Category Archives: insane asylums

Placebo effect on the doctor

Screen Shot 2016-09-01 at 08.39.32Dalrymple relates that in Augy Hayter’s Fit to Be Tied,

a patient who has escaped from an asylum returns to his former office, where he was the boss, and advertises for an employee. A young man applies, but in the middle of his interview a doctor (described as having ‘the arrogance of insecurity’) and a nurse arrive to haul him back to the asylum.

The nurse returns

to the office to reassure the applicant, who asks, ‘Is it true he is being given shock treatment?’ The nurse replies that it is and it isn’t; he goes through the motions of having it, but the apparatus has been disabled so that no electricity goes through his brain. The doctor does not know this but is satisfied with the result.

The play, says Dalrymple,

seems to have been inspired by the commonly repeated story of the electroconvulsive therapy clinic in which the machine had broken down but nobody noticed: to which one can only say they cannot have been very observant.

Colectomy will make you sane

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Henry Cotton

How do we know doctors aren’t in the grip of collective delusions?

Dalrymple notes that an untreated psychotic’s situation can be desperate, but points to the danger of professional abuse once authority is handed over to alleged experts.

He reminds us that among the treatments developed by psychiatrists are

  • frontal leucotomy: nerve pathways in brain lobes are severed from those in other regions
  • Metrazol-induced convulsion therapy: shocks are administered, giving rise to convulsions
  • insulin coma therapy (Insulinschockbehandlung): the patient is turned hypoglycemic with repeated injected insulin
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NJ State Hospital for the Insane, Trenton (John Notman, 1848)

Reviewing Andrew Scull’s Madhouse: A Tragic Tale of Megalomania and Modern Medicine (2005), Dalrymple looks at the case of Henry Cotton, head of the New Jersey State Hospital for the Insane at Trenton.

Cotton believed that madness was caused by focal sepsis — subclinical infection of the teeth, tonsils, sinuses and colon. The answer

was to remove the teeth and tonsils, wash out the sinuses, and cut out the colon. The latter operation, performed in the asylum by Cotton himself — though he had no formal training in surgery — had a death rate of up to 33 per cent.

The operation was a success but the patient died

Phyllis Greenacre with Curt Richter

Phyllis Greenacre with Curt Richter

Cotton was undeterred.

He claimed a very high success rate for his operations, many of which were forced upon unwilling patients: 85% of his lunatics were cured by them, he said. A self-promoter and publicist, he was lionised, especially in Britain.

His claims were disputed,

particularly by Phyllis Greenacre, who proved that the chief clinical effect of his operations was death.

But Cotton

was protected by his mentor at Johns Hopkins, Adolf Meyer, an intimidating pedant rather than a real scientist who was the doyen of US psychiatry for many decades. He wanted to avert a scandal that would damage the standing and power of the profession, and was prepared to countenance the continued mutilation of patients by Cotton to do so.

Adolf Meyer

Adolf Meyer

Meyer suppressed Greenacre’s work and was to write

a laudatory obituary of Cotton, though he must have known by then that Cotton was responsible for hundreds of deaths and untold misery.

How, asks Dalrymple, did so flimsy and, to our eyes, foolish a theory of the cause of madness come to be accepted? Dalrymple points out that

  • the germ theory of disease, which elucidated so many mysteries, was comparatively new
  • the syphilitic cause of general paralysis (from which up to a fifth of the asylum population suffered) had just been discovered
  • hidden infections do often result in acute confusion in the elderly, including hallucinations

It was a short step to hypothesise an infective cause for all madness.

Screen Shot 2016-04-03 at 13.56.25Cotton

believed in his theory to such an extent that, as a prophylactic, he extracted the teeth of two of his sons and subjected one of them to a colectomy. (Both committed suicide as adults.) Later he had his own teeth extracted, believing focal sepsis to be the cause of his angina.

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