In popular culture, the history of mental healthcare is a dismal affair, filled with dark cells, chains, and torture. Psychiatrists are often evil geniuses or mad scientists, and mental hospitals are castles of despair, best escaped from as soon as possible. The most famous asylum films, One Flew Over the Cuckoo’s Nest and The Snake Pit, feature horrifying scenes of psychiatric abuse.
The real story of the past is, as one might guess, far more complex. Heroic efforts to alleviate the distress of sufferers of acute mental illness elbow side by side with frightening exploitation and spectacularly misguided treatments. In order to parse the good from the bad, the noble from the cruel, we must pay closer attention to the reality of the past, rather than settle for simple, satisfying, but ultimately incomplete, stories of “good” versus “evil.”
A case in point is the story of Benjamin Rush. Once considered the “father of American psychiatry,” Rush’s star has waned in recent years, as people have become more aware of some of his more troubling ideas.
Benjamin Rush was born in Philadelphia in 1745. After graduating from the College of New Jersey (now Princeton), he pursued the field of medicine and became the first Professor of Chemistry at the College of Philadelphia. He became a popular local doctor. Then the events of the Revolution swept the colonies.
Rush got involved in the Patriots’ cause. He signed the Declaration of Independence, composed the first major treatise on military medicine (and later the first well-known American medical text), directed medical efforts for the Continental Army, and pushed Tom Paine to write his epochal pamphlet Common Sense.
After the war, Rush dedicated himself to various causes, including battling the vicious Yellow Fever Epidemic of 1793, promoting abolition, supporting women’s education, and helping to fund the first Black churches in Philadelphia.
He also became keenly interested in the care of the mentally ill. At the time, “mad” people were confined to cellars and basements, chained up and poorly fed and clothed. At the Pennsylvania Hospital, the insane were sequestered in filthy straw-covered basement cells. It was believed that they did not feel chills, and so their rooms went unheated.
Rush believed that treatment was possible. He successfully got the hospital to add a wing that provided sufferers of acute mental illness with rooms with windows, better clothing and bedding, and much more personal attention. He then went on to promote the treatment of alcohol addiction, and wrote one of the first scholarly treatments of mental illness.
But history is messy. This celebratory account is not the whole Benjamin Rush story. He heavily promoted bleeding as a cure for almost everything, a method that likely worsened or shortened many lives. And when other doctors opposed his treatment, he accused them of every malfeasance under the sun. His idea for a “Tranquilizer” chair, in which a person is strapped into a chair with a box on their head, does not look great (though at the time he promoted it as safer than the straitjackets currently in use).
Rush also owned an enslaved man, William Grubber, despite his personal abolitionism, for many years. Worse still, he authored a supremely troubling, racist theory about African Americans. Due to this, Rush’s image was removed from the APA’s logo in 2015.
Reckoning with the past is not the same thing as condemning it. It means looking at history in all its complexity and not glossing over the parts that might be disturbing to us. Reckoning means not just seeing things in historical context, but also examining the debates that raged on in the past, and examining what alternatives were available to historical figures. It is insufficient to apologize for flawed actions as just being just “part of the culture,” especially when there were numerous opposing ideas in existence.
The history of mental healthcare is replete with positive steps as well as downright harmful treatments and bad ideas. But there was plenty of progress made, such as efforts to abolish stigma, treat sufferers humanely, and promote mental wellness, dating back to the very beginning. It is not a simple or straightforward story. It is not easy. It is not neat. And this is why we need to look closely and honestly at our past treatment of sufferers of mental illness, in all of its varied dimensions.
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