Sunday, December 16, 2007

Menninger Madhouse

Lawrence J. Friedman's 1990 book Menninger: The Family and the Clinic is an absorbing tour through much of twentieth century American psychiatry. Personally it connected the dots between many of the names that were floating around when I was doing my psychiatric training in the early 1970s. What struck me reading this book was the extraordinary hubris involved in the creation of hospital based psychoanalytic treatment facilities. I was reminded of Andrew Scull's book Madhouse with its caustic treatment of Henry Cotton's focal infection theory and incredible damage that resulted from its arrogant application. One of the most moving parts of Scull's book were the vignettes that allowed one to imagine what it was like for families to have someone treated by Cotton. While I do not want to draw too close a comparison between the Cotton's often lethal methods and the Menningers' subtler mind games, they do have one thing in common: psychiatrists claiming great expertise with very little evidence to back it up. If only Friedman had been given access to case records so that one could have a more vivid sense of what being subjected to treatment at the Menninger Clinic was like. I wonder if ther are first hand accounts.


  1. Your assumption is that Friedman understood what was going on at the Menninger Hospital. Friedman did not make clear the depth of caring demonstrated by the Menninger clinicians. As I understood it, the primary goal at the Menninger clinic was a comprehensive understanding of the patient. This involved psychiatrist working with psychologists, social workers, activity therapists, and nurses all working together in something called mileau therapy which was an innovation at the time, but is now pretty much taken for granted. Now we assume that the disciplines all work together. Maybe the psychiatrists did claim great expertise, but they were working alongside other members of the team equally as important. Nurses, social workers, clergymen, activity therapists of all kinds including horticulturists, woodworkers, painters, musicians as well as librarians and those who serve food in the dining room were all part of the therapeutic environment. The idea was that the healing environment surrounded the patient constantly. This sort of therapeutic environment was possible in a little out-of-the-way place called Topeka Kansas. It's too bad that Friedman didn't capture the caring, compassionate, and concern that was demonstrated by the front-line staff. Friedman commented on the psychoanalytic literature that was generated by the geniuses who felt comfortable surrounded by the beautiful wooded campus on a hill in Topeka. I was lucky enough to glimpse a part of this and get turned on by it. In my own practice, I'm trying to re-create the teamwork, the camaraderie, the exciting teaching environment, and the emphasis on patient care that I saw demonstrated at the Menninger clinic.

  2. Brent
    Thanks for your thoughtful comment. You are right, Friedman's lack of access to case records also prevented him from seeing evidence of the kindness and concern of the many non-physician staff. Having worked in a hospital-based milieu as well as a PACT team providing intensive community treatment to people with severe and persistent mental illness, I can attest that what is best about what we do is found in the kindness and concern of care givers. Menninger, as I read Friedman, held itself out as having curative treatment based on sound theory [as did Cotton]. It was the lack of humility in their claims and the lack of evidence of success that I found to resemble Cotton. EMB

  3. I was a patient at the Menninger Clinic in Topeka in June of 1999. The place was a joke at that time and that should be revealed. There were 67 buildings on the campus, all but 3 or 4 were vacant. There might have been 7 doctors there. We had usually 2 hours of therapy a day with weekends off. That's 10 hours therapy to 178 hrs off. $750 a day. The place was in shambles, the furniture broken. I took up smoking cigarettes and that's what I did almost the whole time I was there. There was little/no treatment going on there, and people should know that at that point in time the clinic was, to me, 100% a money scam. There was a huge cafeteria and every day they had fresh pizza, french fries and every kind of fresh baked cake imaginable. I usually weigh 170 lb, I was 213 lb when I was there because the food was an off-the-wall pig out. They did nothing to help my bipolar disorder. It was sold I believe shortly after that.
    What's funny is that they had a great reputation but if you asked any psychiatrists if they'd been there they said "No, but I hear that they're a tremendous facility".
    I swear that place was a money scam.

  4. I stumbled upon this conversation and blog in general just a few moments ago and was fascinated by the verbiage. I worked with Friedman and spent a good deal of time with him during his early process as he had asked me to do the cover illustration for the book. I was a patient there from 1980-1982 and have considered my time there to be some of the most magical and amazing time of my life.

    It seems that Friedman, being a truly great historian was deeply invested in getting down to the truth of the Menninger family and clinic...Perhaps he was harsh, but he is/was a very kind and gentle man...if seemingly harsh.

    I had more than one occasion to spend time with Dr. Karl, who had a reputation as a scary and incendiary personality. What I saw was an elderly man who, though marred by time and disease, was a profoundly humane and compassionate human being.

    Certainly he was guilty of hubris at times. To transform an entire culture as he and his brother and father and other great recruits did, was an act of great exertion and will...such acts are often criticized as arrogant for those of lesser callings and gifts.

    I was transformed by my time there. I couldn't be more grateful to have been there and to have worked with some of the most conscious, talented and committed human beings to be found anywhere...

  5. I'm glad for you Brent.

    My experience was the opposite, I guess by 1999 almost all of the people there had left and it was, as I've written here before, a money scam.

    Most people will read this and figure me to be a disgruntled mental patient and there's not much I can do to effect that.

    Please consider the possibility that a place like this can start out well and go bad.
    What I saw there could not be called good by any standard.
    It was a broken skeleton with a few hanging on for money by 1999.
    It was an absolutely disgraceful mess!
    It was 99% smoking cigarettes and everyone saying "man, this place is fucked up".

    It's part of an old redneck school of thought that thankfully is going, going, gone.

    It's 10 years and I'm still as pissed off at that shithole as when I was there.
    They hurt me, fuck them.

    - Dave

  6. Sorry, Dave. But Menninger is still going strong and transforming lives!