Category Archives: madness

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.

A peep at the mermaids

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Dalrymple writes that the physician William Heberden treated, among other literary figures, the poet William Cowper. ‘He recommended that Cowper, who suffered bouts of madness, remove to Margate, but this was not altogether a success.’

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.

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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.

Care in the cockpit

Screen Shot 2015-03-30 at 08.00.24Amok-runners have rights, too

Amok, according to a recent account,

is found almost exclusively in men between the ages of 20 and 40. The incidents are characterised by frenzied attacks with kris, pedang or lembing. The assaults are often directed at family members or friends, then extended indiscriminately to others. Whether or not preceded by unusual behaviour (depression, brooding, sakit hati), amok occurs as a sudden outburst resembling a hyperstartle reaction, and amok-runners typically declare amnesia for the duration of the incident. The majority of amok-runners are killed during attempts by others to restrain the murderous rampages; those taken alive may be subjected to execution, imprisonment or institutionalisation in a psychiatric facility.

Screen Shot 2015-03-30 at 08.08.23These penalties may breach the human rights of amok-runners. ‘Care in the community’ or ‘care in the cockpit’ may be preferred. (In the Germanwings case, there may have been a greater fear of an accusation of discrimination against the mentally disturbed than of the crash of an aircraft, Dalrymple points out.)

Screen Shot 2015-03-30 at 08.11.36Who are we to exclude amok-runners from the cockpit? Who can blame them if, under the pressure of discrimination, they lock themselves in? Large numbers of people have died, but we have the consolation of knowing that we are part of a society that is appalled by the discrimination suffered daily by amok-running pilots and by other downtrodden groups, such as passengers who happen to be Islamist terrorists. Our society, if we are to call ourselves civilised, must be prepared to act to correct these injustices. To adapt slightly what Dalrymple has written about surgeons:

Screen Shot 2015-03-30 at 08.16.34Social justice is social justice, and not good flying. The achievement of such justice requires that we all be prepared to make sacrifices for it: a mass murder is a small price to pay for the satisfaction of knowing that commercial airline pilots are demographically representative of the population as a whole.

Wounded narcissism that actuated a mass-homicide-suicide

Screen Shot 2015-03-29 at 22.25.37Der Amok-Pilot

Wounded narcissism is Dalrymple’s hypothesis, though ‘information still to come may refute it’. The tragedy, he writes,

lays bare the preposterous contention that psychological disturbance, known metaphorically as illness, is precisely the same nature as physical illness, a contention now enshrined in the laws of several countries. This has always been dishonest, as witnessed by the public outrage that Lubitz was allowed to fly despite a history of medicated misery.

Did Lufthansa know that its employee had such a history?

If it did, it suggests that it was more afraid of an accusation of discrimination against the mentally disturbed than of a crash of an aircraft.

'Much has been written concerning the acts of homicidal mania called amok, which word in the vernacular means to attack. It was formerly believed that these outbursts were to be attributed to madness pur et simple, and some cases of amok can certainly be traced to this source. These are not, however, in any sense typical, and might equally have been perpetrated by men of another race. The typical amok is usually the result of circumstances which render a Malay desperate. The motive is often inadequate from the point of view of a European, but to the Malay it is sufficient to make him weary of life and anxious to court death. Briefly, where a man of another race might not improbably commit suicide, a Malay runs amok, killing all whom he may meet until he himself is slain.’ — Sir Hugh Clifford, extract from entry on ‘Malays' in Encyclopædia Britannica, 11th Ed. (1910). Clifford spent two decades in Perak; he was British Resident in Pahang (1896-1900 and 1901-03) and held many other posts.

‘Much has been written concerning the acts of homicidal mania called amok, which word in the vernacular means to attack. It was formerly believed that these outbursts were to be attributed to madness pur et simple, and some cases of amok can certainly be traced to this source. These are not, however, in any sense typical, and might equally have been perpetrated by men of another race. The typical amok is usually the result of circumstances which render a Malay desperate. The motive is often inadequate from the point of view of a European, but to the Malay it is sufficient to make him weary of life and anxious to court death. Briefly, where a man of another race might not improbably commit suicide, a Malay runs amok, killing all whom he may meet until he himself is slain.’ — Sir Hugh Clifford, extract from entry on ‘Malays’ in Encyclopædia Britannica, 11th Ed. (1910). Clifford spent two decades in Perak; he was British Resident in Pahang (1896-1900 and 1901-03) and held many other posts.

Not only are we all guilty, we are all mad

Screen Shot 2013-04-05 at 01.44.48Dalrymple reports that according to the Diagnostic and Statistical Manual of the American Psychiatric Association,

people in North America and Europe suffer from an average of about two-and-a-half psychiatric conditions a year. This suggests that either we are all mad or the American Psychiatric Association is mad (though with a shrewd eye to the main chance).