Punishment or therapy. Patients, doctors, and somatic remedies in the early twentieth century

Although it has been argued that psychiatrists entered the modern era with the introduction of shock therapies and lobotomy in the 1930s and antipsychotic drugs in the 1950s, practicing psychiatrists of the 1910s and 1920s did not feel they were in the dark ages of therapeutics. These early twentieth-century psychiatrists had a variety of somatic remedies at their disposal. For example, they had a plethora of sedatives and hypnotic agents from which to choose, although these drugs too often produced troublesome side effects, and, from the point of view of these physicians, too closely resembled physical restraint in their effects on the patient. As we saw, physical restraint had a sullied reputation, psychiatrists believing it, at best, to be a necessary evil and not part of a therapeutic regimen. This did not mean psychiatrists felt helpless in treating insanity for they firmly believed that, unlike drugs and physical restraint, hydrotherapy acted therapeutically. Our examination of every-day treatment practices at Stockton and Patton state hospitals revealed that physicians found hydrotherapy to be a useful remedy on nearly all patients irrespective of diagnosis. The Agnews' investigation allowed us to examine the basic assumptions underpinning early twentieth-century therapeutics, and two major conclusions can be gleaned from this examination. First, how doctors perceive disease is inseparably linked to how they treat disease. In the case of hydrotherapy, physicians believed it effectively controlled their patients' behavior. To assert that it had therapeutic value and to differentiate it from mechanical restraint, however physicians transformed how they saw disease and therapy such that wrapping and bathing the "excited" and "frenzied" patients were therapeutic. Rather than seeing disruptive behavior as simply something in need of physical restraint, hydrotherapy allowed physicians to see these behaviors as the essence of disease and the primary object of their therapeutic ministrations. Second, patients' conceptions of disease and therapy may differ markedly from their physicians, which may be particularly true when disease is defined by visible behavior. At Agnews, patients spoke a different language than their physicians such that restraint differed little from therapy. In contrast to their doctors, patients were unable to see their behavior as necessarily pathologic, and, thus, were unable to recognize and to speak of the difference between mechanical restraint and hydrotherapy; both kinds of technologies simply restricted their bodily movements. With a different therapeutic practice such as malaria fever therapy, doctors and patients saw disease and its treatment in a new light.(ABSTRACT TRUNCATED AT 400 WORDS)