Some 35 years ago, as a young officer for the Public Health Service, I was stationed at St. Elizabeths Hospital. This was one of the first generation of American mental asylums created by the lobbying efforts of Dorothea Dix in the mid-1800s. In its heydays St. Elizabeths Hospital was a walled city upon itself. Boasting of having a small railroad, a fire station, and furniture workshop it fulfilled all needs to its many thousands of psychiatric patients. A scenic point in the grounds had the highest elevation in Washington, DC. Years before my work there, St. Elizabeths was surrounded by a plush polish neighborhood.
National policies in the late 1800s and early 1900s were meant to keep patients secluded and outside the normal discourse of society. This would change in the 1950s with the introduction of powerful anti-psychotic agents like Thorazine (chlorpromazine). Why spend all that money with institutionalization when drugs could do the work for society? Wishful thinking propitiated a wave of patients being released from mental institutions into the community. These patients often had little or no social contacts, no money, and only a bag of drugs to carry with them. Patients never integrated into their communities, remaining homeless but keeping themselves close to the hospital to which they were dependent for medications. The once plush neighborhood of St. Elizabeths thus transformed to a crime ridden slum.
In the 1980s, we still had many patients at St. Elizabeths Hospital, including a cohort that had been lobotomized by Walter Freeman. A neurologist by training, Feeman had been mesmerized by the behavioral results observed after cutting white matter nerve fibers within the prefrontal lobe (leukotomy). This was the procedure for which Antonio Egas Moniz won the Nobel Prize. To perfect his procedure Freeman associated himself with a neurosurgeon by the name of James Watts. Both Watts and Freeman were faculty members at the George Washington University School of Medicine. Together they developed a rather aggressive procedure to sever even more of the white matter in the prefrontal lobes. The procedure was renamed lobotomy and the surgical technique that they standardized was known as the Freeman-Watts procedure. Thousands of patients ended receiving lobotomies, including Rosemary Kennedy (sister of late President John F. Kennedy).
Freeman modified the lobotomy procedure on his own using an ice pick and local anesthesia to approach the prefrontal lobes through the thin bone of the eye socket. Watts adamantly opposed the procedure and thought that Freeman was unqualified to oversee the surgery by himself. Their disagreement led to Watts leaving the practice they had jointly established. In 1969, Watts retired from The George Washington University Hospital. Although retired, I met him several times while visiting some of his ex-patients at St. Elizabeths Hospital. Watts wanted to see if he could still be of help to his patients. I guess this was his way of atoning for past mistakes.
After death, many of the lobotomized patients made their way to the Blackburn Laboratory. This was the first medical facility at the hospital dedicated to the study of mental illness. Dr. Isaac Wright Blackburn was appointed to St. Elizabeths in 1884 and, because of the patient population, became specialized in the gross pathology of the brain of schizophrenic patients. Throughout the years the laboratory initially established by Blackburn had many directors, none more famous (or should I say infamous) than Walter Freeman. The young neurologist had left his hometown of Philadelphia and relocated to Washington, DC in 1924. Taking over the Blackburn Laboratory the autopsy suite soon became a theater for entertainment. He performed thousands of autopsies primarily of schizophrenic patients. Decades after leaving his position at St. Elizabeths, Freeman would donate copies of his written works to the hospital, with the inscription, “To St. Elizabeths Hospital, where I worked 1924-1933, to find some answers to the problem of mental disorder, and where more problems arose than were ever answered”.
Of some 15,000 autopsies performed at St. Elizabeths Hospital about 1,500 brains were preserved in a brain/tissue collection. The specimens are of major importance as many of them predate the use of psychopharmacological drugs that often pose a confound to pathological studies. It can also serve to document the effects of treatment by electroschock, metrazol (high doses causing convulsions), insulin shock, and lobotomy. Unfortunately, sometime in the 1990s the brain collection was transferred, along with other similar resources, to a storage facility. Without any upkeep many of the microscopic slides may have dried and become useless.
Freeman worked hand-in-hand with another neuropathologist, Meta Neumann. Although she retired in 1981, she continued to join us in different congresses, usually choosing to seat in the back row in the company of her husband, neurologist Robert Cohn. They were always holding hands and Robert was very protective of her. She remained quite lucid during aging and died after her hundredth birthday.
Most of the buildings were closed by the time I joined the staff at St. Elizabeths. I worked at the William A. White building, a research bastion for the NIMH being named for one of St. Elizabeth’s Hospital superintendents. I started to work under Richard J Wyatt a psychiatrist who made important contributions to the biochemistry of schizophrenia. Dr. Wyatt had been an early survivor of Hodgkin’s disease but then went on to develop Burkitt’s lymphoma and finally died in a battle with lung cancer. In his obituary, it is said, “His [Wyatt’s] program at NIMH probably resulted in the spawning of more scientists devoted to understanding the biology of schizophrenia than any other program in the history of medical research”. Dr. Wyatt was dyslexic and faced serious difficulties in writing. He never outgrew his dyslexia but certainly overcame the same. I greatly admired him.
Richard Wyatt was married to Kay Redfield Jamison a clinical psychologist who held the position of professor at the Department of Psychiatry at the John Hopkins Hospital. Kay was one of the best doctors in the United States and chosen by Time magazine as a Hero of Medicine. She received a diagnosis of bipolar disorder during adolescence, and later on, co-wrote the classic textbook Manic Depressive Illness. Having trained initially at John Hopkins before moving to the NIMH I had the great pleasure of having met both sides of the family. It is a small world.
I would not like to end this blog without mentioning one of our most distinguished visitors, Dr. Janice Stevens. Early in life she had been a hippie crisscrossing the country by hitchhiking. She claimed a lucky star as nothing bad happened to her. Years later, and if memory serves me correct, she became the first female graduate from the Department of Psychiatry at Harvard Medical School. She then followed her education with a fellowship in Switzerland doing electroencephalography (EEG) and then traveled to India where a particular researcher was doing invasive EEG recordings in schizophrenic patients. Janice loved India and took it upon herself to institute a program on contraceptives throughout parts of the country. Her initiatives were not well received by the government and Janice was promptly expelled. She then moved to Africa where she established over 20 schools for underprivileged children. Whenever she came back to the U.S., she would collect money for her children. Indeed, she used most of her salary as a faculty member of academic institutions in the United States to support the education of children in Africa.
Janice was a distinguished scientist with some 100 publications written primarily as a first author. She was a good friend of Paul Maclean, of Triumvirate brain fame, and we used to meet in social gatherings regularly. Our discussions would gyrate about the role of evolution in designing the brain. We all thought that evolution had been a tinkerer and that any paradigmatic shift had been caused by adding to a preexisting structure rather than a de novo design. Overall, the brain is not as efficient as many people think.
There were numerous stories about Janice Stevens, including some that made her out to be a CIA agent. According to Joseph Wortis, the perennial editor for the Biological Psychiatry Journal, it seemed that whenever the United States was involved in an international conflict, Janice had been there. This extended all the way till modern times and the invasion of Grenada. Joseph was an old fashion editor who would take telephone calls and do a lot of editing himself with little in terms of delegating authority.
I was honored that Janice came to visit my home in Georgia for a few weeks. She served as an example to my daughters, all of whom adored her. Later on in life, I used to attend congresses with Janice and served as her companion. She was having mental problems and needed somebody to reassure her. During the years I have had the curious distinction of having to sit with prominent neuroscientists in order to prevent them from falling asleep and snoring (think Nobel Prize winner) or getting them through challenging environment like train stations. No matter our achievements, aging provides a common denominator to us all.
In future blogs I will write more extensively about some of the personalities that I met while at the NIMH and what I learned from them. My career would have never been as rewarding or instructive without their influence. I have been a lucky person, feeling blessed.
Linda Wheeler, A most unusual brain trust. The Washington Post, April 11, 1995. This article was based in part on an interview I participated along with my friend Archie Fobbs who served as the curator of the Yakovlev-Haleem brain collection.