Malpractice in Treating Mental Illness

 Content Notes: mental illness, psychosis, suicide, medical malpractice. 

As discussed in my previous post, “Exploring Many Minds,” author Virginia Woolf had her share of first-hand experience with mental illness. Her struggles with suicide, bipolar disorder, and psychosis are relatively well-documented through her journals and writing. In Mrs. Dalloway, many of the characters seem directly inspired by Woolf’s experiences, particularly in terms of mental health.

Something that is still an issue for many people today who are struggling with mental health is the worrying risk of having a bad experience with a doctor, psychiatrist, social worker, or therapist. These people who offer help do generally want to provide genuine and kind support or treatment, but sometimes malpractice or abuse occurs. This can be extremely damaging, especially to vulnerable people in a state of mental or emotional crisis. Speaking from a personal perspective, I feel very lucky to have received only kindness and positive support in my treatment and recovery when I consider the number of people I know or love who have experienced abuse and trauma at the hands of medical professionals due to their mental health. 

For someone who is in such a vulnerable state and is finally seeking or receiving help, abuse from those who are supposed to be treating the issue can have devastating effects. Whether this is emotional abuse, sexual abuse, or simply a harmful mindset formed by a misguided therapist, the harm incurred by malpractice in mental health treatment can be extremely damaging.

Medical malpractice seems to be a key feature of early psychiatry, in part because of the principles most doctors and psychiatrists applied in their treatment plans; which usually included rest, isolation, sleep, and total abstinence from excitement or activity. Some of these aspects of treatment may apply to certain physical injuries or illnesses, but, as even the general public knows today, are entirely counterproductive to the treatment of more common disorders like generalized anxiety and unipolar depression. Some of the most important and most accessible non-chemical treatments for anxiety and depression are forming positive attachments (spending time with loved ones or pets, socializing, etc.), exercise, and other mental stimulation, like listening to happy music or watching a funny movie. According to the National Institute of Mental Health, treatment for people struggling with depression should include, sometimes alongside psychotherapy and medication, “[being] active and exercise... [spending] time with other people and [confiding] in a trusted friend or relative” (“Depression”). Hypersomnia is often a symptom of depression—alongside a complaint of sad mood and/or a decreased interest in pleasurable things, insomnia or hypersomnia are considered one of the nine other diagnostic symptoms (Dauvilliers et al.). Prescribing a depressed person sleep and isolation actually feeds the lack of dopamine/serotonin and likely as well the negative self-talk that person might be caught up in. A treatment plan based on sleep and isolation only increases the prevalence of fatigue or hypersomnia in the disordered patient. Psychiatrists of the early 20th century likely reasoned that a person expressing fatigue, an inclination to sleep, and a sad or lethargic mood is expressing a need for rest. A prescription of sleep and isolation has predominately negative effects, seen in 19th-20th century literature like the short story “The Yellow Wallpaper,” by Charlotte Perkins Gilman, in which a woman suffering from post-partum depression goes into psychosis while isolated for her depressed mood (Gilman).

Woolf criticizes this treatment theory and the tendency towards egotism of many doctors in her time in Mrs. Dalloway. I imagine she drew inspiration for these unlikeable characters from her own experiences with misguided and misogynistic psychiatrists and doctors. Sir William, Septimus Smith’s second doctor, seems an improvement upon his previous doctor, Dr. Holmes. However, through Woolf’s third-person omniscient/stream of consciousness style, our view into Sir William's thoughts reveals that he is far more narcissistic and egotistical than he first appears to us. 

First, with a helping of Woolf’s dark humor, Sir William pompously states that a doctor must “invoke proportion,” a term which he equates with health, otherwise “as a doctor he fails”—after stating that his exacting science of proportion has everything to do with what “we know nothing about—the nervous system, the human brain” (Woolf 99). Sir William, of course, does not claim to know nothing about the human brain (while he positions himself as an all-knowing authority on the subject) as a presentation of humility, but rather as a stylistic choice to indicate the entire irony of the situation. Septimus, as discussed in my previous post, is a mortally ill man, who suffers, most likely, from psychotic depression and suicidal ideation. He and his wife Lucrezia are seeking help for his condition and are met with this egotistical, self-absorbed idiot who is more focused on his ego and the literal time he spends on each appointment with a patient—“three-quarters of an hour”—than on the actual science of the brain (Woolf 99). The time we spend inside Sir William’s thoughts are nearly illegible because they are filled with proclamations of “divine proportion,” of which his exact definition is never made clear, and overwrought language like “[the] purlieus of London,” “prophetic Christs and Christesses,” and “penitentially disguised” (Woolf 99-100). Sir William makes it clear that his main wishes are for “his colleagues [to] respect him, his subordinates [to] fear him... [and] the friends and relations of his patients [to feel] for him the keenest gratitude for insisting that these [patients] should drink milk in bed” (Woolf 99). He belittles the pain of his patients in psychosis, establishing that his method of “[invoking] proportion” is a cure-all for his silly little patients who may come in claiming “[to be] Christ” and that they have “a message, as they mostly have,” and “[threaten], as they often do, to kill himself” (Woolf 99). Sir William's genius treatment plan for this psychosis involves “rest in solitude; silence and rest; rest without friends; without books, without messages; six months’ rest” and weight gain (Woolf 99). He considers his patients’ suffering banal and commonplace, and “treats” the disorder only by worsening it. Woolf's repetition of "rest" throughout Sir's William's internal, self-aggrandizing monologue indicates her frustration with rest as a treatment plan. Instead of compassionate, effective treatment, depressed people were met with a recipe for more depression, while simultaneously being totally invalidated by their doctors. Again, speaking on a personal level, my own mental health treatment generally involved the opposite of rest—I was prescribed, among other things, to socialize, exercise, and practice good sleep hygiene, which was to include only a balanced number of hours of sleep. Even with the most empathetic, intelligent, and proactive care, my recovery was still a very long and difficult process. I can hardly imagine what it would be like to attempt recovery with such uneducated and uncompassionate doctors.

Sir William's own wife, Lady Bradshaw, suffers because of him. An intelligent medical practitioner in her own right, Lady Bradshaw becomes stifled under Sir William’s overbearing presence. Whereas “she once caught salmon freely,” now “she cramped... quick to minister to the craving which lit her husband’s eyes so oilily for dominion, for power” (Woolf 101). She is metaphorically reduced to hanging “in ostrich feathers... over the mantelpiece” (Woolf 101). The universe apparently revolves around Sir William to such a degree that even his wife is crushed by his gravity. When Sir William’s patients want to kill themselves, and ask “Why live?” Sir William indignantly replies that “life [is] good” (Woolf 101). Instead of pointing towards something that Clarissa Dalloway might, like some of life’s precious moments that can be appreciated by anyone, Sir William uses his figurehead wife “above the mantelpiece” and his income, which is “quite twelve thousand [pounds] a year” as examples, so wrapped up in his own world is he (Woolf 101). Lucrezia Smith, Septimus’ wife, identifies that Sir William is not a good man, becoming succinctly aware that he “offers help, but desires power” (Woolf 100). 

Additionally, Sir William brings his insufferable superiority complex to his medical practice, stating that he is “master of his own actions,” while “the patient [is] not” (Woolf 101). When his patients break down or sob, they, according to Sir William, are “weak” and “submitting” (Woolf 101). Sir William believes that he is morally superior due to the fact that he doesn’t experience mental illness or show his emotions. He is indignant to any kind of combative behavior and is offended and shocked if his patients dare insult him or call him, “to his face,” of all things, “a damnable humbug” (Woolf 101). He calls his patients' disordered behavior “transgressions” and is of the opinion that only through his ministrations do they learn the “extent” of these “transgressions” (Woolf 101). He labels their suicidal actions or ideation “impious” (Woolf 101). His belittling and constant invalidation of his patients does far more harm than good. In every sense are Sir William’s ideas and perceptions the totally wrong way to go about psychiatry. 

I imagine that Sir William’s repugnant characterization is inspired by the treatment Virginia Woolf experienced, including when she was institutionalized, for her mental illness. Sir William serves as a critique of the psychiatry of the time as a whole and perhaps as a way for Woolf to vent her frustration with this lacking mental health support.

Works Cited

Dauvilliers, Yves, et al. “Hypersomnia and Depressive Symptoms.” BMC Medicine, vol. 1, no. 2013, 2013, pp. 11-78. US National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621400/. Accessed 9 3 2021.

“Depression.” Mental Health Information, National Institute of Mental Health, https://www.nimh.nih.gov/health/topics/depression/index.shtml. Accessed 9 3 2021.

Gilman, Charlotte Perkins. The Yellow Wallpaper. The New England Magazine, 1892. US National Library of Medicine, https://www.nlm.nih.gov/exhibition/theliteratureofprescription/exhibitionAssets/digitalDocs/The-Yellow-Wall-Paper.pdf. Accessed 9 3 2021.

Woolf, Virginia. Mrs. Dalloway. Harcourt, 1925.