Fair Use Blog

Here’s the rules:

1. Pick a quote of one or more paragraphs from something you’ve read, in print, over the course of the past week. (It should be something you’ve actually read, and not something that you’ve read a page of just in order to be able to post your favorite quote.)

2. Avoid commentary above and beyond a couple sentences, more as context-setting or a sort of caption for the text than as a discussion.

3. Quoting a passage doesn’t entail endorsement of what’s said in it. You may agree or you may not. Whether you do isn’t really the point of the exercise anyway.

Here’s the quote. This is from the book I’ve been reading on and off most mornings this week, Ann Fessler’s The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade. This is from chapter 6, Going Away, which focuses on the institutional set-up of the maternity homes themselves and the experiences that pregnant women had when they arrived in them. Although this passage doesn’t discuss it, elsewhere in the book Fessler notes a couple of things which may help put the rest in context: first, Fessler points out elsewhere that, in all the social-work discussion of the causes of illegitimacy, every new wave of theory offered a different explanation of the unwed mother’s defects. Never discussed was whether unplanned pregnancies had anything to do with the personal characteristics, social position, attitudes, psychology, or actions of unwed fathers. The development of theory after theory by the self-styled experts was not a good-faith intellectual effort, and it didn’t emerge in an ideological vacuum; it was theorizing driven by the need to rationalize a social process of shaming and blaming. Second, she also mentions elsewhere the emerging notion of social work professionalism, and the kind of coercive tactics they used, didn’t emerge in an institutional vacuum, either; they were caught up with the fact that maternity homes were increasingly being transformed into intermediaries in health and social services spending by state governments. Women mentioned how social workers would coerce them into surrendering, if they expressed second thoughts, by saying that they would have to pay the state back thousands of dollars for their stay in at the maternity home and for their hospital bills. At the far extreme, one of the women she interviews mentions a case she had heard of, in which a mother who refused to relinquish was forcibly committed to a state mental hospital (on the grounds that she must be crazy) until she agreed to surrender her baby, months later. Anyway. Keeping that in mind, on with the quote:

For most of the women I interviewed, however, especially those who were younger, being sent to a maternity home was a traumatic experience. They had been banished from their schools and homes, they were soon to give birth to a child, and rather than being surrounded by caring family members they were living in institutions among strangers. Although many felt camaraderie with the other young women who were there, they also felt that the environment was cold and demeaning and that the disapproval of those who looked after them was palpable.

The philosophy and mission of maternity homes had changed considerably since the early 1900s, when the maternity-home movement began. The religious women who first ran the homes saw themselves as sympathetic sisters who were there for women who had no other place to turn. The home was a place of refuge and spiritual reform for women who had, in their eyes, been seduced and abandoned. Motherhood, they believed, would increase a woman’s chances of living a good and proper life. During this time, babies were not separated from their mothers except under extreme circumstances, as when women cannot be helped or compelled to meet their obligation as parents. The homes generally encouraged bonding through breast-feeding and they helped the women find employment—usually as domestic servants—which would enable them to care for their child and to work. Well into the early 1940s, some homes still encouraged, if not required, the mother to breast-feed her baby to ensure that a bond developed between mother and child.

But by the end of World War II, a sea change had occurred in the mission and philosophy of the homes. Maternity homes of the 1950s and 1960s were, to a great extent, a place to sequester pregnant girls until they could give birth and surrender their child for adoption. If a young woman was unsure of or uninterested in relinquishment, the staff attempted to convince her that it was her best, and perhaps only, option. Though maternity homes were the only place a girl in trouble could turn for help outside of her family, by the 1950s they best served her interest if her interest was in giving her child up for adoption at the end of her stay.

The change in philosophy was highly contested among those who ran the homes and did not come about uniformly. To a great extent the views at individual homes changed as the staff changed. Between the turn of the century and the 1940s, the women who had founded the homes were supplanted by professional social workers who reshaped the understanding of nonmarital pregnancy.

In the first two decades of the twentieth century, social work evolved into a genuine profession, and those who helped professionalize the field were eager to differentiate themselves from charity workers and reformers, whom they saw as overly sentimental and old-fashioned. These professionals formulated what they considered to be more rigorous approaches to social problems, rather than basing their practices on religious perspectives. As the professionals took positions at maternity homes and began to work alongside religious reformers, philosophical clashes resulted. Social workers claimed expertise. As trained professionals, they considered themselves better equipped to diagnose the problems associated with illegitimacy. While their religious predecessors had generally attributed out-of-wedlock pregnancy to the social circumstances of the women’s lives and to outside social forces, the new breed of social worker focused on the women themselves. Over many years, they posited a number of theories about why single women became pregnant, all of which were predicated on the problems inherent in the women themselves.

In the early 1900s, most social workers argued that women who became pregnant out of wedlock were feebleminded; their pregnancy was proof of their feeblemindedness. This made them seem especially dangerous to society because it was believed that these women were not only likely to be repeat offenders, but that they would produce offspring of low intelligence, claiming that the country was in the midst of moral decay and that the family was breaking down, as evidenced by lower birthrates among the better classes of people. They believed that unwed mothers were both the product of bad homes and the cause of broken homes. During this time the concern over nonmarital pregnancy was so great that many feebleminded unwed mothers were either institutionalized or sterilized.

Classifying all unwed mothers as feebleminded, however, proved impossible. Social workers had to acknowledge that many of the women who became pregnant were normally intelligent and relatively well-balanced young women. So a new category was identified, that of the delinquent. This type of womanhad a parallel in the male population. But where delinquency in the male was identified by criminal behavior, female delinquency was defined in sexual terms. The young women who fell into this category were largely seen as those belonging to the working class. By the 1920s, many single women were working in factories, offices, and department stores. They enjoyed a degree of independence and opportunities to fraternize with men. Their sexual lives did not always conform to middle-class standards and in those cases were labeled sexually deviant. This behavior, incidentally, was soon to invade the ranks of the middle class.

Despite the widespread characterization of unwed mothers as either feebleminded breeders or sex delinquents, letters and internal correspondence from Florence Crittenton homes operating in the 1940s offer evidence to the contrary, and the personnel at the homes were still generally supportive of and empathetic to the girls in their charge. A concrete example of such support was found in the application materials for the Kate Waller Barrett Scholarship, which was sponsored by the Crittenton homes in the early 1940s. These scholarship funds were described in materials printed by the Florence Crittenton Mission as being available to a girl who wishes to continue her education to enable her to care for her child. The application required support letters from the superintendent of the home and if the application was successful, the agreement stipulated that the staff at the Crittenton Home would assume responsibility for the care of the child, if necessary, while the mother attended school.

. . .

The kind of support and compassion demonstrated by maternity-home staff in these letters seems to have all but evaporated in the years after World War II. The ongoing struggles between those who aligned themselves with the sentiments of maternity-home founders and those who adopted newer professional strategies came to a symbolic if not an actual end in 1947, when the National Florence Crittenton Mission abandoned its policy of keeping mother and child together.

As the philosophical differences narrowed in the 1940s and social workers coalesced towards agreement on the best course of action for unwed mothers and their babies, efforts to identify the cause of out-of-wedlock pregnancy took a new turn. With the dramatic rise in premarital pregnancies after the war, and as greater numbers of middle-class women became pregnant, it became increasingly implausible to label all of those women as either feebleminded or sexual delinquents. Social workers noted that many of these new unmarried mothers were middle-class girls from good families. A Crittenton social worker wrote about these girls that the sizeable numbers further confound us by rendering our former stereotypes less tenable. Immigration, low mentality, and hyper sexuality can no longer be comfortably applied when the phenomenon has invaded our own social class—when the unwed mother must be classified to include the nice girl next door, the physician’s or pastor’s daughter.

Social workers turned to the growing field of psychiatry for their answer and, as early as the 1940s, began to classify middle-class girls who became pregnant as neurotic: the unwed mother was a neurotic woman who had a subconscious desire to become pregnant. This theory dominated much of the diagnosis and treatment of unwed mothers in the decades that followed the war. Though social workers had been quick to condemn working girls as sex deviants, this new explanation was more appealing in explaining middle-class pregnancy because it downplayed the issue of sexual drive. By identifying the young woman’s goal as pregnancy, rather than sex, the diagnosis of deviance could be bypassed. Though a young woman’s peers, family, and community may still have attributed her pregnancy to loose morals or an overactive sex life, professionals determined that the problem was in her mind.

One of the outcomes of this new professional diagnosis was the justification of the separation of mother and child: a neurotic woman was seen as unfit to be a mother. Given the stigma of illegitimacy in the 1950s and 1960s, many middle-class parents were quick to agree that the solution to the problem was relinquishment and adoption. Following this course, their daughter would be given a second chance. Her pregnancy would effectively be erased from her history and she could expect to go back to a normal life as if it had never happened. Without her child she would be able to marry a decent man and have other children. She would not have to live with her mistake. Adoption also came to be understood as being in the best interest of the child. Rather than growing up with the stigma of illegitimacy and an unfit, neurotic mother, the child would be raised by a stable, well-adjusted married couple.

And though some maternity-home workers were still empathetic to young women who did not want to surrender their baby for adoption, in the postwar years this breed of social worker was rapidly becoming extinct. Internal struggle at the maternity homes continued even into the 1950s, and are evident in correspondence between the leadership of the Florence Crittenton Association of America and the newly hired staff of individual homes. In a letter dated December 23, 1952, Robert Barrett, the chairman of the Florence Crittenton Mission, expresses his concern over a move to shorten the minimum length of a girl’s stay in the maternity home postpartum. The purpose of a mother’s and child’s returning to the home after birth was, Barrett asserts, to give the mother time to be with her baby before making a final decision to surrender. He writes:

Personally I feel very badly that a girl in our Homes shall not be given every opportunity and help to keep her baby if she wants to. Often a girl who has made up her mind to give up her baby feels different after the baby comes and her mother’s instinct is aroused. Not to give her that chance seems a cruel and unnatural proceeding. I am not sure but I feel it would be better for the girl if she tries to take her baby and fails and has to give it up later.

The new policies were shaped by the experts—primarily psychiatrists, social workers, and medical professionals—and promoted by social organizations that had the power and the means to disseminate the ideas. The women whose babies were being placed for adoption were not in any position to influence the policies made on their behalf. Shame is a very effective way to silence individuals, and those who are less socially or economically powerful are rarely in a position to influence the decisions that affect them.

. . .

In theory it was not the social worker but the mother who made the ultimate decision whether to parent or relinquish. A Florence Crittenton brochure from 1952 reads, The mother is under no compulsion, either to leave her baby with us, or to take him with her. There is no priority for either. But it also states that although the mother should perhaps make the choice, not always is she well qualified to make this last decision. And though maternity homes were thought to be safe havens and the goal of all these efforts combined is to induct into society a mother and child, each well started on the road to successful living, in reality this goal was often not fully realized.

Rather than young women being given a realistic picture of the responsibilities and costs of raising a child and allowing them to weigh that information against the resources available to them so they could participate in making an informed decision, they were rendered powerless. And though it might be easy to empathize with a social worker’s efforts to try to persuade a young woman of few resources to be realistic about raising a baby, especially if she lacked family support and did not understand the difficulty and sacrifice involved in raising a child as a single parent, the persuasive techniques were often quite forceful. The degree of pressure put on the women to surrender sometimes crossed the line from persuasion to outright coercion. Many of the women I interviewed recalled high-pressure campaigns waged by the maternity-house staff.

I remember the woman at the adoption agency, a very pleasant woman, smiling, always smiling, and using comforting tones. She sat there and said that I had nothing to offer a baby. I had no education, I had no job, I had no money. Oh, God, they really knew how to work you. Talk about no support, it was how far can we beat you down while we’re smiling?

The social worker was telling me, No man is going to want to marry you, no man is going to want another man’s baby. She proceeded to tell me that the adoptive parents they would find for the baby would be college educated, degreed, they would be much older, they would own their own home, have high incomes. They would be able to give the baby everything that I could not.

They told me I was unfit because I wasn’t married. I didn’t have this, I didn’t have that. Well, it turns out her adoptive parents were just a couple of years older, and neither one had a college education. Nothing against them, but the adoption agency lied to me. They also divorced when she was fourteen. I’m with the same man for thirty-eight years. Financially, her adoptive family was better off than we were, but other than that it wasn’t anything like what the agency promised.

—Christine

The argument that others would be better parents presumed, of course, that the mother’s own economic standing would not improve anytime soon, if ever, through further education, job or career training, marriage, or family support. It also presumed that the adopting couple’s status would not deteriorate through divorce or job loss. Essentially, the gap in economic and marital status between the mother and adoptive family was seen as fixed, whereas only a decade earlier the mother’s circumstances had been viewed as temporary and improvable, and steps were taken to help her become self-reliant.

In the postwar years, most of the homes aimed simply to ensure that the physical needs of the women were met until they could give birth and relinquish the baby. And despite the momentous life change that they were about to go through, most were sent to the hospital knowing nothing about childbirth, nor were they counseled about the impending separation. Most were completely unprepared for the emotions that would follow their transition from pregnant girls to mothers.

. . .

Of course, the pregnant women who went into hiding were not of one mind; nor were the staff of the institutions they entered. A few women reported that they were counseled in a respectful manner and came to their own decision. But the majority of the women I interviewed did not make a decision to surrender. Many women, even those in their twenties, followed the only path that was available to them—the one prescribed by society, social workers, and parents. After all they had been through, and all they had put their parents through, they felt that, more than anything, they needed to regain their family’s acceptance. Some women decidedly did not want to surrender but were unable to devise a plan that would allow them to care for their baby without some temporary assistance. Many of the women who wanted to parent would have been capable of doing so with a modest amount of support, the kind offered to Bea only a decade or so earlier. But by the mid-1960s professionals were no longer offering this kind of support, and more than 80 percent of those who entered maternity homes surrendered.

— Ann Fessler (2006), The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade. New York: Penguin. 142–153.

Here’s the rules:

1. Pick a quote of one or more paragraphs from something you’ve read, in print, over the course of the past week. (It should be something you’ve actually read, and not something that you’ve read a page of just in order to be able to post your favorite quote.)

2. Avoid commentary above and beyond a couple sentences, more as context-setting or a sort of caption for the text than as a discussion.

3. Quoting a passage doesn’t entail endorsement of what’s said in it. You may agree or you may not. Whether you do isn’t really the point of the exercise anyway.

Here’s the quote. This is from the book I’ve been reading on and off most mornings this week, Ann Fessler’s The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade. This is from chapter 6, Going Away, which focuses on the institutional set-up of the maternity homes themselves and the experiences that pregnant women had when they arrived in them. Although this passage doesn’t discuss it, elsewhere in the book Fessler notes a couple of things which may help put the rest in context: first, Fessler points out elsewhere that, in all the social-work discussion of the causes of illegitimacy, every new wave of theory offered a different explanation of the unwed mother’s defects. Never discussed was whether unplanned pregnancies had anything to do with the personal characteristics, social position, attitudes, psychology, or actions of unwed fathers. The development of theory after theory by the self-styled experts was not a good-faith intellectual effort, and it didn’t emerge in an ideological vacuum; it was theorizing driven by the need to rationalize a social process of shaming and blaming. Second, she also mentions elsewhere the emerging notion of social work professionalism, and the kind of coercive tactics they used, didn’t emerge in an institutional vacuum, either; they were caught up with the fact that maternity homes were increasingly being transformed into intermediaries in health and social services spending by state governments. Women mentioned how social workers would coerce them into surrendering, if they expressed second thoughts, by saying that they would have to pay the state back thousands of dollars for their stay in at the maternity home and for their hospital bills. At the far extreme, one of the women she interviews mentions a case she had heard of, in which a mother who refused to relinquish was forcibly committed to a state mental hospital (on the grounds that she must be crazy) until she agreed to surrender her baby, months later. Anyway. Keeping that in mind, on with the quote:

For most of the women I interviewed, however, especially those who were younger, being sent to a maternity home was a traumatic experience. They had been banished from their schools and homes, they were soon to give birth to a child, and rather than being surrounded by caring family members they were living in institutions among strangers. Although many felt camaraderie with the other young women who were there, they also felt that the environment was cold and demeaning and that the disapproval of those who looked after them was palpable.

The philosophy and mission of maternity homes had changed considerably since the early 1900s, when the maternity-home movement began. The religious women who first ran the homes saw themselves as sympathetic sisters who were there for women who had no other place to turn. The home was a place of refuge and spiritual reform for women who had, in their eyes, been seduced and abandoned. Motherhood, they believed, would increase a woman’s chances of living a good and proper life. During this time, babies were not separated from their mothers except under extreme circumstances, as when women cannot be helped or compelled to meet their obligation as parents. The homes generally encouraged bonding through breast-feeding and they helped the women find employment—usually as domestic servants—which would enable them to care for their child and to work. Well into the early 1940s, some homes still encouraged, if not required, the mother to breast-feed her baby to ensure that a bond developed between mother and child.

But by the end of World War II, a sea change had occurred in the mission and philosophy of the homes. Maternity homes of the 1950s and 1960s were, to a great extent, a place to sequester pregnant girls until they could give birth and surrender their child for adoption. If a young woman was unsure of or uninterested in relinquishment, the staff attempted to convince her that it was her best, and perhaps only, option. Though maternity homes were the only place a girl in trouble could turn for help outside of her family, by the 1950s they best served her interest if her interest was in giving her child up for adoption at the end of her stay.

The change in philosophy was highly contested among those who ran the homes and did not come about uniformly. To a great extent the views at individual homes changed as the staff changed. Between the turn of the century and the 1940s, the women who had founded the homes were supplanted by professional social workers who reshaped the understanding of nonmarital pregnancy.

In the first two decades of the twentieth century, social work evolved into a genuine profession, and those who helped professionalize the field were eager to differentiate themselves from charity workers and reformers, whom they saw as overly sentimental and old-fashioned. These professionals formulated what they considered to be more rigorous approaches to social problems, rather than basing their practices on religious perspectives. As the professionals took positions at maternity homes and began to work alongside religious reformers, philosophical clashes resulted. Social workers claimed expertise. As trained professionals, they considered themselves better equipped to diagnose the problems associated with illegitimacy. While their religious predecessors had generally attributed out-of-wedlock pregnancy to the social circumstances of the women’s lives and to outside social forces, the new breed of social worker focused on the women themselves. Over many years, they posited a number of theories about why single women became pregnant, all of which were predicated on the problems inherent in the women themselves.

In the early 1900s, most social workers argued that women who became pregnant out of wedlock were feebleminded; their pregnancy was proof of their feeblemindedness. This made them seem especially dangerous to society because it was believed that these women were not only likely to be repeat offenders, but that they would produce offspring of low intelligence, claiming that the country was in the midst of moral decay and that the family was breaking down, as evidenced by lower birthrates among the better classes of people. They believed that unwed mothers were both the product of bad homes and the cause of broken homes. During this time the concern over nonmarital pregnancy was so great that many feebleminded unwed mothers were either institutionalized or sterilized.

Classifying all unwed mothers as feebleminded, however, proved impossible. Social workers had to acknowledge that many of the women who became pregnant were normally intelligent and relatively well-balanced young women. So a new category was identified, that of the delinquent. This type of womanhad a parallel in the male population. But where delinquency in the male was identified by criminal behavior, female delinquency was defined in sexual terms. The young women who fell into this category were largely seen as those belonging to the working class. By the 1920s, many single women were working in factories, offices, and department stores. They enjoyed a degree of independence and opportunities to fraternize with men. Their sexual lives did not always conform to middle-class standards and in those cases were labeled sexually deviant. This behavior, incidentally, was soon to invade the ranks of the middle class.

Despite the widespread characterization of unwed mothers as either feebleminded breeders or sex delinquents, letters and internal correspondence from Florence Crittenton homes operating in the 1940s offer evidence to the contrary, and the personnel at the homes were still generally supportive of and empathetic to the girls in their charge. A concrete example of such support was found in the application materials for the Kate Waller Barrett Scholarship, which was sponsored by the Crittenton homes in the early 1940s. These scholarship funds were described in materials printed by the Florence Crittenton Mission as being available to a girl who wishes to continue her education to enable her to care for her child. The application required support letters from the superintendent of the home and if the application was successful, the agreement stipulated that the staff at the Crittenton Home would assume responsibility for the care of the child, if necessary, while the mother attended school.

[…]

The kind of support and compassion demonstrated by maternity-home staff in these letters seems to have all but evaporated in the years after World War II. The ongoing struggles between those who aligned themselves with the sentiments of maternity-home founders and those who adopted newer professional strategies came to a symbolic if not an actual end in 1947, when the National Florence Crittenton Mission abandoned its policy of keeping mother and child together.

As the philosophical differences narrowed in the 1940s and social workers coalesced towards agreement on the best course of action for unwed mothers and their babies, efforts to identify the cause of out-of-wedlock pregnancy took a new turn. With the dramatic rise in premarital pregnancies after the war, and as greater numbers of middle-class women became pregnant, it became increasingly implausible to label all of those women as either feebleminded or sexual delinquents. Social workers noted that many of these new unmarried mothers were middle-class girls from good families. A Crittenton social worker wrote about these girls that the sizeable numbers further confound us by rendering our former stereotypes less tenable. Immigration, low mentality, and hyper sexuality can no longer be comfortably applied when the phenomenon has invaded our own social class—when the unwed mother must be classified to include the nice girl next door, the physician’s or pastor’s daughter.

Social workers turned to the growing field of psychiatry for their answer and, as early as the 1940s, began to classify middle-class girls who became pregnant as neurotic: the unwed mother was a neurotic woman who had a subconscious desire to become pregnant. This theory dominated much of the diagnosis and treatment of unwed mothers in the decades that followed the war. Though social workers had been quick to condemn working girls as sex deviants, this new explanation was more appealing in explaining middle-class pregnancy because it downplayed the issue of sexual drive. By identifying the young woman’s goal as pregnancy, rather than sex, the diagnosis of deviance could be bypassed. Though a young woman’s peers, family, and community may still have attributed her pregnancy to loose morals or an overactive sex life, professionals determined that the problem was in her mind.

One of the outcomes of this new professional diagnosis was the justification of the separation of mother and child: a neurotic woman was seen as unfit to be a mother. Given the stigma of illegitimacy in the 1950s and 1960s, many middle-class parents were quick to agree that the solution to the problem was relinquishment and adoption. Following this course, their daughter would be given a second chance. Her pregnancy would effectively be erased from her history and she could expect to go back to a normal life as if it had never happened. Without her child she would be able to marry a decent man and have other children. She would not have to live with her mistake. Adoption also came to be understood as being in the best interest of the child. Rather than growing up with the stigma of illegitimacy and an unfit, neurotic mother, the child would be raised by a stable, well-adjusted married couple.

And though some maternity-home workers were still empathetic to young women who did not want to surrender their baby for adoption, in the postwar years this breed of social worker was rapidly becoming extinct. Internal struggle at the maternity homes continued even into the 1950s, and are evident in correspondence between the leadership of the Florence Crittenton Association of America and the newly hired staff of individual homes. In a letter dated December 23, 1952, Robert Barrett, the chairman of the Florence Crittenton Mission, expresses his concern over a move to shorten the minimum length of a girl’s stay in the maternity home postpartum. The purpose of a mother’s and child’s returning to the home after birth was, Barrett asserts, to give the mother time to be with her baby before making a final decision to surrender. He writes:

Personally I feel very badly that a girl in our Homes shall not be given every opportunity and help to keep her baby if she wants to. Often a girl who has made up her mind to give up her baby feels different after the baby comes and her mother’s instinct is aroused. Not to give her that chance seems a cruel and unnatural proceeding. I am not sure but I feel it would be better for the girl if she tries to take her baby and fails and has to give it up later.

The new policies were shaped by the experts—primarily psychiatrists, social workers, and medical professionals—and promoted by social organizations that had the power and the means to disseminate the ideas. The women whose babies were being placed for adoption were not in any position to influence the policies made on their behalf. Shame is a very effective way to silence individuals, and those who are less socially or economically powerful are rarely in a position to influence the decisions that affect them.

[…]

In theory it was not the social worker but the mother who made the ultimate decision whether to parent or relinquish. A Florence Crittenton brochure from 1952 reads, The mother is under no compulsion, either to leave her baby with us, or to take him with her. There is no priority for either. But it also states that although the mother should perhaps make the choice, not always is she well qualified to make this last decision. And though maternity homes were thought to be safe havens and the goal of all these efforts combined is to induct into society a mother and child, each well started on the road to successful living, in reality this goal was often not fully realized.

Rather than young women being given a realistic picture of the responsibilities and costs of raising a child and allowing them to weigh that information against the resources available to them so they could participate in making an informed decision, they were rendered powerless. And though it might be easy to empathize with a social worker’s efforts to try to persuade a young woman of few resources to be realistic about raising a baby, especially if she lacked family support and did not understand the difficulty and sacrifice involved in raising a child as a single parent, the persuasive techniques were often quite forceful. The degree of pressure put on the women to surrender sometimes crossed the line from persuasion to outright coercion. Many of the women I interviewed recalled high-pressure campaigns waged by the maternity-house staff.

I remember the woman at the adoption agency, a very pleasant woman, smiling, always smiling, and using comforting tones. She sat there and said that I had nothing to offer a baby. I had no education, I had no job, I had no money. Oh, God, they really knew how to work you. Talk about no support, it was how far can we beat you down while we’re smiling?

The social worker was telling me, No man is going to want to marry you, no man is going to want another man’s baby. She proceeded to tell me that the adoptive parents they would find for the baby would be college educated, degreed, they would be much older, they would own their own home, have high incomes. They would be able to give the baby everything that I could not.

They told me I was unfit because I wasn’t married. I didn’t have this, I didn’t have that. Well, it turns out her adoptive parents were just a couple of years older, and neither one had a college education. Nothing against them, but the adoption agency lied to me. They also divorced when she was fourteen. I’m with the same man for thirty-eight years. Financially, her adoptive family was better off than we were, but other than that it wasn’t anything like what the agency promised.

—Christine

The argument that others would be better parents presumed, of course, that the mother’s own economic standing would not improve anytime soon, if ever, through further education, job or career training, marriage, or family support. It also presumed that the adopting couple’s status would not deteriorate through divorce or job loss. Essentially, the gap in economic and marital status between the mother and adoptive family was seen as fixed, whereas only a decade earlier the mother’s circumstances had been viewed as temporary and improvable, and steps were taken to help her become self-reliant.

In the postwar years, most of the homes aimed simply to ensure that the physical needs of the women were met until they could give birth and relinquish the baby. And despite the momentous life change that they were about to go through, most were sent to the hospital knowing nothing about childbirth, nor were they counseled about the impending separation. Most were completely unprepared for the emotions that would follow their transition from pregnant girls to mothers.

[…]

Of course, the pregnant women who went into hiding were not of one mind; nor were the staff of the institutions they entered. A few women reported that they were counseled in a respectful manner and came to their own decision. But the majority of the women I interviewed did not make a decision to surrender. Many women, even those in their twenties, followed the only path that was available to them—the one prescribed by society, social workers, and parents. After all they had been through, and all they had put their parents through, they felt that, more than anything, they needed to regain their family’s acceptance. Some women decidedly did not want to surrender but were unable to devise a plan that would allow them to care for their baby without some temporary assistance. Many of the women who wanted to parent would have been capable of doing so with a modest amount of support, the kind offered to Bea only a decade or so earlier. But by the mid-1960s professionals were no longer offering this kind of support, and more than 80 percent of those who entered maternity homes surrendered.

—Ann Fessler (2006), The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade. New York: Penguin. 142–153.

Biological psychiatrists--nowadays most psychiatrists--are fond of saying You can't talk to a disease. The communication of so-called schizophrenics makes no sense at all to these doctors who want to control symptoms, such as hallucinations and delusions, with drugs, electroshock, and incarceration.

The idea that these extremes of irrationality are due to a disease is inseparable from the survival of psychiatry as a profession. If schizophrenia is not a disease, psychiatry wold have little justification for using its more devastating treatments. Lobotomy, electroshock, and all of the more potent drugs, including neuroleptics and even lithium, were developed at the expense of locked-up people, most of whom were labeled schizophrenic. The search for biochemical and genetic causes keeps psychiatrists, as medical doctors, in the forefront of well-funded research in the field. The notion that patients have sick brains justifies psychiatry's unique power to treat them against their will. It also bolsters psychiatry's claim to the top of the mental health hierarchy. In short, if irrationality isn't biological, then psychiatry loses much of its rationale for existence as a medical specialty.

60 Minutes Dramatizes Psychospirituality in Schizophrenics

On July 27, 1986, 60 Minutes produced a show entitled Schizophrenia. It was based on biopsychiatric theories, and one of their experts declared, We know it's a brain disease now. It's like multiple sclerosis, Alzheimer's disease. On the show, vignettes of patients were presented to impress the audience with the bizarre quality of their communications, and hence the absurdity of any psychological meaning or underpinning to their disease.

The first 60 Minutes patient, Brugo, bolsters his identity with spirituality, as well as religion, and declares that he's not extinct: And I'm Croatian Hebrew, which is Adam and Eve's kin. And I have been Croatian Hebrew for centuries and cent--upon centuries. And I'm a Homo-erectus man, and I'm also part Neanderthal, and I mean to keep that heritage, 'cause I'm not extinct.

Packed into these few remarks is symbolism about his desperate need for personal value and dignity, his identification with religion and humanity, and perhaps his awareness of primitive impulses stirring inside himself, as well as his fear of personal extinction. Here is more than enough material to stimulate anyone's desire to communicate with him.

The second patient, Jim, is dismissed by the interviewer because he is convinced he was shot to death when he was a baby. Yet his brief remarks seem like a metaphor for child sexual abuse by a male: I had my head blown off with a shotgun when I was two years old. And--and before that, things happened in my crib. I remember all these things and stuff, but I just remember, you know. I remember all this stuff.

A therapist with experience in listening to people immediately would wonder about what lies behind Jim's direct hints about terrifying memories from early childhood, not to mention the symbolism of the crib in relation to his present trapped condition. More than one patient of mine has begun with just such anguished fragments of memory before discovering the agony of his or her abusive childhood and its relationship to current entrapments.

Another 60 Minutes patient, Ronnie, clearly is struggling with his own identity and his separateness or isolation from other people. He, too, talks in psychospiritual terms, again with undertones of possible sexual abuse. I thought everybody's bodies was connected to mine, and their--their spirits were--I was--I was laying in bed and I played--you know how we live, where, you know, like you're smashing some air for yourself? Well, like, I was smashing every spirit next to me, and the--all kinds of bad things were happening.

Still another patient Lynn, identifies herself with God and with being different, and clearly tells us that her wisdom is more than she can handle. She's practically inviting us to ask her about the inner knowledge she cannot bear: I've got the wisdom of God in me, and I have to learn how to cope with it. Nobody seems to think you're suoppsed to survive when you're different. [Crying] But I know--as--like the words in Job said, all I can say was, Have pity on me, my friends. I've been touched by the hand of God.

Brain Disease or Psychospiritual Crisis?

The patients' quotes were selected by 60 Minutes to demonstrate that so-called schizophrenia is a biochemical disease rather than a crisis of thinking, feeling and meaning. Yet people with real brain disease--such as Alzheimer's, stroke, or a tumor--don't talk symbolically like these people do.

Instead of metaphors laced with meaning, brain-damaged people typically display memory difficulties as the first sign that their mind isn't working as well as it once did. They have trouble recalling recently learned things, like names, faces, telephone numbers, or lists. Later they may get confused and disoriented as they display what is called an organic brain syndrome. In fact--and this is very important--advanced degrees of brain disease render the individual unable to think in such abstract or metaphorical terms. The thought processes that get labeled schizophrenia require higher mental function and therefore a relatively intact brain. No matter how bizarre the ideas may seem, they necessitate symbolic and often abstract thinking. That's why lobotomy works: the damage to the higher mental centers smashes the capacity to express existential pain and anguish. As we'll find out, it's also why the most potent psychiatric drugs and shock treatment have their effect.

Objects or Beings?

How are we to approach people who get labeled schizophrenic? Do we think of them as troubled humans struggling in a self-defeating style with profound psychological and spiritual issues, usually involving their basic worth or identity? Or do we view them as if they are afflicted with physical diseases, like multiple sclerosis and Alzheimer's disease, in which their feelings, thoughts, anguishes, and aspirations play no role? Do we try to understand them, or do we try to physically fix them? Do we look for profound hurts and failed psychospiritual efforts in their lives, or for biochemical aberrations in their brains? Do we wonder about what meanings and values they are seeking--and how they became so helplessly mired down in the process--or do we search for the biochemical imbalances that have twisted their brain processes?

If people who express seemingly irrational ideas are best understood mechanistically, then these people are broken, disordered, or defective devices. If we take the viewpoint that they are persons, beings, or souls in struggle, then an infinite variety of more subtle possibilities comes to mind for understanding and helping those who seem mad, crazy, or deranged.

If we are beings rather than devices, then our most severe emotional and spiritual crises originate within ourselves, our families, and our society. Our crises can be understood as conflicts or confusion about our identities, values, and aspirations rather than as biological aberrations. And as self-determining human beings, we can work toward overcoming those feelings of helplessness generated by our past spiritual and social defeats.

By contrast, the typical modern psychiatrist--by disposition, training, and experience--is wholly unprepared to understand anyone's psycho-spiritual crisis. With drugs and shock treatment, the psychiatrist instead attacks the subjective experience of the person and blunts or destroys the very capacity to be sensitive and aware. No wonder the treatment of mental patients often looks more like a war against them. It often is.

--Peter Breggin (1991). Toxic Psychiatry: Why Therapy, Empathy, and Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the New Psychiatry. New York: St. Martin's Press. 23–26.

Here’s the rules:

1. Pick a quote of one or more paragraphs from something you’ve read, in print, over the course of the past week. (It should be something you’ve actually read, and not something that you’ve read a page of just in order to be able to post your favorite quote.)

2. Avoid commentary above and beyond a couple sentences, more as context-setting or a sort of caption for the text than as a discussion.

3. Quoting a passage doesn’t entail endorsement of what’s said in it. You may agree or you may not. Whether you do isn’t really the point of the exercise anyway.

Here’s the quote. This is from Barbara Leon’s essay, Consequences of the Conditioning Line in Feminist Revolution, the 1975 anthology by the Redstockings.

Consequences of the Conditioning Line

The issue of psychological interpretation of behavior has been one of the major ideological divisions between Redstockings and other groups in the women’s liberation movement. While other groups have argued that women submit to their own oppression due to past training, brainwashing, or programming, Redstockings said:

We reject the idea that women consent to or are to blame for their own oppression. Women’s submission is not the result of brainwashing, stupidity or mental illness but of continual, daily pressure from men. We do not need to change ourselves, but to change men. —Manifesto, July 7, 1969

What other groups saw as submissive behavior, Redstockings saw as ways women, when still struggling individually, fight for what they want given their situation.

Judith Hole and Ellen Levine, in their book Rebirth of Feminism, have asserted that it was this position of Redstockings, adopted as the pro-woman line, along with an overemphasis on consciousness-raising, which led to the groups dissolution in 1970:

In the view of many feminists the anti-brainwashing/pro-woman position leads not only to a paralysis of action—what external changes in behavior can a woman effect if her behavior is understood only as a rational response to the social system—but also to a paralysis of thought. Although Redstocking’s rejection of traditionally-accepted psychological expanations of women’s behavior does offer new insights, one former member of the group has argued, When you begin to believe the pro-woman line, it distorts your perception of reality. It’s too simplistic. —Rebirth of Feminism, p. 172

Left out from the book was the pro-woman line’s prescription for collective action and political strategy. Also wrong was its conclusion as to the harmful effects of Redstockings’ anti-brainwashing theory on the history of the group. Redstockings was temporarily halted by the same problems which Hole and Levine ascribe to other women’s liberation groups, most notably attacks on leadership from within and without the group. In fact, the accuracy and importance of the pro-woman line has become more evident with recent developments.

What began, to some extent, as an analysis of women’s behavior in our personal and emotional lives now appears to have even larger political significance as we see the active use of psychological theories to deny women jobs under capitalism and to explain away the continued oppression of women in socialist countries. In both cases, women are told, failure to advance is caused by women’s lack of self-confidence and clinging to traditional roles. This blocks any real analysis of the roots of male supremacy and the continued use of power to keep women in a subordinate position. The capitalist’s self-interest requires that he maintain segregation in order to pay women less and in this way depress the level of all wages. In the case of the socialist, there are conflicting interests. On the one hand, the unpaid services provided by women as wives and mothers have great economic value and raise the standard of living of male workers. On the other hand, men’s opportunism in oppressing women detracts from the united power of the working class.

Brainwashing and Women: The Psychological Attack, which I wrote in the Spring of 1970, outlined the basic position that the new psychological theories used in some parts of the women’s liberation movement—theories that women are brainwashed or conditioned into inferiority—are just a more sophisticated version of the old theories of women’s biological inferiority. As in the following quote from Marcuse, nature is simply replaced by second nature:

… over and above the obviously physiological differences between male and female, the feminine characteristics are socially conditioned. However, the long process of thousands of years of social conditioning means that they may become second nature which is not changed automatically by the establishment of new social institutions. There can be discrimination against women even under socialism.—H. Marcuse, lecture 3/7/74, Stanford University

These theories shift the burden of blame from men to women, obscuring the power differences between men and women, and preventing us from clearly seeing just what the barriers are that have to be overcome—barriers that exist not in our heads but in the real world. My article stressed the punishment given to women who step out of line. It did not go into another important way in which men exercise their power to enforce the status quo—rewarding women for good behavior. Nor did it go into the use of myth and lies promoted by the powerful to deny us access to real information and collective knowledge. This was not simply an oversight. At the time the article was written there was tremendous opposition to the idea that force was ever used against women at all.

Carol Hanisch’s article, published in the July-August 1973 issue of Woman’s World, introduces the idea that conditioning is seen as making women unqualified—an idea that has taken on great economic significance as the newest justification for keeping women out of jobs. She shows that sex role theory as well as conditioning is used as a cover up for oppression. She also analyzes why psychological theories are used by women in the movement, what they get out of defining the problems in this way. Thus, this article, written a year later, begins to take on the political problem of female opportunism and the interests and misconceptions behind it.

Colette Price points out how the conditioning arguments used in the women’s movement are an ironic retreat even from the theories of establishment behavioral psychologists.

By the Fall of 1972, the situation in this country had changed somewhat. Women’s liberation had become a mass movement and the establishment in this country was forced to change its words, if not its practices. In Feminist Art Journal Patricia Mainardi reported on a television interview with William Rubin, Chief Curator of New York’s Museum of Modern Art, in which Rubin used the acceptable rhetoric of liberal feminism as an excuse for not recognizing and showing the work of women artists.

To describe women as culturally or psychologically inferior is untrue, as well as being an insult, as the early radical feminists discovered. To say that this alleged inferiority makes us unqualified for taking on jobs or positions of power is worse, because economic survival as well as respect is involved. This is the full significance of the psychological attack. At every level of society it presents analysis (contrary to the opposite charge of Hole and Levine) and in practical terms blocks the advancement of women. Within the movement, it can be used to discredit anything women say we want. It isn’t necessary to argue over goals, desires or impressions if you can write off the brainwashed women expressing them. Women’s legitimate demands for love and commitment from men, for example, have often been dismissed in this way. Outside the movement, in the job and educational world, real issues can be similarly avoided. It isn’t necessary for an employer or a university to admit to excluding women if he can simply say that no qualified women have applied—or even that none exist at this point in history due to the past effects of sexism. It isn’t necessary for socialist governments to challenge their own backwardness and lack of class perspective regarding half their people if they can instead point to the backwardness of the female population.

Psychology versus power, then, is not an abstract intellectual argument. It is important because the content of your theory determines the content of your action. How you define what is wrong determines how you will try to solve the problem. How much you are allowed to question determines how much you will be allowed to change.

—Barbara Leon, Consequences of the Conditioning Line, from Feminist Revolution: An Abridged Edition with Additional Writings (1975/1979), pp. 66–67.

Further reading:

• Ellen Willis, Ramparts (1969): Women and the Myth of Consumerism
• GT 2005-11-25: Holiday reminder: Buy Something!
• GT 2004-11-26: Buy Something!
• Austro-Athenian Empire 2005-11-10: It’s All in Her Head

You know the rules; here’s the quote. This week’s reading is from Robert Whitaker’s Mad in America again (see also Over My Shoulder #15, on the early modern English mad doctors). This passage was reading from the ride home from work and the walk home from the bus stop. I wish I had something to say, but it’s really too awful to bear comment. Here’s the quote:

For hospitals, the main drawback with insulin-coma therapy was that it was expensive and time-consuming. By one estimate, patients treated in this maner received 100 times the attention from medical staff as did other patients, and this greatly limited its use. In contrast, metrazol convulsive therapy, which was introduced into U.S. asylums shortly after Sakel’s insulin treatment arrived, could be administered quickly and easily, with one physician able to treat fifty or more patients in a single morning.

Although hailed as innovative in 1935, when Hungarian Ladislas von Meduna first announced its benefits, metrazol therapy was actually a remedy that could be traced back to the 1700s. European texts from that period tell of using camphor, an extract from the laurel bush, to induce seizures in the mad. Meduna was inspired to revisit this therapy by speculation, which wasn’t his alone, that epilepsy and schizophrenia were antagonistic to each other. One disease helped to drive out the other. Epileptics who developed schizophrenia appeared to have fewer seizures, while schizophrenics who suffered seizures saw their psychosis remit. If that was so, Meduna reasoned, perhaps he could deliberately induce epileptic seizures as a remedy for schizophrenia. With faint hope and trembling desire, he later recalled, the inexpressible feeling arose in me that perhaps I could use this antagonism, if not for curative purposes, at least to arrest or modify the course of schizophrenia.

After testing various poisons in animal experiments, Meduna settled on camphor as the seizure-inducing drug of choice. On January 23, 1934, he injected it into a catatonic schizophrenic, and soon Meduna, like Klaesi and Sakel, was telling a captivating story of a life reborn. After a series of camphor-induced seizures, L. Z., a thirty-three year old man who had been hospitalized for four years, suddenly rose from his bed, alive and lucid, and asked the doctors how long he had been sick. It was a story of a miraculous rebirth, with L. Z. soon sent on his way home. Five other patients treated with camphor also quickly recovered, filling Meduna with a sense of great hope: I feel elated and I knew I had discovered a new treatment. I felt happy beyond words.

As he honed his treatment, Meduna switched to metrazol, a synthetic preparation of camphor. His tally of successes rapidly grew: Of his first 110 patients, some who had been ill as long as ten years, metrazol-induced convulsions freed half from their psychosis.

Although metrazol treatment quickly spread throughout European and American asylums, it did so under a cloud of great controversy. As other physicians tried it, they published recovery rates that were wildly different. One would find that it helped 70 percent of schizophrenic patients. The next wouldfind that it didn’t appear to be an effective treatment for schizophrenia at all but was useful for treating manic-depressive psychosis. Others would find it helped almost no one. Rockland State Hospital in New York announced that it didn’t produce a single recovery among 275 psychotic patients, perhaps the poorest reported outcome in all of psychiatric literature to that time. Was it a totally dreadful drug, as some doctors argued? Or was it, as one physician wrote, the elixir of life to a hitherto doomed race?

A physician’s answer to that question depended, in large measure, on subjective values. Metrazol did change a person’s behavior and moods, and in fairly predictable ways. Physicians simply varied greatly in their beliefs about whether that change should be deemed an improvement. Their judgment was also colored by their own emotional response to administering it, as it involved forcing a violent treatment on utterly terrified patients.

Metrazol triggered an explosive seizure. About a minute after the injection, the patient would arch into a convulsion so severe it could fracture bones, tear muscles, and loosen teeth. In 1939, the New York State Psychiatric Institute found that 43 percent of state hospital patients treated with metrazol had suffered spinal fractures. Other complications included fractures of the humerus, femur, pelvic, scapula, and clavicle bones, dislocations of the shoulder and jaw, and broken teeth. Animal studies and autopsies revealed that metrazol-induced seizures caused hemorrhages in various organs, such as the lungs, kidney, and spleen, and in the brain, with the brain trauma leading to the waste of neurons in the cerebral cortex. Even Meduna acknowledged that his treatment, much like insulin-coma therapy, made brutal inroads into the organism.

We act with both methods as with dynamite, endeavoring to blow asunder the pathological sequences and restore the diseased organism to normal functioning … beyond all doubt, from biological and therapeutic points of view, we are undertaking a violent onslaught with either method we choose, because at present nothing less than such a shock to the organism is powerful enough to break the chain of noxious processes that leads to schizophrenia.

As with insulin, metrazol shock therapy needed to be administered multiple times to produce the desired lasting effect. A complete course of treatment might involve twenty, thirty, or forty or more injections of metrazol, which were typically given at a pace of two or three a week. To a certain degree, the trauma so inflicted also produced a change in behavior similar to that seen with insulin. As patients regained consciousness, they would be dazed and disoriented—Meduna described it as a confused twilight state. Vomiting and nausea were common. Many would beg doctors and nurses not to leave, calling for their mothers, wanting to be hugged, kissed and petted. Some would masturbate, some would become amorous toward the medical staff, and some would play with their own feces. All of this was seen as evidence of a desired regression to a childish level, of a loss of control of the higher centres of intelligence. Moreover, in this traumatized state, many showed much greater friendliness, accessibility, and willingness to cooperate, which was seen as evidence of their improvement. The hope was that with repeated treatments, such friendly, cooperative behavior would become more permanent.

The lifting in mood experienced by many patients, possibly resulting from the release of stress-fighting hormones like epinephrine, led some physicians to find metrazol therapy particularly useful for manic-depressive psychosis. However, as patients recovered from the brain trauma, they typically slid back into agitated, psychotic states. Relapse with metrazol was even more problematic than with insulin therapy, leading numerous physicians to conclude that metrazol shock therapy does not seem to produce permanent and lasting recovery.

Metrazol’s other shortcoming was that after a first injection, patients would invariably resist another and have to be forcibly treated. Asylum psychiatrists, writing in the American Journal of Psychiatry and other medical journals, described how patients would cry, plead that they didn’t want to die, and beg them in the name of humanity to stop the injections. Why, some patients would wail, did the hospital want to kill them? Doctor, one woman pitifully asked, is there no cure for this treatment? Even military men who had borne with comparative fortitude and bravery the brunt of enemy action were said to cower in terror at the prospect of a metrazol injection. One patient described it as akin to being roasted alive in a white-hot furnace; another as if the skull bones were about to be rent open and the brain on the point of bursting through them. The one theme common to nearly all patients, Katzenelbogen concluded in 1940, was a feeling of being excessively frightened, tortured, and overwhelmed by fear of impending death.

The patients’ terror was so palpable that it led to speculation whether fear, as in the days of old, was the therapeutic agent. Said one doctor:

No reasonable explanation of the action of hypoglycemic shock or of epileptic fits in the cure of schizophrenia is forthcoming, and I would suggest as a possibility that as with the surprise bath and the swinging bed, the modus operandi may be the bringing of the patient into touch with reality through the strong stimulation of the emotion of fear, and that the intense apprehension felt by the patient after an injection of cardiazol [metrazol] and so feared by the patient, may be akin to the apprehension of a patient threatened with the swinging bed. The exponents of the latter pointed out that fear of repetition was an important element in its success.

Advocates of metrazol were naturally eager to distinguish it from the old barbaric shock practices and even conducted studies to prove that fear was not the healing agent. In their search for a scientific explanation, many put a Freudian spin on the healing psychology at work. One popular notion, discussed by Chicago psychotherapist Roy Grinker at an American Psychiatric Association meeting in 1942, was that it put the mentally ill through a near-death experience that was strangely liberating. The patient, Grinker said, experiences the treatment as a sadistic punishing attack which satisfies his unconscious sense of guilt. Abram Bennett, a psychiatrist at the University of Nebraska, suggested that a mental patient, by undergoing the painful convulsive therapy, has proved himself willing to take punishment. His conscience is then freed, and he can allow himself to start life over again free from the compulsive pangs of conscience.

As can be seen by the physicians’ comments, metrazol created a new emotional tenor within asylum medicine. Physicians may have reasoned that terror, punishment, and physical pain were good for the mentally ill, but the mentally ill, unschooled in Freudian theories, saw it quite less abstractly. They now perceived themselves as confined in hospitals where doctors,rather than trying to comfort them, physically assaulted them in the most awful way. Doctors, in their eyes, became their torturers. Hospitals became places of torment. This was the beginning of a profound rift in the doctor-patient relationship in American psychiatry, one that put the severely mentally ill ever more at odds with society.

Even though studies didn’t provide evidence of any long-term benefit, metrazol quickly became a staple of American medicine, with 70 percent of the nation’s hospitals using it by 1939. From 1936 to 1941, nearly 37,000 mentally ill patients underwent this treatment, which meant that they received multiple injections of the drug. Brain-damaging therapeutics—a term coined in 1941 by a proponent of such treatments—were now being regularly administered to the hospitalized mentally ill, and being done so against their will.

—Robert Whitaker, Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (2002), pp. 91–96.

It’s revealed in a footnote (and mentioned later in the book) that the proponent who coined the term brain-damaging therapeutics was none other than Walter Freeman, the pioneer of the icepick lobotomy, in Brain-Damaging Therapeutics, Diseases of the Nervous System 2 (1940): 83.

You know the rules; here’s the quote. This is again delayed (this time, by the belated Tyrannicide Day celebration of going to see V for Vendetta on opening night; in case you’re wondering, it’s very good, but you should read the comic book, too, or you’ll miss out on a lot of good stuff). This week’s reading is from the bus on the way to work: a long passage from the first chapter of Robert Whitaker’s Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (2002). Whitaker is explaining the historical backdrop of Benjamin Rush’s European medical training:

One of the first English physicians to write extensively on madness, its nature, and the proper treatment for it was Thomas Willis. He as highly admired for his investigations into the nervous system, and his 1684 text on insanity set the tone for the many medical guides that would be written over the next 100 years by English mad-doctors. The book’s title neatly summed up his views of the mad: The Practice of Physick: Two Discourses Concerning the Soul of Brutes. His belief—that the insane were animal-like in kind—reflected prevailing conceptions about the nature of man. The great English scientists and philosophers of the seventeenth century—Francis Bacon, Isaac Newton, John Locke, and others—had all argued that reason was the faculty that elevated humankind above the animals. This was the form of intelligence that enabled man to scientifically know his world, and to create a civilized society. Thus the insane, by virtue of having lost their reason, were seen as having descended to a brutish state. They were, Willis explained, fierce creatures who enjoyed superhuman strength. They can break cords and chains, break down doors or walls … they are almost never tired … they bear cold, heat, watching, fasting, strokes, and wounds, without any sensible hurt. The mad, he added, if they were to be cured, needed to hold their physicians in awe and think of them as their tormentors.

Discipline, threats, fetters, and blows are needed as much as medical treatment … Truly nothing is more necessary and more effective for the recovery of these people than forcing them to respect and fear intimidation. By this method, the mind, held back by restraint is induced to give up its arrogance and wild ideas and it soon becomes meek and orderly. This is why maniacs often recover much sooner if they are treated with tortures and torments in a hovel instead of with medicaments.

A medical paradigm for treating the mad had been born, and eighteenth-century English medical texts regularly repeated this basic wisdom. In 1751, Richard Mead explained that the madman was a brute who could be expected to attack his fellow creatures with fury like a wild beast and thus needed to be tied down and even beat, to prevent his doing mischief to himself or others. Thomas Bakewell told of how a maniac bellowed like a wild beast, and shook his chain almost constantly for several days and nights … I therefore got up, took a hand whip, and gave him a few smart stripes upon the shoulders… He disturbed me no more. Physician Charles Bell, in his book Essays on the Anatomy of Expression in Painting, advised artists wishing to depict madmen to learn the character of the human countenance when devoid of expression, and reduced to the state of lower animals.

Like all wild animals, lunatics needed to be dominated and broken. The primary treatments advocated by English physicians were those that physically weakened the mad—bleeding to the point of fainting and the regular use of powerful purges, emetics, and nausea-inducing agents. All of this could quickly reduce even the strongest maniac to a pitiful, whimpering state. William Cullen, reviewing bleeding practices, noted that some advised cutting into the jugular vein. Purges and emetics, which would make the mad patient violently sick, were to be repeatedly administered over an extended period. John Monro, superintendent of Bethlehem Asylum, gave one of his patients sixty-one vomit-inducing emetics in six months, including strong doses on eighteen sucessive nights. Mercury and other chemical agents, meanwhile, were used to induce nausea so fierce that the patient could not hope to have the mental strength to rant and rave. While nausea lasts, George Man Burrows advised, hallucinations of long adherence will be suspended, and sometimes be perfectly removed, or perhaps exchanged for others, and the most furious will become tranquil and obedient. It was, he added, far safer to reduce the patient by nauseating him than by depleting him.

A near-starvation diet was another recommendation for robbing the madman of his strength. The various depleting remedies—bleedings, purgings, emetics, and nausea-inducing agents—were also said to be therapeutic because they inflicted considerable pain, and thus the madman’s mind became focused on this sensation rather than on his usual raving thoughts. Blistering was another treatment useful for stirring great bodily pain. Mustard powders could be rubbed on a shaved scalp, and once the blisters formed, a caustic rubbed into the blisters to further irritate and infect the scalp. The suffering that attends the formation of these pustules is often indescribable, wrote one physician. The madman’s pain could be expected to increase as he rubbed his hands in the caustic and touched his genitals, a pain that would enable the patient to regain consciousness of his true self, to wake from his supersensual slumber and to stay awake.

All of these physically depleting, painful therapies also had a psychological value: They were feared by the lunatics, and thus the mere threat of their employment could get the lunatics to behave in a better manner. Together with liberal use of restraints and an occasional beating, the mad would learn to cower before their doctors and attendants. In most cases it has appeared to be necessary to employ a very constant impression of fear; and therefore to inspire them with the awe and dread of some particular persons, especially of those who are to be constantly near them, Cullen wrote. This awe and dread is therefore, by one means or other, to be acquired; in the first place by their being the authors of all the restraints that may be occasionally proper; but sometimes it may be necessary to acquire it even by stripes and blows. The former, although having the appearance of more severity, are much safer than strokes or blows about the head.

Such were the writings of English mad-doctors in the 1700s. The mad were to be tamed. But were such treatments really curative? In the beginning, the mad-doctors were hesitant to make that claim. But gradually they began to change their tune, and they did so for a simple reason: It gave them a leg up in the profitable madhouse business.

In eighteenth-century England, the London asylum Bethlehem was almost entirely a place for the poor insane. The well-to-do in London shipped their family lunatics to private madhouses, a trade that had begun to emerge in the first part of the century. These boarding houses also served as convenient dumping grounds for relatives who were simply annoying or unwanted. Men could get free from their wives in this manner—had not their noisome, bothersome spouses gone quite daft in the head? A physician who would attest to this fact could earn a nice sum—a fee for the consultation and a referral fee from the madhouse owner. Doctors who owned madhouses mad out particularly well. William Battie, who operated madhouses in Islington and Clerkenwell, left an estate valued at between £100,000 and £200,000, a fabulous sum for the time, which was derived largely from this trade.

Even though most of the mad and not-so-mad committed to the private madhouses came from better families, they could still expect neglect and the harsh flicker of the whip. As reformer Daniel Defoe protested in 1728, Is it not enough to make any one mad to be suddenly clap’d up, stripp’d, whipp’d, ill fed, and worse us’d? In the face of such public criticism, the madhouse operators protested that their methods, while seemingly harsh, were remedies that could restore the mad to their senses. The weren’t just methods for managing lunatics, but curative medical treatments. In 1758, Battie wrote: Madness is, contrary to the opinion of some unthinking persons, as manageable as many other distempers, which are equally dreadful and obstinate. He devoted a full three chapters to cures.

In 1774, the English mad trade got a boost with the passage of the Act for Regulating Madhouses, Licensings, and Inspection. Thenew law prevented the commitment of a person to a madhouse unless a physician had certified the person as insane (which is the origin of the term certifiably insane). Physicians were now the sole arbiters of insanity, a legal authority that mad the mad-doctoring trade more profitable than ever. Then, in 1788, King George III suffered a bout of madness, and his recovery provided the mad-doctors with public proof of their curative ways.

Francis Willis, the prominent London physician called upon by the queen to treat King George, was bold in proclaiming his powers. He boasted to the English Parliament that he could reliably cure nine out of ten mad patients and that he rarely missed curing any [patients] that I had so early under my care: I mean radically cured. On December 5, 1788, he arrived at the king’s residence in Kew with an assistant, three keepers, a straight waistcoat, and the belief that a madman needed to be broken like a horse in a manège. King George III was so appalled by the sight of the keepers and the straight waistcoat that he flew into a rage—a reaction that caused Willis to immediately put him into the confining garment.

As was his custom, Willis quickly strove to assert his dominance over his patient. When the king resisted or protested in any way, Willis had him clapped into the straight-waistcoat, often with a band across his chest, and his legs tied to the bed. Blisters were raised on the king’s legs and quickly became infected, the king pleading that the pustules burned and tortured him—a complaint that earned him yet another turn in the straight waistcoat. Soon his legs were so painful and sore that he couldn’t walk, his mind now wondering how a king lay in this damned confined condition. He was repeatedly bled, with leeches placed on his templates, and sedated with opium pills. Willis also surreptitiously laced his food with emetics, which made the king so violently sick that, on one occasion, he knelt on his chair and prayed that God would be pleased either to restore Him to his Senses, or permit that He might die directly.

In the first month of 1789, the battle between the patient and doctor became ever more fierce. King George III—bled, purged, blistered, restrained, and sedated, his food secretly sprinkled with a tartar emetic to make him sick—sought to escape, offering a bribe to his keepers. He would give them annuities for life if they would just free him from the mad-doctor. Willis responded by bringing in a new piece of medical equipment—a restraint chair that bound him more tightly than the straight waistcoat—and by replacing his pages with strangers. The king would no longer be allowed the sight of familiar faces, which he took as evidence that Willis’s men meant to murder him.

In late February, the king made an apparently miraculous recovery. His agitation and delusions abated, and he soon resumed his royal duties. Historians today believe that King George III, rather than being mad, suffered from a rare genetic disorder, called porphyria, which can lead to high levels of toxic substance in the body that cause temporary delirium. He might have recovered more quickly, they believe, if Willis’s medical treatment had not so weakened him that they aggravated the underlying condition. But in 1789, the return of the king’s sanity was, for the mad-doctors, a medical triumph of the most visible sort.

In the wake of the king’s recovery, a number of English physicians raced to exploit the commercial opportunity at hand by publishing their novel methods for curing insanity. Their marketing message was often as neat as a twentieth century sound bite: Insanity proved curable. One operator of a madhouse in Chelsea, Benjamin Faulkner, even offered a money-back guarantee: Unless patients were cured within six months, all board, lodging, and medical treatments would be provided free of all expence whatever. The mad trade in England flourished. The number of private madhouses in the London area increased from twenty-two in 1788 to double that number by 1820, growth so stunning that many began to worry that insanity was a malady particularly common to the English.

In this era of medical optimism, English physicians—and their counterparts in other European countries—developed an ever more innovative array of therapeutics. Dunking the patient in water became quite popular—a therapy intended both to cool the patient’s scalp and to provoke terror. Physicians advised pouring buckets of water on the patient from a great height or placing the patient under a waterfall; they also devised machines and pumps that could pummel the patient with a torrent of water. The painful blasts of water were effective as a remedy and a punishment, one that made patients complain of pain as if the lateral lobes of the cerebrum were split asunder. The Bath of Surprise became a staple of many asylums: The lunatic, often while being led blindfolded across a room, would suddenly be dropped through a trapdoor into a tub of cold water—the unexpected plunge hopefully inducing such terror that the patient’s senses might be dramatically restored. Cullen found this approach particularly valuable:

Maniacs have often been relieved, and sometimes entirely cured, by the use of cold bathing, especially when administered in a certain manner. This seems to consist, in throwing the madman in the cold water by surprise; by detaining him in it for some length of time; and pouring water frequently upon the head, while the whole of the body except the head is immersed in the water; and thus managing the whole process, so as that, with the assistance of some fear, a refrigerant effect may be produced. This, I can affirm, has been often useful.

The most extreme form of water therapy involved temporarily drowning the patient. This practice had its roots in a recommendation made by the renowned clinician of Leyden, Hermann Boerhaave. The greatest remedy for [mania] is to throw the Patient unwarily into the Sea, and to keep him under Water as long as he can possibly bear without being quite stifled. Burrows, reviewing this practice in 1828, said it was designed to create the effect of asphyxia, or suspension of vital as well as of all intellectual operations, so far as safety would permit. Boerhaave’s advice led mad-doctors to concoct various methods for stimulating drowning such as placing the patient into a box drilled with holes and then submerging it underwater. Joseph Guislain built an elaborate mechanism for drowning the patient, which he called The Chinese Temple. The maniac would be locked into an iron cage that would be mechanically lowered, much in the manner of an elevator car, into a pond. To expose the madman to the action of this device, Guislain explained, he is led into the interior of this cage: one servant shutsthe door from the outside while the other releases a break which, by this maneuver, causes the patient to sink down, shut up in the cage, under the water. Having produced the desired effect, one raises the machine again.

The most common mechanical device to be employed in European asylums during this period was a swinging chair. Invented by Englishma Joseph Mason Cox, the chair could, in one fell swoop, physically weaken the patient, inflict great pain, and invoke terror—all effects perceived as therapeutic for the mad. The chair, hung from a wooden frame, would be rotated rapidly by an operator to induce in the patient fatigue, exhaustion, pallor, horripilatio [goose bumps], vertigo, etc, thereby producing new associations and trains of thoughts. In the hands of a skilled operator, able to rapidly alter the directional motion of the swing, it could reliably produce nausea, vomiting, and violent convulsions. Patients would also involuntarily urinate and defecate, and plead for the machine to be stopped. The treatment was so powerful, said one nineteenth-century physician, that if the swing didn’t make a mad person obedient, nothing would.

Once Cox’s swing had been introduced, asylum doctors tried many variations on the theme—spinning beds, spinning stools, and spinning boards were all introduced. In this spirit of innovation and medical advance, one inventor built a swing that could twirl four patients at once, at revolutions up to 100 per minute. Cox’s swing and other twirling devices, however, were eventually banned by several European governments, the protective laws spurred by a public repulsed by the apparent cruelty of such therapeutics. This governmental intrusion into medical affairs caused Burrows, a madhouse owner who claimed that he cured 91 percent of his patients, to complain that an ignorant public would instruct us that patient endurance and kindliness of heart are the only effectual remedies for insanity!

Even the more mainstream treatments—the Bath of Surprise, the swinging chair, the painful blistering—might have given a compassionate physician like Rush pause. But mad-doctors were advised not to let their sentiments keep them from doing their duty. It was the highest form of cruelty, one eighteenth-century physician advised, not to be bold in the Administration of Medicine. Even those who urged that the insane, in general, should be treated with kindness, saw a need for such heroic treatments to knock down mania. Certain cases of mania seem to require a boldness of practice, which a young physician of sensibility may feel a reluctance to adopt, wrote Thomas Percival, setting forth ethical guidelines for physicians. On such occasions he must not yield to timidity, but fortify his mind by the councils of his more experienced brethren of the faculty.

—Robert Whitaker (2002), Mad in America, pp. 6–13.

This book is one of the only things I’ve read that ever made me cry.

Further reading

• GT 2005-11-19: Happenings Elsewhere: Howard Dully and My Lobotomy on NPR
• GT 2002-08-20: Brain mutilation for fun and profit: the story of Walter Freeman

You know the rules. Here’s the quote. This is from Oliver Sacks’s Seeing Voices: A Journey into the World of the Deaf (1989). I broke the rules a bit here: rather than a single passage of a few paragraphs, I have two, because the latter one reinforces one of the important points of the former, and also because it’s damn near impossible to pick out any one thing that is the most interesting from the chapter. So here goes:

The situation of the prelingually deaf, prior to 1750, was indeed a calamity: unable to acquire speech, hence dumb or mute; unable to enjoy free communication with even their parents and families; confined to a few rudimentary signs and gestures; cut off, except in large cities, even from the community of their own kind; deprived of literacy and education, all knowledge of the world; forced to do the most menial work; living alone, often close to destitution; treated by the law and society as little better than imbeciles—the lot of the deaf was manifestly dreadful.

But what was manifest was as nothing to the destitution inside—the destitution of knowledge and thought that prelingual deafness could bring, in the absence of any communication or remedial measures. The deplorable state of the deaf aroused both the curiosity and the compassion of the philosophes. Thus the Abbé Sicard asked:

Why is the uneducated deaf person isolated in nature and unable to communicate with other men? Why is he reduced to this state of imbecility? Does his biological constitution differ from ours? Does he not have everything he needs for having sensations, acquiring ideas, and combining them to do everything that we do? Does he not get sensory impressions from objects as we do? Are these not, as with us, the occasion of the mind’s sensations and its acquired ideas? Why then does the deaf person remain stupid while we become intelligent?

To ask this question—never really clearly asked before—is to grasp its answer, to see that the answer lies in the use of symbols. It is, Sicard continues, because the deaf person has no symbols for fixing and combining ideas … that there is a total communication-gap between him and other people. But what was all-important, and had been a source of fundamental confusion since Aristotle’s pronouncements on the matter, was the enduring misconception that symbols had to be speech. Perhaps indeed this passionte misperception, or prejudice, went back to biblical days: the subhuman status of mutes was part of the Mosaic code, and it was reinforced by the biblical exaltation of voice and ear as the one and true way in which man and God could speak (In the beginning was the Word). And yet, overborne by Mosaic and Aristotelian thunderings, some profound voices intimated that this need not be so. Thus Socrates’ remark in the Cratylus of Plato, which so impressed the youthful Abbé de l’Epée:

If we had neither voice nor tongue, and yet wished to manifest things to one another, should we not, like those which are at present mute, endeavour to signify our meaning by the hands, head, and other parts of the body?

Or the deep, yet obvious, insights of the philosopher-physician Cardan in the sixteenth century:

It is possible to place a deaf-mute in a position to hear by reading, and to speak by writing … for as different sounds are conventionally used to signify different things, so also may the various figures of objects and words …. Written characters and ideas may be connected without the intervention of actual sounds.

In the sixteenth century the notion that the understanding of ideas did not depend upon the hearing of words was revolutionary.

But it is not (usually) the ideas of philosophers that change reality; nor, conversely, is it the practice of ordinary people. What changes history, what kindles revolutions, is the meeting of the two. A lofty mind—that of the Abbé de l’Epée—had to meet a humble usage—the indigenous sign language of the poor deaf who roamed Paris—in order to make possible a momentous transformation. If we ask why this meeting had not occurred before, it has something to do with the vocation of Abbé, who could not bear to think of the souls of the deaf-mute living and dying unshriven, deprived of the Catechism, the Scriptures, the Word of God; and it is partly owing to his humility—that he listened to the deaf—and partly to a philosophical and linguistic idea then very much in the air—that of universal language, like the speceium of which Leibniz dreamed. Thus, de l’Epée approached sign language not with contempt but with awe.

The universal language that your scholars have sought for in vain and of which they have despaired, is here; it is right before your eyes, it is the mimicry of the impoverished deaf. Because you do not know it,you hold it in contempt, yet it alone will provide you with the key to all languages.

That this was a misapprehension—for sign language is not a universal language in this grand sense, and Leibniz’s noble dream was probably a chimera—did not matter, was even an advantage. For what mattered was that the Abbé paid minute attention to his pupils, acquired their language (which had scarcely ever been done by the hearing before). And then, by associating signs with pictures and written words, he taught them to read; and with this, in one swoop, he opened to them the world’s learning and culture. De l’Epée’s system of methodical signs—a combination of their own Sign with signed French grammar—enabled deaf students to write down what was said to them through a signing interpreter, a method so successful that, for the first time, it enaled ordinary deaf pupils to read and write French, and thus acquire an education. His school, founded in 1755, was the first to achieve public support. He trained a multitude of teachers for the deaf, who, by the time of his death in 1789, had established twenty-one schools for the deaf in France and Europe. The future of de l’Epée’s own school seemed uncertain during the turmoil of the revolution, but by 1791 it had become the National Institution for Deaf-Mutes in Paris, headed by the brilliant grammarian Sicard. De l’Epée’s own book, as revolutionary as Copernicus’ in its own way, was first published in 1776.

De l’Epée’s book, a classic, is available in many languages. But what have not been available, have been virtually unknown, are the equally important (and, in some ways, even more fascinating) original writings of the deaf—the first deaf-mutes ever able to write. Harlan Lane and Franklin Philip have done a great service in making these so readily available to us in The Deaf Experience. Especially moving and important are the 1779 Observations of Pierre Desloges—the first book to be published by a deaf person—now available in English for the first time. Desloges himself, deafened at an early age, and virtually without speech, provides us first with a frightening description of the world, or unworld, of the languageless.

At the beginning of my infirmity, and for as long as I was living apart from other deaf people … I was unaware of sign language. I used only scattered, isolated, and unconnected signs. I did not know the art of combining them to form distinct pictures with which one can represent various ideas, transmit them to one’s peers, and converse in logical discourse.

Thus Desloges, though obviously a highly gifted man, could scarcely entertain ideas, or engage in logical discourse, until he had acquired sign language (which, as is usual with the deaf, he learned from someone deaf, in his case from an illiterate deaf-mute).

—Oliver Sacks (1989), Seeing Voices: A Journey into the World of the Deaf, pp. 13—18.

And:

When Laurent Clerc (a pupil of Massieu, himself a pupil of Sicard) came to the United States in 1816, he had an immediate and extraordinary impact, for American teachers up to this point had never been exposed to, never even imagined, a deaf-mute of impressive intelligence and education, had never imagined the possibilities dormant in the deaf. With Thomas Gallaudet, Clerc set up the American Asylum for the Deaf, in Hartford, in 1817. As Paris—teachers, philosophes, and public-at-large—was moved, amazed, converted by de l’Epée in the 1770s, so America was to be converted fifty years later.

The atmosphere at the Hartford Asylum, and at other schools soon to be set up, was marked by the sort of enthusiasm and excitement only seen at the start of grand intellectual and humanitarian adventures. The prompt and spectacular success of the Hartford Asylum soon led to the opening of other schools wherever there was sufficient density of population, and thus of deaf students. Virtually all the teachers of the deaf (nearly all of whom were fluent signers and many of whom were deaf) went to Hartford. The French sign system imported by Cleric rapidly amalgamated with the indigenous sign languages here—the deaf generate sign languages wherever there are communities of deaf people; it is for them the easiest and most natural form of communication—to form a uniquely expressive and powerful hybrid, American Sign Language (ASL). A special indigenous strength—presented convincingly by Nora Ellen Groce in her book, Everyone Here Spoke Sign Language—was the contribution of Martha’s Vineyard deaf to the development of ASL. A substantial minority of the population there suffered from a hereditary deafness, and most of the island had adopted an easy and powerful sign language. Virtually all the deaf of the Vineyard were sent to the Hartford Asylum in its formative years, where they contributed to the developing national language the unique strength of their own.

One has, indeed, a strong sense of pollination, of people coming to and fro, bringing regional languages, with all their idiosyncracies and strengths, to Hartford, and taking back an increasingly polished and generalized language. The rise of deaf literacy and deaf education was as spectacular in the United States as it had been in France, and soon spread to other parts of the world.

Lane estimates that by 1869 there were 550 teachers of the deaf worldwide and that 41 percent of the teachers of the deaf in the United States were themselves deaf. In 1864 Congress passed a law authorizing the Columbia Institution for the Deaf and the Blind in Washington to become a national deaf-mute college, the first institution of higher learning specifically for the deaf. Its first principal was Edward Gallaudet—the son of Thomas Gallaudet, who had brought Clerc to the United States in 1816. Gallaudet College, as it was later rechristened (it is now Gallaudet University), is still the only liberal arts college for deaf students in the world—though there are now several programs and institutes for the deaf associated with technical colleges. (The most famous of these is at the Rochester Institute of Technology, where there are more than 1,500 deaf students forming the National Technical Institute for the Deaf.)

The great impetus of deaf education and liberation, which had swept France between 1770 and 1820, thus continued its triumphant course in the United States until 1870 (Clerc, immensely active to the end and personally charismatic, died in 1869). And then—and this is the turning point in the entire story—the tide turned, turned against the use of Sign by and for the deaf, so that within twenty years the work of a century was undone.

Indeed, what was happening with the deaf and sign was part of a general (and if one wishes, political) movement of the time: a trend to Victorian oppressiveness and conformism, intolerance of minorities, and minority usages, of every kind—religious, linguistic, ethnic. Thus it was at this time that the little nations and little languages of the world (for example, Wales and Welsh) found themselves under pressure to assimilate and conform.

—Oliver Sacks (1989), Seeing Voices: A Journey into the World of the Deaf, pp. 21—24.