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 mentiones
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 Word 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.
Copyright © MeTZelf
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