The Best Specimen of a Tyrant: The Ambitious Dr. Abraham Van Norstrand and the Wisconsin Insane Hospital

12. “A Critical and Searching Examination”

T W E LV E A Critical and Searching Examination There was no turning back from the course charted by the“brethren,” as the first members of the Association of Medical Superintendents of American Institutions for the Insane liked to call themselves.1 Thirty-six state hospitals opened their doors between 1824 and 1860, most based on the Kirkbride plan.2 The patient population roughly doubled every decade for much of the century, from 2,500 in 1840 to 74,000 fifty years later.3 Hospitals became permanent shelters for the chronically insane, way-stations for the acutely ill, and virtual hospice centers for late-stage syphilitics and other degenerative cases. But by the mid-1860s it was apparent that they did not cure insanity. Sedative medications, rich diets, clean linen, warm rooms, “amusements,” and pastoral views from the windows of scientifically arranged, no-expense-spared temples of caring were essentially palliatives, not cures. Many were comforted but few were healed, and by mid-century public optimism had given way to exasperation . What had gone wrong? So much had been invested, yet so little had changed. Annual reports still celebrated the therapeutic virtues of kindness and caring, of wholesome labor and amusements, but increasingly legislators, newspaper editors, and family members were drawn to darker tales from other sources. Disillusionment bred a search for scapegoats. The demon haunting every superintendent’s dreams—the crusading former patient who is both credible and persistent—emerged just over the border in Illinois during the early years of Van Nor- 164฀฀•฀฀The Best Specimen of a Tyrant strand’s tenure at the Wisconsin hospital. Elizabeth Packard had been committed to the state hospital at Jacksonville by her clergyman husband. It took her years to fight her way out through the courts. She came out angry and stayed that way, writing, speaking, and confronting legislators. Her anger was contagious and spread across state lines. She became the most famous of many former patients whose revelations inflamed the public and sparked reform movements well into the twentieth century. The superintendent at the Illinois hospital lost his job and eventually killed himself. He was not the only one. Suicide, physical or mental breakdown, death at the hands of a patient: such were the occupational hazards of those who assumed absolute authority over public hospitals for the insane.4 Each of Van Norstrand’s three predecessors had stumbled early, lost the confidence of the board, and been forced out under humiliating circumstances. Similar dramas were played out in state after state. Careers and reputations were ruined by scandal, by disgruntled legislatures, by the hounding of the press. At annual conventions and in some annual reports, superintendents expressed bewilderment and anger, seeing themselves as martyrs to an unenlightened citizenry and grudge-poisoned patients. Yet for nearly four years, as unlikely a candidate for sainthood as Abraham Van Norstrand remained at the helm, unchallenged and virtually unquestioned. How did he do it? Independent to the point of surliness, he nonetheless alternately charmed and browbeat a variety of constituencies—legislators , trustees, the medical community, county officials, and patients ’ families. Although essentially pragmatic and authoritarian, he convinced reformers that he was an enlightened practitioner of moral treatment. Above all, he satisfied hard-headed trustees and legislators concerned primarily with economy and good order.Under Van Norstrand, the hospital finally came together as an enterprise and flourished. “The Dr. looks as though his duties agree with him and [he] has years of usefulness before him,” the editor of the Jefferson Banner observed.5 “We are not disposed to dispute the superintendent’s anti-utopian views in regard to the treatment of the insane,” key legislators reported two years later. “He is well posted in regard to all such theories and selects from them such as his judgment recommends , feeling that the treatment of the insane has advanced as rapidly as any other science for the last half century [and that] chains, perpetual solitary confinement, cold, hunger, filth and neglect [have been replaced by] kindness, proper medicine, warm rooms, good beds, good food and plenty of it, books, lectures, singing, riding, boating [and] cheerful care with quiet and unfatiguing agricultural labor.”6 Again and again the trustees boasted that in Van Norstrand they had finally found their man. In the spring of 1865, with the uproar over Reverend Kellogg’s death still ringing in their ears, they concluded that it was an “unavoidable...