Activist Psychiatrist Guided Journal For Three Eventful Decades

The American Journal of Insanity, the forerunner of the American Journal of Psychiatry, was established in 1844 by Amariah Brigham, M.D., superintendent of the Utica (N.Y.) State Hospital. At Brigham's death in 1849, Romeyn Beck, M.D., of the hospital's Board of Managers, became editor of the journal, which was owned by the hospital. Beck stepped down from his hospital post in 1854, when John Gray, M.D., became hospital superintendent. Gray remained editor of the journal for 32 years; only Clarence Farrar, M.D., had a longer tenure, from 1931 to 1965.

The journal published a number of articles under Gray's name, but over the years numerous unsigned articles appeared as editorials, presumably written by Gray and expressing strong opinions on topics of the day. Unquestionably, Gray was a strong leader in the American mental health world of his day.

Gray, born in Pennsylvania in 1825, received his medical degree in 1848 from the University of Pennsylvania and remained there for two years after his graduation. In 1850 he moved to Utica State Hospital as a junior physician, and in 1854 he was elected superintendent, a post he retained until his death in 1886.

During his early years at the hospital, he instituted the “moral treatment” approach of the Tukes of York Retreat in England. Gray followed the existing theories of the causation of mental disorders, which attributed them to moral causes. After long observation and often in disagreement with his colleagues, however, he came to believe that insanity was caused by a disease of the brain. In 1870 he hired a pathologist to conduct autopsies of mentally ill patients.

Over the years, Gray assumed a leadership role in organized medicine. He was president of his county and state medical societies; president of APA's forerunner, the Association of Medical Superintendents of American Institutions for the Insane (1883-1884); and an honorary member of psychological associations in England, France, and Italy.

Gray left his imprint on many areas. He urged successfully that criminally insane individuals be lodged in separate institutions and that children be moved from almshouses to orphanages. He also unsuccessfully argued that“ chronic and acutely ill insane” individuals not be separated from each other; in 1865, a large hospital for chronically mentally ill people was opened in Willard, N.Y.

Gray was also was considered an expert in medical jurisprudence and testified in many notorious trials in New York state and elsewhere. He served as chief medical witness for the prosecution in the trial of Charles Guiteau, who assassinated President James Garfield in 1881. During Guiteau's trial, at which his sanity was at issue, 21 physicians were called to testify—six for the defense and 15 for the prosecution. Most were asylum superintendents.

Several witnesses invoked the moral-insanity defense. Gray strongly defended his view that the prisoner knew what he was doing and thus was sane. A long article in the October 1881 American Journal of Insanity contained an account of Gray's testimony. (The Journal of Nervous and Mental Diseases published testimony from the trial to try to show that Guiteau was insane.) The jury found Guiteau sane, and he was executed about a year later by hanging. Subsequent medical opinion, however, held that he was mentally ill at the time of the shooting.

A few hours after returning from the Guiteau trial in Washington, D.C., Gray was shot in the face by an insane man. He never fully recovered from the attack but continued to serve as superintendent until his death.

A long obituary in the American Journal of Insanity in 1887 extols Gray as a person, a physician, and a leader, noting that the Association of Superintendents recorded its gratitude for the conspicuous fidelity with which its interests were maintained in his editorial leadership of the journal.▪