Literature Review and Historical Assessment
The story of Henry Cotton has become a cautionary tale for modern psychiatry. The man, methods and mentors have been implicated in the exploration of how this situation was able to spiral as it did.
Scull (1987)highlights the dismal state of psychiatry during Cotton’s time. Improvements in medical training, the triumph of Germ Theory and the ‘Bacteriological Revolution’ had increased social and professional standings of medicine. Psychiatry failed to see noteworthy advances, with over-crowded hospitals and neglected institutional facilities.
At Trenton, Cotton removed patient restraints, reorganised wards, retrained staff and introduced patient aftercare (Scull, 1987). Freckelton (2005) notes this demonstrated Cotton’s humanitarian nature and desire to improve conditions. Cotton’s aim was to have psychiatry respected as a medical speciality.
Cotton believed biological causes explained mental diseases. This informed his focal infection theory which concentrated on removal of body parts he believed would be prone to infection, including teeth, tonsils and intestines (Scull, 1987). Brown (2006) notes Scull fails to describe that contextually biological hypotheses were common explanations for numerous conditions at the time.
The extreme measures were overwhelmingly supported by the psychiatric community. Cotton publicised his work, with Scull commenting this would bring “a measure of fame he had long coveted”, emphasising his belief that Cotton aimed for individualistic gain rather than psychiatric benefit (Scull, 1987, p. 563). Scull (1987)presents this as a character flaw, with his enthusiasm seen as arrogance and self-importance. Fellow psychiatrists were disturbed by Cotton publicising his findings more than the poor outcomes of procedures (Hudson-Jones, 2005).
Cotton pushed boundaries with his work by taking radical approaches and acting without consent (Scull, 1987). Poor survival rates raised concerns about his methods. Greenacre was appointed to investigate Cotton’s work and found favourable statistical support for focal infection had been over-estimated. Interviews with ‘cured’ patients found treatments had failed (Scull, 1987).
During a trial into mismanagement of hospital funds, Cotton’s health declined. In the years following, Cotton’s he remained ill, but continued his work at Trenton until his death in 1933(Scull, 1987). Adolf Meyer’s obituary recognised the controversial nature of Cotton’s work, but emphasised the tragedy that he died before research was completed (Meyer, 1934). Meyer referred to Cotton as “one of the most stimulating figures of our generation” and noted the transformation of the hospital as a “remarkable achievement of human spirit” (Meyer, 1934, p.923). Brown (2006) states Cotton was admired by many, with his methods imitated and his treatments sought by prominent individuals.
Brown (2006) emphasises Cotton is treated as a scapegoat, representing the problems of psychiatry. Cotton was not a sadistic monster, rather his actions were for the benefit of patients (Freeman, 2005). In this desire to help, facts incongruent with his ideas were rationalised or ignored to support the message (Freeman, 2005). Cotton’s unsuccessful results ensure he is remembered as a monster and not a medical revolutionist (Almeida, 2008; Freeman, 2005). Questioning of Cotton’s work was not taken seriously enough by his colleagues and no interventions were taken to stop him (Prior, 2006). He was representative of the dominant thoughts of the time rather than an individual acting alone (Freckelton, 2005).
Freckelton (2005) suggests Scull uses Cotton to portray his own message that medicine cannot always function ethically. In allowing professionals to self-police individual patients can be sacrificed in favour of larger outcomes. Prior (2006)argues, similar abuses of power could potentially occur if professionals hold the majority of power in treatment.
Numerous arguments can be made to support or shame the work of Cotton and his respective place in history. Scull presents Cotton as an anti-hero, who through his unchecked ambitions brought about a dark period in psychiatric treatment. Regardless, his life and work provide an exemplar for modern psychiatry to model the importance of ethical decision-making.
Scull (1987)highlights the dismal state of psychiatry during Cotton’s time. Improvements in medical training, the triumph of Germ Theory and the ‘Bacteriological Revolution’ had increased social and professional standings of medicine. Psychiatry failed to see noteworthy advances, with over-crowded hospitals and neglected institutional facilities.
At Trenton, Cotton removed patient restraints, reorganised wards, retrained staff and introduced patient aftercare (Scull, 1987). Freckelton (2005) notes this demonstrated Cotton’s humanitarian nature and desire to improve conditions. Cotton’s aim was to have psychiatry respected as a medical speciality.
Cotton believed biological causes explained mental diseases. This informed his focal infection theory which concentrated on removal of body parts he believed would be prone to infection, including teeth, tonsils and intestines (Scull, 1987). Brown (2006) notes Scull fails to describe that contextually biological hypotheses were common explanations for numerous conditions at the time.
The extreme measures were overwhelmingly supported by the psychiatric community. Cotton publicised his work, with Scull commenting this would bring “a measure of fame he had long coveted”, emphasising his belief that Cotton aimed for individualistic gain rather than psychiatric benefit (Scull, 1987, p. 563). Scull (1987)presents this as a character flaw, with his enthusiasm seen as arrogance and self-importance. Fellow psychiatrists were disturbed by Cotton publicising his findings more than the poor outcomes of procedures (Hudson-Jones, 2005).
Cotton pushed boundaries with his work by taking radical approaches and acting without consent (Scull, 1987). Poor survival rates raised concerns about his methods. Greenacre was appointed to investigate Cotton’s work and found favourable statistical support for focal infection had been over-estimated. Interviews with ‘cured’ patients found treatments had failed (Scull, 1987).
During a trial into mismanagement of hospital funds, Cotton’s health declined. In the years following, Cotton’s he remained ill, but continued his work at Trenton until his death in 1933(Scull, 1987). Adolf Meyer’s obituary recognised the controversial nature of Cotton’s work, but emphasised the tragedy that he died before research was completed (Meyer, 1934). Meyer referred to Cotton as “one of the most stimulating figures of our generation” and noted the transformation of the hospital as a “remarkable achievement of human spirit” (Meyer, 1934, p.923). Brown (2006) states Cotton was admired by many, with his methods imitated and his treatments sought by prominent individuals.
Brown (2006) emphasises Cotton is treated as a scapegoat, representing the problems of psychiatry. Cotton was not a sadistic monster, rather his actions were for the benefit of patients (Freeman, 2005). In this desire to help, facts incongruent with his ideas were rationalised or ignored to support the message (Freeman, 2005). Cotton’s unsuccessful results ensure he is remembered as a monster and not a medical revolutionist (Almeida, 2008; Freeman, 2005). Questioning of Cotton’s work was not taken seriously enough by his colleagues and no interventions were taken to stop him (Prior, 2006). He was representative of the dominant thoughts of the time rather than an individual acting alone (Freckelton, 2005).
Freckelton (2005) suggests Scull uses Cotton to portray his own message that medicine cannot always function ethically. In allowing professionals to self-police individual patients can be sacrificed in favour of larger outcomes. Prior (2006)argues, similar abuses of power could potentially occur if professionals hold the majority of power in treatment.
Numerous arguments can be made to support or shame the work of Cotton and his respective place in history. Scull presents Cotton as an anti-hero, who through his unchecked ambitions brought about a dark period in psychiatric treatment. Regardless, his life and work provide an exemplar for modern psychiatry to model the importance of ethical decision-making.