18 JANUARY 1975, Page 18

The American psychiatric hoax

William Sargant

The Age of Madness Thomas Szasz (Routledge and Kegan Paul £5.95).

This reviewer first did a 'locum' at the old Hanwell Asylum, now renamed St Bernard's Hospital, in 1935. Conditions were terrible in the extreme, though typical of county council mental hospitals of the period. Treatments for mental illness were virtually non-existent. except Freudian psychoanalysis, and psychotherapy related to it, which had already been practised in England for twenty-five years since 1910. But it just did not work with mad patients, who gained nothing by being told that their illness was sexually orientated. Under the old poor law system it seemed easy to be certified, but you needed the judgement of Solomon to be freed again.

Ninety per cent of the patients at Hanwell were certified; and the whole experience brought about a complete change in my own orientation to life. As psychotherapy and psychoanalysis seemed hopeless 'cures' for the mad patient and for the many chronic neurotic patients as well, it seemed that the development of simple physical treatments was the only hope of helping the mass of the mentally ill. The writing was written large on the wall for all to read. Syphillis of the brain had suddenly been found to respond to malaria therapy, the madness of myxoedema to gland treatment and there were already many other instances of the total control of the mind by chemical means, e.g. alcohol.

But so many doctors then going into psychiatry seemed to be the unimaginative failures of general medicine, or philosophers mainly interested in trying to explain why the patient had gone mad psychologically, or for sexual reasons, but much less interested in doing any more about it when their theoretical views had no effect on the course of the illness as such.

Thomas Szasz is an American psychoanalyst who has now published a special English edition, with a special English preface, of a 1973 book, The Age of Madness. In it he has collected and commented on a series of horror writings, dating back to Defoe and describing from the English, Russian, German and American literature the horrors of incarceration in mental hospitals. He believes that it is wrong t o certify or detain patients. Suicide is permissible, even to a genius with a treatable depressive illness, and murderers may have to go to prison for life rather than be forced to accept treatment. The only permissible thing is that they, however mad they may be, may ask for treatment and advice. This advice will be mostly along Freudian lines, since Szasz proudly advertises the fact that he is a member

Spectator January 18, 1975 of the American Psychoanalytic Association and a consultant (? censor) of the Psychoanalytic Review. He is naturally critical of physical methods, such as shock treatment, brain operations, drugs and so on. But his main protest is against giving any unasked for treatment even to the maddest patient. This is hardly practical when a doctor is called to a house where an acute schizophrenic patient is on the point of murdering his greatly loved mother, because God's voice is telling him he must do so!

By 1940 England had got the message that Freudian treatment was worse than useless for most mentally ill patients. A stream of new physical treatments such as drug abreaction, shock therapy, prolonged sleep treatment, insulin therapy and the like were mostly used, and millions of pounds were saved in preventing the chronic 'shell shocks' of World War I. England has never looked back since. America is only just beginning to realise that Freudian treatment as such may be one of the great hoaxes of the century. Throughout World War II, and afterwards, they were preached at by a powerful group of European refugees, who gave Freud a big second wind there. The result has been tragic for thousands of patients.

With the advent of the NHS in 1948 most of the best English psychiatrists were paid highly enough to stay working inside the mental hospitals. An intensive physical treatment approach has mainly been continued, with -additional individual and group psychotherapy given after the patient has become well enough to benefit. Instead of 80-90 per cent of certified patients, only 5-10 per cent are now ever certified. The rest enter and leave mental hospitals voluntarily. Gradually it is intended to close down the old Victorian asylums, as more and more units in general hospitals of fifty to one hundred. beds are used, and most doors of mental hospitals are now open again.

This reviewer s resentful of Szasz lecturing the English in a special edition while his own American augean stables are unswept. For in the United States 80 per cent of all patients in mental hospitals are still certified (as it was at Hanwell in 1935). For the last thirty years since the war, millions and millions of dollars have been spent to no practical effect on Freudian and allied research. America's best psychiatrists still have couches for the rich, group couch therapy for the not so rich, or they lock them up in asylums with doctors looking after them who sometimes cannot yet speak the language. Szasz is right to protest at current American psychiatry, but he himself should only be trusted to treat well behaved, co-operative and probably chronic neurotics. He must keep away from the really mad, but he shows in this book the absolute horror of their fate in old no treatment asylums and the modern Ameri can to modern physical In England, 'short-cut' treatments are being raised by those who feel that the patient is often just being put back to his old life, even though it may be a happy job and a very happy home life. There must be a reason for the illness and patients should not be put back on the industrial scene unchanged, they say, but allowed to experience the horrors and changes that can happen in, say, one of Laing's 'rumpus rooms', coming out with a new orientation to life. Psychiatry here gets mixed up with politics. Some would not mind how much murder and mayhem there was

if it brought out a few more Blakes with their

industrial protests and their hymns. '

But psychiatry must not mix with politics. We must try to get every patient as well as possible, as quickly as possible. Then let him go and talk to Szasz, who is very charming and gentle personally, or any politician, priest,' philosopher or policemen who he feels can now give him further guidance in his life ahead. William Sargant is Honorary Consulting Psychiatrist, St Thomas's Hospital, and author of The Mind Possessed.