Reform began almost simultaneously on either side of the Channel. In England a Quaker merchant, William Tuke, set up the York Retreat, a hospital for the mentally sick, in which restraint was never used and the psychological treatment was aimed, not at frightening the patients, but at bringing them back from their isolation by persuading them to work, play, eat, talk and worship together. In France the pioneer in reform was Doctor Philippe Pinel, who was appointed to the direction of the Bicetre Asylum in Paris at the height of the French Revolution. Many of the patients were kept permanently chained in unlighted cells. Pinel asked permission of the revolutionary government to set them free. It was refused. Liberty, Equality and Fraternity were not for lunatics. Pinel insisted, and at last permission was grudgingly given. The account of what followed is touching in the extreme. “The first man on whom the experiment was tried was an English captain, whose history no one knew, as he had been in chains for forty years. He was thought to be one of the most furious among them. His keepers approached him with caution, as he had in a fit of fury killed one of them on the spot with a blow from his manacles. He was chained more rigorously than any of the others. Pinel entered his cell unattended and calmly said to him, ‘Captain, I will order your chains to be taken off and give you liberty to walk in the court, if you will promise me to behave well and injure no one.’ ‘Yes, I promise,’ said the maniac. ‘But you are laughing at me…’ His chains were removed and the keepers retired, leaving the door of his cell open. He raised himself many times from the seat, but fell again on it; for he had been in a sitting posture so long that he had lost the use of his legs. In a quarter of an hour he succeeded in maintaining his balance and with tottering steps came to the door of his dark cell. His first look was at the sky, and he exclaimed, ‘How beautiful, how beautiful!’ During the rest of the day he was constantly in motion, uttering exclamations of delight. In the evening he returned of his own accord to his cell and slept tranquilly.”

In Europe the pioneer work of Tuke and Pinel was continued by Conolly, Esquirol and a growing number of their followers in every country. In America, the standard bearer of reform was a heroic woman, Dorothea Dix. By the middle of the century many of the worst abominations of the old regime were things of the past. The mentally ill began to be treated as unfortunate human beings, not as Objects. It was an immense advance; but it was not yet enough. Reform had produced institutional care, but still no adequate treatment. For most nineteenth-century doctors, things were more real than thoughts and the study of matter seemed more scientific than the study of mind. The dream of Victorian medicine was, in Zilboorg’s phrase, to develop a psychiatry that should be completely independent of psychology. Hence the widespread and passionate rejection of the procedures lumped under the names of Animal Magnetism and Hypnotism. In France, Charcot, Liebault and Bernheim achieved remarkable results with hypnosis; but the intellectually respectable psychiatrists of Europe and America turned their backs on this merely psychological treatment of mental illness and concentrated instead on the more “objective,” the more “scientific” methods of surgery.

It had all happened before, of course. Cutting holes in the skull was an immemorially ancient form of psychiatry. So was castration, as a cure for epilepsy. Continuing this grand old tradition, the Victorian doctors removed the ovaries of their hysterical patients and treated neurosis in young girls by the gruesome operation known to ethnologists as “female circumcision.” In the early years of the present century Metchnikoff was briefly a prophet, and autointoxication was all the rage in medical circles. Along with practically every other disease, neuroses were supposed to be due to intestinal stasis. No intestine, no stasis—what could be more logical? The lucky neurotics who could afford a major operation went to hospital, had their colons cut out and the end of their small intestines stitched to the stump. Those who recovered found themselves with yet another reason for being neurotic: they had to hurry to the bathroom six or eight times a day. Intestinal stasis went out with the hobble skirt, and the new vogue was focal infection. According to the surgical psychiatrists, people were neurotic not because of conflicts in their unconscious mind, but because of inflammation in their tonsils or abscesses at the roots of their teeth. The dentists, the nose-and-throat men set to work with a will. Toothless and tonsilectomized, the neurotics, needless to say, went on behaving just as neurotically as ever. Focal infections followed intestinal stasis into oblivion, and the surgical psychiatrists now prefer to make a direct assault upon the brain. The current fashion is shock treatment or, on great occasions, prefrontal lobotomy. Meanwhile the pharmacologists have not been idle. The barbiturates, hailed not so long ago as panaceas, have given place to Chlorpromazine, Reserpine, Frenquel and Miltown. Insofar as they facilitate the specifically psychological treatment of mental disorders, these tranquilizers may prove to be extremely valuable. Even as symptom stoppers they have their uses.

The green oasis among the jets and the rockets is crammed to overflowing. So are all the other mental hospitals of the Western world. Technological and economic progress seems to have been accompanied by psychological regress. The incidence of neuroses and psychoses is apparently on the increase. Still larger hospitals, yet kinder treatment of patients, more psychiatrists and better pills—we need them all and need them urgently. But they will not solve our problem. In this field prevention is incomparably more important than cure; for cure merely returns the patient to an environment which begets mental illness. But how is prevention to be achieved? That is the sixty-four-billion-dollar question.

(From Esquire Magazine)

That men do not learn very much from the lessons of history is the most important of all the lessons that history has to teach. Si vis pacem, the Romans liked to say, para bellum—if you want peace prepare for war. For the last few thousand years the rulers of all the world’s empires, kingdoms and republics have acted upon this maxim—with the result, as Professor Sorokin has laboriously shown, that every civilized nation has spent about half of every century of its existence waging war with its neighbors. But has mankind learned this lesson of history? The answer is emphatically in the negative. Si vis pacem, para bellum still is the watchword of every sovereign state, with the possible exception of Monaco. Again, what happens when economic power is concentrated in a few hands? History’s answer to that question is that, whatever else it may be, that which happens is most certainly not democracy. But while politicians everywhere proclaim the virtues of democracy (even the totalitarian states are People’s Republics), advancing technology is everywhere allowed and even encouraged to work for the concentration of economic power. Small-scale operators in agriculture and industry are progressively eliminated, and in their place advancing technology installs an oligarchy of giant concerns, owned and operated either by private corporations and their managers, or by the state and its bureaucrats.

It is interesting to note that the men who, in the teeth of history, proclaimed that, if you want peace, you must prepare for war, were the self-same men who solemnly declared that Experience teaches, experientia docet—or, as Mrs. Micawber more aptly put it, “Experientia does it.” But as a matter of brute historical fact, Experientia generally doesn’t. We got on doing what our own and our father’s experience has demonstrated, again and again, to be inappropriate or downright disastrous; and we go on hoping (this time like Mr. Micawber) that “something will turn up”—something completely different from anything which, on the basis of experience, we have any right to expect. Needless to say, it does not turn up. The same old mistakes have the same old consequences and we remain in the same old mess.