THE LOGIC OF MADNESS
In the Victorian wars - the Crimean and Boer - bad teeth and mental illness were the commonest cause of invalidism. Rampant mouth infection excluded you from the call-up and you were sent home. Disturbed minds were most commonly detected as a consequence of action, and so the army was required to try and treat it. The cost was estimated as even greater than surgery. This concentrated medical minds and, indeed, governments. The late nineteenth century bacteriological revolution brought teeth and mental illness together in William Hunter's fin de siècle theory of septic psychosis. Madness occurs when the sewerage system of the body contaminates the mind. Hunter, being a surgeon, saw the cure as surgical. 'Close the portal, open the outlet.'
Lunatic asylums have always been laboratories. For exorcism, spiritual manipulation, theatrical exploitation, diet experimentation and so on. In the first quarter of the twentieth century some became like surgical wards in wartime. Henry Aloysius Cotton's Trenton State Hospital in Delaware was the cutting edge of pre-emptive intervention. Pulling out the teeth and enemas were not enough. The guts had to be looked at. I suppose opening the abdomen on spec was like examining your tongue in the mirror. The longer you look, the more seems wrong. Exploratory laparotomies revealed nooks and crannies from the stomach to the rectum that were considered potential foci of infection.
Cotton came to consider the large bowel as an unnecessary encumbrance, as redundant in man as the tail, and routinely removed it while remodeling a streamlined gastro-intestinal tract. Though one-third of cases died on the operating table, the medical establishment urged him on, gung-ho. 'Eliminate the cause' was the cry from the Royal Colleges in London. Colectomies were added to his battery. Disembowel the lot! Nobody seemed bothered by the mounting deaths. In 1925 Cotton was proclaiming to universal applause that his cures saved the State of Delaware a million dollars a year (the mortality rate alone would account for that, and more).
Between the wars was the age of charitable visitors. Thomas Chivers Graves, a Cotton exemplar in Birmingham (England), explained to the kindly ladies that, 'No, we did not use anesthetics for tooth extractions as the patients didn't seem to mind'. When their emaciation was observed, and someone wondered why dentures had not been fitted, he was reported to have laughed, 'They can't even manage their shoe laces'.
At the turn of the nineteen twenties Phyllis Greenacre, a young intern, reviewed Cotton's 'success' on behalf of a concerned charity, and found that those returned home as cured were more likely to be patients who eluded the knife. Surgeons in America began to withdraw their scalpels. Though some diehards diversified from the guts to the brain when Egas Moniz won his Nobel Prize (1933) for inventing the lobotomy. Still Graves and others in England remained faithful to surgery to pre-empt septic psychosis well into the nineteen forties, despite its original basis having been scientifically discredited (focal infection theory's main contribution to the world, other than contributing to the aforementioned deaths, was to make dentistry a respectable profession and rich dentists a byword for the opposite).
There was not a single law suit against any abdominal adventurers of the Cotton school. The social stigma of mental illness protected surgeons. Families might complain at the treatment and its outcome, but rarely publicly. The Royal Colleges were content to lend respectability to Graves's methods by default. It was only when insurance companies came to the fore post-war, particularly in America, that the penny dropped. By the nineteen fifties the medical world had returned to patent drugs, or Kellogg's malted bran solution to gastro-intestinal problems, though it didn't do mad people much good. Nevertheless, there were lingering outposts of surgery against septic psychosis. When I was a student in Cork in the nineteen sixties the 'loony bin' in the Lee Road was still yanking out teeth as a preventative. In my first job in St Charles Hospital, London, the 'mental' wards had dental clearances for new patients, but also a denture-making service.
Mental illness is now the most costly of all medical conditions. If a cure was found the multi-national drugs industry would go out of business. And what would all those psychiatristes (sic) do? There's just too many of them! But it is, of course, highly unlikely that anything more than palliative will be achieved in the foreseeable future by the medical profession. Research work remains ill-focused as career imperatives based on vested-interest funding obfuscate the field. Keeping the mad mad is, it seems, in everybody's interests, except taxpayers and possibly the mad.
Kierkegaard described madness as a state when the relation between the parts of the mind are out of proportion, a definition which has withstood the barrage of treatments that the mentally disturbed have submitted to in the twentieth century. He believed it to be the mounting up of little things until the mind can’t see beyond its nose, and believed that, given confidence and patience, the unsighted can feel their way until the self-made obstacles dismantle themselves, and the sky can be seen again. This could explain why the most reliable cure of madness is ‘spontaneous regression’, achieved by time rather than design. My advice to unquiet souls is to be your own doctor. Only you can know your own mind, and put it right.