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259 Perspective: Asylum Doctor In 1930 two graduate students,one at the University of South Carolina and the other at the University of Chicago,chose the South Carolina State Hospital for their master’s degree theses.The South Carolina student wrote of Babcock: “When it is considered how little he had to work with, his accomplishments at the hospital deserve much praise.”1 The Chicago student wrote: “Although Dr. Babcock was well-prepared for the position as chief officer of the institution, there was a marked lack of progress made during the twenty-two years of his administration.He displayed the qualities of the student, the historian, but failed at managing the institution.”2 These opposite conclusions drawn from the same facts remind that we are all subject to observer bias, prisoners of the prevailing paradigms of our times and places to a greater extent than we’d like to think. Future generations , if they remember us at all, will see us differently than our contemporaries see us. Historians and biographers necessarily bring to their work preconceived ideas and—as the story of pellagra attests—so do scientists and clinicians.The present author read as a second-year medical student that “we must not explore the chest by percussing our ideas into it.”3 He later heard on the wards that “we see what we look for and we look for what we know.” Truisms aside, the present author confesses his inability to serve as an impartial judge or jury member in the case of James Woods Babcock, sharing too many career parallels and personality traits with his subject. He has sought to give readers enough facts to reach their own conclusions, especially in such hypersensitive areas as racial and gender disparities in health care. The following perspectives on Babcock in three areas—as an administrator, as a leader in the response to the pellagra epidemic, and as an exemplar of character traits worthy of emulation or avoidance, which is Perspective: Asylum Doctor 260 Asylum Doctor perhaps the ultimate purpose of biography,are proffered as merely that: one person’s perspectives, with which readers may disagree, without argument. Babcock as Administrator Babcock’s career as asylum superintendent serves up a cautionary tale for anyone aspiring to senior management without suitable training and temperament .4 He accepted the job against better judgment after weighing his limitations against the opportunity to make a difference in his native state. The state’s constitution,the asylum’s Bylaws,the staff physicians’turf-protectiveness ,and his own deference and desire to get along—traits evident from his school days—probably doomed him from the start despite his best efforts. The extent to which we should apportion blame for deplorable conditions at the State Hospital for the Insane among Babcock, the regents, the governors, the legislators, and the state’s philosophy of government—“from Wade Hampton onward, it had been accepted as an article of faith among South Carolina political leaders that the least expensive government was the best government”5 —becomes a matter of judgment. In 1915 the American Journal of Insanity was unequivocal that Babcock had “struggled against the most difficult situation, made increasingly worse by lack of financial assistance and an apparent impossibility of awakening any real civic interest in the unfortunate insane of the state.”6 Babcock pleaded year after year for better funding and facilities but,marching in step to the chain of command, took lobbying the legislature as the regents’responsibility,not his.He became an agent for positive change mainly by accident.The 1909−10 and 1913−14 legislative hearings brought pyrrhic victories for Babcock,but progress at the asylum,as public attention drove legislation that propelled the troubled institution toward the mainstream of American psychiatry.His inability to make life much better for the African American patients, one of his main goals when he accepted the job,was no doubt a source of sadness.Their outcomes actually got worse during the years of his administration, first because of tuberculosis and then because of pellagra (see Appendix 1).However,he lived to see the new facility for blacks at State Park become a reality. Babcock was too shy, passive, and sensitive for the nigh-impossible job description, which in today’s terms made him both chief executive officer and chief medical officer of a large, complicated medical center. Abraham Lincoln’s self-assessment of his presidency—“I claim not to have controlled events,but confess that events have controlled...

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