Aldous Huxley, Essays: Madness, Badness, Sadness

Goering and Hitler displayed an almost maudlin concern for the welfare of animals; Stalin’s favorite work of art was a celluloid musical about Old Vienna, called The Great Waltz. And it is not only dictators who divide their thoughts and feelings into unconnected, logic-tight compartments; the whole world lives in a state of chronic and almost systematic inconsistency. Every society is a case of multiple personality and modulates, without a qualm, without even being aware of what it is up to, from Jekyll to Hyde, from the scientist to the magician, from the hardheaded man of affairs to the village idiot. Ours, for example, is the age of unlimited violence; but it is also the age of the welfare state, of bird sanctuaries, of progressive education, of a growing concern for the old, the physically handicapped, the mentally sick. We build orphanages, and at the same time we stockpile the bombs that will be dropped on orphanages. “A foolish consistency,” says Emerson, “is the hobgoblin of little minds, adored by little statesmen, philosophers and divines.” In that case, we must be very great indeed.
That all, or even most, human beings will ever be consistently humane seems very unlikely. We must be content with the smaller mercies of unemployment benefits and school lunches in the midst and in spite of an armament race. We must console ourselves with the thought that our inky darks are relieved by quite a number of lights. Between Los Angeles and Long Beach, California, there stands a mental hospital which admirably illustrates our blessed inconsistency. Bomber plants and guided-missile laboratories surround it on every side, but have not succeeded in obliterating this oasis of organized and instructed benevolence. With their wide lawns, their tree-lined walks, their scattering of nondescript buildings, the hospital grounds look like the campus of an unpretentious college. The inmates, unfortunately, could never be mistaken for undergraduates and co-eds. The mind is its own place, and their gait, their posture, the distressed or remotely preoccupied expression of their faces reveal them as the inhabitants of dark worlds, full of confusion, fertile in private terrors. But at least nothing is being done in this green oasis among the jets and the rockets to deepen the confusion or intensify the terrors. On the contrary, much good will and intelligence, much knowledge and skill are going into a concerted effort to transform their isolated, purgatorial universes into something happier and more accessible. Not long ago a psychiatrist friend took me with him to this oasis. Walking through one of the Disturbed Wards, I found myself suddenly remembering the first occasion on which I had visited a mental hospital. The place was Kashmir, the time more than thirty years ago, and the hospital was actually no hospital, but that part of the local prison which was used for the confinement of maniacs. Naked, unkempt, horribly unwashed, these unfortunates were shut up in cages. Not the spacious enclosures reserved, in zoos, for gibbons and orangutans, but filthy little pens, in which a couple of steps in any direction would bring their occupants to the confining bars. Kashmir is remote, “uncivilized,” non-Christian. But let us be in no hurry to flatter ourselves. The horrors I witnessed there, among the Himalayas, were of exactly the same kind as the horrors which my grandfather and his contemporaries could see in any asylum in civilized and Christian England, France or Germany, in civilized and Christian America. Of the many dark and hideous pages of our history, few are more shameful than the record of Western man’s treatment of the mentally ill. The story has been told at length in Doctor Gregory Zilboorg’s History of Medical Psychology and there are whole libraries of books dealing with special periods and particular aspects of the long martyrdom of the insane. The tormentors of the insane have been drawn, in the main, from two professions — the medical and the clerical. To which shall we award the palm? Have clergymen been responsible for more gratuitous suffering than doctors? Or have doctors made up for a certain lack of intensity in their brand of torture (after all, they never went so far as to burn anyone alive for being mad) by its longer duration and the greater number of the victims to whom it was applied? It is a nice point. To prevent hard feelings, let us divide the prize equally between the contenders. So far as the mentally sick are concerned, Western history has had only two golden ages. The first lasted from about fifty years before the birth of Christ into the second century of our era; the second began, very hesitantly, in the early years of the nineteenth century and is still continuing. During these golden ages the mentally sick, or at least the more fortunate of them in the more civilized parts of the classical and modern world, were treated with a measure of common decency, as though they were unfortunate human beings. During the intervening centuries they were either ignored, or else systematically tormented, first (on the highest theological grounds) by the clergy, later (for the soundest of medical reasons) by the doctors. Let us ask ourselves a question. If I had lived in the eighteenth century, and if I had been afflicted by some mental illness, what would have happened to me? What happened to you in those days depended, first of all, on the financial situation of your family. People with money either locked up their insane relatives in some remote corner of the family mansion, or banished them, with a staff of attendants, to an isolated cottage in the country, or else boarded them out, at considerable expense, in a private madhouse run for profit by a doctor or, under medical supervision, by some glorified jailer. Lunatics confined in the attics (like Mr. Rochester’s wife in Jane Eyre) or in a country cottage were spared the rigors of medical treatment, which could only be administered in an institution staffed by brawny attendants and equipped with the instruments of coercion. Those who were sent to such an institution were first stripped naked. Mad people were generally kept in a state of partial or complete nudity. Nakedness solved the problem of soiled clothes and contributed, in what was felt to be a most salutary way, to the patient’s sense of degradation and inferiority. After being stripped, the patient was shaved, so as to prepare him or her for that part of the treatment which consisted in rubbing various salves into the scalp with a view to soothing or stimulating the brain. Then he or she was taken to a cell, tied down to the bed and locked in for the night. If the patient struggled and screamed, that was a sign of mania; if he reacted with silent resignation, he was obviously suffering from some form of melancholy. In either case he needed treatment and, duly, next morning the treatment was commenced. In the medical literature of the time it was referred to as “Reducing the Patient by Physic.” Over a period of eight or ten weeks the victim was repeatedly bled, at least one pound of blood being taken on each occasion. Once a week, or if the doctor thought it advisable at shorter intervals, he or she was given an emetic — a “Brisk Vomit” as our ancestors, with their admirable command of English, liked to call it. The favorite Brisk Vomit was a concoction of the roots of black hellebore. Hellebore had been used in the treatment of the insane since the time of Melampus, a legendary soothsayer, first mentioned by Homer. Taken internally, the toxicologists tell us, hellebore “occasions ringing in the ears, vertigo, stupor, thirst, with a feeling of suffocation, swelling of the tongue and fauces, emesis and catharsis, slowing of the pulse and finally collapse and death from cardiac paralysis. Inspection after death reveals much inflammation of the stomach and intestines, more especially the rectum.” The doses prescribed by the old psychiatrists were too small to be fatal, but quite large enough to produce a dangerous syndrome, known in medical circles as “helleborism.” Every administration of the drug resulted in an iatrogenic (doctor-induced) disease of the most distressing and painful kind. One Brisk Vomit was more than enough; there were no volunteers for a second dose. All the later administrations of hellebore had to be forcible. After five or six bouts of helleborism, the time was ripe for purgatives. Senna, rhubarb, sulphur, colocynth, antimony, aloes — blended into Black Draughts or worked up into enormous boluses, these violent cathartics were forced, day after day, down the patient’s throat. At the end of the two-month course of bloodlettings, vomits and purges, most psychotics were “reduced by physic” to a point where they were in no condition to give trouble. These reductions were repeated every spring during the patient’s incarceration and in the meantime he was kept on a low diet, deficient in proteins, vitamins and even calories. It is a testimony to the amazing toughness of the human species that many psychotics survived under this treatment for decades. Indeed, they did more than survive; in spite of chronic undernourishment and periodical reductions by physic, some of them still found the strength to be violent. The answer to violence was mechanical restraint and corporal punishment. “I have seen,” wrote Dorothea Dix in 1848, “more than nine thousand idiots, epileptics and insane in the United States, destitute of appropriate care and protection, bound with galling chains, bowed beneath fetters and heavy iron balls attached to drag chains, lacerated with ropes, scourged with rods and terrified beneath storms of execration and cruel blows.” The armamentarium of an English asylum of the Early Victorian period comprised “strait-waistcoats, handcuffs, leg locks, various coarse devices of leather and iron, including gags and horrible screws to force open the mouths of patients who were unwilling or even unable to take food.” In the Lancaster Asylum good old-fashioned chains had been ingeniously combined with the very latest in plumbing. In 1840 its two Restraint Rooms were fitted up with “rows of stalled seats serving the double purpose of a water closet and an ordinary seat. The patients were secured by hand locks to the upper portion of the stalls and by leg locks to the lower portion.” The Lancaster lunatics were relatively well off. The toilets to which they were chained guaranteed a certain cleanliness and the newly installed heating system, of which the asylum was justly proud, preserved them from the long-drawn torture-by-freezing, which was the lot, each whiter, of the overewhelming majority of mentally sick paupers. For while the private madhouses provided a few of the rudimentary creature comforts, the public asylums and workhouses, in which the psychotic “Objects of Charity” were confined, were simply dungeons. (In official documents the phrase, “Objects of Charity” is abbreviated, and the insane poor are regularly referred to as “Objects.”) “I have seen them naked,” wrote Esquirol of the Objects in French asylums, “and protected only by straw from the damp, cold pavement on which they were lying.” And here is William Tuke’s account of what he saw in the lunatic ward of an English workhouse in 1811: “The poor women were absolutely without any clothes. The weather was intensely cold, and the evening previous to our visit the thermometer had been sixteen degrees below freezing. One of these forlorn Objects lay buried under a miserable covering of straw, without a blanket or even a horsecloth to defend her from the cold.” The feet of chained lunatics often became frostbitten. From frostbite to gangrene was a short step, and from gangrene through amputation to death was only a little longer. Lunatics were not merely confined. Attempts were even made to cure them. The procedures by which patients were reduced to physical exhaustion were also supposed to restore them to sanity. Psychoses were thought to be due to an imbalance between the four humors of the body, together with a local excess or deficiency of the vital and animal spirits. The bloodlettings, the vomits and the purges were intended to rid the viscera and the circulatory system of peccant humors, and at the same time to relieve the pressure of the animal spirits upon the brain. Physical treatment was supplemented by psychological treatment. This last was based upon the universally accepted principle that the most effective cure for insanity is terror. Boerhaave, the most influential medical teacher of the first half of the eighteenth century, instructed his pupils “to throw the Patient into the Sea, and to keep him under for as long as he can possibly bear without being stifled.” In the intervals between duckings the mentally sick were to be kept in constant fear by the threat of punishment. The simplest and handiest form of punishment is beating, and beating, in consequence, was regularly resorted to. During his psychotic episodes even George III was beaten — with the permission, of course, of his Privy Council and both Houses of Parliament. But beating “was only one form, and that the slightest, of cruelty toward the insane.” (I quote the words of the great French reformer, Doctor Pinel.) “The inventions to give pain were truly marvelous.” Thus an eminent German doctor had devised a therapeutic punishment, which consisted in tying a rope about the patient’s middle, hoisting him to a great height and then lowering him very rapidly, so that he should have the sensation of falling, into a dark cellar, “which was to be all the better if it could be stocked with serpents.” A very similar torture is minutely described by the Marquis de Sade, the heroine of whose novel, Justine, is punished for being virtuous (among many other ways) by being dangled halfway down a shaft opening into a cavern full of rats and corpses, while her tormentor of the moment keeps threatening, from above, to cut the rope. That this fiendish notion should have occurred not only to the most famous psychotic of the period, but also to one of its leading psychiatrists, throws a revealing light on our ancestors’ attitude toward the mentally sick. In relation to these predestined victims sadistic behavior was right and proper, so much so that it could be publicly avowed and rationalized in terms of current scientific theories. So much for what would have happened to me, if I had become mentally sick in the eighteenth, or even the first half of the nineteenth, century. If I had lived in the sixteenth century, my fate might have been even worse. For in the sixteenth century most of the symptoms of mental illness were regarded as supernatural in origin. For example, the pathological refusal or inability to speak was held to be a sure sign of diabolic possession. Mutism was frequently punished by the infliction of torture and death at the stake. Dumb devils are mentioned in the Gospels; but the evangelists made no mention of another hysterical symptom, localized insensibility to pain. Unfortunately for the mentally ill, the Early Fathers noticed this curious phenomenon. For them, the insensitive spots on the body of a mentally sick person were “the Devil’s stigmata,” the marks with which Satan branded his human cattle. In the sixteenth century anyone suspected of witchcraft would be systematically pricked with an awl or bodkin. If an insensitive spot were found, it was clear that the victim was allied with the devil and must therefore be tortured and burned alive. Again, some mentally sick persons hear voices, see visions of sinister figures, have phantasies of omnipotence or alternatively of persecution, believe themselves to be capable of flying, of being subject to metamorphosis into animals. In the sixteenth century these common symptoms of mental derangement were treated as so many statements of objective fact, so many confessions, explicit or implicit, of collaboration with the Enemy. But, obviously, anyone who collaborated with the Devil had to be tortured and burned alive. And what about the neurotics, particularly the female neurotics, who suffer from sexual illusions. “All witchcraft,” proclaim the learned clerical authors of the Malleus Maleficarum, the standard textbook for sixteenth-century inquisitors and magistrates, “all witchcraft comes from carnal lust, which in women is insatiable.” From this it followed that any disturbed woman, whose sexual daydreams were more than ordinarily vivid, was having relations with an Incubus. But an Incubus is a devil. Therefore she too must be tortured and burned alive. Doctor Johann Weier, who has been called the Father of Psychiatry, had the humanity, courage and common sense to assail the theories and hellish practices of the Catholic theologians and magistrates, and the no-less-ferocious Protestant witch-hunters of his time. But the majority even of well-educated men approved the crimes and follies of the Church. For having ventured to treat the witches’ confessions as symptoms of mental illness, Weier was regarded as a diabolical fellow traveler, even a full-blown sorcerer. That he was not arrested, tortured and burned was due to the fact that he was the personal physician of a ruling prince. Weier died in his bed; but his book was placed on the Index, and the persecution of the mentally ill continued, unabated, for another century. How many witches were tortured and burned during the sixteenth century is not exactly known. The total number is variously estimated at anything from one hundred thousand to several millions. Many of the victims were perfectly sane adherents of the old fertility cult which still lingered on in every part of Europe. Of the rest, some were persons incriminated by informers, some the unhappy victims of a mental illness. “If we took the whole of the population of our present-day hospitals for mental diseases,” writes Dr. Zilboorg, “and if we sorted out the cases of dementia praecox, some of the senile psychoses, some of those afflicted with general paralysis, and some of the so-called involution melancholies, we should see that Bodin (the great French jurist, who denounced Dr. Weier as a sorcerer and heretic) would not have hesitated to plead for their death at the stake, so similar and characteristic are their trends to those he describes. It is truly striking that the ideational contents of the mental diseases of four hundred years ago are so similar to those of today.” In the second half of the seventeenth century the mentally sick ceased to be the prey of the clergy and the theologically minded lawyers, and were left instead to the tender mercies of the doctors. The crimes and follies committed in the name of Galen were, as we have seen, almost as monstrous as those committed at an earlier period in the name of God. Improvement came at last in the closing years of the eighteenth century, and was due to the efforts of a few nonconforming individuals, some of them doctors, others outside the pale of medicine. These nonconformists did their work in the teeth of official indifference, sometimes of active official resistance. As corporations, neither the Church nor the medical profession ever initiated any reform in the treatment of the mentally sick. Obscure priests and nuns had often cared for the insane with kindness and understanding; but the theological bigwigs thought of mental illness in terms of diabolic possession, heresy and apostasy. It was the same with the medical bigwigs. Strait jackets, Brisk Vomits and systematic terrorism remained the official medical policy until well into the nineteenth century. It was only tardily and reluctantly that the bigwigs accepted the reforms initiated by heroic nonconformists, and officially changed their old, bad tune. Reform began almost simultaneously on either side of the Channel. In England a Quaker merchant, William Tuke, set up the York Retreat, a hospital for the mentally sick, in which restraint was never used and the psychological treatment was aimed, not at frightening the patients, but at bringing them back from their isolation by persuading them to work, play, eat, talk and worship together. In France the pioneer in reform was Doctor Philippe Pinel, who was appointed to the direction of the Bicetre Asylum in Paris at the height of the French Revolution. Many of the patients were kept permanently chained in unlighted cells. Pinel asked permission of the revolutionary government to set them free. It was refused. Liberty, Equality and Fraternity were not for lunatics. Pinel insisted, and at last permission was grudgingly given. The account of what followed is touching in the extreme. “The first man on whom the experiment was tried was an English captain, whose history no one knew, as he had been in chains for forty years. He was thought to be one of the most furious among them. His keepers approached him with caution, as he had in a fit of fury killed one of them on the spot with a blow from his manacles. He was chained more rigorously than any of the others. Pinel entered his cell unattended and calmly said to him, ‘Captain, I will order your chains to be taken off and give you liberty to walk in the court, if you will promise me to behave well and injure no one.’ ‘Yes, I promise,’ said the maniac. ‘But you are laughing at me. . .’ His chains were removed and the keepers retired, leaving the door of his cell open. He raised himself many times from the seat, but fell again on it; for he had been in a sitting posture so long that he had lost the use of his legs. In a quarter of an hour he succeeded in maintaining his balance and with tottering steps came to the door of his dark cell. His first look was at the sky, and he exclaimed, ‘How beautiful, how beautiful!’ During the rest of the day he was constantly in motion, uttering exclamations of delight. In the evening he returned of his own accord to his cell and slept tranquilly.” In Europe the pioneer work of Tuke and Pinel was continued by Conolly, Esquirol and a growing number of their followers in every country. In America, the standard bearer of reform was a heroic woman, Dorothea Dix. By the middle of the century many of the worst abominations of the old regime were things of the past. The mentally ill began to be treated as unfortunate human beings, not as Objects. It was an immense advance; but it was not yet enough. Reform had produced institutional care, but still no adequate treatment. For most nineteenth-century doctors, things were more real than thoughts and the study of matter seemed more scientific than the study of mind. The dream of Victorian medicine was, in Zilboorg’s phrase, to develop a psychiatry that should be completely independent of psychology. Hence the widespread and passionate rejection of the procedures lumped under the names of Animal Magnetism and Hypnotism. In France, Charcot, Liebault and Bernheim achieved remarkable results with hypnosis; but the intellectually respectable psychiatrists of Europe and America turned their backs on this merely psychological treatment of mental illness and concentrated instead on the more “objective,” the more “scientific” methods of surgery. It had all happened before, of course. Cutting holes in the skull was an immemorially ancient form of psychiatry. So was castration, as a cure for epilepsy. Continuing this grand old tradition, the Victorian doctors removed the ovaries of their hysterical patients and treated neurosis in young girls by the gruesome operation known to ethnologists as “female circumcision.” In the early years of the present century Metchnikoff was briefly a prophet, and autointoxication was all the rage in medical circles. Along with practically every other disease, neuroses were supposed to be due to intestinal stasis. No intestine, no stasis — what could be more logical? The lucky neurotics who could afford a major operation went to hospital, had their colons cut out and the end of their small intestines stitched to the stump. Those who recovered found themselves with yet another reason for being neurotic: they had to hurry to the bathroom six or eight times a day. Intestinal stasis went out with the hobble skirt, and the new vogue was focal infection. According to the surgical psychiatrists, people were neurotic not because of conflicts in their unconscious mind, but because of inflammation in their tonsils or abscesses at the roots of their teeth. The dentists, the nose-and-throat men set to work with a will. Toothless and tonsilectomized, the neurotics, needless to say, went on behaving just as neurotically as ever. Focal infections followed intestinal stasis into oblivion, and the surgical psychiatrists now prefer to make a direct assault upon the brain. The current fashion is shock treatment or, on great occasions, prefrontal lobotomy. Meanwhile the pharmacologists have not been idle. The barbiturates, hailed not so long ago as panaceas, have given place to Chlorpromazine, Reserpine, Frenquel and Miltown. Insofar as they facilitate the specifically psychological treatment of mental disorders, these tranquilizers may prove to be extremely valuable. Even as symptom stoppers they have their uses. The green oasis among the jets and the rockets is crammed to overflowing. So are all the other mental hospitals of the Western world. Technological and economic progress seems to have been accompanied by psychological regress. The incidence of neuroses and psychoses is apparently on the increase. Still larger hospitals, yet kinder treatment of patients, more psychiatrists and better pills — we need them all and need them urgently. But they will not solve our problem. In this field prevention is incomparably more important than cure; for cure merely returns the patient to an environment which begets mental illness. But how is prevention to be achieved? That is the sixty-four-billion-dollar question. (From Esquire Magazine)

A Case of Voluntary Ignorance That men do not learn very much from the lessons of history is the most important of all the lessons that history has to teach. Si vis pacem, the Romans liked to say, para bellum — if you want peace prepare for war. For the last few thousand years the rulers of all the world’s empires, kingdoms and republics have acted upon this maxim — with the result, as Professor Sorokin has laboriously shown, that every civilized nation has spent about half of every century of its existence waging war with its neighbors. But has mankind learned this lesson of history? The answer is emphatically in the negative. Si vis pacem, para bellum still is the watchword of every sovereign state, with the possible exception of Monaco. Again, what happens when economic power is concentrated in a few hands? History’s answer to that question is that, whatever else it may be, that which happens is most certainly not democracy. But while politicians everywhere proclaim the virtues of democracy (even the totalitarian states are People’s Republics), advancing technology is everywhere allowed and even encouraged to work for the concentration of economic power. Small-scale operators in agriculture and industry are progressively eliminated, and in their place advancing technology installs an oligarchy of giant concerns, owned and operated either by private corporations and their managers, or by the state and its bureaucrats. It is interesting to note that the men who, in the teeth of history, proclaimed that, if you want peace, you must prepare for war, were the self-same men who solemnly declared that Experience teaches, experientia docet– or, as Mrs. Micawber more aptly put it, “Experientia does it.” But as a matter of brute historical fact, Experientia generally doesn’t. We got on doing what our own and our father’s experience has demonstrated, again and again, to be inappropriate or downright disastrous; and we go on hoping (this time like Mr. Micawber) that “something will turn up” — something completely different from anything which, on the basis of experience, we have any right to expect. Needless to say, it does not turn up. The same old mistakes have the same old consequences and we remain in the same old mess. And even when we do permit ourselves to be taught by experience, as embodied in our own or our society’s history, how slow, in all too many cases, how grudging and reluctant is the process of learning! True, we learn very quickly the things we really want to learn. But the only things we really want to learn are the things which satisfy our physical needs, the things which arouse and justify our darling passions, and the things which confirm us in our intellectual prejudices. Thus, in any field of science, new facts and new hypotheses are accepted quickly and easily by those whose metaphysical beliefs happen to be compatible with the new material. They are rejected (or, if accepted, accepted very slowly and grudgingly) by those into whose philosophy the new material cannot be fitted — those, in a word, whose intellectual presuppositions are outraged by the facts and hypotheses in question. To take an obvious example, the evolutionary hypothesis and the factual evidence on which it was based were rejected by the Fundamentalists, or accepted only in a Pickwickian sense and after years of stubborn resistance. In precisely the same way the dogmatic materialists of our own day refuse to accept the factual evidence for ESP, or to consider the hypotheses based upon that evidence. From their own experience or from the recorded experience of others (history), men learn only what their passions and their metaphysical prejudices allow them to learn. A wonderfully instructive example of this truth is provided by the history of hypnotism in its relations with orthodox medicine — the history, that is to say, of an extremely odd and still unexplained phenomenon in its relations with a body of anatomical and physiological facts, with certain officially sanctioned methods of treatment, with a system (in part explicit, in part tacit and unexpressed) of metaphysical beliefs, and with the men who have held the beliefs and used the methods. At the time of writing (the Summer of 1956) hypnotism is in fairly good odor among medical men. During World War II it was extensively used in the treatment of the psychosomatic symptoms produced by so-called “battle fatigue.” And at the present time it is being used by a growing number of obstetricians to prepare expectant mothers for childbirth and to make that blessed event more bearable, and by a growing number of dentists to eliminate the pain of probing and drilling. Most psychiatrists, it is true, fight shy of it; but for that overwhelming majority of neurotics who cannot afford to spend two or three years and seven or eight thousand dollars on a conventional analysis, hypnotic treatment, mainly at the hands of lay therapists, is being made increasingly available. And now let us listen to what a distinguished anesthesiologist, Doctor Milton J. Manner of Los Angeles, has to say about the value of hypnotism in his special field. “Hypnotism is the best way to make a patient fearless before surgery, painless during it and comfortable after it.” Dr. Manner adds that, in severe operations, “perfect anesthesia should be attained by employing hypnotism in conjunction with chemical agents. It can then be a pleasant experience, involving no tension or apprehension.” But, it may be asked, why bother with hypnotism, when so many and such excellent chemical anesthetics lie ready to hand? For the good reason, says Dr. Manner, that hypnotism “places no extra load on circulation, breathing, or on the liver and kidney systems.” In a word, it is entirely non-toxic. Hypnotism, he adds, is epecially valuable in operations on children. Children who have been hypnotized into unconsciousness are more cheerful after surgery, “more alert, more responsive, more comfortable and more co-operative than those who undergo anesthesia produced by chemicals alone.” Patients who have suffered severe burns are in constant pain, greatly depressed and without appetite. Hypnotism will relieve pain, improve morale and restore appetite, thereby greatly accelerating the process of healing. Alone or in conjunction with relatively small amounts of chemical anesthetics, hypnotism has been used by Dr. Marmer in every kind of surgical situation, including even the removal of a tumor from the lung. Every anesthesiologist, Dr. Marmer concludes, should also be a hypnotist. So much for hypnotism today. Now let us turn back to the past and see what lessons the history of hypnotism has to teach. Among the books in my library are two rather battered volumes—Mesmerism in India, by James Esdaile, M.D., first published in 1846, and Mesmerism, in its Relation to Health and Disease, and the Present State of Medicine, by William Neilson, published at Edinburgh in 1855. Esdaile was a Scottish physician and surgeon, who went out to India as a young man and was put in charge of two hospitals in Bengal — one a hospital for prisoners in the local jail, the other a charity hospital for the general public. In these hospitals and, later, in a hospital at Calcutta, Esdaile performed more than three hundred major operations on patients in a state of hypnotic (or as it was then called, “mesmeric” or “magnetic”) anesthesia. These operations included amputations of limbs, removals of cancerous breasts, numerous operations for varicocele, cataract and chronic ulcers, removals of tumors in the throat and mouth, and of the enormous tumors, weighing from thirty to more than a hundred pounds apiece, caused by elephantiasis, then exceedingly prevalent in Bengal. Esdaile’s Indian patients felt no pain, even during the most drastic operations. What was still more remarkable, they survived. In 1846 — the year in which Esdaile published his book -Semmelweiss had not yet taught his students to wash their hands when they came from the dissecting room to the maternity ward, Pasteur was years away from his discovery of bacterial infection, Lister, a mere boy in his teens. Surgery was strictly septic. In the words of a historian of medicine, “suppuration and septic poisonings of the system carried away even the most promising patients and followed even trifling operations. Often, too, these diseases rose to the height of epidemic pestilences, so that patients, however extreme their need, feared the very name of hospital, and the most skillful surgeons distrusted their own craft.” Before the advent of ether and chloroform (which began to be used about 1847), the mortality of patients after surgery averaged twentynine per cent in a well-run hospital and would rise, when the streps and staphs were more than usually active, to over fifty per cent. Chloroform changed the techniques of surgery, but not, to any marked extent, its results. The agonies of the fully conscious patient “had naturally and rightly compelled the public to demand rapid if not slapdash surgery, and the surgeon to pride himself on it. Within decent limits of precision, the quickest craftsman was the best.” (There were famous specialists who could perform an operation for stone in fifty-eight seconds flat.) Thanks to chloroform, “the surgeon was enabled to be not only as cautious and sedulous as he was dexterous, but also to venture on long, profound and intricate operations which, before the coming of anesthetics, had been out of the question. But unfortunately this new enfranchisement seemed to be but an ironic liberty of Nature, who with the other hand took away what she had given.” Bigger and better operations were performed under chemical anesthesia, but the patients went on dying at almost the same ghastly rate. In the twenty years following the introduction of chloroform and preceding Lister’s advocacy of aseptic surgery, the death rate from postoperative infections fell by only six percentage points — from twenty-nine in every hundred cases to twenty-three. In other words, almost a quarter of every Early Victorian surgeon’s clients were still regularly slaughtered. Chloroform had abolished the pain of operations, but not the virtual certainty of infection afterwards, nor the one-in-four chance of a lingering and unpleasant death. Meanwhile, what was happening in Bengal? The answer is startling in the extreme. In a debilitating climate and among sickly and undernourished patients, Doctor Esdaile was performing major surgery without any deaths on the operating table (a distressingly frequent event in the early days of badly administered chloroform) and with a mortality from postoperative infection of only five per cent. How are we to account for this extraordinary state of affairs? First of all, Esdaile never allowed his patients’ morale to be undermined by apprehension. The men and women who came to him were not told in advance when they were to be operated, nor even, in many cases, that an operation would be necessary. After examination by the surgeon, they were taken into a dark room, asked to lie down on a couch, and then put to sleep by “magnetic passes,” which were made by relays of orderlies, who would work on the patient, if it seemed necessary, for three and four hours at a stretch. When the passes had taken effect and the patient was in a deep hypnotic coma, he would be taken into the operating room, have his leg cut off, or his forty-pound elephantiasis tumor removed, be stitched up and carried, still unconscious, to his bed. In most cases patients remained in trance for several hours after being operated, and would wake up unaware of what had happened and feeling no pain whatever. In the days that followed they were frequently re-mesmerized, and so spent most of their time in a state of trance. But in trance, as in natural sleep, the vis medicatrix naturae, nature’s healing power, is able to do its work with the greatest possible effectiveness. The agitated and anxious ego is put to sleep and can make no trouble; left to its own devices, the autonomic system or Vegetative Soul (as it used to be called) goes about its business with infallible skill. In order to be freed from pain and selfconsciousness, Esdaile’s patients did not have to be poisoned by narcotics and analgesics; thanks to hypnotism, they were spared most of the miseries that normally follow an operation, and, thanks to hypnotism, their resistance was raised to such an extent that they could easily get the better of the deadly microorganisms associated with septic surgery. Five deaths to every hundred operations — it was the biggest medical news since the days of Hippocrates! But when Esdaile published the facts, what happened? Were his colleagues delighted? Did they hasten in a body to follow his example? Not at all. Most of them were extremely angry when they heard of his achievement, and the bigwigs of the faculty did everything in their power to prevent Dr. Esdaile from continuing his beneficient work and, when that proved impossible (for Esdaile was backed up by the Governor General of India), to suppress the, to them, embarrassing and distasteful facts. Doctor James Simpson, the first surgeon to advocate the use of chloroform and a most courageous crusader, in the teeth of Fundamentalist opposition, for painless childbirth, was at first intensely interested in mesmeric anesthesia. In a letter to Esdaile he wrote that he had “always considered the few deaths out of so many formidable operations one of the most remarkable things in the history of surgery.” Furthermore, says Esdaile, “Dr. Simpson sent me a message that I owed it to myself and my profession to let my proceedings be known in England, and that, if I wrote an article, he would get it published in the journal he was connected with. I therefore sent him an account of one hundred and sixty-one scrotal tumors removed in the mesmeric trance.” This paper was rejected on the ground that parts of it had appeared (in a greatly garbled form) in another medical journal. “A more general paper was offered; but after some compliments and considerable delay,” Esdaile was informed that Dr. Simpson’s brother editors had declined it as “not being sufficiently practical.” “One of the most remarkable things in the history of surgery!” is Neilson’s justifiably bitter comment. “Namely, how to reduce 23 per cent of deaths to 5 per cent — not practical.” And he adds that “it is very curious that, when Dr. Simpson professed to publish an account of all the means that have ever been used to prevent the pain of operations, he quite forgot to mention mesmerism.” This sort of thing had happened before Esdaile’s day and was destined to happen again, and yet again, thereafter. Doctor John Elliotson, an eminent physician and Professor of Physiology at the University of London, had been derided and boycotted for his advocacy of mesmerism in surgery and general practice. Some of his critics had gone so far as to assert that a mesmerized man who had a leg amputated without showing the slightest sign of discomfort was a mere impostor — pretending that he felt no pain just to annoy the orthodox doctors. And one of them, Doctor Copland, solemnly declared that “pain is a wise provision of Nature; and patients ought to suffer pain, while their surgeon is operating; they are all the better for it and recover better.” Later on, when the anesthetic properties of ether and chloroform had been discovered, the first reaction of many doctors was not to give thanks that the pain of operations had been abolished. No, their first reaction was to gloat over the discomfiture of the mesmerists. “Hurrah!” wrote Robert Listen, the first surgeon to perform an operation under ether. “Rejoice! Mesmerism and its professors have met with a heavy blow and great discouragement.” More soberly, but with equal satisfaction, the official Lancet smugly editorialized: “We suppose that we shall hear no more of mesmerism and its absurdities.” And, in effect, the absurdity of a five per cent death rate was not heard of again until Lister discovered that, if the surgeon used aseptic methods, the patient could survive in spite of lowered resistance and systematic poisoning by chemical anesthetics, narcotics and analgesics. But mesmerism and its absurdities were observable facts and, in spite of everything, they refused to disappear. It therefore became necessary to legislate against them. For almost half a century after the publication of Esdaile’s book, any English doctor who made use of hypnotism ran the risk of being hounded out of his profession. It was not until 1892 that the British Medical Association officially admitted the reality of hypnosis and officially sanctioned hypnotic treatment. In France hypnotism fared better than in England. The first Royal Commission on Mesmerism (of which Benjamin Franklin was a member) had denied the existence of the “magnetic fluid,” which was supposed to account for the phenomena of hypnotism, but had not pronounced on the reality of the physical and psychological phenomena induced by mesmeric procedures. The second commission pronounced in favor of mesmeric treatment. The third, dominated by the orthodox party, pronounced against mesmerism. Later, Charcot tried to prove that hypnosis was a form of hysterical epilepsy. But in spite of everything the practice of hypnotism continued and, at the close of the nineteenth century, was being extensively used for the relief of pain and the cure of sickness. Today, strangely enough, hypnotism is almost unknown among medical circles in France. It is as though such pioneers as Liebault and Bernheim had lived and labored in vain. The remarkable successes achieved by those men and their followers have been more or less completely forgotten. These ups and downs in the popularity of hypnotism are characteristic of its history in every country. At one moment hypnotism seems to be on the point of entering medicine as a widely used form of therapy; then, a few years later, the public and the professional men seem to lose interest in this kind of treatment, which is either quietly ignored or else denounced as dangerous or vaguely immoral. In the United States, for example, hypnotism enjoyed wide popularity in the years following the Civil War. Three quarters of a century ago the editor of the American edition of Deleuze’s Treatise on Animal Magnetism could write as follows: “Probably there is not a city nor village in North America where there could not be found at this time — 1878 — one or more magnetizers. Usually one is to be found in every family.” Very few of these magnetizers were medical men; for most American doctors disapproved of hypnotism almost as heartily as did their British colleagues. But, medical or non-medical, the hypnotists existed and were evidently plentiful. By the turn of the century, however, the American magnetizer was already a rare bird, and by the early Twenties the species was almost extinct. Today, it seems to be on its way back. Within a few years, if present trends persist, every city and village in North America may have its medical or dental hypnotist, every family its practitioners of autohypnotism and mutual suggestion. Why has the history of hypnotism been so strangely checkered? Why is it that, in the words of a great psychologist, the late William McDougall, “in spite of the frequent occurrence of states identical with or closely allied to hypnosis, some three centuries of enthusiastic investigation and of bitter controversy were required to establish the hypnotic state among the facts accepted by the world of European science”? The answer, as I have already suggested, is that most of us believe only what our interests, our passions and our metaphysical prejudices permit us to believe. “As Hobbes has well observed, if it were for the profit of a governing body that the three angles of a triangle should not be equal to two right angles, the doctrine that they were would, by that body, inevitably be denounced as false and pernicious. The most curious examples of this truth have been found in the history of medicine. This, on the one hand, is nothing more than a history of variations and, on the other, a still more wonderful history of how every successive variation has, by medical bodies, been first furiously denounced and then bigotedly adopted.” So wrote an older contemporary of the persecuted mesmerists, the Scottish philosopher and essayist, Sir William Hamilton (who, like every intelligent man of the period outside the medical profession, took a lively interest in the phenomena of hypnotism). It should be added that the “profit” of a professional body is not to be measured exclusively in terms of money and power, or even of prestige. There are vested interests not only in the fields of economics and social position, but also in the field of pure ideas. That a beautiful and genuinely antique theory should be ruined by some new, coarse, essentially vulgar fact of mere observation seems quite intolerable to a mind brought up in a proper reverence for words and consecrated notions. And it goes without saying that, if the threat to a beloved theory should at the same time be a threat to personal reputation, this resentment will be raised to the pitch of outraged disapproval and a burning, righteous indignation. This was clearly recognized by one of the early historians of science, John Playfair, who noted that new ideas, new observations and new methods “must often change the relative place of men engaged in scientific pursuits, and must oblige many, after descending from the stations they formerly occupied, to take a lower place in the scale of intellectual improvement. The enmity of such men, if they be not animated by a spirit of real candor and the love of truth, is likely to be directed against the methods, observations and ideas by which their vanity is mortified and their importance lessened.” If the Early Victorian doctors hated mesmerism, it was because it threatened their vested interests in such time-hallowed therapeutic methods as blood-letting and pillprescribing, and at the same time their vested interests in a time-hallowed philosophy of man and the universe, which had no place in it for the odder phenomena of human psychology. Moreover, they felt that they could not give up these methods or modify this philosophy without gravely injuring their professional dignity. “If mesmerism be true,” wrote Esdaile, “the doctors, old and young, will have to go to school again; and this is what constitutes the bitterness of the mesmeric pill.” (Substitute “parapsychology” for “mesmerism” and “para-psychological” for “mesmeric” — and you have here an explanation of the refusal, on the part of some contemporary scientists, to consider the vast accumulations of evidence in favor of the reality of ESP.) The extreme bitterness of the pill accounts for the extreme violence of the medical diatribes against the new observations and the new methods of treatment, along with all those who had had anything to do with them. It is a violence comparable to that which, all too frequently, has characterized the controversies of clergymen. The doctors loathed the mesmerists with a full-blown odium theologicum, a theological hatred. In his volume of 1855, William Neilson quotes many examples of this truly religious intemperance of language. Disdaining argument and paying no attention to facts, the anti-mesmeric contributors to the Lancet and the Medical Times confined themselves exclusively to abuse. “While pursuing their frauds among lunatics and fools, mesmerists give us neither umbrage nor disquiet; but within the walls of our colleges (there were mesmerists of the highest scientific eminence at the Universities of Edinburgh and London) they are scandalous nuisances and an insufferable disgrace.” Elliotson and his followers practice “a harlotry which they call science.” Worse still, they refuse to bow to the authority of those licensed repositories of ultimate truth, the doctors. Instead, they make their appeal to mere reason and uncensored experience, with the shocking result that they have found enthusiastic supporters in every class of society — “the pert folly of the nobility, the weakest among the literary people, high and low ladies, quack clergymen (among whom, it may be remarked, were several bishops and even an archbishop), itinerant lecturers and exhibiting buffoons.” To sum up, mesmerism is merely a compound of “quackery, obscenity and imposture, and its advocates are at the best deluded idiots, at the worst swindling knaves.” In one of its aspects, as we have seen, the history of medicine is the history of variations — the history of fads pursued and then rejected, of fashions adopted with enthusiasm and then quietly dropped in favor of some more modish style of diagnosis or of treatment. When all these fads and fashions are strictly physiological, the change from one to another can be made without difficulty and without any feeling of mental distress. But where non-physiological factors are involved — factors which cannot be explained in terms of the prevailing medical philosophy — changes of fashion are painful and the resistance to change is stubborn and often violent. Hypnotism involves non-physiological factors; consequently the reality of hypnosis and the value of hypnotic treatment were vehemently denied by the official spokesmen of the medical profession. That the ban upon hypnotism ever came to be lifted was due to a variety of causes. First of all, the metaphysical susceptibilities of the doctors were soothed by the work of Professor Heidenhain. This German researcher was able to convince himself and his colleagues that hypnosis was always the result of strictly physiological causes. It didn’t happen to be true; but, to use the religious phraseology which seems appropriate to the case, it was highly edifying, it brought comfort to the troubled spirit of the doctors, and it helped, incidentally, to make hypnotism respectable. Meanwhile intensive research into the nature of mental illness was being carried on, especially in France and Germany, and the idea of subconscious mental activity gradually forced itself upon even the most physiologically minded psychiatrists. Within the enlarged framework of medical philosophy, hypnosis, though still unexplained, began to make a little more sense. But then — fortunately in some ways, unfortunately in others — the great Doctor Freud made his appearance. Freud banned hypnotism from his system of psychotherapy and, as an entirely illogical consequence of this ban, hypnotism came to be largely neglected in surgery and general medicine, where it is of such inestimable value as a nonpoisonous anesthetic, as a raiser of resistance to infection, as an improver of morale, as a promoter of healing and an accelerator of convalescence. Wars tend to stimulate medical advance, at any rate in those countries which have escaped severe devastation. The current revival of interest in hypnotism is in part due to its successful employment in military hospitals. Medicine has now returned to the position once occupied by Esdaile and Elliotson. That it should have taken four generations to reconquer that position is certainly unfortunate. But better late than never.
(From Esquire Magazine)