December 4, 1998

This is in response to the History Notes column "From the Past: A Blast at Asylums," published in the September 18 issue.

Howard Field's description of the epic address by Weir Mitchell notes the "modest efforts at research [that] began in the more progressive state hospitals." Indeed they were modest, and the hospitals for the mentally retarded were behind them well into this century. The slow changes that did occur were both a personal and a professional saga to me.

During my early childhood, I became aware of outdistancing the developmental progress of my brother, who was two years older than I, and soon learned of the anguish of my parents, who had a hard time coping with his "slowness." Medical advice and schooling were in a primitive state in the early decades of this century. Out of despair, my parents visited Rome State School in New York, and I can still remember the pain and suffering they endured when they returned, vowing never to place my brother there. Never a severe caring problem, he died of leukemia at age 20, leaving a mixed group of memories.

That same year I entered college and with my biology class made a field trip to the same hospital. I was not as shocked as my parents but was impressed with the ways that the sincere people there were trying to cope with the large numbers of patients for whom there then seemed to be no hope. I came away with mixed memories, such as the polished floors continually being buffed by the patients. I saw little of this field as I progressed through medical school and pediatric training and eventually becoming a child psychiatrist, until I arrived in Los Angeles in 1955 to begin training. Some of my pediatric colleagues induced me to come with them to consult at Pacific State Hospital, and there I found another large hospital but one with a major research program, founded and directed by George Tarjan, M.D. (who later served as APA's 1984-85 president).

What a different experience! It seemed to be Dr. Mitchell's dream come to fruition. At every level of staff and every condition of disability, work was being done to discover both causes and methods of help for these patients. While it is true that other forces were at work in the overall management of state systems urged on by issues unrelated to the actual care of the patient populations, studies at this and other large hospital systems were showing what could be done for the care of both the retarded and the mentally ill. Unfortunately for the asylums, the confluence of both financial decisions and therapeutic progress has led to the present state of such large-scale care.

We have not fully achieved the goals set forth by Dr. Mitchell, nor have we resolved the struggles between various members of the healing community. As physicians we feel buffeted by forces beyond our medical control. Yet his challenge for research still rings importantly as an underlying force in all of our efforts. It is difficult for us to fulfill the role of physician as we saw it so clearly when we started medical school. Yet without such a role our patients, and those who care for them, will continue to suffer.

Henry H. Work, M.D.
Bethesda, Md.

Dr. Work is a former APA deputy medical director.