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To head Institute of Pennsylvania Hospital, the hospital Board approached a 31-year-old Quaker physician, Dr. Thomas Story Kirkbride. Although trained as a surgeon, Dr. Kirkbride had gained early experience working with the insane. He became the new asylum's first chief physician, remaining so for 43 years until his death. Many came to refer to the hospital simply as "Kirkbride's."

Dr. Kirkbride was a strong advocate of "moral treatment," a philosophy based upon compassion and respect for the insane. He sought to create a humane environment where both rich and poor were treated with dignity. He believed patients responded to greater freedom with better behavior. Persons suffering from insanity, he insisted "are not disabled from appreciating books...or enjoying many intellectual and physical comforts." While only half of Dr. Kirkbride's patients eventually recovered and resumed their positions in the world, this remains a striking accomplishment in an era when effective medications and other modern treatments were virtually non-existent.

Dr. Kirkbride estimated that one in every 500 persons was insane. Grief, ill health, intemperance and anxiety were the most common reasons cited for patient admissions. But the psychiatrist's case records remind us of other suspected causes of insanity at the time: "religious excitement," tobacco use, prolonged lactation, metaphysical speculation, nostalgia and exposure to the sun's direct rays.

Dr. Kirkbride argued that the cost to society of effective hospital treatment "is not, on the average, one-tenth of what it is to support a chronic uncured case for life."

Early in his tenure, the young Dr. Kirkbride hosted a visit that marked an important occasion in the history of psychiatry. On October 16, 1844, the hospital superintendents of 13 asylums gathered in Philadelphia to form the Association of Medical Superintendents of American Institutions for the Insane -- the first national medical society in the country. This organization evolved into today's American Psychiatric Association.

The West Philadelphia hospital soon doubled in size. In 1859, a twin version of the hospital was opened five blocks west of it. The Department for Males was built at 49th and Market Streets. The original 44th Street hospital became The Department for Females. Now that hospitals for the insane were no longer considered improper places for ladies, this all-female facility accounted for the bulk of new admissions.

"Mental illness [must] be freed from moral stigma, and be treated with medicine rather than moralizing." -- Dr. Benjamin Rush

The dawn of the 20th Century ushered in a fascination with laboratory science. By more closely examining the brain and its workings, physicians believed the mysteries of mental illness could be revealed. Neurologists and microbiologists concluded that insanity was a disorder of the nervous system. Researchers collected brain specimens of the deceased insane to search for clues about the illness. These early neuropsychiatrists were no longer convinced that humane treatment alone was sufficient to bring about recovery for most patients. They looked for more scientifically proven methods. Reflecting this changing view, the hospital's name was changed in 1918 from the Pennsylvania Hospital for the Insane to the "Department for Mental and Nervous Diseases." Nurses and personnel trained in psychiatry replaced attendants.

In 1913, Dr. Edward A. Strecker joined the hospital as an assistant physician. Over his 46 years of service, he became a preeminent author and teacher of psychiatry. In 1920, Dr. Strecker established one of the first psychiatric outpatient community clinics in the world at Pennsylvania Hospital's 8th and Spruce Street campus.

A pioneer in the treatment of alcoholism, Dr. Strecker was one of the first to insist that alcoholism be treated as a disease, not a moral failing. In 1935, Pennsylvania Hospital's West Philadelphia department was the first psychiatric institution to hire a recovering person as an addiction counselor. Dr. Strecker and his former alcoholic patient, Francis Chambers, Jr., developed the "dual therapy" approach for alcoholics, combining abstinence and psychological counseling. The Institute's substance abuse unit was named "The Strecker Program" in his honor; in 1989 it was named "Treatment Center of the Year" by the American Council on Alcoholism.

The Institute also introduced outpatient treatment for those with "psychoneuroses"-- everyday family and work-life problems like sleeplessness, depression or low self-esteem. Psychotic patients in the Department for Males were transferred to 44th Street to make way for services geared to the community at large. The Institute thus became one of the few hospital programs nationally to treat patients ranging from the severely ill to those needing help with the stresses of everyday living.

In 1959, the 44th Street building was closed and all patients were consolidated at 49th and Market Streets, which was restructured and renamed "The Institute of Pennsylvania Hospital." A modern, five-story addition, the North Building, opened that same year. Within a decade, it became the site of the region's first inpatient unit designated for adolescent-age patients.

Throughout its history, Pennsylvania Hospital has both shaped and been influenced by our society's constantly changing attitudes about illnesses of the mind. If some of Dr. Rush's early attempts at treatment now strike us as naive, we nevertheless acknowledge he was one of the first to seek a less judgmental, more scientific explanation for mental illness.

During its 156-year history, The Institute developed a reputation as the premier provider of both inpatient and outpatient psychiatric care. However, in 1997, after years of declining payments from insurers, Pennsylvania Hospital sold the West Philadelphia campus and moved The Institute's behavioral health programs back to the original site at 8th and Spruce Streets. The tradition of excellence will be continued where it began in 1751.

"Psychiatrists are continually discovering that what seems abnormal behavior is really a normal reaction to abnormal surroundings." -- Earl Bond, MD, staff psychiatrist, physician-in-chief and administrator, 1914 - 1968

"Men ought to know that from the brain and from the brain only arrives our pleasures, joys, laughter and jests, as well as our sorrows, pains, griefs, and tears." -- Hippocrates

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