Madhouse

With extraordinary intensity, even ferocity, historians of psychiatry often engage contemporary debates in their scholarly works. Andrew Scull is a case in point. Madhouse is his latest sally against both somatic approaches to mental illness and historians who evidence sympathy for twentieth-century psychiatrists. In lively prose, Scull retells the sensational story of Henry Cotton, the head of the Trenton State Hospital in New Jersey from 1907 to 1930. Trained by Adolf Meyer, Cotton belonged to a generation of psychiatrists determined to move their specialty out of the asylum and into the medical mainstream. Convinced that mental illnesses were rooted in neuropathology and inspired by recent breakthroughs in bacteriology, they aggressively pursued a variety of biomedical therapies. Henry Cotton was particularly interested in the potential of localized inflections (for example, in the teeth, the tonsils, or the bowels) to weaken the rest of the body, including the mind. To combat focal sepsis, Cotton initiated an aggressive surgical program at Trenton State Hospital. On the grounds that they were or might become diseased, teeth were extracted, colons resected, and reproductive organs removed. Between 1918 and 1925, Cotton and his staff performed more than two thousand such operations. The results, he claimed, were astonishing. Patients who had been ill for years recovered at high rates. However, as Scull notes, the cost of such success was high. Approximately one-third of Cotton's patients, many relatively young, died during or after surgery. Although a legislative exposé eventually forced Cotton into retirement, subsequent histories of psychiatry have skimmed over what Scull describes as “a horror story” (p. ix)

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