For psychiatry, a cautionary tale (book review)

[Guest guest]

http://www.boston.com/ae/books/articles/2005/09/19/for_psychiatry_a_cautionary_t\

ale?mode=PF

 

For psychiatry, a cautionary tale

 

By Paul Roazen, Globe Correspondent  |  September 19, 2005

 

Madhouse: A Tragic Tale of Megalomania and Modern Medicine

 

By Andrew Scull

Yale, 352 pp., $30

 

Andrew Scull, a sociologist at the University of California, San Diego

who specializes in the history of psychiatry, has unearthed a Gothic

horror story of abuse in the early 1900s. ''Madhouse " is a shocking tale

about how a doctor at the Trenton State Hospital in New Jersey had for

years surgically removed the teeth, colons, stomachs, spleens, tonsils,

sinuses, gall bladders, and reproductive organs of patients in a

misguided effort to treat mental illness.

 

Dr. Henry Cotton had trained at Johns Hopkins University under the famed

Adolf Meyer, a Swiss-born psychiatrist who became arguably the most

influential single psychiatric leader in 20th-century America. Meyer was

humanely trying to get away from concentrating on classification and

diagnosis and the 19th century's beliefs in heredity and so-called

degeneration. Instead, he tried to understand how people respond to the

stress they encounter.

 

In his program of promoting therapeutic improvement, rather than just

custodial care, Meyer was open-minded about what his students proposed

to undertake. Cotton started his operations in 1917 on the hypothesis

that madness could be caused by local infections. Teeth, even when

X-rays showed no problems, were only the beginning of the bodily

culprits to be removed. If patients were unwilling to undergo these

surgical procedures, such obstruction was viewed as a reflection of

their diminished mental capacities.

 

Scull has constructed an engrossing narrative about how Cotton's

theories and practices were welcomed in certain medical circles (in

Great Britain, for example) at the same time that criticisms began to

mount, especially among local denizens of New Jersey.

 

By mid-1925, when a state legislative committee began to investigate the

charge that patients were being abused under Cotton, the doctor himself

was too unbalanced to be able to defend himself adequately.

 

Cotton had claimed to achieve an astronomical ''cure " rate of 85

percent. In reality, the mortality rates resulting from the operations

were extraordinarily high, and nobody could confirm his alleged rates of

success.

 

Meyer appointed a young psychiatrist, Phyllis Greenacre, to explore what

had happened at Trenton. Although her conscientious findings were

distinctly unfavorable to Cotton, Meyer curiously chose to sit on her

report initially.

 

The Trenton State Hospital remained a house of horrors right up until

Cotton's death in 1933, after which Meyer somehow wrote an appreciative

obituary. Cotton's public standing was such that H.L. Mencken had

accepted an essay by Cotton for The American Mercury.

 

Doctors covered for one another throughout the surgical mayhem, and

teeth went on being pulled for psychiatric purposes at Trenton State

Hospital until 1960.

 

The misguided penchant toward lobotomies, which were undertaken at Mass.

Mental Health Center here in Boston right through the late 1950s, is a

much better-known medical scandal than this episode. As Scull's skillful

telling suggests, popular treatments in mental illness can be flawed,

and we should be on guard about the danger that drugs with serious side

effects will get overused. 

 

© Copyright 2005 The New York Times Company