I head of the American Medical Association's certification board for neurology and psychiatry, is especially enlightening and inspirational. After years of failing to find any anatomical differences in dead human brains that could pinpoint the physical causes of madness he knew must exist, Freeman became the Johnny Appleseed of lobotomies in the 1940s. He became a roving instant brain surgeon, lining up patients in a row to jam ice picks simultaneously up both eye sockets to destroy both frontal lobes, taking less than 10 minutes per patient. The operation was a success if, in Freeman's own words (written with his partner James Watts), the patient was "adjusting at the level of a domestic invalid or household pet."

Whitaker shows how little evidence of therapeutic quality there could have been for any of these theories, practices, and beliefs--except in one respect. They served the interests not of the patient but of the doctor or caretaker. A lobotomized patient may not feel any happier, but affectless, quiescent people are surely easier to deal with in an institution.

The abuses of psychiatry are rooted in the fact that the doctor-patient relationship is frequently not one of service provider to customer but all too often a hegemonic one, with the doctor forcing treatments on the patient. Although no one keeps set figures on this, by cobbling together available sources it is safe to say that even today well more than half a million Americans a year are under the care (and control) of a psychiatrist by law rather than by personal choice. As Whitaker is not the first to note (see the writings of Michel Foucault or of reason Contributing Editor Thomas Szasz), the history of psychiatry fits more comfortably in the history of penology than of medicine.

Defenders of psychiatry argue that things have changed. Such historical unpleasantness says no more about psychiatry today than bloodletting and pre-anesthetic surgery say about standard medicine. Constant changes in theories of etiology and cure no more condemn psychiatric science than outdated theories of phlogiston or ether discredit chemistry or physics.

But Whitaker has just gotten started when he hits the modern, chemical era of psychiatric medicine. When the first modern psychiatric wonder drug, chlorpromazine (Thorazine), was introduced in France in 1950, it was as an anesthetic. It produced a "vegetative syndrome" such that you could do whatever you wanted with patients and they wouldn't complain. Within a few years, the wonders of the psychiatric complex's P.R.--and its hunger for new treatments that justified psychiatry as a bona fide medical discipline, with medicines that cured ailments--had completely recast Thorazine in the eyes of physicians and the public.

The Thorazine fad spread, aided, as Whitaker documents, by credulous popular media reports and paid-for research from drug companies. It was soon joined by fluphenazine (Prolixin) and haloperidol (Haldol). Whitaker tells not just medical history but social and cultural history, tracing how these drugs are hyped and sold. All the emphasis in medical journals on how Thorazine caused motor dysfunction and induced Parkinson's disease-like syndromes gave way to praise for the latest psychiatric miracle.