Recovery From Schizophrenia: Psychiatry And Political Economy

MADNESS AND THE INDUSTRIAL REVOLUTION 121rates at that hospital with current British results. During the previous year, 25 ofthe 28 “recent” cases admitted to the Hartford Retreat—89.2 per cent—hadrecovered, he reported, but “at two most ancient and celebrated institutions” ofthe same type in Britain only 25.5 per cent of “recent” (acute) cases were cured. 96Hall’s claims attracted a great deal of attention on both sides of the Atlantic andwere widely quoted in the press. Soon, other American hospital superintendentsreported similar rates of success. Samuel Woodward at the Worcester StateHospital claimed recovery rates for “recent” (acute) cases of 82–91 per cent forthe early years of the hospital’s operation between 1833 and 1840. John Galt,superintendent at the Eastern Virginia Asylum, announced 92 per cent recoveryin acute cases and 53 per cent recovery overall in new admissions in his report of1842. Around the same time, William Awl, superintendent of the Ohio StateAsylum, reported cure rates of 80–100 per cent for cases of recent onset, and 48 percent recovery for all cases of up to ten years duration admitted over a four-yearperiod. 97 Heads of corporate and public asylums alike argued that recovery frominsanity was the rule, incurability the exception. As stated by Amariah Brigham ofUtica State Hospital: “No fact relating to insanity appears better established thanthe general certainty of curing it in its early state.” 98It is easy to dismiss such claims as American bombast and typical of theentrepreneurial audacity of the New Republic. The claims were, indeed,extravagant and clearly motivated, in part, by a wish to impress state legislatorswith the value of investment in hospital care. Dorothea Dix used these reports ofthe benefits of modern treatment in her successful campaign to establish publicmental hospitals throughout the United States. The episode in Americanpsychiatry has subsequently been disparaged as the “Cult of Curability.” 99Obviously, statistics may have been molded somewhat to improve the effect.Galt’s 92 per cent recovery figure was, like many other reports, based on a smallsample—13 admissions. Criteria for defining “recent” cases and “recovery” weresubject to manipulation; and patients who relapsed, were readmitted andsubsequently discharged again, might be counted as “recovered” more thanonce. 100 Despite such statistical flaws, nevertheless, we cannot rule out thepossibility that cure rates were outstandingly good at the time. Indeed, it seemsquite possible that recovery rates for acutely ill patients admitted to American publicand private mental hospitals throughout the first half of the nineteenth centurywere distinctly better than in the decades that followed or in contemporaryBritain. Two points emerge clearly from the reports of the period. The emphasison curability was largely an American phenomenon, and it pervaded publicpsychiatry as extensively as it did the private institutions. In Britain, GeorgeBurrows reported similarly high recovery rates in 1820 for “recent” casesadmitted to his madhouse, as did the proprietors of other privateestablishments. 101 The same degree of universal optimism, however, did notdevelop in British public hospitals of the period.The enthusiasm of the American hospital superintendents was, in fact, basedupon the observation of distinctly superior rates of recovery. Table 5.6 allows us