Wednesday, June 5, 2013

Mental Health Treatment: Further Attempts

by Debra Brown


My last post, From Madhouse to Asylum: The Evolution of the Treatment of Mental Illness, discussed the beginnings of civil treatment of the mentally ill. Indeed, advances were made, beginning in the eighteenth century, of kind, considerate treatment instead of chaining, caging and tormenting the poor victims.

Even the goverment began to take mental conditions into account.

"In 1843 a Glasgow carpenter named Daniel McNaughton attempted to assassinate British Home Secretary Sir Robert Peel, and accidentally killed Peel's assistant instead. In the celebrated court case that followed, McNaughton's lawyers proved that he had delusions of persecution. For months he had been tormented by the idea that public officials were pursuing him. McNaughton was acquitted of murder on the grounds that he was insane and could not distinguish between right and wrong. The McNaughton case is the foundation of the 'insanity plea' that is sometimes invoked in courtrooms to this day."

Dorothea Dix (1802- 1887) visited England during a low point in her life. She was depressed and alone, and she did not know how she could go on living. Fortunately, she carried a letter of introduction to William Rathbone III. The Rathbones took her into their home and brought her through her melancholy with their heartfelt kindness. At their home she met Samuel Tuke, the grandson of the founder of the York Retreat. She saw and felt the value of what he called "moral treatment".

Dorothea Dix

Dorothea returned to America where she visited state legislatures and convinced many of the need for reform in the treatment of the insane. She had great success, and the dream of places of asylum for them began to be met. The view was that the patients were in need of respite from the pressures of life and family, and that kindly medical care would be a help to them. And it was. Hospitals were small, and each patient was under the care of a doctor trained in this new method of treatment. Rates of cure were considered to be high.

In time, however, populations grew, and it began to be seen that many more people needed this respite from troubles to regain their mental stability. State legislatures balked at rising costs. In 1851, a superintendent said to Dorothea Dix, "The tendency now is not to make hospitals as fit as possible, but as cheap as possible."

Hospitals became much larger and more impersonal, and they were staffed more and more with poorly trained attendants who spent their time struggling to keep the patients under control. This, while thousands of mentally ill persons were still being held in almshouses and prisons. By the late nineteenth century, asylum life bore a disheartening resemblance to that in Bedlam two centuries before. Restraints were used well into the twentieth century.

Deborah Kent writes, "White Americans sometimes argued that immigrants and African Americans had a special tendency toward mental illness. In the years before the Civil War, several 'scientific studies' supposedly proved that free blacks had a higher rate of physical and mental illness than did slaves. Thus blacks must be unfit to cope with freedom, and were better off under slavery." A Dr. Samuel Cartwright detailed two "mental diseases" that were unique to blacks. One "illness", Drapetomania, was caused, he said, by owners that treated their slaves as equals, causing them to have a tendency to run away. Dysaesthesia Aethiopis, the second, resulted in a desire to avoid work and cause mischief. I have my doubts that any of those symptoms related to disease!

The Power of Suggestion

In the late 1700s Franz Anton Mesmer enjoyed studying the new science of electricity. A practicing physician in Vienna, Mesmer conceived a startling new theory to explain human illnesses. An invisible fluid, which he called "animal magnetism," fell from the stars to the earth. This fluid, with its positive and negative charges, existed in all living things, and it flowed from one to another. If they became unbalanced, the charges caused disease.

Franz Anton Mesmer

To bring the charges into balance, Mesmer sat facing his patient. He held the patient's thumbs and stared into her eyes. He ran his hands up and down her arms and legs. Patients burst into fits of laughter, tears or shaking. After this, what Mesmer called a "hysterical crisis", the patient's symptoms disappeared.

In 1778 the authorities accused Mesmer of touching his female patients inappropriately, and they drove him out of the city. He settled in Paris, where he came to have eager patients among the French aristocracy. Eventually Louis XVI ordered an investigation into the scientific validity of Mesmer's claims. Benjamin Franklin was in France at the time, and along with other investigators, he considered the magnetic fluid to be an unsound theory. "The violent effects observed ... are to be attributed to the touching, to the aroused imagination, and to that mechanical imitation which leads us, in spite of ourselves, to repeat that which strikes our senses," he said.


A hundred years later, Jean-Martin Charcot became interested in the practice of Mesmerism, which had persisted and been refined. Charcot was in charge of insane patients in Salpetriere, a Paris hospital. Many of his patients had symptoms with no known physical cause. He decided to use a form of Mesmerism which he called hynopsis on some of these hysterical patients. Often a patient would awake from his trance free of his or her previous symptoms.


The young doctor Sigmund Freud believed all mental illness had biological roots, but he studied under Charcot in 1885 or 1886, and he began to wonder how hypnosis touched into the psyche of the patients and helped them.

Back in his home town of Vienna, Freud and an older doctor, Josef Breuer discussed an interesting case, that of a woman they called "Anna O" in their later book Studies in Hysteria. Breuer had treated a woman for strange symptoms--she lost her appetite, forgot her native German language for a time and even thought her braids were snakes trying to choke her. She had radical personality changes and thought the people around her were wax figures.

Breuer began to question her about her life during the time the illness set in. She talked freely about the stresses she had been under while caring for her dying father. She came to call these discussions her "talking cure". Indeed, she felt they were the reasons her symptoms disappeared.

Freud began to feel that talking, even without the use of hypnosis, would have therapeutic results. He had his patients lay on a couch and talk about whatever came to their minds. Freud called this "free association", the beginning of psychoanalysis. We see in this a start of accepting trauma as a cause of emotional illness and talk as a healing therapy.

Though some of Freud's followers turned away from him as his theories developed, the idea began to grow that if talking about trauma relieved emotional distress, why not prevent the distress to begin with? Child guidance clinics throughout the United States began training parents in compassionate child-rearing and providing treatment for troubled children as well as wholesome sporting and recreational programs. But a good thing could not be left alone.

Along came the thought from some psychoanalysts that mental illness in children had to be the mother's fault. Deborah Kent writes, "Mother emphatically did NOT know best. She was either overprotective or rejecting, demanding or neglectful. No matter what she did, she was seen as a destructive force in her child's life." Cold "refrigerator moms" were the cause of autism. Many mothers bore the distress of seeing their children suffer mental conditions while guilt compounded their sorrow. In later decades of the twentieth century, severe mental illness was finally seen to have biological origins.

One Dr. Henry Cotton in early twentieth century New Jersey was convinced that tooth decay was a leading cause of mental illness--possibly because the mentally ill had no presence of mind to care for their teeth, and they were in poor condition. Without scientific evidence backing his theory, he extracted their teeth for some thirty years. A hospital visitor wrote in 1930 that she saw hundreds of people without teeth. They suffered with indigestion, she said, because they could not chew their food.

Patients were submerged in ice water for up to three hours, perhaps every day for two or three weeks.

Insulin shock therapy was used beginning in 1934, resulting in the deaths of one percent of the patients. Nevertheless, this treatment continued until the 1960s.

An Italian psychiatrist, Ugo Cerletti, examined a group of epileptic patients and came to the conclusion that epilepsy and schizophrenia did not mix--that an epileptic patient could not have the second condition. He felt that if he produced convulsions in schizophrenic patients, their illness would disappear. This led to the use of electrical current therapies. Though he was wrong in his understanding about epilepsy and schizophrenia, Deborah Kent says that the use of electrical currents proved to be a major breakthrough for easing the minds of schizophrenic patients and lifting depression. My own grandmother spent months in an institution, going in severely depressed and coming out surprisingly normal.

A Portuguese doctor, Egas Moniz, developed a grim treatment that he said calmed highly disturbed patients, and this came to be used frequently for a time. Nerves in the front portion of the brain were severed in a process called lobotomy. Some surgeons entered the brain by drilling holes in the skull, much like the ancients did apparently to allow the escape of demons. (Does it seem we went full circle?) Other surgeons went through the eye. Crucial areas of the brain were destroyed, and many had terrible effects. Dr. Moniz was awarded the Nobel Prize for Medicine in 1949.

The sister of the American President John F. Kennedy underwent a prefrontal lobotomy. Massive brain damage resulted, leaving Rosemary unable to communicate or care for her basic needs. She was placed in a nursing home. The public did not learn the truth about this until 1996.

For the most part, the treatments that had been tried in more modern times, even those that resulted in tragedy, had the best of intentions. Not all, however, could make that claim.

Though I've already strayed far from the British Isles in this post, I won't take you back into Nazi Germany and Hitler's treatment of "worthless eaters". I'm sure you've heard more than you wanted to know on that topic.

We can be thankful for the vast improvement in understanding and development of treatments made by researchers and professionals of recent decades. Though we may long for the past, my history-loving friends and I prefer today's medical care!

I recommend to you my resource, the book Snake Pits, Talking Cures, & Magic Bullets: A History of Mental Illness by Deborah Kent. Did you ever realize a Young Adult book could be so full of fascinating information?

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Debra Brown is the author of The Companion of Lady Holmeshire.

Her current work is on a novel, For the Skylark, about an emotionally disturbed woman, based on Charles Dickens' Miss Havisham, and her adult twins.