The history of psychiatry contains many dark chapters, periods when doctors resorted to barbaric and unethical practices in their attempts to treat mental illnesses that they did not understand. One of the most infamous is the lobotomy, in which the connections to and from the prefrontal cortex were severed, leaving patients docile and vacant. Though touted as a cure, this procedure more closely resembled medieval torture. Whilst the brutality of the lobotomy may seem mystifying today, looking at the historical context helps explain how psychiatry could justify such terrible “treatments” marked by stigma, lacking proper oversight, and devoid of empathy. The reasons illuminate the field’s troubled past whilst providing lessons to ensure moral progress continues.
I bring this up because one of my students is studying the works of Tennessee Williams. We found a brilliant article that highlights the theme of neurodiversity that winds its way through Williams’ works.
Not like all the other horses: Neurodiversity and the case of Rose Williams examines the life of Tennessee Williams' sister Rose, who was likely autistic but was misdiagnosed with schizophrenia in the early 20th century. It analyzes how Rose's struggles have been depicted in Williams' major plays, including The Glass Menagerie, Suddenly Last Summer, and The Night of the Iguana.
The author argues that if Rose had lived today, her behaviours and difficulties would likely lead to a diagnosis of an autism spectrum disorder (at the time of the article, 2012, it would likely have been Aspergers). However, autism was not well understood when Rose was young. Her social impairments and restricted interests were seen as evidence of mental illness. Rose received insulin shock treatments and eventually a lobotomy intended to control her upsetting behaviours.
The text explores how Williams grappled with guilt over abandoning Rose and resentment towards his mother for consenting to the lobotomy. His plays portray characters inspired by Rose in different lights - as a fragile victim in The Glass Menagerie, a mistreated woman in Suddenly Last Summer, and finally a near-messianic figure in The Night of the Iguana.
According to the author, analyzing Rose's story through a neurodiversity perspective reveals the subjectivity of mental illness labels and how Williams' perceptions of Rose shifted over time. The text does not suggest Rose's lobotomy was intended as an autism treatment, since autism was so misunderstood then. Rather, it provides cultural context for how Rose's likely autism was misjudged as mental illness and subjected to horrific procedures. Overall, the text makes a case for re-evaluating Rose's story and Williams' relationship to her through a more nuanced, neurodiversity-influenced lens.
Why would they do such horrible things?
There are a few reasons why psychiatry historically was willing to perform procedures like lobotomies on patients:
Lack of effective treatments - In the early-to-mid 20th century, there were not many good treatment options for mental illnesses like schizophrenia, depression, OCD, etc. Antipsychotic medications had not been developed yet. Doctors were searching for ways to alleviate suffering and extreme behaviours, and invasive methods like lobotomy were seen as worth trying.
Influence of eugenics - The eugenics movement promoted the idea that mental illness was due to biological defects and that society would be better off if these defects were not passed on. Lobotomy was seen by some as a way to sterilize patients. The eugenic view devalued mentally ill lives.
Views on consent - Standards around informed consent were less developed historically. Doctors often did procedures without fully informing patients or getting meaningful consent, especially when working with vulnerable populations. Mentally ill patients were not seen as competent to make medical decisions.
Lack of empathy/stigma - There was widespread stigma and lack of empathy for the mentally ill. Their suffering was often discounted and their complaints ignored. Doctors did not always view them as fully human. This made it easier to do radical procedures without concern for quality of life.
Desire for control - Lobotomy often aimed to make patients easier to handle and control in mental institutions. Doctors and asylum directors had an incentive to perform lobotomies for management purposes regardless of ethics.
So in summary, a mix of faulty assumptions, lack of good alternative treatments, problematic attitudes, and desire for social control contributed to psychiatry's willingness to conduct extreme procedures like lobotomy on mentally ill patients. More rigorous ethics, oversight, and patient empowerment has helped prevent similarly inhumane practices today.
The assignment
This assignment is one of the joys I get from being a teacher. I love being able to dive deep with my exceptional students on topics that interest them. As we dove into Williams, the uncomfortable past came up alongside the thematic elements. So we just went where the stories took us.
We found that in The Glass Menagerie, for example, the character of Laura Wingfield represents Rose. Laura embodies the fragile victimhood that mental illness confers upon Rose in the play.
Laura is depicted as utterly helpless and lost. Her shyness is debilitating to the point she can barely interact with others. She escapes the outside world by retreating into her own private realm of glass figurines. This symbolizes how Rose withdrew into her own mind as her condition worsened.
When Laura fails out of business college due to acute anxiety, it reflects Rose's inability to hold a job or function in wider society. Laura's unicorn – her unique glass treasure – is shattered by her gentleman caller, just as Rose's uniqueness was destroyed by her lobotomy in order to make her conform.
The play conveys Laura as fully incapacitated by her mental illness, entirely dependent on others for care. Her extreme fragility suggests that as Rose's brother, Tom/Tennessee bears responsibility for protecting her. Yet in the end he abandons her, indicating his guilt over failing to save Rose from her tragic lobotomy.
Overall, Laura serves as an impressionistic rendering of Rose's victimization by mental illness. Her helplessness highlights the vulnerability conferred upon Rose by her condition, while positioning Tennessee as culpable for not shielding her from devastation.
Other critiques of psychiatry?
Once we made it through Williams, we wondered if there were any other examples in literature of psychiatry’s abuses of the neurodiverse. I though of One Flew Over the Cuckoo's Nest. We investigated.
We found that Chief Bromden serves as the narrator of One Flew Over the Cuckoo's Nest. As a long-term patient diagnosed with schizophrenia living in a psychiatric hospital, Bromden provides a window into historical institutionalization practices and assumptions about mental illness. His experiences under the hospital's controlling, dehumanizing treatment methods reveal mid-20th century psychiatry's unethical approaches to managing and "treating" patients. Bromden is forced to undergo electroshock therapy intended to make him more docile and manageable, much like Rose's lobotomy in The Glass Menagerie. This highlights the lack of consent and agency afforded to psychiatric patients during that time period. Additionally, Bromden's perceptive first-person narration challenges assumptions that the mentally ill lack insight or credibility. Through Bromden's perspective, Kesey provides a critical fictional portrait of the abuses and stigma within the psychiatric system. His character serves a similar purpose as Laura Wingfield's character in illuminating the troubled history of psychiatry's treatment of the mentally ill.
In the end…
Our exploration of lobotomies, autism, and psychiatry reveals an important truth - science is never truly “settled.” What one era accepts as established fact is frequently overturned by new evidence and perspectives.
In the early 20th century, lobotomies were touted as a scientific cure for mental illness. The ability to physically alter the brain convinced doctors this procedure was empirically proven. Yet later analysis correctly recognized lobotomies as barbaric pseudoscience, not a settled treatment.
Likewise, autism was once blamed on “refrigerator mothers” and equated with schizophrenia based on the science of the day. Now we understand autism has biological roots and differs from psychosis. And medications considered ineffective for autism have cured countless cases of schizophrenia.
Chief Bromden’s case reminds us that seeing science as settled can blind us to the humanity of those we aim to help. What psychiatrists viewed as advanced methods of control seemed barbaric to those who recognized mental patients’ humanity.
Progress occurs when we remain open to new paradigms overturning previous “scientific consensus.” Undue devotion to established ideas inhibits progress and risks harm, as psychiatry’s history shows. Science must accept that settled notions of today may one day seem as backward as lobotomies. Maintaining humility and focusing on ethics is critical for scientific advancement.
Whilst autism has often been stigmatized and misunderstood, there is hope that science and society will increasingly embrace neurodiversity and humane support. As awareness spreads that autism comprises a spectrum rather than a monolithic disorder, we can better accommodate varying needs. Researchers devoted to giving voice to autistic perspectives, rather than speaking for them, will uncover new insights about fostering inclusion. Schools can provide accommodations allowing autistic students to thrive academically and socially. Employers can recognize and reward the formidable talents of autistic thinkers, creating careers tailored to their abilities. And one day, our culture may no longer instill shame in those wired differently but celebrate neurodiversity’s invaluable place in human creativity and compassion. Though past misconceptions still haunt our present, the future for autistic people can be one of hope, if guided by greater understanding.
The AutSide is a reader-supported publication. To support my work, consider becoming a paid subscriber.
Psychiatry's horrible history
Psychiatry's horrible history
Psychiatry's horrible history
The history of psychiatry contains many dark chapters, periods when doctors resorted to barbaric and unethical practices in their attempts to treat mental illnesses that they did not understand. One of the most infamous is the lobotomy, in which the connections to and from the prefrontal cortex were severed, leaving patients docile and vacant. Though touted as a cure, this procedure more closely resembled medieval torture. Whilst the brutality of the lobotomy may seem mystifying today, looking at the historical context helps explain how psychiatry could justify such terrible “treatments” marked by stigma, lacking proper oversight, and devoid of empathy. The reasons illuminate the field’s troubled past whilst providing lessons to ensure moral progress continues.
I bring this up because one of my students is studying the works of Tennessee Williams. We found a brilliant article that highlights the theme of neurodiversity that winds its way through Williams’ works.
Not like all the other horses: Neurodiversity and the case of Rose Williams examines the life of Tennessee Williams' sister Rose, who was likely autistic but was misdiagnosed with schizophrenia in the early 20th century. It analyzes how Rose's struggles have been depicted in Williams' major plays, including The Glass Menagerie, Suddenly Last Summer, and The Night of the Iguana.
The author argues that if Rose had lived today, her behaviours and difficulties would likely lead to a diagnosis of an autism spectrum disorder (at the time of the article, 2012, it would likely have been Aspergers). However, autism was not well understood when Rose was young. Her social impairments and restricted interests were seen as evidence of mental illness. Rose received insulin shock treatments and eventually a lobotomy intended to control her upsetting behaviours.
The text explores how Williams grappled with guilt over abandoning Rose and resentment towards his mother for consenting to the lobotomy. His plays portray characters inspired by Rose in different lights - as a fragile victim in The Glass Menagerie, a mistreated woman in Suddenly Last Summer, and finally a near-messianic figure in The Night of the Iguana.
According to the author, analyzing Rose's story through a neurodiversity perspective reveals the subjectivity of mental illness labels and how Williams' perceptions of Rose shifted over time. The text does not suggest Rose's lobotomy was intended as an autism treatment, since autism was so misunderstood then. Rather, it provides cultural context for how Rose's likely autism was misjudged as mental illness and subjected to horrific procedures. Overall, the text makes a case for re-evaluating Rose's story and Williams' relationship to her through a more nuanced, neurodiversity-influenced lens.
Why would they do such horrible things?
There are a few reasons why psychiatry historically was willing to perform procedures like lobotomies on patients:
Lack of effective treatments - In the early-to-mid 20th century, there were not many good treatment options for mental illnesses like schizophrenia, depression, OCD, etc. Antipsychotic medications had not been developed yet. Doctors were searching for ways to alleviate suffering and extreme behaviours, and invasive methods like lobotomy were seen as worth trying.
Influence of eugenics - The eugenics movement promoted the idea that mental illness was due to biological defects and that society would be better off if these defects were not passed on. Lobotomy was seen by some as a way to sterilize patients. The eugenic view devalued mentally ill lives.
Views on consent - Standards around informed consent were less developed historically. Doctors often did procedures without fully informing patients or getting meaningful consent, especially when working with vulnerable populations. Mentally ill patients were not seen as competent to make medical decisions.
Lack of empathy/stigma - There was widespread stigma and lack of empathy for the mentally ill. Their suffering was often discounted and their complaints ignored. Doctors did not always view them as fully human. This made it easier to do radical procedures without concern for quality of life.
Desire for control - Lobotomy often aimed to make patients easier to handle and control in mental institutions. Doctors and asylum directors had an incentive to perform lobotomies for management purposes regardless of ethics.
So in summary, a mix of faulty assumptions, lack of good alternative treatments, problematic attitudes, and desire for social control contributed to psychiatry's willingness to conduct extreme procedures like lobotomy on mentally ill patients. More rigorous ethics, oversight, and patient empowerment has helped prevent similarly inhumane practices today.
The assignment
This assignment is one of the joys I get from being a teacher. I love being able to dive deep with my exceptional students on topics that interest them. As we dove into Williams, the uncomfortable past came up alongside the thematic elements. So we just went where the stories took us.
We found that in The Glass Menagerie, for example, the character of Laura Wingfield represents Rose. Laura embodies the fragile victimhood that mental illness confers upon Rose in the play.
Laura is depicted as utterly helpless and lost. Her shyness is debilitating to the point she can barely interact with others. She escapes the outside world by retreating into her own private realm of glass figurines. This symbolizes how Rose withdrew into her own mind as her condition worsened.
When Laura fails out of business college due to acute anxiety, it reflects Rose's inability to hold a job or function in wider society. Laura's unicorn – her unique glass treasure – is shattered by her gentleman caller, just as Rose's uniqueness was destroyed by her lobotomy in order to make her conform.
The play conveys Laura as fully incapacitated by her mental illness, entirely dependent on others for care. Her extreme fragility suggests that as Rose's brother, Tom/Tennessee bears responsibility for protecting her. Yet in the end he abandons her, indicating his guilt over failing to save Rose from her tragic lobotomy.
Overall, Laura serves as an impressionistic rendering of Rose's victimization by mental illness. Her helplessness highlights the vulnerability conferred upon Rose by her condition, while positioning Tennessee as culpable for not shielding her from devastation.
Other critiques of psychiatry?
Once we made it through Williams, we wondered if there were any other examples in literature of psychiatry’s abuses of the neurodiverse. I though of One Flew Over the Cuckoo's Nest. We investigated.
We found that Chief Bromden serves as the narrator of One Flew Over the Cuckoo's Nest. As a long-term patient diagnosed with schizophrenia living in a psychiatric hospital, Bromden provides a window into historical institutionalization practices and assumptions about mental illness. His experiences under the hospital's controlling, dehumanizing treatment methods reveal mid-20th century psychiatry's unethical approaches to managing and "treating" patients. Bromden is forced to undergo electroshock therapy intended to make him more docile and manageable, much like Rose's lobotomy in The Glass Menagerie. This highlights the lack of consent and agency afforded to psychiatric patients during that time period. Additionally, Bromden's perceptive first-person narration challenges assumptions that the mentally ill lack insight or credibility. Through Bromden's perspective, Kesey provides a critical fictional portrait of the abuses and stigma within the psychiatric system. His character serves a similar purpose as Laura Wingfield's character in illuminating the troubled history of psychiatry's treatment of the mentally ill.
In the end…
Our exploration of lobotomies, autism, and psychiatry reveals an important truth - science is never truly “settled.” What one era accepts as established fact is frequently overturned by new evidence and perspectives.
In the early 20th century, lobotomies were touted as a scientific cure for mental illness. The ability to physically alter the brain convinced doctors this procedure was empirically proven. Yet later analysis correctly recognized lobotomies as barbaric pseudoscience, not a settled treatment.
Likewise, autism was once blamed on “refrigerator mothers” and equated with schizophrenia based on the science of the day. Now we understand autism has biological roots and differs from psychosis. And medications considered ineffective for autism have cured countless cases of schizophrenia.
Chief Bromden’s case reminds us that seeing science as settled can blind us to the humanity of those we aim to help. What psychiatrists viewed as advanced methods of control seemed barbaric to those who recognized mental patients’ humanity.
Progress occurs when we remain open to new paradigms overturning previous “scientific consensus.” Undue devotion to established ideas inhibits progress and risks harm, as psychiatry’s history shows. Science must accept that settled notions of today may one day seem as backward as lobotomies. Maintaining humility and focusing on ethics is critical for scientific advancement.
Whilst autism has often been stigmatized and misunderstood, there is hope that science and society will increasingly embrace neurodiversity and humane support. As awareness spreads that autism comprises a spectrum rather than a monolithic disorder, we can better accommodate varying needs. Researchers devoted to giving voice to autistic perspectives, rather than speaking for them, will uncover new insights about fostering inclusion. Schools can provide accommodations allowing autistic students to thrive academically and socially. Employers can recognize and reward the formidable talents of autistic thinkers, creating careers tailored to their abilities. And one day, our culture may no longer instill shame in those wired differently but celebrate neurodiversity’s invaluable place in human creativity and compassion. Though past misconceptions still haunt our present, the future for autistic people can be one of hope, if guided by greater understanding.
The AutSide is a reader-supported publication. To support my work, consider becoming a paid subscriber.