The 1840s: Early Professional Institutions & Lay Activism

The American Journal of Insanity and Its Editor, Amariah Brigham.

The American Journal of Insanity (AJI) was first published in June, 1844, by Amariah Brigham, Superintendent of the Utica (N.Y.) State Hospital. He was said to have been the author of the entire first issue, which included six articles, a list of existing mental asylums in the U.S., and notes on insanity from France. His aim for The Journal was to acquaint its readers with the nature and varieties of mental illness and with methods of prevention and care for patients.

Amariah Brigham (1798-1849) was born in Marlborough, Massachusetts and received his medical training at the N.Y. College of Physicians and Surgeons. He spent the following year in Europe to further his medical education and returned to Massachusetts in 1829 to establish a practice. In 1840, he became Superintendent of the Hartford Retreat, and in 1842, moved to the Utica State Hospital, the first public mental hospital in New York State.

Brigham had published on mental illness prior to AJI. His book, Remarks on the Influence of Mental Cultivation on Health (Hartford, 1832), went into three editions. He believed that insanity often resulted from ‘moral’ causes such as worries and anxieties. In 1840, he published another monograph, An Inquiry into Diseases and Functions of The Brain, Spinal Cord and Nerves (New-York).

The AJI remained the property of the Utica State Hospital, though it served as the official publication of the Superintendents' Association (see below). In 1892, the journal was bought by The Association, and in 1921, the name was changed to the present American Journal of Psychiatry by The American Psychiatric Association.

The Superintendents’ Association.

By 1844, 25 public and private mental hospitals had been established in the United States. The Association of Medical Superintendents of American Institutions for the Insane was organized in Philadelphia in October, 1844 at a meeting of 13 superintendents, making it the first professional medical specialty organization in the U.S. The objectives of the Association were “to communicate their experiences to each other, cooperate in collecting statistical information relating to insanity, and assist each other in improving the treatment of the insane.” The name of the organization was changed in 1892 to The American Medico-Psychological Association to allow assistant physicians working in mental hospitals to become members. In 1921, the name was changed to the present American Psychiatric Association. (Visit the APA’s website at http://www.psychiatry.org/).

The American Medical Association

The American Medical Association (AMA) was organized in 1847 in Philadelphia through the efforts of Nathan Davis and Nathaniel Chapman primarily to deal with the lack of regulations and standards in medical education and medical practice. Some mental hospital superintendents became active members. Cordial relations between the two groups continued, and members of each attended the others’ meetings.

In 1854, the AMA established a Committee on Insanity which ended in 1867, when a psychology section was organized. Merger of the AMA and the Superintendents’ Association was considered frequently over the years. In 1871, the Superintendents' Association delegated Dr. John Curwen to attend the AMA meeting in San Francisco and explain The Association's rejection of the invitation to a merger. The reasons were that the Superintendents held their annual meeting in a venue where an asylum was located both to assure citizen interest in the care of the insane and to allow the superintendents to visit the asylum. Also, the Association’s meetings were devoted solely to topics relating to the care of the insane, an area of limited interest to general practitioners, and the Association included only psychiatric hospital superintendents.

Over the years, the relationship between the two organizations has waxed and waned. In the 21st century, the APA is an active participant in AMA activities.

Dorothea Lynde Dix: Lay Advocacy for the Mentally Ill.

Dorothea Dix (1802-1887), a school teacher, was the foremost advocate for the humane care of the mentally ill during the 19th century. Her efforts are credited with the establishment of 32 state mental hospitals throughout the United States.

In 1841, Miss Dix visited a Boston jail to teach a Sunday School class. There she found mentally ill people confined under inhumane conditions. She embarked on a lifelong journey to advocate and procure help for the mentally ill. Her methods included personal visits to jails, almshouses, hospitals, and wherever they were confined, and she carefully documented her findings. She used the interest and influence of prominent citizens and legislators to introduce written "memorials" into state legislatures in which she described the conditions she found, the first being in Massachusetts in 1843. The memorials often led to funds being appropriated to improve or establish mental hospitals.

By 1850, Miss Dix had aroused sufficient public support for her endeavors, and bills were introduced into the Congress for federal lands to be apportioned to the states whose sale would provide funds to create or support facilities for the mentally ill. The bill passed in both Houses of Congress in 1851 but was vetoed by President Franklin Pierce on the basis that the care of the mentally ill was a state, not federal, responsibility.

Miss Dix also visited mental establishments in Great Britain, Ireland, and the European mainland, including visits with the Pope. She exerted influence wherever she went in publicizing conditions of care for the mentally ill and advocating for improved care.

She spent her final years as a resident guest at The Trenton State Hospital in New Jersey, a psychiatric hospital founded through her efforts.