As a psychotherapist in the private practice and emergency psychiatry settings, I occasionally have the fortune of meeting patients who have a deep, personal connection to historical events in psychiatry. For me, these types of encounters yield much richer information than one could ever glean from a textbook.
For instance, I once saw a patient who, as a young man, had been treated by the pioneering psychopharmacologist, Nathan S. Kline. Over fifty years later, he still credits Dr. Kline with saving his life by diagnosing manic-depression and starting him on the then-new drug Lithium, which had recently been brought to the U.S. from Australia. This patient could recount, with explicit detail, Nathan Kline’s office décor, the cost of a consultation, and Kline’s flamboyant personality. These types of chance encounters with patients are priceless for someone with an interest in the history of psychiatry.
Recently, I met a 78-year-old man on an inpatient unit with a similar connection to the “old days” of American psychiatry. He was an unassuming elderly gentleman with a long white beard, his speech marked by a distinct New York City accent. As I began asking him about his history of psychiatric treatment, he went on to tell me of his hospitalization at the age of 16 at Creedmoor State Hospital in Queens. He had been in psychotherapy with a psychiatric social worker for problematic behavior when he began developing a psychosis.
During the peak of institutionalization in the 1950s, Creedmoor housed more than 7,000 patients. Its population was eclipsed by Pilgrim State Hospital in nearby Brentwood which housed nearly 14,000 at its peak in 1954—making it the largest psychiatric hospital in the world. Treatment in those days consisted of simple confinement, hydrotherapy, electroconvulsive therapy, and, most notoriously, lobotomy.
This all changed around 1954 when a drug named Thorazine appeared on the psychiatric landscape. “I was one of the very first patients they tried it on,” this man said humbly. After several rounds of electroconvulsive therapy, his psychotic symptoms remained generally unimproved. With an early Thorazine-like drug called Sparine, his symptoms quickly diminished, and he was discharged from Creedmoor after a year-and-a-half-long hospitalization.
Not all was good at Creedmoor, however. He recounted that his psychiatrist, an émigré from Europe, was responsible for hundreds of patients and would round only occasionally. When he did round, patients had to approach him with questions—he would not see every patient. The patient also relayed a story about three hospital orderlies who had beaten a patient to death and were later acquitted. Unfortunately, these types of events were not uncommon in early-to-mid-twentieth century psychiatry, an era before the civil rights of psychiatric patients were protected by law. Creedmoor, along with so many of the other early asylums, now sits largely abandoned.
When I asked this man whether he believed he got any better as a result of his year-and-a-half at Creedmoor, he answered with a resounding “yes.” He was not rehospitalized for another 22 years. This is in stark contrast to the modern reality in which severely ill patients might be hospitalized multiple times a year and treated for only a handful of days. The unfortunate truth is that many of these patients fall through the cracks of our current mental health system, never get their prescriptions filled due to cost or transportation, and continue to suffer with debilitating symptoms. Often, they end up in jail for petty crimes.
Allen Frances and I recently wrote a piece for Psychiatric Times which details the need for significant changes in our current system while carefully protecting civil liberties. As bad as the old hospitals were, we argue that they were certainly better than the alternatives—homelessness or imprisonment. It is a sad present reality that many more of the severely ill are “treated” by the prison system than by psychiatric hospitals.
I am thankful to have the opportunity to meet such patients who offer such a uniquely personal view into the history of our field. I consider the mid-twentieth century to represent the “heyday” of American psychiatry, marked by the popularity of psychoanalysis and the development of the early miracle drugs. Being able to capture these personal stories is, to me, a wonder.
Author’s note: I would like to personally thank this patient for his kindness in sharing his story with me and for giving me permission to share it publicly.