4 ideas
A 1920s investigation by Phyllis Greenacre found the claims unsupported and colectomy deaths approaching a third of cases, but the findings were suppressed and Cotton was celebrated in his lifetime. The case shows how a plausible biological theory, professional authority and patients with no power to refuse can sustain a lethal therapy for years.
Early nineteenth-century 'moral treatment', typified by the Tukes' York Retreat, promised that kind, orderly surroundings could cure the insane, and that promise justified building large public asylums. The asylums then filled with chronic, incurable patients who never left, and overcrowding destroyed the conditions moral treatment required. Psychiatry explained the failure with hereditary degeneration theory, which blamed the patients rather than the institution and recast asylums as places to store people, not to heal them.
The emptying of mental hospitals is usually credited to chlorpromazine and later antipsychotics, but the steepest declines came in the 1960s and 1970s. Discharge was therefore driven largely by cost-shifting, and many patients went to nursing homes, cheap boarding houses, the streets or jails rather than to real community care.
Across history, madness has been read as divine punishment, demonic possession, humoral imbalance, weak nerves, bad heredity and brain chemistry. Each explanation shaped who was classed as mad and how they were treated. Because no reliable biological marker has ever settled what madness is, its meaning and treatment are set by religion, art, literature, institutions and professional interests as much as by science. Viewing it this way turns each era's confident diagnosis into evidence about that culture.