Benjamin Rush: Father of American Psychiatry

by Ron Avery

He studied the insane from every angle: measured their heads, took their blood, studied their blood and constantly engaged them in conversation trying to determine what triggered their madness.

Then in 1812, just a year before his death, Dr. Benjamin Rush penned Medical Inquiries and Observations Upon the Diseases of the Mind. It was the first American book on the causes and cures of insanity and it earned Philadelphia's most renown (and controversial) early American physician the title "Father of American Psychiatry."

The book is a fascinating mix of astute observations coupled with pronouncement that would qualify Rush for psychiatric assistance if he were practicing medicine today.

For instance, Rush writes of a miraculous transformation in an obstreperous female patient at Pennsylvania Hospital after the staff brought a large tub of water into her cell and threatened to drown her. "If all remedies fail, it is proper to resort to the fear of death," he declares.

But Rush was a century ahead of Freudian theories of memory suppression when he observes that "depression of the mind may be induced by causes that are forgotten."

He documents the hereditary aspect of insanity and prescribes physical exercise and mental activity. Most important, he declares that "chains will seldom be necessary and the whip never required to govern mad people."

Rush believed "madness to be primarily seated in the blood vessels (of the brain)," and declares that "early and copious bleeding (20 to 40 ounces at a time) are wonderful in calming mad people. . . . it (bleeding) sometimes cures in a few hours."

Yes, the same man who polarized the city's medical establishment during Philadelphia's horrendous bouts of yellow fever by loudly advocating copious bleeding and massive doses of laxative as the cure, also declares "the quantity of blood drawn (for mental patients) should be greater than in any other organic disease." He cites good results after 200 ounces of blood were taken from a mental patient over a 27-day period and another case where 470 ounces of blood was drained during 10 months.

After pinpointing the root of madness as physical, Rush seems to contradict himself by listing scores of circumstances, events and psychological trauma which he believed could lead to madness, ranging from "inordinate sexual desire" and masturbation to extremes in climate.

He writes of a Maryland clergyman whose mental illness followed his failure to catch a typographical error on a sermon he had printed on the death of George Washington.

He found "two instances upon record of persons who destroyed themselves immediately after drawing high prizes in lotteries."

"An exquisite sense of delicacy" was the cause in the odd case of a schoolmaster who went batty after a student accidentally glimpsed him on the commode.

Rush was correct when he pointed to decayed teeth, lead fumes, tumors and certain dyes as possible sources of mental disease.

But he also warned that in some cases people were driven to madness by "the intense study" of science, the mechanical arts, Biblical prophesies, attempting to turn base metal to gold or efforts to produce "perfect order and happiness in morals and government." Citing an abundance of crazed poets, Rush saw danger in an "excessive imagination."

"Hundreds have become insane in consequence of the sudden loss of money," he declares, noting that rich persons "who lose part of their money are more apt to go mad then persons of moderate means who lose all."

Joy, terror, love, fear, grief, distress, shame might all lead to mental instability. "Where is the mad house that does not contain patients made mad from neglect or disappointed love?" asks the professor.

Like Franklin, Rush was one of Philadelphia's many 18th century renaissance men - as passionate about politics and social reform as he was about medicine. A signer of the Declaration of Independence and fiery foe of King George, he was also anti-slavery, anti-capital punishment, anti-liquor, pro-prison reform, pro-female education.

He was the key staff physician at Pennsylvania Hospital, which from its beginnings in the 1750s set aside basement cells for "lunaticks or persons distempered in mind and deprived of their rational faculties." Often patients were chained. For a time the hospital was actually charging admission to visit - and taunt - the mental patients. Rush put a stop to this cruel sport.

Rush had a large number of children; the eldest was John, who became a physician and Naval officer. In a tragic irony, John Rush went insane in 1810 and lived out the last 27 years of his life in those cells for the insane at Pennsylvania Hospital.

The source of John's madness is ascribed by various authors as shooting and killing a close friend in the Navy. Some say the shooting was accidental. One author says it was a duel, a prevalent practice among Navy officers at that time.

In a letter to Thomas Jefferson, Rush writes, "My son is better. He has become attentive to his dress, now and then opens a book, converses with a few people, but still discovers, with a good deal of melancholy, alienation of the mind upon several subjects, particularly those which associated with the cause of his derangement. He is now in a cell in Pennsylvania Hospital, where there is too much reason to believe he will end his days."

Rush's prognosis was accurate. John never regained his mental balance. He paced back and forth so much, it is said he wore groves in the flooring which became known as "Rush's Walk." He is buried near his parent's in Christ Church Cemetery, 5th and Arch streets. John's madness came long after Rush began his systematic study of insanity.

Rush's does write: In the year 1803 I visited a young gentleman in our hospital who became deranged from remorse of conscience in consequence of killing a friend in a duel." Was he referring to John and simply changed the date to disguise that fact?

Rush makes several generalities on insanity: more women suffer from mental illness than men, more rich than poor, more single than married people. He finds madness rare in "depressed or backward" nations such as China, Russia or Mexico. Among cures, Rush recommends cold showers on a shaved head and tells the reader "music should not be omitted as a remedy in a state of madness."

He stresses correct deportment with patients, urging the physician to "catch" the patient's eye. The practitioner's voice can he "harsh, gentle or plaintive, according to the circumstances. . . the conduct of the physician must be dignified, never descend to levity." Rush urges acts of kindness above all else and handling the patient with "respect and with all the ceremony due to his former rank and habits in living."

For the "highly excited" Rush recommends a vegetarian diet, solitude, darkness, purging (a laxative), cold air, cold water and ice packs on the head. An inventor, Rush recommends his own "tranquilizing chair." In appearance it was akin to a modern electric chair. The patient is strapped in tightly and a hood placed over his head.

He created another chair for those suffering "torpid madness," or catatonia. His "gyrator" was similar to the tranquilizing chair but it could spin the patient thus quickening the pulse and bringing blood to the brain.

Perhaps the most important aspect of Rush's study of insanity was his argument that it was similar to physical illness and was therefore treatable. He sent a copy of his book to his friend John Adams and writes: "The subject (mental illness) have hitherto been enveloped in mystery. I have endeavored to bring them down to the level of other diseases of the human body, and to show that the mind and the body are moved by the same causes and subject to the same laws."