Open Wide

Hey, True Weirdos, thank you so much for all your support. Because of your support, we were able to win some awards with this podcast in the past year. And be sure to stick around for the conversation we have after the episode. It was in 1907, Dr. Henry A. Cotton of Danvers, Massachusetts, Hospital for the Insane, will undoubtedly be selected this afternoon as Medical Director of the New Jersey State Hospital for the Insane at Trenton.

It was a big opportunity, something Henry Cotton could really sink his teeth into. And Dr. Cotton was obsessed with teeth, which you'd expect in a dentist, except Dr. Cotton was a psychiatrist. The most serious result of infected teeth is to be found in the relation of this infection to nervous and mental conditions. We have considered mental diseases as something apart from general diseases, where such things as worry, grief, fear, overwork, and many other elements are usually given as the cause of the disease of the mind.

Was Dr. Cotton right? Could mental illness be caused by infected teeth? And does that mean he could cure the insane just by yanking out all of their teeth? Psychosis isn't a disease, it's a symptom. Open wide. And they got a small beam of light again. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow. Wow.

Wow. Wow. Wow. True. Stuff. The New Jersey State Hospital for the Insane today goes by the name Trenton Psychiatric Hospital. For a time, it was called the New Jersey Lunatic Asylum, the first public mental hospital in the state. It was founded in May, 1848, by that legendary advocate for mental health care reform, Dorothea Dix.

We spent a few hours, very agreeably, yesterday at the New Jersey Lunatic Asylum, an institution which may be regarded as the brightest evidence of the humanity and liberality of the people of New Jersey. Dr. Cotton's work would dim that brightness and challenge the idea of humanity in such a place. The first thing that strikes the visitor upon entering the building is the remarkable cleanliness of every department and the taste and good order displayed in the arrangement of furniture from the reception rooms to the kitchen.

The hospital had been designed according to something called the Kirkbride Plan, the vision of an American psychiatrist from Philadelphia named Dr. Thomas Kirkbride, who believed that the environment in which a patient was treated had a profound impact on their recovery. And this sounds like common sense, right? But it was kind of radical for the time.

Kirkbride hospitals were designed to allow plentiful natural light and fresh air to circulate Dr. Kirkbride's approach to treatment was based on a philosophy of moral care. Patients would be given privacy and made comfortable. Their emotional and social needs would be considered. Dignity would promote healing. And this also sounds like common sense.

But the way human beings and mental institutions were actually treated back then could be utterly barbaric. Patients might be shackled, kept in straight jackets, plunged into icy baths or wrapped for hours in cold, wet sheets. These weren't punishments. These were therapies. Kirkbride was appalled. His approach to care was very much shaped by his faith.

Born into a family of Orthodox Quakers, Kirkbride believed in treating the insane with compassion and dignity. Patients respond to greater freedom with better behavior. Persons suffering from insanity are not disabled from appreciating books or enjoying many intellectual and physical comforts. Kirkbride thought that mental illness was a common thing, with at least one out of every 500 persons being insane, which seems like a lot of insane folks wandering around.

But then, you have to factor in just how insanity was defined in those days. Grief, ill health, intemperance, and anxiety are the most common reasons patients are admitted. And of course, there is also religious excitement, tobacco use, prolonged lactation, metaphysical speculation, nostalgia, and exposure to the sun's direct rays.

Given that criteria, how many of us might have found ourselves in an institution? The New Jersey Lunatic Asylum, as it was called when it first opened in 1848, was built to embody Kirkbride's Age of Enlightenment, Quaker beliefs in the power of nature and beauty and science to come together to heal the broken-minded. This was no dreary snake pit.

This was a haven, a refuge, a place of dignity for those who had no other place to go. And best of all, because ever since humanity came down from the trees, there's always been that one guy hollering, yeah, that's nice, but how you gonna pay for it? You got treating the mentally ill like human beings' money? Kirkbride had done the math.

The cost to society of effective hospital treatment is not, on the average, one-tenth of what it is to support a chronic, uncured case for life. This is as true today, by the way, as it was almost 200 years ago. We spend a fortune denying and restricting care on the pretext of saving money. Close to two dozen studies have found that we could save literally trillions of dollars with single-payer Medicare for All over our current system of for-profit healthcare privateers.

So why don't we? Because we are the children of, say it with me, Max, the Puritans. Some of the most hard-hearted humans ever to dress up hate as faith. And the Puritans believed that poor health, and especially poor mental health, was a moral failing, a character failing, and that the sick deserve their suffering. We've added a few new ingredients to that nasty brew over the centuries, like racism and bigotry.

But at the end of the day, we're still running the show like Miles and Prudence, play-acting virtue, doling out judgment, blaming God's will when things inevitably go wrong. Anyway, y'all already know how we feel about the Puritans around here. Dr. Henry Aloysius Cotton was no Puritan. He was a man of science. And that was huge, given that the words science and psychiatry were almost never even heard in the same sentence at that time.

Doctors working in asylums were said to be so overwhelmed by the day-to-day management of their patients that there was no time or inclination to study or treat these people. As the neurologist Dr. Edward Spitzka put it, Asylum superintendents are experts at everything but the diagnosis, pathology, and treatment of insanity.

Dr. Cotton was born in 1876 in Norfolk, Virginia. He studied medicine at Johns Hopkins. He'd worked under the renowned Swiss neuropsychiatrist Adolf Meyer and had growing recommendations from his bosses in Massachusetts. Trenton was in a hurry to make a hire. Since the current head of the New Jersey Lunatic Asylum, Dr. John Wesley Ward was facing more than a little controversy.

Example, Ward acknowledged that he and his team had been a little lax about the whole typhoid epidemic that erupted at the hospital in 1907. Yes, it was unfortunately true that the hospital had dumped typhoid-infected fecal matter into the Delaware River, aka the city's water supply. Uh-oh. There was the matter of the hospital's dairy, a literal cow sh** show that was utterly filthy, sorry, couldn't resist, and selling contaminated dairy products to the public.

Oopsies. And since he was speaking under oath, Ward had no choice but to also admit there had been more than a few patient beatings and possibly some murder. Yikes. Ward had to go, and fast. There was even talk of indicting him for covering up at least one murder. And here was Dr. Henry Cotton, a man driven by science, a man who said he had no interest in overseeing the business affairs of a hospital.

His passion was caring for patients. It didn't hurt that Dr. Cotton had spent summers as a child with a family member in Princeton. The board was like, well, he'll stay out of our hair and he's kind of a Jersey dude, right? Summer's here and all that. Plus, would you look at those fancy references? Cotton was hired. The institution he took over had been under Dr. Ward's mostly indifferent care for three decades.

The hospital's population had swelled during that time to nearly 1,300 patients. Tainted creatures, as Ward called them, degenerate and biologically inferior. He mostly ignored them, spending his time and energy collecting seashells and art prints. Cotton, though, was a different sort of psychiatrist, a protege of Adolf Meyer, one of the most influential psychiatrists of the early 20th century.

Cotton would bring scientific, laboratory-based principles to the stubborn and baffling problem of madness. Mental illness was a disease and ought to be approached, thought Cotton, in the same way. It was the meeting of biology and psychiatry. With the help of his mentor, Adolf Meyer, Cotton even managed to wrangle a year's study in Munich with three of the most famous figures in neuropathology.

Psychiatrist Emil Kreplin, neuropathologist Alois Alzheimer, yes, he discovered the disease, and Franz Nissel, psychiatrist and neurologist. It just can't be overstated just how dramatically these three individuals changed how we understand the human brain. Kreplin established that psychosis had multiple forms, each with their own characteristics and potential outcomes.

Nissel and Alzheimer pioneered the use of the microscope to study the brain. Again, this seems painfully obvious to us, but it was revolutionary then. Dr. Cotton rolled into Trenton on a wave of public enthusiasm. The local papers had been running giddy stories about his career and his credentials. Look, said the Times.

Hospital treatment of the acute insane and non-restraint is the stand taken by Dr. Cotton. He has written the cytological study of the cerebrospinal fluid in mental disease and a care of unilateral mono-radicular regeneration of the posterior roots of the cord and general paralysis. Now, what the people of Trenton made of that as they read their morning newspaper, who can say?

All they knew was that Cotton would run things very differently from Dr. Ward, and that felt like progress. It felt like the future. Cotton was horrified by what he found waiting for him at the New Jersey State Hospital for the Insane. He told his mentor, Dr. Adolf Meyer, Such a deplorable condition of affairs one could not believe could exist in an insane hospital today.

Because while Dr. Ward was busy buffing his seashells, hospital attendants were brutalizing patients. A whole subculture of violence right out in the open. Patients by the hundred had been restrained for years and no one even knew why. Imagine spending even a week in a straitjacket or lashed to a bed by thick leather straps.

Now, think about living like that for years. The whole place had the atmosphere of a prison where, in the words of the Philadelphia neurologist, Wire Mitchell, In the sadness of the wards, the insane who have lost even the memory of hope sit in rows too dull to no despair, watched by attendants, silent, gruesome machines which eat and sleep, sleep and eat.

Cotton wasn't having it. In his first two months, he confiscated more than 700 pieces of restraint gear from the various wards and had it boxed up for the hospital's museum. He put a program in place to retrain attendants and ultimately turned that into a full training program for psychiatric nursing. Occupational training was introduced, and this was intended to keep patients from just sitting.

These reforms were needed and appreciated, but what Cotton was really after was much loftier change. He meant to apply all of the resources of modern medicine to finally wipe out the scourge of madness. His heroes were brilliant minds like Louis Pasteur. Look what he accomplished when it came to the incurable. Why shouldn't Cotton's work be every bit as transformative?

Cotton encouraged his staff to attend professional conferences, to continue their educations, to undertake their own original research. He invited outside physicians to consult on cases. He changed the way case histories were taken. Cotton required more depth and detail than staff had been gathering. He hired stenographers to document patients who were raving in the grip of psychosis.

He hired full-time social workers. Conditions at Trenton improved. The lives of patients improved in meaningful ways. But therapeutic gains? Those were harder to measure. Dr. Cotton was frustrated. Unlike most of his colleagues, Cotton would not accept that all mental illness was a problem of heredity. Conventional wisdom held that madness, like character, was carried in the blood.

Cotton thought that was far too simplistic. He'd honed his ideas in the many hours he'd spent in the lab working on the problem of paresis. Paresis is a paralytic disorder, and it was the diagnosis assigned to as many as one in five male asylum patients. The symptoms were psychiatric, neurological, and physiological. There was the paralysis, of course, from one limb to all four, along with disordered speech and gait, grandiosity, mania, depression, restlessness, excitability, sudden violence, all progressing relentlessly and remorselessly toward dementia.

Some doctors began to suspect that paresis was actually the terminal stage of syphilis, and then that hypothesis was confirmed. The corkscrew-shaped spirochete bacteria that was syphilis caused lesions on the brain, and it was those lesions that caused paresis. A rebuke to psychiatrists who so easily embraced hereditarian accounts of insanity.

Cotton was convinced that if this microbe caused madness, surely there were others just waiting to be discovered. These were the early days of germ theory. Just how many chronic conditions might be caused by toxic bacteria hitchhiking through the bloodstream or squatting in the lymph nodes. Cotton was hugely influenced by Dr. Frank Billings, former dean of medicine at the University of Chicago, the former president of the American Medical Association, and a man as focused on focal sepsis as any human could be.

Focal sepsis, in simple terms, basically means a localized and general infection in one part of the body that leads to other systemic issues like arthritis or kidney disease. The most common focal infections involved teeth, gums, tonsils, sinuses, gallbladder, and the appendix. Billings hit the lecture circuit. His warnings about the danger of these hidden lurking pockets of bacteria were near apocalyptic.

You must be sure that all sources of focal infection are eliminated. The existence of focal infection of the jaws, without the manifestation of much discomfort, is remarkable, often not discovered by inspection, and escapes the attention of the physician and the dentist. Properly made x-ray films of the jaws will enable one to recognize the real morbid and anatomical condition.

Dr. Billings advised the most ruthless possible approach to dealing with a focal infection. Deplorable as the loss of teeth may be, that misfortune is justified if it is necessary to obliterate the infectious tooth, which is a menace to the general health. There was another cesspool of infection lurking in the body, according to Billings.

Tonsil or tissue in children and in some adults is a cultural medium of pathogenic material, a constant source of danger, as a portal of entry of infectious bacteria through the lymph and bloodstream to tissues of the body. Infected tonsils cannot be sterilized. Entire removal is the only safe procedure. Cotton was taking notes.

Teeth, tonsils, anything else? The digestive tract should have proper medical management, or if necessary, surgical treatment, and the acute focal and chronic infections of the pelvic organs of women should be rationally managed and surgically treated when necessary to safeguard health and life. Dr. Henry Cotton was all in.

In his 1916 report to the Hospital Board of Trustees, he acknowledged that the first 50 patients who'd undergone tooth extraction, as in all of their teeth being pulled, they showed disappointing results. But then Cotton began taking tonsils with teeth, and those results killed him. The cure of insanity by extracting diseased teeth, removing infected tonsils, and clearing the gastrointestinal tract was announced here today by Dr. Henry A. Cotton.

The report gives the results of 11 years experimentation on a number of deranged patients. 11 years of experiments. It's pretty clear that there was no secrecy about what Dr. Cotton was up to. He traveled and gave lectures. He published in journals. He welcomed visitors from all over the world who were curious about his work.

Sometimes with a story like this, we tell ourselves, well, no one knew or they would have stopped it. Someone would have done the right thing and at least tried to intervene, right? The truth is, people did know, and they were fine with it. After all, these patients were defectives. Their lives were wretched and limited, and didn't they owe a debt to society for all the care they'd received?

Shouldn't they be grateful that Dr. Cotton was working so hard to help them? Cotton states that recoveries are not only speedy under the new treatment, but that sanity has been restored to some who have been in the hospital for as long as nine years. Dr. Cotton warned the public that infected teeth were caused not just by neglect, but also by dental work and promiscuous kissing.

The psychiatrist had somehow become both an authority on dentistry and its loudest enemy. Infected teeth may not and often do not cause any symptoms which would lead one to believe that anything is wrong with his teeth. Hence, there's no symptoms which direct the patient's attention to this condition, and often they're amazed when they're told that they must have a certain number of teeth extracted if they wish to recover from their particular illness.

In fairness, penicillin wouldn't be discovered for another eight years, so the whole idea of taking an antibiotic for an infection was still science fiction. Though there was an arsenic-based synthetic antibiotic released in 1910 called salversan for the treatment of syphilis, which apparently was a real plague for our ancestors.

So it's not like Cotton was yanking people's teeth instead of giving them amoxicillin, but he was yanking people's teeth knowing full well that it wasn't curing their madness, no matter what he told the hospital's board or the press. In June 1920, Cotton reported that technicians at his hospital had taken 4,201 x-rays over the past 12 months and that the Department of Dentistry had performed 4,317 tooth extractions.

That number climbed in 1921 to 6,472 tooth extractions, 10 teeth per admission. Cotton pointed to neglect to account for why so many teeth had to go, but he also blamed dentistry. Sure, crowns and root canals preserved the teeth, but at what cost? We want to emphasize our view, shared by many progressive medical men, that modern dentistry is a serious menace to the whole country.

Um, what? Pandering to their patient's vanity, dentists cover up reservoirs of infection with wonderful cosmetic work, leaving germs behind to wreak havoc. Indirectly, these efforts wreak incalculable damage by producing serious systematic disease, eventually leading to death or a condition worse than death, a life of mental darkness.

This was the man running the New Jersey Hospital for the Insane. Unhealthy is the tooth that wears a crown. For a man who could not stop talking about infected chompers, Cotton resented his reputation as a man fixated on bad teeth as the sole cause of insanity. There was more to his practice than teeth. I found it necessary to extract the tonsils of 337 of the 699 patients admitted between June 18th and June 1919.

The following year, the number of tonsillectomies performed increased to 542. But for all the teeth and tonsils that wound up in the trash at Trenton, Dr. Cotton was frustrated by the lack of what he called marvelous results. And then inspiration struck. The oral surgeries had failed to cure insanity because the infection had clearly already spread through the bloodstream or lymph system.

In some cases, they theorized the patient had swallowed their own bacteria-laced saliva. Now the problem was one of surgical bacteriology. Cotton focused first on the stomach. Starting in 1918, he determined that 451 of the 934 patients in his care were harboring infections in the stomach. Partnering with nearby Squibb Laboratories, Cotton tried vaccinating 277 of them with their own bacterial flora.

When that failed to produce a miracle cure, Cotton decided to explore a more extreme program. He partnered with prominent abdominal surgeon Dr. J.W. Draper. And by June 1919, they had performed 57 experimental surgeries, resulting in the death of seven patients. Their first case was Florence B. She'd been admitted in February 1916.

Reason? Hysterical spell. Florence married a man her mother disliked and soon became pregnant. Then her mother suddenly died, and Florence became so anxious and depressed that she attempted suicide. The decision was made by Dr. Cotton to treat Florence with a surgical resection of her colon. Unfortunately, her condition was so bad and her heart so weak that she did not survive.

Although she lived a week. It served to confirm my opinion, however, that her trouble was largely in the intestinal tract. Over the next year, 238 surgeries were performed and as a result of what Cotton called this courageous work. Many psychopathic patients in the state hospital are thus in reality proven to be chronic intestinal invalids in whom the psychic phenomena were purely secondary to extensive disease in a congenitally misshapen and deformed bowel.

Cotton went to town on colon resections, even though the success rate was mixed at best. Between 1919 and 1920, out of 79 procedures, 21 patients recovered, 23 died. Cotton was quick to his own defense. The cases which have died have been those of longstanding mental disease. Dr. Cotton spoke with great optimism and enthusiasm, but the results told a very different story.

In 1922, he presented a paper to the American Psychiatric Association that covered 250 colon operations. 25% of patients recovered, 21% of patients improved, 30% had died. A death rate like this draws negative attention and Cotton was ready with an answer. Increased mortality among the insane reflects the much lower vitality of those suffering mental pathologies.

Psychotic patients are not good surgical risks. Given that, why subject them to the trauma of surgery? Which brings up the whole question of consent. Can a person in psychosis comprehend what it is they're consenting to? There were patients who refused surgery and families of patients who refused surgery. There were reports of patients violently resisting as they were strapped onto gurneys.

You know what? They had surgery anyway. Doctor's orders. If we wish to eradicate focal infections, we must bear in mind that it is only by being persistent, often against the wishes of the patient, that we can expect our efforts to be successful. So here we have a population of highly vulnerable people being subjected to medical experimentation at the hands of a charismatic doctor whose work brought both attention and money to the institution.

See the problem? Because now psychiatrists all over the country were being besieged by requests for the cotton cure. For centuries, for almost all of human history, madness was a mystery, a condition that brought shame and stigma. The idea that madness might just be another physical affliction, that hallucinations, delusions, ravings, and despair might be nothing more than the symptoms of a bacteria-infected brain?

You can see why people were desperate to believe that what Dr. Cotton was doing was an example of modern medical science in action. Something that was probably a major factor in the state of New Jersey looking the other way while Cotton experimented on these patients was the fact that the wealthy were streaming to Trenton offering to pay for the very surgeries that the state was doling out for free.

Madness is an equal opportunity affliction, but no affluent person would consent to being admitted to a state hospital. People with means paid for private home care for their mentally ill loved ones, and there was also an entire network of private sanitariums designed to soothe the fractured minds of the rich. Now the dollars were coming to Trenton.

So much so, Cotton was able to build a thriving practice on the side. It's not hard to see how that kind of revenue was a powerful incentive for hospital administrators to keep an open mind about Cotton's theories. On the surface, it seemed that Cotton had the full support of the entire medical establishment, but there were detractors.

William White, the superintendent of the Federal Mental Hospital in Washington, D.C. said, My opinion is that the emphasis that has been laid upon infected teeth is a most unfortunate one. Not everybody who is mentally ill ought to have all their teeth pulled. I would hesitate a long time before I would subject an individual to the serious disfigurement of having all of her teeth pulled or to the dangers of a surgical operation involving a removal of the considerable portion of the intestinal tract.

Dr. Cotton's mentor, the esteemed Adolf Meyer, also had doubts, but continued to support his protege publicly. Cotton, worried that his detractors might come for him in a bigger way, turned to Meyer because Meyer's formal blessing would surely put an end to any controversy. That was Cotton's thought. So Meyer sent another of his mentees, Dr. Phyllis Greenacre, to Trenton to have a closer look at what Cotton was doing.

And Cotton was staying busy. 1922 saw 81 colon surgeries performed. Teeth were still an enthusiastic focus, along with tonsils, sinuses, stomachs, gallbladders, spleens and cervixes. Oral surgeries picked up. Looking back, we can account for many mistakes in our earlier practice by the fact we were too conservative. The authors of the most widely used psychiatric textbook of the era, Diseases of the Nervous System, not only disagreed, they went right after Cotton in the fourth edition of the book.

These days, the neuropsychiatrist sees patients who have had their teeth pulled, their tonsils gouged out, their eyes refitted or eye muscles cut, their cervixes amputated, their ovaries removed, from nine inches to six feet of gut cut out, all of the endocrine glands dispensed with, orthopedic appliances applied, weeks of colonic irrigation with or without electrical rigmaroles, an orgy of surgical intervention that has accomplished precisely nothing.

It was inevitable that the more Cotton spoke of his great successes in Trenton, the more scrutiny grew. And it was troubling. For all of his talk of patient recovery, the truth was that Cotton had offered very little in the way of actual data. Even the bacterial infection he claimed to be treating, there was no indication in anything he published that suggested techniques, that suggested testing or techniques for testing.

Instead, Cotton spoke of bilious attacks and habitual constipation. These findings struck many as dubious at best. A bacteriologist named Nicholas Kopeloff partnered with a psychiatrist named George Kirby for a 1923 study called Focal Infection and Mental Disease. Their goal was to test Cotton's theory that hidden infection caused insanity.

They examined 58 cases in which 253 teeth had been sacrificed to the trash. And in all cases, the tonsils were also taken. They veered from Cotton's practices and that they did no colon surgeries on the grounds that there was simply no medical justification for that. Their findings were damning for Dr. Cotton. They could find no relationship, no cause and effect between bacterial toxins and focal infections and the functioning of the psyche.

Disagreement was minimal and muted. One Rhode Island psychiatrist suggested that perhaps patients didn't recover their sanity after the removal of the infected tooth or part of an organ because the infection was already too far gone. Now, you'd expect Dr. Cotton to fight back, but he was off in London delivering a lecture on his methods to an enraptured audience who were primed to see medical and surgical interventions as a new frontier for psychiatry.

These folks were a little put off by Cotton's dismissal of heredity as the main driver of madness since a society built on rigid class distinctions couldn't help but love any theory that declared certain people defective and deficient from birth. Still, they were willing to overlook that because the prospect of curing the mad with a scalpel was just too thrilling.

Meanwhile, Dr. Phyllis Greenacre had been at the New Jersey State Hospital for the insane investigating Dr. Cotton's work. She found the man himself to be odd, peculiar. She was uncomfortable in his company. There was something about the facility itself that she described as unwholesome. Dr. Greenacre was stunned by the poor record-keeping, the shoddy data collection, but most of all, it was the patients that concerned her.

Hundreds had died under Cotton's care. Thousands more had been maimed by his treatments. Many of the patients with psychosis had had every single one of their teeth removed. They struggled to eat and to speak. It was nightmarish and impossible not to see just how ineffective the procedure had been for those individuals.

Then Greenacre went looking for the success stories. The patients who traded teeth and tonsils and lengths of their intestinal tract for a cure, only to find that while they had been discharged, many were still clearly struggling with their mental health. This might have been the moment for the whistle to get blown, for Cotton to be stopped, but Dr. Greenacre's boss, Adolf Meyer, suppressed the report, even though he knew he'd visited the hospital prior to sending Greenacre, writing in his private notes that what he'd witnessed there left him troubled and uncertain.

Yet Meyer made the decision to protect Dr. Cotton. Protection that would only delay the inevitable. There were too many cases, too many eyes, too many questions. In 1925, the New Jersey State Senate launched an investigation of its own, led by Senator William H. Bright. The Bright Committee is planning to delve deeply into the stories on fatal operations on inmates in the state hospital for the insane at Trenton.

Dr. Henry Cotton, medical director of that institution, declared today that the stories about the hospital horrors are an exaggeration. Dr. Cotton was stirred up over the story told on the stand before the Senate committee by Miss Edith Strong, a discharged nurse, who gave graphic description of helpless women being dragged to the operating tables against their will and sent to their death, declaring that she knew of four or five women who died after their operations and only two or three who got well.

False! Outrageous! Cotton went on to say that Nurse Strong had been terminated because she herself suffered from delusions. If Miss Strong is not in her right mind, the question arises as to how it was that the state institution for so long a time employed an alleged crazy woman as a nurse. It must also be explained how it happened that Miss Strong was terminated as a nurse only after she had begun to protest against the treatment of some of the patients.

Ain't that always the way? Still, the strain of the investigation was starting to show. Dr. Cotton is said to be suffering from a nervous disorder as a result of the strain caused by the Bright Committee investigation into the conditions at the asylum. Dr. Cotton, it became known today, was advised to remain in bed by Dr. William A. Clark of the hospital staff.

At the same time that the Bright Committee was pouring over conditions at the state hospital in Trenton, the Mercer County prosecutor was looking into the deaths of two female patients there. And now, perhaps for the first time, Dr. Cotton himself was experiencing a mental health crisis. Drunken attendance, battered and bruised patients, unauthorized surgeries, some performed by Dr. Cotton himself despite his having no formal training or credentials.

It's reasonable to think that it was all about to come crashing down for Dr. Henry Aloysius Cotton. Surely there would be consequences. People had been disfigured. People had died. One, he was tireless when it came to publicity. It was the rare month that he wasn't all over the news. Two, his connections were impeccable and powerful.

Even Adolf Meyer, remember, stayed silent about Cotton's work, even as he doubted and disapproved. And three, Cotton was experimenting on institutionalized people. People that were casually referred to as degenerate, defective, delinquent, drunk. Put them all under the blanket heading disposable. Eminent physicians and surgeons testified before the bright legislative committee that the New Jersey State Hospital for the Insane was the most progressive institution in the world for the care of the insane.

Witnesses praised the work of Dr. Henry Cotton. A system like this one is designed to protect itself at any cost. The hospital was a state institution. Cotton was a state employee. So Cotton got lucky. And instead of being the sacrificial lamb, he was the beneficiary. Dr. J.A. Raycroft, vice president of the hospital, submitted a report on an investigation done by his board.

But the committee declined to receive it. The bright committee told Raycroft that they preferred to examine witnesses in person, which was great news for Cotton because those witnesses the committee did call. Asserted no patient was ever operated on without his consent or that of the patient's family, that no experimental operations were ever done on patients, and that there was no evidence of rough treatment of inmates by attendants.

And listen, New York Senator Royal Copeland, himself a physician, when called by the committee to testify, hopefully added. If it were found that an attendant had not treated a patient gently, it was not a reflection on Cotton or hospital management, but rather on the appropriating body. That would be the state of New Jersey.

The appropriating body, which curtailed the amount of money set aside for the payment of attendance. Translation. These folks are underpaid. So what are we going to do? Just let them beat and brutalize the patients and also run a backroom gambling operation. Classic case of the people elected to govern blaming the government for their failures.

Where have we seen that before? That's right. Everywhere, every day, all the time. And so Dr. Cotton dodged accountability and not even by the skin of his teeth. Five years later, Dr. Cotton kicked off 1930 with a January 3rd speech to the members of the Monmouth County Dental Society, who knew that dentists were such a raving masochist, because why would you invite Cotton to speak, knowing how critical of dentistry he was?

Sure enough, he gave them a good talking to. In order to preserve the patient's health, it may be necessary to extract all teeth. The usual mistake is made in not extracting enough teeth. In March 1930, Cotton gave dentists a break and this time went after birth order as the cause of poor mental health. A survey of a thousand cases show that the largest proportion of our patients are third children or after.

Cotton then delicately pointed out that birth control may have to be considered to prevent the continued increase of mental disorders. Oh, there it is. The slippery eugenic slope improved the population by controlling reproduction. Though in this instance, Cotton was suggesting limits on childbearing, not forced sterilization.

So it could have been worse. But not to worry, because the party was about to be over for Dr. Cotton. In the end, it was a little loophole that got him. Cotton was a state employee who also ran a lucrative private practice on the side. The Mercer County Medical Society had been making all kinds of noise about that, right up to threatening Cotton's membership.

They wanted New Jersey to change the rules to stop Cotton from double dipping. The society prevailed, persuading the New Jersey State Board of Control to take action. Dr. Henry A. Cotton, medical director of the Trenton State Hospital for 23 years, will become the medical director emeritus of the institution. Cotton would lose the house and the car that came with the job, along with his expense account.

But he'd keep his annual salary, some equivalent to more than $155,000 today. And a great big deal was made about how this was all Cotton's idea. He was leaving because he wanted to devote more time to research and laboratory work. A month later, he was invited by President Hoover to be a delegate at the White House Conference on Child Health and Protection.

Cotton's departure put an immediate end to the abdominal surgeries at the State Hospital in Trenton. Some of the other procedures, though, those continued right up to the end of the 1950s. And even then, they didn't shut down the operating room. Instead, they used it for the next miracle cure for mental illness, the lobotomy.

Cotton didn't live long enough to see any of that, though. He was widely mourned and remembered with glowing eulogies as a man who treated madness as a medical condition, not a character failing or demonic possession. He was celebrated for abolishing restraints and for treating his patients as people, not as inmates, under his custodial care. They called him a man of principle, pointing out that he practiced what he preached because Dr. Cotton had pulled out all of his own teeth in hopes of curing his nervous breakdown. He removed his wife's teeth, too, and both of his son's teeth. He died a wealthy, highly respected man whose legacy of the deaths of hundreds and the disfigurement of literally thousands of human beings was carefully sanitized while he lived and then kind of, you know, forgotten about after he died. But karma, that girl sure has a sense of humor sometimes. After the extraction of my last four lower teeth, my heart symptoms entirely disappeared. I've had very serious angina and was somewhat incapacitated for a year or so, but I've had no return of symptoms.

Each examination shows steady improvement. Not long after that announcement, while enjoying himself at the Trenton Club, soft foods only please, Henry Cotton dropped dead of a massive heart attack. Next time on True Weird Stuff, there is no bigger party than the one the CIA was throwing during the Cold War with Project MK Ultra. They were dosing everyone they could get their hands on with LSD and not telling them about it ahead of time. So one minute you're fine, and the next minute you're hearing colors and seeing music. And then maybe you throw yourself out of a window, the jumper on the next True Weird Stuff. Special thanks to our voice talents on this episode, Sam Moore, Erin Cox, Kary "Doc" Bowser, and Don Morgan.

Sherry, before we get started, our voice actor Don Morgan, he gets to play the most characters and does it really well and has again, so I just wanted to point that out. He is my muse. He is. You know, the thing about psychiatric, I'll call them psychiatric hospitals because it sounds a lot better than lunatic asylums. Yeah, for real.

It was kind of a catch-all for everything. You had people who were alcoholic, they were autistic, people that suffered from bipolar disorder. All of these people were sort of warehoused in the same place. So on the one hand, I'm so happy that Dr. Henry Cotton kind of brought it out of the dark ages with the straps and everything else. But then he took it into another weird dark age with all of these ridiculous teeth pulling episodes and surgeries.

There's so much to work with here because this is a story about medical ethics, informed consent, and what happens when we fall prey to a charismatic guru. And then there's the whole problem of institutions protecting themselves and powerful people dodging accountability. And boy, if that doesn't sound like it's ripped from today's headlines, I don't know what does, right? So in my other life, let me just throw some bottles around and disrupt this highly professional broadcast. In my other life, I'm an MSW, I'm a social worker, and I'm very proud of that. And when people say to me, what is your practice area? Podcast listeners is my practice area as a social worker. But this is something when I thought for a long time what my goal was, was to work in inpatient mental health care as a hospital social worker, as a medical social worker. I just love that population, and I love that environment. It's fast paced, and it's exciting, and it's very crisis oriented. So I've struggled with getting attached and enmeshed with people, so it was kind of perfect for me. I spent two years there, and I got to know Henry Cotton. I want to say that we've come a long way, and we have in terms of consent and HIPAA, and also in terms of how we view people with mental health diagnoses and serious chronic mental illness, but we haven't come very far. We really haven't. We don't have any kind of resources to care for people, which is why so many of the people that are houseless, homeless, people go, well, they're just crazy. They just emptied the hospitals and let them out. Well, yeah, kind of. But we have no way to provide care for people. Even if you have money and a job, very often your insurance doesn't cover psychiatric or therapeutic care. Ours doesn't. It really doesn't. It says it does after you meet a $13,000 deductible. So what ends up happening in America now is the hospital emergency departments and jails are basically our de facto mental health care systems for the poor and the indigent and the uninsured, and these are human beings. These are people with reasonably good health insurance. It doesn't cover mental health care. It doesn't cover vision. It doesn't cover dental. So we continue to be a greedy, puritanical shit show when it comes to caring for people in this particular crisis. You can say so many good things about Dr. Cotton. You really can. I mean, he came in there and was like, absolutely not away with these straitjackets and restraints. You can celebrate the things he got right, and at the same time, absolutely condemn the things he got wrong. And we have to ask ourselves, where are we now with people who are seriously mentally unwell? Are we treating these people like human beings? Are we providing care that moves them toward regaining some function in their lives? Or are we just kicking the can down the road? Because ain't no money, no resources, and no real public will to do better. So let's talk a little bit about consent and why it was possible for years and years and years and thousands of human beings to be

handled in this way and to be brutalized in this way. And nobody said a damn thing. Does that trouble you? What's troubling about this is he didn't. So he had a theory about what was causing this, but he had no real data to back that up. So he decided what I'm going to do is experiment on it based on my theory, and that's where we really run into the trouble.

And lest his pet theory be proven wrong, he had to do everything to defend what he was doing and continue doing it even to a larger extent. And therein lies the problem with this whole thing, because all I can think about is, you know, we think about what all the horrible things that Dr. Mengele did in Nazi Germany, but what this guy was doing was kind of the same thing.

Same, same. Yeah. Same, same without a snappy uniform and an armband. One of the things that blows people's minds is when they learn that it was really like, you know, the 1970s when we put some laws in place about experimenting on human beings. Because we've talked about this in other episodes, other stories. So you have to climb back into the Wayback Machine and remember that for Dr. Cotton, he was not breaking any laws. There were no laws to break. He was, you know, pushing the frontiers of knowledge and medical science. How did he get away with it? How did hundreds of people die? How were thousands of people disfigured? How did you have this beautiful and the Trenton State Hospital?

Now, not so much because, you know, time and, you know, budget cuts and blah, blah. But as it was first built, it was a masterpiece of this Kirkbride model for how a sanitarium, you know, should basically be constructed for light and air and comfort and peace and all of those things. It's kind of hysterical because the idea now of giving a damn about a person's comfort and peace in a hospital setting is kind of funny, isn't it? But back then, it was a great big deal. This was a beautiful facility and it was built with such idealism and such hope. How did Cotton pull it off for so long? Here's the answer. Because the people in his care were poor folks. Back then, as we said in the story, if you had means, you didn't go to the state hospital. You had other options. If you were really wealthy, your family could send you to a luxurious private sanitarium where you would be just as sick but nobody would take all your teeth. Or they would, you know, they hired caregivers and they kept family members at home. There were some horror stories of people that were kept basically locked in a bedroom for most of their lives because of the shame of their madness, you know, the stigma of that insanity. But in this story, we have the usual culprits. We have people who have no money. The poor are treated differently. Their humanity weighs less on the scale than people with money and resources. That's still true today. You can say that it isn't and you can use one of my favorite expressions which is, well, I like to think that's not true. Do you? Well, I like to think I'm a magical talking horse and yet I don't have hooves. So what we like to think and what reality is are very often two different things.

So when you have poor people, you have a captive population with no advocacy, no means of defending or fighting back and no alternatives. And because you have poor people in the state hospital at this time, they're equally poor family members are out there scraping a living together and probably in most cases have no idea what's going on to their relative in Trenton. Do you see how easy it was for this thing to snowball and turn into an atrocity? Well, there's two things here that are troubling about Dr. Cotton and one is even scientists by this point in our history as human beings knew that you had to have a certain way that you went about experimentation or a certain way that you went about doing things. And with poor record keeping and all of that, he wasn't following any of that.

That's the first part of it. The other part of it is where is your sense of morality when it comes to human beings? Or do you say, well, they're, they're on a scale of one to 10, maybe they're only a three human beings. So it makes it okay that I can do this. I can rationalize, I can justify that I can do this because they're not quite the human being that I am.

Bingo. Think about the words that we use to describe people with mental illness back then degenerate, diseased, lunatic, insane, worthless. I mean, this, you know, this was a population of people whose humanity had very much been downgraded. And, you know, we have laws now, we have all sorts of laws now on how patients are cared for, how their privacy is respected.

We have laws on experimentation in medical settings, you know, laws that did not exist back then. But I can promise you that the stigma is still real. And there are healthcare providers who are monstrous when it comes to dealing with patients in this population. And that's a fact. Because as long as there are human beings at the party, we're always going to have at least one monster show up, right? That's, that's what we're capable of. But so many things, so many safeguards have been put into place to try to protect these people who are so vulnerable.

If you are in a state of psychosis, you are detached from time and place in reality. And you are, you are absolutely at the whims of the people caring for you. And the fact that you're diagnosed means that you don't have as much credibility if you complain. It was very easy for Cotton and his staff to get away with this because of the people they were treating.

They were poor, and they lacked credibility because they had a diagnosis of madness. And the sad part of this is, there's a lot of sadness here. So much suffering, so much needless suffering, and death, and absolute ruination. But Cotton was brilliant. And in a different context, with more robust safeguards, he may have ultimately done so much good. But he was allowed and indulged. He had celebrity and charisma. And you know what happens when celebrity and charisma get some power. You know, there's always the risk of abuse, and God knows we live it every day. Sure. Because of ego, because of ego, he believed his own BS. He had to. Otherwise, he was a failure. And so he was going to believe it to the point of taking out the teeth of his family and his own. That's the one place I give the man a tiny bit of credit. His choices were monstrous, and he wreaked havoc on people.

But he died without teeth, and took his wife and his kids' teeth. And okay, so the other thing, like back then, it's only pretty recently that we understand that if you pull out all of a person's teeth, it's not just that they can't chew anymore. The whole, like the shape of your, everything, everything is jacked up by that. And one of the was that you could almost plot it on a graph, the freshly out of surgery, dental surgery patients, versus the ones who've not had teeth for a decade. And the decline, the decline in these human beings. There's somebody else here, who I think is a real black hat. And it's easy, and he's hoping that we've already forgotten about him. But Adolf Meyer, who was Cotton's mentor, a towering figure in the field, right? Adolf Meyer had his doubts, so much so that he sent Greenacre in. And then when she came back with the report, what did he do? He stuffed it, because for the same reason that Cotton wanted to believe in what he was doing, otherwise he's a failure, Adolf Meyer said, I have to protect my boy here, otherwise I'll look like a failure.

And so everybody's, everybody's worried about their ego, which was more important than what the, whatever the actual hell they were doing with these poor people. You know, one of the things I see on social media a lot lately, and I know you've seen it too, is people posting, is there not one person willing to blow the whistle on this whole Epstein scandal and take the fall to save us all? Heroes are very hard to find. There really wasn't a hero in Dr. Cotton's story, was there? There really wasn't anyone willing to do that. And so people suffered and died. And Cotton, except for karma getting him, you know, he announces that he's cured his own heart disease only to go down with a big old widow maker at the country club. Cotton, you know, everyone involved covered up the mess and protected him. It is so rare. Hollywood has conditioned us to believe that a hero will appear when you need one most. And that's just not true. That is not, that's Hollywood, that's not history. In history, very often, the hero doesn't come at all.

And that's why when we get a big real life heroic hero, in a historical sense, that person, they become immortal. You know, their act of goodness and sacrifice becomes immortal. And I'm really, I'm sad about this for so many reasons, not least of which is if Trenton, so Cotton's predecessor was also a giant bucket of tomfoolery. I mean, he just, he was collecting seashells while people were choking on their own vomit and straight jackets and restraints. He was not, he was not anything to be sad about leaving. When Trenton replaced Ward with Cotton, at that moment, it could have gone one of two ways because the hospital itself was poised to change the game for the people with mental illness. And it was just unfortunate that they put a man in charge and then let him run unchecked with these, you're right, Mengele level experimental surgeries. We talk a lot about the teeth because it's shocking, you know, insanity in your teeth, he pulled out everyone's teeth.

He, without any training, or knowledge or data, was cutting people open and resectioning their lungs, taking the chunks of their stomachs. He was performing some real, real half-assed hysterectomies on people in the hopes that this, that this would work in the hopes that when you, it's so funny when we were going through this and said that he was not trained to be doing what he was doing. I wrote down the word lobotomy, because that's kind of the same thing that we did in the episode that we had about the lobotomies, and how barbaric that was. And so the lobotomy part of this sort of dovetailed with this stuff. Well, when you think about how they turned those operating rooms into lobotomy rooms at the state hospital in Trenton, after the late 1950s, I mean, we did an episode a couple years ago called Ice Pick to the Brain about the wild, insane craze for lobotomies that swept this country. And many of them took place right there in those same rooms where people had their tonsils yanked and their colons resectioned.

You cannot, and there are always people that are like, yeah, but you know, he did have some good ideas and he did do some good things. Folks, he took vulnerable people who had no idea what was happening to them, and he tied them down to a table and cut them open. He did not fished around, he did not operate in a scientific way. This wasn't so long ago that we didn't know that there was a scientific way to go about doing whatever it is that you're doing. I mean, we knew, he knew by then. And these are people, here's what you have to understand.

If I tied you down, Max, and took out all your teeth, it would suck for you. But you would know a couple of things. You would know that I had tied you down and taken all your teeth. But if I do that to a person who is in a psychotic state or a person with schizophrenia, a person who is not oriented to reality, to time or place, and I knock you cold and I pull out all your teeth, when you come to, you don't know what the hell has happened to you. You have no way of understanding what has happened to you. You are a human being who is treated like a bag of meat.

Your humanity is completely taken from you. It must always be front and center that these were patients who had severe mental health diagnosis, that he did this to. These are not people who could have consented on their best day and who didn't understand. That was one of the things Phyllis Greenacre saw. These were people that were drooling and struggling and unable to eat, many of them wasting away for lack of adequate calories.

They didn't understand any of why this was happening. The cruelty, the barbarism is jaw-dropping. He talks about the fact that he had gotten consent from the families. The thing is, you are a doctor at a psychiatric hospital. Your loved one is in there. You would love for your loved one to be free of whatever it is that is troubling them. You are going to trust the doctor.

We trust doctors. When the doctor tells us something, we trust them. If he says, this is fact, you believe that that's fact. He's not going to them and going, listen, I'm conducting some experiments. What I'd like to do is experiment and hope that this might help your family member. That part of it. It's the power imbalance. Remember, this is a state hospital. These are not affluent patients.

These are the patients of poor people, poor working people, some of whom really couldn't read or write. It's not like they even understood what was being said to them about their family member. He's an esteemed authority figure. You've got that power differential, which is ripe for abuse. That's why we have to have safeguards in place in hospitals and everywhere else.

You walk into a patient's room and you have power and authority. If you choose to abuse that power and authority, do you see where it goes? The other thing about Dr. Cotton, and you can file this one under rich people can be real stupid. You know how we're seeing a phenomenon right now? They call it Mar-a-Lago face where people are getting plastic surgery and filler injections to the point where they look distorted and not even quite human. Do you know what I'm talking about? Yes, I do. I could name a couple of specific names, but I don't want to pick on people for their appearance. That phenomenon of rich people flocking to something because other rich people are doing it, what ultimately brought Dr. Cotton down was as word got out of this miraculous insanity cure via tooth removal and tonsillectomy, a funny thing happened.

People with money who would never, ever consent to being placed in a state hospital, they came to him and they were like, hey, on the side, what do you think? I'll pay. This part of this, Sherry, is really troubling. He set up a whole private practice embedded inside the state hospital that again, everyone knew about the way everyone always knows about this stuff and then the way they make shock Pikachu face when they get caught. Anyway, he set up this whole private practice and rich people would come in and they would open wide and he would take their teeth and tonsils and colons or whatever. That was what got the Mercer County Medical Society all up in arms. They were sideways about that. They thought that was unethical. They were right and grotesque. Yes, again. It was that pressure that ultimately pushed Cotton out of the state hospital. It wasn't the death and the deformity and disfigurement.

It wasn't the lack of consent or anything approaching reasonable ethics. What got him in trouble was that he was double dipping and his colleagues were pissed. If that doesn't sound like God bless America, man, I don't even know what. It's a shame that that's what it took, but thank God. Eventually, you hear the expression follow the money and that's how you'll fix it. They say that about everything. This was another case of follow the money. Even when he was quietly and diplomatically removed from his position, you'll notice that it was a golden parachute. We're going to get him out of the way, but we're not going to punish him or in any way make him have a loss of standing. We're just going to move him out of the way and hope no one remembers what happened here. They had to have all known by that point that none of that was working and just the barbaric nature of taking out people's colons and then not only doing that but his mortality rate was rather high. Shockingly so.

That's because he wasn't trained to do that. The nurse who finally came forward as a whistleblower, what did he say about her? She's crazy. Reality, can we get a new script? Because aren't you tired of the same thing playing out over and over again in all of our major social institutions, government, medicine, the military? Don't you just desperately want a new script? You do. You do. Because this is the same old, same old. The other thing about Dr. Cotton, so now I'm about to be charitable toward the man because he was brilliant and he did do many fine things in his tenure in Trenton. Sometimes, and I'm guilty of this, I think we all are in some ways. I'm extra guilty of it. You just want to believe so much that you're willing to skip past the things that challenge it, whether it's us wanting to believe in Bigfoot or you wanting to believe in your marriage or wanting to believe that this person you voted for isn't the devil, whatever it is. Don't you know what it feels like to want to believe so desperately that you ignore the evidence against it? Mm-hmm. Yes. And brilliance without morality is just plain dangerous. Oh, yeah. So, woulda, shoulda, coulda, right?

And there's no way of knowing how things might have played out differently. But when I look at, and of course, after deinstitutionalization and the Reagan administration, even if the state hospital in Trenton had been a model of absolute top-notch healthcare and compassion and dignity for this vulnerable population, it still would have gone to hell because no matter how many years pass between today and the 1600s, we are still operating in that mindset that there's something fundamentally, morally, or at a character level wrong with people who are mentally ill. And you hear the way people talk about folks now who have serious recurring mental health issues. I mean, I hear it. Oh, look at him standing on the corner talking to himself.

Well, do you think if he had somewhere else to go, he might not choose that? What does it say about us that our streets are crawling with the mentally ill and that our prisons, our jails are packed with it? I did my master's thesis on bipolar disorder, on the intersection of bipolar disorder and care in the criminal justice system. If you have a bipolar disorder diagnosis, your chances are sky high of spending some time in a corrections institution because your symptoms, if you're in mania, your symptoms can be frightening and can present as threatening or violent. What you need is you need medical attention. You need care.

Throwing you in the jail doesn't fix anything. It doesn't. And it's certainly because most jails are not equipped to be able to handle what that situation is. And what the unfortunate part about that is a lot of times you're not able to identify it until it reaches a point that somebody has committed offense that sends them to prison. So there's a bit of a merry-go-round with that that's really difficult. Yeah. If I can, before we wrap this episode up, so let me share something that absolutely blew my mind and gassed at me flabbers, as the kids say. So I learned a lot in my field placement as a grad student. I learned a lot about things I only sort of tangentially knew about, like for example, a mandatory psych hold. So if you present at a hospital emergency department or you're picked up by the cops or brought in by a family member, whatever, and it's determined that you're a danger to yourself or others, they can place you on a they cannot discharge you for a minimum of 72 hours. So what ends up happening, you're placed on that 72-hour hold. And in those 72 hours, the goal is to stabilize you for safe discharge. Safe discharge does not mean healed or improved necessarily. It just means that you're admitted on that mandatory hold, that they hit the clock and it's running with the goal to get you out of there. And so you come in and very often, you would have people that they were experiencing an episode because they weren't taking their medication because they didn't have money to buy their medication and they didn't have stable housing and a place to keep their medication. And as someone who does a lot of work in the community, Max, you know how quickly that snowball. Well, I want to tell this story, but I don't want to virtue signal.

But when I when I lived in the downtown area, there was a woman who used to hang in front of the Starbucks and she would she would beg for money. And somebody I knew who had lived at the shelter said her life, her life on the street is not good. And so I thought to myself, is there any possible thing that I can do to be able to help with this situation? So I called a guy that I went to high school with and he's he's a psychiatrist and he was involved with state hospitals and everything else. And I can just tell you that it is such a labyrinth of.

Horror to try to navigate through that, to be able to figure out a way to help this person. I even got I was in touch with the police department and talked to somebody who had seen what her plight was on the street because the policemen see these people all the time. And you realize how woefully inept we are at being able to handle people like her today.

Who we we are completely failing this population, and it's not the fault of health care workers. If you watch The Pit on HBO Max, there was an episode recently where a homeless person with serious mental health issues rolled into the emergency department. They referred to him as a frequent flyer, which is what what those folks are called. And the charge nurse played by Katherine Lanassa, Dana, says to him, you're OK today, but what about tomorrow? What about next week? You need to use the system. It's what it's there for. And for some people, their only way to receive care is to roll into the emergency department, get placed on that mandatory hold, get a place to sleep, some meals, get their medication stabilized, and then they're back out again. And we would discharge them with a little paper bag that had like a turkey sandwich in it and a bus pass or a whatever, you know, depending on the day. So there was not any. It's not that there's malice or indifference. It's this is the system. And when when when people say stuff like, well, isn't there somewhere they can go? No, there is nowhere they can go.

Isn't there some? But surely the city, the state? No, no. I had a I had a situation where a friend called me in a panic one day and said so and so and this and that. And where who can they call and what can they do? And they need to be hospitalized. Isn't there? What about the state hospital? What about it? This isn't 1950. Here's what's going to happen. They're going to go to the emergency department. And if they're assessed as a risk to themselves or others, they're going to be placed on a 72 hour hold. Then they're going to be discharged.

Now they're going to come back. And the cycle repeats and repeats. And and I've seen people show such contempt for those frequent flyers. When in fact, that's the only means they have of receiving any kind of care. So yeah, I'm a little bit of a nutcase on this subject. This is my area. This is my social work practice area. Well, and I had tried to get a friend of mine that worked as a television reporter. I said, can anything be done about the story? I think there's a story here. And he said, people do not. This is what he said is so true. And it's kind of haunting.

He said, people don't want to look at stories about people with mental illness. They don't want to watch it. It horrifies them too much. They don't want to know about it. He said, so I can't sell this story because nobody will want to watch it. Even though the story of this woman who had who had achieved a level of mental health at some point along the line, because I went I went deep into this. So anyhow, that's that kind of makes a statement about that. I think that that is probably the most telling statement about all this. It's, um, it's really difficult. Because we don't want you don't want to walk out of your job, heading for your car, and have a person who's clearly hallucinating, or having an episode confront you in a threatening way. I mean, when I was a college student in Philly, we were tripping over people that were actively hallucinating on the street. Remember, it's kind of like it was a, you know, you can tell it like a funny story. But remember, right during the beginning of the COVID lockdown, I had to go downtown for something to play. Oh, yeah, it was like, super mega man. And I'm walking down the street and this man comes running toward me just screaming and shouting. And he threw a thing of Chef Boyardee, like a little microwavable Chef Boyardee ravioli at me, hit the street and exploded and went all over me. And, and all I could think was, you need to go to the hospital, but I know you're, they're gonna kick you out after 72 hours, you need your medication.

And also, I've never eaten Chef Boyardee. And some of that shit just touched my skin. Oh, my God. So I'm not trying to be, oh, she spun in her grave. Listen, I'm not trying to be some kind of like, Oh, you know, I'm better than y'all. I just, I got plunged into this world. And I knew what you knew about it, which was nothing. Yes. And was shocked by the inhumanity, not on the part of healthcare workers. No, so many. I saw so many social workers and nurses and doctors genuinely doing whatever they could to help this individual and also horrifying things.

People who are in who are not in their minds, do not behave like people they it can be terrifying, it can be violent and scary. And yet to show up every day and clock in and say, I got this one. I mean, the courage and the compassion that I saw day in and day out on the part of particularly nurses, because they do the brunt of healthcare, and the social work team that I worked with, the way that even though they've been in this world for decades, that their hearts had not ever hardened. They were not cynical. They still had hope that maybe this time we're going to get that placement, you know, we were always looking for placements, can we get this person into, can we get them a bed in a rehab facility? Can we get them a bed in a, in a skilled nursing facility, like these social workers were doing everything in their power to see this patient in front of them as a precious human worthy of care and compassion and respect.

The problem is, is that it's a tsunami coming at these people, and they don't have the beds, they don't have the resources. And we don't have the will as a society to give a damn. And that's the real story of Dr. Cotton in the state hospital in New Jersey. So yeah, what else do you want to add before we go kick the CIA around for a while?

Nothing. I just paid a visit to the Facebook profile of the woman that I was talking about and just saw her picture. And of course, there's been no activity in the last, she's probably not even still alive. There's no activity in the last 15, 16 years. But she had a blog and she wrote and she was, there was a certain beauty to it. And I think as a human being, you see that and you go, How can I help with this? I feel it's incumbent upon us to do something to help people with some things. I can't run out. I'm not educated to be a mental health worker.

But at the same time, you can, I certainly don't have to have an education to see somebody suffering and want to help. You know, it really does start like though, at the end of the day, what we have, you can you can follow people's priorities by looking at where their money goes, right? Where do your where the direction that your feet, your wallet point in show you who you are, as a society, you like, you know, we, we can be better advocates, I got news for you. People are not paying enough attention to what is coming down the road for you to be a perfectly capable able bodied, mentally healthy American. The, the disaster, if they succeed in unwinding the EMTALA statute, which is the Emergency Medicine Treatment Act of Labor, it's the law that requires a hospital emergency room to treat you to stabilize you even if you don't have money to treat you and get you discharged. If they unwind that, I mean, we're talking about this is not dramatic or in any way an exaggeration. We're talking about mass death.

And that's eugenics, by the way, because a quick way to cull the herd is to let all of the most vulnerable, the elderly, the infirm, the chronically ill, the mentally ill, just let them go off to their own devices and drop dead. That'll cull the herd pretty quick. We do, we, we bump into eugenics a lot on this show. We do. And, and do not kid yourself. And if you think, well, you know, people should get a job and pay their bills. I pay my bills. Let me tell you, you're one catastrophe away from being on the street. We all are. None of us. The average American doesn't even have $400 in savings. Like the data is really bleak. If, if you're in pain and you don't have money or health insurance, maybe you've gotten laid off, who can say what can come and you roll up to a hospital emergency room and they don't have to treat you. They don't have to stabilize you. They can turn you away. Then what? Then what? So we, we, this is not happening to other people somewhere else or happening to other people a long time ago. And isn't that awful? And what a cool story this is happening right now to you and healthcare workers know it. Once you ask somebody who works in the healthcare system, why don't you, why don't you pour them a drink and say, tell me the truth. I can take it. Yep. And hopefully you can, they know you can, they know what they're up against. So, um, if you are a, um, hospital healthcare worker, social worker, a therapist, if you're in this fight, Godspeed, we see you. And I'm doing my part to make other people like, wake up. This is real. Now this is a small audience, but it's somebody, you know, you can only change one person's heart at a time. You never know.

Now, next week on true weird stuff, we have a pair of episodes. They're not, it's not a two parter, but it's two coins of the same store. It's two parts of the same story. Um, we're going to, you know, it's been a minute since we gave the CIA a good ass whooping, isn't it? I feel like it's been a minute. We're doing that again, Sherry. I miss my spooky brothers in Langley.

So, um, there's an infamous story that, um, wasn't really brought into the light again until the seventies and president Ford's administration. Oh, what the CIA day did not get up to an MK ultra what they're probably still not getting up to. But anyway, we're going to take a look at an infamous CIA story. Did, did they dose one of their own scientists and then throw him through a 10 story window to keep him quiet? That looks like it. Yeah. Well, we'll take a look. Maybe we're wrong. And they're just like really good hardworking guys who are just trying to save the world. And that man who even knows the jumper that's on the next true weird stuff. And if you listen to us on Apple podcasts, hit the plus button in the top right corner. And now it helps an independent podcast like ours to get discovered. And we really appreciate it. If you subscribe rate and review true weird stuff, hit our website, true weird stuff.com for show notes and photos and videos when we have it.

Bonus content, everything true weird is waiting for you at true weird stuff.com and follow true weird stuff on Instagram. True weird stuff is a Now! Media production. Our executive producer is Anthony Garcia. The show is written and hosted by me, Sheri Lynch, along with my deeply weird director, Max. Our equally odd producer is Kary Bowser, additional production by the mysterious Stephen Call our digital witch and social media cult leader is Heather Furr original graphics by Kevin Nash. Original artworks by Olivia Axland. True weird original music composed and performed by Jack Griffin. Copyright 2026. Now! Media. All rights reserved. All wrongs remembered.

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