The Benjamin Rush Prescription (Part 2 of 2)

Continued from Part 1

Despite being an abolitionist, Benjamin Rush's racial views suggested little actual tolerance for racial minorities.  He argued that "Negroes" suffered from a skin condition which he labelled "negritude" (akin to leprosy) and that the only cure was for them to become white.   While there was no indication that he ever treated African-Americans for this "disease", he argued against intermarriage between races to ensure that negritude would not be spread further.

Of course, Benjamin Rush is best known as the "father of American psychiatry".  In 1812, he published Medical Inquiries and Observations upon the Diseases of the Mind, which became the standard American textbook for treating the mentally ill for most of the 19th century.   Based on his own practices with mental patients in the Pennsylvania Hospital, Rush concluded that mental illness was caused by faulty circulation in the blood vessels of the brain.  He also supported the popular idea of "faculty psychology", that humans were born with specific "faculties" of logic, emotion, and behaviour linked to specific areas of the brain.    He was the first to coin the term "phrenology" as it related to the study of how the brain was linked to specific faculties although he had nothing to do with how the pseudoscience that eventually became associated with the word.   

Appalled by the poor care that mental patients received (whether in hospitals or confined in their family homes), he became an advocate of the moral treatment pioneered by Philippe Pinel, William Tuke, and other European reformers.   Benjamin Rush led the campaign in 1792 to build a new hospital wing for mental patients where they could be treated more humanely.   By the turn of the 19th century, a massive drive for reforming how the mentally ill should be treated sprang up on both sides of the Atlantic.  Sparked by the very public insanity of King George III and his ongoing need for humane care, the conventional "madhouse" approach was rejected in favour of more humane alternatives.   While medicine was often inadequate to deal with the causes and effective treatment of various types of mental illness, moral treatment advocates stressed that mentally ill or brain-damaged patients could be rehabilitated and trained to do useful work.   Although Rush believed that poor brain circulation was the cause of insanity, other reformers suggested that insanity was due to direct or indirect brain damage that could be linked to "overwrought emotions or strained intellectual facilities".   

Certain  groups were specifically targeted as being at high risk for developing mental illness (and likely stigmatized them in the process).  Rush in particular identified,

  • Children of insane parents
  • Individuals who were isolated and lonely, such as unmarried persons or women living in frontier settlements
  • Those with dark hair
  • People between the age of twenty and fifty
  • The "rich and idle who unlike the toiling, pragmatic poor, had leisure to look back upon past and to anticipate future, and imaginary, evils"

Rush also pointed out that certain occupations were more susceptible to insanity than others because they "dwelled too much on emotions" and tended not to be grounded in reality.  He cited Philippe Pinel who suggested that painters, poets, sculptors, and musicians were especially vulnerable while scientists were relatively immune. 

Although Benjamin Rush continued to stress that insanity was due to physical causes, the treatments that he advocated ranged from the practical to the bizarre.   Along with his familiar standby, bloodletting, he also advocated purgatives and emetics (his "thunderclappers" likely got a lot of use as well).   In keeping with his own views on blood circulation in the brain causing insanity, bloodletting was often aggressive.  In cases of mania, patients were restrained while a vein was opened (including the jugular vein in extreme cases).  For younger patients, the bleeding occurred while they were held upright to encourage fainting "to diminish excessive arterial action in the brain".   Calomel (i.e., mercury) was used in treating melancholia.  Not content to rely on standard medical treatments, Rush  also developed a remarkable invention. Based on circulating swings used by English doctors,  Rush's own innovation, the gyrator, used centrifugal force with patients sitting in the machine as they were spun around.  Intended to force blood to the brain, Rush was dissatified with the results and commented that "it would be more perfect did it permit the head to at a greater distance from the center of motion".   He also invented a better system of restraint which he dubbed "the tranquilizer". 

For Rush, the most painful case of his career involved dealing with his eldest son, John.  In 1807, just a few months after killing a man in a duel, John  Rush's mental state went into a downhill spiral which eventually led to his becoming completely insane by the end of the following year.  A once-promising military officer, John Rush made several suicide attempts (as well as attempting to kill his doctor and other medical staff dealing with him).  He was eventually sent to Philadelphia Hospital so that his eminent father could oversee his treatment.   In a memorable letter written to Benjamin Rush by his son's commanding officer, the commandant described his bizarre behaviour and John Rush's skill at hiding a razor on his person despite repeated searches.   Although John's emotional state often varied with long episodes of relative normality (suggesting some form of Bipolar Disorder), he eventually became a patient of his father by 1810.   Despite attempts by his family to deal with him at home, he was later placed in Pennsylvania Hospital in the new wing for mental patients that his father had built.    After diagnosing him with "melancholy derangement", Benjamin Rush left John's treatment to other doctors.  Despite changes in John Rush's condition with occasional releases from the hospital, he would eventually die there in 1837.

After Benjamin Rush's death in 1813, psychiatry fell into long neglect with few lectures being given on the subject in medical schools for decades afterward.   Despite the criticisms of Amariah Brigham and other reformers, Rush continued to be venerated as the chief authority on how the mentally ill should be treated, including the use of bleeding in treating patients well into the 1850s.   When Pliny Earle published An Examination of the Practice of Bloodletting in Mental Disorders in 1854, he argued against Rush's recommended bleeding practices on the grounds that bloodletting had fallen out of favour in most hospitals (although some European doctors were still using cupping and leeches at that time).   Despite the changing attitude towards bleeding, Earle still needed to be diplomatic about Rush given his stature in the field.   There was still considerable resistance however since the asylums were filled with patients who were completely resistant to any form of treatment.  It would not until the 20th century that better methods would become available.

Although Benjamin Rush's theories haven't stood the test of time, his complex legacy and the impact that he had on later American psychiatrists is considerable.  Not only is his silhouette on the formal seal of the American Psychiatric Association but Chicago's Rush University is named for him.  Although it is easy to criticize his antiquated treatment methods, which likely did far more harm than good, he also revolutionized psychiatric hospitals and prisons at a time when they were little better than medieval dungeons.  

In many ways, Benjamin Rush was very much a pioneer.  Perhaps that is how he would have liked to be remembered.


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