Great and Desperate Cures

(Literary Masterpieces, Volume 9)

Priests and healers in ancient times are said to have drilled holes into the skulls of people who exhibited bizarre or destructive behavior to let the evil spirits out. Eminent surgeons as recently as in the 1950’s did the same—but used the holes to insert picks and probes into the brain itself, thereby destroying some of the patient’s personality, volition, and intellectual function. Tens of thousands of prefrontal lobotomies and similar surgical procedures were performed during the 1940’s and 1950’s, even though medical science failed to provide an adequate theory which drew on knowledge of the brain’s anatomy and function to explain why the procedure should work. Practitioners recognized that even in the best “cures,” patients lost initiative, ambition, creativeness, and reasoning ability; the lobotomized patient, when discharged from a mental hospital, was likely to be passive, childlike, and in need of constant supervision. As chemical therapies became available—and as more accurate neurological mapping suggested that lobotomy’s tranquillizing function was merely an accidental by-product of the brain damage it caused—the procedure was gradually discontinued.

How could an operation which had no convincing theoretical support and never showed consistent evidence of success be performed on thousands of private patients as well as on the inmates of state institutions and, furthermore, be recognized with the award of a Nobel Prize? As Elliot S. Valenstein demonstrates in a book that serves as a cautionary tale about medicine in general, the circumstances were not unique to this one story. Science is still ignorant about the biochemical and physiological and neurological mechanisms of a great many diseases, both mental and physical. Patients and their families are desperate. Doctors feel compelled to do something—anything—so as to feel less helpless. The media uncritically publicize therapies that seem to offer hope. Physicians are often driven by ambition; medical specialties compete with one another; the market and related economic factors influence therapeutic decisions.

Described by Lewis Thomas as The Youngest Science (1983), medicine in the 1920’s had very little support from the careful experiments and controlled research needed to understand the physical mechanisms of health and disease. In the mid-1930’s, students at Harvard Medical School were told that 90 percent of the practice of medicine lay in keeping the patient comfortable while nature took its course. They were taught diagnosis and prognosis; they learned by observation to make predictions about the outcome of disease; they knew which drugs would alleviate certain symptoms or affect the action of some bodily processes. Except for surgery to remove or repair damaged organs and limbs, however, few of their interventions could actually change the course of a disease.

The treatment of mental illness had even less grounding in the kind of knowledge that could be verified through scientific method. Neurologists and psychiatrists disputed both turf and theory: Neurology studied physical mechanisms in the brain and nervous system, while psychiatry worked from the premise that mental illness was the consequence of life experience. Even among psychiatrists, however, most were convinced that psychoses had biological causes; psychotherapy was used primarily with neurotics and was, in any event, totally impractical for treating the large numbers of patients confined to asylums and state hospitals. In the 1930’s, as in the 1980’s, a variety of other specialists also competed to treat many of the same patients—neurosurgeons, psychologists, social workers, and trained or self-proclaimed therapists of various persuasions. In the face of the competition, psychiatrists as well as neurologists had a vested interest in promoting treatments unavailable to those competitors who were not actually licensed to practice medicine.

Since no treatment offered a proven cure for any variety of mental illness, almost anything was worth a try: the removal of one gland or another, ovariotomy, castration, sedated sleep (the patient was kept in a light coma for up to a month), drugs to stimulate respiration or metabolism, surgery which removed sources of...

(The entire section is 1749 words.)


(Literary Masterpieces, Volume 9)

The Atlantic. CCLVII, May, 1986, p. 100.

Choice. XXIII, July, 1986, p. 1738.

Library Journal. CXI, April 15, 1986, p. 87.

Los Angeles Times Book Review. April 13, 1986, p. 2.

Nature. CCCXX, April 17, 1986, p. 568.

The New York Review of Books. XXXIII, April 24, 1986, p. 7.

The New York Times. April 1, 1986, p. 25.

The New York Times Book Review. XCI, April 6, 1986, p. 30.

Psychology Today. XX, September, 1986, p. 74.

Publishers Weekly. CCXXIX, March 21, 1986, p. 78.