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De Young's Encyclopedia of Asylum Therapeutics, 1750-1950s is a fascinating book that is far richer and less slanted than its front and back covers would lead us to believe. This book is a history of psychiatry, as seen through the eyes of a sociologist who has researched primary sources extensively and parlayed that data into highly readable, sometimes even poetic, prose.
Because this is an encyclopedia and not a history of medicine text per se, each entry stands alone, and there is no need to start from the beginning. Unlike more standard history texts, we never get that feeling that we opened the pages in the wrong place. Everything is interesting, even if many entries are disturbing. Luckily, de Young includes enough intriguing factoids to wash away unpleasant reactions to ill-conceived treatments of the past. She never lends the impression that she is politicking or polemicizing, as can easily happen with such histories.
They say one should not judge a book by its cover, and that old adage is true here. The cover photo shows a white-clad nurse shooting streams of water at an unclothed inmate. The picture reminds us of the hose down scene in Clint Eastwood's Changeling (2008), starring Angelina Jolie. Changeling was modeled after a real life case from the late 1920s, which led to legislative changes on involuntary commitment in California. [Packer, Sharon: Cinema's Sinister Psychiatrists: from Caligari to Hannibal. Jefferson, NC: McFarland, 2012.]
The back cover promises pages about "'awakening' patients with firecrackers, easing brain congestion by bleeding, extracting teeth and excising parts of the colon, dousing with water, raising or lowering body temperature, shocking with electricity or toxins, and penetrating the brain with ice picks." Expecting the worst, I braced myself for text that could turn into a third version of House on Haunted Hill, with its asylum setting and everything but Vincent Price.
Fortunately, Professor de Young includes enough intriguing information about practices of the past to satisfy readers who are just plain curious. I will not catalogue the horrific past, except to say that her entry on the Nobel-Prize winning fever therapy for neurosyphilis is worth rereading.
Her section on Dr. Cotton's surgical cures for hypothetical infectious sources of psychosis--and his astoundingly high mortality rate of 33%-- adds fresh information about the political climate that allowed him to remain superintendent of Trenton State Hospital of New Jersey for so long. He even earned praise from the public and the press, in spite of his mutilating and near-murderous surgeries. We learn more about the young psychiatrist Phyllis Greenacre, who challenged Cotton while early in her career, long before gaining more fame as a psychoanalyst and analytic supervisor. After reading this section, we come away realizing that office-based ice pick lobotomies from mid-century were just the tip of the iceberg.
There is also information about pleasant asylum treatments and philosophies of the past and tie-ins with important contributors to culture. Among the multiple entries on expressive therapy are quotes from Charles Dickens, who described a "Lunatics Ball" he witnessed in 1845: "As I was looking at the marks in the walls of the galleries, of the posts to which patients were formally chained, sounds of music were heard from a distance. The ball had begun, and we hurried off in the direction of the music." The author reminds us that Americans were more ambivalent about those balls than Dickens and the British, for many Americans remained wary of religious revivals in the aftermath of the Second and Third Great Awakenings. Some associated dance with reawakening of carnal desire (which was off-limits in their eyes), while others recollected the bizarre barking rituals practiced on the American frontier and in the "burnt-out" regions.
There is encouraging data about dance and music therapy in asylums--without confirming clinical improvement. Some asylums encouraged patients' participation in musical and dramatic performances, and some hosted outside orchestras. At least one luminous musical career was launched though an asylum orchestra. Sir Edgar Elgar began as the band conductor of the Worcester County Pauper and Lunatic Asylum, leading both staff and patients. He went on to compose "Pomp and Circumstances," which is played ritualistically at graduation ceremonies.
We learn of the tragic fate of Zelda Fitzgerald, a once-celebrated flapper and a multi-talented artist in her own right who became better known as the estranged wife of F. Scott Fitzgerald. She became a feminist symbol posthumously, thanks to Nancy Milford's timely biography, Zelda (1970). Diagnosed with schizophrenia, Zelda received a variant of fever therapy, administered via intrathecal horse serum injections (into her spinal cord) to induce aseptic meningitis. She showed some improvement post-treatment but relapsed soon after and was readmitted repeatedly, before dying in fire at Highland Hospital in 1948, along with eight other patients.
At another point, de Young tells us more about Ernst Hemingway, who stirred almost as much discussion among psychiatrists and psychoanalysts as among literary scholars. Included in the entry on ECT (electroshock therapy), Hemingway shot himself after his second ECT treatment. Names of other celebrated artists, actors, and musicians appear in this section, including Judy Garland, Gene Tierney, Lou Reed and Vladimir Horowitz. Of course, Ken Kesey's One Flew Over the Cuckoo's Nest (1962) and its 1975 cinematic adaption by Milos Forman are here.
Some information is more obscure but equally relevant. For instance, the author introduces us to Johann Christian Reil, a German physician who coined the term, "psychiatry," founded two journals on the subject and launched what came to be known as "Romantic Psychiatry." De Young notes that Reil paid homage to Romantic era philosophers Kant and Schelling, and that he viewed insanity as a failure in "self-consciousness," brought on by "progress in civilization that propelled the human race forward but also pushed it backwards and closer to the madhouse". This conclusion is uncannily close to critiques of our own Information Age and the era of electronic communication!
De Young does not forget to mention some of Reil's less laudable approaches to psychiatric treatments, such as salting his patients' feet so that goats could lick off the salt and cause "awakenings" to restore self-consciousness. She notes that Reil immersed patients in baths of eels, but avoids hypothesizing that this practice may have been a carry-over from Hippocrates and Galen, who endorsed similar techniques to treat melancholy or epilepsy. Nor does she calculate the significant voltage emitted by those eels, to compare those shocks to ECT.
She includes information on nitrogen inhalation therapy and on nitrous oxide inhalation therapy, which recollects William James' self-experimentation recorded in his classic volume on The Varieties of Religious Experience (1902)--and anticipates current clinical trials on NO2. Other fascinating factoids revolve around color therapy, with purple or blue being used to calm patients, red to arouse patients, and yellow to cure epilepsy (all with mixed results).
In fact, this book contains so many fascinating factoids that I must refer this reader to the book itself, lest I spend too much time and space recounting more of the information she has to offer.
© 2015 Sharon Packer
Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books includeDreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at firstname.lastname@example.org .