From Ronald Hoffman, MD
For centuries, medicine has grappled with psychiatric illness, wielding a variety of techniques. Nevertheless, success has been at best marginal; a recent study of antidepressants and psychotherapy in the treatment of major depressive disorder has shown a response rate of just 24%. For schizophrenia and psychosis, the results have been even more abysmal. Random violence and rampant homelessness attest to the pervasiveness of unaddressed psychiatric disorders; childhood and adolescent anxiety, depression, and behavioral disorders are soaring in prevalence.
For those patients who obtain relief from modern psychiatric drugs, it’s often partial and transient, and comes at the cost of life-impairing side effects.
But today’s therapies are benign by comparison with some of the barbarities perpetrated in the past on persons suffering from mental illness. Andrew Scull has provided us with a meticulously-researched history of these desperate remedies—and it’s a cautionary tale about the extremes to which medical hubris can lead us, with true contemporary relevance.
The underlying theme of Desperate Remedies is that the psychiatric profession has gyrated from one misguided treatment paradigm to another, culminating in its current infatuation with psychopharmacology, often with disastrous results. It’s a true illustration of how blind zeal for “cures” has led to terrible excesses, not just in psychiatry, but in all arenas of medicine.
Until the mid-20th Century, people with mental disorders were confined to asylums, where conditions were horrific. Patients were warehoused there with little hope of recovery. Straightjackets, padded cells, beatings, forced immersion in tubs of ice water, and sexual abuse were rampant.
With the popularization of Darwin’s evolutionary theories of “survival of the fittest”, the notion developed that the insane represented a form of hereditary degeneracy. On the contrary, sophisticated modern gene-mapping has been hard put to find one or even a constellation of genes that make people schizophrenic or depressive. But 19th and early 20th Century eugenicists became convinced that the human bloodline should be purged of “inferior” stock. This led to mass (involuntary) sterilization in asylums and was the antecedent to the Nazis’ extermination of “life unworthy of life”; Hitler drew his inspiration from America.
