Tuesday, March 13, 2012

A Mad Tea Party

Okay, back to other matters. I've quoted before from Michael E. Staub's Madness Is Civilization, (Chicago, 2011). Staub also tells how it became known in 1967 that
... a military psychiatrist named Lloyd H. Cotter had conducted behavioral experiments on patients diagnosed with schizophrenia at the Bien Hoa mental hospital in South Vietnam. Cotter’s stated goal was to help these patients, but it was impossible for critics not to read in Cotter’s report an utter disregard for the terror and suffering he must have brought them. In brief, Cotter had become enamored with “operant conditioning,” a technique devised by psychologist B. F. Skinner that suggested that “positive” and “negative” reinforcements could encourage individuals to give up behaviors deemed undesirable. Cotter had also read how psychiatrist O. Ivar Lovaas had withheld food from autistic children to promote a reduction in their antisocial behavior, and decided he would starve his own “difficult-to-activate patients.” Some patients held out for five days without food before they succumbed to Cotter, but the doctor was in the end able to announce that every single patient had finally “volunteered for work.” Yet this was not all. Cotter further administered to recalcitrant patients unmodified electroconvulsive treatments (a technique already illegal in the United States because it meant patients did not receive anesthetics or muscle relaxants and therefore ran a risk of fractured bones and compression injuries of the spine). Undeterred by the frank chance that he might injure his patients, Cotter announced that he’d given “several thousands” of these shock treatments, and that “our objective of motivating them to work was achieved.” And what kind of work exactly were these patients asked to do? It was growing crops for a deployment of Green Berets stationed nearby [124-5].
As I understand it, operant conditioning as B. F. Skinner developed it stressed rewards rather than punishments: "negative reinforcement" was seen as ineffective. But regardless of what Skinner thought, Cotter seems to have been more interested in negative reinforcement. What he was doing really sounds more like human experimentation, of the kind the Nazis were notorious for, than anything therapeutic.

Perhaps you'll argue that Cotter was a lone kook, a mad scientist doing his dirty work in the Vietnamese jungle far from responsible scrutiny, and that he therefore shouldn't be seen as representative of psychiatry in the 1960s. That argument won't work, though, because Cotter published his report not in Soldier of Fortune or Spanking Tales but in the American Journal of Psychiatry, a peer-reviewed professional publication -- which means that his colleagues read the article and concluded that it was a serious contribution to scientific knowledge in the field. According to Staub it was "radical therapists" who were appalled by it, not mainstream psychiatrists.

Staub then discusses another controversial issue from the same period:
In late 1967 another case sparked indignation, this time involving three doctors at Harvard Medical School who had suggested that social and economic factors alone could not explain the violent rioting in Detroit that summer – riots that left forty-three dead, more than a thousand injured, and resulted in over seven thousand arrests. In an oft-cited essay, “Role of Brain Disease in Riots and Urban Violence,” which appeared in the Journal of the American Medical Association, psychiatrist Frank Ervin and neurosurgeons Vernon Mark and William Sweet argued that while it was “well known” that poverty, unemployment, slum housing, and inadequate education underlie the nation’s urban riots,” the “obviousness of these causes may have blinded us to the more subtle role of other factors, including brain dysfunctions in the rioters who engaged in arson, sniping, and physical assault.” There was a strong need for clinical studies to be conducted “of the individuals committing the violence” to determine whether “brain dysfunction related to a focal lesion lays a significant role in the violent and assaultive behavior” of black ghetto dwellers. There was additionally a need, the doctors added, to develop “reliable early-warning tests” to detect and screen for potentially violent offenders. This last research agenda received major grants of more than $600,000 from the National Institute of Mental Health and the Justice Department’s Law Enforcement Assistance Administration, monies designed expressly to study “the incidence of violent disorders in a state penitentiary for men; estimate their prevalence in a non-incarcerated population; and improve, develop and test the usefulness of electrophysical disorders in routine examinations.” There had also to be established diagnostic detection centers that could help to prevent violent outbreaks. The first such center “for the study and reduction of violence” opened at UCLA in 1972 (and received more than a million dollars in state moneys from California governor Ronald Reagan in 1973) [125-6].
(The Journal of the American Medical Association is also peer-reviewed, by the way.)

Staub doesn't mention the vogue for psychosurgery in the same period, nor the role American psychiatrists played in developing new forms of torture, but they had the same intent: to treat dissent and resistance as symptoms of brain dysfunction, and to control subjects' behavior. No psychiatric professional seems to have thought of applying the same concepts and remedies to the practitioners of state violence, not even to the police who attacked Civil Rights demonstrators with clubs, firehoses, and attack dogs, let alone to Ronald Reagan.

It's a safe bet, though, that they would have considered the possibility of brain dysfunction in the demonstrators themselves. Armchair psychoanalysis of white student dissidents was a popular pastime in those days. Commentators like "Sidney Hook, George Kennan, Jacques Barzun, Irving Kristol, Nathan Glazer, and H. Stuart Hughes each offered his own unflattering diagnosis of young radicals’ mental states, identifying all sorts of possible analytic explanations for student radicalism" (168), despite "hundreds of empirical research summaries – most finding student radicals to be well adjusted" (235, note 11)" that indicated otherwise. None of those pundits was qualified to diagnose anyone's mental health, of course.

Later in Madness Is Civilization, Staub briefly mentions Marge Piercy's 1976 novel Woman on the Edge of Time. That story, you may remember, shuttles in time between the 1970s present and a utopian twenty-second century future. The protagonist, Connie, is in a mental hospital and has been drafted for an experiment involving the implantation of electrodes into patients' brains to enable control of their behavior by the doctors. Staub remarks that "in the evil 1970s, however, psychiatrists are sinister figures and the main character is involuntarily committed and diagnosed paranoid schizophrenic" (176). Given the evidence Staub himself has collected, it seems fair to say that many mainstream psychiatrists have been "sinister figures."

Which isn't to say that they all were, only to point out why many people in that period came to distrust the profession. Your psychiatrist might genuinely be trying to help you, or he* might be trying to advance his career, with you as a guinea pig. And even if he did want to help you, he might have no idea how to do so. A lot of empirical research also showed that psychiatric treatment was less effective than placebos or no treatment at all. Remember too that homosexuality was still officially a disease until 1973, and not until this century did the psychiatric profession reject attempts to change sexual orientation as the quackery they were.

Nor am I denying that there are people who are distressed and disabled by what goes on in their minds, or that they shouldn't be helped. It appears that changes in medication have helped some of them, though I retain some skepticism about that since the profession also touted its successes in the days of the talking cure, electroconvulsive therapy, and psychosurgery. I wonder what mainstream practices of today will have to be forgotten another generation down the line.
*I'm not using "he" generically; in those days most doctors and psychiatrists were male.