I have attended several seminars on substance abuse and treatment for those addicted or who are also suffering psychological disorders. Dr. King served as the medical authority for these workshops. She impressed me with her depth of knowledge, sensitivity to those in treatment, and her commitment to provide for the best care and treatment of those in need. You will enjoy getting to know Dr. Lucy King.
Al: Lucy, I would like to know something about you personally, where did you go to
school, what did do for a living, and how you are spending your retirement.
Al: Why did I think you were in Bloomington at one time?
Lucy: Well, people think that Indiana University is there, but the medical school is in Indianapolis.
Al: Why did you choose psychiatry?
Lucy: Washington University at that time was somewhat ahead of its time in psychiatry in the United States. It was already interested in neurochemistry and genetics. So, it was an opportunity to be involved with patients and to be involved with science.
Al: Were you one of the first women psychiatry?
Lucy: No. Women psychiatrists go back to the 19th century. Nevertheless, there were not many women in medical school when I was. There were only three women in my class of about ninety in the 1950s. However, psychiatry has always had a fair number of women. Most women went into psychiatry, pediatrics, and obstetrics. At least half the medical students in the 21st century are women, and they enter all the specialties of medicine.
Al: You told me the other day that you recently retired that you went back to work
writing a book. Can you give my readers some information about it?
Al: How is it going to be marketed, and will it be for professionals or for lay people?
Lucy: Both. It's written so that a layperson could understand it, but I think it would be of interest to all professionals in the mental health fields. It is a history, and many of us don't know a great deal about the history of psychiatry. We know there were asylums, but there were a lot of misconceptions about treatment back then. I think that my book is really a fun read for professionals and an interesting read, I hope, for the lay public and people interested in history.
Al: Are you working on any other books?
Lucy: No. However, I'm interested in the field of healthcare delivery, particularly in mental health and addictions. We just don't provide good healthcare for everybody. So, I'm thinking of doing some writing along that line. There's an enormous amount written in this area already.
Al: Would you like to speak a little about the relationship between Anna Agnew's illness and her creativity?
Lucy: There was an interesting study done at the University of Iowa by Dr. Nancy Andreasen, and of course, the connection between creativity and bipolar disorder has been made well known by Dr. Kay Jameson who has written not only a scientific work on research, but also some very interesting books about bipolar disorder and creativity.
When I retired in 1999, I started as a volunteer at the History of Medicine collection at Indiana University Medical School Library and the librarian there, then, Nancy Ackerman, called my attention to this book. I read it and got interested in 19th century asylum reform literature. There is a lot of it out there: pamphlets, books, newspapers. Mrs. Eckerman sent around to every library we could find that would send us a 19th century book written about a mental asylum patient who was not famous but just an ordinary citizen. We got seven books written by eight authors. Part of what I was interested in was what their diagnosis was. I really didn't know at the time.
It turns out that six very clearly had bipolar
disorder and the other two might have. I was somewhat surprised by that, and
then went back and looked at other literature. There does seem to be an
association between bipolar disorder and creativity. A lot of well-known
musicians, writers, poets, and artists suffer from bipolar disorder. However,
the books we looked at were by ordinary people. I think one reason is because
their illness remits, so they write when they are well. The thing that I
enjoyed about the book that was written by the patient that write about was that
it wasn't just a polemic. Usually, people are complaining about abuses-with
excellent reason. She tells the awful stuff and the good stuff. She gives us
an insight into the everyday life in the asylum, and she was not only there when
there were some very abusive practices but also when there was reform. There
was a physician named Dr. William Fletcher, and like all of the doctors she
mentions, this doctor had been in the Civil War. He was a great reformer. He
took all the restraints in the hospital and burned them in a giant bonfire on
Christmas Day of 1883. It made all the newspapers around the Midwest. She
described this. Dr. Fletcher brought in many reforms. He hired the first woman
doctor at the hospital. There were only twenty-two women doctors in state
mental hospitals around the country in the 1880s.
Lynn Orvis, who is a genealogy researcher working with the history of medicine collection, helped me to go around to libraries and archives to find out about this woman's family. It's been an interesting quest. She and Nancy Eckerman, the librarian, have compiled biographical material on 19th century Indiana physicians. When this patient mentioned her doctors, and we were able to know who they were.
Al: What do you think the patient/author's motivation to write her detailed journal
of her life at the time in the asylum?
Her plea was to the state legislature that they would make reforms and require that all people who worked with mental health patients would be trained nurses. We still have that problem today. It's much improved, but there are still abuses; there is still low pay and lack of training in some instances.
Al: I know there had been some treatments, like electroshock. Were there other treatments that were prevalent in that institution other than just the warehousing of patients?
Lucy: Electroshock was not introduced until the late 1930s. Warehousing was never considered a treatment. It was a result of overpopulation, and the treatment they had went back to the middle 1700's. Philippe Pinal in France freed mental patients who were chained to the walls and living in terrible conditions. He invented something that he called "treatment morale," which is translated into English as "Moral Treatment," but it doesn't mean "moral" as much as "morale." The theory was that we should treat people kindly, provide them activities, and respect them. It is really the beginning of psychotherapy. It is a little bit of a forerunner to cognitive-behavioral therapy, and that worked fine as long as you didn't have a whole lot of patients. But with the increases in population and urbanization, you had 2,000-3,000 patients in these institutions. The superintendent just could not keep up with what was going on. Although they were dedicated, kind attendants in spite of their difficult jobs, abuse appeared at all levels of staffing. Anna Agnew described one physician who was horrible and of course, the doctor hid this from the superintendent. But, the goal was moral treatment. The goal was never warehousing. This was an unfortunate consequence of too many people. As in the care today, we don't want to pay more taxes; therefore, state institutions are often left with very meager budgets.
Al: Give me an idea without giving me the end of the story what her day would be
Now, Fletcher in particular, but also some of the other superintendents, had a drama club and similar activities. Patients had a piano, and they would play and sing. They had beautiful grounds. That was part of the moral treatment. They had a farm that not only provided food, but patients could work there as their recreational activity. They made some sewing and crafts which were sold and brought in a little bit of money, and some of the doctors in the better days, would actually spend time talking with them. It was both a follow-up on moral treatment and a predecessor of what would happen in the 20th century. However, overcrowding increased, and things got out of hand.
Al: Is the building or institution still in existence?
Al: Where is it actually located?
Lucy: It's at 3045 West Vermont, west of the Indianapolis Zoo on Washington Street.
Al: Regarding our time, I would like your opinion about mainstreaming. What is your feeling about putting people out of the old state hospitals back into the community?
Lucy: It depends entirely on the individual patient. It depends on what illness they have. Is it severe, a chronic mental illness? Do they have a family support system and does the community provide support? This mainstreaming started in the 1950s when we first had antipsychotics drugs. There was effective treatment for the first time. There is an interesting article in the 1996 "Psychiatric News" by a sociologist named Leona Bachrach who has studied this issue. For some people, outpatient treatment in the community has worked. If you have a really good support system, a mental health clinic that follows these people, case management, help with getting a job, all the things they need in a community, it can work very well and for some people it has. In other situations, because our health system is so fragmented, it doesn't. There are still a few people for whom you can't do a great deal, although we can do more now than they did then. I think what we have gotten into is either "everybody goes in the hospital for a long time" or "everybody comes out of the hospital," and that just doesn't work. I think we still need long-term supervised care for lots of people, but it depends on the individual. There are all kinds of options like intensive outpatient programs, daycare, residential care, etc.
What is the societal responsibility for people who do not want to be
institutionalized. We refer to them as street people who are at risk but are
reluctant to accept treatment or assistance.
There was a very interesting review of this by the Institute of Medicine, which is part of the National Academy of Sciences, a quasi-governmental organization that provides scientific medical data to Congress and the Executive. They published a book which is on the Internet at http://www.aami.org/subject/safety/ and you can also purchase it. It's called Crossing the Quality Chasm: American Healthcare in the 21st Century. It addresses all the problems of all healthcare and makes some suggestions. There are many groups working on this issue--very recently, both the AFL-CIO and the Chamber of Commerce have come together about this issue. The Robert Wood Johnson Foundation has given a lot of money to exploring these healthcare issues. Lots of people are thinking of healthcare reform. In the long run, from a purely selfish standpoint, it would cost us much less to have this coordinated and to provide care to everybody that needs it. Each political party is in debt to a particular special interest groups, and we saw the whole uproar about the healthcare reform about ten years ago. Nobody wants to pay more taxes, etc, but the thing is getting it all coordinated so that good care is provided at the lowest possible cost. What is the bottom line? There is the cost to society, the cost to the criminal justice system, the cost to everybody, etc. Any citizen who is interested should get involved. In the mental health field, it's the National Alliance of the Mentally Ill, the National Mental Health Association. Both have local chapters. With bipolar disorder there is the National Depressive and Manic Depressive Association which has headquarters in Chicago.
Al: Is there a specific country that would be a typical model for America?
I had the experience last fall of falling and breaking my kneecap. I had to be in the hospital four days and have surgery. Now, as a physician, I am very accustomed to hospitals and know how to deal with the system. I was at a university hospital, had excellent care; a coordinator came into set-up outpatient stuff, but she didn't get there the last day. The physical therapist came, but not until the last day. So, when I got home, I started calling around over a few days and finally found out that I was in their computer; the people at the hospital got in touch with somebody else, who got me in touch with somebody else. I finally got a nurse to come in and check the dressing, got a physical therapist, but they didn't do basic home healthcare. I have steps in my home, and the orthopedic surgeon was upset about my using them with a leg immobilizer and crutches. I just wanted someone to come in to help me with that, and we got another group to get a home health aide who came in and helped me with chores. How many sixty-nine-year old women in this country have this kind of care? I had "Cadillac" care, but the majority of people in this country do not. Even with the best possible care, it is fragmented. It was only because I'm a fussy old maid and got in there and screamed and yelled that I got it organized for myself. However, this is not available to people who may be working very hard, but have terrible health care benefits. I know the system; I've worked it for forty years. I thought, my gosh, this is wonderful for me, but what about all the others?
I think both healthcare professionals and patients are angry. The problem is how you get this complicated system together, and there a lot of people with different interests all lobbying about this. Nevertheless, America can do a lot of things; I'm always hopeful. In this country, if you have the money and if you know how to work the system, you get the best healthcare in the world. However, that's only for a small percentage, and a lot of people just aren't getting it. People without the money go into emergency rooms because they can't afford everyday care. That's the most expensive possible way of providing healthcare. It's costing everybody, and it's not helping patients as much as if they had regular follow-up, regular physicians, etc.
Al: And the thing is that we will see that healthcare cost in our insurance premiums to us directly.
Lucy: You want my two favorite movies? One is an old one that came out in the 60's or 70's with George C. Scott called Hospital. It's incredibly funny, but it's a very dark humor picture. He is a hospital administrator. The other is a recent one, Traffic. I am interested in addictions, but it is NOT a nice movie. It's harsh, but I think it is very true.
Al: What is it that you would want people to learn, that you have learned, but that you could pass on to them so they don't have to reinvent the wheel.
Lucy: Psychiatric disorders and substance dependence are diseases like any other disease, and these patients as well as all patients, should be treated with compassion. We fluctuate in our treatment. We lock people up and beat them, and then we let them all out and treat them nice. We have done this for thousands of years.
It was interesting, the group got into a little bit of a heated discussion about
whether or not alcoholism was a choice.
The following is the publisher's news release for Dr. King's new book.