The history of psychiatry is not suitable for those of a squeamish disposition. For over 200 years psychiatrists (medical doctors of the mind) have clung to the belief that mental health problems, such as psychosis and depression, are primarily caused by biological disturbance inside the body. As such, these physicians have persisted in their attempts to “cure” those unfortunate enough to be labelled as mad, deploying physical interventions that range from the eccentric to the sadistic.
Having decided (in their medical wisdom) which bit of the human body is the culprit, under the guise of treatment, the suspected source of the illness has subsequently been assaulted, drowned, electrocuted, surgically removed or starved of sustenance. Listed below, in broadly chronological order, are the 10 most shameful interventions that doctors have inflicted on those deemed to be mentally ill.
Expelling fluids from the body
Hippocrates in the 5th century B.C. proposed a “Humoral Theory of Mental Illness” that suggested that mental disorders were caused by “hot blood” that needed to be extracted to achieve a cure. Further impetus to the medicinal potential of blood-letting was provided in the early 17th century when William Harvey described the circulation of the blood through the body. Subsequently, the removal of blood via leeches and other methods became a widespread practice for the treatment of both physical and mental illnesses.
The 18th century medical men perpetuated the idea of curative blood extraction. Anticipating a profitable business, they argued that madness was an illness like any other and therefore their specialist expertise was required to heal these mental afflictions. Ants and leeches were applied to the skin of the mentally disturbed patient to suck out the bad blood. During the 19th century, fluid removal as a treatment for mental illness extended beyond blood extraction, 34 different emetics (to induce vomiting) and over 50 different laxatives being employed by medical experts for the expressed purpose of restoring sanity.
Physical assaults
In the 2nd half of the 19th century, physicians strived to justify their claims to possess the expertise to treat madness by deploying a range of increasingly eccentric interventions. Many of these so called treatments involved some form of physical assault on the patient’s body, including: sudden immersion in cold water; buckets of ice-cold water poured over the patient’s head; rapid spinning in a chair; 48-hours continuous exercise on a treadmill; whipping with stinging nettles and applying red-hot pokers simultaneously to the head and feet!
Incarcerating wives for the convenience of their husbands
Psychiatrists have the statutory power to compulsorily admit to a mental institution those deemed to be insane and continue to this day to exercise this power with disturbing regularity. The criteria for legitimately concluding that someone is suffering from a mental disorder of sufficient severity to justify involuntary incarceration have always been contentious and psychiatrists have often been notably swayed in their judgements by the prevalent culture and whim of the time.
One stark example of the arbitrary diagnosis of madness is with regards to women who have been compulsorily detained in a psychiatric asylum purely in response to requests from their husbands. Thus, in 1851 the state of Illinois enacted a statute that “married women … may be received and detained at the hospital on the request of the husband of the woman … without the evidence of insanity or distraction required in other cases.” So if a wife was deemed a nuisance by her spouse she could, purely on his say-so, be conveniently removed to the local mental institution.
Chastity belts and genital surgery
As the 19th century progressed, medical doctors became increasingly convinced that severe mental illness was linked with masturbation. In 1867 Henry Maudsley, a highly respected British psychiatrist of the time, asserted that masturbatory insanity was "characterized by ... extreme perversion of feeling and corresponding derangement of thought, in earlier stages, and later by failure of intelligence, nocturnal hallucinations, and suicidal and homicidal propensities." Following logically from the assumption that masturbation causes madness, creative contraptions were invented to try to discourage the practice, including the insistence that children wear mittens spiked with metal thorns or chastity belts constructed to deny access to their own genitals.
If these preventative measures failed, surgical interventions ensued including removal of the clitoris or the severing of the main dorsal nerve to the penis.
Surgical removal of organs
As recently as the early part of the 20th century some medical experts continued to believe that mental illness was caused by toxins from infected bodily organs seeping into the brain. Hence, effective treatment was thought to necessitate the removal of the infected part.
One extreme advocate of this approach was Dr. Henry Cotton, the much lauded Medical Director at the New Jersey State Hospital at Trenton between 1907 and 1930. Those unfortunate enough to reside within his psychiatric institution were subjected to sequential removal of their bodily organs. Initially, all the patient’s teeth were extracted. If this surgical intervention did not produce the desired improvement in mental state, tonsils, testicles, ovaries and colon were, in turn, excised. Without the benefit of antibiotics, about 45% of patients died during or shortly after the operation.
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Insulin coma therapy
Insulin is a hormone that acts to lower the level of glucose in the bloodstream. In diabetes, the production of insulin is impaired resulting in the sufferer experiencing the unpleasant effects associated with high levels of blood glucose. Treatment commonly consists of insulin injections to return the glucose levels to normality. If too much insulin is given, blood glucose levels will fall to dangerously low levels, starving the brain of sustenance and leading to loss of consciousness and ultimately death.
In the early 1930s, psychiatrist Manfred Sakel claimed that an insulin-induced coma had a positive effect on psychotic symptoms (for example, voice hearing and paranoia). Introduced to the USA by Joseph Wortis in 1935, insulin coma therapy was touted to be a specific treatment for schizophrenia and was widely deployed across the western world throughout the 1940s and 50s.
The treatment involved a hefty injection of insulin, typically administered six days per week over a period of two months. As blood sugar dipped, the patient would often experience an epileptic seizure. Once a coma had been achieved, this state would be maintained for one to three hours. Sometimes, unconsciousness reached such an excessive depth that the patient could not be revived by infusions of glucose and death ensued in up to 10% of cases. The recipients typically had to endure intense fear and feelings of suffocation at the start of the insulin coma therapy, and ravenous hunger in the aftermath. Furthermore, many patients soiled themselves during the procedure.
It took almost 30 years for the psychiatry profession to deduce that the treatment was ineffective, a controlled study by Acker and Oldham in 1962 finding that an insulin induced coma produced no anti-psychotic effects over and above a period of unconsciousness induced by other means.
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Leucotomy
Around the same time as psychiatric patients were being inflicted with insulin-induced comas, a Portuguese neurosurgeon was slicing brains under the guise of treating mental illness. Egas Monitz (a Nobel Prize winner) conducted the first pre-frontal leucotomy in 1935, a surgical operation that involved the cutting of the nerve fibres that connect the brain from front to the back.
The procedure was subsequently refined by Walter Freeman, an American neurologist and psychiatrist together with his neurosurgeon colleague, James Watt. Their “precision method” involved drilling holes in the scalp and required access to a surgical operating theatre and the skills of a neurosurgeon. Freeman strived to further simplify the procedure so as to enable psychiatrists in the large mental asylums to conduct the intervention themselves. Deploying an ice-pick and mallet, Freeman would access the frontal lobes through the eye-sockets. To publicise his methods, in the 1950s he travelled around the United States in a van he named the “lobotomobile” demonstrating the technique to doctors in the state hospitals.
In the United States approximately 40,000 people underwent leucotomies, with 17,000 procedures carried out in the United Kingdom. Despite lofty claims about its efficacy with a range of psychiatric disorders, the leucotomy (at best) rendered the patients malleable and easier to control. The less fortunate victims of Freeman’s interventions suffered more catastrophic consequences, including Rosemary Kennedy (23-year-old sister of future President John F. Kennedy) who was rendered dumb, incontinent, and destined to spend the remainder of her life in an asylum.
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Electro-convulsive therapy
During the 1930s there emerged among medical professionals the erroneous view that epilepsy and “schizophrenia” were mutually incompatible. By inducing epileptic fits they anticipated a corresponding improvement in a patient’s psychotic symptoms. At first, drugs were used to induce these seizures but in 1938 two Italian neuro-psychiatrists, Cerletti and Binni, developed an alternative way of triggering fits, a process that became known as electro-convulsive therapy (ECT).
Having observed pigs being stunned by electric shocks in the slaughter-house, Cerletti and Binni developed the idea of passing electricity through the human brain to evoke a generalised seizure. In the early days these seizures were so violent that, despite the nurses holding the patients’ arms and legs during the procedure, fractures of the limbs, ribs and even the spine were commonplace.
The modern-day version of ECT has been developed to make it much safer. The patient is administered both an anaesthetic and muscle-relaxant prior to electrodes being placed on the skull and the “shock” delivered. Although no longer advocated for the treatment of psychosis, ECT is a recommended psychiatric intervention for severe depression that has not responded to other interventions (drugs and psychotherapy).
Currently, the use of ECT remains controversial among both professionals and the general public. Although achieving some significant benefits for a sub-group of severely depressed patients, the improvements are short-lived. Furthermore, ECT is responsible for a range of unwanted side-effects, including short-term and long-term memory deficits, a greater number of shocks being associated with increased risk of memory impairment. A recent extensive literature review by psychologist John Read in 2010 considered all the evidence and concluded that, “the cost- benefit analysis for ECT is so poor that its use cannot be scientifically justified.”
Gas chambers to exterminate the mentally ill
Psychiatry’s darkest hour undoubtedly occurred during the 2nd World War. Early research exploring the genetic basis of mental illness was pioneered by German physicians who were supportive of the Nazi regime. Before the large scale extermination of Jews commenced, psychiatrists were overseeing a euthanasia programme targeting the mentally ill, deciding which lives were worth saving and which were not. To develop an effective means of culling the mentally defective, psychiatrists were instrumental in designing the gas chambers.
Under the guise of protecting the sane members of society, the systematic murder of mental patients commenced in 1939 and as many as 100,000 German psychiatric inmates may have been killed before Hitler officially ended the programme in 1941. Despite the Fuhrer’s intervention, psychiatrists in the local state hospitals independently continued their campaign murdering a further 70,000. The slaughter was not restricted to Germany; for example, around 30,000 psychiatric patients are believed to have perished in occupied Poland.
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Neuroleptic medication
In 1949 Henri Laborit, a French surgeon, made the chance discovery that a group of chemicals known as phenothiazines rendered patients more tolerant of pain and indifferent to their surroundings. Following some minor refinements, two French psychiatrists (Delay and Deniker) tried out the drug, later to be known as chlorpromazine, on a number of agitated psychiatric patients and found it had a calming effect. It was later demonstrated that, in addition to sedation, this class of “neuroleptic” drugs had a specific therapeutic effect on psychotic symptoms. Thus the first effective treatment for schizophrenia was born and soon chlorpromazine, and a raft of similar compounds collectively known as typical anti-psychotics,were being extensively used in psychiatric services across the world.
Although undoubtedly beneficial for many people experiencing psychosis, the serious side-effects associated with these neuroleptic drugs were grossly underplayed. Shortly after starting these medications patients commonly experience stiffness, shakiness, sexual difficulties, sluggish thinking and restlessness. But it is the consequences of long-term anti-psychotic medications that are of much greater concern, particularly in light of the fact that psychiatrists almost always recommend that the schizophrenia-sufferer remain on these drugs indefinitely to prevent the symptoms returning.
Peter Breggin, an American psychiatrist and a vehement critic of traditional psychiatric practice, has highlighted the risk of patients developing a condition known as tardive dyskinesia as a direct consequence of anti-psychotic medication. A disorder of the voluntary muscles, tardive dyskinesia is characterised by jerky movements of face, torso and limbs. Those afflicted typically display recurrent grimacing, lip-smacking, rapid blinking, pursing of the lips and extreme chewing movements. The prevalence rates for tardive dyskinesia are contentious but probably somewhere between 20% to 40% of patients taking anti-psychotic drugs will show significant signs of this neurological disorder.
Symptoms of tardive dyskinesia emerge after 6 to 24-months of neuroleptic use. Psychiatrists were slow to recognise and highlight the risk of tardive dyskinesia; as Breggin acerbically states in his book Toxic Psychiatry, “for twenty years the profession simply failed to notice that a large percentage of its patients was twitching and writhing from the drugs” (p 95).
A small number of patients taking anti-psychotic medication will suffer a catastrophic reaction to the drug, a condition known as neuroleptic malignant syndrome. Those unfortunate enough to develop this disorder will typically experience a period of apathy and disinterest in their surroundings, followed by fever, heart problems, coma and death.