Recovery From Schizophrenia: Psychiatry And Political Economy

MADNESS AND THE INDUSTRIAL REVOLUTION 123course and outcome to acute mental illnesses in early nineteenth-centuryAmerica, which needs to be explained.THE COVER-UPFew physicians care to believe that their methods are not as successful as those ofothers and, still less, that the achievements of their profession are following aprogressively downhill course. Such concerns may well explain the intensity andsomewhat derisory air with which later American psychiatrists have attempted torefute the curability claims of the moraltreatment era. They have been anxious tosee the errors in these reports but less keen to validate any truth within them.Most vigorous and influential of these critics was Pliny Earle, and his work TheCurability of Insanity, published in 1876, is frequently cited as the definitivedebunking of the “myth of curability.” 104 Dr Earle contended that the excellentrecovery rates recorded by Samuel Woodward during the earliest years of theWorcester State Hospital were grossly exaggerated by statistical juggling. He mademuch of the fact that the same patient might be counted as “recovered” afterevery relapse and that percentages of recoveries were calculated on the basis ofthose discharged, not on the numbers admitted. His conclusion, much more inkeeping with the figures for his own institution, late in the century, was thatinsanity was, in fact, far less curable than had been supposed.Pliny Earle’s attempt to rewrite psychiatric history, however, has itself beenexposed as a cover-up. Dr Sanbourne Bockoven, who has reanalyzed Dr Earle’sfigures and uncovered more material on Samuel Woodward’s patients, 105concludes that Earle himself was guilty of statistical juggling. Dr Earle knew, forexample, that the counting of repeated recoveries, which he so criticized andwhich has been raised by every critic since, made almost no difference to theoverall recovery rate of Worcester State Hospital patients—a difference of lessthan a quarter of a percentage point. Dr Earle also knew of the existence of acomprehensive follow-up study of Samuel Woodward’s discharged patients,conducted by Dr John Park, a later superintendent of Worcester State Hospital—a study that showed that outcome was, indeed, so superior in the early decades ofthe hospital’s operation that Dr Park judiciously withheld the results frompublication.At Dr Earle’s suggestion, Dr Park had compiled a retroactive review ofadmissions and discharges since the opening of the hospital in 1833, employinghis own criteria for “recovery,” not Dr Woodward’s. His results (continued up to1950 with modern data), showing the changes in the percentage of admissionsdischarged as recovered from Worcester State Hospital, are displayed inFigure 5.1 (taken from Dr Bockoven’s book). Dr Park, who was as keen as DrEarle to demonstrate that the early recovery rates were artificially inflated, wasunable to reduce Dr Woodward’s figures by more than two or three per cent.Overall recovery rates of 45 per cent in the moral-treatment era, as we can see,