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
to 1801 - 1850