Tag Archives: American Medical Association

Unflattering Views on Mental Health Care

The Journal of the American Medical Association Published Its First Cigarette Ad in 1933

Over a two year period beginning in 1931, Dr. John Maurice Grimes inspected all U.S. institutions caring for the mentally ill. This was done at the request of the American Medical Association. Grimes’ report was so unflattering that he ended up publishing it himself after the AMA withdrew its support. One of the dismaying situations he discovered was how chronic most hospital stays had become. Patients no longer came under care to get well, but to get out of the way of their families.

“The average length of stay of a patient in a state hospital is measured in years,” wrote Grimes. “A patient remaining in a hospital for such a period is not under medical treatment; he is not even under medical observation. …Many of these patients have been practically forgotten by their relatives, and the hospital has made little or no effort to prevent that forgetting or to freshen and strengthen the sense of family obligation.”

Grimes suggested an increase in the number of social workers available to oversee trial “paroles” for patients. The practice of parole or furlough (another common term for visits home) had been adopted by many forward-thinking psychiatrists at the time. The practice served to free up physician time and attention for other patients, and to help the furloughed patient begin to transition back to normalcy. The practice wasn’t as widely adopted as it might have been, because there weren’t enough social workers to help with the process. In some cases, families didn’t really want the burden of caring for their family member again.

At the Canton Asylum for Insane Indians, Dr. Harry Hummer refused to give furloughs. If he thought a patient might relapse, he saw no sense in sending the person home. Unfortunately, there were few cases in which Hummer had complete confidence that a patient had been cured. Though a few patients were discharged, the majority of patients under his care were never allowed home even for short visits. This practice made their homesickness and loneliness much worse.

Patients Create a Lawn at a North Dakota State Hospital

Morningside Hospital Patient Ward, circa 1935

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What’s Up, Doc?

Abraham Flexner

Abraham Flexner

During the early part of the 20th century, Native American medicine men probably had as great a cure rate as their white counterparts, and certainly had  as much credibility. American medical education was patchy at best, and no standards existed.

Before the early 1900s, many people became doctors through an apprenticeship, or by simply reading medical textbooks and  setting up shop. Some, of course, attended medical school. In 1906 the American Medical Association’s Council on Medical Education inspected all 155 medical schools in the U.S. and Canada. It discovered that many of them simply churned out students so that the doctors who owned them could profit from tuition fees.  In 1910 the Council issued a report, Medical Education in the United States and Canada (commonly known as the Flexner Report for its author, Abraham Flexner).

This report had significant repercussions for U.S. medical education. By 1920, the number of medical schools decreased to 85 and the number of students from 28,142 to 13,798. The percentage of  schools requiring two years of college for admission rose from three to 92.

Medical Students Using Stethescope, circa 1900

Medical Students Using Stethoscope, circa 1900

Johns Hopkins in early 1900s, courtesy the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions

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