Elizabeth Packard: A Noble Fight

6 Andrew McFarland and Mental Medicine

6 Andrew McFarland and Mental Medicine El iz a bet h wa s a t f ir st impressed by asylum superintendent Dr. Andrew McFarland. She described him as a “fine looking gentleman” and was charmed by his sophistication and attentiveness. McFarland, she said, “very gallantly” permitted her ample time to share her thoughts, while her husband “sat entirely speechless.” She believed McFarland, unless her “womanly instincts” deceived her, was equally charmed by her.1 McFarland’s friends described him as urbane, sophisticated, domineering, and so self-controlled as to appear “impassable and cold.” But they also knew him as a man who held “tenderest sympathies” for the “poor, afflicted, and distressed.”2 Like the Packards, Andrew McFarland was a product of New England. Born 14 July 181 7 in Concord, New Hampshire, he too grew up in Figure 3. Andrew McFarland as depicted in Modern Persecution. Source: Packard, Modern Persecution (1875), vol. I, unpaged, after title page. a devoted family as the son of an “eminent Congregational clergyman” and a mother “noted for her great piety and good works.”3 He graduated from Dartmouth College in 1840, married Annie H. Peaslee of Gilmantown, New Hampshire, in 1842, and graduated from Jefferson Medical College in Philadelphia the following year. After practicing general medicine for several years, he, reportedly, changed to mental medicine after his mother suffered a case of temporary insanity.4 He began his career in psychiatry as superintendent of the New Hampshire Asylum for the Insane in Concord. McFarland was, in many ways, representative of the mixture of altruism and elitism that characterized American psychiatrists during the formative years of the profession. Exceptionally well-educated and with strongly held beliefs he was, nevertheless, practicing an undeveloped profession that was still struggling to establish definitions and diagnoses for various types of insanity. McFarland’s life and decision to focus his career on asylum medicine followed the pattern described by historian Constance McGovern in her study of the founding fathers of psychiatry. McGovern discovered that most early psychiatrists shared a New England reform heritage that inspired both ambition and a desire to work in a calling that would be useful to humanity.5 McGovern found that many of these men began working in general medicine and turned to asylum medicine after either unsuccessful or unrewarding experiences in general practice. General practitioners often found themselves competing for patients with self-trained “doctors,” proponents of homeopathic medicine, and outright charlatans, all of whom became lumped together with them in the public mind. The men who thus turned to mental medicine determined to maintain higher standards for their new specialty, a decision that would later earn them a reputation for elitism.6 In1842,thirteenasylumsuperintendentsfoundedtheAssociationofMedical SuperintendentsofAmericanInstitutionsfortheInsane(AMSAII),forerunner of the American Psychiatric Association. Andrew McFarland was among the ten additional men who joined at the Association’s second meeting. The group was selective in its membership, even excluding assistant asylum physicians. AMSAII members were also reluctant to associate with other medical organizations . When the American Medical Association formed in 1846, asylum superintendentshesitatedtojoinbothbecauseofthe“disreputeassociatedwith general medicine” and because of their desire to establish mental medicine as a distinct specialty.7 Asylum building had burgeoned in America during the 1840s and 1850s Andrew McFarland and Mental Medicine 69 due in part to the efforts of Dorothea Dix in moving the mentally ill out of prisons and poorhouses into hospitals where they could receive treatment. Asylum doctors would be criticized, perhaps unfairly, for devoting too much time to building and managing asylums and too little effort to advancing their profession scientifically. However, as historians have suggested, this initial emphasis on administration was inevitable as these men essentially helped to create the workplace in which to practice their new profession.8 These early psychiatrists had embarked on a daunting task of creating a new profession with little theory or research to guide them. At the time McFarland entered the profession there was no formal education for the specialty. Practitioners of mental medicine learned by studying treatment models practiced in Europe and by observing patients in their work as asylum superintendents. By the 1850s there were efforts within psychiatry to achieve consensus regarding terminology and classifications for insanity as well as to improve patient care. But causes for insanity remained mysterious and, when proposed, were often clothed more in philosophy, religion, and popular wisdom than in science.9 Religion, a pervasive feature of nineteenth-century America, was...