Andrew Scull’s latest book is important to practicing psychiatrists, to historians of psychiatry and those interested in the philosophy of psychiatry. I would expect it to interest other mental health professionals as well, and it certainly speaks to anti-psychiatry scholars. 

But be forewarned—Professor Scull’s pronouncements are as pessimistic as the jeremiads articulated by the Hebrew prophet whose writings inspired this English-language noun.  In fact, much of this book evokes the Book of Jeremiah, and not only because Professor Scull presents his case with religious-like zeal, albeit it with annotation and documentation. 

He links the anti-psychiatry movement to Mary Baker Eddy’s Christian Science, and chronicles other American religious movements’ roles in faith healing cum therapy. He connects spiritual healing to American Transcendentalism or the California counterculture or Dr. Kellogg, but he mostly laments the fact that psychiatry’s promised cures for mental distress did not come to pass. In other words, the psychiatric profession has not delivered us to the Promised Land. 

Au contraire. Professor Scull confirms that some of psychiatry’s most ambitious treatments mangled many unfortunate patients—and not only because of psychosurgery. Such is the case with Dr. Cotton’s theories about the infectious etiology of mental disorders, which led to mutilating—often deadly–surgeries intended to excise the (hypothetical) pathogenic loci of infection from colons, teeth, tonsils, and elsewhere. Save for historians of psychiatry, and readers of this book, few of us hear about Cotton’s horrific approaches, while most of us have heard about ECT (electroconvulsive therapy), if not through formal education, then though filmic or theatrical or literary renditions of One Flew Over the Cuckoo’s Nest. While scary lobotomy stories are likewise well-known, Scull updates the standard tales with tidbits about clandestine lobotomies performed at the Institute of Living’s luxurious quarters, with gardens designed by Fredrick Olmstead, the same architect who designed New York’s Central Park. 

Professor Scull leaves no doubt that the psychiatric tribes are still wandering through the desert, lost and unable to find their way, yet forging ahead nonetheless, exuding confidence and claiming certainty, even without a reliable roadmap. Those “tribes”—or opposing schools of thought–typically war with one another, embroiled in turf wars, rather than real wars.  

All too often, those tribes worship latter-day equivalents of Molech, as described by the Hebrew Bible, and by the profoundly pessimistic prophet Jeremiah, who condemned child sacrifices passed through the fiery mouth of this particular pagan idol. Scull’s condemnation of the false gods worshipped, one after another, by the gullible public and touted by an endless succession of false psychiatric prophets, recollects these Biblical abominations. It is difficult for me to read about Dr. Cotton’s so-called “cures” without flashbacks about Molech worship. 

Scull begins by telling us about the profitably of the “mad trade” (or “trade in lunacy”), not by contemporary American for-profit hospitals or unlicensed boarding homes or venture capital-backed revolving door rehabs, which are commonly condemned today, and often propel political platforms. Rather, Professor Scull recollects enterprising Europeans who operated such homes since the 18th century. Fortunately, Scull does not linger too long on Freud and his legacy, for Freud has been burned in effigy so many times over that the story starts to sound trite. 

Scull has too many more idols to break to devote too much time to Freud. Instead, he tells us savory details about Freud’s most vocal detractors. Foucault, for example, merits his own chapter, and rightly so. Foucault bolstered his anti-psychiatry arguments with many unsupported claims. Foucault’s citation of the proverbial yet fanciful Ship of Fools is one of his most colorful examples, even though there is no confirmation that the mentally ill were set adrift on a ship, as depicted in the Bosch painting. The debates surrounding the most recent rendition of the DSM will be familiar to those who follow psychiatric debates and are well-summarized in its own chapter and much of this material was previously published but is still useful when presented in conjunction with the copious other material included in this book. 

There is much additional intriguing information in other chapters, but one of the more unique chapters concerns psychiatrist and psychoanalyst Phyllis Greenacre, M.D. Greenacre was once one of the four most recognized names in psychiatry and the only American-born analyst to rise in the New York psychoanalytic establishment when the field was still dominated by European emigre analysts. 

In contrast to the opprobrium he heaps on so many psychiatric players in his drama, and in spite of the vitriol he spews at triumphalists who self-aggrandize, Professor Scull describes Greenacre’s professional peregrinations and her personal travails in sympathetic detail.  He details the sexism she endured, and the successes she achieved, despite several seemingly impenetrable barriers. He tells us about her rejection by her family of origin, which opposed her decision to pursue a medical career. He proceeds with tales of her repeated hospitalizations for depression, her betrayal by her superficially supportive but ultimately undermining boss, Adolph Meyer, M.D., and her humiliation by her philandering husband, Curt Richter, also a psychiatrist but one who carved out a successful career researching the neurological basis of behavior. 

Scull is arguably at his most engaging when he recounts the intersection between Greenacre’s psychiatric pursuits and Cotton’s surgical catastrophes. Cotton continued his surgeries until the mid-1950s, despite Greenacre’s damning revelations from the mid-1920s. Like Greenacre and Richter, her one-time husband, Dr. Cotton was one of Meyer’s proteges. 

Curing psychosis, as per Cotton, involved removing the offending organs responsible for psychiatric epiphenomena, for he believed that toxins excreted by unrecognized infections poisoned the brain to produce psychosis. Apart from this untenable theory, Cotton claimed cure rates which were never supported by reproducible records. 

Dr. Meyer assigned Greenacre to review Cotton’s data from Trenton State Hospital in New Jersey but forbade her from publicizing her meticulously documented findings from 1926. Scull elaborates on the show of support granted to the [male] asylum superintendent, despite hard evidence against his approaches. Yet he leaves the reader to react to the 30-year time gap between Greenacre’s expose and the date when the surgeries stopped. Even readers who do not endorse the psychoanalytic credo that Greenacre eventually embraced will likely come away with intense admiration for her professional and personal perseverance—as well as anger that her serious concerns with patient safety were dismissed because of probable “gender-bias.” 

There is much more to say, and I appreciate the opportunity to review this book. I am inclined to agree with Scull overall, yet I hope that the failures of the past, which Scull dutifully chronicles, do not discourage psychiatrists of the future from searching for better approaches.  

© 2020 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 drpacker@hotmail.com .