Great and Desperate Cures
The Rise and Decline of Psychosurgery and
Other Radical Treatments for Mental Illness
by
Elliot S. Valenstein
1986
reviewed by Mira de Vries
This title was taken from a quote of John Bunyan,
writing in 1668 about the arrogance of doctors.
Bizarre treatments have been the mainstay of psychiatry
from its first medical pretensions. They have included:
- showers, steam, bathes, and wet packs
- injections of blood infected with malaria or
typhoid fever
- surgical removal of a variety of glands
- castration
- keeping the patient comatose with sedative drugs
for up to a month
- noxious gases
- chilling
- pulling the teeth
- tonsillectomy
- hysterectomy
- amputating a piece of the colon
- gyration devices
- shaking helmets
- hyperbolic chambers
- induction of seizures using poisons, insulin,
and electricity
Most of this book is dedicated to psychosurgery by its
various names: lobotomy, leucotomy, cingutomy.
All of these treatments were inspired by “opposing
theories of mental dysfunction; a long political struggle
within medicine between psychiatrists and neurologists; a
desperate human need and a procedure that offered to cure
it; immediate enthusiasm in the popular press; uncritical
acceptance by the medical profession, which not
infrequently paid little attention to the validity of the
claims of success; and determined and ambitious doctors.”
Indeed, Valenstein dwells extensively on the personalities
and backgrounds of the inventors (he calls them
“discoverers”) of these treatments. His main characters
are Egas Moniz, who is credited with inventing
psychosurgery (though he didn’t) and received a Nobel
prize for it; and Walter Freeman, who brought it to the
United States. The widespread adoption of the treatments
they championed had more to do with their social status
and political connections than with any improvement in
their patients, who were little more than props in the
doctors' shows. Freeman did follow up on his patients,
writing them letters and visiting them if he could find
them. The poor results they displayed did not deter him
from continuing to perform the operations until he was in
his seventies. When his methods were attacked, he defended
them simply by producing a box of Christmas cards sent to
him by his patients and their families.
Curiously, Valenstein does not reject lobotomy outright.
He belongs to the “they may be helpful in a small minority
of patients when all else has failed” school. What that
“all else” might be and which operations ever don’t fail,
he doesn’t say, only that they should be better regulated,
as though regulation can turn brain mutilation into a safe
operation. He also uses the word schizophrenia throughout
the book, never defining it, let alone questioning its
validity, even though he showcases Thomas Szasz’s
rejection of the existence of mental illness. It is
incredible how Valenstein and authors like him can write a
whole book about the harmfulness of psychiatry without
concluding the obvious.
In Great and Desperate Cures Valenstein only
briefly mentions neuroleptic (antipsychotic) drugs, though
his later book, Blaming the Brain (1998) is
totally dedicated to them. I pass on reviewing the latter,
as two similar books
are already reviewed on this site. However, I do wish to
draw a parallel between the treatments Valenstein
describes in Great and Desperate Cures and today’s
neuroleptics.
Although he doesn’t sum them up, Valenstein makes the
following points about the bizarre treatments:
- They were thought up after an anecdote. For
instance, it was related that a man in Japan kept an
unruly woman sedated to the point of coma during a few
days for the convenience of transporting her. Upon
arriving at their destination, she awoke to being
normal. This anecdote gave rise to “prolonged narcosis
therapy.”
- Elaborate biological theories were proposed based on
the flimsiest of evidence.
- In spite of claims to the contrary, the treatments
were applied to patients indiscriminately.
- They were claimed to be administered carefully and
precisely, tailored to the individual’s needs, but
were in fact completely crude.
- Long-term effects were not systematically studied.
- When such a treatment was deemed not to have been
successful after all, it was repeated rather than
abandoned. For instance, many people were repeatedly
lobotomized.
- Patients were forced or tricked into complying.
- Physicians turned a blind eye to the damage their
treatments caused, or considered it a worthwhile price
to pay for the alleged improvement.
- Physicians rushed to announce their newly invented
treatments to the press, long before reasonable
evaluation could have been possible.
- The media loved these treatments, and reported on
them extensively, triumphantly, and uncritically,
often initiating a flood of requests for the treatment
from the general public.
- Criticism, if any, came from other physicians and
was motivated mostly by professional rivalry and
jealousy.
- The inventors of the treatments had been born into
well-to-do families, and were influential,
self-confident, flamboyant, and highly politically
connected.
With minor adjustments, every one of these features
applies to today's drug treatments as well:
- They were not invented as a result of understanding
the cause of the conditions they supposedly treat, but
after their sedating or stimulating effects were
discovered serendipitously.
- Elaborate biological theories based on the flimsiest
of evidence (though widely believed by physicians)
justify their use.
- They are massively prescribed to all psychiatric
patients, on the basis of no chemical tests
whatsoever.
- The pretense of careful tailoring has even given one
class of drugs its first name: Selective, even though
selectivity in altering brain chemistry is actually
impossible.
- Although drugs today are approved for market after
extensive trials, these trials are done only
short-term. There is no systematic long-term follow up
of people taking the drugs for years.
- When the drugs don't do what the physicians expect
them to do, the dose is doubled or trebled, or other
drugs are added on.
- Patients are drugged involuntarily, or are enticed
into taking the drugs by unsubstantiated claims for
their efficacy and safety, though these claims are
believed by the physicians who were trained to
prescribe them.
- Physicians systematically deny the side effects, or
consider them relatively unimportant.
- News of new wonder drugs is rushed to the press as
soon as the patent is issued.
- The media compliantly, enthusiastically, and
uncritically pass this news on to a gullible public.
- Criticism, if any, is motivated mostly by
competition. For instance, "truth in advertising"
suits are usually brought by the manufacturers of a
rival drug, very rarely by patients, and never by
government watchdog agencies.
- And now comes one difference: instead of the
treatments being invented and promoted by flamboyant,
politically connected physicians, they are developed
by anonymous chemists and advertised by marketing
experts employed by pharmaceutical companies. Far more
even than the flamboyant physicians of yore, these
drug companies are heavily politically connected.
On a different note, the opponents of psychiatry sometimes
maintain messy methods too. Some are quick to seize on any
criticism of psychiatrists in general, whooping when one
has been caught for sexual misconduct or cheating on his
income taxes. One rumor that just won’t go away in the
psychiatric survivors’ movement is the high incidence of
suicide among psychiatrists. Valenstein’s book may shed
light on the origin of this rumor. He states,
“Freeman read Ernest Jones’s biography The
Life and Work of Sigmund Freud and was struck by
the fact that at least eight of Freud’s close associates
had committed suicide. Examining obituaries in
psychiatric journals and tracking down death
certificates, Freeman concluded that suicide among
psychiatrists was about eight times the frequency among
white males.”
I suspect that Freeman, like today’s medical researchers,
found in the obituaries what he set out to find.
Valenstein says no more about Freud’s eight colleagues.
One explanation could be that when the nazis rolled their
mass murder machines through the heart of Europe, many
Jews who could not flee, possibly including Freud’s
colleagues, preferred suicide to succumbing.
Misunderstanding this cause, Freeman may have started a
rumor that still circulates today, and is just as wrong as
psychiatric treatments and their justifications, though
less pernicious.
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