Care of the Mentally Ill
Until the nineteenth century, the mentally ill (referred to as “the insane” well into the twentieth century) were often regarded as possessed by the devil and were treated like animals or criminals. They were considered to be beyond help. Very gradually that notion changed. Several states opened asylums which were little more than warehouses where the mentally ill were put away.
In the 1840s Dorothea Dix investigated the prevailing conditions and treatment of “the insane.” Her work led to the opening of many state-operated hospitals. It was not until 1885 that Dakota Territory opened such a hospital, still called an asylum, in Jamestown. The following reports as constructed by The North Star Dakotan discuss the question of treatment as it was understood in 1915. The quotations by Dr. Hotchkiss and Dr. Gillette in the report are their words as found in state government reports.
How Well Are We Treating the Mentally Ill in North Dakota?
The State Hospital for the Insane first opened its doors in 1885 on a 1,200-acre tract of land just south of Jamestown. In its first year of operation the hospital admitted 176 patients; today that population has swollen to 942 (571 males and 332 females).
The hospital’s superintendent, Dr. W. M. Hotchkiss, recognizes that serious problems exist at the hospital. He complains that, “The North Dakota State Hospital for the Insane would not rank well with eastern institutions because of lack of facilities and equipment, lack of help, and such a meager wage that it is those that are not desired by the better institutions that are available.”
Although Dakotans must be given due credit for recognizing very early the need for such a hospital, the fact of the matter is that Dr. Hotchkiss is not exaggerating conditions at the hospital. A team of experts from the University of North Dakota has recently given the hospital a thorough examination. The prominent sociologist, Dr. John M. Gillette, agrees with Hotchkiss’ assessment.
Referring to the status of the physical plant, treatment for patients, and the quality of the staff, Gillette confirms: “Our present hospital is backward or lacking in every one of these items.”
The Physical Plant
The physical plant is a cluster of several buildings including an administration, a hospital, and seven ward buildings. Gillette believes that this is inadequate: “There has been an inhumane crowding and congestion of patients, breaking down the morals of the population and rendering curative treatment almost impossible.” Superintendent Hotchkiss agrees that the increase of population at the hospital has severely strained the facility. “It has been necessary for us to make use of a building that was never intended for patients,” he admits.
The North Star Dakotan has discovered two shocking results of this overcrowding. This past year Hotchkiss has moved forty patients to the Grafton State School which cares for the mentally disabled, popularly referred to as the “feeble minded.” This means that those patients receive absolutely no treatment for their mental problems. Just as bad, the hospital has no “contagious building” where patients with communicable diseases can be isolated from the general population. In November of 1913 an epidemic of small pox struck the hospital. Although the hospital’s administration converted some old wooden buildings into “contagious buildings,” Dr. Hotchkiss admits that this was, in his words, “a very poor substitute.” It is almost impossible to prevent epidemics of scarlet fever and diphtheria given the crowded conditions. Even more startling, eighty-five tubercular patients are mixed in with the other patients! Because tuberculosis (TB) is such a highly transmittable and killing disease, health officials maintain that TB patients must have isolated quarters. To the state’s credit, the old administration building will be remodeled next year to house those who are ill with this dread disease. The bottom line on the physical plant: it is inadequate but hospital officials know that and are trying, with limited funds, to remedy the situation.
The most common treatments for mentally ill patients today are occupational, hydro (water), and drug therapies. While psychotherapy has developed over the past few decades, very few medical doctors have training in or experience with what is now called psychiatry.
Both Hotchkiss and Gillette agree that treatment at the North Dakota State Hospital is terribly inadequate. Hotchkiss blames the crowded conditions. According to the Superintendent, “If acute cases could be placed in a room by themselves, it would be much better, but that is impossible in the present crowded conditions. Medicine, care, exercise and good food is of little avail when sleeping quarters are so crowded that the air is poisonous.”
Gillette finds the two most recommended therapies, occupational and hydro, lacking. Currently, mental health experts believe that the useful training of patients to make or do things is a key to beginning a sound mind. These proponents of occupational therapy believe that enforced idleness which characterizes most hospitals is at the root of all evil in mental institutions. The North Star Dakotan contacted two leading national authorities on this subject, Dr. Henry Frost of Boston State Hospital and Horatio Pollock of the New York State Department of Mental Hygiene. Dr. Frost claims that occupational therapy has helped some of his most difficult patients return to normal life. Pollack calls this therapy the “best available method of treating the vast majority of chronic mental patients.”
Dr. Hotchkiss realizes that some kind of work makes patients more cheerful but has not established an occupational therapy program. Male patients work on the hospital’s farm and tend to the lawn. Women do cleaning and scrubbing chores. But these are as much money saving as therapeutic activities.
Hydrotherapy ranks high as a type of treatment in mental hospitals. Its chief form is the continuous bath in which the patient is suspended in a hammock in a bathtub filled with constantly changing water—sometimes hot, sometimes cold. A shower spray douses the patient with alternating hot and cold water. This treatment, which lasts an hour or two, is designed to relax “excited” patients. It helps keep patients passive during the day and quiet for sleep at night.
Hotchkiss sees hydrotherapy as a very important form of treatment: “The more hydrotherapy that is used, the more we are convinced of its unrivaled supremacy over all other means of treating mental symptoms.” Gillette points out, however, that the Hospital has only one such bath, when, according to the sociologist, “It should have dozens or scores.” The hospital plans to have more hydrotherapy when the state provides a new building.
Psychotherapy does not flourish in state institutions; it is reserved mostly for private practice. North Dakota is no exception. Even if the hospital’s four medical doctors had training in psychotherapy, which they do not, their case loads of three-hundred patients each permit only routine medical care. Hotchkiss admits that this is a serious problem. He has told the North Star Dakotan: “This institution lacks much in properly caring for the unfortunates who are here confined. It is short of help in every department; fourteen to twenty more employees are needed to properly carry on the routine work.” Dr. Gillette sharply criticizes the lack of competent staff: “The staff of attendants is composed of pickups and transients with no special interest and insight in their work and whose average tenure is about one-third of a year.”
Hospital physicians are especially attracted to drugs that tend to calm noisy or troublesome patients. Based on the philosophy that “a good patient is a quite patient,” various sedatives and hypnotics are regularly employed, especially opium and its derivatives like morphine. They cure little, but quiet the “excited” patient. The Jamestown Hospital spends about $5,000 a year for drugs.
Other than more money to provide for better facilities, treatment, and staff at the Jamestown Hospital, Gillette recommends several changes in North Dakota’s approach to mental illness: (1) The establishment of district or county hospitals for the treatment of less severe mental problems. (2) Improvements in the methods of admission and commitment to provide for voluntary commitment and to prevent a family from institutionalizing a member for little reason. (3) Laws that prevent marriages between “insane persons,” that require doctors to have training in psychiatry, and that compel relatives to take some financial responsibility for the care of family members. Gillette concludes, “A program of prevention means a much greater portion of insanity will be either prevented or cured than at present.”
By Dr. D. Jerome Tweton
Originally published as The North Star Dakotan student newspaper, written by Dr. D. Jerome Tweton and supported by the North Dakota Humanities Council.