Madhouse: A Tragic Tale of Megalomania and Modern Medicine [Paperback]
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Madhouse revealsa long-suppressed medical scandal, shocking in its brutality and sobering in its implications. It shows how a leading American psychiatrist of the early twentieth century came to believe that mental illnesses were the product of chronic infections that poisoned the brain. Convinced that he had uncovered the single source of psychosis, Henry Cotton, superintendent of the Trenton State Hospital, New Jersey, launched a ruthless campaign to “eliminate the perils of pus infection.” Teeth were pulled, tonsils excised, and stomachs, spleens, colons, and uteruses were all sacrificed in the assault on “focal sepsis.”
Many patients did not survive Cotton’s surgeries; thousands more were left mangled and maimed. Cotton’s work was controversial, yet none of his colleagues questioned his experimental practices. Subsequent historians and psychiatrists too have ignored the events that cast doubt on their favorite narratives of scientific and humanitarian progress.
In a remarkable feat of historical detective work, Andrew Scull exposes the full, frightening story of madness among the mad-doctors. Drawing on a wealth of documents and interviews, he reconstructs in vivid detail a nightmarish, cautionary chapter in modern psychiatry when professionals failed to police themselves.
- Paperback: 384 pages
- Publisher: Yale University Press; 1 edition (September 4, 2007)
- Language: English
- ISBN-10: 0300126700
- ISBN-13: 978-0300126709
- Product Dimensions: 9.2 x 6.1 x 1.1 inches
- Shipping Weight: 9.6 ounces (View shipping rates and policies)
- Amazon Best Sellers Rank: #944,718 in Books (See Top 100 in Books)
When I talk about healthcare reform with psych students, I often
try to include an example or two from our own field in order to press
home that we are not immune from the scientific sloppiness and
misguidedness that afflicts american healthcare. I have often used
Egas Moniz's conflation of lab studies on frontal lobotomy in monkeys
and diminished retention of simple learning tasks with Freudian
theories about the causes of psychopathology & the tragedy of
frontal lobotomies in schizophrenics. Its never been an entirely
satisfactory example because the frontal lobe syndromes probably
did result in symptom reduction for some patients - reduced aggression
due to apathy, or disinhition "curing" withdrawal. Even misguided
reasoning sometimes, inadvertently, produces salutary results.
But Scull provides an even better example in the efforts of Henry
Cotton, the superintendent of Trenton State Hospital for the Insane
in the 1920s. Cotton believed in the "theory of focal infection" as
the cause of all forms of insanity - essentially an extension of delirium
to all the chronic cases warehoused in hospitals like his. In an era
when the differences between "Dementia Praecox" (Schizophrenia)
and "Manic-Depressive Illness" (Bipolar Disorder) were still not fully
appreciated, and state hospitals also housed severe depressives,
severe anxiety patients, mental retardation and demented patients,
Cotton's one-treatment-cures-all vision was surely a ray of hope.
In pursuit of "cures" he hired dentists and surgeons to come and remove
larger and larger numbers of "infected" organs - teeth, tonsils, adenoids,
colons, uteruses, segments of bowels, seminal vesicles, etc.
Rear view mirrors often contain the printed admonition that "objects in this mirror may be closer than they appear." Historical accounts of events nearly a century ago should also come with a disclaimer: "There is no history, only "histories" or accounts of past happenings as one person imagined them to be." Madhouse is the story of medical research gone overzealous; of needed oversight and peer sanctions being ineffective. Madhouse provides an account of Dr. Henry Cotton, a psychiatrist in search of a physical cause for mental illness. He performed surgery on numerous patients with the belief that their conditions were caused by focal infections.
There is little question that scientific understanding does not move forward with the objectivity and logical progress that would best serve humankind. There are personalities and careers at stake, political influences and reputations, and of course the dogma of any science on any given day. Even today, much of medical practice has yet to be substantiated by randomized clinical trial, yet it presses on doing the best that it can. This is especially true in psychiatry. There are dangers in looking only for molecular or cellular explanations of disease at the expense of considering the consequences on the everyday life of the patient.
Although Scull's account makes for sensational reading, and contains interesting historical facts about the personalities and events of the time; what it lacks is what no historian can really provide and what every psychiatrist should be concerned with. There are spaces of "meaning" between the events of a life that only the individuals involved can truly know. Did Dr. Cotton intentionally harm these patients, or did he honestly believe that the eradication of infection would help them recover?
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