Madhouse: A Tragic Tale of Megalomania and Modern Medicine

by Andrew Scull

Madhouse reveals a long-suppressed medical scandal, shocking in its brutality and sobering in its implications. It shows how a leading American psychiatrist of the early twentieth century came to believe that mental illnesses were the product of chronic infections that poisoned the brain. Convinced that he had uncovered the single source of psychosis, Henry Cotton, superintendent of the Trenton State Hospital, New Jersey, launched a ruthless campaign to “eliminate the perils of pus infection.” Teeth were pulled, tonsils excised, and stomachs, spleens, colons, and uteruses were all sacrificed in the assault on “focal sepsis.”

Many patients did not survive Cotton’s surgeries; thousands more were left mangled and maimed. Cotton’s work was controversial, yet none of his colleagues questioned his experimental practices. Subsequent historians and psychiatrists too have ignored the events that cast doubt on their favorite narratives of scientific and humanitarian progress.

In a remarkable feat of historical detective work, Andrew Scull exposes the full, frightening story of madness among the mad-doctors. Drawing on a wealth of documents and interviews, he reconstructs in vivid detail a nightmarish, cautionary chapter in modern psychiatry when professionals failed to police themselves.

Genres: History, Psychology, Medicine, Nonfiction, Psychiatry, Science, Mental Illness

376 pages, Hardcover

First published April 10, 2005

About the author

Andrew T. Scull (born 1947) is a British-born sociologist whose research is centered on the social history of medicine and particularly psychiatry. He is a Distinguished Professor of Sociology and Science Studies at University of California, San Diego and recipient of the Roy Porter Medal for lifetime contributions to the history of medicine. His books include Madhouse: A Tragic Tale of Megalomania and Modern Medicine and Madness in Civilization: A Cultural History of Insanity.

Scull was born in Edinburgh, Scotland, the son of Allan Edward Scull, a civil engineer and Marjorie née Corrigan, a college teacher. He received his BA with first class honors from Balliol College, Oxford. He then studied at Princeton University, receiving his MA in Sociology in 1971 and his Ph.D. in 1974. He was a postdoc at University College London in 1976-77.

Scull taught at the University of Pennsylvania from 1973 until 1978 when was appointed to the sociology faculty at University of California, San Diego as an Associate Professor. He was appointed a full professor in 1982, and Distinguished Professor in 1994.

Reviews

[Terri · Rating 4 out of 5]

“We are all born mad. Some remain so.” - Samuel Beckett

One of the scariest non-fiction books I have read in a long time and it is so shocking that it kept me up nights. This is the history of a nightmarish mental state hospital in Trenton, New Jersey in the 1920's and its young medical director, an unethical American psychiatrist named Henry Cotton. Dr. Cotton sincerely believed that all mental illness was caused by infection (germs and pus) of the body. He was not the only doctor that felt this way in this time period and people were desperate to find a cure for their mental illness or their loved ones.

Dr. Cotton and his staff started to remove their patients teeth, spleens, colons, testicles, gall bladders, uteruses, stomachs and tonsils to avoid infection which “poisoned” the brain. (He also removed his own teeth, his wife Della and their two children Henry and Adolf to avoid becoming mentally ill.) 30 to 45% of his patients did not survive their surgeries. If the surgical team removed teeth and the patient did not improve, then they would experiment and keep removing organs until they were satisfied with the results. After all, Dr. Cotton had told his colleagues that there would be a 85 per cent cure rate of mental disorders if they did his advanced procedures. They ended up doing over 645 of these major organ removing surgeries on people and one out of three people died from them.

But what makes the horrifying story so much worse, is when the good doctor is told that his germ theory is wrong and that not only are his patients not getting better but in fact they were dying in alarming rates. He decides to aggressively continue the surgery practice and attempts to shut down anyone who stands in his way. He lies and commits fraud about his test findings. His ego is so huge that he is willing to risk and ruin people's lives to become famous for his "advanced" theories and his career. And instead of reporting his findings to his peers, he shares them with newspapers. His male friends, for the most part (and in the same field) support him (despite the damning evidence) and no one dares to stands up to him. When one of his brave female colleagues get suspicious and writes a report that states that this is a dangerous, useless and an incorrect theory, it is buried by his fellow co-workers.

These surgeries continue for another thirty years at the Trenton Mental State Hospital even after until his death of a heart attack in 1933. NOTE -Saddest ending-His two children (both sons) ended up killing themselves as adults. They like the hundreds of patients, their father had treated, had most of their teeth removed and one son had part of his colon removed. It is estimated that hundreds of people were maimed for life and hundreds had died.

Fantastic and riveting book written by Sociology professor Andrew Scull. Any reader interested in the history of psychiatry, medicine or historical scandals will want to have this in their library. Four stars.

[Lindsey · Rating 2 out of 5]

Would have made a great, long essay in a magazine, but this book is overwritten. There are some compelling pieces - the image of women get dragged into an operating room kicking and screaming, to have their teeth, tonsils, colons and ovaries removed (in order to remove an sepsis that could be leading to their insanity, in line with the mad doctor's theory) - that's pretty chilling. But I had to skim over bits detailing the doctor's trips abroad, his reception in the medical community, etc. If you read Chapter 9, you get the idea.

[Lara · Rating 4 out of 5]

An intriguing and informative read that's haunted me for the many months since I finished reading it. It's not as fresh in my mind as it was even a few weeks ago but I can still compose a few thoughts. It tells an amazing tale that should be known by more people. By 'amazing' I mean horrifying. It's a difficult book to read, not only because of its dark subject matter, but because many chapters plod along dully and without strongly engaging the reader. I suspect this is why it has an average rating of roughly three stars. Still, when it gets engaging, boy howdy.

I would love to adapt this one as a screenplay--with a minimal amount of dramatizing and some light temporal kneading, it could unfold as a very gripping cautionary tale about 20th century psychiatry and medical hubris. I'm not sure that's a lesson that needs to be shared in the current political climate, which is sadly hostile to science as a whole, but if cleverly told...

"Madhouse" is not on par with some other nonfiction prose science mystery books that I've read, in terms of pure page-turning, but it's a worthy read nonetheless.

[Jackie Blanton-Watkins · Rating 3 out of 5]

I wanted to like this more. The content is interesting, but it frequently veered off into a Stephen King-esque "how is this relevant?" space so I skimmed several parts. It felt like this couldn't decide if it wanted to be scholarship, or if it wanted to be narrative history, which interrupted my reading groove fairly often. Occassionally I wondered if the problem came from too much to say and not enough editing, or if a word count needed to be met.

In all, though, it was interesting and I don't regret reading it.

[Barbara Miller · Rating 3 out of 5]

A real slog, but an appalling history of the horrible mistreatment of mental patients by a doctor who was director at New Jersey's Trenton State Hospital. His theory that all mental illness was caused by infection and the treatment thereof was the removal of teeth as well as parts of organs such as the colon led to thousands of crippled and dying patients. That his insanity spread throughout the world and other hospitals in places like California and Britain was equally shocking. While the facts were interesting, the writing style is dry and academic, so it takes a real commitment to get through.

[Emily · Rating 4 out of 5]

This book is about a horrifying chapter in American medical history. Psychiatrist Henry Cotton practiced in the early 1900s and became convinced that mental illness was caused by infection in other parts of the body, such as the teeth, the colon, the tonsils, and the uterus, and therefore recommended removing some or all of these organs in order to reverse the mental illness. He believed this so strongly that he had all of his childrens' teeth pulled out to prevent them from going nuts later in life. It's quite shocking, especially when it becomes evident that many other doctors and administrators knew that Cotton's data (that supposedly showed that his technique was successful) was hopelessly flawed. It's a terrific argument for the vital importance of truth-telling and accountability in health care.

[Miriam · Rating 5 out of 5]

This is an important book for people working in the mental health field and clients both to read. The author lapses into a style reminiscient of Edgar Allen Poe's Victorian drama at times, but that just added to my enjoyment. This book certainly shows the effect of discrimination against people with mental illnesses- his "treatment" having over 30% mortality rates was never seen as a problem! A couple of evil doctors (Cotton AND Meyers), a brilliant and troubled female doctor's betrayal and censoring, it sounds like fantasy but is in reality historical fact. I could not put it down! Very worthwhile reading.

[Jeffrey Acorn · Rating 5 out of 5]

I highly recommend this book if you are interested in learning about the history of medicine in psychiatry. Andrew Scull brings forth the history of one foul doctor in a highly engaging, page turning story. Scull commands mastery of style and does not just present facts. He weaves a story such that you might find in the mystery section of the bookstore. If you work in the profession, its important to see where the field once was and where it was going especially in light of the evidenced based treatment movement.

[Julia Taylor-Golbey · Rating 4 out of 5]

This book vacillated between a historical thriller and a white paper on mental illness, so it took away some of my enjoyment ( if you can view the whittling away of helpless mental patients a pleasant endeavor). Style issues aside, it merits a read to get an idea of just how far the treatment of the mentally impaired has come but also a reflection on how stigmatization remains rooted in how society handles mental illness.

[Katie · Rating 3 out of 5]

ok, so i didn't really finish this book. but i've been wanting to for some time. i brought it on a vacation weekend --- shoulda brought the gossip girl series instead. topically this is the book i want to write. so yea, what i read was interesting for those who are into those sorta things... megalomania, modern medicine, yea.

[Joe B · Rating 2 out of 5]

The content of this book was all new to me and extraordinary. 'Trust me, I'm a doctor' will never ring so hollow again for me. However, the writing style was laboured and infected with too many, so very needless, medical words. So that spoiled it for me, a layman. The writer could have taken a note out of 'Blood and Guts; a history of surgery' and written far more accessibly.

[Alison · Rating 4 out of 5]

Really interesting, shocking material. I agree it's a bit longer than it needs to be, but the book is really well-researched and Scull's range of sources is impressive. Madhouse makes you wonder what we're doing today about which people will be slapping their foreheads 50-100 years from now.

[May Ling Wu · Rating 4 out of 5]

I found this fascinating.

[Amy]

Not nearly as exciting as the title and back cover imply. Focused more on reports and documents then mental illness.

[Monica Haley · Rating 3 out of 5]

Interesting material but the writing was not the best. So much of the information was just repeated over and over and there were a few obvious jokes that were just simply out of place.

[Paul Coletti · Rating 3 out of 5]

Quite dull at some points but very well-written.

[Nate · Rating 4 out of 5]

Absolutely fascinating. The guy was a bit flamboyant with his prose sometimes and tried to really pull out some impressive words almost to comic effect, but overall really in-depth research.