Saturday, December 29, 2007

The Cobweb

William Gibson, who was married to the psychoanalyst Margaret Brenman-Gibson, spent some time in Topeka, Kansas, while she was associated with the Menninger Clinic in the early 1950s. The Cobweb, published in 1954, is a novel set at a psychiatric hospital located in a mid-western town. In this novel Gibson, who won fame for writing plays such as The Miracle Worker, tells a tale of institutional politics and infidelity that reads somewhat like the script for a 1950s B movie. His descriptions of clothing and cars as well as drinking and smoking habits create a vivid sense of the period. Attitudes towards race and gender are painfully, but not judgmentally, presented. What I enjoyed most, however, is the snapshot that Gibson takes of hospital based psychiatry at that moment when psychoanalytic treatment and milieu therapy were on the cutting edge. Seen from the 21st century optimism about the therapeutic value of patient government seems quaint. I think it is important, however, to revisit all those moments of false optimism that litter the history of psychiatry. Gibson's book provides an enjoyable way to visit at least one of them.

Sunday, December 16, 2007

Menninger Madhouse

Lawrence J. Friedman's 1990 book Menninger: The Family and the Clinic is an absorbing tour through much of twentieth century American psychiatry. Personally it connected the dots between many of the names that were floating around when I was doing my psychiatric training in the early 1970s. What struck me reading this book was the extraordinary hubris involved in the creation of hospital based psychoanalytic treatment facilities. I was reminded of Andrew Scull's book Madhouse with its caustic treatment of Henry Cotton's focal infection theory and incredible damage that resulted from its arrogant application. One of the most moving parts of Scull's book were the vignettes that allowed one to imagine what it was like for families to have someone treated by Cotton. While I do not want to draw too close a comparison between the Cotton's often lethal methods and the Menningers' subtler mind games, they do have one thing in common: psychiatrists claiming great expertise with very little evidence to back it up. If only Friedman had been given access to case records so that one could have a more vivid sense of what being subjected to treatment at the Menninger Clinic was like. I wonder if ther are first hand accounts.

Friday, September 14, 2007

Spikes in the Brain, and a Search for Answers

William Grimes review of the book My Lobotomy by Howard Dully and Charles Fleming is well worth reading even if you don't plan to read the book. Grimes uses the narrative of the book to point to the ambiguities and complexities of recalling a life, particularly a life marked by a dramatic traumatic experience.

Surprise Visit

I had a chance to read a story titled "Surprise Visit" by Antonia White. As fiction it recounts the story of a 38 year old woman who visits Bethlem Hospital after its conversion into a war museum. Having been a patient in that hospital 15 years earlier, she re-experiences her feelings from that time in a way that allows the reader to experience something of what a flashback must be like. The story appears in the book Strangers by White. In the introduction to that book Hermione Lee compares "Surprise Visit" to "The Yellow Wallpaper," which seems an apt comparison to me. White had indeed spent much of her 23rd year in a psychiatric hospital and the story has the quality of a memoir. For more on White try the link to the Wikipedia article on her.

Sunday, April 08, 2007

Stella Chess, 93, Psychiatrist and Author

The New York Sun
March 20, 2007 Tuesday

BYLINE: STEPHEN MILLER - Staff Reporter of the Sun

Stella Chess, who died Wednesday at 93, devoted her long
career in child psychiatry to challenging the notion that
children's personality problems are caused by bad parenting.
Together with her husband and research partner, Alexander
Thomas, she used a groundbreaking decades-long study of
children to show that mental health is the result of a
complicated interplay between an infant's inborn temperament
and parenting style. The result was an important challenge
to the earlier orthodoxy, which held that an infant at birth
was a blank slate and that mental problems could be chalked
up to defective parenting; for instance, autism was blamed
on "icebox" mothering.

"It was unprecedented, especially studying children who did
not have a disease," the director of the New York University
Child Study Center, Dr. Harold Koplewicz, who worked with
Chess over the past decade, said. "Temperament is now taken
as a normal convention."

Chess and Thomas met at the New York University College of
Medicine, were married in 1938, and soon became

Among the books they published were "Your Child Is a Person:
A Psychological Approach to Parenthood Without Guilt"
(1965), "The Origin of Personality " (1970), and "Know Your
Child: An Authoritative Guide for Today's Parents" (1987).
Chess and Thomas were unusual in psychiatry for publishing
popular books despite being involved in clinical research,
Dr. Koplewicz said.

In "Your Child Is a Person," they insisted, "Prevailing
psychoanalytically based theories of child care are wrong."

They went on to check off the list of Freudian pitfalls:
toilet training, thumb sucking, and weaning. Rather than
representing some kind of trauma, they wrote, each was a
normal part of childhood development. Of toilet training,
they wrote, "It seems incredible that a task accomplished
routinely in most of the civilized and uncivilized world for
a very long time could create so much worry in 20th century

Chess was born in Manhattan to parents who were Russian
immigrants. Her father became a lawyer and her mother a
schoolteacher who was said to have helped create the concept
of maternity leave when she brought a suit against the New
York City Board of Education in 1911 for terminating her
when she was pregnant.

Chess studied at the Ethical Culture School and Smith
College before entering the NYU medical school in 1935. In
addition to a private practice in Manhattan, she held
various appointments, including psychiatrist at the
Northside Center for Child Development. In 1954, she became
the first professor of child psychology at New York Medical
College. She later founded the first pediatric psychiatry
unit at Bellevue Hospital and was a professor at NYU.

"Preventive care concentrated on changing the mother's or
father's behavior, and cultural influences were often
ignored," Chess wrote in the Harvard Mental Health Letter in
1997. "But it became clear that some children with serious
problems had adequate or excellent parents."

Begun in 1956, the New York Longitudinal Study of Child
Development followed the lives of 238 young people, just
over half of them middle-class whites and the rest poorer
Puerto Ricans.

Based on the study, Chess and Thomas delineated three basic
temperaments that were present from birth: "easy,"
"difficult," and "slow to warm up." They identified nine
temperamental qualities, such as level of physical activity
and distractibility. The trick, they said, was the "goodness
of fit" between parenting styles and the child's

Seeking to look beyond bad parenting as a cause of autism,
Chess in 1971 published "Psychiatric Disorders of Children
with Congenital Rubella." According to Dr. Koplewicz,
rubella is no longer suspected of causing autism, but the
idea that autism might be an organic brain disorder was
"decades ahead of its time."

Chess and Thomas continued to publish well into what would
be retirement for most. Their last book was "Goodness of
Fit" (1999).

Thomas died in 2003, and Chess continued to work at NYU,
rejecting emeritus status in order to stay involved in
day-to-day research. The staff found out she had died
because she didn't show up for work last week, Dr. Koplewicz

Stella Chess

Born March 1, 1914, in Manhattan; died March 14 at St.
Luke's Hospital in Manhattan; survived by two sons, Richard
and Kenneth, six grandchildren, and four

Sunday, March 18, 2007

Facing Life With a Lethal Gene - New York Times

Facing Life With a Lethal Gene is a very moving story about a woman who chose to learn that she had the gene for Huntington's Chorea. While this kind of knowledge is, of course, a relatively new development, it reminded me that doctors have long had some degree of prognostic ability that they could share with patients. I always recall the story of the poet John Keats, who was a physician, coughing red blood into his handkerchief and proclaiming something like, "I see here my death warrant." It also brought to mind the following story from the history of general paresis of the insane:
J.E.D. Esquirol, one of the architects of psychiatry's early nineteenth century therapeutic optimism, as well as one of the first do describe paresis among the insane boasted that his specialized expertise allowed him to detect signs of paresis that had eluded a provincial colleague. The patient was a 'strong, robust' thirty year old man who had persuaded himself that he possessed immense fortune and had yielded 'to all the excesses of the most fashionable life.' He was brought to Paris by the ‘skillful and estimable' Dr. K., who deferentially presented the patient to Esquirol. 'I commit to your care,' Dr. K. said to Esquirol ‘a very interesting patient, who is but slightly excited, and whom I have withdrawn from scenes calculated to augment his excitement, which you will speedily cure.’ Esquirol conducted a half an hour ‘conversation’ with the patient,during which he observed ‘some hesitation in the pronunciation of certain words’ and an ‘undue readiness’ to remain in a hospital. On the basis of these findings Esquirol disdainfully told his hopeful colleague, 'I think that your patient is incurable; that he will not recover, nor survive a year. Remain in Paris, and you will see, as the malady is making rapid progress.'5 Displays of diagnostic and prognostic abilities such as Esquirol's would be repeated by others during the nineteenth century but such displays could never fully conceal psychiatry's impotence in the face of this completely devastating and extremely common disorder.

Morgagni & Mid-18th Century Treatment of the Mad

I recently ran into the English translation of Giovanni Battista Morgagni's [1682-1771] treatise The Seats and Causes of Diseases Investigated by Anatomy. It consists of a series of Letters, the eighth of which is on madness. This letter is a rambling affair, where Morgagni sometimes sticks to his stated task of describing dissections of brains, but often describes clinical cases in some length. I found it an intriguing window into mid 18th century clinical psychiatric practice. Here is one of the shorter cases:

A strong man, by trade a blacksmith, having been liable, from a boy, to the incubus and vertigo, which had been brought on him by a fright, fell down suddenly in the winter-time, and complain'd, in confus'd words, of an internal pain in his breast. Being immediately brought into the hospital, he answer'd scarcely any thing to those who ask'd him questions; but shut his eyes, and cover'd his face with the sheet, like a man out of his senses. He was hot at the same time, and trembl'd' nor had drunkenness, or any other cause of that kind preceded; and a fever likewise attended. On the following day, he began to leap out of bed, to cry out, to threaten, and even to strike, all about him; so that being evidently a maniac, it was necessary that he should be confin'd with bands. He cried out violently and continually; and, at the same time, his whole body was agitated with convulsive motions. Then the physician, having order'd a vein in the foot to be open'd, and a pound of blood to be taken away, also ordered the cataplasm I have told you of [fresh cheese, of the coarser sort, mix'd with oil of violets] to be laid upon his head after being shaved. Do you ask me what was the event? Why by this means, within twelve hours, he was restored to perfect sanity; but whether the cure was accidental, or the effect of blood-letting only, or in some measure owing to the assistance of the external remedy [the cataplasm], I will leave you to determine. Those who foment the heads of insane patients with milk, will readily believe, that the cataplasm contributed thereto.

Giovanni Battista Morgagni, The Seats and Causes of Diseases Investigated by Anatomy, [English edition, 1769, reprinted 1960, original 1761] v1. pp. 149-150.

Saturday, March 10, 2007

On the madness of neuroscientists

Pierre-Jean-Georges Cabanis [1757-1808], an advocate of a monist or neuroscientific view of mind, writing about Democritus, an ancient Greek materialist relates the following story:
Hippocrates, called by the Abderans* to heal Democritus of his supposed madness, found him dissecting animal brains, from which he was trying to unravel the mysteries of … physical sensibility and to recognize the organs and the causes that produce thought. The two wise men spoke together on the general order of the universe, and on that of THE SMALL WORLD, or of man, with which both were almost equally occupied, …. In this conversation, Democritus appears to have felt even more the close connections between … physical and … moral states. And the doctor, as he retired, judged that it was to the Abderans, and not to the supposed patient, the the hellebore* should be administered [P-J-G Cabanis, On the Relations of the Physical and moral Aspects of man, Johns Hopkins U.P., 1981, v1,p 41].
*Abderans, residents of Abdera, Democritus' home. The air of Abdera was proverbial in Athens as causing stupidity
*Hellebore, a powerful laxitive and emetic thought to cure difficult diseases such as mania, by removing black bile.

Friday, March 09, 2007

Jay D. Haley, 83, Early Advocate of Involving Family in Therapy, Dies - New York Times

Learning of Haley's death brought to mind how much things have changed over the last thirty years.
I can remember when Haley's ideas about the double-bind and schizophrenia were the hottest around. Reading about paradoxical intentions in psychotherapy was both exhilarating and frightening. Having spent many years working with people suffering with schizophrenia, however, I can see clearly how wrong headed, and in the wrong hands, dangerous Haley's ideas were. Nonetheless, I can't help but admire his efforts to unravel the mysteries of this terrible affliction.
Jay D. Haley, 83, Early Advocate of Involving Family in Therapy, Dies - New York Times

Saturday, February 24, 2007

Insanity vs. Malice as Motives of Rampage - New York Times

Perhaps we should consider a new DSM diagnosis, say Media Crazed Disorder or MCD. It has a nice ring to it.

Insanity vs. Malice as Motives of Rampage - New York Times: "But to Mr. Hinckley, the prosecutor, Mr. Johnson’s words were evidence not of mental illness but of a widespread phenomenon familiar to anyone who watches “American Idol” on television.

Mr. Johnson was simply media-crazed, and determined to get his 15 minutes of fame, the prosecutor said.

“The defendant didn’t have any command hallucinations,” or orders from God telling him to kill white people, Mr. Hinckley said. Rather, “he knew he would create media attention” by shooting up a bar, and he wanted his family to profit from his 15 minutes of “notoriety.”

Mr. Hinckley rattled off a long list of other people he said were similarly obsessed by fame, perhaps criminal in some cases but not insane. The list included Mel Gibson, Osama bin Laden, Timothy McVeigh, abortion clinic bombers, Palestinian and Iraqi suicide bombers, members of the Aryan Nations, and any number of amateur singers competing on “American Idol.”"

Wednesday, February 21, 2007

A Casualty on Romania's Road Back From Atheism - New York Times

This story from 2005 makes it clear that older ways of understanding madness have not altogether disappeared from the earth. Today the Times reports that Daniel Petre Corogeanu was sentenced to 14 years in prison for killing a 23 year old nun in a crucifixion exorcism ritual…The four nuns arrested with him were sentenced to terms of five and eight years. Had she died during a procedure prescribed by bio-medical science the practitioner, probably would not have faced criminal charges, but would have been liable for negligence and perhaps sued for malpractice. The dominance of a belief system matters.

A Casualty on Romania's Road Back From Atheism - New York Times

Sunday, February 18, 2007

An Autism Anomaly, Partly Explained - New York Times

An Autism Anomaly, Partly Explained - New York Times
Here is a snapshot of the emergence of a new 'epidemic' in psychiatry. The question that isn't asked is whether the definition of a 'new' disease has morphed as vigilance about it increases. My guess is that states that find more autism also use a broader definition of that disorder. This certainly seems to be the case of the definition of depression over the 'prozac years.'

Saturday, February 17, 2007

U.N. Troops Fight Haiti Gangs One Street at a Time - New York Times

In case you thought that the overt political use of psychiatric detention was a thing of the past:
U.N. Troops Fight Haiti Gangs One Street at a Time - New York Times: "Mr. Mulet, of the United Nations, said he believed that the gang leaders were beyond rehabilitation. “They’ve been killing people, kidnapping people, torturing people, raping girls,” he told reporters recently in Washington. “It is very difficult to reinsert into society someone like that. A psychiatric institution would be the best place to place them in the future — after we arrest them.”"