Psychiatry in Indiana
The First 175 YearsBy Philip M. Coons Elizabeth S. BowmaniUniverse, Inc.
Copyright © 2010 Philip M. Coons, M.D., and Elizabeth S. Bowman, M.D.
All right reserved.ISBN: 978-1-4502-6072-5Contents
Dedication..........................................................................................................vForeword............................................................................................................xixPreface.............................................................................................................xxiiiAcknowledgments.....................................................................................................xxvIntroduction........................................................................................................xxixChapter 1 A Brief History of Psychiatry y in the United States.....................................................1Chapter 2 Public Psychiatric Institutions...........................................................................9Chapter 3 Indiana's Public Psychiatric Hospitals Built in the Late Nineteenth Century...............................18Chapter 4 Twentieth Century Public Psychiatric Hospitals in Indiana.................................................38Chapter 5 Private Psychiatric Institutions..........................................................................50Chapter 6 State Developmental Centers...............................................................................57Chapter 7 Correctional Facilities...................................................................................68Chapter 8 Community Mental Health Centers...........................................................................72Chapter 9 Psychiatric Organizations.................................................................................77Chapter 10 Department of Psychiatry, Indiana University School of Medicine..........................................93Chapter 11 Child Psychiatry.........................................................................................104Chapter 12 Notable Indiana Psychiatrists of the Nineteenth Century..................................................109Chapter 13 Notable Indiana Psychiatrists of the Twentieth Century...................................................119Chapter 14 Notable Non Psychiatrist from Indiana....................................................................152Chapter 15 Laws.....................................................................................................164Chapter 16 Cases, Famous and Infamous...............................................................................182Afterword...........................................................................................................193Chapter Notes and References........................................................................................197About the Authors...................................................................................................239Appendix A Interview with John Greist, M.D..........................................................................241Appendix B Interview with Philip Reed, M.D..........................................................................245Appendix C Presidents of the Indiana Neuropsychiatric Association & Indiana Psychiatric Society.....................259
Chapter One
A Brief History of Psychiatry in the United States "It has been remarked, that the maniacs of the male sex in all hospitals, who assist in cutting wood, making fires, and digging in a garden, and the females who are employed in washing, ironing, and scrubbing floors, often recover, while persons, whose rank exempts them from performing such services, languish away their lives within the walls of the hospital." Benjamin Rush, Medical Inquiries and Observations upon the Diseases of the Mind, 1812
We begin the history of psychiatry in the United States with Benjamin Rush, M.D., (1745-1813), the founder of American psychiatry. Rush was not only a physician but a writer, educator, humanitarian, and signer of the Declaration of Independence. He was the author of the first textbook on psychiatry, Medical Inquiries and Observations upon the Diseases of the Mind, first published in 1812. In his book Rush described hypochondriasis, mania, dissociation, and derangements of faith, memory, will, morality, and sexual appetite. Rush's remedies for these various ailments included garlic infusions, blood letting, purging, and the use of bark or opium. Perhaps the most interesting and sometimes appropriate treatments, even by today's standards, are his remedies for an overactive sexual appetite. These included matrimony, avoidance of the opposite sex, avoidance of obscene pictures, temperance with alcohol, cold baths, purges, diets of bread and water, and immersion in business or study.
Another of Rush's accomplishments was a successful campaign to establish a separate ward for mental patients at the Pennsylvania Hospital. Rush was considered a pioneer in occupational therapy because he advocated work for both men and women. He was a pioneer in alcohol addiction treatment and was the first to conceptualize alcoholism as a medical disease rather than a sinful failing. Rush was a prominent educator who trained over three thousand medical students during his lifetime.
Dr. Rush worked at the Pennsylvania Hospital, which opened in Philadelphia in 1751. The hospital's care of the mentally ill in overly crowded psychiatric wards was removed to west Philadelphia in 1841 when the Pennsylvania Hospital for the Insane was opened. The hospital's first superintendent was Thomas Story Kirkbride, M.D., (1809-1883), founder of the American Association of Medical Superintendents of American Institutions for the Insane and also inventor of the Kirkbride Plan of constriction of hospitals for the insane (See Chapter 2). The Pennsylvania Hospital eventually became the Institute of Pennsylvania Hospital. The hospital had some private rooms and the patients not only received medical treatment, but worked outside, participated in recreational activities, attended lectures, and had use of a hospital library.
The Pennsylvania Hospital for the Insane, however, was not the nation's first psychiatric hospital. That honor goes to the Friends Hospital which opened its doors to fifty patients on May 15, 1817. Isaac Bonsall, a successful Pennsylvania farmer, was its first superintendent. The hospital was situated on fifty-eight acres of farmland and the area that wasn't cultivated included a park-like setting with shaded walks, ponds, and forest paths. This hospital, operated by the Quakers, was a haven for the insane. In order to maximize light and fresh air, rooms were placed on only one side of a corridor. Males were quartered on one end of the hospital and women on the other. The more violent patients were housed on the second floor and there were special rooms on the fourth floor for "noisy" patients. Patients were helped to recover from their illnesses by working on the hospital grounds and farm. They were treated humanely and were part of a family, which included the superintendent and his family, physicians, a matron, a nurse, and attendants. The symptoms of mental illness requiring treatment were like those encountered at the Indiana Hospital for the Insane (See Chapter 2), including melancholy, abusive behavior, filthiness, negativism, agitation, depression, suicidal behavior, self-mutilation, anxiety, suspicion, insomnia, excitement, anorexia, alcohol and drug addiction, and "obliterated ideas."
Early insane asylums in the United States and elsewhere operated under the principles of "moral treatment" or "traitement moral" as coined by Philippe Pinel (1745-1826), the famous French physician who unchained patients at the hospital Bicêtre in Paris, France. The moral approach involved treating patients humanely, without restraint, with close patient-staff interaction, and involving them in various therapeutic activities.
The first association of physicians treating mental disorders was called the American Association of Medical Superintendents of American Institutions for the Insane. This group of thirteen superintendents of American insane asylums first met in Philadelphia in October 1844. It was the first medical specialty group in the United States and it collected statistical data about mental illness and furthered the treatment of the insane. It 1892 this association's name was changed to the American Medico-Psychological Association to allow assistant physicians working in state insane asylums to become members. Finally in 1921 the group's name was changed to its present form, the American Psychiatric Association.
The classification of psychiatric illnesses has a long history. Hippocrates, the famous Greek physician who lived during the fourth century BCE, and his followers were the first to classify physical and mental illnesses. Hippocrates thought that illnesses were due to an imbalance in blood, yellow bile, black bile, and phlegm. The words mania, melancholia, paranoia, and phobia actually stem from the Greek. For example, Hippocrates thought that melancholia was caused by an excess of black bile. English physician, Thomas Sydenham (1624-1689), developed the concept of a syndrome, or a collection of symptoms which made an illness. During the eighteenth century the classification of physical and mental diseases, developed from the idea of biological taxonomy, developed by Carl Linneaus (1707-1778). The taxonomy approach was abandoned in the nineteenth century in favor anatomical and clinically descriptive approaches. It wasn't until the late nineteenth century that German psychiatrist Emil Kraepelin (1856-1926), divided the psychoses into manic depression and dementia praecox, which was later to become known as schizophrenia, a term coined by Swiss psychiatrist Eugen Bleuler (1857-1939). It was left up to Sigmund Freud (1856-1939) to describe the various neuroses. Finally, the mid-twentieth century saw the publication of the first Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association in 1952.
Isaac Ray (1807-1881), American psychiatrist and founding member of the American Association of Medical Superintendents of American Institutions for the Insane, is credited with originating American forensic psychiatry. In 1838 he published "A Treatise on the Medical Jurisprudence of Insanity," an authoritative text for many years. This text was used extensively by defense attorney, Sir Alexander Cockburn, in his defense of Daniel M'Naghten at his 1843 trial for the murder of Edward Drummond, the private secretary of England's Prime Minister, Robert Peel. Out of this trial grew the M'Naghten Rule, whereby an accused is judged not guilty by reason of insanity.
In addition to the development of moral treatment of the nineteenth century, a number of other psychiatric treatments evolved during the first half of the twentieth century. Various types of the "water cure" have been with us since antiquity, but hydrotherapy as a psychiatric treatment was a late nineteenth and early twentieth century phenomenon. Emil Kraepelin first wrote about the benefits of long baths for dementia patients in 1891. By the mid 1930s all state psychiatric hospitals had hydrotherapy units. A typical hydrotherapy unit consisted of a room filled with special bath tubs. The patient's body was submersed in a tub of warm water and a canvas sheet with a hole for the patient's head and neck was stretched over the tub. The warm water was continuously flowing and was set at a temperature, usually between ninety five and one hundred degrees Fahrenheit, ordered by the physician. This form of hydrotherapy was supposed to exert a calming effect on the agitated patient. A similar form of therapy was called a hot or cold wet sheet pack or wrap. In this form of therapy the patient was wrapped in a sheet which ranged in temperature from forty to one hundred degrees Fahrenheit. Generally agitated patients were wrapped in cold sheets. Sheets were cooled by either placing them in a tub of ice water or placing them in a freezer.
In 1917 Julius von Wagner-Jauregg, M.D., (1857-1940), an Austrian physician, discovered the "fever cure" for tertiary neurosyphilis, a frequent cause of mental illness until penicillin was discovered. In this form of therapy the patient was infected with malaria. The infection caused recurrent fevers, which in turn resulted in a dramatic improvement in patients with neurosyphilis. This form of treatment was eventually adapted for use at Central State Hospital in Indiana. In 1927 Wagner-Jauregg became the first psychiatrist to ever win the Nobel Prize.
Another Austrian psychiatrist Manifred Sakel, M.D., (1900-1957), invented insulin coma therapy in 1927. In this form of therapy, a coma from low blood sugar was induced through the injection of insulin. Such treatments sometimes brought about dramatic improvements in schizophrenic patients. This treatment was dangerous, however, and was abandoned with the introduction of Thorazine, the first antipsychotic medication. Insulin coma therapy was used extensively in Indiana mental institutions.
Hungarian neuropsychiatrist Ladislas Meduna, M.D., (1896-1964), invented Metrazol shock therapy in 1934. In this form of therapy pentylenetetrazol was injected to induce seizures. This form of therapy produced dramatic improvements in schizophrenic patients who were in a catatonic state, an extreme form of motor rigidity which the patient may hold a posture without moving for hours or days. This form of therapy was also used in many psychiatric hospitals in Indiana.
In 1938, electroconvulsive therapy was invented by Ugo Cerletti, M.D., (1877-1963) and Lucio Bini, M.D., (1908-1964), both Italian psychiatrists. In this type of treatment an electric current is applied to the head in order to induce an electrical seizure. Electroconvulsive therapy was used initially in schizophrenia and later in those with either depression or mania. Although it has largely been abandoned in the treatment of schizophrenia in favor of medication, it still has a major role in treating severe depression or mania which has not responded to medication and psychotherapy.
Egas Moniz, M.D., (1874-1955), a Portuguese neurologist, was the developerofcerebralleucotomyorlobotomy,anearlyformofpsychosurgery, in which the connections of the prefrontal cortex are separated from the frontal lobe of the brain. In the mid-1930s Moniz and neurosurgeon, Pedro Lima, M.D., perfected their technique. It had been known for many years that disease of the prefrontal areas of the brain resulted in a calm, sometimes apathetic state. In their initial study of twenty-two patients, composed mostly of schizophrenics and depressed patients, Moniz and Lima noted that two thirds of patients who underwent lobotomy were either greatly or moderately improved in their anxiety and agitation. Walter Freeman, M.D., (1895-1972), an American neurologist, became fascinated with Moniz's work, and together with James Watts, M.D., (1904-1994), an American neurosurgeon, brought this surgical technique to the United States. Dr. Freeman, however, became dissatisfied with the laborious neurosurgical technique and developed the trans-orbital lobotomy whereby an ice pick-like devise was driven by means of a mallet over the eyeball and through the upper part of the eye socket. This instrument was then swept side to side in order to sever the prefrontal fibers from the rest of the frontal lobe. Dr. Watts was aghast when he discovered Freeman performing this procedure in their office and their partnership abruptly ended. Freeman went on, however, to demonstrate this procedure in mental hospitals across the United States. By 1951 nearly nineteen thousand patients had been lobotomized in the United States. Perhaps the most famous patient to undergo a trans-orbital lobotomy was Rosemary Kennedy, sister to President John F. Kennedy. Lobotomies were performed at two state mental hospitals in Indiana, Logansport State Hospital and Evansville State Hospital.
In 1938 Donnadieu first reported atropine coma therapy. Atropine coma therapy was used for treating agitation experienced during psychoses. This form of treatment consisted of the induction of a prolonged four to ten-hour coma by the intramuscular injection, intravenous injection, or even intra-carotid injection of massive doses (150-200 mg) of atropine. Although sedatives were given before such treatments, this type of treatment never became wildly popular with patients because of the disorientation, delirium, hallucinations, rapid heart rate, and nausea and vomiting caused by the atropine. These treatments were labor intensive because of the extensive pretreatment medical workups and extensive medical monitoring required during the duration of the coma. The usual course of treatment consisted of five to twenty-five treatments given two to six times a week. By 1958 Forrer and Miller reported that they were able to terminate the atropine coma with physostigmine. Side effects of atropine coma therapy included urinary retention and hyperthermia. Mortality ranged from none in one large series of three thousand patients to one in four hundred patients. Atropine coma therapy never gained wide acceptance in the United States and was mostly used in a few state hospitals from about 1950 through about 1970. Evansville State Hospital used atropine coma therapy.
These crude somatic treatments came to an abrupt end, however, when Thorazine was brought to the United States in the mid-1950s. Thorazine, or chlorpromazine hydrochloride, was first synthesized in France in 1950 and the first published clinical trial was performed in Paris in 1952 by Drs. Jean Delay and Pierre Deniker, both French psychiatrists. Chlorpromazine was first marked in Europe as Largactil. It and other similar antipsychotic medications revolutionized the treatment of schizophrenia and enabled many long-term patients with schizophrenia to be released from state psychiatric hospitals.
In 1948 John Cade, M.D., (1912-1980), an Australian psychiatrist, discovered that lithium carbonate an oxidized salt of the metal lithium, stabilized the mood of those suffering from manic depression, now known as bipolar disorder. Mogens Shou, M.D., (1918-2005), a Danish psychiatrist replicated Cade's results in a double-blind study published in 1954. By the mid-1960s lithium carbonate was in wide use in the United States. It was the first pharmacologic agent to effectively treat both the mania and depression of bipolar disorder. A research group at Larue Carter Memorial Hospital was involved in the early testing of lithium carbonate in the United States.
While the early somatic treatments developed in the late nineteenth and early twentieth centuries in the United States and Europe, a revolution in thinking about the psyche was brewing in Austria, Germany, and Great Britain. Sigmund Freud, M.D., (1856-1939), an Austrian neurologist, was a leading proponent of talk therapy. Through his theories about the unconscious, defense mechanisms, psychosexual development, the structure of the psyche, and his therapeutic concepts including free association and transference, Freud founded the psychoanalytic school of psychiatry. In September 1909 Freud came to the United States and lectured at Clark University in Worcester, Massachusetts. Freud's youngest child, Anna Freud (1895-1982), along with Austrian-born British psychoanalyst Melanie Klein (1882-1969), were cofounders of psychoanalytic child psychiatry. The accomplishments of these pioneers and their followers form the basis for most of our modern ideas about adult and child psychotherapy. Psychoanalytic training centers were established in the United States, initially mostly on the East Coast. Two such centers, in Chicago and Cincinnati, lay just outside Indiana's borders. Indiana narrowly missed out on having a psychoanalytic treatment center when Herbert Gaskill, M.D., chairman of the Indiana University School of Medicine Department of Psychiatry, left Indianapolis and moved to Denver Colorado where he established the Colorado Psychoanalytic Institute.
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