Psychiatry in Indiana: The First 175 Years

The 20th-century discipline of psychiatry in Indiana evolved from neurology. The Indiana Neuropsychiatric Association was founded in 1938 and was open to any physician who listed a P, an N, or an NP after his name in the American Medical Association directory. Many of the early members were neurologists. The association became a district branch of the American Psychiatric Association (APA) in 1954 and renamed itself the Indiana Psychiatric Society in 1965.

Academically, the process was similar. Although the Indiana University School of Medicine was founded in 1903, there were no full-time instructors in psychiatry until 1939–1940, at which time psychiatry became a division of neuropsychiatry. The neuropsychiatry department was formally separated into the neurology and psychiatry departments in 1952.

Indiana has no psychoanalytic tradition. There is no psychoanalytic institute or organization as there is in the nearby cities of Cincinnati and Chicago. There have generally been only one to two analysts practicing at any given time in metropolitan Indianapolis. Early 20th-century treatments in Indiana institutions included hydrotherapy, malarial therapy for syphilis, and insulin and metrazol shock therapies. In the late 1940s, most of the patients at Norways sanitarium, the major private psychiatric hospital in Indiana, were receiving ECT, metrazol, or insulin coma therapy. During 1952–1954, more than 300 lobotomies were performed at Logansport State Hospital, many using the trans-orbital technique developed by Dr. Walter Freeman. Most patients were said to have improved with this procedure, though later it fell into disrepute. In the mid-1950s, Indiana institutions began wide use of thorazine and other psychotropics, as they were also widely used in the rest of the nation.

The lack of attention to psychoanalysis and emphasis on somatic treatments is one distinctive feature of Psychiatry in Indiana . Indiana also has the dubious distinction of passing the first eugenic sterilization law in the United States in 1907. The involuntary procedure was not finally eliminated until 1974. Under the law, 1,167 men and 1,257 women were sterilized, mostly prior to 1955; most sterilized individuals were intellectually disabled. The sterilizations were carried out at state hospitals, developmental centers, and correctional institutions.

At the same time, Indiana was a pioneer state in biological psychiatry. A pathology laboratory was built on the grounds of Central State Hospital in 1895. The Laboratory Building was the location of psychiatry research and teaching for the Indiana University School of Medicine until the early 1950s. For many years, brain specimens from patients with psychiatric disorders were preserved and studied here.

Margaret Morgan, M.D., was named the first state Commissioner of Mental Health in 1953. Along with Governor George Craig, she planned and built one of the first dedicated research institutes in psychiatry on the Indiana University Medical Center campus in 1956. Within several years, the Institute of Psychiatric Research supported the work of six full-time and four part-time scientists, as well as five consultants. The emphasis was on basic studies of neurochemistry and behavior; the staff was about one-half Ph.D.s and one-half psychiatrists and neurologists.

In the mid-1960s, Drs. Joyce and Iver Small arrived at LaRue Carter Hospital on the Indiana University campus. They revitalized the Research Service at Carter and carried out extensive studies on ECT, lithium, carbamazepine, clozapine, and electroencephalographic correlates of psychiatric disorders and treatment over the next 40 years.

Coons and Bowman, the authors, have concentrated on developments in psychiatry between 1800 and 1975. Philip Coons is a forensic psychiatrist who has been a longtime faculty member at Indiana University. His wife, Elizabeth Bowman, is adjunct professor of neurology at the University, having spent many years on the psychiatry faculty as well. Both are past presidents of the International Society for the Study of Trauma and Dissociation and have received awards from that society. Bowman also holds a Master of Sacred Theology degree and has received APA's Oskar Pfister Award for work integrating religion and psychiatry. They have been working on this history for several decades.

I found the book to be a surprisingly fascinating read. There are a number of interesting topics and discussions. As an example, Logansport State Hospital was built in the late 19th century to be an economically self-sufficient facility. It was sited attractively on a bluff overlooking the Wabash River. Cattle, pigs, chickens, turkeys, rabbits, and ducks were raised on the hospital farm. The gardens produced 178,000 tomato plants and 272,960 cabbage plants during 1 year in the 1940s; the hospital had a cannery for preserving fruits and vegetables. The 1954 patient population was 2,448. In 1968, the farming operation ceased. The census in 2009 reported 327 patients at Logansport.

As Coons and Bowman point out, criticism of the state hospitals seems to run in cycles. One such cycle occurred in the years following World War II. In 1946, Life Magazine ran an article exposing abuse and neglect in the 180 state mental institutions across the country (housing 400,000 patients). This aroused public indignation (and legislative appropriations), and 5 years later, a follow-up article in Life found conditions much improved. They cited Logansport as one of the success stories. Forty years later, more negative attention focused on Indiana state hospitals. In particular, Central State in Indianapolis was the subject of periodic scandals. The hospital was closed in 1994 by Governor Evan Bayh, with the idea that most patients would be cared for in community facilities. In a follow-up study several years later, about one-half of the patients were in the community. Forty-one percent were in other state facilities, 2% were in correctional facilities, 8% were in nursing homes, and 5% had died. As the authors point out, this is a microcosm of our experience with closing state hospitals across the nation. In the last decade, more patients have found themselves in the correctional system. Currently in Indiana, 6,393 persons with serious mental illness are incarcerated, and 2,413 occupy a psychiatric bed. Coons and Bowman assign blame to the Indiana State Legislature, blame that is surely deserved but hardly unique to Indiana.

This is a well-told story. The authors have done their homework, including personal interviews of many persons who played critical roles. It is obvious that they enjoyed the task; the result is a candid, colorful, and detailed historical record of psychiatry as a discipline and the treatment of the mentally ill as a social phenomenon within the boundaries of Indiana. Though it concentrates on one state, anyone interested in the history of psychiatry and psychiatric illness in the United States will find this to be a valuable reference.