Category Archives: mad people

When Moslems go out of their tiny little minds

Even those, writes Dalrymple,

who are not psychiatrically disturbed may have an outlook on life of a distinctly paranoid flavour. When Moslem believers go mad, their madness often has a religio-paranoid content.

Mother and malignant child

In 1865, writes Dalrymple, 'the asylum notes show Richard Dadd to have been painting almost every day. His thoughts were mad, but he continued to work until he became too weak physically to go on. His output was considerable, of high quality and deeply disturbing. A mother and child, painted in 1860, were clearly modelled on the religious motif, but the mother holds the child without tenderness, and the child, still a baby, stares straight ahead with an appraising look of concentrated malignity. On a ledge in the background sits a blackish bird with ruffled feathers that appears to be a vulture'.

In 1865, writes Dalrymple, ‘the asylum notes show Richard Dadd to have been painting almost every day. His thoughts were mad, but he continued to work until he became too weak physically to go on. His output was considerable, of high quality and deeply disturbing. A mother and child, painted in 1860, were clearly modelled on the religious motif, but the mother holds the child without tenderness, and the child, still a baby, stares straight ahead with an appraising look of concentrated malignity. On a ledge in the background sits a blackish bird with ruffled feathers that appears to be a vulture’.

Halt in the Desert

c. 1845. Richard Dadd, writes Dalrymple, was alive to 'the beauty of the world and (incidentally) to the dignity of the people through whose lands he had traveled. It would take an Edward Said to see anything other than admiration'

c. 1845. Richard Dadd, writes Dalrymple, was alive to ‘the beauty of the world and (incidentally) to the dignity of the people through whose lands he had travelled. It would take an Edward Said to see anything other than admiration’

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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Politely Told to Fuck Off

Station at the London suburban settlement of Barking

Station at the east London suburban settlement of Barking

That is what PTFO stood for in the old handwritten doctors’ notes which, says Dalrymple,

in lapidary fashion told you a great deal about the patient (or sometimes the doctor).

N4N meant Normal for Norfolk,

which is not a reference to the charms of the countryside of that county.

Here again! or Not again!

told you either that the doctor failed to diagnose a troublesome or occult chronic condition, or (more likely) that the patient was a frequent attender whose visit to the doctor might have been the highlight of his or her week, and who cherished symptoms like a hobby.

LNWL stood for Life Not Worth Living.

The travails of a patient were reduced to, or summarised by, these four letters.

TATT meant Tired All The Time, meaning the patient was suffering from

a form of taedium vitae.

IG11 stood for

the madness of a patient, not in the medical or literal sense but the metaphorical one, IG11 being the postcode for Barking.

Certain eminently defensible subsidies

Screen Shot 2015-09-13 at 08.40.33The best city for cinema, Dalrymple points out, is Paris.

You have only to go round the corner to see an intelligent and unusual film. In other places it takes a special effort to do so, if it is possible at all. Even the commercial cinemas in Paris show better films than elsewhere, reflecting the more elevated taste of the Parisian public.

Dalrymple once spent a week in Paris seeing two or three films a day from exotic places.

They often showed at tiny cinemas at odd times in the morning, and sometimes I was the only viewer. If there was anyone else present he or she was usually a peculiar person, even a psychiatrically disturbed one.

Screen Shot 2015-09-13 at 08.49.31This

of course stimulated in me a certain amount of self-examination. The cinemas must have been subsidised by the city, for the seats were very cheap, and while I am in general and on principle opposed to subsidies I am, of course, in favour of them for the things that I am interested in and benefit from. Those subsidies seem to me eminently defensible, and it always gives me a certain wicked pleasure to know that each time I travel on the TGV the French taxpayer is contributing to my fare. The pleasure, I should imagine, is not reciprocal.