In the early part of this book is an embedded essay on the history of the treatment of the mentally ill placed as a writing assignment done by the protagonist for his high school English class. The teacher tells Brad it's one of the most interesting essays she's ever read, but can only give him a B because of too many spelling errors. Here's the essay, with the spelling errors, I hope, corrected.
If you judged a civilization by how it treated its insane, it would modify your opinion of how advanced we were. And are.
At first the insane were allowed to roam at will and whipped out of villages when they became a nuisance.
When Dante was writing The Divine Comedy, the insane were believed to be possessed and were burned at the stake. In The Divine Comedy the word “bizarre” first appeared to describe a madman.
When Galileo was proving that the Earth went around the Sun, the insane were given holy water to drink from a church bell. If that didn’t work, they were burned at the stake. Want to guess how many times it worked?
About the time that Heidelberg and Cologne Universities were founded, Bethlehem Hospital in London became an institution for the insane. It was so poorly funded that its inmates were given licenses to go begging for food. The hospital was such an ungoverned mess that the way Bethlehem was pronounced, Bedlam, became a word for uncontrolled madness.
In the years Shakespeare was writing his plays, you could take your family on an outing for six-pence and view the madhouse chamber of horrors where the restrained violent, often egged on by visitors, would snap and snarl at you, or you could be entertained by inmates who believed they were Oliver Cromwell, Julius Caesar, and even the Virgin Mary. Great laughs.
In France, while Lavoisier was proving that air was a mixture of mostly oxygen and nitrogen, the inspector general of French hospitals reported that thousands of lunatics were locked up in prisons without anyone even thinking of administering the slightest remedy. The half-mad mingled with the totally deranged. Some were in chains. Some were free to roam. He called them the step-children of life.
Life for normal people in France wasn’t all that healthy, either. Out of 1,000 live births only 475 reached age 20. Only 130 reached age 60.
It was kind of an irony that our own Pinel Building for the Criminally Insane was named in honor of the French doctor during the French Revolution who freed the insane from their shackles. But ironies abound in the history of insanity.
While Harvey was developing his proof of circulation, the inmates at Bedlam were treated en mass. At the end of each May they were all bled, then made to vomit weekly, then purged. The attendants must have dreaded that time of the year.
Into the beginning of the 1800s, when John Dalton introduced the atomic theory into chemistry, the insane were treated with such loony cures as plasters of mashed up Spanish fly, or had the veins in the forehead cut so the head could be bled. Later, on an opposite theory, inmates were strapped in a chair called the gyrator that spun the inmate around so more blood would circulate to his head.
In the late 1800s when society was really getting civilized, Dr. David Yellowless of Glascow developed a surgical attack on what was then called masturbatory insanity, which alienists believed was at epidemic proportions. Dr. Yellowless inserted a silver wire in the foreskin, making erections so painful it would eliminate the crazy-causing things. Other methods called for safety pins to be used on uncircumcised men so that their foreskins were pierced by the silver-coated (to reduce infection) pins through the glans of the penis, also causing pain during erections, another method for eliminating the damnable things.
The Rush Building, where Suzanne was housed, was named after Benjamin Rush, honored as the father of American psychiatry, who firmly held to the belief that masturbation caused insanity. Oh, and he was the fellow who invented that gyrator. And he also believed that blacks were black not because God created them that way but because they suffered from a congenital form of leprosy, mild, to be sure, but enough so it resulted in excess pigmentation.
Rush wrote in his Medical Inquiries upon Diseases of the Mind that masturbation produced seminal weakness, impotence, painful urination, emaciation, pulmonary consumption, indigestion, dimness of sight, vertigo, epilepsy, hypochondriasis, loss of memory, idiocy, and death. A French physician, Pouillet, concurred. Masturbation posed a grave threat. Pouillet wrote: “Of all the vices and of all the misdeeds which may properly be called crimes against nature, which devour humanity, menace its physical vitality and tend to destroy its intellectual and moral faculties, one of the greatest and most widespread -- no one denies it -- is masturbation.”
Freud, too, regarded adult masturbation as a pathologic practice and part of the cause of neuroses.
But, in one of the great turnabouts in the history of psychiatry, therapists later would prescribe masturbation as healthy to the mind and body.
For women, it was once believed that mental disorders were caused by pelvic excitations and clitoridectomies were tried, especially in cases of epilepsy.
Later, sex therapists would recommend masturbation for women, too, as a way to healthy sex.
In the Soviet Union they tried prolonged sleep therapy on the insane. America used hydrotherapy, placing agitated patients in hot water for days so that blood flow increased to the body’s largest organ, its skin, thus lowering respiration and blood pressure and creating a state of relaxation.
In the 1930s the increase of admissions of patients diagnosed as schizophrenic was so high it was theorized there must be a schizococcus germ that could pass on schizophrenia to an offspring. In 1936 a committee of the American Neurological Association hoped that American physicians could someday emulate the clinical efficiency of the Germans in their treatment of eugenics. Germany had over 200 courts to determine which psychiatric and neurological patients should be sterilized. During Hitler’s Reich more than 400,000 sterilizations were counted.
The most effective sterilization is death and the Nazis tested methods of mass murder first on mental patients before they applied them to other undesirable populations. At the start of the Third Reich there were 200,000 patients in mental hospitals. At the end of the Third Reich there were 20,000. An interesting twist in early Nazi civilization is that it was deemed humanitarian to euthanize incurable mental patients, but not Jews. Jews were considered subhuman and so not worthy of euthanization.
From 1909 to 1934 in the civilization called America, California sterilized 15,000 psychiatric patients. Twenty-seven states adopted sterilization laws. They were used often against the retarded.
One attempted treatment for schizophrenia, as well as depression and psychosis, was -- what many people regarded as a kind of euthanasia -- the lobotomy. Its main American proponent, Dr. Walter Freeman, would make driving trips across America to stop at state hospitals and perform the procedure he had simplified to the point he felt that a sterile field wasn’t even necessary. First you anesthetized the patient with electro-shock, rolled back his eyelid, place the tip of instrument, a leucotome, which was a modified ice pick, against his tear duct (which is 98 percent sterile) and drove it through his eye socket with a hammer whack, shoved it into the brain and wiggled it around. Forty-thousand people were lobotomized between 1945 and 1955 in America. In 1949, the Portuguese doctor who first did lobotomies was the co-winner of the Nobel prize for medicine and was cited for discovering the value of freeing the brain from the disturbing effects of its pre-frontal lobes.
Larned State Hospital came from a time when a concern grew that the rate of insanity in America was way too high: one out of 262 persons compared to a rate of one out of 1,000 in Europe. Blamed then was the rapid acquisition of wealth in America, that with luxury, insanity kept pace. It was the price of civilization, some reasoned. The quicker you go rich, the more likely you were to get nutty, too.
So what those patients needed was order and discipline restored to their lives. Asylum superintendents spent much of their time planning, and writing detailed papers on, how a hospital and its buildings and grounds should be laid out. How high the ceilings should be, how boring its wards. How a patient’s day should be structured. Then they rivaled each other by announcing cure rates. A person was cured if he was released back into society. Sometimes a person would be cured five times because they would have to be re-admitted, cured, released and have to be re-admitted. But it upped the cure rate.
Shortly after World War II, when we had learned of the horrors the Nazi’s afflicted on the Jews in the concentration camps, “The Baltimore Sun,” in 1949, printed a series of articles called Maryland’s Shame, which detailed how that state treated its mentally ill. More than 9,000 inmates were crammed in fire-trap institutions designed for 6,000 patients. Few received any treatment. Thousands lived like animals. Many rolled in their own excrement. Others slept nude in the winter because there were no blankets. Attendants, paid less than prison guards, stole patients’ money, got drunk on duty and raped female patients. Sex offenders and small children were housed together.
Oh, and while man was making his great scientific and engineering achievement of walking on the moon in 1969, lobotomies were still being performed.
In 1976, “The Philadelphia Inquirer” would win a Pulitzer prize for a series of articles it ran about the conditions of Farview State Hospital, the institution of last resort for the criminally insane in Pennsylvania. Here, too, hundreds of patients who had no work to do did nothing but sit in ward chairs all day long. Only three percent received any real psychiatric care. Men died after beatings by guards or by other patients, egged on by guards. Such deaths were certified as being caused by heart attacks. There was an unwritten code among guards that all guards present had to hit a patient if one guard hit him. Commitments to Farview were so easy that cases were recorded of a 30-day disorderly conduct sentence turning into a 30-year sentence.
The history of commitment procedures makes for interesting reading, too. For example, in France, in 1737, a father had his son committed because the son was heavily in debt and had been dismissed from the army and so had disgraced himself and his family. In 1697, a French woman was committed because she was the mistress of a nobleman who had practically abandoned his wife, family, and duty because he was so nuts over the skirt. In other words, people were committed as insane who disturbed the social order. When society didn’t have the basis to bring criminal legal proceedings against those who offended it, they found ways to get rid of them by using nut houses to throw them in, nut houses that were such hell holes that, as the old saying goes, if you weren’t crazy when you got there, you would be after you stayed.
Back in the Farview case, all it took was the signature of two physicians, and they didn’t need to be psychiatrists, to certify to a court that the subject was mentally ill and in need of treatment to get him committed. That didn’t secure treatment, but it did secure incarceration, sometimes until the patient died of old age. Finally, a court case was successful that freed the patients based on the cruel and unusual punishment clause in the Constitution. Patients were transferred to civil hospitals or back into the community. A follow-up study showed only a fourteen percent recidivism rate among these 500 patients previously designated by Farview as criminally dangerous.
In 1964, the year I was a junior in Larned High School and living on the grounds of Larned State Hospital, we were living in what one author called the “enlightened fourth phase” of dealing with the insane. Society had moved from 1) being afraid of the mentally ill because they were possessed of evil spirits to 2) simply protecting itself from the insane by chaining them or locking them up to 3) treating them in a humanitarian way by placing them in asylums where they were harbored but not really treated and so suffered chronic anonymity to 4) now seeing mental illness as an illness to be treated and cured.
It’s just we still didn’t really have a clue how the hell to do it.
Later, we’d just give up and send them back into the streets to roam at will, beg for food, be beaten by police, and again be housed with criminals. Some evangelicals would return to the possession theory and try to drive the demons out. This time in front of television cameras.
And some theorists would suggest that it wasn’t the insane who were insane, rather it was the sane who used such people to mark the boundaries of their own sanity. The so-called insane were the people we used to sort of pee on so we could mark the territory of our own smug, mentally secure property.