were suffering delusions
might be offered ECT or the
chemical cosh (drug
treatments that left the
patient stunned, based on
chemicals synthesised for the
clothes-dyeing industry). Or, if
they got a Freudian doctor,
they might be told that it was
their fault because the mother
was “schizophrenogenic”, ie
madness-inducing. The
parents of autistic children
were blamed for being “cold”.
Scull, a Scottish sociologist-
cum-historian who teaches in
California, has written some
eloquent books on the history
of psychiatry, though they
have previously had a tighter
focus. Here, it is as though
taking a panoramic view of
the whole subject has brought
home to him, finally and with
considerable emotion, what a
pitiful racket it has been. He
struggles sometimes to keep
an academic tone. And in the
light of the evidence, who can
blame him?
For a long time it was
thought that heredity played
an important part in psychosis
because statistics suggested
you were more likely to suffer
from schizophrenia if a familymember had it. But identical
twin studies (in which one
twin developed it and one
didn’t) showed there were
other, “environmental”
elements at work. The biggest
boost to this view came, alas,
from the Nazis, who murdered
all such patients they could
identify, reducing the German
psychotic population to near
zero. But by 30 years after
the war the incidence of
schizophrenia was higher
than before.
Following the Human
Genome Project, genome-widesurveys have identified
hundreds of genes that may
have some bearing on some
predisposition to mental
disorder. However, many
psychiatrists now think there
are no such entities as
schizophrenia or bipolar
disorder; just human madness
on a never-ending spectrum
of intensity. In America big
pharmaceutical companies
made it clear to academic
partners that their “research”
was expected to find in favour
of the sponsoring company’s
own patent “antipsychotics”.
(This word was itself a
dishonest sleight of
hand: the dyers’
chemicals were
only ever there
to stun some
symptoms, not
cure theirin common was a blind zeal
for their own methods; avid
financial careerism; contempt
for the techniques of others;
and a consistently dishonest
way of presenting their
results. The asylums had
made the public accustomed
to the fact that patients could
not be helped, but only
managed and disciplined; the
profession used many of its
“treatments” as punishments,
while pretending otherwise.
As biology failed, so
listening to the patient
became popular. In the 1890s
an ambitious young
neurologist in Vienna
proposed universal laws
about the human psyche on
the basis of a few young
women he had “cured” of a
complaint whose biological
basis he could not establish.
To be fair to Freud, he did not
claim his theories should be
used to treat seriously
deluded patients; but by a
bizarre sequence of events, to
do with sectarian squabbling
within professional bodies,
they were. In mid-20th-
century America a family first
taking their precious 20-year-
old into hospital because they
Brutal Preparing
a patient for a
lobotomy in 1949;
right, Sigmund FreudGETTY IMAGES(^) GETTY IMAGES
cause.) GlaxoSmithKline,
Johnson & Johnson and Pfizer
have all been fined millions, in
some cases billions, of dollars
for dishonesty in psychiatric
drug research and marketing.
Partly as a consequence they
have almost given up on this
area, seeing a surer profit
elsewhere. The fifth edition of
the handbook for American
psychiatry, the Diagnostic and
Statistical Manual of Mental
Disorders (or DSM-5), is viewed
with derision in the profession
as the outcome of warring
factions, special interests and
financial corruption.
Psychiatry has in 200
years had one success: the
discovery that general
paralysis of the insane was a
symptom of terminal syphilis.
The patients weren’t “mad”
after all: they had VD. As for
the rest, well... The chemical
cosh can dampen some
symptoms in some patients,
albeit with terrible side
effects. Some of the modern
Prozac-type pills can produce
small improvements in a few
depressed users, though the
upswing is negligible when
compared to the effects of
time and circumstance.
Cognitive behavioural therapy
can be helpful to some people
with life difficulties, but is
ineffective with serious
illness. Some truly helpful
work has been done with
post-traumatic stress disorder,
but the qualifying symptoms
have been farcically redefined
and extended by DSM-5.
That’s about it.
In the late 20th century the
asylums were emptied and
closed, their patients handed
over to “care in the
community”; but there was
scant care on offer, and no
community. Talking therapy
was only ever for the rich; the
American and European
taxpayer wouldn’t stand the
cost of providing public
hospital care for the seriously
unwell. They are mostly on
the street now, or in jail.
So, basically, we are back in
Bedlam. And the year might as
well be 1247. Madness remains
the most fascinating —
arguably the defining — aspect
of Homo sapiens. But it’s too
hard for most of us to think
about. And in Scull’s
harrowing account, this is in
large measure because the
majority of those drawn to
its treatment have been
morally or scientifically
bankrupt. Often both. c
Freud did not
claim he could
treat seriously
deluded
patients
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