When the shrink goes nuts  By Yoel Donchin  "Madhouse: A Tragic Tale of
Megalomania and Modern Medicine" by Andrew Scull, Yale University
Press, 360 pages, $30

In 1920 in Germany, the surrealistic silent film "The Cabinet of Dr.
Caligari" was made about an institution for the mentally ill. At the
end of it, we do not know whether Dr. Caligari is the director of the
institution or more suited to being one of the patients there. In
Alfred Hitchcock's film "Spellbound," Ingrid Bergman - who plays a
psychoanalyst - tries to help the talented new director of an asylum,
but apparently his own situation is worse than that of his hospitalized
patients.

But why turn to fiction and imaginary plots, when the true story is
more exciting and suspenseful than all the best-sellers a talented
writer or a smart computer program can produce? Here is the plot: The
year is 1907. Medicine is advancing by giant steps. Within a few years
the secrets of blood groups will be discovered. It is already possible,
with the help of X-rays, to look inside the human body. New drugs for
treating infections are being discovered; maybe they will even
eradicate syphilis. But it is beyond the reach of those who treat the
mentally ill to save them.

These patients, in effect, are hospitalized only to keep them away from
society. The psychiatrist has nothing to offer apart from walls that
will keep what happens inside the institution. Sigmund Freud has just
discovered the role of sex drive and of dreams in the life of the human
psyche, but his is an exhausting form of treatment and special training
in it is essential. The mentally ill do not recover and the financial
burden on the patients? families and the state that pays for the
treatment increases every year.

Dr. Henry Cotton, a very influential doctor, returns from advanced
study and research in Germany and takes up the post of director of an
institution for the mentally ill in Trenton, New Jersey, one of the
largest mental institutions in the United States. This respected doctor
has a theory that the main cause of mental illness can be found in
focal infections inside the human body. Now all he needs to do is prove
that he is right.

His theory derives from the clinical observation that people who come
down with an infectious illness accompanied by a high fever talk
nonsense and display signs of insanity. The chronically mentally ill
must be hiding these centers of infection inside, and their removal
from the body will ensure a cure. Because there is no possibility of
creating a model with the help of laboratory animals, Cotton decides to
test his scientific theory on the patients at the hospital he directs.

Hard facts
At the beginning of the 20th century there was no need to get the
patient's permission or to submit a well-founded plan in order to
conduct research. Cotton began the first phase of his research based on
the clear assumption that the main source of mental illness is teeth
that are suffering from decay or another infection hiding inside them.
With the help of a large number of dentists he extracted teeth in
wholesale quantities from his many patients. The excellent results were
not long in coming and were published immediately thereafter in the
medical literature: 50 percent cure! For the first time in the history
of psychiatry! If despite this treatment there were no improvement in
the symptoms of mental illness, the surgeons whom Cotton employed would
perform tonsillectomy, and then move on to a thorough cleansing of the
large intestine (enemas and other means of medical torture). As a last
resort, when the patient refused to return to the straight and narrow,
without his teeth and his tonsils and his gall bladder - they would
perform radical surgery and remove large parts of the large intestine.

After all these treatments Cotton reported an 85 percent success rate.
He published his results in the most respected medical journals, and
was supported morally and financially by the greatest psychiatrists at
the time as well as by politicians. Hundreds of patients flocked to the
hospital in Trenton for treatment. This led to the opening of a private
hospital alongside the public facility (evidence of the beginning of
the growth of private medical services). Cotton became famous and
received a royal welcome in England. No one dared to say that the
emperor had no clothes.

Andrew Scull?s book "Madhouse," which recounts this story, deals mainly
with the inability of the scientists who saw what was happening at the
hospital to stop the terrible slaughter and exploitation of the
patients (50 percent died due to the intestinal surgery, fabricated
results, biased statistics, mistreatment or surgical procedures
performed against the will of the patients and their families). The
actual numbers and the hard facts were in the hands of a young woman
researcher who had been sent in by one of the leading psychiatrists in
America - the head of the psychiatry department at Johns Hopkins
Hospital in Baltimore, Prof. Adolf Meyer. However, the latter was a
great admirer of Cotton and did not give his permission to publishing
the incriminating findings.

Another doctor who examined what was happening inside the institution
came to similar conclusions and proved that the mortality rate among
the patients who had undergone surgery was very high and that there had
been no improvement in those who survived it. But in this instance,
too, all the accusations were dismissed by the
doctor in charge.

As in a real thriller, an amazing development occurs here as well: An
investigative committee on behalf of the state of New Jersey examined
the issue and in an open hearing, asked Cotton questions he could not
answer. He left the courtroom, stood out in the pouring rain without a
coat or an umbrella - and lost his sanity. His supporters and the
hospital management hid the doctor from the public eye until ... he
came back to direct the institution and conduct deadly operations for
another 15 years.

Even after Cotton's death his students continued to perform tooth
extractions and tonsillectomies, until 1960. Even the inception of a
treatment that was thought to be innovative at the time - lobotomy, the
surgical removal of part of the brain's frontal lobe by inserting an
ice pick into it, which was supposed to replace other treatments - did
not lead to the end of the amputations and other surgery.
(Incidentally, the developer of the lobotomy, who performed hundreds of
the procedures, won the Nobel Prize for Medicine and also a great deal
of support, until the real results of the treatment were revealed: The
destruction of the brain tissue affected the functioning of the
patient, who became a kind of zombie. Recently, several lobotomy
patients' families have asked that the Nobel Prize be rescinded.) The
studies that pointed to the danger and stupidity of Cotton's methods
were buried in the archives of Johns Hopkins and the management of the
hospital in New Jersey.

Many books about historical events have become best-sellers - about
Stalingrad, Berlin, Churchill's life. And here we have a historical
incident that could have affected our parents' lives, which happened
not very long ago. But its historical lessons have not yet been
learned, apparently.

Anyone who reads this important book must ask himself: Is it possible
in 2005 that political power combined with the dominance and arrogance
of the medical profession could lead to patients receiving an
ineffective (or harmful) medication, or that a reputable surgeon could
perform
experiments and distort the results?

To my regret, the answer is in the affirmative, although fortunately
for us the charlatan is likely to be exposed quite quickly. Required
reading for people who are nuts about this sort of thing.

Prof. Yoel Donchin is the head of the Patient Safety Center at Hadassah
University Hospital in Ein Karem. He is an anesthesiologist.
http://www.haaretz.com/hasen/spages/652753.html