Tuesday, June 8, 2010
Does anyone here know what the word “asylum” means?
Right. That's the key one. Shelter, sanctuary. It's really not a dirty word. And back in the old days, insane asylum was not a dirty word. So, hold that thought.
My research, as I say, often takes me to strange places. This little adventure started in front of my computer. One day, for the heck of it - way too much time on my hands. obviously - I checked out the very first issue of the American Journal of Psychiatry, which came out in 1844. Back then it was called The Journal of Insanity.
Yep - I could have written that one, you know. It would have been an autobiography.
The American Journal of Psychiatry is published by the American Psychiatric Association, which was also founded in 1844.
Now, you heard me mention this morning how modern brain science is showing that stress makes us sitting ducks for all kinds of mental illness and other weird stuff. And I also mentioned that psychiatry already knew this back in 1952 when the first DSM came out. As it turns out, the principle was already an old one back in 1844.
Of all things, this first issue of the Journal of Insanity had a long article dealing with Shakespeare. Cool, I thought. So I started reading. This from King Lear. He's the physician character talking to one of the daughters of the mad king. You have to imagine me with a cape on and one of those Shakespeare hats:
“Be comforted, good Madam, the great rage You see is cured in him, and yet it is danger To make him even o’er the time he has lost; Desire him to go in, trouble him no more Till further settling.”
As the Journal observed:
“Now we confess, almost with shame, that although near two centuries and a half have passed since Shakespeare thus wrote; we have very little to add to his method of treating the insane.”
Wow. So this really is an ancient principle, then. And the modern psychiatric science of 1844 just validated it.
The Journal goes on to say:
“To produce sleep and to quiet the mind by medical and moral treatment, to avoid all unkindness, and when patients begin to convalesce, to guard, as he directs, against everything likely to disturb their minds, and to cause a relapse is now considered the best and nearly the only essential treatment.”
I just want to put this to you guys: Does this sound more enlightened than the psychiatry of today?
[Affirmative responses from audience.]
Yeh, that's pretty interesting, isn't it? Cuz wasn't the 1800s supposed to be the bad old days? Before science? Weren’t asylums terrible places where they locked away - “the insane”?
Yeh, you got it. Not always. And this is really interesting. It turns out the 1830s and 40s was a great reform era. Abraham Lincoln came of age around this time. This is the society that formed his ideas. This was a time of enlightened science meeting enlightened Christianity. Have you had a look at the buildings and grounds of these old institutions? They were beautiful. Palatial country estates.
Yep - and I'm getting reinforcement from Janet, here - they even had farms attached to them.
There's this one out here ... that used to be a beautiful building. It was like a spa.
And they don't put evil insane people in beautiful places. That's not what these buildings were designed for.
Well, talk about coincidence. It turns out that this same 1844 Journal - the one that had a long piece on Shakespeare - it also had a report describing an institution in Utica, that was then in operation for 18 months. According to the report, of 433 patients admitted, 123 had recovered.
Okay - we can’t be sure what the report meant by the term, recovery. But it is fair to assume that in an age of no psychiatric meds or other treatments - or even “treatments” that made patients worse, like throwing mercury down the hatch - more than one-quarter of those admitted were deemed to be in good enough condition to return to their homes and communities.
Not long after I came across that 1844 psychiatry journal almost three years ago, I found myself in LA. This was about three years ago. Maybe it was two - I can't count. I was on my way to my daughter’s wedding in New Zealand and I was staying at a friend’s house before flying out.
I don’t know about you, but I don’t look forward to any holidays. Because that means I have to crank out three weeks of work in just one week. So here I was, in LA, all worked out - stressed like nobody's business needing to relax, needing to get away from work.
I should have known. I'm sure a lot of you know this already. If you’re a mental health advocate, you really gotta watch hanging out with fellow mental health advocates - they're bad for your health. So what’s my friend’s idea - who's a mental health advocate - her idea of a good night on the town in LA? Attending a three-hour lecture on mental health, that’s what.
Great. I’m in vacation mode. I want to forget about work, and here I am being dragged out into the night to sit in on a university class for some psychology majors at USC. A leading world authority on psychiatric rehabilitation, Robert Liberman of UCLA, was giving a guest lecture.
Okay, I decide to go along with my friend, because I hate fights. But that didn’t mean I had to listen.
So, anyway, here I am, in a college classroom, in one of those ridiculous classroom desks that I used to sit in back in the 1960s - how these survived into this century I don't know. So, I'm trying very hard not to listen, when suddenly Dr Liberman starts telling us how the insane asylums of old were very enlightened places, with high recovery rates.
My ears pricked up. Wasn't I just reading something like this?
This is the way we learn. We need a few repetitions before the message gets in there.
So Dr Liberman went on to say in so many words that mental illness was a product of the industrial age. Just jam people into large noisy smelly dirty cities and watch what happens.
This is why, you know, Kansas is so nice with its open skies. It's spacious. I felt my mind resting when I came out here.
Asylums were built to get people away from all that. Only later, he explained, did cash-strapped state governments give up on us. I guess it's easier putting up nice buildings and you don't have people doing enlightened stuff in the nice buildings, anymore. You just make prisoners out of us.
So, of all things, on the ride back, I’m thanking my friend profusely for dragging me out into the night. So I still go up and visit her every once in a while.
Anyway, when I got back from New Zealand, I looked up Dr Liberman, and it turns out he is one of the leading proponents of what they call the “diathesis-stress” model, namely that certain individuals are more genetically disposed than others to break down under stress.
Now he came up with that in the 1970s, and of course we find that the brain science of the 2000s is validating it. We're those people who break down under stress ...