A Century of Improving Mental Health Care at Michigan
At the end of the 19th century, Americans with mental illness were not so much
diagnosed and treated as managed and sheltered. People with schizophrenia, alcoholism
and depression were housed alongside people with cerebral palsy, epilepsy and
“feeblemindedness.” Innovations in patient care, such as Thomas
Kirkbride’s renowned and almost palatial asylum architecture, had put
a better face on conditions for mentally ill Americans, but inside the spacious
halls and cottages, little effort was made to apply scientific methodology to
people with mental illness.
In Ann Arbor, that was about to change.
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| William Herdman |
In the late 1890s, U-M Professor of Nervous Diseases and Electrotherapeutics William J. Herdman (M.D. 1875) set the wheels in motion to build, at the University, a psychopathic hospital for the care and study of mental illness. In 1901 the Michigan state legislature allocated the funding for the facility, and in 1906 the State Psychopathic Hospital opened its doors. The hospital was among the first of its kind in the nation — one intended to provide diagnosis and research on mental diseases rather than custodial care. It contained state-of-the-art research equipment, including a laboratory in which psychiatrists trained in pathological examination studied brain tissue sent from hospitals all over Michigan.
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| The State Psychopathic Hospital opened its doors on Catherine Street in 1906. |
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| Albert Barrett |
Albert M. Barrett, M.D., the hospital’s first director, oversaw both psychiatry
and neurology within what was originally called the Department of Nervous and
Mental Diseases until 1920, then continued as chair of the newly formed Department
of Psychiatry until his death in 1936.
Shortly after the hospital’s opening, an article in a University publication
stated, “For the treatment of the nervous system, the hospital is furnished
with apparatus for generating all kinds of electric current. Attendants especially
skilled in the application of electricity and massage are put in charge of these
cases.”
It’s easy to dismiss these early approaches to psychiatric treatment as
primitive and ineffective, but in fact, Michigan’s clinicians were demonstrating
their awareness that abnormalities in brain function were at the core of depression,
bipolar disorder, schizophrenia, Alzheimer’s disease and other disorders.
The search for answers was on.
A paper Barrett published in the 1920s, “Hereditary Occurrence of Hypothyroidism
with Dystophied (sic) of the Hair and Nails,” demonstrates his curiosity
about the genetic underpinnings of some of the symptoms he observed in his patients,
and his willingness to conduct research that, for his day, was rigorous and
revolutionary. He constructed the family tree of a “feebleminded”
boy in his care, making note of physical, intellectual and psychosocial characteristics
of the boy’s relatives going back six generations.
Barrett also worked to standardize information-gathering for new patients, drafting
a series of admission forms that asked vital, detailed questions, and sought
to maintain patient dignity. One question, for example, asked for the patient’s
narrative, in his or her own words, of the development of the disorder.
Michigan’s groundbreaking experiment — looking at mental illness
through a lens of scientific scrutiny coupled with humane compassion —
was proving successful; by the 1930s, the need for more beds, more physicians
trained in psychiatry and more opportunities for residents interested in the
field made expansion a priority. The Neuropsychiatric Institute was opened in
1939, adjacent to the University of Michigan Hospital (Old Main), a proximity
which signaled a new relationship between medicine and psychiatry. New director
Raymond Waggoner (M.D. 1924) immediately set up a three-room psychiatric consultation
unit — one of the first such units in a general hospital in the country.
Institute faculty and staff fostered increasing ties with medical departments
through consultation and outpatient clinics.
Throughout his long tenure (1937-70), Waggoner embodied much of the change that
was taking place in the treatment of the mentally ill. Originally trained as
a neurologist, he embraced both psychoanalysis and biological theories in psychiatry.
His openness to new ideas and his willingness to see each patient as a total
person with emotional and physical forces at play helped to forge the biopsychosocial
model that is the foundation of psychiatry today.
During this period, across the country, psychoanalysis came to be largely regarded
as the treatment of choice for mental illness, and Michigan boasted a cadre
of nationally leading academic analysts.
Albert Silverman, M.D., Waggoner’s successor as department chair from
1970-81, oversaw the increasing move toward biological research and treatment.
In tandem with Gardner Quarton, M.D., director of the Mental Health Research
Institute, a number of internationally leading investigators were recruited.
Since taking the helm of the department in 1985, John Greden, M.D., has worked
tirelessly to integrate and translate neuroscience and behavioral science advances,
and to battle stigmas that, even today, keep people from seeking help. His work
in depression, for example, has brought Michigan national recognition —
and given hope to hundreds of thousands of people who suffer from this disease.
The new University of Michigan Depression Center is a place where behavioral
scientists, neuroscientists, clinical investigators and multidisciplinary leaders
from other schools and departments across campus, such as Nursing, Public Health,
Pharmacy, Social Work and Psychology, come together to share information, collaborate
on research, and offer patients the most up-to-date and comprehensive treatments
available.
A century ago, in a simple brick and wood edifice that cost $50,000 to build,
several U-M faculty members and nurses strived to care for an unending stream
of desperate patients while knowing virtually nothing about what caused psychiatric
disorders, and with no way to evaluate underlying brain functions. Today, several
hundred U-M faculty and hundreds of nurses, social workers, therapists, and
trainees of all kinds make powerful, tangible differences in the lives of thousands
of patients in the Department of Psychiatry and the Depression Center in the
recently-opened Rachel Upjohn Building.
For patients — most of whom are now treated on an outpatient basis —
the U-M Department of Psychiatry has become a place where true healing from
frightening and disturbing psychiatric disorders can and does happen, and where
hope and compassion are buoyed by science.
—Whitley Hill with Laura Hirshbein
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