Thursday, October 27, 2016

Flawed pioneer of biological psychiatry

I have been reading Richard Noll's book American Madness, which is well worth a read. He includes information about Bayard Taylor Holmes (1852-1924), a Chicago physician and surgeon, whose son was diagnosed with dementia praecox aged 17. Holmes was devastated by his son's illness and vowed to use his scientific expertise to find a cause and cure for dementia praecox (the precursor name for schizophrenia).

He came to believe that caecal stasis led to the production of ergot-like toxic amines that poisoned many organs in the body, including the brain leading to dementia praecox. The solution was appendicostomy or caecostomy and daily irrigations of the caecum. This theory was congruent with popular theories of autointoxication at the time. For example, Emil Kraepelin, the originator of the concept of dementia praecox, speculated that the sex glands were the source of toxins that poisoned the brain in dementia praecox. In fact, Kraepelin was unusual in blaming the sex glands rather than the intestines for autointoxication.

The first patient Holmes operated on was his son, but unfortunately he died 4 days later. This didn't stop him and colleagues operating on a further 21 patients. Only one other patient died from complications of his surgery. This story needs to be set in the context of Andrew Scull's book, Madhouse (see my review), about Henry Cotton, who operated on 645 patients by removing what he considered to be hidden infections in various parts of the body, particularly teeth and tonsils. 25-30% of Cotton's patients died, particularly from colectomy.

As I said in my book review, I think we can learn from our sense of outrage about these misguided attempts to produce biological cures for mental illness. Psychiatric practice needs to have a strong ethical foundation.


Anonymous said...

Yes that has to be our hope, that we can learn from these "misguided attempts".

However it will require action as well as outrage. Targeted, focused action to bring about a paradigm shift in ways of working with people who experience psychoses, altered mind states and/or extreme emotional states. Speaking from personal experience of having to pick up the pieces after coercive, abusive psychiatric treatment.

Mark Needham said...

I've always thought the most important lesson from figures like Cotton and Holmes is the depth of self-deception professionals are capable of toward their failure. Here's a man who killed at least a quarter of his patients without ever questioning his theories. (and emphasis on killed With all due respect, saying 25-30% of his patients merely "died" grossly understates the atrocity of his practice.) Cotton, Holmes, the enthusiasm earlier generations had for lobotomy and electroshock — all these ought to make us realize how easily psychiatrists can delude themselves while harming their patients even today.