Two patients in smocks, one standing, one seated on the floor, in a hallway lined with barred metal doors.

Tearing Down the Walls in Mental Health Care

By Susan Speaker

May is Mental Health Month, an annual opportunity to raise public awareness about mental health problems and reduce the stigma associated with mental illness through advocacy and education. For the history-minded, it’s also a chance to see how much things have changed since the first Mental Health Week was observed, back in 1949. Mental illness carried a much heavier stigma then, and those with severe psychiatric problems were often confined to institutions for years, forgotten and ignored. Their advocates were only beginning to protest this status quo. One such reformer was Mike Gorman (1913-1989), whose legacy is now featured on the National Library of Medicine’s Profiles in Science website.

A young man in a suit holding a document talks on the phone.
Mike Gorman at the Daily Oklahoman, ca. 1948
Profiles in Science Mike Gorman Papers

In July of 1946 Gorman was a young reporter for the Daily Oklahoman newspaper. Sent out to investigate a reader’s complaint about conditions in the Central State Psychiatric Hospital, he found the story that would change his life. At Central State, patients lived in appallingly crowded, filthy, dilapidated buildings; with few physicians or nurses, they received little medical attention, and were often kept in restraints or seclusion by the overworked, underpaid attendants. Most of the other state hospitals Gorman subsequently visited were as bad or worse. When he looked into the causes of this miserable situation, he found that neither the public nor their legislators liked to think much about the intractable, sometimes frightening problems of the mentally ill. State budgets for their care reflected this apathy.

Gorman’s series of articles, “Misery Rules in State Shadowland,” shocked and outraged many Daily Oklahoman readers, generating a call for action. With the support of his editor and publisher, Gorman helped establish a state mental hygiene association to educate the public about the desperate need for better psychiatric facilities and personnel, and raise money to lobby the state legislature for increased funding. When the legislature met in early December 1946, a special state senate investigating committee visited Central State Hospital and saw that Gorman’s reports were not exaggerated. For the next six months, the state lawmakers considered bills to reform the state mental hospital system. These included large appropriations for new buildings and more professional staff, new commitment laws, and a new administrative structure unconnected to state political patronage systems. When opponents attempted to slash budgets or attach limiting amendments to the proposed legislation, Gorman and his associates used civic and professional associations and the press to mobilize public opinion and apply pressure to the politicians. The mental health bill finally passed, largely intact, in May of 1947.

 

 

During his four years in Oklahoma, Gorman wrote over four hundred stories and sixty editorials about the state of mental health care. His first newspaper series was reprinted as a pamphlet for distribution by mental hygiene associations across the nation. An expanded version titled Oklahoma Attacks Its Snake Pits, appeared as a Reader’s Digest condensation in 1948. Gorman went on to investigate public and private psychiatric facilities in other states, writing exposés of the worst ones and praising the best as models of what was possible. This work attracted considerable attention, and he received a Lasker Award in 1948 “for Public Information Leading to Public Action in Mental Health.”

In 1953, philanthropist and health policy activist Mary Lasker appointed Gorman director of the National Committee Against Mental Illness, which she had established several years earlier. In that post, Gorman became perhaps America’s best-known crusader and publicist in the cause of psychiatric hospital reform and the community mental health center movement. He was a key member of the Joint Commission on Mental Illness and Health, which for five years did formal studies on mental illness and health and contributing factors, methods for diagnosis, treatment, care, and rehabilitation, recruitment and training of mental health personnel, and psychiatric hospital conditions. The final report, released in early 1961, provided a blueprint for mental health policy for the next decade. It recommended increased funding for basic research; rapidly expanding treatment of the acutely ill mental patient in all directions, via community mental health clinics, general hospitals, and mental hospitals; and increasing public information about mental illness to reduce the stigma attached to it.

To Gorman’s dismay, reforms of the psychiatric care system—like many reforms of the Great Society era—were realized slowly and incompletely. But Gorman and his fellow crusaders succeeded in bringing mental health and illness into national policy discussions, and their efforts, together with new treatments, profoundly transformed the “snake pit” mental hospitals he first encountered as a young reporter in 1949.

We invite you to learn more about Mike Gorman on NLM’s Profiles in Science and view the images in this post (and more) on the Profiles in Science Pinterest page.

Susan Speaker, PhD, is Historian for the Digital Manuscripts Program of the History of Medicine Division at the National Library of Medicine.

5 comments

  1. In the years before antipsychotic medications such as the phenothazines, prefrontal lobotomy was gaining in popularity to treat severe mental disorders such as schizophrenia, e.g. Rosemary Kennedy. I wonder how Mr Gorman felt about this surgical technique, particularly since he was active in those years, late 1940’s and early 1950’s.

    1. Although he didn’t talk about lobotomy in the documents I’ve reviewed, Mike Gorman’s early work regularly mentioned shock therapy (insulin, Metrazol, or electric) as an effective treatment. For example, he commended the staff at Central State Hospital for using shock therapy on small numbers of patients even though the medical staff wasn’t big enough to employ it routinely. In general, Gorman believed that psychiatric patients–especially those in institutions–deserved to have access to the latest treatments, even if rigorous clinical studies were lacking (as they usually were in that era.) When the first antipsychotic drugs became available in the 1950s, he railed against those psychiatrists who wanted to take a more cautious approach to their use, including many at the National Institute of Mental Health. See, e.g., his speech “We are winning the fight against mental illness” (item TGBBBJ) in Section 3 of the Gorman site.

  2. Looks like surgery was less popular than electrical shock in mid 1940’s. Between 1935 and 1941 more than 75,000 patients received shock therapy.

    While only 18,608 patients underwent underwent psychosurgery between 1936 and 1951

    Source -“Foundations of Social Policy: Social Justice in Human Perspective
    By Amanda Barusch” (Page# 242 ) and Grob, 1994

  3. Well at least he brought Mental Health to the public domain, out of sight and out of mind Was no longer a dirty secret. Exposing institutional inhuman cattle markets. Therapies such as E.T.C, against will, compulsory treatment, forced. The latter is what horrifyingly cruel. ECT, is used today and helps many. Obviously with patient consent after many treatments failed. Having informed choice is what makes treatment work, era is no get out Claus. The book/film Frances Farmer, Hollywood actress only starred in 4 Films. What she suffered anyone would want a lobotomy.

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