Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill
by Robert Whitaker
Basic Books, 2nd edition
Well written and researched, Mad in America is the first of two books that journalist Robert Whitaker has written about mental illness. Whitaker has won numerous awards for his work on medicine and science. Here his graphic description of the treatment of the mentally ill from the late 1700s up until the present day is riveting, spell-binding, and sometimes unbelievable.
Back in the 1700s the mentally ill were institutionally housed in unheated, dingy cells, confined in chains, and displayed for public amusement. These “lunatics,” “brutes,” and “wild beasts” needed to be subdued and kept fearful of their captors.
Private asylums in England, which were owned by doctors, were known to be places where husbands could get rid of annoying wives or relatives. Physicians became the sole arbiters to determine the diagnosis of insanity and some became quite wealthy at their “practice.” The number of madhouses soon doubled and insanity became a common condition. Women were often the victim of “asylum medicine,” and “female insanity” in the 1890s was commonly “cured” by removing the uterus or amputating parts of the female anatomy.
Mentally ill patients were also treated with powerful purges, emetics (to induce vomiting), mercury and blistering of the skull with mustard powders. Injections with such things as animal parts, sheep extract, horse serum, arsenic, strychnine, toxic chemicals, and malaria serum were common treatments. Removing various body parts and teeth because of “hidden infections” caused death in nearly 43 percent of patients.
Submersing the patient in waterfalls, pummeling him with painful blasts of water, dropping him or her into a deep tub of cold water (“Bath of Surprise”), near drowning in the “Chinese Temple,” and the use of swinging chairs were considered effective “medical” treatments. Copious bloodletting, as well as creating wounds and keeping them open for months to induce a permanent discharge (to “let out” the insanity) were also commonly employed.
Yet, despite the inhumanity of these early procedures, the “darkest era in the treatment of the mentally ill” was the period between 1900 and 1950. The eugenics movement arising in the late 1800s set the stage for the development of further inhumane psychiatric treatments. Eugenics proponents judged the mentally ill as “societal wastage” and the product of a “defective germ plasm.” The advocates of eugenics determined that mental illness is inherited and the end stage of a progressive decline in a family line. A “neuropathy gene,” dubbed the “insanity gene,” was a recessive gene that caused mental illness. A “normal” person could also be a carrier of such a gene. The theory of “tainted genes,” popularized by Aaron Rosanoff, MD, who conducted a medical study on the topic, became a medical paradigm published in The Science of Eugenics.
Thus, the only solution to stop the spread of mental illness, according to the eugenicists, was sterilization. This country’s lawmakers agreed and as a consequence gave the U.S. the first laws for the compulsory sterilization of the mentally ill. In 1907 Indiana was the first state to pass the mandatory sterilization law followed by thirty other states. In 1914 Connecticut prohibited the mentally ill from marrying. In 1927 the U.S. Supreme Court, led by Justice Oliver Wendell Holmes, in Buck v. Bell, ruled that these laws were indeed constitutional. After that ruling forced sterilizations increased by 66 percent. Doctors claimed that it had a therapeutic benefit; the sperm was conserved and the operation led to an improvement in mental health. Soon it was considered a “medical treatment” for the mentally ill.
The National Eugenics Conference of 1914 was funded by John Harvey Kellogg, the inventor of the boxed cold cereals. The Second International Conference on Eugenics in 1921 was financed by Andrew Carnegie and John D. Rockefeller, with speakers from prestigious universities taking their turn at the lectern discussing topics such as “The Jewish Problem” and the public cost of caring for defectives. In the same year some forty-four colleges introduced eugenics into their curricula and taught the courses as a bona fide science. Academics at Harvard, Yale, MIT, Columbia and other prestigious colleges researched and published articles on the subject in The Journal of Heredity. Eugenics dogma flowed into the American school system.
Rockefeller money contributed cash prizes to clergymen who delivered the best sermon on eugenics. The Reverend William Matson won with his sermon when he declared, “We may raise the pig in the parlor, but he is still a pig.” In 1928 Rockefeller gave two and one-half million dollars to the Psychiatric Institute in Munich, Germany for “eugenics research.” Alexis Carrel, a medical doctor who won a Nobel Prize for his work at the Rockefeller Institute, proposed in 1935 that society “dispose of criminals and the insane in small euthanasia institutes with proper gases.”
Grounded in pervasive hatred, pedantry, prejudice, hubris and fear, treatments for the mentally ill reached their lowest and most debased levels. From the 1920s to mid-1950s the use of the insulin coma became a common treatment for schizophrenia. The coma caused hemorrhages in the brain and destroyed nerve tissues. The next popular treatment was metrazol shock injections which produced “explosive” seizures in which the “patient would arch into a convulsion so severe that it would break bones, cause spinal fractures and loosen teeth.” The procedure was used in 70 percent of U.S. hospitals by 1939. But the worst was yet to come.
The following lines are a summary of general instructions on how to perform a quick lobotomy from the medical textbook, Psychosurgery (1950) written by Walter Freeman and James Watts, the most well-known advocates and performers of lobotomy, which was a procedure commonly performed on the mentally ill in the 1940s and 1950s:
Instead of drilling holes in the sides of the patient’s head, Freeman attacked the frontal lobes through the eye sockets. He would use an ice pick to poke a hole above each eye, insert it seven centimeters deep, then move behind the patient’s head and pull up on the ice pick to destroy the frontal lobe nerve fibers. To quicken the process, he would drive picks into both eyes at once and then step behind the patient and pull up on both icepicks at the same time. Instead of anesthesia he would knock patients out with electroshock beforehand which “saved time.” He dispensed with the use of any sterile precautions (p 133-134).
Antonio Egas Moniz, the psychiatrist who originated the lobotomy procedure and shared a Nobel Prize in Medicine in 1949, claimed that emotional disorders became fixed in the frontal lobes and destruction of the cellular connections would cure patients. After many surgeries he determined that lobotomy failed in the case of schizophrenia, but Freeman reported that they could indeed be helped by the procedure.
Freeman performed the procedure, which took from ten to twenty minutes, at state mental hospitals and on an outpatient basis hundreds of times, perhaps thousands. One of Freeman’s youngest patients, Howard Dully, was lobotomized at age twelve. His parents considered him a difficult child and handed him over to Freeman’s quick icepick. Dully documented his experiences in his book My Lobotomy.
In the 1950s state mental hospitals were gradually dismantled due to the crippling costs to state budgets, and a large captive group of patients were no longer available for such procedures. Lobotomy was gradually abandoned around the same time, after reports of similar surgeries in Nazi Germany revolted and shocked the American general public.
After lobotomy, electroshock therapy (ECT) was one of the most cruel and disabling treatments doled out by medical professionals of the last century. It continues to be used today despite its abysmal failure rate at relieving mental illness, especially depression.
In the recent film, Blue Jasmine, Cate Blanchett, whose character is named Jasmine, talks about receiving a dose of “Edison’s medicine” because she was depressed. A recent episode of the television series Royal Pains showed Dr. Hank recommending ECT to a troubled housewife and her total recovery afterwards.
ECT was invented by an Italian psychiatrist who first experimented on vagrants. It was introduced into the U.S. in the 1940s. Electrodes were placed at the patient’s temples, which induced spasms accompanied by memory loss, reduced cognitive function and permanent impairment of learning capacity. The procedure was repeated many times on the same patient “to induce therapeutic confusion,” which would somehow cure the patient. Patients often became incontinent and walked around naked. Children were also subjected to shock therapy. In an experiment on twenty children who were shocked twice per day for twenty days, many later became extremely violent and disturbed.
Patients who received the therapy speak of the extreme pain it caused: the broken bones and shattered teeth. Those who tried to escape were dragged screaming into the treatment room. Most patients, once shocked, became so difficult to manage when they heard about another pending treatment that psychiatrists began to shock them without their consent. The opinion of the American “electroshock doctors” was that they had the right to act in the patient’s best interest, even over his or her screaming protests.
ECT was a common practice for two decades to frighten, control, and punish difficult patients in state facilities. To quiet wards, doctors and nurses set up a schedule for shocking rows of patients, going up and down the aisle with the equipment. Nurses at one Georgia asylum regularly threatened difficult patients with “a Georgia power cocktail.”
The Rockefeller Institute is at least partially responsible for the rise of psychiatry in America. It provided sixteen million dollars over twenty years to develop new techniques and new departments of psychiatry and neurosurgery at medical schools and for the experiments which led to the development of lobotomy and electroshock.
Even though psychiatrists knew the outcomes of electroshock and realized that the treatment caused permanent brain damage and disability, the procedure became commonplace. Whitaker states that these gruesome and inhuman treatments survived and were practiced by so many professionals because of the “storytelling partnership.” One doctor told the story in a medical journal and at medical conferences that his treatment was successful. This story was told by another doctor, then another. With time, the treatment was discussed in major newspapers as the treatment of the hour. Doctors practicing these “therapies” became famous and rich.
Before lobotomy, asylum medicine and asylum doctors were considered the lowest on the medical totem pole. After the bells and whistles of lobotomy and electroshock, psychiatrists took over the treatment of the mentally ill.
After reading this book, one cannot help but be deeply moved. Readers may question how such treatments were sanctioned and performed, not once, but thousands of times, on innocent, ill people. How could we in 2014 not judge the treatments of the mentally ill in the past as contrivances of those who were mad themselves? Genuine Bedlam.
Remember, the worst practices were occurring when Dr. Price wrote Nutrition and Physical Degeneration, in which he bravely argued that mental illness was not the result of genetics but of poor nutrition. When, oh when, will the psychiatrists realize that people who are mad are people whose brains are starving?
Of the over nine hundred ratings on “Good Reads,” the majority describe Mad in America as “disturbing,” “heartbreaking,” “shocking,” “gruesome,” “incredibly useful,” “important,” “best non-fiction book,” “mind-blowing,” “well-researched” and “a wakeup call.” University professors have chosen this book as a review project for their classes and it can be found in academic libraries throughout the country, but psychiatrists have called it “venom” and “a general attack on psychiatry.”
You be the judge. I give this book a well-deserved thumbs up.
This article appeared in Wise Traditions in Food, Farming and the Healing Arts, the quarterly journal of the Weston A. Price Foundation, Winter 2014