Psychiatry has not a checkered past but a past that must push all of us into a more enlightened future. Relating the past, just as educating ourselves about all history, is important. As George Santayana so presciently warned, “Those who do not remember the past are condemned to repeat it.”
Want an example of past excess in psychiatry? Read how Freud and Wilhelm Fliess, his associate, almost killed a patient by operating repeated on her nose because they believe she masturbated excessively. And it’s not that long ago that tragedies in these hospitals were tossed off as “treatments” that didn’t work. I’ve heard tales from elderly workers who were there during those unbelievably cruel times.
I’ve seen the paint-chipped walls that were sealed off to hide the ugly truth of the chains on the walls, the tubs, and the fire hoses. And I’ve seen the result of four-year-old children being shuttled away forever to live their lives in these institutions.
One woman had never had a birthday card, a gift, or a visitor and didn’t know how to open a car door or that everything in a supermarket wasn’t free for the taking. Her diagnosis? Of course, it was schizophrenia at age 4, when she had a seizure disorder and diabetes and learned to talk like a patient.
“My feet,” she said to a mental health worker, “are talking to me.” How would you hear that? Actually, she had painfully distorted feet and large bunions, but she said the pain was “talk’” and they labeled her psychotic. How many children were raised in these institutions? Yes, raised. Once they reached 18, they were transferred to an adult facility. Do you know how sad it is to see seesaws at a psychiatric hospital?
I was taken to one in an East Coast state, and it was a forlorn horror worthy of something out of a Wes Craven film. The lights in the halls were from 25-watt bulbs, and the road leading to it was a mire of mud next to a filthy pond.
Today, I read that an impressive advocate for the mentally ill had died in October 2021 with little notice. How cavalierly we toss our heroes aside when it doesn’t suit us. Her name was Darby Penney. In addition to patient advocacy, she wrote The Lives They Left Behind, an examination of the wrenching contents of suitcases in a psychiatric hospital attic and the people who never left.
Those who died in these institutions were often buried in graves marked, if at all, with numbers. There, their remains lay in overgrown fields, forgotten by many, unbelievably, that these cemeteries existed at all. I knew a group that had set out to give all of them back their names in a tireless effort reading crumbled hospital notes left behind in abandoned buildings. They are heroes. The dead do speak to us if we listen.
Mental Health Progress
How far have we come from those dark days of whippings, rapes (a form of therapy by one of the medical directors), and starvation? The perspective and the research would seem to point to incredible advances supported by millions in grants. Much of the result has been to provide newer medications. But some researchers continue on a path that harks back to the age of mechanical interventions.
Do we truly understand the neurobiology of mental illness and, if not, what is to be done? Should we be seeking to bombard the scalp with light or yet more versions of electrical stimulation? When we still don’t know the precise mechanism, how can we know what to do to help bring the patients’ minds into some manner of normalcy? How much can artificial intelligence help in this effort? Are we using it sufficiently?
Perhaps the question should be directed first at diagnosis rather than treatment. Has the American Psychiatric Association’s DSM gone too far? It gives behavioral indicators only for diagnosing a mental disorder. How can that be adequate when we know there’s much more here than behavior?
Freud believed masturbation in women was a problem. How many know what was fact and what was fiction in his writings? Was Jeffrey Masson too close to the truth, and that’s why Anna Freud didn’t give him the care of Freud’s archive?
I suspect Freud was too full of himself not to see his own limitations and biases. When did he come up with the construct of Thanatos? When he was dying of mouth cancer from smoking too many cigars. Did he smoke cigars because of “oral fixation?”
The questions beg answers, and we are often footslogging without intense, lengthy questioning. Of course, you can see me as jaded, misguided, or too full of myself. That is your prerogative. I ask only that you ask. And that we never forget the forgotten lost in the mire of mental illness.
Thank you, Darby Penney, for reminding me that we need reminding.