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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:
  1. 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.”
  2. Elaborate biological theories were proposed based on the flimsiest of evidence.
  3. In spite of claims to the contrary, the treatments were applied to patients indiscriminately.
  4. They were claimed to be administered carefully and precisely, tailored to the individual’s needs, but were in fact completely crude.
  5. Long-term effects were not systematically studied.
  6. 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.
  7. Patients were forced or tricked into complying.
  8. Physicians turned a blind eye to the damage their treatments caused, or considered it a worthwhile price to pay for the alleged improvement.
  9. Physicians rushed to announce their newly invented treatments to the press, long before reasonable evaluation could have been possible.
  10. 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.
  11. Criticism, if any, came from other physicians and was motivated mostly by professional rivalry and jealousy.
  12. 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:
  1. 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.
  2. Elaborate biological theories based on the flimsiest of evidence (though widely believed by physicians) justify their use.
  3. They are massively prescribed to all psychiatric patients, on the basis of no chemical tests whatsoever.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Physicians systematically deny the side effects, or consider them relatively unimportant.
  9. News of new wonder drugs is rushed to the press as soon as the patent is issued.
  10. The media compliantly, enthusiastically, and uncritically pass this news on to a gullible public.
  11. 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.
  12. 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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