Madness in Civilization -- Andrew Scull

This shining review of Andrew Scull's Madness in Civilization is particularly noteworthy, given that the reviewer, Daniel Pick, is a psychoanalyst, and Scull is habitually dismissive of psychoanalysis. Veterans of my Abnormal Psychology course should pat themselves on the backs for already knowing about Henry Cotton, Walter Freeman, and Julius Wagner-Jauregg (malarial treatments).

"If there is a subtext to Scull's mostly cool and appraising survey, it is indeed the propensity of the doctors to go mad for their theories and to regard abandonment of doubt as tantamount to professional strength. The notorious surgeon Henry Cotton, who was allowed during the interwar years to bring havoc to the lives of his patients in New Jersey, was already the protagonist in one of Scull's earlier books, Madhouse (meaning not so much a residence for the mad, but a site of mad operations). Cotton's reign at the Trenton State Hospital is also briefly recapped here. His crazed surgical practices were based upon his settled view that the patients were almost invariably suffering from sepsis; their condition often required, in his eyes, the excision of parts or the whole of their internal organs. He caused much misery (and many deaths) with his unfettered assaults upon stomachs, spleens, cervixes and colons. Despite the serious misgivings of colleagues, nobody seemed able to stop him or blow the whistle. Such institutional failings and cover-ups, a collective incapacity to curb the lunacy of the individual or coterie, as we know all too well from more recent scandals, provide the most shocking story of all.

From Cotton we move on to the vicissitudes of insulin treatment, the sagas of those experiments to deliberately infect physically healthy patients with the blood of malaria sufferers, and so to the postwar brain operators such as Walter Freeman, who so refined the treatment that he boasted of how he could deal with a dozen or more people in sequence in a single afternoon. Scull's description of Freeman's fast-track 'transorbital lobotomy' is not for the faint-hearted. Few would defend this now, but ECT remains in existence, refined from the earlier experimental phases and a subject of division and debate in the psychiatric profession.

...

Scull is a good storyteller and not shy of expressing his own opinions. He offers up the best and worst of what has been thought and imagined, and what has been done, in the name of mental healing. Given the forest of monographs, theses and grand theories that faces any new entrant to what we might call 'history of madness studies', it would be hard to imagine a more useful single-volume synthesis. Well researched, strong on details and alert to the big picture, this book certainly deserves to find a wide readership. It sits well with other moving testimonies to the dilemmas of the doctors and the possibly counterproductive effects of certain weapons in their arsenal. It complements the accounts of success and failure by various surgeons themselves, in dealing with physical rather than mental illness. In fact the recent bestselling works Do No Harm and Being Mortal might well be read alongside Madness in Civilization; all three would be on my recommended reading list for aspiring medical students and therapists alike."