Asylum Doctor: James Woods Babcock and the Red Plague of Pellagra

2. Superintendent: Hoping, Moping, and Coping

25 C h a p t e r 2 Superintendent Hoping, Moping, and Coping James Woods Babcock returned to South Carolina in 1891 as the state’s first fully-trained psychiatrist or, to use the then-current term, “alienist.” He had attained at age 35 what was then a psychiatrist’s highest ambition: to be an asylum superintendent.However,the South Carolina Lunatic Asylum was an extreme example of the deterioration of public asylums into convenient places for inconvenient people. Meager state appropriations could not keep up with the steady influx of patients, whose diagnoses commonly included such conditions as alcoholism, epilepsy, imbecility (mental retardation ), senility, or terminal illness of any kind. Babcock’s idealism, energy, and vision could not compensate for his lack of administrative experience and his reluctance to press the legislature for more money. The Bylaws gave him little power over his staff physicians. As conditions slowly but inexorably worsened, he tried on several occasions to leave. In the end he stayed, sublimated through hobbies and community activities, and became a much-admired public figure despite the dismal conditions at his asylum. His twenty-two-year career at the helm illustrates the mot that top administrators often pass through three stages: hoping, moping, and coping. His was hardly the best of times to be a state asylum superintendent or, for that matter, to be a psychiatrist. Psychiatry in the Late Nineteenth Century What is now the American Psychiatric Association began in 1844 when thirteen men formed the Association of Medical Superintendents of Superintendent Hoping, Moping, and Coping 26 Asylum Doctor American Institutions for the Insane, the first organization of medical specialists in the United States. They were called “alienists” on the premise that mentally disturbed patients were alienated from reality.1 Most superintendents lived on campus. They saw their institutions as therapeutic environments for the newly-minted social and community psychiatry. They acknowledged both psychosocial and biological dimensions of mental illness, recognized the role of heredity, and occasionally suggested that mental illness might someday be reducible to neurology. In their optimism they launched the American Journal of Insanity. Their optimism was short-lived. With rare exceptions such as McLean, the position of asylum superintendent was by 1891 hardly an enviable job. In the social hierarchy of American physicians they ranked somewhere near the bottom. What went wrong? Historians identify several factors, of which the most important was the sheer numbers of patients flooding asylums during the late nineteenth century. Families and communities caught up in the Industrial Revolution welcomed institutional alternatives to home care. Overwhelmed by overcrowding and underfunding, superintendents put Phillipe Pinel’s “le traitement moral” on the back burner if they found time for it at all. Asylums became little more than jails for the mentally ill and other “undesirable” people. And the superintendents operated in political minefields.They were high-profile public figures in states strapped financially by growing welfare systems. Finally, nineteenth-century advances in medical science had largely bypassed psychiatry. Bacteriology empowered generalist physicians to diagnose what had formerly been just “fevers.”Anesthesia and aseptic techniques empowered surgeons to operate without pain and prohibitive risk of infection. Psychiatrists meanwhile were stuck with such quaint diagnostic terms as melancholia,idiocy,dementia,mania,and monomania—broad categories for which there was neither specific diagnosis nor effective therapy. And psychiatrists were losing turf battles to the more-prestigious neurologists , who had begun to appropriate functional disorders such as “neurasthenia ”that lent to lucrative practices.2 Psychoanalysis had not yet taken off. Psychiatrists had few career options. Babcock assumed a highly-visible public position at a time when the power and prestige of psychiatrists in the United States was at its all-time nadir. And his impression from afar that “the asylum problem” in South Carolina was “a grave one” that “should be trusted only to the most experienced humanitarians” turned out to be correct. Superintendent 27 The South Carolina Lunatic Asylum An asylum, according to the first definition in the Oxford English Dictionary , is “a sanctuary; a place of refuge and safety.”Churches and monasteries offered refuge from at least the fourth century onwards,and we still speak of “political asylum”for those whose lives would otherwise be in danger.Large asylums for isolating disadvantaged or persecuted people—including not only the insane but also the incurably ill,the poor,and the criminal—cropped up during the Middle Ages and the trend accelerated...