497. Psychiatry: Mother hugs, seizures, lethargy, or an ice pick through the eye.

 

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                        PSYCHIATRY

It wants to help.  Over the years it has tried to help.  Sometimes it has wanted to be rigorously scientific, like the natural sciences, and sometimes it has abandoned this approach, stopped squinting through a microscope, and began talking at length to patients.  But its catalog of ailments, as chronicled in successive issues of its Diagnostic and Statistical Manual (DSM), went from 106 in 1952, to 182 in 1968, 285 in 1980, and 307 in 1994.  One may well ask, as some therapists did, if there were really so many ways to be ill.  Were all these categories driven by rigorous scientific inquiry, or did they reflect an arbitrary and subjective approach by the profession?  Which makes a lay observer suspect that psychiatry, far from being rigorous and scientific, is something of a mess.

And an evolving mess, to be sure.  It has gone through phases.  Consider those phases from the nineteenth century on:

• Mental illness derives from organic pathology, a belief reinforced by the discovery that general paralysis was caused by syphilis (late 19th century).
• Mental illness derives from the patient's thoughts, feelings, and perceptions (early 20th century, reinforced by Freud's work).
• Euthanasia is, or is not, permissible (a 1924 US law permitting it was cited by Germany's Nazi government in 1933 to justify a similar law of its own).
• Shock treatments, especially for schizophrenia: treatment with malaria, then with insulin, to produce comas; drug-induced epileptic seizures; electroconvulsive therapy (ECT) to produce convulsions; prefrontal lobotomy of the brain, first done with ice picks through the patient's eye sockets (1920s and 1930s).
• A Freudian psychoanalytical approach: emphasis on patient's childhood and unconscious conflicts, and "remothering"of the patient to cure "maternal deprivation" (1940s).
• Motherhood is to blame for mental illness: "smother love" makes a son homosexual, coldness causes autism, permissiveness leads to delinquency (1950s).
• Tranquilizers are given to reduce "psychic energy" and get patients out of long-stay hospitals, which some critics likened to concentration camps (1960s).
• Researchers posing as patients get themselves admitted to psychiatric institutions, are diagnosed with schizophrenia or manic-depressive psychosis, and then, upon release, report abuses and assert that psychiatry can't tell the sane from the insane (1973).
• Antidepressants are mass-marketed to the public, despite side effects and the risk of dangerous overdoses; depression is a chemical imbalance correctable by drugs (1970s, 80s, 90s).
• Yet another new approach: patients given their own apartment, and/or access to a supportive community, improve noticeably, even to the point of needing little or no attention from psychiatrists (today).

So what does all this mean?  Depending on when and where it occurred, mental illness was supposedly caused by germs, the unconscious, mental institutions, or too much mother or too little.  And by way of treatment patients risked epileptic seizures, malaria, sterilization, hugs from a therapist who encouraged gifts of feces, an ice pick through the eye, or even euthanasia.  When one researcher got himself admitted to an institution, and was obligingly diagnosed, a fellow patient said to him,"You're not crazy.  You're a journalist or a professor checking upon the hospital."  The researcher's conclusion: the mentally ill are better judges of sanity than the clinicians. 

Many in the profession are trying earnestly to help people, and some are even succeeding.   But I am thankful that, today, I can pass for "normal" -- whatever that is -- and not risk seizures, a mother hug from a therapist, drug-induced lethargy, or an ice pick through the eye.

Source note: This post was inspired by "Changing Psychiatry's Mind," Gavin Francis's review of two books on psychiatry in the New York Review of Books, January 14, 2021.

©  2021  Clifford Browder