Homeless people gathering at busy intersections remind us that thousands of them are mentally troubled or captive to various additions, needing interventions by caring organizations to help them. Fully one-fourth to one-third of the homeless are thought to be mentally ill. Folks my age also remember how the closing of state mental hospitals contributed to this problem. In Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness (Cambridge: Harvard University Press, c. 2022; Kindle Edition), Andrew Shull shows why this has occurred. “In this book,” he says, “I have attempted to provide a skeptical assessment of the psychiatric enterprise—its impact on those it treats and on society at large” (p. ix). During the past two centuries, mental “illnesses” have been diagnosed and treated by physicians who thought they were akin to other ailments they treated with medicines or therapeutic remedies. Psychiatry first developed “as a specialized branch of medicine claiming expertise in the management and cure of what was then called insanity or lunacy” (p. x).
For centuries the “insane” had been confined to facilities akin to prisons, keeping them apart from “normal” folks. This changed, early in the 19th century, when reformers such as Horace Mann and Dorothea Dix, confident they could cure the mentally troubled, helped establish “asylums” throughout the country. The reformers’ optimism, however, proved illusory, and the medical experts (“alienists” or “psychiatrists”) heading them widely discredited. They had claimed they could cure up to 80 percent of their patients and utterly failed. Indeed, by the end of the century the asylums “had been transformed into mausoleums of the mad, a captive population of several thousand and assorted support staff” (p. 4). Then, following the Civil War, physicians dealing with mental illnesses decided to call themselves “neurologists” and “insisted that these patients’ troubles had an organic origin and were the result of wear and tear caused by overtaxing of the brains” (p. 7). They “dismissed asylum doctors as mere boardinghouse keepers and curators of dead souls, willfully ignorant of the latest scientific advances” (p. 7).
Rather than try to cure folks, some medical doctors suggested eliminating them. Influenced by the theories of Charles Darwin and his cousin Francis Galton, they invoked “defective biology” to explain pathologies as diverse as “crime, drunkenness, epilepsy, and hysteria, with madness and feeble-mindedness” thrown into the mix. Inasmuch as natural selection relentlessly improves the species, defective individuals are necessarily swept aside into the dustbin of failures. As one “alienist” declared, every year “‘thousands of children are born with pedigrees that would condemn puppies to the horsepond.’ Lunatics were waste products of the evolutionary process, ‘morbid varieties fit only for excretion’” (p. 28). A “New York physician W. Duncan McKim, heir to a banking fortune and contemptuous of his social inferiors, warned darkly of ‘the ever-strengthening torrent of defective and criminal humanity.’ He urged that ‘a gentle and painless death’ was ‘the most humane means’ of resolving the societal problem that they presented” (p. 28). Indeed: “‘The idiot and the low-grade imbecile,’ he hastened to reassure his readers, ‘are not true men, for certain essential human elements have never entered into them, and never can; nor is the moral idiot truly a man, nor, while the sad condition lasts, the lunatic. These beings live amongst us as men, but if we reckon them as human we shall fare much as if we bargained with the dead or with beasts of prey.’ They should be exterminated en masse with ‘carbonic gas’” (p. 29). Darwinians such as “Clarence Darrow joined in the chorus, advocating efforts to ‘chloroform unfit children’ so as to ‘show them the same mercy that is shown to beasts that are no longer fit to live’” (p. 29). That theoretical Social Darwinism leads to actual gas chambers can hardly be better illustrated.
Other physicians thought the mentally ill might be rehabilitated rather than discarded. So they began trying a variety of physiological treatments designed to treat the mentally ill. Perhaps microscopic bacteria caused schizophrenia as well a syphilis! Psychobiology was embraced and biological remedies prescribed. Though slowly embraced by physicians, the germ theory of disease was embraced at the beginning of the 20th century. Whatever ails one must have a tiny germ as its cause. Thence emerged a curious theory, focal sepsis—“the presence of unobserved low-grade infections lurking in the corners and crevices of the human body, pumping out poisons via the bloodstream and the lymphatic system—as the likely cause of a host of chronic disorders” (p. 73). Clean out the sepsis and you heal the disease. Eat the right food and you cleanse the system—so the health food prescriptions of John Harvey Kellogg were often embraced. Decayed teeth were suspected of sheltering harmful germs, so extracting the teeth of mentally ill patients became quite popular. So too it was thought “the poisons that lurked in the bowels” should be surgically treated with colectomies. Others imagined removing the stomach would resolve mental problems. There were many claims regarding cures, but virtually no evidence for them.
Following WWI, with many soldiers suffering “shell shock,” innovative psychiatrists experimented with them, theorizing that their minds needed to be shocked back into normality. One popular endeavor was to infect a patient with malaria, thinking his elevated temperature would transform his mind. “The 1920s and 1930s were a period of experimentation with other mechanisms for inducing fever. Some tried injecting horse serum into patients’ spinal canals, thereby producing meningitis. Injections of the organisms that caused rat-bite fever were tried, as were injections of killed typhoid bacilli and colloidal sulphur, a technique that by design led to the formation of abscesses. Alternatively, efforts were made to employ sweat boxes (or diathermy machines, to use the preferred term) to break down the body’s ability to maintain a steady temperature” (p. 95). Other physicians tried injecting large amounts of insulin, and the director of California’s state hospital system extracted $2 million from the state legislature to implement its use. Throughout these decades the malarial treatment persisted, and there was a “widespread acceptance of the claim that a biological treatment for a major form of mental illness had been discovered—one that, as crude as it was, seemed to improve the fate of at least a fraction of the afflicted. Still more crucially, these claims had been validated by the award of a Nobel Prize—an accolade no other psychiatric therapy would achieve until Egas Moniz won the same award in 1949 for inventing the lobotomy” (p. 97).
Then came electroshock treatments! They induced seizures thought beneficial for mentally ill patients. During the 1940s they were widely prescribed, especially in mental hospitals, where they were effective in making troublesome patients more passive and obedient. In one hospital, it was reported that: “‘Within two weeks from the beginning of our intensive electric shock treatment the character of the ward changed radically from that of a chronic disturbed ward to that of a quiet chronic ward’” (p. 125). No one knew precisely how it worked, but some patients said it eased their distress or even restored their sanity. So rather quickly it was also widely used to treat “diseases” such as depression. Some patients, however, complained at its brutality, often inducing such violent seizures that broke bones. Ernest Hemingway was one such complainant. Before he “blew his brains out with a shotgun, he denounced his doctors at the Mayo Clinic: ‘What these shock doctors don’t know is about writers … and what they do to them.… What is the sense of ruining my head and erasing my memory, which is my capital, and putting me out of business? It was a brilliant cure but we lost the patient’” (p. 133).
Even worse were tens of thousand lobotomies done in the 1940s and 1950s! Nobelist Egas “Moniz asserted that in compulsive psychoses and melancholia, the mental life of patients was ‘constricted to a very small circle of thoughts, which master all others, recurring again and again in the sick brain.’ The ‘anatomico-pathological explanation’ of the psychoses, he deduced, must be that the connections between the neurons making up the brain had become stuck, and ‘after two years’ deliberation, I determined to sever the connecting fibers of the neurons in question’” (p. 144). Within the medical community there was considerable criticism of the procedure, but the medical press endorsed it with such enthusiasm the public generally thought it efficacious. In time, however, the disastrous results of lobotomies became clear, as is evident in the case of Joseph Kennedy’s daughter, “Rosemary, whose rebelliousness and slight developmental problems he feared might lead her to pregnancy and scandal.” He arranged for a lobotomy in 1941, which had “disastrous results. From 1941 till her death in 2005, Rosemary Kennedy was severely mentally handicapped, unable to speak, incontinent, barely able to walk, and hidden from public view (as well as ignored by her parents while they were alive)” (p. 169).
By 1960, despite a half-century’s “orgy of experimentation,” nothing the psychiatrists championed had effectively cured mental illness! So they were consistently challenged by psychoanalysts (following Freud or Jung) who prescribed “talk therapy.” Far more popular in America than Europe, and to “the chagrin of most American psychiatrists, Freud’s ideas about the sources and treatment of mental illness drew considerable public interest in the years immediately following the First World War” (p. 203). His ideas promised a liberation from conservative sexual standards and gained many devotees during the “roaring 20s.” Psychoanalysts following his theories soon opened lucrative practices treating wealthy folks needing a long series of sessions exploring their childhood, dreams, and sexual fantasies. Therapists such as brothers Karl and William Menninger established national reputations. European psychoanalysts, fleeing Nazi persecution, located in New York and other cultural centers and effectively promulgated their ideas. For a variety of reasons, fully explained by Scull, by “the 1960s, the chairs of the great majority of university departments were analysts by training and persuasion, and the discipline’s major textbooks heavily emphasized psychoanalytic perspectives” (p. 226). Through stage and film, novels and historical works, Freud and Jung were successfully infused into American culture. Amazingly, “the first celebrity pediatrician, Benjamin Spock,” in his wildly popular The Commonsense Book of Baby and Child Care, which would sell 50 million copies, “translated Freudian ideas about neurosis into prescriptions for child-rearing, helping to indoctrinate a whole generation of young parents into the psychoanalytic perspective on life” (p. 229).
Despite the apparent eminence of Freudianism, any evidence for its efficacy was markedly anecdotal—illustrations rather than empirical data. Talk therapy certainly helped mildly-troubled souls who mainly needed someone to talk with, but for deeply-disturbed, mentally ill patients it manifestly failed. Consequently, almost overnight, in the 1980s the Freudians were dislodged by clinical psychologists armed with a panoply of drugs. The old conviction that mental illness resulted from purely biological malfunctions returned. It was, Scull says, truly a “psychiatric revolution!” Psychopharmacology reigned. Rooted in decades of experimentation, when “few rules rules constrained” their conduct, “the standards for assessing the value of new drugs were remarkably lax” (p. 272). Nevertheless, some of the drugs seemed effective in certain cases, including “veritable medicinal” lobotomies—in the 1950s Thorazine was touted as a magic pill, reducing “‘the need for electroshock therapy’” (p. 278). One researcher almost accidentally discovered that lithium carbonate helped schizophrenic, depressed, and manic patients” (p. 284).
Psychiatric drugs were also far cheaper than psychoanalysis—something most appealing to bureaucracies and insurance companies! Insidiously, psychopharmacology established close ties between psychiatrists and pharmacology corporations. Then the Federal Drug Administration entered the picture, convinced “that mental illnesses had the same form as physical illnesses, a decision that ensured that drug companies would test and advertise their products as treatments for specific diseases” (p. 318). Armed with the official manual of the American Psychiatric Association, psychiatrists would ultimately diagnose some 380 “diseases” and prescribe appropriate medications following 10 minute consultations. Prozac, for example, was routinely prescribed for depression. “‘Shy? Forgetful? Anxious? Fearful? Obsessed?’ Newsweek asked its readers in a cover story on the wonders of Prozac, only to promise the secrets of ‘how science will let you change your personality with a pill’” (p. 327). By 2013, 12 percent of Americans over the age of twelve were taking antidepressants, including “nearly one in five people over the age of sixty” (p. 333). Restless children—kids suffering attention-deficit / hyperactivity disorder (ADHD)—rose within a decade “by 41 percent. . . . A recent study found that the United States accounted for more than 92 percent of the worldwide expenditures for ADHD-treatment drugs. Nearly one in five American high school boys and one in eleven American high school girls had been diagnosed with ADHD, by far the highest incidence in the world” (p. 334).
However! Once again psychiatrists may have foundered! Psychopharmacology may have run its course! Study after study, scholar after scholar, have discredited its efficacy. “Once more, psychiatry is in crisis” (p. 338). The psychiatric establishment remans “firmly committed to a biologically reductionist view of mental disorder. Yet the hunt for the physical roots of mental disturbance has not led to the decisive breakthroughs its enthusiasts were convinced it would” (p. 339). It appears that mental illnesses are something more than brain disorders. Assertions regarding such ailments as schizophrenia and bipolar disorder seem increasingly “spurious” and the alleged expertise of the profession questionable. In truth: “In 1886, the American alienist Pliny Earle lamented that ‘in the present state of our knowledge, no classification of insanity can be erected on a pathological basis, for the simple reason that, with but slight exceptions, the pathology of the disease is unknown.… Hence … we are forced to fall back upon the symptomatology of the disease.’ Nearly a century and a half later, nothing, it seems, had substantially changed” (p. 349).
After pouring endless streams of money into psychiatric research, the long-term director of National Institute of Mental Health (NIMH), “Thomas Insel insouciantly summed up what all these dollars had purchased. ‘I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded in getting lots of really cool papers published by cool scientists at fairly large cost—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, [or] improving recovery for the tens of millions of people who have mental illness’” (p. 358). Prescription drugs simply haven not helped people diagnosed with schizophrenia, bipolar disorders, and depression. Unintended consequences—and costly litigation—have made Big Pharma increasingly unwilling to manufacture drugs targeting mental disorders.
Desperate Remedies cannot but sober us. Scull’s exhaustively researched, dispassionate work shows how demonstrably one of the most trusted, allegedly “scientific” professions abjectly failed. Mentally ill persons can be restrained in various ways, but how to cure them is as yet unknown.
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The critique of psychiatry set forth in Desperate Remedies needs to be read in conjunction with Frederick Crews’ indictment of the founder of psychoanalysis in Freud: The Making of an Illusion (New York: Henry Holt and Co., c. 2017; Kindle Edition). Concerned to finally tell the full about his subject, Crews says: “My main concern here, however, is with Freud in person—and, indeed, with only one question about him. How and why did a studious, ambitious, and philosophically reflective young man, trained in rigorous inductivism by distinguished researchers and eager to win their favor, lose perspective on his wild hunches, efface the record of his mistakes, and establish an international cult of personality?” (p. 3). This is a long, meticulously documented, often troubling account, including much material dealing with other psychiatrists in that era, leaving one with a decidedly negative view of Freud and his theories. Crews reluctantly shows why the “emperor has no clothes.” He was a plagiarist and adulterer (conducting a long affair with his wife’s sister and funding an abortion of their child). He mainly treated his “patients” to collect substantial fees and could never produce one of them actually cured by his ministrations. There’s nothing to respect about the man and no substance to his “psychoanalytic” dogmas.
Born into an Austrian Jewish family, Freud early embraced kulturdeutsch and “aimed at Germanization,” changing his given name, renouncing his ancestral religion. He “briefly considered declaring himself a Christian simply in order to avoid a rabbinical wedding. His bride, the pious granddaughter of a distinguished Hamburg rabbi, would be admonished that no religious observances could be tolerated in his household. He would arrive late for his father’s religious funeral and would skip his mother’s altogether” (p. 22). Though trained as a medical doctor he had no interest in practicing medicine, aspiring instead to make a name for himself as a medical scientist, publishing many books and articles between 1877 and 1900. None of them were pathbreaking or noteworthy, in part because he lacked mathematical aptitude. “‘To be tied down to exactitude and precise measurement,’ Ernest Jones observed, was not in his nature’” (p. 26).
Unfortunately, his “lazy reluctance to collect sufficient evidence” blemished his pretensions to “scientific” methodologies. He preferred to make sweeping generalizations based on a few “case studies” with selected patients. He mulled over myths, folklore, and history. He was, in fact more a philosopher, especially enamored with Ludwig Feuerbach, whom he admired “above all other philosophers,” and who had “‘developed the thesis Freud would elaborate in The Future of an Illusion (1927): that the God posited by Jewish and Christian theology is nothing other than a projection of human needs and fears” (p. 28). He would formulate narratives, knowing “that none of his assertions could be checked” (p. 385). He had, Crews quips, “retired his microscope for good and had replaced it with a crystal ball” (p. 540). He, not his patients, “reconstructed” their childhood traumas” (p. 514). Late in life he would even admit to “fibbing” about case studies, and one wonders just how much Freudianism lives by lies.
Significantly affecting his career, Crews insists, was Freud’s 15 year long use of cocaine. Introduced to it in the 1880s, when few medical doctors understood its potency, Freud both used and prescribed the drug. He early considered it a “magical remedy” that would make him successful and famous. He introduced a friend of his to cocaine, and a man who had been “a brilliant scientist” quickly became “a broken man” who wasted away into invalidism before dying within a decade. In time Freud would try to “obscure his record,” but the lengthy chapters Crews devotes to the issue demonstrates how cocaine must be considered when evaluating the man. His daughter Anna and legions of Freudians carefully censored the fact, but in pivotal works such as “The Interpretation of Dreams (1900) Freud had repeatedly alluded to his preoccupation with the drug. Among his seventeen long dreams analyzed in the book, no fewer than eight explicitly involved cocaine” (p. 454). In time Freud replaced coke with wine, drinking heavily, finding it to be “an old friend” he needed to sip every two hours or so, admitting “‘it deludes me into thinking that things are not really so bleak as they appear to me when sober’” (p. 544).
In the 1890s Freud moved away from biological reductionism to a position allowing for the reality of non-material ideas, and he began speculating about the importance of “unconscious” factors in the human psyche. His “hunches” dealing with troubled souls in his Vienna office led him to think sublimation, repressed memories, frustrated sexual desires, wish fulfillment, family traumas, incestuous longings, etc. actually caused mental illnesses. He ventured many “guesses,” and “he guessed wrong every time” (p. 554).
Unfortunately, his one-time colleague, Wilhelm “Fliess, growing impatient with Freud’s succession of brainstorms that were never followed up by testing, had come to suspect that his friend was incapable of objective observation. As he would put it in August 1901, in the most cutting insult Freud would ever receive, ‘the reader of thoughts merely reads his own thoughts into other people’” (p. 547). There you have it! A man who projected his thought onto others managed to become one of the most influential (and corrosive) charlatans of the 20th century. One of the most celebrated icons of the intelligentsia was a fraud.
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