The practice of psychiatry in America began in the basement of a hospital in colonial Philadelphia.
I often get the bus at Third and Walnut just blocks from Independence Hall. There’s a beautiful garden there with a plaque on the wall that identifies the site as the location of Benjamin Rush’s residence.
Rush signed the Declaration of Independence and brokered the peace between Thomas Jefferson and John Adams, but his most lasting legacy was as a physician and the role he played in the treatment of those with mental illness.
All of this is told with wit and clarity in the book Rush: Revolution, Madness & the Visionary Doctor Who Became a Founding Father by Stephen Fried.
The eighteenth century was not a great time to have a mental illness. Treatment was draconian, and conditions in hospitals were deplorable. Benjamin Rush, with the establishment of Pennsylvania Hospital, opened a ward for diseases of the mind that was humane, and he employed a caring staff to attend to those suffering from what was often described as mania.
Fried details how Rush believed the causes of mania were physical and, in this time long before Freud and his emphasis on psychology, treatment should be physical as well. Patients were often bled. Bleeding was the treatment for everything from yellow fever to consumption at the time, so those with mental illness were not exempt from this now horrifying therapy.
But Fried notes that bleeding caused a shock to the system not unlike that of electroconvulsive therapy today. Sometimes the results were positive. But it was a time when few were cured, and most who were committed to Pennsylvania Hospital stayed there for life. The plight of those with mental illness struck Rush deeply, and personally. His oldest son suffered from severe mental distress and spent much of his life as a patient in Rush’s ward.
While the results of the treatment he gave were mixed, the shift in how mental illness was viewed, as a disease of the body, not one of poor morals or spiritual deficit, is Rush’s lasting contribution. He wrote, according to Fried:
“Among the medical causes, or triggers, were head injury, tumor, water in the brain, epilepsy, palsy, vertigo, headache, gout, dropsy, consumption, pregnancy, malnourishment, and ‘profuse evacuations.’ But the single biggest cause of mental illness that he had seen at Pennsylvania Hospital was ‘excessive use of ardent spirits’-an issue for more than a third of the patients in the mental health ward.”
While the list seems to cover everything, the older, more judgmental factors blamed for mental illness are absent and the focus on substance abuse was something new to medicine.
Fried is sympathetic to his subject, yet recounts Rush’s failings with the same studied insight that he uses to present the positive impact Rush had on our early nation and early medicine. The book is complete, detailed and thoroughly researched. Still it’s a quick, entertaining read.
Fried is not afraid to comment on the impact of Rush’s views, both positive and negative. The histories of psychiatry and the founding of the United States are incomplete without this learned, artful book.