Historically Speaking: The Long, Dark Shadow of the Real ‘Bedlam’

Today’s debate over compulsory treatment for the mentally ill has roots in a history of good intentions gone awry

The Wall Street Journal

January 12, 2023

This year, California and New York City will roll out plans to force the homeless mentally ill to receive hospital treatment. The initiatives face fierce legal challenges despite their backers’ good intentions and promised extra funds.

Opposition to compulsory hospitalization has its roots in the historic maltreatment of mental patients. For centuries, the biggest problem regarding the care of the mentally ill was the lack of it. Until the 18th century, Britain was typical in having only one public insane asylum, Bethlehem Royal Hospital. The conditions were so notorious, even by contemporary standards, that the hospital’s nickname, Bedlam, became synonymous with violent anarchy.

Plate 8 of WIlliam Hogarth’s ‘A Rake’s Progress,’ titled ‘In The Madhouse,’ was painted around 1735 and depicted the hospital known as ‘Bedlam.’
PHOTO: HERITAGE IMAGES VIA GETTY IMAGES

The cost of treatment at Bedlam, which consisted of pacifying the patients through pain and terror, was offset by viewing fees. Anyone could pay to stare or laugh at the inmates, and thousands did. But social attitudes toward mental illness were changing. By the end of the 18th century, psychiatric reformers such as Benjamin Rush in America and Philippe Pinel in France had demonstrated the efficacy of more humane treatment.

In a burst of optimism, New York Hospital created a ward for the “curable” insane in 1792. The Quaker-run “Asylum for the Relief of Persons Deprived of the Use of Their Reason” in Pennsylvania became the first dedicated mental hospital in the U.S. in 1813. By the 1830s there were at least a dozen private mental hospitals in America.

The public authorities, however, were still shutting the mentally ill in prisons, as the social reformer Dorothea Dix was appalled to discover in 1841. Dix’s energetic campaigning bore fruit in New Jersey, which soon built its first public asylum. Designed by Thomas Kirkbride to provide state-of-the-art care amid pleasant surroundings, Trenton State Hospital served as a model for more than 70 purpose-built asylums that sprang up across the nation after Congress approved government funding for them in 1860.

Unfortunately, the philanthropic impetus driving the public mental hospital movement created as many problems as it solved. Abuse became rampant. It was so easy to have a person committed that in the 1870s, President Grover Cleveland, while still an aspiring politician, successfully silenced the mother of his illegitimate son by having her spirited away to an asylum.

In 1887, the journalist Nellie Bly went undercover as a patient in the Women’s Lunatic Asylum on Blackwell’s Island (now Roosevelt Island), New York. She exposed both the brutal practices of that institution and the general lack of legal safeguards against unwarranted incarceration.

The social reformer Dorothea Dix advocated for public mental health care.

During the first half of the 20th century, the best-run public mental hospitals lived up to the ideals that had inspired them. But the worst seemed to confirm fears that patients on the receiving end of state benevolence lost all basic rights. At Trenton State Hospital between 1907 and 1930, the director Henry Cotton performed thousands of invasive surgeries in the mistaken belief that removing patients’ teeth or organs would cure their mental illnesses. He ended up killing almost a third of those he treated and leaving the rest damaged and disfigured. The public uproar was immense. And yet, just a decade later, some mental hospitals were performing lobotomies on patients with or without consent.

In 1975 the ACLU persuaded the Supreme Court that the mentally ill had the right to refuse hospitalization, making public mental-health care mostly voluntary. But while legal principles are black and white, mental illness comes in shades of gray: A half century later, up to a third of people living on the streets are estimated to be mentally ill. As victories go, the Supreme Court decision was also a tragedy.

Historically Speaking: The Fungus That Fed Gods And Felled a Pope

There’s no hiding the fact that mushrooms, though delicious, have a dark side

The Wall Street Journal

October 21, 2022

Fall means mushroom season. And, oh, what joy. The Romans called mushrooms the food of the gods; to the ancient Chinese, they contained the elixir of life; and for many people, anything with truffles is the next best thing to a taste of heaven.

Lovers of mushrooms are known as mycophiles, while haters are mycophobes. Both sets have good reasons for feeling so strongly. The medicinal properties of mushrooms have been recognized for thousands of years. The ancient Chinese herbal text “Shen Nong Ben Cao Jing,” written down sometime during the Eastern Han Dynasty, 25-220 AD, was among the earliest medical treatises to highlight the immune-boosting powers of the reishi mushroom, also known as lingzhi.

The hallucinogenic powers of certain mushrooms were also widely known. Many societies, from the ancient Mayans to the Vikings, used psilocybin-containing fungi, popularly known as magic mushrooms, to achieve altered states either during religious rituals or in preparation for battle. One of the very few pre-Hispanic texts to survive Spanish destruction, the Codex Yuta Tnoho or Vindobonensis Mexicanus I, reveals the central role played by the mushroom in the cosmology of the Mixtecs.

ILLUSTRATION: THOMAS FUCHS

There is no hiding the fact that mushrooms have a dark side, however. Fewer than 100 species are actually poisonous out of the thousands of varieties that have been identified. But some are so deadly—the death cap (Amanita phalloides), for example—that recovery is uncertain even with swift treatment. Murder by mushroom is a staple of crime writing, although modern forensic science has made it impossible to disguise.

There is a strong possibility that this is how the Roman Emperor Claudius died on Oct. 13, 54 A.D. The alleged perpetrator, his fourth wife Agrippina the Younger, wanted to clear the path for her son Nero to sit on the imperial throne. Nero dutifully deified the late emperor, as was Roman custom. But according to the historian Dio Cassius, he revealed his true feelings by joking that mushrooms were surely a dish for gods, since Claudius, by means of a mushroom, had become a god.

Another victim of the death cap mushroom, it has been speculated, was Pope Clement VII in 1534, who is best known for opposing King Henry VIII’s attempt to get rid of Catherine of Aragon, the first of his six wives. Two centuries later, in what was almost certainly an accident, Holy Roman Emperor King Charles VI died in Vienna on Oct. 20, 1740, after attempting to treat a cold and fever with his favorite dish of stewed mushrooms.

Of course, mushrooms don’t need to be lethal to be dangerous. Ergot fungus, which looks like innocuous black seeds, can contaminate cereal grains, notably rye. Its baleful effects include twitching, convulsions, the sensation of burning, and terrifying hallucinations. The Renaissance painter Hieronymus Bosch may well have been suffering from ergotism, known as St. Anthony’s Fire in his day, when he painted his depictions of hell. Less clear is whether ergotism was behind the strange symptoms recorded among some of the townspeople during the Salem witch panic of 1692-93.

Unfortunately, the mushroom’s mixed reputation deterred scientific research into its many uses. But earlier this year a small study in the Journal of Psychopharmacology found evidence to support what many college students already believe: Magic mushrooms can be therapeutic. Medication containing psilocybin had an antidepressant effect over the course of a year. More studies are needed, but I know one thing for sure: Sautéed mushrooms and garlic are a recipe for happiness.

Historically Speaking: Anorexia’s Ancient Roots And Present Toll

The deadly affliction, once called self-starvation, has become much more common during the confinement of the pandemic.

The Wall Street Journal

February 18, 2022

Two years ago, when countries suspended the routines of daily life in an attempt to halt the spread of Covid-19, the mental health of children plunged precipitously.

Two years ago, when countries suspended the routines of daily life in an attempt to halt the spread of Covid-19, the mental health of children took a plunge. One worrying piece of evidence for this was an extraordinary spike in hospitalizations for anorexia and other eating disorders among adolescents, especially girls between the ages of 12 and 18, and not just in the U.S. but around the world. U.S. hospitalizations for eating disorders doubled between March and May 2020. England’s National Health Service recorded a 46% increase in eating disorder referrals by 2021 compared with 2019. Perth Children’s hospital in Australia saw a 104% increase in hospitalizations and in Canada, the rate tripled.

Anorexia nervosa has a higher death rate than any other mental illness. According to the National Eating Disorders Association, 75% of its sufferers are female. And while the affliction might seem relatively new, it has ancient antecedents.

As early as the sixth century B.C., adherents of Jainism in India regarded “santhara,” fasting to death, as a purifying religious ritual, particularly for men. Emperor Chandragupta, founder of the Mauryan dynasty, died in this way in 297 B.C. St. Jerome, who lived in the fourth and fifth centuries A.D., portrayed extreme asceticism as an expression of Christian piety. In 384, one of his disciples, a young Roman woman named Blaesilla, died of starvation. Perhaps because she fits the contemporary stereotype of the middle-class, female anorexic, Blaesilla rather than Chandragupta is commonly cited as the first known case.

The label given to spiritual and ascetic self-starvation is anorexia mirabilis, or “holy anorexia,” to differentiate it from the modern diagnosis of anorexia nervosa. There were two major outbreaks in history. The first began around 1300 and was concentrated among nuns and deeply religious women, some of whom were later elevated to sainthood. The second took off during the 19th century. So-called “fasting girls” or “miraculous maids” in Europe and America won acclaim for appearing to survive without food. Some were exposed as fakes; others, tragically, were allowed to waste away.

But, confusingly, there are other historical examples of anorexic-like behavior that didn’t involve religion or women. The first medical description of anorexia, written by Dr. Richard Morton in 1689, concerned two patients—an adolescent boy and a young woman—who simply wouldn’t eat. Unable to find a physical cause, Morton called the condition “nervous consumption.”

A subject under study in the Minnesota Starvation Experiment, 1945. WALLACE KIRKLAND/THE LIFE PICTURE COLLECTION/SHUTTERSTOCK

Almost two centuries passed before French and English doctors accepted Morton’s suspicion that the malady had a psychological component. In 1873, Queen Victoria’s physician, Sir William Gull, coined the term “Anorexia Nervosa.”

Naming the disease was a huge step forward. But its treatment was guided by an ever-changing understanding of anorexia’s causes, which has spanned the gamut from the biological to the psychosexual, from bad parenting to societal misogyny.

The first breakthrough in anorexia treatment, however, came from an experiment involving men. The Minnesota Starvation Experiment, a World War II –era study on how to treat starving prisoners, found that the 36 male volunteers exhibited many of the same behaviors as anorexics, including food obsessions, excessive chewing, bingeing and purging. The study showed that the malnourished brain reacts in predictable ways regardless of race, class or gender.

Recent research now suggests that a genetic predisposition could count for as many as 60% of the risk factors behind the disease. If this knowledge leads to new specialized treatments, it will do so at a desperate time: At the start of the year, the Lancet medical journal called on governments to take action before mass anorexia cases become mass deaths. The lockdown is over. Now save the children.

A shorter version appeared in The Wall Street Journal