Category Archives: lunatic asylums

Psychoanalysis is that mental illness for which it regards itself as therapy

An American psychologist by the name of John Gartner argues that Donald Trump should be removed from office on psychiatric grounds:

We live in a pre-fascist society…The German psychiatric association said nothing during the rise of Hitler…We are facing a crisis that threatens to engulf the world in flames…Trump meets standards for commitment and should be required to undergo psychiatric evaluation, whether he wants to or not…The man is threatening to murder an entire country…We cannot call the authorities because the homicidal patient is the authorities.

Dalrymple notes that Gartner

displays no knowledge of or imaginative insight into what it is like to live in a totalitarian dictatorship—his Jewishness notwithstanding—despite countless memoirs, academic books, and films attesting to and describing life under authoritarian rule. Such ignorance or lack of imagination is culpable. For an American to compare contemporary life in the USA, no doubt unsatisfactory as it is in many respects, with life in a fascist dictatorship is self-dramatising, self-pitying, and an insult to those millions who suffered or died under totalitarian dictatorships.

It is legitimate to oppose the government and to despise the person of the president;

it is another thing to claim jurisdiction over whether he should be entitled to be president and whether he ought to be removed by committal to a mental institution. In the Soviet Union, psychiatrists occupied the kind of commissarship that Gartner is appealing for.

Gartner

shows an implicit contempt for US institutions and history if he thinks that the election of one allegedly unstable man can turn his country into a fascist dictatorship almost overnight.

He is

what Kraus said of psychoanalysis, a cause of the disease it pretends to cure. He believes that people who show instability, anger, paranoia, feelings of persecution, and cognitive confusion would and should be involuntarily committed for psychiatric evaluation.

Dalrymple suggests that Gartner read Chekhov’s 1892 short story Ward No. 6, in which Dr Ragin is committed to his own asylum.

The human rights of psychotic patients

Buddha-like calm: R.D. Laing

Dalrymple explains that as the law stands in Britain, prison doctors

are not permitted to give treatment against a patient’s will, except under the direst emergency, for fear that they might abuse such power and forcibly sedate whomever they choose contrary to the patient’s human rights.

Hence psychotic patients

are kept in prison hospitals for months without any treatment, taking part in an interesting if not altogether pleasing experiment in the natural history of psychosis.

Recently Dalrymple observed a psychotic patient for several weeks, who

  • addressed the world night and day through his prison window in words of muddled religious exaltation
  • refused all food on the grounds that it was poisoned, his flesh melting away before my eyes
  • attacked anyone who came within reach
  • painted religious slogans on the walls of his cell with his excrement, imparting a nauseating fæculent smell to the entire hospital

It might be alleged, says Dalrymple,

that he behaved in so disturbed a fashion because he was incarcerated, and that his conduct was (in the opinion of R.D. Laing) a meaningful and enlightened response to his terrible social situation, and that he, of all the 1,400 prisoners in the prison, was acting in the most appropriate way. But this would be not only to ignore his medical history but also the fact that he was incarcerated because he had viciously and without provocation attacked a 79-year-old woman in a church, injuring her badly while reciting verses from the Bible, which suggests that his disturbed mental state preceded his incarceration and was not a consequence of it.

Dalrymple checked the situation with lawyers.

Although he had a fully documented history of psychosis and an entirely favourable response to treatment, attested to by both doctors and relatives (who said that when treated he was a pleasant and intelligent man), I was not entitled, in the name of human rights, to treat him against his will. In the name of human rights, the prison officers and the other prisoners had to endure weeks of revolting air, as well as disturbed nights in which sleep was all but impossible.

The doctors to whom Dalrymple proposed to send the patient

accepted the conditions in which he lived with Buddha-like calm that would have been admirable had the suffering been theirs. Only the prison officers, among the most despised of all public servants, seemed to be moved by the scandal. The doctors were so inured to such situations that they accepted it as normal and nothing to get excited about. The shortage of beds and the administrative difficulties that this shortage caused had steadily eroded their common humanity.

It was only when Dalrymple threatened to expose the scandal publicly, and had taken photographs of the man’s cell and said he would send them to the government minister responsible for prisons (a proceeding against the rules, but supported by the prison warden, who did not want his prison turned into a surrogate lunatic asylum), that the man was finally found a place in a hospital, where he could be treated.

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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