INDIANA MEDICAL HISTORY
QUARTERLY
INDIANA HISTORICAL SOCIETY
Volume IX, Number 1
March, 1983
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The Indiana Medical History Quarterly is published by the Medical History
Section of the Indiana Historical Society, 315 West Ohio Street, Indianapolis Indiana 46202.
EDITORIAL STAFF
CHARLES A. BONSETT, M.D., Editor 6133 East 54th Place Indianapolis, Indiana 46226
ANN G. CARMICHAEL, M.D., Ph.D., Asst. Editor 130 Goodbody Hall Indiana University Bloomington, Indiana 47401
KATHERINE MANDUSIC MCDONELL, M.A., Managing Editor Indiana Historical Society 315 West Ohio Street Indianapolis, Indiana 46202
MEDICAL HISTORY SECTION COMMITTEE
CHARLES A. BONSETT, M.D., Chairman
JOHN U. KEATING, M.D. BERNARD ROSENAK, M.D. WILLIAM M. SHOLTY, M.D.
KENNETH G. KOHLSTAEDT, M.D. DWIGHT SCHUSTER, M.D. W. D. SNIVELY, JR., M.D.
MRS. DONALD J. WHITE
Manuscripts for publication in the Quarterly should be submitted to Katherine
McDonell, Indiana Medical History Section, Indiana Historical Society, 315 West Ohio Street, Indianapolis, Indiana 46202. All manuscripts (including footnotes) should be typewritten, double-spaced, with wide margins and footnotes at the end. Physicians’ diaries, casebooks and letters, along with nineteenth century medical books and photographs relating to the practice of medicine in Indiana, are sought for the Indiana Historical Society Library. Please contact Robert K. O’Neill, Director, Indiana Historical Society Library, 315 West Ohio Street, Indianapolis, Indiana 46202. The Indiana Medical History Museum is interested in nineteenth century medical artifacts for its collection. If you would like to donate any of these objects to the Museum, please write to Dr. Charles A. Bonsett, Indiana Medical History Museum, Old Pathology Building, 3000 West Washington Street, Indianapolis, Indiana 46222.
Copyright 1983 by the Indiana Historical Society Pictured on the cover is an interior scene of the Women’s Department (Seven Steeples) at Central State Hospital during the 1920’s. (Photograph in the collection of the Indiana Historical Society Library.)
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IN THIS ISSUE
This issue of the Quarterly deals with the age-old problem of mental illness. In spite of ever-progressive knowledge and change, the problem of caring for the mentally ill will always be with us. The articles which follow represent three different, and yet equally provocative, approaches tothe history ofmental health care in Indiana during the late nineteenth and twentieth centuries.
The first article, by Dr. Hugh C. Hendrie, describes Central State Hospital from the perspective oflocal twentieth century newspapers (with primary emphasis on the year 1973). Newspaper articles, particularly during this period, tend to be highly critical of the hospital. The reader of these periodic expose's is left with an indelible impression that something is grossly amiss with the system, the hospital, or its management.
Dr. Hendrie’s unique and enlightening topic, if expanded to cover the hospital’s
135-year history, would make a most interesting book since controversial events, attracting the attention of the press, also have occurred from time to time during the nineteenth century. Dr. James Athon of Central State, for example, in response to the state legislature’s failure to make the necessary appropriation in 1857, returned his patients to the communities from which they were committed. This action prompted an immediate response from the press, and from the legislature. Dr. William B. Fletcher, the Hoosier Pinel who became superintendent in 1883, initiated his term by making a public bonfire using all the hospital’s mechanical restraints. Although the medical reform implicit in this act was long overdue, he was promptly rebuked on the editorial page of the local press. Later, when he exposed the graft, political corruption, and abuse taking place in the state hospital system, he was fired.
In the second article, the late Carrie (White) Lively (1871-1957) reminisces about her experiences as a ward attendant, first at Central State Hospital (or more correctly, at the Indiana Hospital for the Insane as it was designated at that time), and later at East Haven in Richmond, Indiana. Mrs. Lively’s experiences within the state hospital system occupy about twoyears, most ofwhich was at the Richmond hospital at the turn of the century. It is important to bear in mind that she began her work at Central Hospital with no preparation or training. She was a young widow (about twenty-nine years old with four children to support) who was suddenly confronted with the task of attending to society’s most severe examples of mental illness. However unpleasant the task, her family responsibilities made her persevere. Further, she was a sympathetic person, identifying with her patients, which made her sensitive to what she considered their abusive treatment.
The following information may be useful to fully appreciate Mrs. Lively’s article.
The state hospital system, then as now, was underfunded. Dr. George Edenharter, superintendent at the time that Carrie Lively worked at Central State, strove for economic efficiency through a very tightly structured organization. His period of superintendency (1893-1923) was characterized by progress and growth, and the newspaper coverage of his period is generally of a laudatory nature. Actually Central State’s high water mark in public esteem was achieved during the Edenharter years, and since his superintendency the hospital course has been slowly but progressively downhill. Mrs. Lively’s observations, which are critical of Edenharter, then are especially noteworthy as they describe problems existing during a more salutary
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period of the hospital’s history.
Dr. Ellen Dwyer provides the final article for this issue. She tells of the medical and budgetary limitations of the system which permitted the development of the symptomatology described by Hendrie and Lively. Dr. Dwyer provides a brief outline of the history and development of the mental health institutions in Indiana and why they have functioned in a less than perfect manner. Her scholarly article provides the perspective necessary to visualize the overall problem, an essential first step in comprehending this most complex subject.
Charles A. Bonsett, M.D. Editor and Chairman
George P. Edenharter served as superintendent of Central State from 1893 to 1923. (Photograph in the collection of the Indiana Historical Society Library.)
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PRESS COVERAGE OF CENTRAL STATE HOSPITAL:
ALARMS AND EXCURSIONS
Hugh C. Hendrie*
There is a perception held by observers and critics of the health professions that physicians are inadequately trained to practice medicine in this modern complex society. Doctors are too often puzzled and irritated by the patient’s response (or lack of it) to their well-meaning advice and bewildered and often angered by their interactions with governments, hospitals, or insurance companies. The fault, say critics, lies not in the medical student’s mastery of medical science and technology, but in his or her ability to place the practice of medicine within its societal context.
This problem, however, has not passed unnoticed among medical educators. To quote Henry Sigerist:
Medical education can never reach definite forms, but isobliged to adapt itself to ever-changing conditions. Every society required of its physicians certain qualities such as knowledge, skill, devotion to patients, conscientiousness. But the position of the physician in society and the tasks assigned to him changed and were determined primarily by the social and economic structure of a given society and by the scientific and technical means available to medicine at that time.1
The educator’s dilemma then is determining an appropriate vehicle to teach this health-societal interaction. Concentration on present-day issues is fraught with problems because educators are also integral members of their culture. It is difficult to distance oneself from society to observe objectively its effect on medicine. Sometimes it is much easier to perceive, for example, the effects ofthe political process on the practice of medicine in foreign cultures like the Soviet Union than it is to observe a similar process in one’s own country.
There is one possible method of conveying the relationship between medicine and society in an unbiased manner. Again, to quote Sigerist discussing the teaching of medical history:
It should give us a more complete picture of this development of civilization and ... should make us aware [of] where we come from in medicine, at what point we are standing today, and in what direction we are marching.2
It was with this aim in mind that I considered incorporating histories of the treatment of the mentally ill in teaching clinical psychiatry to medical students. However, upon inspecting these documents, one is reminded of the Japanese film Rashomon, which was devoted to the exploration of a single event as remembered in different ways by the participants. So in the history of psychiatry, one has the “insider’s” view of it being a triumphal procession to the present state of enlightenment, contrasted with that of the social critic who perceives it as an increasingly sophisticated medium for social repression.
‘Hugh C. Hendrie is Albert E. Sterne professor and chairman of the Department of Psychiatry at Indiana University School ofMedicine. This paper, originally entitled “Institutionalizing the Insane,”was delivered at the Indiana Historical Society’s annual meeting on November 7, 1981. The author wishes to thank Michele Rudnick for her research assistance during the summer of 1981.
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The present study arose from the hypothesis that perhaps one could examine best the interrelationships between society and psychiatry by utilizing the Rashomon-like qualities of the various reminiscences to construct parallel views of a representative institution. As Central State was a convenient, and in many ways, archetypical institution, I undertook to explore the history of the hospital from the viewpoint of 1) the involved professionals — primarily drawn from the superintendent’s reports; 2) the public — mostly from newspaper accounts; 3) the patients — using oral history techniques; and 4) the legislators — from the governors’ papers and other sources. This, as I am now aware, is a monumental task which may well take the rest of my professional life to accomplish properly. The following paper therefore represents only a preliminary analysis of a small part of the press coverage of the hospital.
Thanks to the good graces of newspaper reporter Fremont Power, my research assistant and I were able to gain access to the archives of the Indianapolis News and
the Indianapolis Star and its predecessor, the Indianapolis Journal. We
supplemented this with material from the Indianapolis Times (in the Indiana State Library). While there were a number of smaller newspapers which probably ran stories on Central State, we felt these major papers would represent a fair sample of the press coverage during the period. We attempted to record all stories pertaining to Central State Hospital from 1900 through 1975. We are reasonably certain we obtained almost all the articles for the post-1940 period. However, for the pre-1940s we uncovered fewer accounts, making us suspect that a considerable number were missed. We next counted the number of stories each year and in each decade separately. Table I shows this count for the decades from 1940 onward. As one can see, a distinct pattern emerges. A flurry of stories usually occurs in aone-or-twoyear period and is followed by a much longer, relatively quiescent period with the appearance of only a few articles. We then scrutinized the contents ofthese stories, paying particular attention to those years when the most articles were written. For the purposes of this paper, I will follow the press coverage of Central State during 1973, when no fewer then twenty-eight articles about the hospital were published.
Coverage of the hospital began in the May 22,1973, issue ofthe Indianapolis News with an article entitled “Central State Patient Abuse Revealed.”This story was under the byline of Skip Hess and Reginald Bishop. The reporters apparently had carried out a random investigation ofpatients at the hospital. The reasons for the News ’ s investigation are unclear. As a result of this probe, however, Hess and Bishop wrote the
TABLE I
Number of Newspaper Articles Relating to Central State Hospital Per Year of Study
1 9 7 0 - 6 1 9 7 1 - 7
1960 1961 1962
———
11 6
1 9 5 0 - 5 1951 10
1 9 4 0 - 1 1941— 0 1 9 4 2 - 0 1 9 4 3 - 2 1 9 4 4 - 3 1 9 4 5 - 0
—
1972 1973 1974
———
6
- 0
- 1 9 5 2 - 1 5
1 9 5 3 - 1 6
28 5
1 9 6 3 - 1 1 9 6 4 - 4 1 9 6 5 - 3 1 9 6 6 - 6
1954
—
3
1 9 7 5 - 6
1 9 5 5 - 6
1 9 5 6 - 4 1 9 5 7 - 5 1 9 5 8 - 9 1 9 5 9 - 1 2
1946 1947
—
3
- 3
- 1967
1 9 6 8 - 1 2 1969
—
2
—
1 9 4 8 - 7 1 9 4 9 - 7
—
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- PRESS COVERAGE OF CENTRAL STATE HOSPITAL
- 7
article alleging a number ofabuses. These included: 1) forcing men and women to use the same toilet facilities; 2) subjecting patients to physical and verbal abuse (e.g. an elderly woman patient claimed she was forced to beg forgiveness on her knees to an attendant); 3) failing to properly clean patients’rooms (e.g. some rooms were filled with cockroaches); and 4) using seclusion rooms solely for patient control. When the newspaper reporters approached the superintendent and the chief nurse about the findings, they were promised a full investigation.
The allegations quickly escalated. The May 24, 1973, edition of the Indianapolis
News had as its headline “State Mental Health Group Asks Patient Abuse Probe.”In this story, again written by Skip Hess and Reginald Bishop, the president of the Mental Health Association demanded a full-scale probe into the reports of patient abuse and stated that he was going to “insist upon charges being filed against any person implicated.” At the same time, the president took the opportunity to reproach the legislators, who in the last session had reduced the budgeted hospital personnel funds. He stated that “this may well have forced state hospitals toviolate patient rights to adequate medical treatment and housing.” He went on to invite legislators to visit Central State “to observe the effects of their action on mental patients.”The patients apparently now began to notify the reporters of their willingness to testify for the investigators. One ex-patient said she “was treated like an animal.” She added: “The help I got was the most degrading and most depressing three years of my life.” She blamed the public for these conditions: “Do you really think the public gives a damn about mentally ill pepole?”
The legislators answered the call. The headline of the News on June 1,1973, was
“Bowen Deplores Facilities in Visit to Central State Hospital.”This report was about Governor Bowen’s unannounced hospital visit in which he found the facility “deplorable and shameful.” He discovered, for instance, there were only seven registered nurses at the hospital. Bowen was equally disturbed by the approximately one-to-onehundred ratio of nurses to patients. He stated, however, that the new facilities (which were ordered in September, 1971) were finally being built. Rather slyly, the News added that the new buildings were ordered only after their reporters had conducted a similar investigation in 1971. The article ended with a quotation from Bowen: “We are going to make up for past deficiencies, but it cannot be done at once.”
Revelation now followed revelation. The headline of the June 4, 1973 News was
“Mental Patients Forced to Work Without Pay.” This article explained that mental patients at Central State Hospital were working close to forty hours a week without pay, an obvious violation of federal law. A spokesman for the State Department of Mental Health agreed that they should have been paid, but that the General Assembly had only budgeted $50,000 for patient pay when they needed $2,000,000. One department supervisor stated that with the shortage of hospital employees, it would be impossible to run his department without patient workers. The following day the News carried an article entitled “Two Team Probe of Hospital Set” which stated that the Mental Health Commission had now set up an impartial task force and inspection team to carry out the audit of Central State Hospital. The task force was expected to complete its evaluation within a week.
In the meantime, the sister newspaper, the Indianapolis Star, remained strangely aloof from the scandals, a posture they maintained for the entire year. The newspaper’s first report on Central State Hospital was on June 7, 1973. There, in a story entitled “Central State Construction Work Pushed,”reporters described the new facilities to be opened at least four months ahead of schedule.
Skip Hess, from the News, however, was unrelenting in his coverage. TheJune 11,
1973, story was headlined “Central State Probe Begins.” There, Hess described the seven-man investigation team which included two Indiana State Police detectives.
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The executive assistant governor said that employees should not fear the investigators. He also encouraged former patients and employees to come forward with information on patient abuse. On June 12,1973, the Star once again remained benign. It ran a short article entitled “Special Bus Assists Wheelchair Patients,” describing the Marion County Mental Health Association’s present of a bus, allowing wheelchair patients to be taken to their various activities.
The Indianapolis News, however, increased their barrage. Headlines on June 21,
1973, read “Hospital Patient Denied Treatment.” There, again, Skip Hess described his own independent investigation of psychiatric care at the hospital. Hess discovered 160 mentally ill patients had not been seen or treated by a psychiatrist for more than five months, and in general, found psychiatric care at the hospital inadequate. The assistant superintendent, in response, complained about the inability to hire psychiatrists. In fact, “last week,” he said, “the hospital was just notified to cut $516,000 from their personnel budget,” in marked contrast to what Governor Bowen had stated on the first of June. The executive assistant to the governor, however, disagreed saying management, rather than money, was the problem.
Another story on the subject appeared in the June 26, 1973, News and was headlined “Conditions Filthy at Central State, Probers Tell Board.”This article described the findings of the ten-member board (apparently they had gained three members within a week). They found the conditions at Central State “deplorable and dehumanizing,” and, if the situation was not changed dramatically, the board warned that the two new units “again, will very quickly become an old, new Central State Hospital.” They then cataloged the deplorable conditions, the poor and inhumane care, and the hundreds of code violations they had found in their probe.
The Central State officials fought back. In a June 27,1973, News article, entitled
“Central State Officials Blame Public Legislature” and again written by Skip Hess, the officials of Central State said “ the present situation is a result of a lack of public support, unsympathetic legislators, and inadequate funds.” The News was accepting no excuses, however. In their parallel editorial, “Get on With It,” they stated: “The history of Central State Hospital is laced with alibis, excuses, and buck-passing. Point out a problem, you’ll get a reason why it can’t be eliminated.”They made the point that it is not only additional dollars that were necessary, but also a strong hospital administration that was not content to let deplorable conditions exist. The editorial added that they needed additional financial assistance from the legislature, but said “until that help comes, it is high time that the administration and the staff get on with the job.”
The next article in this series by Skip Hess, “Clean up Ordered at Central State,” appeared in the July 5, 1973, edition of the Indianapolis News. Hess reported that Governor Bowen’s office had announced a program to eliminate all unsanitary conditions at Central State Hospital. To keep the new facilities at Central State in good condition, a project engineer was to be hired. Moreover, seventeen workers from the State Farm Prison in Putnamville were to be brought in to help employees clean up the hospital grounds. Bowen’s investigators also said that they disagreed with the Central State officials’assertion that doctors on leave could not be replaced. “There is no reason in the world their doctors can’t be replaced,”said the executive assistant to the governor.
In the next article by Skip Hess, headlined “Treatment Quality at Central State
Blamed on ‘Politics’” (appearing in the News, July 9, 1973), Central State officials struck back. The assistant superintendent of medical service and clinical director of Central State Hospital said politics was the reason physicians could not achieve their goals in patient care at the hospital. One bone of contention was that the new facilities at Central State were designed to work under the unit clerk plan. According to this
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idea, the clerks were to relieve doctors and nurses from paperwork, leaving the professional staff more time for patient care. The 1973 General Assembly, however, did not provide enough funding for the eight clerks needed. “I can’t really put the blame on the legislators, budget, or personnel,” the assistant superintendent said, “it’s just politics.” The article reported that Governor Bowen’s cleanup project was under way. It also stated that the two police detectives in the investigation expected arrests for criminal activity at the hospital.
The following day in an article by Skip Hess, headlined “Central State Blame
Accepted,” a rather unique event occurred. Central State’s chief engineer said he would accept full responsibility for the conditions at Central State Hospital. “I’ll take my lumps but I’m going to get this place straightened out come hell or high water,”he declared. He also said that the expose by the News “laid us wide open.”
That same week on July 12,1973, Skip Hess reported an “allegation”made by two state hospital employees that “a maintenance worker hit a mentally ill patient with his fist__”The employee continued: “All the patient did was ask for a drink ofwater. We