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The Dangerous roots of Psychiatry

written by: Stanley Wilkin

@catalhuyuk

In Britain, the newly created USA, and to a lesser extent in European countries, private asylums for the insane emerged in the 18th century, growing in importance during the early decades of the 19th century. This paper looks at the behaviour of mad-doctors/ alienists, rarely more than laymen with no systemic education on mental health, who ran these establishments and whether their theories and behaviour have influenced present psychiatric thinking and conduct.

This paper considers incarceration, often for money, of the sane in mad houses, the notion of normality formed from the ideas of John Locke and how these have affected ideas of insanity, and the rational basis of torture as a form of treatment.

The expansion of psychiatry evidenced intensive patient abuse of considerable duration based upon the veracity of medical diagnosis and, I suggest, social prejudices. This provides a particularly expressive contradiction as now we tend to believe everything psychiatry says, critique little, and accord psychiatrists unquestioned scientific status. We assume a passive response to psychiatric treatment and ideas. The general public view psychiatrists with trepidation, as those with intimate knowledge of them and others, august, aware, authoritative but this cannot be squared with the behaviour of psychiatrists over the past two centuries, nor with the majority now who rarely demonstrate much psychological or sociological insight. This leads to the question as to what complex processes have occurred to produce this dominance of psychiatric perceptions and the now extraordinary power of psychiatrists. Where did psychiatry obtain its influence and status? Was it really the result of the emergence of the construct of reason and the need to define it through an apparent antithesis as suggested by commentators such as Foucault?

Obtaining expertise:

From the 17th century the mind became seen as part of the paradigm of illness, and thereby subject to medical treatment and cure. It took longer for doctors to assume the role of experts in this area, although James Monro active in the mid-18th century was perhaps the first to specialise in the treatment of madness. Until Victorian times, most alienists or mad doctors were lay-people, some gaining results. The torture-like treatments of most alienists, many just opportunists, were not only similar to exorcism but would have been considered criminal in general circumstances. Partly, these were allowed because lunatics were considered to have ‘lost their reason’, thereby without cognition and feelings. This perception, rooted in John Locke’s ideas, continues to the present day only with different kinds of treatment preferred to that of the early 19th century. Locke’s ideas of personality structure reflects the political and social changes of his age, and are probably neither universal nor immutable. The theoretic principles behind psychiatry focus on the authenticity of the everyday, the material world not that of imagination and spirituality. Any behaviour that does not conform to this narrow perception of behaviour would have been, and still is, considered abnormal.

Nevertheless, the above explanation is perhaps being too kind for many owners and managers of madhouses. Many were in it for the money, and created treatments from whim. Their theories were dragged out of the air, based upon superficial observations of physical phenomenon and whether the patient was loud or quiet, co-operative or resistant. Things have not necessarily changed much. Understandings of normality were constructed upon the power of the alienist or within power constructs within the family. Patients were often announced cured once they understood that they had to ape the behaviour expected of them, observing the alienist more acutely than the alienist observed them.

The treatments employed to cure or eradicate lunacy, purges, leeches, secret compounds, were used on the basis that as insanity was only a disease of the brain treatments successful on bodily diseases would be successful on that organ as well. (Arnold: 2009). Of course they were not actually successful on treating bodily symptoms such as cancer, heart problems, etc, physicians just imagined they were. This myopia surely encourages concerns about modern day psychiatry with its similar obsession with single causes, for chemical imbalance on the surface appears analogous with bodily imbalance?

The expansion in the number of mad-houses has been put down to alienist’s desire for recognition and professional status (Scull: 1993) or simply to entrepreneurial activities targeted on the wealthy . Probably, it was a synthesis of these factors, greater cultural focus on mental health, combined with the growth of capitalist society with its concern for work and profitability and an increased perception of mental illness as life-long rather than temporary. Certainly, the increased incarceration of ‘lunatics’ involved the objectification of the vulnerable and poor by the medical profession (An Unusual Power: Mad-Houses: Sane or Insane?), and the view that patients were a commodity and for the use of experimentation. The evidence suggests that the more mad-houses were assigned or built the more patients there were to fill them; the more alienists/psychiatrists were trained the more mental health illnesses arose exponentially.

Before:

A brief overview of Acts of Parliament regarding lunacy:

• The 1774 Act for Regulating Madhouses occasioned the licencing and inspection of private mad-houses in order to eradicate flagrant abuse. The act dealt with madhouses inside and outside of London, divided into two sections. Inspection were made inside London by an officer from the Royal College of Physicians, and outside London regulated by local clerks. Each patient had to be certified by a doctor on admission, and a registry book had to be kept with the names of all past and present patients. This provision was meant to stop the incarceration of sane individuals and preventing access to them by friends and relatives. It had become widely known that mad-houses took in anyone, sane or insane, and kept them prisoners. Whatever the merits of the act, it did not concern itself with treatments or with the conditions in which patients were kept.

• Criminal Lunatics Act 1800. This sanctioned a version of insanity, one connected to violent acts, and provided sweeping powers to courts dealing with those considered insane. Those who committed violent or criminal acts through insanity/or judged to be insane, could be detained for life in a prison, Bridewell or asylum. Those considered unfit to stand trial or plead through reasons of insanity could also be detained-probably for life. Those who were arrested and considered insane were denied bail. These restrictions on freedom were and are far-reaching. The prison reformer Sir George Onesiphorus Paul, asked to look into the state of madhouses by Lord Spencer, the then Home Secretary, recorded that some parish authorities encouraged lunatics in their care to as a consequence of the Vagrancy Act to commit crimes in order to be reclassified as criminal lunatics and re-housed in jails.

• County Asylums Act 1808. Initiating the establishment of county asylums.

• County Asylums Act 1828 allowed for central authority involvement in county asylums but continued the practice of amateur commissioners.

• 1828 Madhouse Act. A Metropolitan Lunacy Commission was founded, restricted to London Asylums, which gave inspectors the right to revoke the licences of individual madhouses and free individual patients. Asylums containing more than a 100 inmates were required to have a residential medic and religious services.

• Care and Treatment of Insane Persons Act 1832. Passed to deal with the consequences of using magistrates as lay inspectors as often they were unable to perform the exacting duties, preferring as was to be expected, the opinions of alienists and asylum owners (Scull: 1993: 131).

Where it involved treatment, in 1810 William Black, the medical statistician, saw no reason why lunatics should not be kept as wild beasts, manacled constantly: corporal punishment was widely conceived of as part of treatment, if possible though avoided: and the use of the eye resorted to, or the moral force of the physician’s gaze. Each of these methods were employed to put fear into, coerce and dominate the lunatic in order to reshape their minds. Certainly torture and incarceration were employed by some mad-houses to extend the stay of profitable patients and, it seems, make their care much cheaper to manage (Scull: 1993: 67).

Preview:

The specialism of mad-doctors was less the result of madness becoming an object of scientific speculation than of commercial developments, the mad becoming a commodity. The theories behind the treatments offered appear to have been appended in order to provide an appearance of medical authenticity.

When patients were not chained or held within restraints of some kind or another, they endured treatments that were ineffectual, if commonplace. Often the treatments were simply harmful and increased whatever mental problems a patient suffered from or induced physical ill-health that weakened patients and caused death. When not suffering chaining or beating (known by the alienists in charge, if not acknowledged) the patient could be forced to take powerful laxatives and receive repeated blooding and/or blistering.

John Locke:

According to Scull, Locke in Essay Concerning Human Understanding held that the human mind is moulded/conditioned by the education of the senses, thereby creating distortions or misassociations. This position was later utilised by Freud. Although Locke’s views provided theoretical justification for alienist treatments there was much more involved.

Employing, consciously or not, Locke’s concept of individual will gave alienists the rationale for their behaviour, believing that they could interpose their own will into the patient’s mind and jolt them into reason. Beating patients into submission had validity in this context. By torturing, bleeding, blistering the patient would regain use of their will and regain reason. Through reason participation with society was possible, as perception was the way to realise reality. He considered the restriction of reality, according to Alexander and Shelton (2014), to be based on external and internal or individualistic necessities. An uneasy mind Locke identified with unhappiness.

Locke’s ideas were bound up with individualistic perceptions of people, coherent in a society where ideas of ownership and citizenship prevailed, combined with notions of society’s forces, that is external forces, to ensure the prevalence of will/reason based perceptions. Alienists therefore had powerful arguments about their role in the resurrection of reason/will in their patients. In addition, the idea explored by Locke that reason and the engagement of individual will (Alexander/Shelton: page 279) are connected to pleasure or pleasurable experience, which is congruent with happiness, expressed through social experience, gave the professional impetus to their unlikely cures. Alienists held that they could banish one set of ideas, by putting others in their place. What evidence for the efficacy of their treatments consisted of the ‘cures’, those who appeared relieved of their problems-only of course to suffer a relapse or simply be feigning. George 111 relapsed irremediably in his last years.

Notions of human rationality were largely based upon John Locke’s conception of personal identity in terms of ’mental connectedness and continuity’. This concerned, or appears to have concerned, Protestant beliefs in individual responsibility as well as a materialist approach to ontological questions. In the sense that Locke’s investigations were used, rationality involves the connection to the everyday world, irrationality to its disconnection. The everyday world is here supposed to be materialist and not that of imagination or spirituality. Therefore earning, governing, and business activity reference normality, physical inactivity, not earning or exhibiting coherent plans or objectives abnormality. These points will also be considered in relation to modern psychiatry. In the early 19th century, these concepts were linked to delusion, or delusory states whereby a patient considered some state or some life to be theirs when all reliable evidence suggested otherwise-usually these states involve one person in a usually hostile or aggrieved relationship with everyone else. Reality requires, it seems, the support of the many before it is agreed on and believed in.

Locke held to the importance of action and roles in the creation or substantiation of identity. Roles can, and usually do, reflect a role in society. Actions specify an end result. Locke also held that individuals should be possessed of reason and reflection, where continuity and identity does not depend on the continuity of the nature of their environment. This insists on a degree of freedom in choice and judgement, which according to Locke can be unbalanced by uneasiness in feeling or thought.

From this, it can be concluded that the mad are driven by forces that disconnect experience and reflection, causing thereby actions to be inappropriately associated with un-reflected-upon identity. When someone imagines they are the new messiah (whether or not they are) such an identity is inappropriate if not contained by actions in past and present. As Locke’s understanding of identity is of an individual, and not based within the community except where the community is the object of an action, madness must be within an individual.

Treatments:

Apart from the methods described above, other treatments, considered equally dependable, were Benjamin Rush’s ‘tranquillizing chair’, forced streams of cold water directed to the head of a restrained maniac, and traumas connected to controlled drowning (Scull: 1993). Of equal cunning was the swinging chair devised by Joseph Mason Cox, which allowed for a patient to be strapped into a chair and swung violently. The idea was that by initiating fear, terror and other passions in the patient, by effecting fatigue, horripilation, vertigo, vomiting and nausea a moral and physiological treatment would ensue that would alter the patient’s trains of thoughts and perceptions. The mad-doctors who employed the swing of course issued magnificent testimonies, via case studies, to its usage. If done well, for example, all a patient’s orifices were likely to discharge waste at the same time. Methods similar to these are still employed through osmosis. Modern psychiatric ideas on mental illness and the efficacy of treatments are not vastly dissimilar.

The above methods, although referencing Locke’s concept of mind, appear to be further extensions of Humoral medicine, whereby the badness of mental illness was contained within the body and required removal. Also, they appear to have been based upon exorcism of devils and other variations of evil, which often required/requires individuals suspecting of hosting such evil entities to be beaten and broken. Clearly, mental illness was viewed then as now as bad/evil requiring incarceration and torture.

Background:

The early 19th century saw considerable public focus on insanity and madhouses. One clear reason was the madness of George 111 (1760-1820) and the treatments he received from Willis, which did much to enhance the alienist cause demonstrating alienist power over the most powerful in the land and the apparent justification of their methods.

George 111’s reoccurring illness has been described as manic-depressive psychosis or porphyria. At the time many doctors denied the King suffered from insanity, although anecdotal evidence indicates that this was the case. He first suffered symptoms when he was 24, and was consequently bloodied and blistered. Afterwards, over the years he endured several short attacks until he reached fifty when he was subject to a particularly acute attack that, according to one commentator, drove him insane. As the evidence for his worsening symptoms is unavailable or missing, we cannot know the basis for this observation, but it should not be hastily dismissed. Several doctors were called in to deal with his proposed insanity, but without success. Eventually Dr Francis Willis, who had originally taken Holy Orders before late in life becoming a physician and establishing a madhouse at Gretford, was sent for. Although Willis’s madhouse was civilised by the standards of the time, the patients often being taken for walks in the countryside, it was observed that he ruled through fear. Keepers were allowed to strike patients, a common enough practice, if required or perhaps even desired.

Willis saw his treatment as based on a battle of wills, see above, whereby he would dominate the patient employing intimidation, coercion and constraint. Any rebellion meant that the patient would be punished by being forced into a straightjacket and their legs tied to the bed. As was common at that time in the treatment of lunacy, the King was blistered, cupped and leeches were applied to his temples. The blistering caused him immense pain and unable to walk. In addition, he would, even when removed from the straightjacket, have his arms fastened across his chest, and later placed in a constraining chair.

Although subjected to all this, the King began to recover, but whether because or despite his treatment it was unclear. Likely, the attack, whether caused by physical or mental problems, subsided as had happened before. Although many continued to regard him as a charlatan, Willis was well-rewarded for his efforts. In 1801 George 111 again had a relapse, and Willis once again involved subjected the now old monarch to kidnapping, staring (whereby the doctor stared at a patient, cowing them into disobedience) and possibly beatings. He after suffered a number of violent mood swings, imagined he was talking to angels and had erotic delusions. Power was given to his son, the Regent, in 1811, .and he died insane in 1820. Hunter and MacAlpine famously studied George 111’s medical condition and decided, noting symptoms such as skin complaints, photosensitivity, coloured urine and paranoia that he suffered from porphyria.

John Perceval:

Perceval’s case in the early 19th century remains important for his insights into the treatment of the time, and to his ability to communicate such insights which he did in A Narrative of the Treatment Experienced by a Gentleman during a State of Mental Derangement: Designed to Explain the Causes and the Nature of Insanity and to Expose the Injudicious Conduct Pursued towards many Unfortunate Sufferers under that Calamity. In modern parlance it represents an expose of mad-houses, Alienists and the treatments accorded to patients. Unfortunately, the authority of a patient could not and cannot carry the authority of the Alienist or Psychiatrist, as belief and trust is so fixed in the latter as to deny analyses.

John Perceval was a son of Spencer Perceval, the only British Prime Minister to be assassinated. At the time of his father’s death, John was still a child. No doubt deeply affected by his father’s death, nevertheless John pursued the expected career path of one of his class. Educated at Harrow, he joined The Grenadiers and served in Portugal, but found army life boring and missed both women and study. From an early age he appears to have been analytical, sceptical of human institutions and religious.

As he grew more religious, regularly fasting, he began to experience prophetic visions. As a consequence he fell in with a religious sect to which he may have been introduced by his older brother, Spencer, the ‘Row Heresies’ or ‘Row Miracles’, and there learnt to speak in tongues. Feeling filled with the Holy Spirit, he returned to Oxford. While there he had an episode with a prostitute and feared he had become infected with venereal disease. This caused him deep-seated religious anguish and guilt. Also, he self-medicated with liberal doses of mercury. Alarmed by his subsequent behaviour, his friends called in a doctor, whereby he was restrained and later Spencer his brother was contacted and an Alienist’s help enlisted. To John, spirits had invaded his mind, voices that instructed his behaviour.

As a consequence of the above, John arrived at Brislington Asylum run by Edward Long Fox at Downend in Bristol. There patients were segregated according to class, gender and the potential towards violence. John was placed with the violent gentlemanly class of patient. Outwardly respectable, neither John’s brother nor the local JPs who inspected and licensed such facilities could see anything remiss in its treatment of the mad.

As a patient in Brislington, John experienced restraints in a room alongside 12 others, feet manacled and secured to the floor and his body attached to the wall by a wide leather strap. On occasion, patients fouled themselves or wept at their fate. Throughout his ordeal, his tor-nails went uncut, his hair cut in a bizarre fashion by an attendant and his physical health declined. His spirits, or voices, would instruct him to wrestle with one of the attendants, resulting in his being strait-waistcoated. He later reported canning and beatings by his attendants, although this was contrary to the rules of the institution. His attendant, whom he long considered Herminet Herbert, but who in fact was Samuel Hobbs (Wise: 2012: page 39), tormented and ridiculed him. Abuse on all occasions by other attendants was habitual.

Prone to seeing Jesus amongst labourers, his unsettled mind could not be doubted. His spirits, or voices, were particularly vigorous, seeming to come from within his skull, from another part of the room or in the air. Each voice was different, speaking in different tones, and resembling friends and relatives. Voices of contrition dwelt in his left temple and forehead, while those of joy and honour were coming from his right. His voices informed him that he was suffering as the consequence of purely imaginary crimes. Then, according to Perceval, he rejected his voices, he began to deny their authenticity and acknowledge where and who he was. He requested a pocketbook where he was able to ‘collect, arrange and rearrange his ideas.’

Although demonstrating clear signs of improvement, Dr Fox became more benevolent towards him but still controlled his environment and his communication with others. By now, John considered himself as almost back to normal. John Perceval was isolated from his family on Dr Fox’s instructions as it was held that outside stimulation would affect any cure. John’s letters to his mother, full of complaints, were withheld. His mother, Lady Carr, accepted Dr Fox’s version of events and of her son’s health. Nevertheless, evidence remains that John at this point employed abusive language that others required protection from it seemed, although whether he used epithets through continued mental illness or frustration is difficult to say.

During his time at Brislington John made a number of observations. 1) The Fox’s habitually kind expressions apparently incongruent with the coercive nature of the services in Brislington. This was probably in line with the accepted belief of the time that lunatics were no more than children in their intellectual perceptions and general behaviour. 2) How other patients were calm and rational when they entered the mad-house, but quickly deteriorated into beast-like behaviour after suffering a few months of the treatment at Brislington. To this John averred that turning humans into pigs must be part of the treatment, and part of the cure back to the correct state of mind. 3) In order to cope with his situation, John developed political and social explanations of aristocratic decline and other social changes that allowed for more brutal mind-sets to dominate. Perhaps this, although bearing a strong relationship to the truth, was his reaction to becoming a commercial commodity-an object. As probably with many other intelligent and educated patients, the belief that brutality could be a form of treatment and induce cures was hard for him to appreciate, nor was it perhaps easy to sidestep such cognitive barriers and accept that the real reasons lay often with greed and power. John nevertheless grasped that what was occurring at Brislington demonstrated a new age of exploitation of the weak and vulnerable, see also in the state-approved use of pauper corpses for medical research.

Scull (1993: 79) views Dr Fox and Brislington House differently, describing the treatment there as enlightened compared to other mad-houses, where restraint was rarely used and violence towards patients non-existent. Perhaps, in this we should take Perceval’s word for the nature of Brislington House rather than that of a House of Commons Select Committee that visited Fox’s mad-house in 1815. While clearly part of the problem was one of expectations, and Fox was a man of good intentions, surely Perceval’s criticisms are correct? Fox, in a position of power, saw himself as an expert and his views on the treatment of the mad correct, but scientific and logical reasoning gave the lie to both beliefs. His acquisition of the role fulfilled nevertheless one of Locke’s principles of reality-as Perceval’s role of patient completed another.

When John eventually induced his relief from Brislington, to his distress he was taken to Ticehurst Asylum instead of the family home. This proved to be a more civilised environment and he was given his own quarters free of restraints. By then, he was physically ill and his nerves, whether because of his mental issues or because of his experiences at Brislington, were in a very poor condition. By 1832 John considered himself sane again and began to consider suing Dr Fox. At Ticehurst Asylum a gentler form of ‘moral treatment’ was the preferred method.

Although John, according to his testimony, showed clear signs of recovery Dr Newington, who ran Ticehurst, refused to let him leave noting that it was essential for recovering patients to be kept away from excitement. John rejects this notion, declaring that exposure to other viewpoints and situations strengthened his reason, which John appears to perceive of as understanding, while Dr Newington and other alienists would more likely to have considered as willpower. Was Dr Newington’s continued capture of John based on specialist concern or as Wise appears to believe on the prestige of having a member of the Perceval family in his mad-house and the large sums he regularly received for his care? What was Dr Newington’s specialist knowledge except for his proprietorship of an institution and regular observation of its patients? Having John in his mad-house was good for business. Yet, as Wise goes on to record, Newington ploughed most of his profits into care for pauper lunatics and to the development of his facility.

John’s growing anger ensued his continued stay as anger then and now was seen as evidence of madness. To the carers they are only doing good so patient anger is not congruent with their perceptions of reality. According to Wise (2012: page 57), John came to the understanding that in order to be released, he was required to give up his individuality and autonomy, that he had to assume the role of the mad person and become un-challenging, conformist and un-analytical. This position can also be found in more recent patients of modern mad-houses. Perceval saw the ‘moral treatment’ offered at Ticehurst as equally cynical as the brutal coercion of Brislington mad-house as it involved repression of the real person, their thoughts and feelings, through mildness, coaxing and solitary confinement. Nevertheless, he appears to have understood that in order to be released he must appear to be sane, and to achieve that he needed to appear to share the perceptions, the conformist view of reality, of his guards. In earlier periods, the threat of further torture was sufficient for incarcerated souls to submit to conventional mind-sets.

Letters written by John were not delivered to the designated person, one escape attempt resulted in his being manacled, and his clear, concise replies to the three Sussex justices of the peace elected to safeguard the sane from wrongful incarceration, rightly noting the commercial reasons that Dr Newington prolonged his stay and that of others was accused of imagining things. Would he have been released earlier if he had said instead that his treatment was marvellous, that Dr Newington was a wonderful alienist who knew exactly what he was doing?

Analyses:

Did the treatment of John Perceval and others at the time have any effect on subsequent cures? On what basis would it have done so? In further papers, I hope to establish that the flaws within psychiatry exhibited above, the attachment to unscientific theories, the behaviour, remains the same, and that these early abuses still exist, if in different forms.

By present standards, none of the alienists had spent any time studying mental illness as such courses did not exist. They were self-declared experts, justified by the existence of madhouses, the prominence of madhouses in any location in which they were placed, their management of madhouses, lengthy observation of the inmates and the acceptance of their expertise by members of the state whether local or central. There is only limited evidence that any had any awareness of human nature, capacity for analyses or scientific inclinations. They appear instead to have possessed fixed ideas about madness and the world in general based upon unexamined premises.

The establishment of madhouses, the creation of the alienist role inhabited by individuals who may or may not have had medical degrees (although in this area, these meant nothing), changed the treatment of the mentally ill from that of funny or dangerous local eccentrics into long term inhabitants of institutions, creating also a legal reason for imprisonment that did not involve criminal activity or necessarily the courts, but was based upon the judgement and will of the Alienist. Sarah Wise (2012) records numerous cases of false imprisonment within mad-houses as a consequence of avaricious, controlling parents/children, alienists/psychiatrists subjective views on religion, crookery, and jealousy. It also created the idea that lunacy was for life-even now part of the medical profession’s viewpoint. Anyone once judged mentally ill must be forever policed. It created the idea that problems of the mind were strictly a medical matter, only to be treated by doctors, and bound by any theories on the mind expounded by doctors. It expounded a particularly unfortunate view of the mentally unbalanced, that it affected their whole being. Sarah Wise (2012: 137) describes Sir Alexander Morison, a celebrated alienist, insisting that one patient, a Mrs Cumming, probably falsely incarcerated as a development in quarrels with her daughters and their husbands, as wilfully suppressing her madness as she gave ample evidence of business acumen. According to Morison, madness was entire and all aspects of the individual are affected. This view has since been continuously held by psychiatrists. He decided she was suffering from monomania, relating to her views on her daughters and their husbands. In fact evidence for Mrs Cumming’s madness came almost entirely from her family who stood to gain from her incarceration. As I will later show, then as now, psychiatry is often dependent upon anecdotal evidence-often from relatives of the supposed lunatic.

Madness, especially its diagnosis, is complex involving family, patient and the medical profession, but invariably the identified mad-person is used as a point to distract other issues.

Great Incarceration:

Although the Great Incarceration proposed by Michel Foucault appears not to have occurred in Britain during the Enlightenment, it did so in the early 19th century in connection with the involvement of doctors (real or self-proclaimed) in the containment and curing of madness, the growth of private and public madhouses, and the provision of solutions for the poor and criminals based upon notions of intentionality.

Had John been treated today, likely as not it would be for Schizophrenia, the dominant symptoms of which are hearing voices. Even now, his consumption of mercury would not be considered an issue for diagnosis as these ‘illnesses’ stand alone, apart from contingency and environment. He would not have experienced an epiphany as his reasoning capacities would be severely reduced by the drugs prescribed. He would in addition be under a doctor for life with the expectation of regular confinement. Any notion that the voices would naturally disappear would be ridiculed or dismissed. The mind’s self-healing properties are rejected outright, except by William Battie, the founder of St. Luke’s Hospital for Lunatiks (Arnold: 2009: 131). Perceval’s cogent analysis of his illness and independent recovery demonstrates the mind’s capacity for spontaneous re-structuring.

If, by some good fortune, he was not categorised as schizophrenic it would instead be for personality disorder or border-line personality disorder. His rejection of treatment, rejection of psychiatric thinking would be enough to encourage this viewpoint. Then as now, the patient’s relationship with the doctor, a supremely powerful figure who determines in his/her person and behaviour the nature of reality, determines diagnosis and treatment.

In fact, here we are faced with philosophical points that are invariably deflected by psychiatrists as their expertise is perceived of as outside the usual cognitive processes dependent as they are on medical will. Although I will later consider this at greater length, a problem with psychiatric treatments then and now is that psychiatrists do not believe that anything they do affects the patient except benevolently or rather with curative possibilities. On this basis, can it really be scientific?

For psychiatrists in general and as an elite group, psychiatric abuse is in the past and has no connection to the present and future, which is considered triumphantly. For psychiatry, the past is always another country from which nothing can be learnt. Later papers will demonstrate that the failings of analyses and intelligence considered here, evident also in psychologists and psychotherapists, can be found in present treatments and psychiatric viewpoints.

In John’s case, the alienists would not see that their brutal behaviour could affect their patients deleteriously, nor that their more considered treatments, such as induced monotony, were bad for them. John believed that communication between patient and alienist was essential as otherwise all evidence remained fantasy, anecdotal and guesswork. Understanding of madness was framed within the authority and perceptual systems of the alienist.

Perceval possessed high intelligence and intuition, but did not have the success in life he should have had. This seems to have been a direct consequence of his diagnosis, such as it was, and incarceration in two prominent mad-houses. In the previous century, mental health problems were not enough to exclude success in life, as evidenced by Dr Johnson and Pitt the Elder, a successful Prime Minister, who may have suffered from Manic Depression. Catharine Arnold asserts that 18th century Britain was replete with the mad, with many famous ones including, apart from the two above, William Blake and Collins. Not really that many, nor really mad. The growth of alienist status and the growing acceptance of mad-houses appears to have altered public perceptions of mental illness. The progressive use of control, even if played out away from public gaze, meant that anyone accused of madness and incarcerated in a madhouse remained unproductive.

Cases:

If normality or abnormality is dependent on the formulations of an elite group, those with power, then this can be imposed upon others.

While John showed clear signs of distress, in another age they might have been dealt with through religious care or a religious vocation. Clearly John experienced levels of guilt others did not share, and because in the early 18th century religious feeling and experience were distrusted his feelings and thoughts were thereby abnormal. Assertions of John’s lunacy were directly connected to his inability to engage with the everyday world-intuitively considered real and rational.

During the 19th century new concepts of mind developed, usually constructed on core beliefs and from the position of a small elite group. To a considerable extent, this was based on Locke’s empiricism which held that each person had an agentic, reflective mind (Alexander/Shelton: 2014: page 259) and was capable of thinking clearly and intelligently. Each was fully capable of achieving happiness in a free society under a representative government. For Locke, people were separate embodying partially independent, realised entities of Self. Locke’s vision of psychology was connected to responsible citizenship and commercial society. This, in many ways, still influences psychiatrists’ thinking in the present day. Of equal consequence was and is the effect of Locke’s version of reality, based upon perception rather than belief, and determined by conventional material acceptance. By the 20th century, this had morphed into ideas of normality/abnormality often employed as a yardstick by psychiatrists and psychotherapists.

NOTE FROM THE AUTHOR:

This essay is revised from a paper that forms part of a greater piece 'An Unusual Power: the rise and influence of medical doctors' published at present in Academia.edu. The greater piece charts and analyses the expansion of medical power and status and the credibility of medical theories.