There may not have been any good times to have been mentally ill in the last 200 years, but there have been some spectacularly bad ones. Having all your teeth pulled out to end your “madness” might seem as extreme as it gets, but if you were unfortunate enough to be under the care of Dr Henry Cotton in the early decades of the 20th century, there was a real risk that your intestines might follow. If you were female your cervix was a potential victim, too. Unsurprisingly, survival was not guaranteed, no one got better, and quality of life for those who lived was severely curtailed.
Fast forward a few years, past the insulin-induced coma treatment and the frequent administration of electric shock therapy (several times a day), and you might also want to avoid Dr Walter Freeman, who wielded a modified ice-pick to lobotomise up to 20 patients in one session. Hardly surprising, perhaps, that those who could afford it turned to psychoanalysis – often painful itself, but in a very different way.
Andrew Scull’s book, which tells the story of mental illness in the US over the past two centuries, is dominated by extremes and hopes. It is meticulously researched and beautifully written, and even funny at times, despite the harrowing content. This is a history of serious mental illness – schizophrenia, bipolar disorder, severe depression – and there is no happy ending. But among psychiatrists there is considerable and diverse striving to understand causes, discover remedies and, frankly, make patients easier to manage.
While each wave of medical professionals seems to think they have achieved these elusive goals, they are largely doomed to disappointment and often disgrace. At times their egos fly much higher than their ideas, but perhaps that is human nature, and maybe it is necessary. Without ambition and mistakes, we would never achieve very much. For some there is an almost frenzied hope of success, but whether for the benefit of patients or personal aggrandisement, it isn’t always clear.
The attempt to elucidate mental illness’s biological underpinnings has driven much of this experimentation. If these could be revealed, then psychiatrists were real doctors, and real cures might be found. But in this context, the patients who were lost to “cutting-edge” treatments, or simply to appalling care, hardly seem like people – something of which Scull is painfully and compassionately aware. More often than not they are women, and seem to have been regarded as expendable.
Scull, as a sociologist, is not entirely sympathetic to psychiatry and psychiatrists. It’s right that he doesn’t spare them, and as the book draws to a close, he writes passionately of the need for a broader approach, embracing more than the currently dominant biological paradigm. His analysis of prevailing diagnoses and their links with pharmacological treatments is sceptical, but he also acknowledges the vital relief of symptoms that can be provided by some medicines and modified ECT. He asks for caution, honesty, humility, and, above all, for understanding.
This book is an unfinished story, and I would very much like to know what happens in the sequel. What we have seen up to now is a rollercoaster of emotion, with many casualties strewn along the way. It is easy to recoil in horror when reading of the treatments and asylum conditions of the early 20th century, but we judge by our own standards, and will ourselves be judged by those of the future. Mental illness is something we all fear, in ourselves and others, and those who experience it are often disempowered in their interactions with specialists. One hopes we are showing more kindness now than in the past, but Scull is right in saying that we have a long way to go.
• Rebecca Lawrence is a consultant psychiatrist. Desperate Remedies: Psychiatry and the Mysteries of Mental Illness is published by Allen Lane (£25). To support the Guardian and Observer, order your copy at guardianbookshop.com
