contemporaries could see in any asylum in civilized and Christian England, France or Germany, in civilized and Christian America. Of the many dark and hideous pages of our history, few are more shameful than the record of Western man’s treatment of the mentally ill. The story has been told at length in Doctor Gregory Zilboorg’s History of Medical Psychology and there are whole libraries of books dealing with special periods and particular aspects of the long martyrdom of the insane.
The tormentors of the insane have been drawn, in the main, from two professions—the medical and the clerical. To which shall we award the palm? Have clergymen been responsible for more gratuitous suffering than doctors? Or have doctors made up for a certain lack of intensity in their brand of torture (after all, they never went so far as to burn anyone alive for being mad) by its longer duration and the greater number of the victims to whom it was applied? It is a nice point. To prevent hard feelings, let us divide the prize equally between the contenders.
So far as the mentally sick are concerned, Western history has had only two golden ages. The first lasted from about fifty years before the birth of Christ into the second century of our era; the second began, very hesitantly, in the early years of the nineteenth century and is still continuing. During these golden ages the mentally sick, or at least the more fortunate of them in the more civilized parts of the classical and modern world, were treated with a measure of common decency, as though they were unfortunate human beings. During the intervening centuries they were either ignored, or else systematically tormented, first (on the highest theological grounds) by the clergy, later (for the soundest of medical reasons) by the doctors.
Let us ask ourselves a question. If I had lived in the eighteenth century, and if I had been afflicted by some mental illness, what would have happened to me?
What happened to you in those days depended, first of all, on the financial situation of your family. People with money either locked up their insane relatives in some remote corner of the family mansion, or banished them, with a staff of attendants, to an isolated cottage in the country, or else boarded them out, at considerable expense, in a private madhouse run for profit by a doctor or, under medical supervision, by some glorified jailer. Lunatics confined in the attics (like Mr. Rochester’s wife in Jane Eyre) or in a country cottage were spared the rigors of medical treatment, which could only be administered in an institution staffed by brawny attendants and equipped with the instruments of coercion. Those who were sent to such an institution were first stripped naked. Mad people were generally kept in a state of partial or complete nudity. Nakedness solved the problem of soiled clothes and contributed, in what was felt to be a most salutary way, to the patient’s sense of degradation and inferiority. After being stripped, the patient was shaved, so as to prepare him or her for that part of the treatment which consisted in rubbing various salves into the scalp with a view to soothing or stimulating the brain. Then he or she was taken to a cell, tied down to the bed and locked in for the night. If the patient struggled and screamed, that was a sign of mania; if he reacted with silent resignation, he was obviously suffering from some form of melancholy. In either case he needed treatment and, duly, next morning the treatment was commenced. In the medical literature of the time it was referred to as “Reducing the Patient by Physic.” Over a period of eight or ten weeks the victim was repeatedly bled, at least one pound of blood being taken on each occasion. Once a week, or if the doctor thought it advisable at shorter intervals, he or she was given an emetic—a “Brisk Vomit” as our ancestors, with their admirable command of English, liked to call it. The favorite Brisk Vomit was a concoction of the roots of black hellebore. Hellebore had been used in the treatment of the insane since the time of Melampus, a legendary soothsayer, first mentioned by Homer. Taken internally, the toxicologists tell us, hellebore “occasions ringing in the ears, vertigo, stupor, thirst, with a feeling of suffocation, swelling of the tongue and fauces, emesis and catharsis, slowing of the pulse and finally collapse and death from cardiac paralysis. Inspection after death reveals much inflammation of the stomach and intestines, more especially the rectum.” The doses prescribed by the old psychiatrists were too small to be fatal, but quite large enough to produce a dangerous syndrome, known in medical circles as “helleborism.” Every administration of the drug resulted in an iatrogenic (doctor-induced) disease of the most distressing and painful kind. One Brisk Vomit was more than enough; there were no volunteers for a second dose. All the later administrations of hellebore had to be forcible. After five or six bouts of helleborism, the time was ripe for purgatives. Senna, rhubarb, sulphur, colocynth, antimony, aloes—blended into Black Draughts or worked up into enormous boluses, these violent cathartics were forced, day after day, down the patient’s throat. At the end of the two-month course of bloodlettings, vomits and purges, most psychotics were “reduced by physic” to a point where they were in no condition to give trouble. These reductions were repeated every spring during the patient’s incarceration and in the meantime he was kept on a low diet, deficient in proteins, vitamins and even calories. It is a testimony to the amazing toughness of the human species that many psychotics survived under this treatment for decades. Indeed, they did more than survive; in spite of chronic undernourishment and periodical reductions by physic, some of them still found the strength to be violent. The answer to violence was mechanical restraint and corporal punishment. “I have seen,” wrote Dorothea Dix in 1848, “more than nine thousand idiots, epileptics and insane in the United States, destitute of appropriate care and protection, bound with galling chains, bowed beneath fetters and heavy iron balls attached to drag chains, lacerated with ropes, scourged with rods and terrified beneath storms of execration and cruel blows.” The armamentarium of an English asylum of the Early Victorian period comprised “strait-waistcoats, handcuffs, leg locks, various coarse devices of leather and iron, including gags and horrible screws to force open the mouths of patients who were unwilling or even unable to take food.” In the Lancaster Asylum good old-fashioned chains had been ingeniously combined with the very latest in plumbing. In 1840 its two Restraint Rooms were fitted up with “rows of stalled seats serving the double purpose of a water closet and an ordinary seat. The patients were secured by hand locks to the upper portion of the stalls and by leg locks to the lower portion.” The Lancaster lunatics were relatively well off. The toilets to which they were chained guaranteed a certain cleanliness and the newly installed heating system, of which the asylum was justly proud, preserved them from the long-drawn torture-by-freezing, which was the lot, each whiter, of the overewhelming majority of mentally sick paupers. For while the private madhouses provided a few of the rudimentary creature comforts, the public asylums and workhouses, in which the psychotic “Objects of Charity” were confined, were simply dungeons. (In official documents the phrase, “Objects of Charity” is abbreviated, and the insane poor are regularly referred to as “Objects.”) “I have seen them naked,” wrote Esquirol of the Objects in French asylums, “and protected only by straw from the damp, cold pavement on which they were lying.” And here is William Tuke’s account of what he saw in the lunatic ward of an English workhouse in 1811: “The poor women were absolutely without any clothes. The weather was intensely cold, and the evening previous to our visit the thermometer had been sixteen degrees below freezing. One of these forlorn Objects lay buried under a miserable covering of straw, without a blanket or even a horsecloth to defend her from the cold.” The feet of chained lunatics often became frostbitten. From frostbite to gangrene was a short step, and from gangrene through amputation to death was only a little longer.
Lunatics were not merely confined. Attempts were even made to cure them. The procedures by which patients were reduced to physical exhaustion were also supposed to restore them to sanity. Psychoses were thought to be due to an imbalance between the four humors of the body, together with a local excess or deficiency of the vital and animal spirits. The bloodlettings, the vomits and the purges were intended to rid the viscera and the circulatory system of peccant humors, and at the same time to relieve the pressure of the animal spirits upon the brain. Physical treatment was supplemented by psychological treatment. This last was based upon the universally accepted principle that the most effective cure for insanity is terror. Boerhaave, the most influential medical teacher of the first half of the eighteenth century, instructed his pupils “to throw the Patient into the Sea, and to keep him under for as long as he can possibly bear without being stifled.” In the intervals between duckings the mentally sick were to be kept in constant fear by the threat of punishment. The simplest and handiest form of punishment is beating, and beating, in consequence, was regularly resorted to. During his psychotic episodes even George III was beaten—with the permission, of course, of his Privy Council and both Houses of Parliament. But beating “was only one form, and that the slightest, of cruelty toward the insane.” (I quote the words of the great French reformer, Doctor Pinel.) “The inventions to give pain were truly marvelous.” Thus an eminent German doctor had devised a therapeutic punishment, which consisted in tying a rope about the patient’s middle, hoisting him to a great height and then lowering him very rapidly, so that he should have the sensation of falling, into a dark cellar, “which was to be all the better if it could be stocked with serpents.” A very similar torture is minutely described by the Marquis de Sade, the heroine of whose novel, Justine, is punished for being virtuous (among many other ways) by being dangled halfway down a shaft opening into a cavern full of rats and corpses, while her tormentor of the moment keeps threatening, from above, to cut the rope. That this fiendish notion should have occurred not only to the most famous psychotic of the period, but also to one of its leading psychiatrists, throws a
