Insanity Treatment Methods in Psychiatry History
Table of Contents Introduction Institutionalization Treatment Invasive Procedures Invented in the 20th Century Works Cited Introduction Insanity has long been recognized as a problem, but it has been given both religious and medical explanations. Different societies used various methods of the treatment of insanity based on their beliefs about its nature. The analysis of different approaches to insanity, its treatment, institutions created for people suffering from mental disorders, and real experience of people admitted to mental hospitals reveals that the social construction of mental illness has experienced significant changes during different historical periods. Besides, such analysis demonstrates that the relation between the social construction of insanity and the institutionalization has often resulted in the virtual imprisonment of people whose behavior was considered deviant by society but had no actual signs of insanity.
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Insanity is mostly regarded as a collective name for mental deviations, which makes the person unable to function as a member of society and control his/her actions. It is characterized by irrational behavioral patterns and mental instability. As a non-scientific term, insanity is not used in medical practice but is considered a term that unifies all mental disorders presenting a significant danger to a person’s ability to lead a normal life. The attitudes to insanity have changed throughout human history and numerous approaches to defining its nature and presentations have evolved. Careful analysis of the biological and the Freudian approaches to insanity helps clarify how modern western society has framed insanity and better allows us to track the changes to mental disease over the past two centuries. Both the biological approach, which argues that all mental disease has a biological root (either in faulty structure or neurobiochemistry) and the Freudian approach, which argues for psychological causes for insane behavior, share the belief that insanity can be diagnosed when a person is unable to properly control his/her psychological state and actions because of an abnormal perception of the external world (Freud Dream Psychology par. 4). Such a disability leads to the person’s dependence because she/he cannot perform daily activities or does so in a destructive way. Insanity can result in passiveness and a lack of willingness to interact with the society that results in the patient’s isolation, or it can produce aggressiveness and violent behavior that pose a threat to everyone around the patient. Another typical symptom of insanity is an inability to accurately perceive the world, resulting in inappropriate attitudes and judgments. This can lead to irrational behavioral patterns characterized by the persistent repetition of certain traumatic actions called “repetition compulsion” (Freud Beyond the Pleasure Principle par. 3). The biological approach to insanity is also called neurological, as it relies on the claim that mental disorders are caused by the structure of the brain leading to deviations in its functioning. This approach relies on neurophysiology and studying the functioning of the nervous system. The Biological approach excludes the possibility of causes of mental disorders that do not have an organic or physical nature. While the Freudian approach considers studying the human mind the key to investigating insanity, the biological approach regards the proper functioning of the brain as the main factor affecting mental health. Some studies support the biological approach, as certain differences in brain structures, such as gray matter loss in a network of brain regions, are present in various mental disorders, such as schizophrenia and depression (Goldman par. 2). That makes a group of scientists consider the identification of biological causes of insanity a key to managing mental disorders. There are, however, no mental disorders cured by drugs. Some can be chemically managed, but drugs fail to make the people suffering from mental disorders no longer depressed, manic-depressive, or schizophrenic. Therefore, considering insanity to have a purely organic nature does not resolve the question of how to treat it. Perhaps, like congenital biological disorders such as multiple sclerosis or cerebral palsy, it can only be managed. But since its management is difficult and appears to be highly individual, Freud’s psychology might also offer some insight into how insanity can be understood. It certainly provides important insight into how it has been socially constructed, since the diseases that made Freud’s reputation, especially hysteria, are entirely the product of social expectations for femininity and female sexuality as held in early 20th century Germany.
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Even the early evidence for the biological approach, however, reveals evidence of the social construction of insanity. Charcot, the “father of neurology” who made his career studying hysterics at the Salpatriere, quite literally photographed his patients to demonstrate their insane behavior. While he claimed to be studying the biological causes of hysteria, his photographs emphasize the most sexual aspects of his patients’ “fits,” demonstrating the link between female insanity and sexuality as early as the 19th century in France. George Didi-Huberman’s book Charcot and the Photographic Iconography of the Salpetriere serves as an example of studying insanity from the biological perspective. Charcot’s work was based on the assumption that insanity is caused by common abnormalities in brain structure. Charcot, as a founder of neurology, was focused on physiological manifestations of insanity and objectified the body of the patients. His approach to examination and treatment of the patients was based on the leading role of the physician, who did not pay much attention to the subject’s narrative (Didi-Huberman 24). Such an approach is brightly illustrated by the case of “Charming Augustine,” whose repetitive recalls of a rape scene did not attract the attention of physicians who were focused on her body postures (Didi-Huberman 115). The collection of such data helped Charcot to understand the symptomatic of mental disorders and structure the knowledge about their common signs. Such knowledge helped the neurologist to master the art of diagnosing, which was considered the key to successful treatment. Charcot considered the manifestation’s natural consequences of biological deviation, did not pay much attention to the psychological aspect of the suffering of the objects of his photographs and was searching for an “ever-shifting kind of neurophysiological lesion in the cortex” (Didi-Huberman 24). Didi-Huberman criticizes Charcot’s methods and claims that the institution was structured as a “bribe” forcing the patients to demonstrate certain behaviors to avoid being placed under worse conditions (Didi-Huberman 170). The silence of the Salpetriere patients became the basis for Freud’s reflections on the role of encouraging the patient to speak and using the collected information for psychoanalysis. Besides, while Charcot considered hypnosis a neurological phenomenon, Freud regarded it as a psychological one. Freud used Salpetriere’s experience to develop a wholly new approach to insanity. Ironically, though considered one of Charcot’s biggest admirers, Freud gave a start to the approach that opposed many of Charcot’s beliefs and assumptions. Krafft-Ebbing is considered another great contributor to the development of the biological approach. In his “Text-Book of Insanity, Based on Clinical Observations for Practitioners and Students of Medicine”, the psychiatrist emphasized the role of hereditary factors and neuropathic constitution in promoting the development of psychiatric illnesses: “Next to hereditary predisposition, the most important predisposing factor in the individual is that peculiar condition of the nervous system that has been called neuropathic” (Krafft-Ebbing Text-Book of Insanity 163). Though the psychiatrist recognized the role of external factors, such as parental influence and “defective education,” in the development of psychiatric deviations, he considered studying neurological factors the main keys to understanding the nature of such illnesses (Krafft-Ebbing Text-Book of Insanity 164). Freud, on the opposite, considered childhood “a primeval period which is already a part of the individual existence” playing the crucial role in the development of the one’s psyche and regarded psychological factors as the primary causes of psychiatric deviations (Freud Three Essays on the Theory of Sexuality 173). Besides, sexual deviations, considered by Freud’s consequences of negative childhood experiences, are regarded by the biological camp as the results of abnormal brain functioning. Krafft-Ebing expressed his views in his fundamental work “Psychopathia Sexualis” and demonstrated that sexual deviations, such as homosexuality, are the consequences of biological abnormalities experienced by the organism at different stages of its development (Krafft-Ebing Psychopathia Sexualis 295). Freud, on the contrary, regarded homosexuality as a purely psychological deviation related to the unconscious (Freud Letter to an American Mother 787). He claimed that the nature of inversion cannot be explained: “by the hypothesis that it is innate” (Freud Three Essays on the Theory of Sexuality 140). Kraft-Ebing’s and Freud’s views on sexual deviations illustrate the differences between the biological and the Freudian approach to insanity. But both reflect the cultural construction of same-sex desire as pathological, a view that has been slowly eroded since the late 19th century when Kraft-Ebbing wrote and the early 20th century when Freud was working.
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It was not until 1976, however, that the Diagnostic and Statistical Manual 3-revised, the listing of psychiatric disorders used by Western physicians, removed homosexuality as a diagnosis. It did not entirely disappear, however. A new diagnosis, “gender nonconformity” took up the space previously reserved for homosexuality. While American medicine was willing to try thinking of homosexuality as not pathological, it was not willing to permit fluidity in gender performance that might indicate homosexual tendencies. The cultural framing of homosexual desire and gender non-conformity as pathological reflects an important example of the cultural production of mental disorders and has led to the institutionalization of a great many people. The Freudian approach to insanity is based on psychoanalytic theory developed by the famous neurologist in the late 19th century. Freud moved from trying to understand mechanical malfunctions in the brain to exploring the mind. He defined specific features of mind as the cornerstones of mental deviations leading to insanity. Freud’s theory is based on the belief that the key to different characteristics of a person’s mental development depends on the unconscious. This portion of the human mind is hidden from a person due to its “innermost nature” but significantly influences his/her behaviors and mental health (Freud The Interpretation of Dreams 613). Freud emphasized the significant role of childhood experience and sexual drives and considered them the main drivers of any personality (Freud Fragment of an Analysis 115). Therefore, curing mental deviations was supposed to be done with the help of psychoanalysis, which would reveal the original problem hidden in the unconscious and allow the tension surrounding it to be released, thus ending the deviant behavior and ideation. According to the Freudian approach, the key to successful treatment lies in making the unconscious side of the mind conscious. Freud believed that as hidden thoughts lead to mental deviations, their unveiling through the interpretation of dreams, which he called “the royal road to a knowledge of the unconscious activities of the mind,” can be the basis of effective therapy (Freud The Interpretation of Dreams 608). The Freudian approach to mental disorders reveals that the main constituents of insanity include mental deviation caused by traumatizing experience and leading to the unconscious development of irrational motivations related to sexual issues resulting in certain behavioral patterns. Dora’s case illustrates the specifics of the Freudian approach in practice. The case describes the specifics of diagnosis and treatment of hysteria in the patient Ida Bauer. Hysteria was studied by Freud from the perspective of his approach to the analyzing unconscious. He referred to the sexual etiology of hysteria and regarded hysterical symptoms as the consequence of inappropriate sexual desire repressed at an early age (Romano 20). Though the treatment of the patient failed and the lady refused to continue it, Freud considered the case a vital part of the arguments proving the rightness of his theories (Romano 21). Analysis of the case demonstrates how the Freudian approach to insanity was used in practice – instead of using traditional methods of curing hysteria, the psychoanalyst tried to uncover the unconscious part of Dora’s mind through the exploration of her experience and interpreting the dreams as referring to her sexual life (Romano 96). The example of Dora’s case illustrates the unique features of a Freudian approach to mental disorders, and it also reflects the social construction of hysteria as a disease-centered around female sexuality. Given the constraints on female desire in the early 20th century, the pathologization of any outward sign of female sexual pleasure is not surprising, nor is Freud’s attempt to locate a series of unrelated symptoms to female sexuality and call it hysteria. The construction of hysteria as a disease of oppressed female sexual desire reflects a new take on its long history (it was considered to be the result of a wandering uterus beginning in the ancient world and continuing well into the early modern period) and a new step in the social construction of mental illness. Society allowed no room for upper-middle or upper-class women to express desire, so Freud argued that they quite literally became mentally ill from trying to manage it.
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The Freudian approach to insanity has not only shifted the face of modern psychiatry and psychology but has also influenced the legal procedures related to the insanity defense of the crime suspects. Leopold and Loeb’s case became the first trial, in which the Freudian approach replaced the biological one. This trial is explicitly described and analyzed in Simon Baatz’s book “For the Thrill of It: Leopold, Loeb, and the Murder that Shocked Chicago (Baatz, 2008)”. The author reveals the specifics of the murder of a young boy committed by two college students and describes the process of their defense. Though the killers fully confessed to prosecutors, their defender Clarence Darrow attempted to use the Freudian approach to insanity to acquit the criminals and avoid capital punishment (Baatz 278). The alienists hired by the defense found the roots of the crime in the emotional inability of the young men to control their actions caused by oppressive governesses experienced in childhood resulting in sexual perversion and violence. Such an approach to the insanity defense opposed the traditional methods of psychiatry used for diagnosing the mental health of the criminals (Baatz 278). Though the jury still found the defendants guilty, the killers were not sentenced to death due to their young age and the unwillingness of the court to “make an addition” to the number of minors “put to death by legal process.” The trial still brought national attention to the battle between biological and psychological explanations of deviant behavior and became crucial to popularizing Freudian ideas and the basics of psychoanalysis (Baatz 402). Leopold and Loeb’s case played a crucial role in demonstrating the benefits of the Freudian approach based on analyzing the subconscious motives to a wide public. Institutionalization Though the approaches to understanding the nature of insanity and defining the most appropriate way of treating the patients suffering from mental deviations have experienced significant changes throughout the past several centuries, the important role of medical institutions created for the continuous treatment of mentally-ill people has been recognized by most prominent figures in psychiatry. The history of the creation of the institutions serving people suffering from insanity illustrates how the attitudes to the asylum for such people changed over time. The first mental hospitals officially recognized as institutions for treating mentally-ill patients were created by Muslims in the 8th century in Baghdad (Murad and Gordon 28). Western Europe adopted the views reflecting the notion that the treatment of insanity requires institutionalization that occurred much later, in the 18th century. The first public mental asylums in Europe were established in Britain. The notion of an asylum that would serve specifically as a shelter for mentally retarded individuals first appeared in England in the 18th century. Historians of mental illness argue that humanitarian progress allowed the doctors of the 18th century to distinguish a new form of a disease that revealed itself in a form of lunacy or irrational behavior. Lunacy was not, however, a disease disconnected from its social context. According to the theory of social control, the ruling class of England created madhouses to show the laboring classes the real nature of mental recovery and discard the beliefs of religious remedy, which existed among the citizens at that time. In this way, wealthy Anglicans established a new form of social manipulation. Other historians claim that the introduction of asylums was a direct consequence of the Industrial Revolution and a new economy of private entrepreneurship. Private madhouses became a significant source of profit. “Madhouses and mad-doctors arose from the same soil that generated demand for general practitioners, dancing masters, man-midwives, face painters, drawing tutors…” (MacKenzie 12). Private madhouses of the 18th century had many features that illustrate the inhuman attitude to mentally-disabled people. The well-known facts about the regulations in St. Mary of Bethlehem mental hospital in London reveal the rules of madhouses of that time in general: some of the inmates were placed at the bottom of a pit with a “spectator gallery” enabling the members of the public to witness the “lunatics” (Weckowicz and Liebel-Weckowicz 91). Moreover, the members of the public had an opportunity to rent long poles for an additional fee and prod the patients who seemed to quiet (Weckowicz and Liebel-Weckowicz 91). Another example of an institution for mentally ill people was Juliusspital in Germany, which was known for the usage of chains and manacles for restraining the patients. The patients were also flogged with “leather-encased bullwhips” for breaking the hospital rules (Weckowicz and Liebel-Weckowicz 92). In the Narrennturm hospital in Vienna, the patients were shackled with chains and iron rings to the walls of their cells, and the physicians communicated with them through little holes in the doors (Weckowicz and Liebel-Weckowicz 92). All of these examples illustrate the dominating beliefs about insanity prevailing in the society of that time and reveal how they were reflected in the system of madhouses. The inhuman conditions in those institutions, including the grim architecture, lack of hygiene, and use of painful tools like masks, chains, and other immobilizers, promoted the violence and outrage of the inmates, which resulted in the tendency of choosing the attendants for their physical strength. The transition from the brutal system of madhouses to the more human and regulated ones occurred in the 19th century. The terrible rules described above were not the only problems related to such institutions. The absence of legislation caused numerous abuses based on the forced detention of those who were falsely claimed to be insane. The Madhouses Act of 1774 was strengthened by a series of laws creating a framework for regular inspections of asylums (Porter 294). Similar laws were passed in other countries and changed the face of institutions for mentally-ill people. The inmates of such institutions were no longer viewed as lunatics but were treated like patients while “mad-doctors” started to be regarded as psychiatrists (Scull 6). The attitudes to the requirements for the architecture, rules, and treatment used in madhouses were changed and resulted in their significant humanization. Madhouses flourished in the 19th century when they benefited from a theory that said beautiful surroundings were the key to mental recovery. Greek architecture featuring high ceilings, large windows, airy rooms, and carefully landscaped grounds became the model for asylums and an opportunity for architects to demonstrate their skills. These asylums were exceptionally beautiful and equally expensive, and their luxury raised ire among many of the working class who struggled to survive in horrific slums while wealthy lunatics relaxed in resort-like settings. In fact, most of the people who worked in the madhouses could not have afforded to stay in one, which demonstrated the socioeconomic disparities in access to mental health care. Thus, the psychologists concluded that madness could arise on two grounds. First, it was a direct consequence of multiple physical injuries. Second, it evolved from childhood traumas and repeated rights abuses. When the poor were admitted to asylums, much as when they were admitted to private hospitals, it was as a form of charity and on an unequal basis. Indigent patients were housed in lesser quarters and denied access to many of the entertainments and benefits offered (Yanni 9). Since asylums depended on wealthy patients to survive and psychiatrists often held posts at madhouses while simultaneously seeing private patients, private physicians became an excellent means of recruiting mental patients. Any wealthy person—especially woman—deemed emotionally sensitive or socially inappropriate could be sent to the asylum to protect her from the world’s stresses. Family arguments, refusals to accept an arranged marriage, homosexual inclinations or relationships, and many other private problems were labeled as symptoms of insanity and became the rationale for admitting someone to the madhouse. Since asylums were generally far from cities to protect patients from urban stressors, visits from family and friends were difficult if not impossible. Mackenzie argues that this allowed asylum physicians and staff to engage in abuses and neglect that would not otherwise have been possible (MacKenzie 67). Yanni demonstrates that the mythology behind the theory of locating asylums in a rural paradise so that the mentally ill could return to sanity by communing with nature. In fact, patients were not allowed to spend time outside without staff supervision, and since staff were not thrilled by the prospect of being alone in a field with a large group of lunatics, they rarely allowed the patients to spend much time outside. (Yanni 123) Thus, the tradition of insane treatment in the 19th century was based on fraud and health commercialization. The creation of mental hospitals simultaneously encouraged the growth of the field of psychiatry. Thus, the first specialists in the sphere were either the owners of the madhouses or the workers of such institutions since they had a chance to track the improvements or downfalls in the patients’ mental health. In the USA, the science was called asylum medicine since the major investigations were conducted inside the institutions. Due to the elevated social rankings of madhouse treatment, the profession of a psychiatrist gained instant popularity among the young professionals and quickly surpassed other specializations. Different theories were offered to explain mental illness, largely based in neurology. Psychiatrists contended that the mentally ill possessed highly sensitive nervous systems that staggered under the constant stimuli of modern life. The only cure for overly stimulated nerves was a rest in a calm, beautiful place that could return the nerves to a state of rest. This theory supported the creation of the beautiful asylums that proliferated in the 19th century and provided the landscape in which the next stage of psychiatry emerged. Treatment The treatment of mental illness has a long and often horrible history. In Bethlem (nicknamed Bedlam), the first hospital in Europe to specifically address mental illnesses, the changes in treatment demonstrate broader changes in understandings of mental illness. The presence of six male patients deemed “insane” in 1403 begins the hospital’s long history treating the insane. At that time, treatment consisted of prayer, solitary confinement, and sometimes physical restraint. Insanity was sometimes still considered the product of demonic possession in the late medieval period, but it was also considered a congenital medical problem and often dealt with according to the prevailing medical approach, humoral theory. Thus, the person’s symptoms would be treated with their opposites in an attempt to even out the patient’s constitution, and the treatment would also contain a broader approach to regulating the patient’s regimen to bring his body back into balance (Kavey, “Lecture on humoral theory”). By the early modern period, bleeding and leeches would also be used to try to drain off excess bad humors. At the same time, the insane were considered to be “devoid of reason” and were often treated like animals—whipped, beaten, restrained, and starved—in an attempt to return them to their right minds. An alternative was founded by the Quakers, who were disturbed by the violent conditions in asylums and offered “moral treatment” instead. They attempted to integrate the patients into a community characterized by regular labor and prayer. Patients who cooperated were rewarded, while those who did (or could) not were punished or frightened in an attempt to make them cooperate (Porter, A Social History of Madness). The latter treatment is demonstrated in the film, “The Madness of King George,” in which the English king is pressured to cooperate by his Quaker physician through a combination of work, solitary confinement, and punishment for speaking inappropriately. The film also illustrates the more traditional humoral approach and pointedly demonstrates both its horrors and its shortcomings. By the nineteenth century, institutionalization had become a gentler alternative than it had been for the preceding 500 years, in that the institutions themselves were quite beautiful and part of their promise was for a rest from the busy society that, itself, was believed to be a threat to sanity. But the treatment offered in these places remained barbaric—and in fact, became more invasive and frightening as science and psychiatry cooperated. Hot (to the point of causing burns) and cold (sometimes resulting in hypothermia) water treatments, electroshock therapy, insulin shock therapy, and lobotomies were among the treatments offered to mentally ill patients in the 19th and 20th centuries. The earliest types of psychotherapies take their roots from the 17th century. In this context, one usually regards the practices of various physical exposures and modifications, which were interpreted as the reactions to intellectual disabilities. For instance, the first psychologists were used to applying hydrotherapy as a producer of multiple bodily reactions. Since the human organism provides certain impulses in response to high and low temperatures, water was often heated or frozen (“Restoring Perspective: Life and Treatment at London Asylum” 1). Psychiatrists and psychiatric nurses, faced with highly disturbed or aggressive patients, initially employed the usage of isolation as a treatment technique beginning in the medieval period. Patients’ excessive rage and violence was seen as a threat to staff and other patients, so they were separated and often restrained to prevent them from harming themselves. Consequently, isolation became a treatment technique. At the end of the 20th century, however, it was certified by the psychological investigations that solitude does not allow people to cope with their problems. In contrast, it only stiffens their desires, which can evolve in the further mental complications, and so the practice was forbidden (“Isolation of Patients in Protected Rooms during Psychiatric Treatment” 5). Invasive Procedures Invented in the 20th Century The 20th century was marked with the introduction of many new invasive procedures used for the treatment of mental illnesses. The history of shock therapy in psychiatry began in the first decade of the 20th century and stemmed from the idea of convulsions being the effective treatment of such illness as apathy. Since the convulsions can be evoked by the electroshock therapy or insulin-imposed coma, the shock-based approach to recovery was developed. The method functioned for 70 years and was widely spread throughout multiple clinical settings (Shorter and Healy 10). Electroconvulsive therapy, deep sleep therapy, insulin shock therapy, and cardiozol shock therapy are among the most common methods used by the adherents of a shock-based approach to the treatment of mental diseases. Electroconvulsive therapy (ETC) is mostly used with informed consent in cases when other methods of treatment do not give visible results. It has been used till nowadays for treating major depressive disorder, mania, and catatonia. Deep sleep therapy is sometimes used in the combination with ETC in rare cases when there is a need to control patient’s aggression. Cardiozol shock therapy was used in convulsive therapy mainly as a part of the treatment of depression and was later replaced by ETC. Insulin shock therapy, based on the injections of insulin provoking coma, was used in the middle of the 20th century mainly for the treatment of schizophrenia. All of the methods of shock therapy have provoked controversial attitudes among professionals and ordinary people. The practice of lobotomy, in which the connections are severed between the prefrontal cortex and the rest of the brain, was initially employed as an effective response to prolonged depressions, schizophrenia, and some other severe mental illnesses. While it did result in some cases in a lessening or cessation of symptoms, it also had significant negative side effects, including often altering the patient’s ability to function and changing his original personality. The treatment first evolved in Portugal. It was developed by a neurologist, Egas Moniz, who deduced that gaining direct access to the human brain through drilling holes in a skull might improve the intellectual stability of a person. He shared the Nobel Prize in 1949 for the technique, and by 1951 lobotomies were frequently used in mental institutions, with at least 18,608 performed in the United States between the introduction of the procedure in 1948 and 1951 (Berrios 61). Despite its popularity, results were poor. Patients experienced significant losses in their intellectual and emotional range, many experienced seizures, and some even committed suicide after the procedure. Others died during it (Cooter 215). In 1967 an American patient died directly during the session of lobotomy, consequently, the practice was discarded by the World Health Organization (Tartakovsky 12). The twentieth century was marked by the evolvement of new attitudes to the nature of insanity and its treatment. As discussed above, the psychiatry has become more focused on the psychological side of insanity and the methods of psychoanalysis. However, the role of mental institutions has not decreased. Some of the real experiences of being treated in mental hospitals described in literary works illustrate the drawbacks of the system of healthcare-related to treating the patients of people with mental deviations. One of the brightest examples of literary works exploring the destinies of people put in kept in mental hospitals in the 20th century is the book by Penney and Stastny (2008) “The Lives They Left Behind”. The book presents several cases of patients of Willard State Hospital and reveals that thousands of people that spent their lives in the walls of the hospital needed to receive some help for overcoming severe tragedies or adjusting to social or cultural conditions to deal with psychological problems. Instead, they were proclaimed insane and put into the hospital to the end of their lives. The case of Lawrence Marek, who spent fifty years in Willard and died there, is a bright example of how society neglect those who seem to be deviant in certain aspects and remove such people by putting the label “insane”, which in fact has little to do with the real mental state of that people. Marek was not insane but simply distressed by the cultural bewilderment caused by his moving from Austria to the U.S. (Penney and Stastny 13). However, his distress was enough to encourage the authorities to put Marek to Willard. Another patient, whose case is presented in the book, is Ethel Smalls, who spent forty years in Willard and died there. The woman was admitted to Willard though she did not have any distinct symptoms of insanity. She simply was depressed after experiencing the death of children and her father, and the betrayal of the husband (Penney and Stastny 71). Both Marek and Ethel could have lived relatively happy and full lives if the society helped them to overcome their distress instead of isolating them in the hospital and condemning them to meet the death in Willard. In her 1997 novel The Last Time I Wore a Dress, Daphne Scholinski comes up with the autobiographical account of her years, spent in mental institutions during the eighties, due to having been diagnosed with the ‘gender identity disorder’ – the condition that was extrapolated by the character’s juvenile delinquency and by her emotional discomfort with being a female. According to Scholinski, it was not only that the psychiatric treatment she used to receive did not do her any good, but that it has in fact facilitated even further the author’s abnormal ways – this appears to be the novel’s main idea. To substantiate the soundness of this idea, Scholinski exposes readers to her memories of being endowed with the sense of lessened self-worth by psychiatrists, who according to the author tended to mistreat her, to feel better about themselves: “Everybody feels weird, and everybody is trying to tiptoe around and make you think they’re not” (75). Thus, The Last Time I Wore a Dress can be referred to as the actual indictment of how America’s system of psychiatric care used to operate a few decades ago. At least, this is how the author would like her novel to be perceived by readers – the fact that that the novel in question features some rather graphic accounts of psychiatric patients being subjected to the electroshock therapies supports the validity of this suggestion. Marya Hornbacher’s 1999 autobiographical novel (memoir) Wasted: A Memoir of Anorexia and Bulimia is essentially about the incapacitating effects of eating disorders (anorexia and bulimia) on the author’s ability to lead a productive life. In it, the author expounds on her memories of having been provided with different medicinal treatments, as the means to lessen the severity of these effects. The main idea, promoted throughout the novel, is that due to being affiliated with the ego-centric/individualistic values, the American healthcare system continues to remain utterly arrogant of the needs of people, affected by eating disorders – something that resulted in putting Hornbacher on the path of becoming a socially alienated individual. Another important idea, explored in the novel, is that contrary to what many people assume, eating disorders are not ‘physiological’ but rather ‘mental’. The author refers to them in terms of a “sinister, malevolent and predatory mental construct” (Hornbacher 5). Partially, this explains why, as it appears from the novel, the author’s exposure to the conventional therapies for treating bulimia and anorexia, did not prove beneficial in the long run. Quite to the contrary – Hornbacher contemplates the idea that it was namely due to these therapies that, as time went on, the sheer acuteness of her existential angst continued to increase. Thus, just as it is the case with Scholinski’s novel, Wasted: A Memoir of Anorexia and Bulimia can be best referred to as a literary piece that helps readers to grow increasingly aware that eliminating unpleasant symptoms in patients, as such that has the value of a ‘thing in itself’, can be no longer considered the legitimate objective of healthcare in the West. In her 1995 memoir An Unquiet Mind: A Memoir of Moods and Madness, Kay Redfield Jamison presents readers with her life-account of having struggled with the mental condition of manic-depressive disorder, while advancing the idea that it is rather inappropriate to assume that individuals, affected by this disorder, are not able to attain social prominence, by definition (Jamison holds Ph.D. in psychiatry). According to the author, even though the socially observable extrapolations of the concerned disorder do lead many people to assume that the affected individuals are ‘mad’, this is far from being the actual case – Jamison’s career serves as the best proof, in this respect. In fact, the memoir’s actual aim was to show that the reason why this disorder is considered strongly incapacitating is that even today the etiology of this mental condition remains largely unclear. This is the reason why, throughout the memoir’s entirety, Jamison never ceases to stress the importance of understanding that, within the context of a particular person developing the condition in question, the genetic factors are being just as imperative as the environmental ones. Moreover, Jamison strives hard to convince readers that it is not only that people should not be ashamed of their manic-depressive condition, but that they may, in fact, benefit from it, because being affected by this disorder naturally prompts individuals to indulge in analytical thinking. All that matters, in this respect, is to ensure that one’s manic anxieties are being properly channeled – hence, the author’s comparison of the concerned mental state to fire, which “by its nature, both creates and destroys” (Jamison 123). It is understood, of course, that Jamison’s outlook on the discursive significance of manic-depressive disorder is rather unconventional, but this is what contributes to the objective value of An Unquiet Mind: A Memoir of Moods and Madness even further. There can be only a few doubts that the summarized earlier literary works do interrelate in a variety of different ways. All of the cases described in the discussed literary works illustrate the social construction of psychiatric disease. They reveal that many people have been proclaimed mentally-ill based on the subjective opinions common in the society. The cases show that deviation from the social norms often serves as the cause of considering someone sick and insane. Therefore, the understanding of insanity is highly influenced by the beliefs of what is normal prevailing in the society. Besides, the writing agenda of the authors appear to have been concerned with these writers’ intention to educate readers about the commonly overlooked societal consequences of being diagnosed with a particular mental/neurological disorder. Also, we can mention the fact that the autobiographical novels in question radiate the strongly defined spirit of tolerance – according to all three authors, there is no rationale in deeming the behavioral ‘strangeness’, on the part of those affected by mental/neurological disorders, as the most obvious indication of their lessened social worth. Finally, regardless of whether the mentioned authors deliberately strived it to be the case or not, but the reading of their literary accounts about one’s struggle with mental and neurological issues, will naturally encourage readers to wonder about whether the euro-centric paradigm of Western healthcare, as we know it, can be considered consistent with the realities of modern living. After all, given the authors’ negative experiences of having been subjected to the conventional psychiatric therapies, it will be thoroughly appropriate to assume that all three literary pieces advance the idea that the time has come for the psychiatric interventions to serve the purpose of providing patients with the chance of ‘holistic’ (concerned with body and soul) recovery, rather than merely the purpose of helping them to conform to the society’s ways. This alone qualifies the discussed autobiographical novels to be recommended for reading by just about anyone. The analysis of the approaches to insanity and its treatment during the last several centuries demonstrates that psychiatry appears to have become more human and patient-centered. However, the analysis of the history of the institutions for mentally ill people and the methodology employed by them reveals the flaws in modern psychiatry. 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