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Mechanism Compulsive Disorder & Psychosis, June 8, 2011
This review is from: Madhouse: A Tragic Tale of Megalomania and Modern Medicine (Paperback)
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. Somehow
he managed to convince himself and his colleagues, and a considerable
number or practitioners both in the U.S. and England, that patients were
being cured. Its impossible to know whether some of these patients had
abcesses which, once removed, actually did improve mental state. Cotton
(CLEARLY a Type A) was a true believer - he had his own teeth as well
those of his wife and children, all removed prophylactically to ward off any
incipient insanity. Cotton used no standard measures and did no followup.
He may have perceived the relative quiescence of patients in the post-surgical
period (due to blood loss, pain, and anaesthetics/analgesics) as "cures". The
mortality rate for his colectomies averaged 30%!
The field chose to ignore a RACC Trial conducted and presented
by a team from Massachusetts which found no such increase in cured
patients. Seeking validation from his former mentor, Adolph Meyer,
Cotton welcomed a young female psychiatrist, Phyllis Greenacre, from
Johns Hopkins to do the followup spadework on his patients. She found
that his "cures" were uncured, and that patients receiving the most
surgery did worse rather than better as the theory would dictate. Cotton
immediately turned on her rather than dispassionately examining her data,
and Meyer colluded in suppressing the data because of Cotton's agitation
- probably for fear of the scandal it would occasion. It never saw publication.
Scull does an excellent job of referencing sources and private
correspondence to document the thinking and behavior of the actors in this
drama. It is a vivid depiction of the personality types, the evolution of the
delusion and the social system which permits this kind of craziness to
exist. Medicine would do well to commit this syndrome to memory &
revisit it every time some heroic cure is on offer.
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