Back to the Future: Thorazine for Sanity

healing or control?

I sat around in a circle with my cohort of post-doctoral fellows appropriately snickering. Our training director, Joe Shay, had distributed a list of hundreds of different types of psychotherapy. Many of them were laughable, sad, or just outrageous. How could anyone have practiced these therapies with a straight face? Didn't they know they were quacks?

With our recently minted doctorates in hand, we all looked smug and self assured. We were training to practice dialectal behavioral therapy--the state of the art treatment for people diagnosed with borderline personality disorder. Our mentors were elite luminaries in the field.  Our offices were in the heart of Harvard Square in Cambridge Massachusetts. I felt I arrived in the liberal elite intellectual promised land.

With a deft few words, our training director swept away my smug look of superiority and taught me an enduring lesson. This post today is what I came to know in thinking about Joe's lecture that day.

People have come for treatment for hundreds--if not thousands--of years for phenomena that we currently call borderline personality disorder. People have turned to shamans, priests, friends, psychiatrists, psychologists, and others to receive treatment. Many have gotten better. Some have not.

I walked into that training room as a post-doc thinking I was learning a superior treatment. I couldn't imagine that the treatment I was providing--DBT--could ever be viewed as ridiculous, barbaric, old fashioned, or just plain weird. I could never be seen like those people we were learning about in Joe's lecture. We were better. I was better. These are modern treatments.

As many do, I failed to look forward. I failed to account for the fact that society is evolving. What one considers humane now, will be inhumane tomorrow. What are considered unquestionable facts today will be seen as antiquated examples of magical thinking tomorrow.

I will become a dinosaur one day. The way I practiced psychology will be looked at by some (if I am even remembered) as laughable--or worse.

I had this in mind yesterday morning while I was looking at vintage advertisements for Thorazine.

New Orleans City Insane Asylum

New Orleans City Insane Asylum

I couldn't pass these records up. The New Orleans City Library has select patient records of people who were committed to the New Orleans City Insane Asylum. The city asylum appears to have served as a sort of assessment center. Local residents, police, and other officials would drop people off for evaluation. Dr. Y. R. LeMonnier, the physician of record, would make an evaluation and determine whether or not the patient would be sent to the East Louisiana State Hospital for the Insane.

The records offer up a fascinating glimpse into what behaviors were considered abnormal in the late 1800s. Some individuals were "cured" and returned home to their families. Many lived out their lives in the asylum and were buried in unmarked graves on the asylum grounds. One can only imagine what the lived experiences of these people, deemed insane by the state of Louisiana, must have been like. Here are a few of their stories:

• Abigail vs. Mrs. Lincoln – F – Blk – entered April 26, 1865 – aged 43 years. Today April 25,/82 – 61 years old [sic] – native of U.S. 5 3 ½ feet high. Kind of Insanity when she entered – Furious Mania – Today her disposition same is quiet & obedient – but she is turbulent, vulgar and obscene when irritated, yet very clean about her person. All doctors are her husbands brothers. Health rather good.

Quiet and obedient. No wait, just quiet. Also prone to being turbulent, vulgar and obscene when irritated. That's the record for Abigail. It's not much to go on. Not much at all. Take a closer look at the dates Dr. Le Monnier entered into the record. Abigail was brought to the asylum during the second year of the Civil War. It's unclear what the record means by "entered April 26 1865." It's entirely possible that Dr. LeMonnier didn't get around to entering the data into the record until years later. It is also possible that it was the day  Abigail was transferred to the East Louisiana State Hospital for the Insane. While the meaning is unclear, the date is interesting. April 26 1865 entry occurred just days after General Lee surrendered the Confederacy to the North on April 9, 1965. 

One wonders if Abigail was mentally ill or damned angry at being held in slavery. Was her illness the failure to fit in with White society's expectation of normal behavior for their slaves?

• Victorine – F – Blk – Entered Oct. 26, 1866 – 45 yrs old – Today, April 25, 1882, 62 years old – Native of U.S. 5.3 feet high – Kind of Insanity when she entered – Erotomania. Today, same. Disposition: quiet and obedient. Excited at times, at the sight of men, strangers to the institution, but even then very obedient. When her thoughts are turned to the pass [sic], on whatever subjects, she will at times seem to be a raving maniac. At these moments it suffices to call her, for her reason to return and she becomes quiet and obedient. Her health is very good. She makes herself useful.

Erotomania is a diagnosis that describes a person who has a delusional belief that a person of higher social status falls in love with them and is making sexual advances toward them. The record makes no mention of who was the subject of Victorine's advances. One wonders if she was in love with a White man, and if he loved her back. Could it be that a society with rigid anti-miscegenation laws diagnosed Victorine to keep races separate?

Was Victorine mentally ill or a victim of a racist culture?

• Ah Sing – Chinaman – age unknown (35? yrs)[sic] – Committed to the Asylum June 28rd*, 1882.This man is very excited. Being a Chinaman nothing can be obtained from him. Attached is a specimen of his writing – His tongue is good. Yesterday (26th) he was very wild, Raving Mania, to-day he is much better. This improved state is probably due to exhaustion. Yesterday his P. was 108, small; weak; to-day the 27th it is small and weak at 84. 

I'm speechless here, really. Was Ah Sing insane, or unable to communicate in English? Imagine how you might behave if you were kept against your will by captors who did not speak your language. Raving Mania, indeed.

• Anna Doyle, female, white, 35 years of age, native of Indiana, married, recommended her commitment to the State Insane Asylum, on November 3d, 1882, finding her suffering from Puerpueral Mania. This young woman is of a crabbid [sic] and peevish nature, using at times a very obscene; insulting language. She is naked, has a diarrhoea, and constantly dirties on her. At times rational, then incoherent in her speech. Her present condition is the result of a miscarriage or parturition – I have been unable to learn which or the exact date – a few weeks ago. She was sent to the hospital but her insanity caused her removal to the parish prison, for examination, prior to be sent to Jackson. At the hospital as here, she was very disagreeable; unmanageable [sic].

My heart goes out across time for poor Anna Doyle. It's interesting that she had no family to speak for her--Dr. LeMonnier wasn't sure if she had a miscarriage or live birth. Where was her husband? The record says she was married. Was the child the result of an affair? Was the husband uninterested--or dead?

It's important to note that no psycho-social factors were considered in any of these records. Do you suppose we take into consideration the context of peoples when  making diagnostic decisions in 2012? If you were to read the records of psychiatric patients who are hospitalized in 2112 would the records indicate an ignorance of the ways in which context influences sanity.

• Wm. Turley, male, white, 19 years, native of N.O., La. recommended his commitment to the S. I. A. at Jackson, on February 13th, 1883, finding him suffering from Stupidity. This young man is an epileptic, and is to-day reduced to an advanced state of Stupidity, which renders him unable to distinguish his right hand from the left. He knows not his age; says he is 10/years[sic] of age. He knows not the difference between 10 & 20.

It has been nearly erased from history that people who suffered epilepsy generally faced a lifetime of institutionalization. 

• Mrs. John Morehiser born Mary Grady, female, white, single (i.e. not legally married) native of Ireland, 27 years of age, recommended her commitment to the S-I-A. at Jackson on Feb’y 28th/83 finding her suffering from Puerperual Mania. This unfortunately woman was living with a man, to whom she was devoted. He proved untrue to her. She became jealous, and shortly, one or two months, after the birth of her last (3d) child, she showed the first symptoms of insanity. She is very quiet, speaks very little, her answers are slow to come, the questions often, having to be asked several times before being answered. The answers are not always rational. Her eyes are constantly roaming to & fro looking for something. She speaks of her children who are in the garden, whereas they are not present, nor is there a garden near by.

I found the admission record for Mary when she was adjudged to be insane by the Civil District Court for the Parish of Orleans. The reason official reason for her insanity? Jealousy. Was she insane or was she angry (or dejected) that her lover abandoned her and their children? 

• Augustine Smith, male, white, single, 21 years of age, native of Algiers, LA recommended his commitment to the S-I-A. at Jackson, on March 21st 1883, finding him suffering from Klopemania He is in a state of excessive hilarity. Laughs, jumps, claps his hands, runs at a great speed across the room, sets down jumps up again, puts his hand in your pocket, in a word does not remain two minutes quiet. At the station house, I found him in his cell, having torn his shirt to pieces, broken the lamps glass with his shoe, and laughing at his deeds. A month or two ago, he was arrested. He had robbed a ladder at night, brought it to the police station (Algiers), and there was asking for the loan of a hatchet that he might fix it, to enable him to light all the street lamps of Algiers. The citizens of Algiers complain of his night prowlings & thefts, and fear that he may some night be shot as a thief, if he be not placed in a safe place.

A modern day reading of Augustine's record suggests he might be suffering from a manic or hypomanic episode. What's interested about this record is that it suggests the protective use of hospitalization: Augustine was placed in a safe place so his behaviors didn't get him shot as a thief. One can infer from  Dr. LeMonnier's writing that he didn't believe Augustine was responsible for his own behaviors. Perhaps an interesting precursor to the notion of 'not guilty by reason of insanity'?

• Elizabeth Riley, female, white, about 35 yrs old, married, native of Ireland. Recommended her commitment to the S.-I.-A. at Jackson, on March 11th/84, finding her insane, suffering from Hallucinations. She is afraid of bodily harm, when anyone approaches

Hallucinations or flashbacks? The experience of Elizabeth is mostly erased from time. I wonder if perhaps she was victimized by someone--perhaps rape or physical abuse? 

Vibrator Miscellanea

My post-doc director of training frequently reminded us that 20 years from now we'll look back at the kind of therapy we practiced and be unable to believe we practiced that way. Our ways of understanding will become more complex, new types of therapy will develop and evolve, and things that were once popular will fade into obscurity.

Let's take hysteria as an example. During a large portion of the 19th century hysteria was all the rage. Women's sexually, however, has been deemed pathological and diagnosed long before that. In her book The Technology of Orgasm: Hysteria, the Vibrator, and Women's Sexual Satisfaction, Rachel P. Maines quotes a medical text from 1653:

When these symptoms indicate, we think it necessary to ask a midwife to assist, so that she can massage the genitalia with one finger inside, using oil of lilies, musk root, crocus, or [something] similar. And in this way the afflicted women can be aroused to the paroxym. This kind of stimulation with the finger is recommended by Galen and Avicenna, among others, most especially for widows, those who live chaste lives, and female religious, as Gradus [Ferrari da Gradi] proposes; it is less often recommended for very young women, public women, or married women, for whom it is a better remedy to engage in intercourse with their spouses.

We have the ancient Greeks to thank for the notion of hysteria. Plato thought the uterus was a living creature that wanders around a women's body. At times it can wander to the wrong area which would cause "blocking passages, obstructing breathing and causing disease." Those pesky uteri.

What are the symptoms of hysteria? They include faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and as Maines aptly writes, "a tendency to cause trouble." Ladies, if you have any of these symptoms you might need treatment.

Charcot demonstrates a case of 'hysteria' c. 1885

Thankfully, treatment options expanded quickly in the 19th century. Physicians, interested in increasing their income, looked for ways to improve tedious manual treatments. It could take hours to manually induce a hysterical paroxysm. This seriously cut into billable hours. Also, for those of you who think physicians enjoyed this--they didn't. There is no evidence that physicians of the time found this an enjoyable task. To the contrary, they found it tedious and uninteresting work. It probably would have been considered unimportant work had it not made a significant amount of income.

How is this for an interesting fact: electric vibrators were first used in medicine in 1878 and were made available as a consumer product by 1900. The first appliances (in order) electrified: sewing machine, fan, teakettle, toaster, and electric vibrator. It took another ten years until the electric vacuum, iron, and frying pan were consumer products that were available for purchase. This tells you a little something about what made money at that time (businesses will develop products most likely to sell) and thus, what people considered important. Hysteria was big business.

Vibrators were so widely available they could be purchased for home treatment (medical use only, please!) from the Sears catalog:

We also have an advertisement from a 1913 edition of the New York Times:

Curious for even more images? Check out the vibrator museum. There is a collector for everything, isn't there? I wonder how many accidental electrocutions there were from these contraptions.

Cabinet Card Gallery

Curious why a fainting couch appears here on this post? It appears that these Victorian ladies, reclining on their fainting couches experiencing "the vapors," were actually having a personal physician apply the appropriate treatment for hysteria. Who knew? I certainly never did.

Back to Maines book one last time:

Hysterical women represented a large and lucrative market for physicians. These patients neither recovered nor died of their condition but continued to require regular treatment. Russell Thacher Trall and John Butler, in the late nineteenth century, estimated that as many as three-quarters of the female population were "out of health," and that this group constituted America's single largest market for therapeutic services. Furthermore, orgasmic treatment could have done few patients any harm, whether they were sick or well, thus contrasting favorably with such "heroic" nineteenth-century therapies as clitoridectomy to prevent masturbation. It is certainly not necessary to perceive the recipients of orgasmic therapy as victims: some of them almost certainly must have known what was really going on.

And now back to my point. We forget in our current modernity that we all all one day be obsolete. While we might not be applying "vibration" to heal the wounds and maladies of our day, our current notions of sanity and insanity are as tightly wound with the Zeitgeist of 2011 as they were in 1900. 

The vibrating doctors meant well--at least most of them probably did. We mean well, too. We do the best we can with the knowledge and understanding of the world that is currently available to us. Too bad only a few of us have figured out that some certain portion of what we call therapy now will sound ridiculous in another 100 years.


 (Not to mention the aspects of therapy that already sound ridiculous but clung to to by a some ardent believers of different kinds of historical therapies).

By the way, apparently Maggie Gyllenhall is staring in the upcoming movie "Hysteria" that was recently screened at the Toronto Film Festival 

Forgotten History

I recently came across a link to the London Science Museum on the Mind Hacks blog. It lead to an interesting morning clicking around looking at all sorts of medical oddities. Where else would I be able to find a diorama of Dr. Lister's ward where he pioneered modern antiseptic techniques? Perhaps you are interested in something older? How about a different diorama depicting the removal of a cataract in 11th century Persia? If that one didn't make you flinch how about an antique dentist chair? There is the interesting (antique acupuncture needles) and the gory (a German amputation knife). Have more prurient interests? How about a reusable condom that needed to be washed, powdered, and dried flat? How about an electric "massager" circa 1913 that physicians used to treat "hysterical" women. Talk about forgotten history!

Of particular interest to me were two grave markers in the London Science Museum collection. These markers came from a place first opened in 1765 as the House of Industry for Looes and Wilford Incorporated Hundreds (a work house for the poor), named the Suffolk County Lunatic Asylum in 1827, renamed again the Suffolk District Asylum in 1906, and then called St. Audry's Hospital for Mental Diseases from 1917 until it closed in the 1990s. The grounds are rather pretty.

Some people spent most--if not their entire--lives in this hospital. They grew up, aged, and died on the grounds of this hospital. The only memory that remains of them are numbered metal grave markers. Recently even the markers were removed when workers came in to renovate the old asylum grounds into a golf course. The surviving buildings have been converted into residences.

There was no record left of these human beings. No mention of their hopes and dreams or their struggles and pains. Reduced to small rusted metal crosses with an embossed number, these people disappeared. I wish there was some way I could reach back in time and let the persons now known as #325 and #1587 know that they were valuable just because they were.

I can't do that. None of us can. We cannot travel back in time and we cannot right what has been made wrong. We can remember the past to honor those who were thrown away. For example, there is a website that collects and chronicles the experiences of workhouses in the United Kingdom.

We can treat each person like they matter--with dignity, respect, and honor. Can you try that today?

Snake Pit: Madness in the Movies

Poor Mrs. Cunningham. The doctor tells her "Don't be afraid, we just want to talk to you." Would you really want to talk to Dr. Kik? I'm not sure I would.

In the 1948 movie "Snake Pit" Olivia de Havilland plays the role of Virginia Stewart Cunningham. Mrs. Cunningham has gone mad and is hospitalized at Juniper Hill State Hospital. What do we learn about madness from this movie? What does the "Snake Pit" show us about madness in 1948? One interesting way to interact with a movie or text is to watch it while asking a single question framed as such: "Mad people are people who ..." 

This basic structure can be used to look at  lots of different questions. For example, what does a particular advertisement for a car company tell you about people who drive that car? In a recent car commercial I watched there were a few key images: children in the back seat, parents singing to classic 80s music, children being embarrassed, children in the backseat watching a DVD quietly, and children in another car not being able to watch TV.

Plug this into the basic structure: People who drive this car have children; people who drive this car sing 80s music; people who drive this car are embarrassing to their children; people who drive this car are better than people who don't; etc. What are you really buying here--a car or a tool to feel better than the people who don't have what you have?

Back to the movie.



3:43 "You heard me ladies, fall in. No talking." Mad people are people who need to follow rules.


4:43 "No talking ladies." Mad people are people who need to follow the rules.


4:56 "Why do we have to keep in line? I don't like regimentation." Mad people are people who need regimentation. Mad people are people who don't know what they need.


5:21 "They treat you like criminals." Mad people are people who are criminals. Mad people are people who are treated like criminals.


Part three might be traumatic for some. Watch at your own peril: it depicts a scene of electro-convulsive shock therapy from 1948.





0:05 If I say I demand a lawyer they'll have to do something. It's in the constitution." Mad people are people who have demands. Mad people are people who don't have rights afforded by the constitution. Mad people are people whose demands are ignored


This next clip offers a harrowing depiction of what might be seen as a hallucination starting at 6:17.




6:35 "Come on. Stop it. Get in there before I..." Mad people are people who are ignored. 

6:52 "Come on, cut it out. No one is going to hurt you." Mad people are people who are not to be taken seriously. 


This final clip offers us the view--and line--that gave us the title of the movie.




9:21"It was strange. Here I was among all those people and at the same time I felt like I was looking at them from someplace far away. The whole place seemed to  me like a deep hole and the people down in it like strange animals, like snakes." Mad people are people who are different. Mad people are people who are in a hole. Mad people are people who are strange animals, like snakes.

Not a pretty picture, eh? What images of madness have you seen and accepted as true? Over the years of our lives each of us accumulate schema--patterns of understanding--for madness and mental illness that create our understanding of the phenomena. What are your's? Have you questioned them?

Can you look beyond your schema and see something larger?