Although professionalism often means a striving for excellence, American professionalism has too frequently meant an association with a stubborn failure to acknowledge the limitations of ignorance. In medicine, in particular, there's too much history of unwillingness to admit that a science in its infancy can be a danger to patients. A good illustration is the story of how psychiatry became obsessed with infections as a likely cause of madness.
In the early 20th century, tuberculosis was rampant and existed in every hospital for the mentally ill in America. For a good part of the 19th century, as much as 60 percent of patients in British insane asylums died of tuberculosis. Since in the 19th century there was never much difference between British and American insane asylums, we can assume similar statistics applied to American asylums. As late as the 1890s, three times as many people died of tuberculosis in insane asylums as in the general population.
The disease was also a mystery, and among many psychiatrists a focus of silly early psychoanalytic interpretations. For example, the famed psychiatrist and psychoanalyst William Alanson White (1870-1937) suggested in 1916 that tuberculosis might be defined as a failure in the sublimation of respiratory libido, a failure whose causes could be determined only if the unconscious mind of the patient became known. White proposed this even though it was already known that tuberculosis was apparently a contagious disease that killed millions of people, especially the urban poor. The tuberculosis bacterium had been identified by Robert Koch in 1882, and Koch had received the Nobel Prize for his work in 1905. White's attempt to apply the psychoanalytic concept of "organ inferiority" to tuberculosis seems ridiculous now, but in his time it was well received by many people in the psychiatric community whose infatuation with psychoanalytic ideas apparently overrode consideration of any existing science.
The general problem of tuberculosis in insane asylums was stated concisely in 1919 by S. A. Silk, a physician at St. Elizabeth's Hospital in Washington, D.C. (formerly known as the Government Hospital for the Insane):
"When a tubercular patient has to remain in bed all the time, he is beyond hope, and while in such condition is much less of a danger to spread the disease among the other inmates than when he was an ambulant patient, coughing and expectorating all over the ward, or being transferred from one ward to another. The reasons for this deplorable fact are many, but they are chiefly the neglecting of the physical side of the patient and lack of knowledge on the part of the members of the medical staffs of the physical signs indicating pulmonary tuberculosis."So we have the striking situation in the early part of the twentieth century that medical staffs of most insane asylums in America lacked training in recognizing the symptoms of one of the most important lethal endemics in the country. Or maybe these physicians had the training and lacked the intelligence to apply it. None of it speaks well of American medicine in the year 1919. Since Dr. Silk had wide experience, not only at St. Elizabeth's, but also at hospitals in Philadelphia and Los Angeles, his assessment is significant.
Even more striking is the remarkable fact that during the second half of the nineteenth century the association between tuberculosis and madness in insane asylums was so common (already common in the first half of the nineteenth century) that the influential British psychiatrist Thomas Clouston (1840-1915) maintained for nearly thirty years, between 1863 and 1892, that tuberculosis and insanity constituted a new form of mental disorder that he labeled "phthisical insanity". ("Phthisis" is an old term for tuberculosis, usually pulmonary tuberculosis.)
This is the same Thomas Clouston who was the martinet superintendent of the prestigious Royal Edinburgh Asylum, an asylum manager who believed insanity was a loss of self-control, and that the role of the asylum was to force "a strict and ordered regime to help patients regain mastery over their unruly behavior." As might be expected, he was also an ardent eugenicist.
Clouston's idea of "phthisical insanity" was taken seriously and intensely debated in the psychiatric community, even after the discovery of the tuberculosis bacillus in 1882. Clouston was convinced the correlation of insanity and tuberculosis in asylums was due to some common biological interaction. It apparently never occurred to him--or to most other established psychiatrists--that the asylum population of Britain and America consisted of mostly paupers and other social rejects, and that a common cause might be the most serious endemic conditions in Western society in that time--physical disease and psychological stress produced by poverty.
There were other ideas at this time about the connection between madness and infections. Some of the ideas had unhappy consequences, including the death (long kept secret) of a young mental patient at the hands of a physician--his own father--who thought he had a cure for dementia praecox. I will discuss this case in a later essay.
The major point here is the rot of dogma can develop in the minds of the educated as easily as in the minds of the uneducated. We like to talk about the "best and brightest" of a generation, but history shows us again and again that the best and the brightest are often as prone to dangerous dogma as anyone else. Caveat emptor is a caution not only for people buying bananas, but also for the public buying ideas.
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By Dan Agin:
Black and White in America: Deception, Fallacy, & Prejudice in U.S. Society. Spectrum Focus, 2010.
More Than Genes: What Science Can Tell Us About Toxic Chemicals, Development, and the Risk to Our Children. Oxford University Press, 2010.
Junk Science: How Politicians, Corporations, and Other Hucksters Betray Us. St. Martin's/Thomas Dunne, 2006.
I didn't know anything about the history of medical science(or not..lol) until about 5 years ago when I read Barry's "The Great Influenza". I've heard people complain about the book's editing, but I found it riveting; I couldn't put it down.
Thanks for another interesting tidbit.
In addition to that, during the last half-century (in the West) the rhetoric of medical care is now almost always conflated with "medical insurance." I am old enough to remember when these notions were not universally accepted dogma, but an entire generation of Americans has now matured with the illusion that medical practice is a financial enterprise.
Under the leadership of Barack Obama, Democrats in Congress are attempting to make ‘health care’ neither a right, nor a privilege -- but an obligation for individual citizens, by enfranchising a government-mandated profit center for private corporations.
For the first time in American history, politicians are using the coercive power of the federal government to force every American -- simply by virtue of being an American -- to purchase the products of a private company. In effect, this represents an historic defeat for the type of American idealism represented by the New Deal and the Great Society, and marks the ascendancy of a new type of 'corporatism'.