Inside Schizophrenia: Evolution of Schizophrenia Treatments
Schizophrenia has been around since the beginning of time, but in fact it has only been treated for the past 100 years. In this episode, host and schizophrenic Rachel Star Withers walks you through the dark and disturbing evolution of schizophrenia treatments. From systematic euthanasia to hydrotherapy and electroconvulsive therapy to the notorious lobotomy.
Did these doctors torture "mad scientists" the mentally ill, or were they the only ones trying to help a population that was seen as a burden?
About our guest
Miriam Posner is an Assistant Professor at the UCLA School of Information. She has a Ph.D. in Film and American Studies from Yale University. She is a digital humanist with an interest in work, race, feminism, and the history and philosophy of data. As a digital humanist, she is particularly interested in the visualization of large amounts of data from institutions of cultural heritage and the application of digital methods for analyzing images and videos. A trained film, media and American studies scholar, she often writes about the application of digital methods to the humanities. She is working on two projects: the first, what “data” could mean for humanistic research; and the second, how multinationals use data in their supply chains.
Items:
The case of the missing faces
Frequently asked questions about the lobotomy
Highlights from "Evolution of Schizophrenia Treatment"
(4:00 am) The term "schizophrenia" is used first
(05:00) Views of the top mind of the time
(07:00) euthanasia of the mentally ill
(8:22 am) Nazi Germany's plan to eradicate schizophrenia
(13:40) Mad scientist or helpful doctor?
(14:00) Fever therapy, sleep therapy, insulin coma therapy, hydrotherapy
(19:00) seizure therapy, electroconvulsive therapy
(23:00) The lobotomy
(31:30) The first antipsychotic
(36:00) Interview with Miriam Posner Ph.D.
(50:00) Walter Freeman's views on the lobotomy
(1:03:00) Rachel's thoughts – it's not the patient's story
Computer generated transcript of the "Evolution of Schizophrenia Treatment"
Editor's note: Please note that this transcript was computer generated and therefore may contain inaccuracies and grammatical errors. Thank you.
Announcer: Welcome to Inside Schizophrenia, a glimpse into better understanding and living a good life with schizophrenia. Moderated by the well-known lawyer and influencer Rachel Star Withers and with Gabe Howard.
Sponsor: Listener, could changing your schizophrenia treatment plan make a difference? There are options that you may not be aware of. visit OnceMonthlyDifference.com to learn more about once-monthly injections for adults with schizophrenia.
Rachel Star Withers: Welcome to Inside Schizophrenia. I am your host, Rachel Star Withers here with my wonderful co-host, Gabe Howard. How are you today, Gabe?
Gabe Howard: I'm great. As always, thank you for having me.
Rachel Star Withers: I'm really excited about tonight's episode. I have a feeling we're going to talk about some really interesting things. I was just about to say cool. But maybe, maybe interesting would be a better descriptor.
Gabe Howard: I don't think you can have a full-fledged conversation about mental illness without the history, and part of that story is how treatments are developed. And these treatments were often used in the sick with psychosis, schizophrenia. And we're going to talk a lot about lobotomies because it is, I think everyone has heard about it, but I don't think people really understand.
Rachel Star Withers: Right. I mean, look, we've been doing this podcast for two years and before that I was doing numerous videos and other types of media about schizophrenia. And yet I learned so much from doing the research for this episode, things about who I was, oh what? I'm just surprised I've never heard that before. What drives me crazy is all we talk about, in the past, you know, 100 years. It's not like the 1500s they thought, well
Gabe Howard: Right.
Rachel Star Withers: It's back in the 50s you know
Gabe Howard: Yeah, yeah
Rachel Star Withers: As if people are still alive.
Gabe Howard: Our grandparents are still alive
Rachel Star Withers: Right? Yes. It really wasn't that long ago. And that blew my mind when I learned how treatments have evolved to where we are right now.
Gabe Howard: I was blown away too, because when we think of something like a lobotomy we think of someone who flew over the cuckoo's nest and like anyone who has listened to us long enough has heard us say, you understand not from popular culture schizophrenia. Still, we fell straight into the trap. We thought we understood lobotomies. Why we saw it on TV. Even at our level, Rachel, we still realize that there is just so much to learn. It's a lot more complicated than we thought.
Rachel Star Withers: Yeah, even finding a guest for tonight's show that turned out to be a hunt.
Gabe Howard: So hard.
Rachel Star Withers: I didn't think so. You know, the title and how I reached out to various professors and doctors was that we were talking about the evolution of schizophrenia treatment. And I look at people who are literally teaching about the evolution of psychiatry over the past 100 years. I think it fits right in there. And so many felt uncomfortable talking about these treatments. And our wonderful guest, whom we will hear from later, I would say she is not what you would expect. She is a digital humanist I didn't know what that was. But she's actually one of the best people to talk to about lobotomies. And it blew me away. She was totally awesome. So it comes a little later.
Gabe Howard: I think we should point out that Miriam Posner is also an assistant professor at the UCLA School of Information. She studied it like she had a degree. It was fascinating, both in everything she said and the number of people who for some reason didn't want to talk about it. As you said, don't you study that? Yes. Do you teach about this to classes? Yes. Do you have a Ph.D. in this? Yes. Do you want to talk about it? No, why not? It shows you that the misinformation is allowed to continue because so many people believe that this is something that people should not understand. It was confusing. We were very excited that Ms. Posner was joining us.
Rachel Star Withers: Before we can dive into all of the crazy treatments that have been featured in the media, we need to talk about how schizophrenia was viewed. The first time schizophrenia occurs is in 1910. A Swiss psychiatrist coined the term schizophrenia, which in Greek meant split mind. What he meant was like a relaxation of thought, your thoughts split off. But of course that was very quickly misunderstood as a split personality and that has stuck to schizophrenia, this confusion, since 1910. Which is just crazy for me, it's like they knew from the start that this was a bad name, but we're sticking with it. The following year, one of the best psychiatrists described schizophrenia as the senility of youth. And basically, if your brain deteriorated, you'd undo. At the same time we have Sigmund Freud who is also quite famous. He revolutionized for better and worse psychology. And many of his theories and things are still very prominent today. And Freud had many opinions about human schizophrenia. That they couldn't deal with reality and that their paranoid delusions are motivated by unconscious homosexual impulses.
Gabe Howard: Paranoid delusions are motivated by unconscious homosexual impulses? That Rachel.
Rachel Star Withers: I know he only committed multiple crimes so I'll just insult them all in one sentence. He also described people with schizophrenia who would eventually return to a childlike state of about six months to six years. So you need to understand that the top minds have no hope at this point as we near the beginning of the 20th century. They saw schizophrenia as something these people like like adult babies. Your thoughts will only get worse. There's no oh we can handle that. Oh let's find a way to help. No, these people are terrible. That is a lot.
Gabe Howard: It's a lot, and they categorize them as becoming different. They are different, it is okay to do what we want with them because they are the worst that society has to offer. They stopped calling them evil because they said they were the worst society has to offer because they are sick. But let it know that it was all up for grabs because I guess society didn't really care about them.
Rachel Star Withers: Society classified people with schizophrenia and other serious mental disorders as a major burden at the time. Most families were ill-equipped to help their family members. Hence, mental health facilities were their only options. And then you have doctors in the mental hospitals who are obviously following what the leaders of the country tell you. And many of them viewed euthanasia as a killing of grace. Some thought, as these various psychiatrists have said, these people can only get worse. So we should probably kill them now so they don't suffer. Many mental hospitals had a mortality rate of 30-40% per year. That is a great death rate. You know if you go to a hospital you might rethink this hospital.
Gabe Howard: Well.
Rachel Star Withers: And this isn't advertised as they don't openly say, hey, you could be one of them, but that's how reluctant what happened.
Gabe Howard: And there are reports like a mental hospital in Lincoln, Illinois feeding their arriving patients with tuberculosis-infected milk. They only experimented with people with schizophrenia. And again, I want to point out that this is 1950.
Rachel Star Withers: At the same time, sterilization in the US has been huge. Many states had enforced sterilization of patients in mental health facilities. During today's episode, Gabe, I keep getting surprised by the fact that so much of this stuff was aimed at women. I would think sterilization. I honestly think men. But the majority was that they sterilized the women because they are like that, we have to stop the babies. If you think about it, men can give birth to a lot more babies than women.
Gabe Howard: Yeah.
Rachel Star Withers: But yeah, so many times when women went to mental hospitals, that was the first thing that happened. It wasn't the cleanest or most beautiful way of doing things. It was done as cheaply and quickly as possible. Unfortunately this is all over America. At the same time, Germany begins in the Nazi era. I did a lot of research on the Holocaust. I actually went through the camps in Auschwitz. The fact that I didn't know this stuff was showing up is bizarre. But Germany, especially Adolf Hitler, really liked our eugenics programs and they decided that schizophrenia is a hereditary trait. And Germany has launched a plan to eradicate schizophrenia, which sounds great. You know it's like that, hey guys, we're gonna do this. They started an organization called the Charitable Foundation for Curative and Institutional Care. That sounds wonderful.
Gabe Howard: Right, it sounds fine on the surface, we're going to get rid of schizophrenia, the name of the organization is good. And remember, by the time this happened, we didn't understand that the Nazis were still bad.
Rachel Star Withers: And this program was 70-100% effective in eradicating schizophrenia in the German population, depending on the years. So if you were believed to have schizophrenia, you would need to be assessed by three different doctors. If two of them decided you had schizophrenia, then you were put to sleep. And a lot of these people were children. They wanted to catch it as young as possible. So you are trying to find schizophrenia in children which is very difficult these days you know and you have two doctors and you know knowingly yes this one is out. To cope with this, they began building extermination centers in the six main psychiatric hospitals that later became concentration camps. That blew me away. Little did I know that concentration camps started in psychiatric hospitals. I've never been told that before. They also did various programs to see how little the schizophrenics could be fed and slowly starved to death, how much they could work. And they took all this data that they had learned and did not use it for the people in the concentration camps many years later. It's easy to be Rachel, of course they're Nazis. They do crazy things. And it's easy to sweep it all under the rug like it's Nazi bad stuff.
Rachel Star Withers: But it wasn't just her. In 1934, the Journal of American Medical Association, they actually did a report on German eugenics and pretty much went on and on about the expected benefits. One of America's best psychiatrists praised Hitler's program, and one of America's most renowned neurologists warned at the time that American mothers might feel guilty for killing their mentally ill children. And he suggested that there should be a public education to overcome emotional resistance to their children's euthanasia. That's the top neurologist. He was also the president of the American Neurological Association. He was on the board of directors of American Psychiatry. This is the top, and they talk about killing children very openly. And these are the main journals that go to all doctors. Everyone, everyone at this time thinks you know the only way to deal with this is extermination, euthanasia. I didn't know how intense the belief was. I kind of thought, you know, yeah, a couple of back alleys, you have some crazy doctors who want to mess around and kill people. But no, these are the leaders of the medical community at the time.
Gabe Howard: So we have people who are using science and data and listening to experts in the field who say this is the best course of action and the right answer is to say no, the doctors, the researchers, the data, the Science, it's all wrong. This is not the way we should treat human life. We are in a situation here in 2020 where we are trying to get people to listen to data, science and doctors. But it was less than 100 years ago that something like that happened. And you can see where this creates a ripple effect in the confidence of the medical facility. You can see where people diagnosed with these diseases think back to how they were treated in the 50s and 30s. All of this is in America less than a hundred years ago. And you wonder why people don't trust or don't want to rely on their diagnosis? If you are Rachel and I, there's a higher than average chance our grandparents know someone who was honest about their illness and institutionalized for life, or worse. It made it very difficult to move forward. And while we listen to this and Rachel continues to explain the evolution of treatment for schizophrenia, worrying about being diagnosed with schizophrenia for fear of stigma and discrimination may not be just about being named or not getting a job. It is not too far in our history that it was literally a matter of life and death.
Rachel Star Withers: And I think society has tackled all of the crazy treatments. They make great horror films that kind of criminalize it all. But what I have learned is that the doctors who perform these treatments are ill-advised to many, the only ones actually trying to help. Yeah, some of it is kind of crazy. And why do you think that would help? You are the only ones because the great medical minds say they don't even get treated. It's pointless. I think I come to this realization, Gabe, that was pretty hard for me because you see these different people and you think they were just torturing people with schizophrenia, doing those terrible things, but at the same time you were the only ones who were the one Did therapy and tried something. They were the only ones who gave these people a relatively good chance. Some of the crazy ones, and this one just blows me away, fever therapy. So they actually want to inject you with sulfur or other oils so that you have this terrible fever. The reason for this is because they noticed that people with malaria don't have psychotic symptoms. I mean, I think that's a stretch. But OK, something about a fever makes you less psychotic. Another one they did was deep sleep therapy. And here they would like to put you to sleep for days, sometimes weeks. Insulin coma therapy is very close by. They just repeatedly injected large doses of insulin into psychiatric patients and put them into a coma, and the coma only lasted about an hour. But you'd be doing about 50 to 60 of these comas in six weeks to two years, and only getting in and out of such a coma repeatedly. This is great for me. What kind of life is that?
Gabe Howard: I don't think it's a great life at all, do I? I think this is a great example of where the phrase that the treatment is worse than the disease comes from. It sounds terrifying. It sounds traumatic. It sounds painful. And it wasn't particularly effective. Correct?
Rachel Star Withers: And as we'll see when we talk about some of these treatments, parts of them worked. Here is the problem. Parts worked. Trying to separate these parts has unfortunately resulted in a lot. I would describe torture to many people trying to achieve this. And many of them were psychotic at the time and had no idea what was happening to them or could agree to it in any way or it was a family situation. You can see that so many children actually went through all of these treatments. You know, when we think back to horror movies and stuff, it's always grown-ups. When you have a kid you do this to, it is no longer a horror movie. This is just going to be something really just bad and gross. Why would you even do that? And realizing that this was the truth is that it happened to the majority. All children suspected of having schizophrenia. Another is hydrotherapy. So, Gabe, if anyone's watched the new Netflix show Ratched, they're actually doing hydrotherapy, and I've never seen it before. I thought what is it? But really interesting. And there they would put you in either really, really hot or really, really cold water. Sometimes you would be literally strapped into a bathtub. You could stay in that bathtub for days. You know, when you first think of a continuous bath, it sounds good. But when you're like you've been in hot water for three days, I mean.
Gabe Howard: It's terrifying. Each is more scary than the other, and you're not done yet.
Rachel Star Withers: Oh no, I'd say these are the softballs. Oh, you have to understand, but there was logic. They found that warm water helped with insomnia. It helped people who had committed suicide and it helped calm people down. Cold water, frozen water was usually used on people who were psychotic. There was something about the cold water, slowing the flow of blood to the brain and reducing mental activity. You know you see different parts of what worked, unfortunately terrible ways to get to those little parts. One of the things about hydrotherapy is that one of the psychiatric facilities actually chains the psychiatric patients to the wall and hoses them on.
Gabe Howard: Wow.
Rachel Star Withers: It's so simple that one of these treatments turns into torture so quickly.
Gabe Howard: Rachel, I have to ask you, however, do you realize that if you were born 100 years ago this is the treatment you would have been given. Rachel, as someone living with schizophrenia, how are you doing right now?
Rachel Star Withers: I think back to middle school age sixth grade. But that was the first time my parents took me to see an outbreak and issue counselor. You know i sat there I didn't like the woman. I don't remember anything. I remember not liking her. We saw a few different, some religious, some normal. And I think if that had been the situation, let's say in the 40s, it could have been me. Well, let's just spray what, 12 years old, down with the fire hose, that would probably have been what could have happened.
Gabe Howard: Yeah, they would have sprayed you with the fire hose. What do you think of the idea that your parents might have sprayed you with a fire hose and then learned from the best psychiatric doctor in America that all they have to do is manage their emotions while they watch you get sprayed with the fire hose? ? Actually, he said, manage your emotions to get you to sleep, but let's push back a layer and just say, manage your emotions to see her 12 year old get sprayed with a fire hose.
Rachel Star Withers: It's mind-blowing.
Gabe Howard: It's terrifying.
Rachel Star Withers: The problem now is that we're starting to find out more about what works, but how we get there is the problem. And this is where seizure therapies came in. And when they realized that it was indeed a Hungarian pathologist, he noticed that people with epilepsy almost never had schizophrenia and that these people are very happy after an epileptic seizure. So the idea was that if I give people with schizophrenia attacks, it should help them. There are numerous ways in which they could do this. It started with many, many injections of drugs. They found they could go back to insulin and inject you tons of insulin. It would give you seizures. These are all terrible things and obviously many side effects from just injecting tons of random chemicals. What happened was that they found a much better way. I like the story of how it came about because there is so much of this stuff, red flags, electroconvulsive therapy, where electricity is shot through the brain to cause a seizure. The first attempt on humans took place in 1938. Some time ago. But the idea was that the doctor had learned that before pigs like to kill pigs to eat them, like in a large plant, pigs would electrocute them and pass out. And somehow it was like that, you know what? I think this can help the schizophrenics. And I don't know exactly how you were in a pig factory that they're there
Gabe Howard: Wow,
Rachel Star Withers: What?
Gabe Howard: Wow.
Rachel Star Withers: This is where electroconvulsive therapy came about. Fortunately, they did it quite a bit in the 40s. At this point they were not using muscle relaxants or anesthesia. Many people were fully aware when they were shocked and broken bones. They had people holding them. And it was a very intense procedure. By the 50s, they had learned to make a modified version in which they would put you to sleep and give you muscle relaxants. This is how the really bad horror stories have been for about ten years. And then, in the 50s, we're going to keep doing that, but we have to find a better way. And I really think this was a good turning point in mental health as we need to find better ways to do it.
Gabe Howard: I think it's important to understand that electroconvulsive therapy with ECT is still a treatment that is used today. It works very well. In fact, you had ECT so you named a lot of very scary things and things that they no longer do. But all of this creepy list, one of them has remained.
Rachel Star Withers: Yeah, it's always a very sensitive issue because I have people reaching out to me who just see it as torture because it happened to so many people. And I agree that it has been used terribly. Another thing they enjoy doing with children is shocking them twice a day for 20 consecutive days. I was an adult when I had ECT and I can't imagine anyone doing it to a child. I had it for two weeks, three a week. There have been so many bad things about ECT. But where it was in the 40s, where it is now, is different. If you ever speak to my mom she will always tell you how this was a big change for me. For me it helped and I tried to get it back. So I understand that it's a very controversial thing. Does it work for some people? Yes. This section leads us to Gabe, one of the most notorious treatments, the lobotomy. What's crazy is that when you hear lobotomy you think of schizophrenia. But when they actually did it, you got a lobotomy for everything. It was for ADHD. It was for manic episodes.
Rachel Star Withers: It was for depressive episodes. It was for people who didn't fit in with it. The lobotomy was the goal. But when you look back in history you think, oh man, this is what they do to schizophrenics to get them under control. That was the permanent picture. Lobotomy is actually called psychosurgery. And that's every time the brain is operated on to relieve a mental disorder. And a lobotomy is one of the psychosurgeons. Psychosurgery is still performed today. Versions of the lobotomy still take place today. Is any of this like the 30s to 60s? No, that is very different. The first form of lobotomy was actually done. They drilled holes in the skull and then injected ethanol into them. And the goal was to destroy some of the white matter in the frontal lobes. And for some reason they learned that the destruction of the white matter in the frontal lobes somehow calms people down. They notice that their personality had changed when the soldiers returned after the wars with brain damage to the front of their head. So here's where the whole thinking process came in, why you know we should start poking holes in people's brains.
Gabe Howard: I understand what you are saying, but the exact words were used that this psychosurgery made people calmer. They didn't say that people get better or that people get to get the best of their lives. It seems very much that this was a behavior control mechanism, not necessarily what was best for the patient.
Rachel Star Withers: And here we come to so many interesting things that Miriam Posner will help us understand some of them because yes, it is a double edged sword. There are so many people who swear by it and it has helped them. This is why they could have life. And then you have other people who, for one, died. Quite a few people died from it, not only because they stabbed parts of their brains, but also because of the circumstances. Many had meningitis. Walter Freeman, one of the most important neurologists who like to do lobotomy, did not use gloves or a mask and they were already using them then.
Gabe Howard: Wow.
Rachel Star Withers: So you have people who are dying. And Walter Freeman, one of the things he's known for is the ice pick lobotomy. And he found a way to avoid drilling holes in the brain. That sounds great at first. We don't have to drill parts into the skull. I found a way that is much faster and easier. It is an ice ax.
Gabe Howard: Ich, das ist nicht besser.
Rachel Star Withers: Nein, es ist nicht so, dass der mentale Prozess all dieser Dinge immer gut beginnt und dann plötzlich eine falsche Wendung nimmt. Und ja, er entdeckte, dass man mit einem Eispickel durch die Augenhöhle gehen konnte. Es ist intensiv zu sehen. Es gibt viele YouTube-Videos zu diesen Operationen. Ich würde sagen, nachdem ich so viele Videos gesehen hatte, kam mir der Gedanke, dass kein Film jemals in die Nähe gekommen ist. Es hat etwas damit zu tun, diese Schwarz-Weiß-Videos zu sehen, in denen sie der Person, die so nervt, einen Eispickel bringen. Es ist nicht wie irgendwelche verrückten Bilder aus Filmen, in denen sie es tun. Es ist viel realer und intensiver. Und die meisten Lobotomien wurden an Frauen und Kindern durchgeführt. Sie hatten also ein Kind mit ADHS oder hatten den Verdacht auf Schizophrenie oder passten nicht dazu und waren komisch? Lobotomie. Das war der Weg zu
Gabe Howard: Wow.
Rachel Star Withers: Es ist eine sehr dunkle Zeit in der Psychiatrie im Allgemeinen. Hat es einigen Leuten geholfen? Yes. Hat es die Leute beruhigt? Also, Gabe, das lässt mich zurückdenken, denn ja, die meisten dieser Behandlungen sollten kommen und den Menschen helfen, die Kontrolle über ihre Schizophrenen zu erlangen. So war es. Dies soll Ihnen helfen, die Kontrolle über Ihren geliebten Menschen zu erlangen. Es war definitiv nicht so, den geliebten Menschen besser zu machen. Aber ich schaue zurück auf mein ECT. Und was hat es für mich getan? Es nahm meine Depression weg. Es hat mir viel von meiner Zwangsstörung genommen. Meine Halluzinationen waren viel schwerer zu bewältigen. Ich würde sagen, ich war nicht kontrollierbar. Hat ECT mir das angetan? Ich denke schon. Es hat mir geholfen, ja. Aber hat es mich im Wesentlichen ruhiger gemacht? Yes. Ich meine, dies ist ein moralisches Dilemma für mich, da ich immer mehr darüber lerne, weil ich beide Seiten davon sehe und nicht einmal weiß, wo ich stehe, wenn ich darüber nachdenke.
Gabe Howard: Ich verstehe sicherlich, dass die Idee von etwas zwei Dinge sein kann. Ich meine, wenn Sie ruhiger sind, wenn Sie leichter zu sprechen sind, wenn Sie in der Lage sind, die Regeln zu befolgen, ist das definitiv ein Vorteil für Freunde, Familie, wenn Sie sind im Krankenhaus, im Personal oder in der Gesellschaft. Aber es gibt auch etwas zu sagen, das auch für Sie am besten ist. Correct? Ich denke, das ist es, was ich sage. Sie müssen nur hin und her gehen, ob ECT Sie nur besser gemacht hat, Sie für Ihre Freunde und Familie besser gemacht hat. Sie treffen diese Entscheidungen jedoch selbst.
Rachel Star Withers: Richtig.
Gabe Howard: Sie möchten, dass Ihr Privatleben ruhig, ruhig und stabil ist. Correct. Nur weil Ihre Familie von Ihren Entscheidungen profitiert, werden sie nicht rückwirkend zu Ihren Entscheidungen. Bei einigen dieser Behandlungen wissen Sie jedoch nicht einmal, wo Sie sich befinden. Was war der Ort, an dem sie dich zwei Jahre lang schlafen ließen? Sie wecken dich alle vier Wochen, um was zu mögen, dich zu drehen? What kind of a treatment is that? It didn’t make you better. When you hear stuff like this, you can see why people are terrified of the treatments for schizophrenia, because, again, it wasn’t that far in the past before the outcome of treatment was just you obeyed and made life easier for the people around you, but your quality of life was nonexistent.
Rachel Star Withers: And especially there’s so much around the lobotomy, it was thought to be around 50% effective, which again, for the time period, your other option is death or pretty much just going on as you are and probably becoming homeless or other things and eventually dying of those reasons. So if someone offers you a 50% chance of being normal, that’s I mean, I’m like, well, that’s a pretty good deal. That’s a good deal. It had a death rate of around 14%, you know, so a lot of the people willingly had this done. They were desperate. They knew what could happen. It was very well known that your personality could change. You might have to relearn how to do everything. The neurologist, Walter Freeman, who did most of these, he called it a surgically induced childhood. They know what they’re doing. I don’t think they looked at anyone as this is going to make you better and take away this thing. It’s no, it’s going to make you more childlike. And you go from there. I don’t know. I worry because when I read his thoughts and a lot of the doctor’s thoughts, like, it’s like you kind of knew you weren’t doing a good thing. I just,
Gabe Howard: It’s what it sounds like, right?
Rachel Star Withers: Yeah. He described one of his patients who was a success story, he said following her lobotomy, she was a smiling, lazy, satisfactory patient with the personality of an oyster.
Gabe Howard: That’s not successful treatment.
Rachel Star Withers: It’s like, wait, what? You know, and later he had another patient he actually wrote notes about and said that the best that can be done for a family sometimes is to return the patient to them in an innocent state, much like a household pet.
Gabe Howard: Literally, it’s an incredible quote that the best that you can hope for your patient is to give them back to their family. He actually said as a veritable household pet. That’s the exact quote from his note. Like, that’s what the doctor thinks about the patient. Like, it is terrifying.
Rachel Star Withers: And that’s a success story,
Gabe Howard: Right.
Rachel Star Withers: That was a success story. That’s thing, it’s just like he’s like, this is good. He is promoting this.
Gabe Howard: Yeah, he’s proud of himself.
Rachel Star Withers: Yes.
Gabe Howard: Wow, wow. But luckily we moved past that, we get to medication therapy. The very first antipsychotic came out in the 1950s, and this is what I think people think of now when people think about the treatment for schizophrenia, now they think of antipsychotics. And those came onto the scene in the 1950s. Tell us about that, Rachel.
Rachel Star Withers: That was pretty much the revolution. Now, you don’t have to have that weighing on your conscience of having to stab your family member with an ice pick. It is they could take a medication and they can go they can get a bunch of pills and then come home and take them one a day, etc. So you also had people could come back and live with the family more. You didn’t have to worry that any of the procedures were going to leave them with brain damage, having to relearn how to read and write. Now, the way they came up with this for the first antipsychotic was it was used as a histamine. The point was that they noticed it had a calming effect. It all goes back to making people calmer. That was where antipsychotics started, was making people calmer and it went on from there. And at the same time, ironically, there is this crazy new form of psychotherapy that was gaining speed called cognitive behavioral therapy. And that was the first psychotherapy they had found that actually helped schizophrenics. They had tried different ones in the past. But there’s something about the cognitive behavioral, it really helped people with schizophrenia. So this was a big turning point.
Gabe Howard: And the medication is still the standard today, I mean, you know, medication therapy, peer support, but the big one, the one that everybody thinks of when managing schizophrenia is medication. And I think people are unaware of, you know, just how recent of a discovery that was. And it’s important to understand that the first one came out in the 1950s, that the first of anything, you know, the first cars were not so great.
Rachel Star Withers: Yes.
Gabe Howard: They took time to perfect cars from when they were invented. And I would argue that we still haven’t perfected medication treatments for schizophrenia. Would you agree with that? I mean, there’s side effects. There’s issues. There’s still a lot that we don’t understand. New medications are coming out all the time. Research is ongoing. And I only bring that up because I think so many people are like, well, just take your meds, Rachel, and you’ll be fine.
Rachel Star Withers: It’s kind of like looking back at all these old timey treatments, it’s like you’re trying to figure out what works and just do that without all the other horrible things. Ironically, that’s where we’re still at now. Luckily, the side effects are not death as many times as it was back then or sleep for two years. But that’s just yeah, that’s just the evolution of these treatments. To get to where we are now a lot of that stuff had to happen.
Gabe Howard: Obviously, we want to make sure that our listeners understand that there’s just a lot going on, it’s not as simple as good versus bad or right versus wrong or any of that. There’s just a lot going on and it’s difficult to understand. But I think that sometimes when people think about this, they’re really quick to say, oh, why are you so worried, patient with schizophrenia? The doctors had their best intentions in mind. So we give the benefit of the doubt to the doctors for the mistakes that the medical community has made. Well, why don’t we give the benefit of the doubt to the patients who are leery of the medical community, given the number of mistakes that they’ve made? And I think that’s one of the things that is missing. When we talk about people with schizophrenia who are afraid of medical treatment, there’s an actual factual basis to be concerned about what they’re being told. This isn’t made up of whole cloth.
Rachel Star Withers: And now a word from our sponsor.
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Gabe Howard: And we’re back discussing the evolution of schizophrenia treatments on Inside Schizophrenia.
Rachel Star Withers: Yes, I absolutely agree, and that’s why we reached out to our guests today, Miriam Posner, to help us understand this side of psychiatry.
Gabe Howard: Without further ado, here is that interview.
Rachel Star Withers: We’re here speaking with Dr. Miriam Posner, and she’s an assistant professor at UCLA School of Information and she’s a digital humanist. Miriam, tell us what is a digital humanist?
Miriam Posner: It’s a field of study where scholars use and experiment with digital tools to explore humanity’s questions, and so it can look like a lot of different things for different people. But if you think about like maps to show the spread of a historical event or a network diagram to show how people were corresponding during, say, the Renaissance or even there are some experts in computer assisted text analysis who try to find patterns in text. So, yeah, so I’ve been part of that community for about a decade now.
Rachel Star Withers: So the reason we asked you to be on our show today is that you have spent a considerable amount of time studying lobotomies and you wrote some different articles. The Case of the Missing Faces, frequently asked questions about the lobotomy. Tell us a little about that part of your research.
Miriam Posner: What got me interested in lobotomy was that I’ve always been interested in medical images and the kind of work that medical images do to persuade people or affect our understanding of disease and patients. And a professor in grad school just happened to show the class a clip from a film that was made of lobotomy patients after they had had surgery. And the footage was just so affecting to me. It was one thing to read about the effects of lobotomy and what it was like to have a lobotomy. And it was another thing to watch the patients struggle to find themselves afterward. Those images really stuck in my head and I started wondering how many other images are there of people who had lobotomies and what was the point of images in the history of lobotomy? I was looking at how physicians were using photographs and film to make arguments about lobotomy. But along the way, I learned a lot about that episode in our history and also about Walter Freeman, who was the foremost exponent of lobotomy in the United States.
Rachel Star Withers: And can you explain to us the pictures that you had studied, the before and after photos? Tell us about those.
Miriam Posner: Yeah, one thing that really took me by surprise is that Walter Freeman was obsessed with taking before and after photos of his patients, he would routinely take a before picture of a patient before performing a lobotomy. And then even years later, he would come back and follow up with a patient to take an after picture. He was very dedicated to seeking out patients and he would drive across country to stop at people’s houses and take after photos of his patients. And I just thought, what? Like why? Like, why would you do that? And it was really surprising to me. And I thought, what did he think he was showing with these images?
Rachel Star Withers: What is your interpretation since you’ve been studying them? What is yours of looking at all these different photos?
Miriam Posner: Well, to Walter Freeman, I think that those before and after photos constitute proof that lobotomy was effective in treating patients’ mental illnesses. The kind of strange thing is, that to us, it’s not always clear what about the after picture is proof because it’s really hard to tell what exactly he was seeing that meant that the person was visibly cured. In order to understand why he thought those after pictures were effective, I had to do research about what constituted mental health to Walter Freeman and to other psychiatrists in the period where he was active. The signs of improved mental health are often things like putting on makeup for women, wearing appropriately feminine clothes, being surrounded by family, for men wearing a suit and working what Freeman thought was an appropriate job and even putting on weight was for him like an example of mental health.
Rachel Star Withers: Interesting, but those also seem like that’s something that could be easily staged for as far as the clothing, the makeup.
Miriam Posner: For sure, for sure.
Rachel Star Withers: I’m not an emotional person, but I was looking at the before and after photos of this woman, and it made me cry because the before photo was very almost like a mug shot. She looked
Miriam Posner: Yeah.
Rachel Star Withers: Kind of annoyed that this was happening. And the second one, she was smiling and it wasn’t like a big smile or anything, but her eyes to me, what grabbed me was her eyes. And it just made me cry because just what I went through with depression. Now, I don’t know the story behind it. That could have been one of the ones, Oh, and she’s happy but had to relearn how to walk. But just the photo itself to me was incredibly powerful, if you would have just shown me that. And it was like this is proof that it works. I’d be like, wow.
Miriam Posner: That’s something that hits me, too, is that these photos are actually emotionally pretty powerful to look at, but really probably not for the reasons that Walter Freeman thought that they would be powerful. He thought you could take a look at them and just be like, wow, that person got better. But just as you say, you feel like you can look in someone’s eyes and see that things are not OK, even though that’s not what Walter Freeman saw. But it kind of makes sense that the makeup and the dresses and markers of like appropriate gender presentation, that he thought that those were evidence of mental health just because of the way that psychiatrists like Freeman thought about mental health in the 30s and 40s. Mental health was not so much about a person’s insight or ability to articulate and identify their own feelings. It was much more about integrating the person into society in a quote unquote, useful way. Could the person hold a job? Could the person have a family and perform like a gender appropriate role in the family? Could the person show up to an event and not be disruptive? So that was mental health to him. It really wasn’t so much about a person’s feeling fulfilled as a human being.
Rachel Star Withers: I was very shocked to recently learn that majority of lobotomies were performed on women and even children. In your opinion, looking at the photos and now telling us this, that so much of it was the person playing the gender role correctly, why do you think more women had lobotomies? Was it that gender bias or is it just because women tend to seek help quicker than men do?
Miriam Posner: I don’t have an authoritative answer for you, but I can speculate a little bit about that. When the lobotomy first started being performed in the late 30s in the United States, it was reserved for patients for whom there was no or they believed there was no alternative. Patients with really intractable mental illness. But as the years went by, the indications for lobotomy expanded to include lots of other symptoms, things like depression, pain and inability to integrate into family and work. And it seems to me that it’s in that period of expanding diagnosis that women presented more often as candidates for lobotomy. And you’ll read case studies where it appears to a modern reader that the woman is unhappy with her lot in life. She’s not fulfilled by her role as a homemaker. She’s in an unhappy marriage. She perhaps doesn’t want to perform the activities appropriate to a woman during this period. And for some women, those signals became interpreted as depression that was severe enough to qualify her for a lobotomy. I don’t think that Walter Freeman or other lobotomists had an explicit policy of lobotomizing women more frequently. But I do think that they tended to interpret what they saw as maladjusted symptoms pretty loosely as making them good candidates for lobotomy.
Rachel Star Withers: As you spoke on, the lobotomy was used as a cure all for mental illnesses around that time, they didn’t have as much information on them. However, I think nowadays, when you look back on lobotomy, the disorder that’s most commonly associated with it is schizophrenia,
Miriam Posner: Mm hmm.
Rachel Star Withers: Why do you think that is? Why do you think that schizophrenia is, when they think of lobotomy, they think crazy person, screaming, schizophrenic? They don’t think depression. They don’t think ADHD. They don’t think, yeah, like you say, just not adjusting to the times, being oppressed.
Miriam Posner: Yeah, I do think that people sometimes have a mistaken understanding of the history of lobotomies, maybe because of the way it’s depicted in films. A lot of people assume that lobotomy was confined to the back halls of disreputable mental institutions, that it was disreputable physicians who performed lobotomies, that it was always a sketchy procedure. But what a lot of people don’t know is that during the heyday of lobotomy in the 30s and 40s, it was considered the top of the line, most modern and most effective treatment. Walter Freeman was on the cover of magazines. He was mentioned for a Nobel Prize. There was no sense that lobotomy was a weapon of cruelty. Lobotomy was understood to be the most current, up to date, scientifically precise treatment for mental illness. And I think people associate schizophrenia with being uncurable. So I think in people’s minds, because they believe schizophrenia is incurable, that lobotomy would be the most likely candidate for a disease. But while it was performed on people with schizophrenia, in fact, the indicators for lobotomy were actually a lot more broad than people suspect.
Rachel Star Withers: How has public perception changed as far as lobotomies and that type of treatment? Obviously 30s, 40s when Walter Freeman was at his height, yeah, that seemed like a go to. At what point did the public kind of start to pull away from this miracle cure?
Miriam Posner: One big rupture was the introduction of antipsychotic medication, chlorpromazine was introduced in 1954 and that really provoked a sea change in treatment of people with schizophrenia and related diseases. So suddenly there was another treatment that didn’t require biological surgical intervention and that could be fine tuned and didn’t seem quite as drastic as a surgical procedure. There was also increased interest in talk therapies around that time. Freeman’s brand of psychiatry, which was always most interested in biological organic causes for her mental illness, fell out of favor a little bit. And so as the years went by, it became more common for people to see lobotomy as a really brutal, inhumane treatment. But one thing that’s interesting about Walter Freeman is that he never really accepted that interpretation of lobotomy. He believed until the end of his life that lobotomy was the most appropriate treatment for people with intractable mental illness. And his interpretation of treatment with antipsychotic medication was that it was like a temporary solution to a problem that could be permanently solved by surgical intervention. Medication he thought was kind of a Band-Aid, but the real successful way to intervene would be to go in and separate the thalamus from the frontal lobe.
Rachel Star Withers: That’s interesting because we usually only see it from the side of the lototomy was a horrible, torturous thing, not the other
Miriam Posner: Mm-hmm
Rachel Star Withers: Way of him being like, yeah, the other option is like a Band-Aid. Very interesting. I think one of the most popular portrayals of a lobotomy was from the movie One Flew Over the Cuckoo’s Nest, and it’s known for its bad portrayals of mental hospitals, of people with mental illnesses, of showing electroconvulsive therapy in a very bad light. And, of course, in the movie, I’m sorry if you haven’t seen anyone listening. But, yes, a lobotomy takes place and he’s pretty much brain dead at the end. How do you think those massive media portrayals have affected research into psychosurgery and other types of mental surgeries?
Miriam Posner: I think that lobotomy often is interpreted as kind of a joke now, it feels like really distant in the past to a lot of people, and it is very closely associated with brutality and something that was performed in the like back wards of really brutal mental institutions. But it’s important if we really want to understand lobotomy to understand that a lot of people were on board with it. A lot of institutions and individuals thought that it was a good idea and there was a way in which it was part of a continuum of therapies that are called somatic therapies. So any kind of therapy that’s performed on the body. In many institutions, you’d start with a somatic therapy, like being tied to a bed and then continue on through this spectrum, through ECT or insulin shock therapy or being submerged in ice water. And when the patient failed to get better after this kind of chain of somatic therapies, they finally were seen as a good candidate for lobotomy. We tried everything and now it’s time for the real king of somatic procedures, which is lobotomy.
Rachel Star Withers: From all of your research, looking over Walter Freeman’s work and other aspects of lobotomy and portrayals with media, what is your overall take away?
Miriam Posner: What I like for people to understand about lobotomy is that the episode is not an aberration. It’s not the result of a couple kooky physicians who made miscalculations and somehow managed to sneakily lobotomize a lot of people. Instead, that’s science. That was mainstream science. That was considered the peak of good clinical practice at the time. And if we accept that’s true, then we have to accept that science can make some real drastic miscalculations and can inflict real damage on people just in the day to day course of doing business. So it’s not an aberration. It’s not a crime that people got away with. It was something that was endorsed at the highest level of the psychiatric profession.
Rachel Star Withers: Tell us what happened with Dr. Walter Freeman after the public and the medical community started to move away from lobotomies and it fell out of favor.
Miriam Posner: He never really accepted the rejection of lobotomy, and he was advocating for lobotomies until the end. He performed his last lobotomy in 1967 and shortly after that he was stripped of his operating privileges and was incredibly indignant about it. One episode that kind of sticks in my mind is that in order to make his case to the hospital board that he should be able to continue to perform lobotomies, in order to make this case, he brought a box full of Christmas cards from his former patients where they expressed thanks for what he’d done to them and concern for him as a human being. And so he emptied this box on the table and said, is this the result of a procedure that’s inhumane and brutal? Look at this. My patients are all grateful to me. And it’s in a way like for me, encapsulates just some of the weirdness of the whole episode and how confusing it is to try to understand what Walter Freeman thought he was doing. Because I really do think that he thought that he was fixing people and there were some people who did interpret what he had done to them or members of their family as a positive change. And he could never get his head around the idea that people didn’t see it that way anymore.
Rachel Star Withers: That’s a very powerful thought that, yeah, he saw it one way and all of the Christmas cards, the photos that he documented, and then, of course, I’m sure the actual people themselves. But then when you contrast it to the fact that his last lobotomy, the woman died and
Miriam Posner: Mm hmm.
Rachel Star Withers: So many people who became severely impaired, it’s very interesting when you think about
Miriam Posner: Yes.
Rachel Star Withers: The extremes of the lobotomies, how it worked out for everyone.
Miriam Posner: Yeah, nothing is ever black or white, and there are so many strange stories that still surprise me that pop up.
Rachel Star Withers: Given this kind of very dark area of schizophrenia treatment in the past, I know a lot of people could use this to not want to get psychiatric help today. Tell us your thoughts on that.
Miriam Posner: Well, I mean, they’re right that it’s a really sobering episode in the history of psychiatry and in thinking back about it and what it means to me today, one of the lessons that I hope that psychiatry has learned is that judging people’s mental health by their ability to integrate into mainstream society is actually really dangerous because there are a lot of reasons someone might not fit in. And to assume that they can’t fit in because something’s wrong with them is really damaging. And I think there has been a turn among psychiatrists to look at how patients themselves define health for themselves and to understand that mental health may not look the same for everybody and it may not look like psychiatrists want it to look for everybody. So the lesson is actually, I think, pretty simple, if difficult to actually realize. And that’s but you have to listen to patients, like you have to understand what their goals are, what their definition of health for themselves is. And you have to respect that for them, living a fulfilling life may look different than what we want them to think.
Rachel Star Withers: Is there any media that you suggest that you think really shows this treatment and is a good thing for laypeople like me to watch, to understand more?
Miriam Posner: There is a radio documentary called My Lobotomy, which is a long interview and a series of meditations by a guy named Howard Dully, who is still alive today and is one of the last people on whom lobotomy was performed. It was performed on him when he was a teenager. He talks about the experience of getting a lobotomy and how it still affects his life to this day. And it’s a really powerful documentary. And he also has a book that’s called My Lobotomy that is equally effective and moving. There’s a documentary, too, that’s called The Lobotomist that focuses more on Walter Freeman, the biggest cheerleader for lobotomy. What was going through his head? Why was he so convinced that lobotomy was the way to go? And talks a little bit about the context in which he was performing these procedures. Those are really good ways to get acquainted with how lobotomy was conceived of at the time.
Rachel Star Withers: Thank you so much for speaking with us today, Dr. Posner, about all this, so much good and bad when it comes to looking back over the different treatments for severe mental disorders just over the past hundred years alone. How can our listeners learn more about you and your work?
Miriam Posner: They can certainly check out my website, which is www.MiriamPosner.com, and I have a lot of materials about lobotomies there and a blog where I sort of talk about what’s preoccupying me now. And they can always get in touch with me on Twitter, too. My handle is @MiriamKP, and I’m always really interested to hear from people particularly who have experience with the mental health system and can help me understand what their experiences are like.
Rachel Star Withers: Awesome, thank you so much for speaking with us today, Dr. Posner.
Miriam Posner: My pleasure.
Gabe Howard: Rachel, she was awesome and I’m super glad that she agreed to be on our show. What was your biggest takeaway after speaking to Ms. Posner?
Rachel Star Withers: I enjoyed this interview so much. I enjoyed her so much, I think because she wasn’t the doctor, she wasn’t one of the typical psychiatrists that I had originally reached out to. She definitely came at this with a different viewpoint. And that was kind of interesting to see, you know, someone who wasn’t directly in the psychiatric community as a patient or as a doctor, counselor or whatever, to be able to say, look, this is my views of what happened over this time. It was very refreshing and it was different the way she spoke about things than I would say any other guests we could have picked.
Gabe Howard: I would agree with that. Her understanding of history was very commanding. You think you understand because everybody’s talking about it. But as a researcher, she just had this other level that I thought was very, very interesting.
Rachel Star Withers: Yes. Should we look into becoming digital humanists or is it too late?
Gabe Howard: I did not know that that was a thing, but she explained it well and it’s understandable. I think this is another example of how modalities and research and life moves forward. I mean, digital humanist wasn’t a thing 50 years ago, but it is now and it’s understandable how we got here. And I think that’s very analogous to where we are with the treatment of schizophrenia. There is trauma in our past. There’s a lot of trauma. And I do think that we need to do more to address that trauma. The general attitude is, well, we were doing that for your own good. Well, we were trying to help. And I do think that we need to openly discuss mistakes that were made so that we can have more buy in that these mistakes won’t happen again. I do think that she did an excellent job of making sure that people understood the history of this particular schizophrenia treatment and where we’ve come from. And I think that’s overwhelmingly positive.
Rachel Star Withers: When I asked her final thoughts about advice for seeking treatment for schizophrenia. I kind of meant it as like, you know, a closing type kind of squishy question. And when she responded, it kind of threw me off because she spoke to psychiatrists in her response and about the definition of health. I was just like, oh, OK. I thought she would be like, oh, the medical community has come so far, blah, blah, blah. But no. And that was kind of it made me think because I’m like, well, that was weird that she spoke to them. You know, I clearly would have spoke to other people with schizophrenia, I think most doctors and whatnot when we have them on the show, that’s who they speak to and loved ones. But from delving into all of this research about how schizophrenia treatment has evolved, my main takeaway is that it is a story about the medical community. It’s a story about individuals who shaped how schizophrenia was perceived and how it was to be managed. It’s not a story at all about the patients. It’s not even a story about schizophrenia in general. So much of what I found when it comes to the coma therapy, ECT, lobotomies, it all related to the physical aspects of what was done, and so many cases of abuse and all of the doctors and researchers and neurologists who came up with these things.
Rachel Star Withers: I never found anything that was, oh, water therapy was found to calm the symptoms of psychosis and schizophrenia and helped the patients regain a physical feeling of reality or patients of schizophrenia found an easier treatment that insulin therapy because they didn’t have to be injected with harmful chemicals. That’s not what was worded. And I feel that that’s what’s missing. You know, I don’t care as a schizophrenic who came up with the idea of sticking an ice pick through the eye. Lobotomies were successful 50% of the time, and some patients with schizophrenia voluntarily got multiple lobotomies, up to four. My question is, what made these patients want to go through it again? And I think as people who have schizophrenia and loved ones and the medical community, I think that’s really the important part. It’s people seeking to get better and learning to focus more on what helps these people, not just what calms all the people down and makes them controllable. I think it’s going to be a question that hopefully we’ll always be answering as we continue to evolve our treatments. I’m Rachel Star. Thank you so much for listening to this episode of Inside Schizophrenia. Wherever you downloaded this podcast, please subscribe. Also, take a moment to rate, rank and leave a written review so other people know why they should listen too. We’ll see everyone on the next episode of Inside Schizophrenia.
Announcer: Inside Schizophrenia is presented by PsychCentral.com, America’s largest and longest operating independent mental health website. Your host, Rachel Star Withers, can be found online at RachelStarLive.com. Co-host Gabe Howard can be found online at gabehoward.com. For questions, or to provide feedback, please e-mail talkback@PsychCentral.com. The official website for Inside Schizophrenia is PsychCentral.com/IS. Thank you for listening, and please, share widely.
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