Psychopathic Hospital Research Articles

The psychopathic hospital.

A new psychiatric institution emerged in the late nineteenth and early twentieth centuries: the psychopathic hospital. This institution represented a significant development in the history of psychiatry, as it marked the profession's reorientation from asylum-based to hospital-based care, and in this way presaged the deinstitutionalization movement that would begin half a century later. Psychopathic hospitals were also an important marker of psychiatry's efforts to redefine its professional boundaries and respond to its vociferous critics. This entailed both a rapprochement with general medicine in an effort to assert its scientific bona fides and a redefinition of its scope of practice to absorb non-certifiable 'borderland' cases in order both to emphasize non-coercive treatment and to enlarge the profession's boundaries.

Choosing Cures for Mental Ills: Psychiatry and Chinese Medicine in Early Twentieth-Century China

Abstract In the late nineteenth and early twentieth centuries, Western physicians and missionaries opened several psychopathic hospitals in urban China, including the John Kerr Refuge for the Insane in Guangzhou and the Beijing Psychopathic Hospital. Although local families relied on the charitable services offered by these facilities, they generally remained ambivalent about, if not outright resistant to, neuropsychiatric theories and practices. This article examines how and why ordinary families made medical decisions when faced with the problem of mental illness. In contrast to previous research on biomedicine in the Republican period (1911–1949), which has tended to emphasize issues relating to ideology and cultural nationalism, this paper argues that support of (and resistance to) neuropsychiatry was less often framed in terms of identity politics than in terms of far more practical concerns, such as access, intelligibility, and effectiveness. Disparities in how “mental” disorders were conceptualized in Chinese and Western medicine, problems pertaining to translation and communication, and the very ineffectiveness of psychiatric treatment itself help to explain why families may have patronized psychopathic hospitals but remained unconvinced by the epistemic foundations of neuropsychiatric medicine.

In Defence of Theodore Gray: Architecture as a Vehicle for Re-evaluating a Doctor's Commitment to Patient Care

Theodore Gray was director-general of New Zealand's mental hospitals from 1927–47. During this time the psychopathic hospital, electroconvulsive therapy, and effective psychopharmaceuticals all became available for the treatment of mental illness, yet Gray continued to believe that a suitably designed hospital environment was the best means of treating mental illness. Contemporary historians have criticised Gray's leadership as institutionalised and conservative; limited by his faith in the villa hospital. This paper argues that Gray was an innovator who understood the drawbacks of asylum care and whose architectural developments, specifically at the Kingseat and Lake Alice hospitals, confirmed both a remarkable commitment to open-door hospital practices and a sincere desire to improve the delivery of patient care. These architectural responses could have improved mental hospital design internationally.

The Invention of Madness: State, Society, and the Insane in Modern China by Emily Baum

Reviewed by: The Invention of Madness: State, Society, and the Insane in Modern Chinaby Emily Baum Hsuan-Ying Huang (bio) Emily Baum. The Invention of Madness: State, Society, and the Insane in Modern China. Studies of the Weatherhead East Asian Institute. Chicago and London: The University of Chicago Press, 2018. ix, 267 pp. Hardcover $112.50, isbn978-0-226-55842-0. Paperback $37.50, isbn978-0-226-58061-6. The Invention of Madnesstraces how Chinese society, with its traditional notions of madness, evolved to accommodate and, to some extent, assimilate [End Page 179]the new conceptions of mental illness during the first three or four decades of the twentieth century. Author and medical historian Emily Baum proposes the term "invention" as a useful heuristic device for analyzing the introduction and reception of modern psychiatry in non-Western societies—in this case in the city of Beijing. Madness, she contends, underwent "an ongoing process of becoming" (p. 187) during the period; its associated ideas and practices were created and re-created along the way according to the interests and needs of local actors who were brought into contact with the condition. Emphasizing concrete actions that involve knowledge production and identity formation across time, space, and society, she challenges the common imaginary that psychiatric modernity can be transplanted or adopted in a new environment as a whole and ready-made package. Baum uses new materials unearthed from several archives, the most important of which are the Beijing Municipal Archive and that of the Rockefeller Foundation. The story of the Beijing Municipal Asylum—China's first public asylum and later a hospital where the country's initial institutionalization of psychiatry occurred—constitutes a major thread through the book. Established under the auspices of the city's police department, it eventually morphed into the Beijing Psychopathic Hospital with the aid of the Rockefeller Foundation-affiliated Peking Union Medical College (PUMC). However, the book is far from an institution-centered account; it explores beyond this unique asylum-hospital, foraying into other parts of the therapeutic landscape and Chinese society. Medical anthropologists would feel at home reading this book as it tacitly endorses medical pluralism, the model proposed by the discipline's founders for the health care landscape of a socially and politically complex society. Arthur Kleinman, for instance, divides the medical system in 1970s Taiwan into professional, folk, and popular domains, each of which is culturally shaped and furnished with a distinct explanatory model that constructs its clinical reality. 1Baum seems to have turned this synchronic model into a diachronic one. The book begins and closes with two apparently different yet similarly heterogeneous pictures, one set in the late Qing dynasty and the other during the onset of the Second Sino-Japanese War in 1937. The intervening chapters offer multiple snapshots of the time line spanning the two periods, with considerable attention focused on the overlaps between seemingly incompatible domains where inventions and reinventions happened. The outcome is a historical narrative that is dynamic and remarkably kaleidoscopic. Chapter 1 (Contracting the "Mad Illness") examines an era still unaffected by Western psychiatry, a world in which madness—or more precisely "mad illness" (fengbing)—was not a discrete illness category but an epiphenomenon with a plurality of somatic, emotional, moral, and supernatural etiologies. [End Page 180]Chinese medicine considered the heart as the locus of cognition and recognized an association between madness and mucous congestion, whereas folk religious healers invoked demonic possession as the cause. The Qing law dictated that home confinement of the insane was the responsibility of the family, but its lax enforcement made wandering patients a common street scene that Western missionaries found deplorable. The state, as chapter 2 (The Birth of the Chinese Asylum, 1901–1918) describes, shifted toward a paternalistic stance with the founding of the Beijing Municipal Asylum in 1908. This institution, initially a subsidiary of the Municipal Poorhouse, was administered by the police; it was nowhere near a modern hospital, although Chinese medicine did play a marginal role in it. Incarceration was its main function, as the police began to take those perceived as mentally deranged and threatening to the public order into custody. Through...

He Wanted the Moon: The Madness and Medical Genius of Dr. Perry Baird, and His Daughter’s Quest to Know Himby Mimi Baird, with Eve Claxton; New York, Crown Publishing, 2015, 250 pages

Back to table of contents Previous article Next article Book ReviewsFull AccessHe Wanted the Moon: The Madness and Medical Genius of Dr. Perry Baird, and His Daughter’s Quest to Know HimJeffrey L. Geller, M.D., M.P.H.Jeffrey L. GellerSearch for more papers by this author, M.D., M.P.H.Published Online:3 Oct 2016https://doi.org/10.1176/appi.ps.671006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by Mimi Baird, with Eve Claxton; New York, Crown Publishing, 2015, 250 pagesIn He Wanted the Moon, Mimi Baird sets out to tell the story of her father. In 1944, when Mimi Baird was six years old, her father, Perry, stopped coming home, for reasons never explained to her as a child. Perry Baird had been admitted that year to Westborough State Hospital (WSH) in Massachusetts, the fourth hospital to which he had been admitted for manic episodes. He was 41 years old, stayed in the hospital 95 days, and never rejoined the family. Her father was always a mystery to Mimi, until she inherited the manuscript for a book he never finished that recounts his experiences with bipolar disorder.Ms. Baird has created a first-person account that speaks from three perspectives: her father’s, that of the psychiatric hospital medical records, and her own. One unfortunate shortcoming of the book is that Ms. Baird writes well (with the assistance of Eve Claxton) and has interesting observations to share, whereas her father’s writing makes a lot of detours before getting to cogent or engaging points.The medical records are quite interesting, providing the reader glimpses of psychiatric treatment in the 1930s–1940s. Interventions tried with Perry Baird included, for example, an 11-day narcosis treatment using sodium amobarbital. He provides views of other treatments of that era, for example, “constant restraint,” which was the maintenance of restraint that alternated between straightjackets and cold packs. Perry Baird experienced much of his treatment as “torture” devised by “state hospital psychiatrists.”Historical figures in psychiatry make their appearance. Dr. Baird came from a family of means, and he was able to get a specially arranged consultation. Harry Solomon, who was superintendent of the Boston Psychopathic Hospital and who subsequently became the Massachusetts Commissioner of Mental Health, came to see him at WSH. Dr. Solomon opined, “The manic does not know what he is doing,” and Perry Baird’s response was “Even a man of distinction, experience and education could fail to understand the manic.”Perry Baird was transferred from WSH to Balpate Hospital, a private psychiatric hospital, where his attending psychiatrist was a friend and colleague. He lasted there but two weeks. His property destruction and threats to nursing staff were too much for the private hospital, and he was sent back to WSH. Three weeks after his return to WSH, Perry Baird was notified that his license to practice medicine had been revoked.Perry Baird had a great disdain for the treatment he received at WSH: “WSH and other places like it have nothing to offer; nothing but a jail-like incarceration, brutality, and ugliness. The patients who come here recover not because of the treatment they receive, but in spite of it. Some are submerged by it, die of it.” After about one month of this final WSH admission, Perry Baird gets his freedom by escaping.Perry Baird tried and failed to connect with earlier acquaintances. He tried and failed to connect with his daughter, Mimi. He described his feelings of being victimized by stigma against people with a mental illness. He found refuge in alcohol. He died alone in a hotel room in Detroit at the age of 55.The better part of the book is Mimi Baird speaking of her life, which constitutes the last one-third of the book. It turns out Mimi’s mother had the same experience as she did—a father with bipolar disorder who left the family when his daughter was a child (in this earlier instance the daughter was ten, and her father spent the rest of his life in Norristown State Hospital). Part of Mimi Baird’s story is her quest to put together her father’s life—hospitalizations at Boston Psychopathic Hospital and Butler Hospital before the admittance to WSH and later, Galveston State Hospital. Ms. Baird learns that her father, a dermatologist, made a quite significant contribution to the psychiatric literature. I suggest you check it out: http://journals.lww.com/jonmd/citation/1944/04000/biochemical_component_of_the_manic_depressive.3.aspx.And then get a copy of He Wanted the Moon. There’s a lot more here than in many first-person accounts.Dr. Geller is the medical director at Worcester Recovery Center and Hospital, Worcester, Massachusetts, and he is editor of the Book Reviews section.The reviewer reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byNone Volume 67Issue 10 October 01, 2016Pages e12-e13 Metrics PDF download History Published online 3 October 2016 Published in print 1 October 2016

Smiling Response, Stranger Anxiety, and Autistic Disorder

Letter to the Editor I would like to suggest that an enterprising young colleague conduct a series of experiments to explore the following hypotheses: One: Infants who develop autism spectrum disorder (ASD) have an absent, delayed, or modified ‘‘Smiling Response’’. Two: ‘‘Infants who develop ASD have an absent, delayed, or modified ‘‘Stranger Anxiety Response’’. The background for this suggestion comes from a lecture I attended while a resident in psychiatry at the Boston Psychopathic Hospital, Harvard Medical School in 1958. Dr. Rene Spitz, the world-renowned Austrian psychologist and expert on infant development was presenting at Grand Rounds; (To the best of my recollection).

Frankwood E. Williams (1883–1936)

FRANKWOOD E. WILLIAMS was convinced that the new science of human nature would not only provide treatment methods for severe and persistent forms of mental illness but also intervention strategies for their prevention. During his association with the National Committee for Mental Hygiene from 1916 to 1931 (the last 9 years of which he served as medical director), Williams stimulated, guided, and oversaw the implementation of a wide range of preventive methods. The National Committee was founded in 1909 by Clifford W. Beers, who had spent 3 years in mental hospitals, and Adolf Meyer, by then the foremost American psychiatrist. It aimed to increase the status of psychiatry, placing the discipline on a sound scientific footing by arranging funding for medical research and improving the care provided to individuals institutionalized in mental hospitals. At that time, there were no effective treatments for severe and persistent forms of mental illness. The Committee therefore embraced the ideal of prevention as the most effective measure to decrease the incidence of mental illness. Williams had studied medicine at the University of Michigan in Ann Arbor and specialized in psychiatry at one of the first hospitals established for the scientific study of mental illness in the United States. His teacher, Albert M. Barrett, adhered to a strictly somatic approach within psychiatry, as did E. E. Southard, director of the Boston Psychopathic Hospital, where Williams spent 2 years after the completion of his studies in 1913. Southard was also known for his interest in social issues such as alcoholism and criminality, issues that also became of interest to Williams. During the first decade of operation, the psychiatrists associated with the National Committee conducted a number of surveys that demonstrated the social significance of mental illness. Williams participated in a survey of prisons in the county of New York that showed that a significant percentage of individuals confined in them suffered from mental illness.1 Among recidivists, the number was even higher. To Williams, these findings indicated that judges and jail keepers were dealing with mental illness without any insight into its nature. These findings inspired the psychiatrists of the National Committee to develop clinics for the treatment of juvenile delinquents. With early intervention, it was thought, a life of crime could be prevented. In the 1920s, mental hygienists became interested in childhood as the period during which preventive measures could most effectively be implemented. In 1925, Williams traveled to Vienna to undergo psychoanalysis with Otto Rank, who at that time was one of Sigmund Freud’s closest disciples. According to Williams, Freud’s psychoanalysis indicated that virtually all problems later in life were caused by difficulties in early childhood. To prevent these problems, intervention strategies that targeted early childhood were needed. The National Committee oversaw the establishment of a dozen Child Guidance Clinics where parents confronted with troublesome children could ask for help. Williams actively promoted progressive education because he believed that only a complete transformation of the educational system could make it congruent with the demands of emotional development. He was also actively involved in the establishment of several college mental hygiene programs in the belief that college students, the future leaders of society, needed to be free of emotional problems.2 At the time Williams wrote “Finding a Way in Mental Hygiene,” he had already announced his resignation from the National Committee and had come to doubt the effectiveness of its programs. He recognized that to realize the sometimes utopian ideals of the mental hygiene movement, only the complete reorganization of American society along the lines of the science of human nature would do. He began to spend most of his time conducting psychoanalytic psychotherapy, which he had come to see as the only effective way to change human nature. In 1929, the stock market crashed, which was followed by a worldwide economic depression. For most mental hygienists, the consequences of the Depression were disconcerting and at times even alarming. Because of widespread economic insecurity, the incidences of depression, anxiety, and suicide were at an all-time high. To counter this, they argued that structural instead of individualized measures were urgently needed. In 1931, Williams visited the Soviet Union and was astounded by what he witnessed in the carefully maintained villages designed for visitors from the West, where a life of plenitude, happiness, and mental health was enjoyed by all. Williams returned as a convert to the Soviet cause and championed its accomplishments during the remaining 5 years of his life.3 He had never been aware of the atrocities of Stalin’s regime and died in the conviction that the ideals of the mental hygiene movement could be achieved through structural and political means only.

Infectious insanities, surgical solutions: Bayard Taylor Holmes, dementia praecox and laboratory science in early 20th-century America. Part 2

Part I of this article on Bayard Taylor Holmes (1852-1924), a Chicago physician and surgeon, detailed his laboratory research on dementia praecox and his presumed discovery in 1915 of evidence in support of a focal infection theory of its aetiology. In May 1916 he began to experiment with a rational therapy based on this theory: abdominal surgery and daily irrigations of the colon. He operated first on his own son, who had been afflicted with dementia praecox since 1905, but he died four days later. Part II deals with Holmes' continued surgical treatment of dementia praecox patients and the outcomes of the operations. It also describes how Holmes set up the short-lived Psychiatric Research Laboratory of the Psychopathic Hospital at Cook County Hospital in 1917, and discusses the dismissal of a key research colleague, H. M. Jones, whose experimental results directly contradicted those of Holmes.

The history of psychogeriatrics in the United States.

During the late 19th and early 20th centuries, elderly individuals with severe mental illness living in the United States were cared for in state-run facilities that went by various names (asylums, psychopathic hospitals, state hospitals, state mental hospitals, and medical centers). Since the beginning of the 20th century, approximately 20% of patients in state hospital facilities had brain diseases such as dementia, usually complicated by behavioral disorder.

American Psychiatrists and the Modern Man, 1900 to 1920

This article examines two competing popular and professional constructions of masculinity in the first two decades of the century. One was the masculinity of youth, separatist and oppositional vis-à-vis women; the other was the respectable masculinity of bread-winning and married life. Drawing on psychiatric case records (from the Boston Psychopathic Hospital) as well as a range of published sources, this article argues that professionals advocated both constructions of masculinity and that men lived by both in their everyday lives. Particular attention is given to the role of sexuality in the consolidation of male identities; to “failures,” designated psychopaths; to battles over alcohol, with psychiatrists unwilling to align themselves too closely with women and prohibitionist aims; and to World War I and male hysteria.

Psychiatry and its origins

Psychiatry and Its Origins Jack D. Pressman Elizabeth Lunbeck. The Psychiatric Persuasion: Knowledge, Gender, and Power in Modern America. Princeton: Princeton University Press, 1994. xiv + 431 pp. Ill. $29.95; £25.00. The author of this ambitious, extensively researched and documented monograph aims to examine “the process by which psychiatrists in the early twentieth-century effected [a] momentous shift in their discipline’s foundations and fortunes”—namely, that of creating “a new psychiatry, . . . a discipline that deals as much with everyday problems as with established mental diseases” (pp. 3–4). By the 1930s and 1940s, the new scientific unit of analysis in psychiatry was neither “the symptom [n]or even the disease,” but “the whole person and his or her fit to the environment” (p. 306). It is this psychiatry, “not the psychiatry of serious mental maladies,” that is the “predecessor of the discipline that today enjoys a measure of cultural authority” (p. 46). In Lunbeck’s estimation, the true origins of psychiatry in America thus have yet to be explored, in spite of the enormous mass of historical literature on the subject that has already accumulated. The existing historiography, she explains, generally sorts out into three camps, each severely limited. Stories written by friends of the discipline tend to focus on the scientific or medical developments, ignoring the all-important turn to the normal. Ironically, this same defect is exhibited in the second kind of accounts, those written by psychiatry’s critics who have been preoccupied with the matter of social control as perpetrated within the [End Page 129] large asylums. A third kind of story, the evolution of psychoanalysis—with its elaboration of the “psychopathology of everyday life”—seems more on target, but Lunbeck dismisses this approach as well, indicting it as anachronistic. In her assessment, the new psychiatry emerged in the beginning of the second decade of this century; yet Freud did not substantially influence the American profession until after World War I. Lunbeck draws our attention instead to the emergence of a novel institutional form in this period, the urban psychopathic hospital, and to the dramatic transformations it engendered in the way psychiatrists viewed both their profession and their discipline. One of the most visible or important of these institutions was the Boston Psychopathic Hospital (BPH), which opened its doors in 1912. The bulk of this monograph is thus a richly textured reconstruction of what happened within the walls of the BPH—and outside, through the reaches of its innovative program of psychiatric social work. In Lunbeck’s version of the events, the bold new extensions of psychiatry did not follow a consciously planned or well-articulated professional agenda. Rather, the unusual mandate of the psychopathic hospitals set in motion a series of unintended consequences that had a profound effect. Unlike their aging cousins, the large state hospitals (in which the severely insane were warehoused into underfunded, cramped facilities far removed from contact with society or even the general medical community), the psychopathic hospitals were envisioned as state-of-the-art medical sites that would combine teaching, diagnostic, and research functions with a commitment to serving the myriad problems of the rising metropolises. Here, staff psychiatrists faced the expected mix of psychoses, dementias, and nervous ills that filled up the wards of the state hospitals. But they also encountered a very different type of patient as referrals began to stream in from a growing list of civic agencies that included juvenile courts, habit clinics, social welfare foundations, and the police. Some clients even voluntarily walked through the clinic doors, seeking advice. Consequently, many of the patients were clearly not insane but simply troubled or troubling. In grappling with such cases, the psychiatrists discovered a new world of disorder ripe for colonization. The lessons they learned would eventually allow them to speak to the problems that surfaced in the home, the school, the workplace, and everywhere else; in pursuing these issues, the psychiatrists would radically move the center of their profession away from the asylums and into private practice—and would establish a new basis for their cultural authority. Lunbeck’s story is explicitly Foucauldian, both in its overall narrative form and in the methodology brought to...

The psychiatric persuasion: knowledge, gender, and power in modern America

In the years between 1900 and 1930, American psychiatrists transformed their profession from a marginal science focused primarily on the care of the mentally ill into a powerful discipline concerned with analyzing the common difficulties of everyday life. How did psychiatrists effect such a dramatic change in their profession's fortunes and aims? This study focuses on the revelatory ideas of gender that structured the new psychiatry of the normal, a field that grew to take the whole world of human endeavour as its object. The author locates her study in early 20th-century Boston, providing a vivid picture not only of the Boston Psychopathic Hospital, upon whose patient records she has drawn extensively, but also of the increasingly urbanized society that shaped its goals and practices. As she tells a variety of stories about individual patients, psychiatrists and social workers, Lunbeck shows that early 20th-century Boston offered psychiatrists a vast reservoir of material with which to work. Psychiatrists made strenuous attempts to deal with the treatment of syphilis and with other newly urgent social issues, such as immigration, poverty, delinquency and drunkenness.

The alchemy of mental health policy: homelessness and the fourth cycle of reform.

As noted in the literature'-3 the history of public mental health policy is characterized by a cyclical pattern of institutional reforms. Each cycle was marked by public support for a new environmental approach to treatment and an innovative type of facility or locus of care. The first cycle of reform in the early 19th century introduced moral treatment and the asylum;'7 the second cycle in the early 20th century was associated with the mental hygiene movement and the psychopathic hospital;8'2 and the third in the mid 20th century developed out of the community mental health movement and its support for community mental health centers.1316 Each of these reforms promised that early treatment of acute cases would prevent chronic mental illness. Each innovation proved successful with acute and milder-not chronic-forms of mental disorder, yet failed to eliminate chronicity or to fundamentally alter the care of the severely mentally ill. In each cycle, the optimism of reform gave way to pessimism and therapeutic nihilism toward the increasing numbers of incurable chronic mental patients. In the face of an expanding population of needy patients, public support turned to neglect. The reform movements that stimulated these cycles often gained momentum by transforming social problems (e.g., dependency, senility, criminality, poverty, and racism) into mental health issues. Failure to address the basic social problems themselves has resulted in a repeating cycle of policies which only partly accomplish the goals of their activist proponents. This paper examines a fourth cycle of reform emerging in the past decade in response to the failures of community mental health and deinstitutionalization. The new reform advocates creating community support systems, a broad network of mental health and social welfare services for care of the chronically mentally ill in noninstitutional settings. This reform movement is different becaue it directly addresses the needs of the chronically mentally ill rather than promising to prevent chronicity through the early treatment of acute cases and because it recognizes the problem of the chronically mentally ill as a public health and social welfare problem. The breadth of this mandate, however, is threatened by shrinking health and welfare resources and by a growing expectation that it will solve the problem of homelessness.3

Planning services for the mentally handicapped: a look at Sweden.

The modern hospital does credit to latter day civilisation. Physical restraint is no longer practised. Neat dormitories, cosy single rooms, and sitting and dining rooms please the eye. In place of bare walls and floors and curtainless windows are pictures, plants, rugs, birds, curtains and, in many asylums, even the barred windows have been abolished.1 This quotation from the Encyclopaedia Britannica of 1911 is part of an article on the mentally ill and mentally handicapped, which ends with the sentence, But the ideal system is that of the psychopathic hospital and the colony for the insane.

"I Am Not Contented": Female Masochism and Lesbianism in Early Twentieth-Century New England

Previous articleNext article No AccessArchives"I Am Not Contented": Female Masochism and Lesbianism in Early Twentieth-Century New EnglandMartin Bauml DubermanMartin Bauml Duberman Search for more articles by this author PDFPDF PLUS Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinkedInRedditEmail SectionsMoreDetailsFiguresReferencesCited by Signs Volume 5, Number 4Summer, 1980Women: Sex and Sexuality Article DOIhttps://doi.org/10.1086/493771 Views: 4Total views on this site Copyright 1980 The University of ChicagoPDF download Crossref reports no articles citing this article.

The Childhood Emotional Pattern and Corey Jones: A Psychoanalytical Biography

This book, a thinly veiled autobiography, is labeled "unique in that it deals with a healthy rather than an abnormal subject... the<i>first</i>to trace its subject from infancy to old age. It clearly demonstrates the profound impact of childhood emotional patterns on marriage, career, and other aspects of adult life." The author, Leon J. Saul, has had a life strictly comparable with that of the fictitious Corey Jones. He was born in 1901 in New York City, graduated from Harvard Medical School in 1928, and, after a medical internship, had his psychiatric training at the Boston Psychopathic Hospital. He then held a Commonwealth Fellowship, studied with Dr Franz Alexander, married a graduate of Radcliffe, and had three daughters and nine grandchildren. In 18 of the book's 31 chapters, the opening sentence reads, "said Corey Jones." Most likely, the book's Dr Camp is Macfie Campbell, who was professor of psychiatry

Behavioral precipitants of restraint in the modern milieu

Physical restraint of the psychiatric patient is a persisting reality in the acute management of uncontrolled, disruptive, or violent behavior. Depite advances in pharmacologic and milieu management, the “quiet room”, locked seclusion, or mechanical restraint often remain the last resort in control of the acutely disturbed patient. In this era of nonrestraint, little is taught or written of the practice of restraint. The literature contains few systematic studies of its persistence in modern milieu wards. The practice of restraint is viewed in resident education as an embarrassing anachronism, yet persists in some form in most clinical settings. This incongruity between teaching and practice led us to systematically survey our own use of physical restraint in an acute inpatient milieu. The diagnosis of patients restrained and the behavioral precipitants of restraint are the focus of this report. The modern therapeutic milieu stands in philosophic opposition to physical restraint by virtue of widespread acceptance of dynamic management of violent patients and confidence in the efficacy of pharmacologic treatment. The clinical belief that dynamic understanding in experienced hands can render a potential combatant “quickly cooperative” 1 is widely held. Following Connolly's famous admonition that “restraint and neglect are synonymous,” 2 the milieu staff shares responsibility for the patient's disruptive behavior. Violence and impulsive behavior are not so much the product of autistic process as they are defensive responses to “ambiguous, confusing, belligerent or threatening treatment.” 1 A violent outcome and resort to physical restraint implies staff failure and a punitive response to fear of the threatening patient. In his study of factors sustaining the practice of locked seclusion at the Boston Psychopathic Hospital, Greenblatt identified the “evils” of “overroutinization of use, lack of knowledge concerning the patient's feelings, poor communication about these feelings among the staff and lack of adequate motivation for serving the basic psychologic needs of the patient.” 3 Attention to these dynamic considerations in a therapeutic milieu augmented by the use of potent pharmacologic agents has greatly reduced but not eliminated the use of physical restraint. The question of who is restrained on the modern milieu ward and why must be asked in this dynamic context.

The Iowa 500: field work in a 35-year follow-up of depression, mania, and schizophrenia.

This paper reports a follow-up and family study being carried out at the University of Iowa College of Medicine on primary affective disorders and schizophrenia in patients hospitalized thirty-five years ago. The purpose of this project is to obtain objective data to shed light on our understanding of these two major functional psychoses -- their diagnostic validity, clinical features, course and outcome, heterogeneity, life histories, related illnesses and characteristics of familial association. This research started with 525 patients selected from inpatients consecutively admitted to the Iowa Psychopathic Hospital between 1934 and 1944, and with a stratified random sample of 160 surgical patients admitted to the University General Hospital during the same period. A specially designed structured interview form -- the Iowa Structured Psychiatric Interview (ISPI) -- is used to follow up all living index patients, and as many of their living first-degree relatives as possible. At this time, over one-third of the estimated total study population of three thousand patients and relatives have been personally interviewed, and the preliminary findings are reported here.

A fifty-year review of experiences with dyslexia

Fif ty years ago, in 1923, I transferred from the University of Chicago where I had been studying medicine and pathology to the State University of Iowa, at tracted by S a m u d T. Or ton ' s reputat ion as a scholar and researcher of the brain. At the State University of Iowa I lived at the Psychopathic Hospital which was Dr. Orton 's headquarters. There I was officially a neuropathologist, did the routine studies of autopsied brains, taught neuropathology to the medical students, carried out research in neuropathology with Dr. Orton, and continued my medical studies. I was in almost daily contact with Dr. Orton, who was a genial giant, tall, physically imposing, inexhaustably curious, and with a stimulating, brill iant mental i ty . He was a keen observer, always alert to new ideas, easily communicative, and always warmly accepting of his students and associates. Within the year, that is, in 1924, fifty years ago, he was talking about his preoccupations with the problem some children had in learning to read. He was excited about the implication for brain functioning; the possible relationship to dominance in the cerebral cortex and for hands, feet, and eyes; the frequency of reversals in reading and writing or in visual perceptions; the familial trends and evident importance of heredity; and the apparent specificity for all language funct ionsreading, writing, spelling and speech. He never doubted that this was a brain problem, but rejected any concept of brain pathology such as he had observed in acquired aphasias and of Hinshelwood's rigid concept of "congeni ta l" ; and he entertained a more functional idea of "developmental" (Orton 1925, 1937).

The Iowa State Psychopathic Hospital (part two)

The Iowa State Psychopathic Hospital (part two)