From a patient's perspective: Clifford Whittingham Beers' work to reform mental health services.

Abstract

The founder of the mental hygiene movement, Clifford Whittingham Beers (1876–1943) launched one of the earliest client-advocate health reform movements in the United States. A former patient who was institutionalized for three years, Beers led national and international efforts to improve institutional care, challenge the stigma of mental illness, and promote mental health. His efforts resulted in a major shift in attitudes toward mental illness, as well as the introduction of guidance counselors in US schools and the inclusion of evidence of a defendant's psychological state in law courts.1 Beers was born in New Haven, Connecticut, in 1876, to Ida Cooke and Robert Beers. The couple suffered a series of tragedies, including the death of one child in infancy. A second child, who began having seizures as a teenager, also died early, and as a young man Clifford worried that he would develop the same condition. Although he and three other siblings lived into adulthood, all died in mental health institutions—two by committing suicide.2 Beers graduated from Yale University's Sheffield Scientific School in 1897, after experiencing frequent bouts of depression as a student. Over the next three years, he worked as a clerk in New York City, gradually becoming increasingly anxious and distressed. In June 1900, he returned to the family home and tried to kill himself by throwing himself from his bedroom window. While in the hospital recovering from these injuries, he experienced hallucinations and paranoia. As he convalesced at home, his mental state deteriorated further and he gave up speaking, convinced that he and his family were in grave danger. His family decided to place Beers in an institution for the care of the mentally ill. Between 1900 and 1903, he was hospitalized at Stamford Hall, The Hartford Retreat, and the Connecticut State Hospital at Middletown. He was mistreated by staff, experiencing physical abuse and degrading treatment, and resolved to campaign for reform. After his release, he returned to New York City but suffered a relapse and spent the last few months of 1904 back at the Hartford Retreat. In January 1905, he left the institution and completed a book about his experiences, A Mind That Found Itself (1908).3 The book made an immediate impact and helped to launch the mental health reform movement in the United States. By acknowledging the seriousness of his condition as well as highlighting the brutal practices that may have slowed his recovery, Beers' example helped to remove the stigma of mental illness among the general public. Psychiatrist Adolf Meyer wrote an enthusiastic review and united with Beers in his campaign for reform.4 Two months after the publication of his book, Beers joined with Meyer, physician William H. Welch, and philosopher William James to found the Connecticut Society for Mental Hygiene to improve standards of care and attitudes toward the mentally ill, and to prevent mental illness and promote mental health. Several other states joined the movement and established their own societies. In 1909, Beers launched the National Committee for Mental Hygiene, which spearheaded legal reforms in several states, provided grants for research into the causes of psychiatric disorders, and funded training for medical students. The organization also published the quarterly magazines Mental Hygiene and Understanding the Child to raise public awareness of mental health issues. Beers married Clara Louise Jepson in 1912, but the couple decided not to have any children as a result of their concerns about hereditary mental illness.1 In 1930, Beers organized the International Congress for Mental Hygiene in Washington, DC, attended by representatives from 53 countries. The meeting launched international reform efforts and led to the development of the International Committee for Mental Hygiene. Beers became overwhelmed and depressed while fundraising for the organization, and in 1939, he committed himself to Butler Hospital in Providence, Rhode Island, where he died four years later.5 Beers received great recognition during his lifetime for his pivotal role in the mental health movement. He was awarded an honorary degree by Yale University for his contribution to humanity and in 1933, Welch presented him with a book of tributes from hundreds of leading figures involved in mental health care. In 1950, the International Committee joined with the National Mental Health Foundation and the Psychiatric Foundation. Known today as Mental Health America, the organization continues Beers' mission to raise awareness and promote the highest standards in mental health services.6