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Madhouse: A Tragic Tale of Megalomania and Modern Medicine Paperback – September 4, 2007

ISBN-13: 978-0300126709 ISBN-10: 0300126700 Edition: 1st

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Editorial Reviews

From Publishers Weekly

In the early part of the 20th century, psychiatrist Henry Cotton was so obsessed with the idea that mental disorders were caused by infections that he had all his children's teeth pulled to prevent tooth decay from driving them mad. Unfortunately, he was the director of a New Jersey mental hospital and prescribed invasive surgeries—from tonsillectomies to the removal of colons and uteruses—for thousands of patients, some "dragged, resisting and screaming" to the operating room. The tale is horrifying, at times luridly so, but Scull, a sociologist specializing in the history of psychiatry, points out that Cotton was not a renegade scientist. Scull's meticulous historical narrative tracks the enthusiastic response within the psychiatric community of the time. Cotton's published research, as well as the reluctance of skeptics to attack his attempts at reconciling mental and physical health. The story changes gears abruptly with the arrival in 1925 of Phyllis Greenacre, an independent researcher assigned to audit Cotton's results, and takes another dark turn when her findings are suppressed to preserve Cotton's reputation. Scull's closing arguments for the story's modern relevance as an example of the mental health industry's tendency to protect its own at the expense of patients are largely successful, but it's the parallels with whistle-blowers in other fields that may call attention to this compelling account of a shameful episode.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved. --This text refers to an out of print or unavailable edition of this title.

Review

"'Scull writes an exemplary narrative - reminding us that today's respected clinician can still easily become tomorrow's mad scientist.' Michael Moorcock, Daily Telegraph 'Madhouse is fascinating. Scull's detection is impressive; it extends over years.' Hugh Freeman, Times Literary Supplement 'A brilliant piece of medical scholarship...' The Irish Times"
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Product Details

  • Paperback: 384 pages
  • Publisher: Yale University Press; 1 edition (September 4, 2007)
  • Language: English
  • ISBN-10: 0300126700
  • ISBN-13: 978-0300126709
  • Product Dimensions: 1.2 x 6.2 x 9.2 inches
  • Shipping Weight: 9.6 ounces (View shipping rates and policies)
  • Average Customer Review: 2.6 out of 5 stars  See all reviews (8 customer reviews)
  • Amazon Best Sellers Rank: #382,474 in Books (See Top 100 in Books)

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Most Helpful Customer Reviews

21 of 22 people found the following review helpful By John Harpur on September 7, 2005
Format: Hardcover
This book describes the treatment of a variety of psychiatric disorders using radical surgery by the American psychiatrist Joseph Cotton. He was a advocate of the doctrine of 'focal sepsis' which located the seat of mental illness in bacteriological infections of various body organs. While this may appear crank thinking now, Cotton was simply elaborating one trend in medical thinking at the time. Admittedly his elaboration was robustly surgical. 'Infections' leading to psychoses were found in the teeth, the sinuses, the ileum, colon, almost all parts of the intestines, the cervix, testicles, and naturally the stomach.

Cotton's 'enucleation' of offending organs and parts was intended to cure the patient. However, with mortality rates of 30%, the treatment was much worse than any disease. Cotton was effectively little more than a butcher that rountinely cut up his patients involuntarily. How did he get away with it for so long? What events finally opened a window on the horror of his methods? Well these are the stuff of the book. If you know any Kuhn or Lakatos, this book will absolutely grab your attention. Well worth reading.
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17 of 20 people found the following review helpful By Russell Sheaf on August 19, 2005
Format: Hardcover
Andrew Scull meticulously exposes blinkered practice, faulty ego, and inertia in the face of overwhelming facts. At times this book felt like a nightmarish novel but all the evidence was there-thousands of people experienced and witnessed a medical holocaust. I found it compelling and tragic. Little wonder that evidenced based medical practice emerged from catastrophes like these. Not to be missed by any patient who has ever thought of seeking a second opinion. Madhouse was my `read` of the year.
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7 of 9 people found the following review helpful By Dr. Mark W. Ketterer on June 8, 2011
Format: 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.
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15 of 31 people found the following review helpful By C. Christi on September 2, 2006
Format: Hardcover Verified Purchase
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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