#502 – Psychiatry, Insane Asylums, Mental Illness, ECT, Lobotomies, Freud & Jung

Why does it matter? Because psychiatry spent $20 billion and admits it helped no one.

Thomas Insel spent thirteen years directing the National Institute of Mental Health. His summary of that tenure: after funding geneticists and neuroscientists who "did a lot of really interesting science," he concluded that "after spending twenty billion dollars, the lot of the mentally ill has improved not one bit." Andrew Scull has spent decades documenting why that failure was structurally inevitable — and why the next version of the same cycle is already underway.

• Psychiatry has symptomatic treatments, not cures — for any condition, without a single exception • The "80% cure" claim has surfaced in every generation of psychiatric treatment, from insulin coma therapy to Cotton's stomach removals — and Scull hears it forming again around ketamine and psychedelics • American eugenics money directly funded the German psychiatrist who became the architect of Nazi mass murder of an estimated 250,000 mentally ill people — the first victims of the Final Solution, killed in prototype gas chambers • The government's own 2005 trial found 67–82% of patients quit psychiatry's flagship antipsychotics because the drugs either didn't work or were intolerable

$20 billion in brain research, zero improvement in patient outcomes — psychiatry's own leadership said so

The National Institute of Mental Health spent a generation betting on neuroscience and genetics as the path to understanding mental illness. The tools were genuine: decoded human genome, gene-wide association studies, a neuroscience field that grew from a few hundred researchers in the 1970s to tens of thousands. The plan was to replace the DSM's symptom-checklist diagnoses with categories grounded in actual biological pathology.

By 2008, that plan had been quietly abandoned. When DSM-5 was released, Insel and his predecessor Steven Hyman — the two most recent NIMH directors — publicly denounced it as "unscientific and useless." The men who had directed the investment condemned the result.

Scull's framing is precise: what psychiatry has are symptomatic treatments. "We don't have a psychiatric penicillin for any of the conditions we're going to be talking about." Not for schizophrenia, not for bipolar disorder, not for depression. When the field's own architects acknowledge this, it becomes harder to treat incoming neuroscience-based breakthroughs as anything other than the next iteration of the same failed bet.

The '80% cure' has appeared in every generation of psychiatry — and every time it was wrong

Cotton pulled teeth, tonsils, spleens, and stomachs. He described stomachs as "cement mixers on a construction site" that "could be dispensed with." He claimed to cure 80% of patients. Forty-five percent of those who received abdominal surgery were dead within a year. The New York Times called it a breakthrough. Princeton published the lectures.

That number — eighty percent — runs through the history of psychiatry like a refrain. Sakel's insulin coma therapy: eighty percent cured. The early asylums: seventy to eighty percent, if patients arrived soon enough. Each time, the claims collapsed under scrutiny, or patients died, or a randomized controlled trial arrived too late and too slowly. Scull reads the repetition as a structural feature of a field that generates false confidence through placebo effects, publication pressure, and the long delay before independent trials materialize.

His current warning is direct: "I'm very worried at the moment. I see ketamine and psychedelics being propounded as a miracle cure for depression, and the evidence for that is enormously weak is the best way to put it. I've seen this movie before too many times."

The gas chamber was invented for psychiatric patients, funded partly by American eugenics money

The mentally ill were not a late addition to the Nazi extermination program. They were its beginning. An estimated quarter million people were murdered in what Scull calls the prototype for the Final Solution: "It was in the mass killing of the mentally ill, which may have been as many as a quarter million people, that the technology of the gas chamber was developed, and the technology of disguising the gas chamber as showers was developed."

The intellectual scaffolding came partly from America. The Rockefeller Foundation funded Ernst Rüdin — the leading German psychiatric geneticist — who absorbed American eugenics lessons about sterilization and became, in Scull's account, "a very enthusiastic proponent of that, and then a supporter of murdering mental patients." By the time Hitler launched the T4 program, German psychiatry largely collaborated.

The causal chain Scull traces runs through language. A British psychiatrist said openly that if his patients had been puppies, "we'd have tied them up in a sack with some lead weights, and thrown them in a pond and drowned them." That isn't presented as historical color. It's what dehumanization looks like before it becomes policy.

Psychiatry's best drugs fail the majority of patients — that's not the critics talking, that's the trial data

In 2005, with no drug company money controlling the data, the NIMH funded the CATIE study. It compared one cheap, old antipsychotic — a 1950s molecule — against four expensive newer drugs. Published in the New England Journal of Medicine, the results were, Scull argues, badly underreported.

Finding one: the new drugs were no more effective than the old one. Steve Hyman concluded they "aren't really any advance on the ones by accident we found in the fifties."

Finding two: between 67% and 82% of patients, depending on the drug, dropped out of the trial. Not because of protocol failures — because the drug wasn't working or the side effects were intolerable. The newer drugs had largely traded tardive dyskinesia for metabolic syndrome: weight gains of 10 to 50 pounds, diabetes, heart disease.

These are psychiatry's best available treatments for its most severe patients. The odds of a drug working without intolerable side effects: below one in three.

Schizophrenia may not be a real disease — and psychiatry may be forced to announce that within a decade

Reliability and validity are not the same thing. Scull draws the distinction cleanly: "Reliability means you and I faced with the same sets of facts reach the same conclusion, but that conclusion may or may not reflect the underlying reality of things." The DSM was built for reliability. Whether its categories correspond to real, distinct biological diseases is a different question — and the answer coming back from genetics is unsettling.

Decades of psychiatric genetic research has not found discrete signatures of schizophrenia and bipolar disorder as separate conditions. It has found overlap: "There is a great deal of overlap in the kinds of genetic abnormalities that heighten the susceptibility to bipolar disorder or schizophrenia or autism." The categories that DSM treats as distinct diseases blur into each other at the genetic level.

Leading psychiatrists are now speculating openly that within ten years the field may have to say the categories don't exist as distinct diseases. Scull's assessment: "that will tend, I suspect, to have pretty bad effects on people's trust in psychiatry." Two generations of research into the causes of schizophrenia may have been studying a label, not a thing.

One Flew Over the Cuckoo's Nest has probably kept suicidal patients from a treatment that works

ECT was used as a tool of punishment — Scull doesn't hedge on that. In the 1940s and '50s it was overwhelmingly deployed for discipline and control rather than therapy. CIA-funded Ewen Cameron gave multiple ECTs a day until patients couldn't walk, talk, or feed themselves.

Modern modified ECT is a different procedure. Muscle relaxants eliminated the fractures. Anesthesia made the process manageable. Controlled trials have accumulated enough evidence that Scull, who has spent a career documenting psychiatric abuses, no longer places ECT in the same category as lobotomy or insulin coma therapy. "Patients who were on the brink of suicide, who had long-running depressions, some of them had ECT and they describe it as lifesaving."

Kesey's 1975 film fixed a 1950s image permanently in the public mind and, Scull argues, "helped end interest in ECT, except for a small handful of enthusiasts for decades." For patients in suicidal crisis today, a cultural artifact is functioning as a medical barrier.

The serotonin deficiency story was pharmaceutical marketing — and millions can't stop taking the drugs it sold

Depression became "the common cold of psychiatry," and Scull thinks a large part of that expansion was drug companies selling the world a mechanism invented to create a market. The serotonin deficiency story gave SSRIs a scientific origin — a broken brain, fixable chemistry — that the evidence never actually supported.

The drugs beat placebo in every controlled trial. But "not necessarily in a clinically significant margin." On a 60-point depression rating scale, a one or two-point improvement can reach statistical significance without changing how anyone actually lives. More than 40% of depressed patients don't respond at all.

The side effects include emotional flattening, loss of libido that sometimes doesn't return, and withdrawal that can be severe. "Many patients find themselves trapped on those drugs for a long time, and we don't know what the effects of that are gonna be." The drugs marketed as a liberation from the dangerous older antidepressants created a different kind of dependency.

The next 80% cure is already being announced

The pattern Scull traces across 150 years has one fixed feature: each era's overconfident cure becomes the next era's cautionary tale, without interrupting the cycle that follows. Ketamine and psychedelics may yet show genuine therapeutic value for specific patients — serious researchers are doing serious work. What Scull is predicting is that the field will announce the result before the evidence is in, because that is what the field has always done.

He's heard the eighty percent before.

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Topics: psychiatry, mental health, history of medicine, neuroscience, psychopharmacology, eugenics, lobotomy, electroconvulsive therapy, psychoanalysis, cognitive behavioral therapy, antipsychotics, antidepressants, NIMH, DSM, Freud, Jung, asylum history, Big Pharma, SSRI, schizophrenia, depression