“Every age has its peculiar folly; some scheme, project, or phantasy into which it plunges, spurred on either by the love of gain, the necessity of excitement, or the mere force of imitation.”
Extraordinary Popular Delusions and the Madness of Crowds
The contemporary mental health movement—epitomized by the dogmatic belief that “mental illness is like any other illness”—is an instance of what Charles Mackay called a “crowd madness.” It is in the very nature of such a popular delusion that, while it rages, it is impervious to criticism. The belief’s overwhelming popularity and the absence of authoritative opposition to it are viewed as proof of its validity.
Long ago I became persuaded that it is not possible to understand modern psychiatric practices unless they are seen as manifestations of a popular madness; and that it is not possible to perceive them in such a light without being familiar with the history of psychiatry, which furnishes ample evidence to compromise its moral and scientific pretensions. In my January column—on Krafft-Ebing and the birth of sexology—I presented an illustrative episode from that history. Here, I shall briefly retell the story of what, until relatively recently, had been the most commonly diagnosed and most enthusiastically treated mental disease in the history of medicine, namely, masturbation.
Masturbation was—and, in principle, remains—the ideal mental illness. First, it is a form of behavior: that is, something people do, not something that happens to them. Second, it is a form of behavior universal to mankind, engaged in from early childhood*: this makes it ideally treatable, since behaviors can be controlled, especially in children who are powerless to resist the well-intentioned brutality of adults. Third, the act makes use of a sexual organ, ideally suited for attaching fantasies of great harm (as well as great pleasure) to its uses and abuses.
* Actually, masturbation occurs in utero as well.
Not surprisingly, masturbation is a disease of modernity. In antiquity and the Dark Ages, people worried about real diseases, such as the plague and consumption. Only after the Enlightenment did people awaken to the possibilities of scientific medicine, assigning material (physical), rather than spiritual (religious), causes to disease, disability, and death.
Not having the faintest idea what caused most diseases, the medical mind went in search of a scapegoat and found it in self-abuse. By the end of the 1700s, it was medical dogma that masturbation caused blindness, epilepsy, gonorrhea, tabes dorsalis, priapism, constipation, conjunctivitis, acne, painful menstruation, nymphomania, impotence, consumption, anemia, and of course insanity, melancholia, and suicide.
How did physicians know and why did people believe that masturbation caused all these diseases? The same way that physicians now know and people believe that chemical imbalances cause mental diseases, such as attention deficit disorder: by “diagnosing” and “treating” the (involuntary, child) “patient” and by discovering “cures” for the disease. Among the widely accepted treatments of masturbation, the most important were restraining devices and mechanical appliances, circumcision, cautery of the genitals, clitoridectomy, and castration. As recently as 1936, a widely used pediatric textbook recommended some of these methods.
Who were the beneficiaries of these medical miracles? Children and the insane—then, as now, the two groups of ideal (involuntary) “patients.” Powerless vis-à-vis their relatives and doctors, minors and mental patients could not resist being fitted with grotesque appliances, encased in plaster of Paris, having their genitalia cauterized or denervated, or being castrated—for their own good.
Error or Arrogance?
The contemporary reader is likely to dismiss masturbation-as-disease as a medical mistake. However, scientific errors, especially obvious ones, are usually soon detected and corrected.
Young males always experienced and displayed nocturnal emissions, the manifestations of normal pubertal male genital physiology. What, in the eighteenth century, made nocturnal emissions turn into the dreaded “symptoms” of dangerous “spermatorrhea”? The same thing that has turned youthful male exuberance into the dreaded symptoms of dangerous attention deficit disorder in our day: parental annoyance and anxiety combined with medical imperialism and furor therapeuticus. Today, diagnosing ADD and prescribing Ritalin are big business. A hundred years ago, it was big business to diagnose “spermatorrhea” and “treat” it with spike-lined rings. For a glimpse into this aspect of the medical-economics of the anti-masturbation business, the reader may consult the facsimile catalogue of the 1898 American Armamentarium Chirurgicum—which contains pictures and prices of many anti-masturbation devices.
Belief in masturbatory insanity and its treatment with castration and clitoridectomy was not an innocent error. This belief—like beliefs in other popular delusions—enhanced the identity and self-concept of the believers. Ostensibly, such beliefs assert facts; actually, they credential believers.
Henry Maudsley, the acknowledged founder of British psychiatry, stated: “The sooner he [the masturbator] sinks to his degraded rest, the better for the world which is well rid of him.” For this and similar views he was hailed as a great humanitarian: A famed psychiatric institute in London is named after him. For Freud, too, sexual behaviors of all kinds, especially masturbation, were manifestations of maladies of which he was a master diagnostician and therapist.
As recently as 1938, Karl Menninger—the undisputed dean of American psychiatry in mid-century—declared: “In the unconscious mind, it [masturbation] always represents an aggression against someone.” (Emphasis added.)
None of psychiatry’s classic mistakes—from masturbatory insanity and its cures, to the disease of homosexuality and its compulsory treatment with “aversion therapy,” and to the attribution of the cause of schizophrenia to reverberating circuits in the frontal lobes and its cure with lobotomy (rewarded with a Nobel Prize in Medicine)—are “innocent” errors. Invariably, the false belief and the medical interventions it appears to justify serves the needs of the believers, especially the relatives of “patients” who seek control over the misbehavior of their “loved ones,” and the physicians who gain prestige and power by “diagnosing” and “treating” misbehavior as if it were disease.
We fool ourselves if we believe that psychiatry’s current popular delusions—such as the chemical causes and cures of depression, schizophrenia, suicide, and so forth—do not fit the same mold.