Our Society Needs To Rethink How We Treat The Mentally Ill

Buffalo State Asylum for the Insane

Buffalo State Asylum for the Insane
The Granger Collection, NYC

The City Journal has a long, interesting article about the history of how our society has cared for the mentally ill. In the late 1800′s Dr. Thomas Kirkbride, a founding member of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which was the precursor to the American Psychiatric Association, promoted a method of housing and treating those with mental disorders in a humane way. His ideas pretty much became standard – beautiful asylums, sitting on manicured, park-like grounds, were constructed across the country and they were run by the states. His thinking was that if the insane were treated humanely in decent surroundings that they might be returned to sanity.

It sounds like it worked out pretty well until the 1930′s or so, and things went downhill from there. (I notice that psychiatry took a turn for the worse around the same time the progressive eugenicists were doing their thing.)

At a time when the medical science of mental illness was in its infancy, the Kirkbride Plan created alternative, protected worlds for patients. It echoed many of today’s more holistic approaches to treatment by encouraging patients to participate in social activities, games, and crafts. Kirkbride institutions often sported their own baseball diamonds, golf courses, bakeries, bowling alleys, ice cream shops, dairy farms, gardens, and stages for plays and other performances.

But in the twentieth century, a shadow fell over the Kirkbride asylums, as doctors there began using more invasive procedures. The Austrian psychiatrist Manfred Sakel introduced insulin shock therapy, now known as insulin coma therapy, in the 1930s. Electroshock therapy arrived from Italy soon after. Both treatments induced seizures to alter brain chemistry in patients with depression and schizophrenia. In 1949, the Portuguese neuropsychiatrist Egas Moniz won a Nobel Prize for developing the frontal lobotomy, which he had invented in 1935. Walter Freeman, a clinical neurologist in Washington, D.C., further popularized the treatment through his own outpatient procedure, which came to be known as the transorbital, or “ice-pick,” lobotomy. Freeman performed the ten-minute operation—in which he inserted long metal rods around the eyeballs of his patients and penetrated, stirred, and severed their frontal brain matter—some 3,500 times. Among the recipients of lobotomy was 23-year-old Rosemary Kennedy, the future president’s sister, who wound up severely disabled by the procedure in 1941.

As her siblings embarked on a lifetime crusade against institutionalization and invasive treatment, they joined a growing chorus that included civil libertarians and conscientious objectors who had been assigned to work in the asylums during World War II. Starting in the 1950s, these critics could tout powerful new antipsychotic drugs, such as Thorazine, as an alternative to institutionalization. By temporarily blocking receptors in the dopamine pathways, the drugs could inhibit psychotic hallucinations and produce a semblance of clarity for many patients—so long as the drugs were regularly administered. The miracle medicines seemed to obviate the need for separating the mentally ill from the rest of society.

But as it turned out, those medicines really weren’t miracles in most cases.

Read the whole thing, it’s long but worth the time. Most of the Kirkbride institutions have been shut down and are now in extreme states of disrepair. Instead of the states managing the care of the mentally ill, we now have the federal government running things. That’s not working out very well. It calls to mind this photo essay I saw in the Post Standard the other day of the homeless and hopeless in Syracuse, NY. It’s heartbreaking. We took better care of the mentally ill in 1900 than we do today. Now we just let them live this cold, hungry, hopeless existence on the streets of our cities while we look the other way. We have record numbers of citizens of sound mind and body receiving food stamps and other welfare benefits, while those who really, truly need our help are left to dumpster dive for their subsistence. Not to mention the relatively few who go on murderous rampages leaving us scratching our heads and wondering why.

Maybe it’s time to take another look at the Kirkbride plan. I think he was on to something.

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Just as a side note, I majored in psychology in college. (I know, dumb move.)  I don’t recall ever learning about Dr. Kirkbride. They were too busy pushing the teachings of guys like that pervert Alfred Kinsey instead.

Update: Linked by The Camp of the Saints and The Necropolitan Sentinel – thanks!