NOTE: This entry is about the founding of Mental Health America and its driving force, Clifford Whittingham Beers, a pioneer in advocating for improved treatment of mental illness. It was excerpted from the booklet “Clifford W. Beers: The Founding of Mental Health 1908-1935” produced by The Human Spirit Initiative, an organization with a mission to inspire people to desire to make a difference and then act on it.
The leaders of The Human Spirit Initiative believe that today’s established organizations were new ideas 75-100 years ago and we owe those ideas to their founders. By studying, researching and communicating the details of the lives of these founding leaders within the context of their times, it is possible to create greater understanding of and commitment to strengthening civil society through individual initiative and collective endeavors in building community. For more information on The Human Spirit Initiative and a list of their publications visit: www.human-spirit-initiative.org

The Origins of the Mental Health Movement — 1908 – 1925

Note: A major contributor to this portion of the booklet: “Clifford W. Beers: The Founding of Mental Health 1908-1935” was Michael Gray working with Deutsch Communications.

Introduction: In 1908, Clifford Whittingham Beers published his autobiography “A Mind That Found Itself.”  The publication chronicled his struggle with mental illness and the shameful state of mental health care in America.  In the first page of his book, Beers reveals why he wrote the book: “…I am not telling the story of my life just to write a book. I tell it because it seems my plain duty to do so. A narrow escape from death and a seemingly miraculous return to health after an apparently fatal illness are enough to make a man ask himself: For what purpose was my life spared? That question I have asked myself, and this book is, in part, an answer….” (Beers, 1908. 1)

While confined in three different mental institutions over a period of three years, Beers experienced brutal acts from untrained attendants and punitive rather than therapeutic instructions from heedless physicians.  He was cursed, spat upon and beaten regularly, Beers and his fellow patients were a ready cash source for the “doctors” who in those days were often just sanitarium owners collecting a weekly rate. Early in the book, Beers lets the reader know that this book is not just a cry about his experiences but a plea for all kept in institutions. “…I trust that it is not now too late, however, to protest in behalf of the thousands of outraged patients in private and state hospitals whose mute submission to such indignities has never been recorded….” (Beers, 1908. 19) He documented petty punishments, forced feedings just for spite, the use of straitjackets and hand-restraints, quaintly called muffs after the ladies’ fashion accessory of the day.

His abuse at the hands of poorly paid and poorly trained “attendants” and from his witnessing the abuse of so many other patients created a desire in Beers to become a crusader for the dignity of the institutionalized. He imagined an advocacy organization that would spread from local to international levels—an organization that would (1) fight to improve care and treatment of people in mental hospitals, (2) work to correct the mistaken impression that one cannot recover from mental illness, and (3) help to prevent mental disability and the need for hospitalization.  The actualization of the movement began that same year the book was published when Beers founded the Connecticut Society for Mental Hygiene. The Society expanded the following year, forming the National Committee for Mental Hygiene. The Society, both in Connecticut then nationally, set forth the following goals:

• • To improve attitudes toward mental illness and the mentally ill;
  • To improve services for the mentally ill;
  • To work for the prevention of mental illness and promote mental health.

The Challenge of Building an Effective Organization: Just three years after publication of his autobiography to wide acclaim and launching the National Committee

for Mental Hygiene the situation looked as dire as any of the panicked moments in the hospital. Colleagues and coworkers had to be wondering if Beers had bitten off more than he could possibly chew, his past delusions of grandeur finally getting the best of him.

By now his own savings were depleted, as well as the money he had tapped from friends and family. He had boldly brushed aside concerns over the rapid expansion of two organizations he had founded. There were staff issues at both offices, but he continued to solicit donations from wealthy family friends and the Yale alumni who would still take his calls or respond to his passionate, if not florid letters. To make things worse, Dr. Adolph Meyer, had resigned months earlier. (Note: The basic ideas of mental hygiene were derived from the dynamic psychiatry of Adolf Meyer (1866–1950). According to Meyer, mental illness and mental disorder were the out-come of the dynamic interaction of individuals with their environments. Inspired by evolutionary theory and the philosophy of pragmatism, Meyer interpreted these conditions as inadequate responses to the challenges of everyday life or as forms of maladjustment. Investigating an individual’s life history enabled psychiatrists to trace the origins of maladjustment and to intervene therapeutically. In Meyer’s views, the treatment of early forms of maladjustment could prevent more serious problems later on. His ideas also contained suggestions for preventive measures.)

Dr. Meyer called Beers delusional and questioned his spending and his ability to lead.  Meyer had been one of Beers’ earliest supporters for

changes in mental hospital conditions and had advised him throughout the editing of his book. Adolf Meyer was the dominant figure in American psychiatry during the first four decades of this century. He was a major force in molding psychiatry into its current form, but his teachings have become so solidly incorporated into American psychiatric theory and practice that the sweep and depth of his influence are often over-looked.  Beers and others had to be wondering too. The staff, frugally paid, if not outright volunteers, had found them both hard to work with. They had to be wondering, was it all for naught. Was Clifford Beers sliding back into relapse? Was it mania, or was this just a normal outgrowth of his enthusiasm and stubborn, optimistic determination to make a difference?

Others could walk away, change jobs; not Beers. The pressure and obligation was never going to let up as long as he could physically do the job. Everyday he woke up knowing that across the country patients were being abused just as he had been. Beatings for petty offenses, spiteful, untrained guards harassing patients too far gone to understand simple commands; putative hospital administrators taking per capita fees and throwing patients into overcrowded rooms where they could be easily watched by just a couple of guards with truncheons. There would always be other patients to help. People were counting on him. But could it be his candle, his fountain of energy, was about to burn out?

The relationship between Beers and Dr. Meyer had always been tense. Useful but volatile, it was the product of two powerful personalities. The older austere psychiatrist, complete with a dark, pointed Vandyke beard, was a cautious mover who disliked sensational headlines. Beers, by contrast, was the energetic crusader with a genius for public relations and a life-time supply of venom for those doctors and lay persons not committed to helping those in their care. They used each other, needed each other, but how had it come to this?

Meyer, the man who actually coined the term “Mental Hygiene” was leaving the organization. Money would likely be even harder to raise now. In the midst of planning for his own wedding, Beers needed to find a new medical director. He had a few recommendations in hand and he had made the acquaintance of a few other like-minded doctors, but nobody was going to work for free. Armed just with his stock in trade: optimism; powerful letters and personal appeals, he soldiered on. This was, after all, a very determined man. A man who, once on the road to recovery, got himself sent to the “violent ward” just to make sure he knew what it was like; so he could talk knowledgeably about it when he was released.

One afternoon in November, 1911, he received a letter from Dr. William H. Welch, a nationally recognized physician of the Johns Hopkins Medical School, and later one of the four physicians memorialized in the famous painting by John Singer Sargent. Would he, Welch inquired, be interested in meeting with a wealthy industrialist, turned philanthropist who was looking to make the best use of $50,000 to “ameliorate the condition of the insane in public and private institutions.” Of course Beers would! Welch steered Henry Phipps to Clifford Beers and the National Committee on Mental Hygiene. A week later Beers and Phipps met for the first time. It was a fruitful meeting as Beers came away with money to cover his own personal debts and a promise of $50,000 to come.

Phipps, the son of English immigrants grew up in very modest conditions and, made his first fortune working his way up with friend and neighbor Andrew Carnegie in his steel business. He eventually became the second largest shareholder in U.S. Steel, and then made another fortune investing in real estate before taking on a third stage of his career as one of the nation’s premier philanthropists. In 1912, Phipps funded the first in-patient hospital for the mentally ill at Johns Hopkins University, which still bears his name today. In keeping with the spirit of that time, many industrialists believed in giving back to the community. Rockefeller, Vanderbilt, Harriman and Carnegie are the best known examples. Phipps focused his efforts on alleviating poverty and biomedical research, which was mostly privately funded until after World War II. Today the botanical gardens in Pittsburgh bear his name as does the Phipps Institute for Study at the University of Pennsylvania. He would eventually donate more than $200,000 to the NCMH and take a seat on the board of directors.

This donation was spectacular and well received, but just as crucial in the charity business was the important vote of confidence Phipps provided. A donation of that size signaled to others the credibility of Beers and the laudable work of the NCMH. (Rockefeller would later become a regular contributor)

Financial worries set aside for at least a short time, Beers married Clara Jepson and then plunged back into his work. He knew the first thing he needed to do: simply count the number of mentally ill persons institutionalized in the United States, and then develop a list of the medical professionals to treat them. Very basic indeed, but this was where they had to start. Dr. Thomas Salmon was named the new medical director, a role he would hold for many years. But the name that would be on every hospital director’s lips for the next decade as the organization grew to national prominence, would be Dr. Samuel Hamilton. Hamilton would be in charge of the state surveys and reports on the conditions in institutions across the country, the hammer through which the NCMH would become a national force for reform and an advocate for the mentally ill.

But now a lot of people were counting on Beers, hundreds of thousands he had never met, who would never realize what he and the NCMH would do for them. With the very large shadow of Meyer gone, Beers understood that if this organization was going to succeed he would need to be the figure head; the public face and the lightning rod, the fundraiser-in-chief as well as the cheerleader. If he was going to spare others abuse so that they might one day recover and not be concussed into permanent withdrawal, he would, to borrow a phrase from the bible, have “to set his face like flint and refuse to be ashamed.”

The National Committee began fulfilling its mission of change immediately, initiating successful reforms in several states. In 1920 the Committee produced a set of model commitment laws which were subsequently incorporated into the statutes of several states. The Committee also conducted influential studies on mental health, mental illness, and treatment, prompting real changes in the mental health care system. At the close of World War I, the organization Beers founded prepared to move into its second decade. Beers was firmly at the helm of the NCMH and a widely known public figure. Already the committee lead by Dr. Hamilton had surveyed the quality of care and staff training and conditions at numerous institutions across the country. Some states like South Carolina and Texas took immediate action. After the survey in South Carolina, the state legislature appropriated $600,000 to improve the care and housing of their citizens suffering from mental illness. A relatively young state, Texas adopted many of the NCMH’s recommendations on improving its conditions and quickly moved to begin building more modern hospitals and institutions. Equally important was the legislation they adopted that many states around the country would model as well: removing and prohibiting persons with mental illness from being housed in jails, almshouses and other community shelters, their traditional dumping grounds.

It was no accident that three of the Committee’s first four surveys were done in the South; Tennessee and Pennsylvania being the other states. In general, conditions there were worse, and worse still if you were black. After the abolition of slavery, blacks in need of care now overwhelmed already crowded state hospitals across the south, leading often to hastily built distinctly second class facilities. Elsewhere though, states had begun to form their own chapters under the umbrella of the National Committee for Mental Hygiene. In 1914 there were 10, by 1920, though still very nascent in some cases, the NCMH had representation in nearly every state.

Rather than dreading the arrival of Dr. Hamilton and his team, many states would begin asking for the Committee’s help. The NCMH actually had a waiting list with more than a dozen states or organizations seeking assistance. The surveys and recommendations certainly went a long way toward improving conditions at state hospitals. The reports also served as a forum to bring together psychiatrists to discuss standards of care and guidelines for identifying different types of mental illness. This was one of Beers gifts. He had a genius for organization, but he was smart enough to leave the day-to-day running of the organization to his staff and the medical direction to doctors, professionals, like-minded psychiatrists.

Products of the Theodore Roosevelt progressive era, Beers, his staff and allies believed they could do good, to fill the gaps where governments couldn’t or wouldn’t go. Echoing the African proverb that “one volunteer can do the work of 10 forced men,” they firmly believed that dedicated volunteers could change American society. Besides being an indefatigable letter writer, Beers was also quite good at attracting support from high profile public figures and wealthy patrons with his brand of infectious enthusiasm. An early sign of Beers shrewd understanding of public relations, politics and the medical profession was how he picked his targets. Where others had stumbled in their exposés, the NCMH and Beers made a point of not embarrassing doctors or politically connected people who may be in a position to help, or be seen helping. Beers nearly made such a mistake early on in his campaign by attacking the governor of Connecticut, an approach he would not repeat.

Beers never alienated other doctors and psychiatrists when, after what he went through, it would have been easy to imagine doing so. He realized that there were a lot of good people, trying yet disorganized, or simply not knowing what is the best course of treatment or how to handle patients.  The NCMH even assisted the federal government in conducting a census which would count for the first time the number of people in institutions in the United States.

Labor practices were examined, more specifically the by products of various manufacturing techniques and conditions, factory housing, 12-15 hour work days, etc. The NCMH published studies on the effects of rapid industrialization and the growth of urban slums as recent immigrants competed with newcomers from rural America for space and jobs. At the time, labor unions, brotherhoods and other job- and immigrant-linked welfare organizations were all trying to call attention to the same issues: the new economic reality came with a host of social ills.

The end of WWI also marked the start of a long-running relationship between the military and the psychiatric profession, one the NCMH would help organize into the Army Division of Neurology and Psychiatry. They looked at English and French treatment of soldiers suffering from “shell shock,” or what we might call today, post-traumatic stress disorder. Through these efforts, military psychiatrists helped develop innovative treatment methods and established ways for medical professionals in various countries and services to share information.

Also, at the urging of Gen. John Pershing, the U.S. Army turned to the NCMH for help in screening recruits and draftees after realizing how many were completely unsuitable for military life. Salmon and others found that treating soldiers as early as possible, and close to the front, offered better results and improved prospects for rapid recovery. Sadly however, this advice and example was not always followed. During World War II soldiers were still shipped back to the U.S. in conditions reminiscent of a modern day slave ship, confined below decks and prohibited fresh air. Blame can be attributed to a dearth of qualified professionals across the military, but all too frequently it was a simple lack of understanding and following basic instructions.

Spurred and financed by the Rockefeller Foundation in 1924-25 the NCMH would also begin a study, eventually called “The Psychiatric Causes of Dependency and Chronic Poverty.” On top of all this, despite cautions from friends and staff about over-reaching and endangering his health, Beers began laying the groundwork for aninternational organization.

During this period, one of the NCMH’s lasting accomplishments was developing guidelines for state commitment laws. At this time, parents and husbands could have their spouses or children committed to institutions on less than solid medical reasons and in some celebrated cases, rather dubious grounds.

Note:  For a more extensive history of Mental Health America visit: The Human Spirit Initiative and their publication “Clifford W. Beers: The Founding of Mental Health 1908-1935:” www.human-spirit-initiative.org