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Episode 62: Evolution of Psychiatry & The Menninger Clinic with Dr. Walter Menninger

• The Menninger Clinic

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The story of the Menninger Clinic is rooted in the history of psychiatry in the United States. To start the new year, we have our very own Dr. Walter Menninger on the podcast to share the hidden history of the Menninger Clinic. Drawing inspiration from his memoir, “Like What You Do,” Dr. Menninger shares anecdotes from his forensic psychiatry career and how Menninger Clinic faced the challenges of psychiatry in the 20th century. Dr. Menninger reflects on the institutional changes Menninger has made throughout the decades to elevate itself from other providers and cement its place as a national leader in mental healthcare.  

 Dr. Walter Menninger, M.D., served as the dean of the Karl Menninger School of Psychiatry and Mental Health Science and served as the CEO of the Menninger Clinic before his retirement in 2001. Dr. Menninger’s specialty in the field of forensic psychiatry led him to serve on numerous boards and committees across the U.S. to reform prisoners and prison mental healthcare as well as inform law enforcement procedures at the state and federal levels for violence prevention. Dr. Menninger authored a national column on psychiatry and served as editor of Psychiatry Digest. His latest book, “Like What You Do,” reflects on his personal career as well as the legacy of being the third generation of the Menninger family.  

 “It’s hard for a free fish to understand what is happening to a hooked one,” Dr. Menninger remarked. “Empathy is crucial for successful treatment and what my father and brother centered the Menninger Clinic mission around.” 

 Learn more about Dr. Menninger and his legacy as a mental health leader in this special Mind Dive conversation. 

Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!

Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.

Dr. Boland: 0:02

Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr. Bob Boland and Dr Kerry Horrell.

Dr. Horrell: 0:11

Monthly we explore intriguing topics from across the mental health field and dive into hidden realities of patient treatment.

Dr. Boland: 0:18

We also discuss the latest research and perspectives from the minds of distinguished colleagues near and far.

Dr. Horrell: 0:23

So, thanks for joining us.

Dr. Boland: 0:25

Let's dive in, all right. So, we have a special podcast today. It's special for a couple of reasons. One, unfortunately, Dr. Kerry Horrell is not here, so it is just me as host. That's the bad news. The good news is that we have a special guest today. We have Dr Walter Menninger. As you know, we're at the Menninger Clinic and if you're wondering why, it's called that, you'll hear more about that today.

Dr. Boland: 0:54

So, Dr Walter Menninger he's actually a third generation of the family that you know is and this is really not hyperbole, it's credited with changing modern psychiatry. He served as the dean of the Menninger School of Psychiatry. He was chief of staff at the Menninger Clinic, and he was president and CEO of Menninger this position that he held until he retired in 2001. He consulted the US Secret Service and the Federal Bureau of Prisons. He was a psychiatrist for the Medical Program Division of the Peace Corps. After the assassination of Robert Kennedy, Lyndon Johnson appointed him to serve on the National Commission on the Causes and Prevention of Violence, making him the first psychiatrist appointed by a president to a National Investigatory Commission. So, Dr Menninger graduated from Stanford. He got his medical degree from Cornell Medical School and with his wife, connie, he raised seven children, which he considers his greatest achievement, and he's now in his 90s and he lives in Topeka, Kansas, where he remains active in his community. So, with all that, thank you so much, Dr. Menninger, for coming on.

Dr. Menninger: 2:05

I'm delighted to be here, especially in this place.

Dr. Boland: 2:09

It's wonderful to have you here. So you know, I asked him to do this podcast after I read his recently published memoir, which is called Like what you Do, which is a fascinating history of both your accomplishments and those of the family and really kind of it's an essential work for anyone who understands the history of American psychiatry. And why don't we start with the title? You distinguish between what you call it like what you do, and you distinguish that between doing what you like. Can you say a little bit more about that?

Dr. Menninger: 2:40

In medical school. A mentor in my second year was a doctor who had wanted to be a chemist like his father, and his father wanted him to become a doctor, a MD, and so he dutifully went to medical school and hated it and he learned to like and enjoy practicing medicine when he served his stint in the army and was a doctor of general medicine, family and so forth at Fort Dix. When he got back to his home in New York, Brooklyn, he actually found enjoyment, developed a little private practice. But he also got a job with the Memorial Sloan Kettering Center and asked for some bench space to do research, as his father had done, and he, with a colleague, developed a test of the blood to identify the evidence of damage to blood vessels. I think it was initially the Robleski-Ladew test. Anyway, I'm not sure how it is. I have to ask cardiologists to know whether it's still relevant.

Dr. Menninger: 4:00

At any rate, he was a man who I had experience with beginning the second year of medical school and he had all kinds of aphorisms and sayings. He had little diagrams, you know like keep your ear to the ground, keep your eye on the ball, keep your nose to the grindstone. Now try and work that way of the grindstone. Now try and work that way. And he said, the important thing in life is not so much to do what you like, but to like what you do. And he had done that. In effect, he had learned to like medicine. Well, I had a point in my life where I was invited to change my workspace from being as part of the Menninger Clinic to be over supervising psychiatric residents in a state hospital and working as a state hospital physician, and this was something that I came back from a trip, a fundraising program, and I learned that my brother had volunteered to do yeah.

Dr. Menninger: 5:17

Unbeknownst to you, unbeknownst to me. I was dutifully preceded in that and it's rewarding work, I mean, in many respects. After a year, they wanted me to assume more responsibility at the state hospital. Ultimately, this one became a section director and then clinical director of a 250-bed mental hospital.

Dr. Menninger: 5:46

But after the year I went back, and I sat with my brother, and it was perfectly clear he wanted me out of his hair. I have to pay proper respect for my brother who just died, three days short of his 98th birthday. But he kept me at a distance, and I ended up spending a decade and I wasn't sure I would get back to being part of Menninger. Ultimately, I was able to. I snuck in by a side route because the head of forensic psychiatry left and that was a subspecialty of mine. So, I was able to go back and assume responsibility in forensic psychiatry for the institution. And then my brother had occasion to ask me to take on education and I headed the Department of Education, was dean of the School of Psychiatry, and then part of the concern is that part of the story of Menninger is there was a point at which I mean it was founded by grandfather whose eldest son, carl, was interested in psychiatry and came back to Topeka to help establish a clinic.

Dr. Boland: 7:08

But grandfather was a general physician and was the intention then to be a psychiatric clinic.

Dr. Menninger: 7:13

Well, it was grandfather, just grandfather was struck by the model of the doctor's mail in Rochester Sure, and he didn't care. Mayo in Rochester, and he didn't care.

Dr. Menninger: 7:31

Carl came back interested in neurology and psychiatry from his experience of training at Harvard and grandfather said that's fine, as long as we practice together. And then, when Carl's patients couldn't be hospitalized in the general hospital because of their behavioral problem, they were challenged to buy a farmhouse and a farm to become a place where patients could be housed and treated. And what became of the Menninger Sanitarium? This would be about when this was in 1925. Carl came back in 1919, but it was by 1924 or so forth. They were aware that they needed to do something. So, they created the Menninger Sanitarium Corporation in 1925, sold stock to townspeople and so forth to be able to buy what was then the property and became the Menninger Sanitarium.

Dr. Menninger: 8:34

And my father, who was six years younger, came back or was finishing training. He had a medical surgical 18-month experience at Bellevue in New York and he didn't anticipate being a psychiatrist. But Carl called him and said we need you, come back. So, my father and mother married on December 12th and moved back to Topeka and Carl put dad immediately in charge of the sanitary. Oh wow. So, training in psychiatry was a little different, exactly.

Dr. Boland: 9:17

And your father was.

Dr. Menninger: 9:19

William right, Father was called William, he was called Dr. Will and there was Dr. Carl, and my grandfather was Dr. CF. So those were the trio and the institution gradually grew. Dad got some perfunctory psychiatric neurological experiences at St Elizabeth's in Washington DC and then they both Carl in the early 30s got interested in psychoanalysis and went to Chicago where Franz Alexander had created a psychoanalytic institute and carl had certificate number one graduated from the Chicago institute. My father followed in the early 30s, but alone that. Several events happened that brought more attention in terms of the reputation of Menninger in psychiatry. One was Carl wrote a book trying to explain some basic principles. It was published in 1930 called the Human Mind. But he articulated the concepts in such a straightforward manner and readable manner it became a bestseller. Yeah, and I think that's what probably first brought the Menninger name into general awareness.

Dr. Boland: 10:59

Well, I imagine there's a great need for that, because I mean having trained in some of that as well. I mean reading one of those early works and stuff like that are pretty difficult. Yes, Exactly, and not straightforward.

Dr. Menninger: 11:10

No, and Carl knew how to use similes and examples.

Dr. Menninger: 11:18

He begins his book with. When a trout rising to a fly gets hooked on a by and finds himself unable to swim about freely, he begins struggles and splashes and sometimes an escape. Often, of course, the situation is too tough for him. In the same way, a human being in life encounters hooks and so forth, and the key word is that it is hard for a free fish to understand what is happening to a hooked one. And then Carl in straightforward English. So that was an important aspect of it. Then the work. My father's forte was in developing a program of treatment for emotionally troubled patients in a protected setting, a sanitarium. That involved engaging all of the staff, and this is not a time when you had specific medicines.

Dr. Boland: 12:25

Right, yeah, I was hoping to say a bit more about that, Right, because there were a few other sanatoriums and stuff and asylums around at the time. But my guess is the treatment was quite different than what you were trying to go for.

Dr. Menninger: 12:36

Well, your family, not you. They had developed this way that really engaged the whole staff in a milieu therapy program. That was unique, what ultimately led to further. There were two other things. They got approved for training nurses and then doctors in the early 30s to train doctors to become psychiatrists. The other aspect Fortune magazine in 1935-36 did an article about private psychiatric hospitals in the country and they did it with four or five, but the only one west of the Allegheny Mountains because all notable ones were on the east coast, and the Menninger Hospital, the Menninger Sanitarium, was in that article and so it then got notoriety. And then in the early 30s they started the Bulletin of the Menninger Clinic as a professional journal so that the staff could share their professional observations and the like. And the publication continues to this day. Yeah, yeah, still under the auspices of Menninger.

Dr. Boland: 14:02

Menninger and Baylor University. Yeah, yeah, still under the auspices of Menninger, Menninger and Baylor University. Yeah, I mean, and I think it puts in perspective, because I mean now, like pretty much every hospital does know psychiatric hospital knows about milia therapy and does it.

Dr. Menninger: 14:34

I think it wasn't common at the time. Well, and I don't know that any hospital has developed it in the manner with which my father would set up a program help externalize aggression in safe ways or allow a person to be able to become a little less inhibited, in that manner that you change a vector of psychological forces within the individual that can move toward healing and more normal function and I think one of the things that you stress in the book that is novel is that all the staff was involved in the treatment.

Dr. Menninger: 15:18

When you think of milieu, the total environment, you need all the people. So that, in fact, I'm reminded of this. I quote in my book a letter I got from one of my patients. This is many years later, still at Menninger, when I was a resident physician, young staff member at Menninger, yeah, and this person was struck by the fact of how all the personnel, whether it was the groundskeepers, people in dietary and the cafeteria serving out food for them.

Dr. Boland: 15:56

Mm-hmm.

Dr. Menninger: 15:58

All the professional staff were people who were caring and loving, and her experience, part of her problem, was that she'd always experienced love, any expression of love, with somebody planning to take advantage of her. So, she was very reticent about that. So, she was very reticent about that, and she began to see how everybody loved, and the institution was centered in terms of a loving environment.

Dr. Boland: 16:38

It was insightful on the part of this particular person. I think it's meaningful because that really has sort of established a legacy here. One of the first community meetings I went to community being of all the patients meeting with most of the staff there on the unit. The patients give out awards and one of the first awards, you know, for good care and one of the first awards they gave was to one of the housekeepers who indeed was a very kind person, who you know was very helpful, got to know each patient, their predilections and kind of really customized her service to different people. That's amazing. Yes, yeah Now, but a lot of this is before your time. How did you get involved with the vinegar clinic? Obviously, your family, but not everyone goes into the family business.

Dr. Menninger: 17:21

Well, I don't know at what point.

Dr. Menninger: 17:25

I identified with my father and as long as I can remember I wanted to do what my father did, but he was concerned with how to make the essentials of psychiatric understanding of human behavior available to everyone.

Dr. Menninger: 17:48

And so he wrote a book called you and Psychiatry that was published just after the war and he had me, while I was in high school, read it, not to edify myself but to see how a teenager would understand, would be able to grasp and get the concepts and so forth, and he made the whole profession and human behavior most understandable and it just reinforced my plan was always to go to college, go to medical school, become a psychiatrist, be part of Menninger, and there were little hiccups along the way but that basically has been the course, the course, so I would, you know, all of us who go into medicine, at least at that time and to fulfill a commitment to Uncle Sam because they had the doctor's draft and you know that was one of my detours along the way my brother detoured me to the state hospital Exactly, but I finally was able to get back on track.

Dr. Boland: 19:20

And I'm intrigued by your commitment to education because you were the dean of the medical school.

Dr. Menninger: 19:26

Well, it was called a school. I'm sorry, I said medical school. Yeah, it didn't have a formal medical school of affiliation, but basically, we trained all aspects. We had clergy as well as clinical psychology, social work, all related psychiatric disciplines.

Dr. Boland: 19:46

And it's amazing because I've run into quite a few. I'm associated with the Menagerie. I've run into quite a few psychiatrists who say that at least part of their training took place at the Menagerie Clinic and that obviously was the center of psychiatric training for a time. But what particularly amazes me is now okay, so I came from a residency of about I think it was eight per year. I worked in residencies that got up to about 15 per year and that was considered a lot. How many residents did?

Dr. Menninger: 20:15

you all have. Well, what happened was that during the war there was a realization of a need for psychiatric care. Actually, the Army had to train a lot of 90-day psychiatrists and the VA knew that there were going to be a lot of casualties to be dealt with, psychiatric casualties, and they were going to need a lot of psychiatrists. And so, Paul Hawley worked in terms of that and had a representative come out and explore. They were trying to expand psychiatric training all over the country at the end of the war World War II, I think, in 1946. Yeah, and so a representative came and talked with Uncle Carl and said we need more training. And Carl said Well, we trained maybe five or six in Menninger at that time initially.

Dr. Menninger: 21:16

But they thought if they took over an army hospital to become a veterans hospital, maybe we could create enough physicians. So, Carl said Well, maybe we could train 19 or 20. And they said no, we want you to train 100. When you had to do a kind of revolution, you can't have 100 training after the professor on the rounds. So, there were more structured courses. Carl and a couple of colleagues wrote a manual for psychiatric study that I think. Still, I don't know that any of the residents today whether they're even aware of the book, but it was our text at Menninger School of Psychiatry and so we had a text, we had lectures, and then we had clinical placements, and there were clinical placements at the VA. Later to the state Saw what had happened and said can't we become part of this? And so, residents were placed at the state hospital and there were residents at Menninger and so forth, and so ultimately there were by the end of 46, 100 doctors in training.

Dr. Boland: 22:33

It frightens me just to think of running a program like that.

Dr. Menninger: 22:36

But in addition, Menninger, well the numbers then were reduced. We were down to maybe 30 residents when I was in charge of the school. But we also had programs for clinical psychologists, psychiatric social workers, training programs for psychiatric nurses, for all range of adjunct therapists, music therapists, recreational therapists and so forth, for clergy, to help train clergy and doing appropriate counseling and the like. So, everything related to mental health disciplines where we had programs at the Menninger School of Scholarship and also at Menninger, we ended up having seminars for business executives toward understanding men and so forth. So, we had a major educational effort.

Dr. Boland: 23:30

 Wow, it must have been quite a place to work.

Dr. Menninger: 23:33

It was! We attracted visiting professors Margaret Mead Actually, anna Freud came to Topeka, wow and a number of significant novelists and others, as well as different psychiatric experts. It was a stimulating place to be.

Dr. Boland: 23:59

I can only imagine, yeah, and we haven't really. I know you've done other interesting things along the way. Right, we're only going to scratch the surface, but is there any other sort of outside of Menninger experience? I know you've worked with the Peace Corps; you've worked with the government in various capacities. Anything you want to point out as something you particularly enjoy doing or something you found particularly satisfying?

Dr. Menninger: 24:20

Part of the challenge is helping more people understand and have an appreciation for what they can do in terms of coping. I got approached in the early 80s to write a syndicated news feature. They're all gone now, but I ended up writing a column called In-Sites, because it wasn't straight medical, wasn't straight psychological, but a combination. It wasn't straight psychological but a combination and I for about eight years wrote the first year was two times a week, but then three times a week. That was a wonderful opportunity to try to get more knowledge and information out to the general public about coping with various psychological issues. That was sad. I've actually been able to touch a lot of bases. I mean to go.

Dr. Menninger: 25:25

I spent 30 years as a primary consultant to the local police department. Wow. I evaluated candidates for the police department. I evaluated candidates for the police department. I was there to help when policemen had their own crises I mean after shooting incidents or after being shot and working with them in a post-traumatic context, helping negotiate with individuals who are holding somebody hostage or responding to a disaster. We had a person come in and invade the local courthouse and it was basically quarantined for eight hours. They went in with bombs and killed a couple of people and being involved with the after effects and the decompression of all the courthouse staff and the people who were involved in dealing with the trauma and the people who are involved in dealing with the trauma, so, as an institution, being able to provide first aid and then follow up to a community of people. So, I've had an opportunity to work with the Secret Service, yep.

Dr. Boland: 26:48

That's been interesting.

Dr. Menninger: 26:50

I've been able, I've been blessed with a number of opportunities.

Dr. Boland: 26:54

You sure have Wow. But you know, I think it's interesting that at the end of your book, towards the end, you sort of like deal with some big concepts and kind of like your thoughts about. You know a lot of different problems, different things you're facing. And I wanted to bring up one, because you do talk about the idea of a healthy community, and I think that's particularly relevant now. I mean, everywhere we look, we read about the divisiveness and, you know, going on and polarization of society. I'd love to hear some of your thoughts about that and what we should be doing about it.

Dr. Menninger: 27:27

well, the person who was really heavily into that was a colleague who trained at Menninger before me and actually was an NIH for many years and then out in California, who was concerned about how do we maintain, how do we establish, maintain healthy communities? Yeah, establish, maintain healthy communities, yeah. And the example I make reference to in my book is there was one year when the community of Lawrence, Kansas, where the university of Kansas is located it's about 30 miles east of Topeka, about 40 miles west of Kansas city was in crisis with all kinds of disruptions going on. They had competing communities, they had street people, they had the university complex, they had the local citizens and so forth and so on, and they had had a number of incidents. And they came to Menninger and asked could we devise a program to help them find the solution to their crises?

Dr. Menninger: 28:36

Identifying what were the various elements, some elements of the community, the business community, the student body, the street people, that all were at odds, and then bringing sample groups together on neutral territory to talk about these issues and realize they weren't so far apart, et cetera, and together put together kind of a roadmap of things that need to be done to help resolve the conflicts in the community. And it was striking. I mean it wasn't overnight, sure, because it took a number of weeks. You had to first get each sub-community to come in and be a part of the process and then to find representatives to have these groups to talk about things. But it offers a possibility in terms of trying to deal with the community process.

Dr. Boland: 29:50

That's just amazing.

Dr. Menninger: 29:52

And there's more written about healthy communities. I'm sure if you look up Leonard Duhl, d-u-h-l, d-u-h-l, d-u-h-l. Leonard Duhl, you can find reference there. It was part of his, it was active, and he was active at UC Berkeley. I see, yeah, I see.

Dr. Boland: 30:12

Yeah, out there. Wow, You're very good at giving credit to others, but I wanted to have the last word be yours, because a lot of our listeners are clinicians and psychiatrists and psychologists and other various mental health workers and you know with all your experience what advice do you have for people Listen. That's good advice.

Dr. Menninger: 30:35

You know, I operate with the assumption that everybody really wants to be good and wants to. We're frustrated by the fact that what some people feel is good we may not do it right. Others may have the same value, but it's important to try to understand where we're each coming from and try to find where the points of commonality are that can bring us together rather than split us apart.

Dr. Boland: 31:12

Sure enough, Wow. Well, once again you've been listening to Dr Walter Menninger, who's been talking to us today, and thank you so much for being on. Thank you Great and again. This is the Mind Dive Podcast. I am your host, Bob Bowen. Dr Keri Harrell is absent today, but we'll be back next time and thanks everyone for diving in.

Dr. Horrell: 31:35

The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Boland: 31:45

For more episodes like this, visit www.menningerclinic.org.

Dr. Horrell: 31:50

To submit a topic for discussion. Send us an email at podcast@menninger.edu.