So much for what would have happened to me, if I had become mentally sick in the eighteenth, or even the first half of the nineteenth, century. If I had lived in the sixteenth century, my fate might have been even worse. For in the sixteenth century most of the symptoms of mental illness were regarded as supernatural in origin. For example, the pathological refusal or inability to speak was held to be a sure sign of diabolic possession. Mutism was frequently punished by the infliction of torture and death at the stake. Dumb devils are mentioned in the Gospels; but the evangelists made no mention of another hysterical symptom, localized insensibility to pain. Unfortunately for the mentally ill, the Early Fathers noticed this curious phenomenon. For them, the insensitive spots on the body of a mentally sick person were “the Devil’s stigmata,” the marks with which Satan branded his human cattle. In the sixteenth century anyone suspected of witchcraft would be systematically pricked with an awl or bodkin. If an insensitive spot were found, it was clear that the victim was allied with the devil and must therefore be tortured and burned alive. Again, some mentally sick persons hear voices, see visions of sinister figures, have phantasies of omnipotence or alternatively of persecution, believe themselves to be capable of flying, of being subject to metamorphosis into animals. In the sixteenth century these common symptoms of mental derangement were treated as so many statements of objective fact, so many confessions, explicit or implicit, of collaboration with the Enemy. But, obviously, anyone who collaborated with the Devil had to be tortured and burned alive. And what about the neurotics, particularly the female neurotics, who suffer from sexual illusions. “All witchcraft,” proclaim the learned clerical authors of the Malleus Maleficarum, the standard textbook for sixteenth-century inquisitors and magistrates, “all witchcraft comes from carnal lust, which in women is insatiable.” From this it followed that any disturbed woman, whose sexual daydreams were more than ordinarily vivid, was having relations with an Incubus. But an Incubus is a devil. Therefore she too must be tortured and burned alive.
Doctor Johann Weier, who has been called the Father of Psychiatry, had the humanity, courage and common sense to assail the theories and hellish practices of the Catholic theologians and magistrates, and the no-less-ferocious Protestant witch-hunters of his time. But the majority even of well-educated men approved the crimes and follies of the Church. For having ventured to treat the witches’ confessions as symptoms of mental illness, Weier was regarded as a diabolical fellow traveler, even a full-blown sorcerer. That he was not arrested, tortured and burned was due to the fact that he was the personal physician of a ruling prince. Weier died in his bed; but his book was placed on the Index, and the persecution of the mentally ill continued, unabated, for another century. How many witches were tortured and burned during the sixteenth century is not exactly known. The total number is variously estimated at anything from one hundred thousand to several millions. Many of the victims were perfectly sane adherents of the old fertility cult which still lingered on in every part of Europe. Of the rest, some were persons incriminated by informers, some the unhappy victims of a mental illness. “If we took the whole of the population of our present-day hospitals for mental diseases,” writes Dr. Zilboorg, “and if we sorted out the cases of dementia praecox, some of the senile psychoses, some of those afflicted with general paralysis, and some of the so-called involution melancholies, we should see that Bodin (the great French jurist, who denounced Dr. Weier as a sorcerer and heretic) would not have hesitated to plead for their death at the stake, so similar and characteristic are their trends to those he describes. It is truly striking that the ideational contents of the mental diseases of four hundred years ago are so similar to those of today.”
In the second half of the seventeenth century the mentally sick ceased to be the prey of the clergy and the theologically minded lawyers, and were left instead to the tender mercies of the doctors. The crimes and follies committed in the name of Galen were, as we have seen, almost as monstrous as those committed at an earlier period in the name of God. Improvement came at last in the closing years of the eighteenth century, and was due to the efforts of a few nonconforming individuals, some of them doctors, others outside the pale of medicine. These nonconformists did their work in the teeth of official indifference, sometimes of active official resistance. As corporations, neither the Church nor the medical profession ever initiated any reform in the treatment of the mentally sick. Obscure priests and nuns had often cared for the insane with kindness and understanding; but the theological bigwigs thought of mental illness in terms of diabolic possession, heresy and apostasy. It was the same with the medical bigwigs. Strait jackets, Brisk Vomits and systematic terrorism remained the official medical policy until well into the nineteenth century. It was only tardily and reluctantly that the bigwigs accepted the reforms initiated by heroic nonconformists, and officially changed their old, bad tune.
Reform began almost simultaneously on either side of the Channel. In England a Quaker merchant, William Tuke, set up the York Retreat, a hospital for the mentally sick, in which restraint was never used and the psychological treatment was aimed, not at frightening the patients, but at bringing them back from their isolation by persuading them to work, play, eat, talk and worship together. In France the pioneer in reform was Doctor Philippe Pinel, who was appointed to the direction of the Bicetre Asylum in Paris at the height of the French Revolution. Many of the patients were kept permanently chained in unlighted cells. Pinel asked permission of the revolutionary government to set them free. It was refused. Liberty, Equality and Fraternity were not for lunatics. Pinel insisted, and at last permission was grudgingly given. The account of what followed is touching in the extreme. “The first man on whom the experiment was tried was an English captain, whose history no one knew, as he had been in chains for forty years. He was thought to be one of the most furious among them. His keepers approached him with caution, as he had in a fit of fury killed one of them on the spot with a blow from his manacles. He was chained more rigorously than any of the others. Pinel entered his cell unattended and calmly said to him, ‘Captain, I will order your chains to be taken off and give you liberty to walk in the court, if you will promise me to behave well and injure no one.’ ‘Yes, I promise,’ said the maniac. ‘But you are laughing at me…’ His chains were removed and the keepers retired, leaving the door of his cell open. He raised himself many times from the seat, but fell again on it; for he had been in a sitting posture so long that he had lost the use of his legs. In a quarter of an hour he succeeded in maintaining his balance and with tottering steps came to the door of his dark cell. His first look was at the sky, and he exclaimed, ‘How beautiful, how beautiful!’ During the rest of the day he was constantly in motion, uttering exclamations of delight. In the evening he returned of his own accord to his cell and slept tranquilly.”
In Europe the pioneer work of Tuke and Pinel was continued by Conolly, Esquirol and a growing number of their followers in every country. In America, the standard bearer of reform was a heroic woman, Dorothea Dix. By the middle of the century many of the worst abominations of the old regime were things of the past. The mentally ill began to be treated as unfortunate human beings, not as Objects. It was an immense advance; but it was not yet enough. Reform had produced institutional care, but still no adequate treatment. For most nineteenth-century doctors, things were more real than thoughts and the study of matter seemed more scientific than the study of mind. The dream of Victorian medicine was, in Zilboorg’s phrase, to develop a psychiatry that should be completely independent of psychology. Hence the widespread and passionate rejection of the procedures lumped under the names of Animal Magnetism and Hypnotism. In France, Charcot, Liebault and Bernheim achieved remarkable results with hypnosis; but the intellectually respectable psychiatrists of Europe and America turned their backs on this merely psychological treatment of mental illness and concentrated instead on the more “objective,” the more “scientific” methods of surgery.
It
had all happened before, of course. Cutting holes in the skull was an immemorially ancient form of psychiatry. So was castration, as a cure for epilepsy. Continuing this grand old tradition, the Victorian doctors removed the ovaries of their hysterical patients and treated neurosis in young girls by the gruesome operation known to ethnologists as “female circumcision.” In the early years of the present century Metchnikoff was briefly a prophet, and autointoxication was all the rage in medical circles. Along with practically every other disease, neuroses were supposed to be due to intestinal stasis. No intestine, no stasis—what could be more logical? The lucky neurotics who could afford a major operation went to hospital, had their colons cut out and the end of their small intestines stitched to the stump. Those who recovered found themselves with yet another reason for being neurotic: they had to hurry to the bathroom six or eight times a day. Intestinal stasis went out with the hobble skirt, and the new vogue was focal infection. According to the surgical psychiatrists, people were neurotic not because of conflicts in their unconscious mind, but because of inflammation in their tonsils or abscesses at the roots of their teeth. The dentists, the nose-and-throat men set to work with a will. Toothless and tonsilectomized, the neurotics, needless to say, went on behaving just as neurotically as ever. Focal infections followed intestinal stasis into oblivion, and the surgical psychiatrists now prefer to make a direct assault upon the brain. The current fashion is shock treatment or, on great occasions, prefrontal lobotomy. Meanwhile the pharmacologists have not been idle. The barbiturates, hailed not so long ago as panaceas, have given place to Chlorpromazine, Reserpine, Frenquel and Miltown. Insofar as they facilitate the specifically psychological treatment of mental disorders, these tranquilizers may prove to be extremely valuable. Even as symptom stoppers they have their uses.
The green oasis among the jets and the rockets is crammed to overflowing. So are all the other mental hospitals of the Western world. Technological and economic progress seems to have been accompanied by psychological regress. The incidence of neuroses and psychoses is apparently on the increase. Still larger hospitals, yet kinder treatment of patients, more psychiatrists and better pills—we need them all and need them urgently. But they will not solve our problem. In this field prevention is incomparably more important than cure; for cure merely returns the patient to an environment which begets mental illness. But how is prevention to be achieved? That is the sixty-four-billion-dollar question.
(From Esquire Magazine)
A Case of Voluntary Ignorance
That men do not learn very much from the lessons of history is the most important of all the lessons that history has to teach. Si vis pacem, the Romans liked to say, para bellum—if you want peace prepare for war. For the last few thousand years the rulers of all the world’s empires, kingdoms and republics have acted upon this maxim—with the result, as Professor Sorokin has laboriously shown, that every civilized nation has spent about half of every century of its existence waging war with its neighbors. But has mankind learned this lesson of history? The answer is emphatically in the negative. Si vis pacem, para bellum still is the watchword of every sovereign state, with the possible exception of Monaco. Again, what happens when economic power is concentrated in a few hands? History’s answer to that question is that, whatever else it may be, that which happens is most certainly not democracy. But while politicians everywhere proclaim the virtues of democracy (even the totalitarian states are People’s Republics), advancing technology is everywhere allowed and even encouraged to work for the concentration of economic power. Small-scale operators in agriculture and industry are progressively eliminated, and in their place advancing technology installs an oligarchy of giant concerns, owned and operated either by private corporations and their managers, or by the state and its bureaucrats.
It is interesting to note that the men who, in the teeth of history, proclaimed that, if you want peace, you must prepare for war, were the self-same men who solemnly declared that Experience teaches, experientia docet—or, as Mrs. Micawber more aptly put it, “Experientia does it.” But as a matter of brute historical fact, Experientia generally doesn’t. We got on doing what our own and our father’s experience has demonstrated, again and again, to be inappropriate or downright disastrous; and we go on hoping (this time like Mr. Micawber) that “something will turn up”—something completely different from anything which, on the basis of experience, we have any right to expect. Needless to say, it does not turn up. The same old mistakes have the same old consequences and we remain in the same old mess.
And even when we do permit ourselves to be taught by experience, as embodied in our own or our society’s history, how slow, in all too many cases, how grudging and reluctant is the process of learning! True, we learn very quickly the things we really want to learn. But the only things we really want to learn are the things which satisfy our physical needs, the things which arouse and justify our darling passions, and the things which confirm us in our intellectual prejudices. Thus, in any field of science, new facts and new hypotheses are accepted quickly and easily by those whose metaphysical beliefs happen to be compatible with the new material. They are rejected (or, if accepted, accepted very slowly and grudgingly) by those into whose philosophy the new material cannot be fitted—those, in a word, whose intellectual presuppositions are outraged by the facts and hypotheses in question. To take an obvious example, the evolutionary hypothesis and the factual evidence on which it was based were rejected by the Fundamentalists, or accepted only in a Pickwickian sense and after years of stubborn resistance. In precisely the same way the dogmatic materialists of our own day refuse to accept the factual evidence for ESP, or to consider the hypotheses based upon that evidence. From their own experience or from the recorded experience of others (history), men learn only what their passions and their metaphysical prejudices allow them to learn.
A wonderfully instructive example of this truth is provided by the history of hypnotism in its relations with orthodox medicine—the history, that is to say, of an extremely odd and still unexplained phenomenon in its relations with a body of anatomical and physiological facts, with certain officially sanctioned methods of treatment, with a system (in part explicit, in part tacit and unexpressed) of metaphysical beliefs, and with the men who have held the beliefs and used the methods. At the time of writing (the Summer of 1956) hypnotism is in fairly good odor among medical men. During World War II it was extensively used in the treatment of the psychosomatic symptoms produced by so-called “battle fatigue.” And at the present time it is being used by a growing number of obstetricians to prepare expectant mothers for childbirth and to make that blessed event more bearable, and by a growing number of dentists to eliminate the pain of probing and drilling. Most psychiatrists, it is true, fight shy of it; but for that overwhelming majority of neurotics who cannot afford to spend two or three years and seven or eight thousand dollars on a conventional analysis, hypnotic treatment, mainly at the hands of lay therapists, is being made increasingly available. And now let us listen to what a distinguished anesthesiologist, Doctor Milton J. Manner of Los Angeles, has to say about the value of hypnotism in his special field. “Hypnotism is the best way to make a patient fearless before surgery, painless during it and comfortable after it.” Dr. Manner adds that, in severe operations, “perfect anesthesia should be attained by employing hypnotism in conjunction with chemical agents. It can then be a pleasant experience, involving no tension or apprehension.” But, it may be asked, why bother with hypnotism, when so many and such excellent chemical anesthetics lie ready to hand? For the good reason, says Dr. Manner, that hypnotism “places no extra load on circulation, breathing, or on the liver and kidney systems.” In a word, it is entirely non-toxic. Hypnotism, he adds, is epecially valuable in operations on children. Children who have been hypnotized into unconsciousness are more cheerful after surgery, “more alert, more responsive, more comfortable and more co-operative than those who undergo anesthesia produced by chemicals alone
.” Patients who have suffered severe burns are in constant pain, greatly depressed and without appetite. Hypnotism will relieve pain, improve morale and restore appetite, thereby greatly accelerating the process of healing. Alone or in conjunction with relatively small amounts of chemical anesthetics, hypnotism has been used by Dr. Marmer in every kind of surgical situation, including even the removal of a tumor from the lung. Every anesthesiologist, Dr. Marmer concludes, should also be a hypnotist.
Collected Essays Page 42
