The Evolution of Mental Health Care: 200 years at Hartford HealthCare's Institute of Living: Episode 2
•Hartford HealthCare PodCast•Season 1•Episode 2
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In recognition of the 200th anniversary of Hartford HealthCare’s Institute of Living (IOL) this year, Hartford HealthCare has partnered with the Connecticut Historical Society to present Common Struggle, Individual Experience: An Exhibition About Mental Health.
This special podcast series will take us through the history of mental health treatment in Connecticut, and behind the scenes of the IOL, the first psychiatric hospital in the history of Connecticut and the third in the nation.
The journey of mental health care through the 19th and 20th century is a fascinating one. The IOL played a significant role in fundamentally changing approaches to mental health – blazing a trail of moral, ethical treatment for others to follow.
In episode two, Hartford HealthCare’s Steve Coates talks to Dr. Harold "Hank" Schwartz, psychiatrist-in-chief emeritus at the Institute of Living.
They take us back to the state of mental health in 1822. A time when those with mental illness were treated like prisoners, or worse. The field was on the cusp of much-needed change, which began in Europe. That change would soon reach the American shores and would be spearheaded by Eli Todd, a physician in Farmington, Connecticut, and who served as the first director of the Institute of Living.
Check the links in this episode’s notes to listen to episode one featuring the Connecticut Historical Society’s Director of Exhibitions Ben Gammell, and Research Historian Karen Li Miller describing the “Common Struggle” exhibit which is now open at the Connecticut Historical Society.
Be sure to follow Hartford HealthCare on your favorite podcast platform where more episodes focusing on the IOL’s history, present and future will publish throughout the year. Just search “Hartford HealthCare” on your favorite podcast platform.
The Evolution of Mental Health Care: 200 years at Hartford HealthCare's Institute of Living: Episode One
The background, the traditional way of approaching people with mental disorder, which, you know, by today's standards was really deplorable. People with mental illness were placed in almshouses, jails, sometimes towns around Connecticut and everywhere else in America would bid the care out to the lowest bidder who might put up a little cage along the side of the barn and keep somebody that way. In France, a physician by the name of Philippe Pinel was instrumental in this movement to remove chains from the people with mental disorder and to treat mental disorder as an illness. I mean, what a change from treating it as possession by the devil or, you know, a sort of inherent evil.
SPEAKER_00
In recognition of the 200th anniversary of Hartford Healthcare's Institute of Living this year, Hartford Healthcare has partnered with the Connecticut Historical Society to present Common Struggle Individual Experience, an exhibition about mental health. This special podcast series will take us through the history of mental health treatment in Connecticut and behind the scenes of the IOL, the first psychiatric hospital in the history of Connecticut, and the third in the nation. The journey of mental health care through the 19th and 20th century is a fascinating one. The IOL played a significant role in fundamentally changing approaches to mental health, leaving a trail of moral and ethical treatment for others to follow. In episode two, Hartford Health Christ Steve Holmes talks to Dr. Hank Horse, a physician and chief emeritus at the Institute of Living. They take us back to the state of mental health in 1822, a time when those with mental illness were treated like prisoners or worse. The field was on the cusp of much-needed change, which began a miracle. That change would soon reach the American shores and would be spearheaded by Eli Todd, a physician in Farmington, Connecticut, and who served as the first director of the Institute of Living. The tides of change in the field of mental health, from then until now, are remarkable. Here's Steve Coates.
SPEAKER_01
Dr. Schwartz, thanks for being here today. 200 years for the Institute of Living. What a milestone for the institution. And looking back over those 200 years and the formation of the IOL, what was the climate like for mental health care, for behavioral health care back in 1822?
SPEAKER_02
Go back to 1822. There really are two forces going on at the same time that are almost in a contradiction to each other. One was the background, the traditional way of approaching people with mental disorder, which, you know, by today's standards was really deplorable. People with mental illness were placed in almshouses, in jails, sometimes towns around Connecticut, and everywhere else in America would bid the care out to the lowest bidder who might put up a little cage along the side of the barn and keep somebody that way. That was the background. But at the same time, that two things were happening. One was that it was the time of what's called the Second Great Awakening in America, which is it was a kind of religiously infused time of good public works. It was the time when the progenitor of the Hartford Asylum for the Deaf was created. All kinds of other institutions were created, the Athenaeum as a museum. So people were invigorated with the notion of public works for the public good. And at the same time, there was a change in the philosophy of attitude towards and philosophy of treatment about people with mental illness. This change originated in Europe. It was called moral treatment. It came to us really from two places in Europe, the York Retreat in York, England, which took the position that individuals with mental disorder really needed to be treated with kindness and attention to their psychological and spiritual issues. Also, in France, a physician by the name of Philippe Pinel was instrumental in this movement to remove chains from the people with mental disorder and to treat mental disorder as an illness. I mean, what a change from treating it as a possession by the devil or you know, a sort of inherent evil. So the philosophy of moral treatment crossed a pond to America. Uh, and here uh a number of people took it up, but one of the really primary people in America was Eli Todd, who was a physician in Farmington, had uh his own experience with mental illness, his sister and his father. He brought around a group of like-minded physicians who were very interested in um establishing uh a more appropriate, humane way to address mental illness, and as part of that, developed a commitment to creating an asylum.
SPEAKER_01
Was there a science behind any of this, or was it just these patients aren't well, we need a place to put them?
SPEAKER_02
I don't think you'd call it uh necessarily the result of science. I think you would call it almost early or pre-science observation by physicians that people with mental illness did appear to be ill, not disordered in some you know demonic way. Um and so uh, you know, those observations really contributed to a what was primarily a philosophic change, a change in attitude. Um and uh that's what we saw with the establishment of moral treatment at places like the Hartford Retreat for the Insane.
SPEAKER_01
Aaron Ross Powell So looking back to the 19th century and even into the turn of the 20th century, were there treatments that were effective like we have today, or was this just a place where we were putting patients?
SPEAKER_02
Well, I'll answer that in just a moment, but let me say before we get to the 1860s or whatever, the the science did begin in roughly the 1840s. The third superintendent of the Hartford retreat was a doctor by the name of uh Aramiah Brigham. And he was um an early neuroscientist. He would follow the course of patient's illness, and when the patient died, he would do postmortem examinations of the brain, trying to correlate abnormalities of the brain with the history of the patient's illness. This really is a part of scientific, yeah, an example of scientific uh investigation. In fact, what he was doing then, we are still doing today, but with contemporary methods. So we are examining patients with functional magnetic resonance imaging scanners, the kinds of MRI scanners you go under if you get a hit on the brain or whatever, and and it needs to be evaluated or have a stroke. Um, so we're we're still trying to do something that Brigham started in the 1840s, which is to correlate brain with mind and behavior. In terms of treatments, one of the huge advances was the notion that mental disorder is an illness. And if it's an illness, it needs to be treated like other physical illnesses. Now, in the very earliest days of the Institute, uh of the Heart of Retreat, that was before it was renamed as the Institute, that medical treatment might be bloodletting. Now that seems primitive. How could that be in advance? But it was in advance to think that if we were using bloodletting to treat pneumonia, because pneumonia was a real illness, that we would use the same sort of thing to treat mental illness. There were other um things that, you know, medications. Uh, for instance, there were opioids in in those days. Uh morphine and opium tinctures and other uh like substances were used to calm patients. Patients were given emetics, um, and uh that was felt to be uh helpful. Modern psychopharmacology didn't really start until uh 1950s, 1960s.
SPEAKER_01
Maybe I'm skipping a time period here, but I've heard so much about what has been called the golden age, the golden era of the IOL, maybe the 40s and 50s, when the rich and famous would come here to be treated, movie stars would come here uh for a retreat. Is is there truth to that?
SPEAKER_02
So the superintendent, uh the most famous superintendent of that time uh was a man by the name of Charles Growing. Um and he famously said that he thought the institute should be part hospital, part university, and part country club. And we went ahead, you know, creating just that kind of place. And um it became uh the place that many people would come from across the country uh with alcohol issues to uh to dry out. And some came with uh more traditional, very serious mental illnesses, others came for quote, the rest cure. Now, now Burlingham game, in addition to wanting to create this hospital university country club, also believed that physicians should really be familiar with the stethoscope. In other words, that you know, we needed to be a place that also provided the very best medical treatment and the best psychiatric care uh that was available. But we certainly had a reputation that was uh in a country club fashion. We had an indoor pool and an outdoor pool and tennis courts and a golf course and a squash court. People could come and have their own cottage and bring a servant with them. Of course, that was expensive. Um, there were also much less expensive accommodations for people who didn't have that kind of money or had more traditional um mental illness and needed a very different kind of care.
SPEAKER_01
So, what causes that type of shift in changing it from this long-term facility where the rich and famous would go in that golden age that we're talking about? Is it more about the insurance companies wanting some accountability for that length of stay?
SPEAKER_02
Well, there were a few steps to that. Um one was the introduction of medications that actually worked specifically for psychiatric um conditions, lithium, for instance, for bipolar disorder, thorazine and haldol for psychotic um conditions, um, Eleville and other antidepressants, you know, they created a huge revolution. All of a sudden, um people could be treated effectively in shorter periods of time. And so the draw uh began to shift towards a more traditional kind of psychiatric treatment of psychiatric disorder. Then there was the deinstitutionalization era um in which the state hospitals basically started going out of business in part because of the promise of psychopharmacology. People didn't have to stay in hospitals um for years, uh, in part because governments really wanted to shift away from funding um long-term care in state hospitals. But the big change for an organization like the Institute of Living was the managed care movement. So um managed care, which was the decision by the insurance industry, that they would just no longer write blank checks for patients to stay in hospitals as long as doctors said they needed to be there. Instead, they would require evidence that the patient really needed to be in a hospital at all. And then every week or so, uh further evidence that the hospitalization needed to continue. The managed care movement uh cut the heart out of the Institute of Living. In 1989, when I arrived at the Institute of Living, the average length of stay was over 60 days, and many patients stayed for 120 days. A few years before that, the average length of stay was was over a year. The Institute of Living in 1989, when I arrived, had 400, I'm sorry, not in 1989, in the late 1980s, had 400 beds. By the time I arrived in 1989, it was reduced to 200 beds, and then through nine separate downsizings to about 120 beds, and the average length of stay was reduced to 12 days.
SPEAKER_01
So five years after you arrive, the IOL merges, becomes part of Hartford Hospital, which becomes part of Hartford Healthcare. I think some of the reasons, obviously for financial reasons, but it seemed logical because of the proximity to the campus and perhaps maybe sharing medical staff. Take us through that process.
SPEAKER_02
But uh the IOL had so many programs of excellence that frankly it worked very well. In the long term, the merger with Hartford Hospital provided a platform from which the IOL could again become nationally prominent in the delivery of psychiatric services. And after a couple of years of adjustment and scrambling to make things work, we were able to begin the development of a whole group of new contemporary programs, a major research center, invigorate our training programs, um, and ultimately, you know, as I said, move from a solid foundation to the organization we are today.
SPEAKER_01
In the context of working in this larger health system, what has made the IOL so successful in addressing behavioral health concerns and continuing to establish itself as a premier uh destination for behavioral health?
SPEAKER_02
Aaron Powell Well, first of all, here at home, as you know, the IOL is has become the flagship um service within the larger behavioral health network, which um consists of the psychiatry departments uh and a number of hospitals and ambulatory programs really that are across the state. So we're we're part of a much larger system. We're opening a new residency program. The system, Hartford Healthcare, is um uh based at St. Vincent's. We're growing our research programs. We've developed the match programs for medication-assisted uh substance abuse treatment um throughout the state. So, you know, we're growing and we're trying to meet the needs of the community, but as is obvious right now, the needs of the community have taken a huge, huge leap in demand um really um with the pandemic, which isn't to say that the demand wasn't growing before the pandemic, it was. And the mental health system in America is still disorganized in many ways. Uh the pressure now to meet many of the demands is just growing more and more intense. I do think that as part of a larger system, the Hartford Healthcare's Behavioral Health Network, we're better positioned to be more flexible, meet the demand with services where they're needed and when they are needed. But I don't want to underplay uh the challenges of meeting the current really called mental health crisis that we're in right now as a result of the opioid crisis, rising rates of suicide, hugely rising rates of suicide, rising rates of depression and anxiety that have been kind of going through the roof uh with the pandemic.
SPEAKER_01
As we come to a close here, I'll ask the resident historian of the Institute of Living, what is it about the IOL that makes it such a special place in attracting physicians and attracting colleagues? What is it?
SPEAKER_02
I'd say there's a couple of reasons. One, unlike many other organizations, the IOL has stayed committed to the many parts of psychiatric care. So there are some organizations that just are totally biologically based into medications. There are others that are more traditional that have stayed closer to the psychotherapy realm. There are some that are research institutions and others that are just clearly clinical. We keep our fingers in all of those pots very significantly. We have outstanding research programs that feed what we do clinically. We have terrific training programs in all of the disciplines that provide uh mental health services. And I think we have a wonderful clinical program. The people who come here are people who want to teach and want to provide care. They want to be in an intellectual atmosphere that is contemporary and at the cutting edge. Uh, and that enables us to you know draw leadership and staff that are really first rate. The second thing I would say is that the leadership of Hartford Healthcare has an understanding of the relationship of mental illness to overall health care. And so they don't consider psychiatric services, mental health services to be a stepchild. They consider it to be, you know, a vital component of what we all need to move forward in good health. And you know, that's a critical support.
SPEAKER_01
Doctor, thanks so much for your time. Thank you, Steve.
SPEAKER_00
Thank you, Steve Coates and Dr. Schwartz. Check the links in this episode's notes to listen to episode one featuring the Connecticut Historical Society's director of exhibitions, Ben Gamble, and research historian Karen Lee Miller. They describe the Common Struggle Exhibit, which is now open at the Connecticut Historical Society. Be sure to follow Hartford Healthcare's podcast, where more episodes focusing on the IOL's history, present, and future will publish throughout the year. Just search Hartford Healthcare on your favorite podcast platform. For Hartford Healthcare, I'm Ananda Pierre. Thanks for listening.
