The Clifford Beers Story: The Origins of Modern Mental Health Policy
By: Michael B. Friedman
“…the afternoon of May 6, 1908…a little knot of people sat down together in a residence in New Haven, Connecticut, upon the invitation of Clifford Whittingham Beers—a young man with a remarkable history—to organize the Connecticut Society for Mental Hygiene, the first…association of its kind and the beginning of the organized mental health movement in America.”
With these words Nina Ridenour begins her excellent history of mental health policy in the United States in the first half of the 20th Century. It is a high and well-deserved tribute to Clifford Beers, the founder of what has become the Mental Health Association movement. At the age of 32, five years after he had emerged from three harrowing years of psychiatric hospitalization in three different hospitals, Beers took the first step towards realizing a grand vision he developed while he was in the hospital. It was a vision that arose from his personal experience of abuse at the hands of poorly paid and poorly trained hospital “attendants” and from his witnessing the abuse of so many other patients. He imagined an advocacy organization that would spread from local to international levels—an organization that would (1) fight to improve care and treatment of people in mental hospitals, (2) work to correct the misimpression that one can not recover from mental illness, and (3) help to prevent mental disability and the need for hospitalization.
Within a year of the founding of the Connecticut Society for Mental Hygiene, beers founded The National Committee for Mental Hygiene and began groundbreaking work that would change the face of mental health in the first half of the 20th Century.
Beers’ success in developing a national, and ultimately an international movement, began with his autobiography, A Mind That Found Itself. He hoped it would have an impact on the scale of Uncle Tom’s Cabin. IN it he traced the course of his illness. He was a graduate of Yale University at the beginning of a promising career in business when he developed an obsessive fear of mental collapse subsequent to the death of a brother from epilepsy. His despair became so great that he attempted suicide. This led to the terrible years he spent in private, voluntary, and state hospitals in Connecticut and eventually to his recovery and his determination to reform the treatment of people with mental illnesses.
Although there had been other exposes before Beers’, none had the impact that Beers’ account did. Norman Dain, Beers’ biographer, comments, “…other exposes…described treatment in asylums as cruel and inhumane, but most went beyond credulity, so that they were not effective propaganda…”. Beers’ autobiography has the ring of truth and reason. While exposing abuses, he has revealed a great deal about his inner suffering and confusion about his provocative behavior when he was in the hospital. He condemns the abusive behavior of attendants and lack of supervision exerted by the physicians who should have helped to protect him and other patients who could not comply with dehumanizing hospital routines, but he also acknowledged his own illness and showed considerable respect for the physicians’ knowledge and abilities. The balanced voice and substance of A Mind That Found Itself unquestionably contributes to its power. Robert Coles has suggested that it is also the artistic quality of the writing that make sit so effective. In the Preface to the 1980 edition, he says that most exposes “prompt compassion…and maybe a kind of clinical understanding, but not the larger response that a work of art commands—a broadened moral sensibility.”
A Mind That Found Itself is, unquestionably, morally compelling. Most people who read it feel horrified by the suffering it reveals and are moved to help to humanize our society’s actions towards people with serious mental illnesses.
From the beginning Beers was able to attract very prominent supporters. The first was William James, the most important psychologist of his day and one of the founders of American philosophical pragmatism. James helped open many doors for Beers prior to the publication of the autobiography, including to his publisher and to a number of people who had the resources to help to found a movement. In addition, Beers won pre-publication interest from Adolph Meyer, one of the most prominent psychiatrists of the era. While Meyer—who ran a psychiatric hospital—was disturbed by some of Beers’ most troubling allegations about hospitals, he too believed that hospitals needed substantial reform and recognized that Beers had the potential to generate the kind of public support that was needed to bring reform about. He and Beers formed a partnership which gave the National Committee on Mental Hygiene its initial directions.
Beers combined a number of leadership characteristics that were essential to the success of the National Committee on Mental Hygiene and of the state and local societies that it spawned. He had a clear, powerful vision. He had remarkable ability to communicate in writing and face-to-face. He had unending determination to realize his vision even at considerable personal cost. (He ran up a significant debt to get the National Committee going.) He had the flexibility to compromise when he had to in order to forge and preserve alliances, but he also had the courage to stick to his own views when he thought it was critical. He had a sharp business acumen. And he understood that an enterprise of the magnitude that he imagined could not be the work of one man. From the start his goal was to build a unified advocacy community. He knew that he needed the moral and financial commitment of prominent lay people and that he also needed the highly regarded mental health professionals—particularly physicians. The laypeople and mental health professionals who joined Beers in the development and expansion of the mental health movement were a veritable who’s who of America.
When the National Committee on Mental Hygiene began its work, most of what we take for granted now in the mental health system in the United States not only did not exist; it was yet to be imagined. Beers and the National Committee played a major role in formulating what would become the core of mental health policy in the 20th Century. His included building a database that would inform the development of mental health policy. The National Committee was the first to compile lists of mental institutions and psychiatrists. Until the Census Bureau took over the function of count6ing people with mental illnesses in institutions and related data gathering, the National Committee put out the only annual statistical report about mental illness. Through this work, it became clear that data gathering was hampered by lack of shared nomenclature; and the National Committee played a leadership role in the development of the first official diagnostic language. It was also the first to successfully call attention to the lack of trained personnel to deliver mental health services and organized the first systematic training efforts with support from the Commonwealth Fund and the Rockefeller Foundation. It created a division of Psychiatric Education, which, in collaboration with the American Psychiatric Association developed psychiatric training curricula and created the American Board of Psychiatry and Neurology to provide certification for psychiatrists. It also collaborated on the development of psychiatric field work.
The National Committee is probably best known for the work it did to bring about major changes in legislation and in funding for mental health services. Early on it collected and analyzed mental health laws. Most importantly it conducted numerous surveys of the conditions in institutions for people with mental disabilities of all kinds and used the findings of these surveys o advocate state by state for increased funding so as to humanize the institutions. (It was later that the National Committee begun to recognize the wisdom of reduced use of institutions.)
At the core of the National Committee’s work was a constant cycle of research and reform. In this regard, as Albert Deutsch points out in The Mentally Ill in America, Beers and the National Committee were a piece of the Progressive era, the period during which they began their work. It was also typically “progressive” in its use of Meyer’s concept of “mental hygiene.” This concept arose from his awareness that people’s psychological states and their ability to overcome mental illness, were highly dependent on their social environment. Meyer was perhaps the first to realize that people with mental illnesses with social supports fared better than people without them. This emphasis on the importance of the environment to people’s ability to fare well in our society was typical of the Progressive Era.
Eventually, however, Beers and the National Committee developed a new insight—that all sorts of troubling human behavior, not just the behavior associated with “insanity”—might reflect mental health and illness. This insight was the source of the development of the child guidance movement in America, which emerged under the leadership of the National Committee with support from the Commonwealth Fund. The initial goal of this movement was to help juvenile delinquents and reduce delinquency not with harsh punishment and so-called “reform”, but with good childrearing and treatment. Later the movement spread to the fields of education, family service, and child development.
The child guidance movement has left a remarkable legacy. The model it developed for child guidance clinics became the model for outpatient mental health clinics for all populations throughout the United States. This model is the source of the concept of a mental health treatment team consisting of psychiatrists, psychologists, and social workers—a concept which is now embedded in the delivery of mental health services in this country. Even more fundamentally, the child guidance movement fostered widespread efforts to use psychological knowledge to help children develop into decent adults, efforts which have been prevalent ever since. Perhaps even more fundamental ahs been the linkage that has developed in the American mind between troublesome behavior and emotional disturbance.
Clifford Beers was not the originator of all the ideas that emerged from the National Committee on Mental Hygiene. But he was, by his very person, their inspiration; and he had the wisdom to allow other people’s ideas to guide the movement that he created—a remarkable ability in its own right.
Beers’ ideas, and the ideas of those who worked with him, have been among the most influential of the 20th Century. They are embedded in the shape and substance of America’s mental health system. They continue to inspire advocacy for greater humanity towards people with mental illnesses and to reach those who still do not get the services they need. The persistent power of his ideas is also evident in the fact that many of them remain controversial sixty years after his death. Debates continue about the viability of prevention, about how far-reaching the field of mental health should be, and even about the kind of alliances that are needed to advance the cause of mental heath.
Clifford Beers was a great builder of alliances as well as a visionary, a leader, a man of powerful moral determination, and a relentless fundraiser. We certainly could use another like him today.
Useful References
Clifford Beers; A Mind That Found Itself: An Autobiography; University of Pttsburgh Press; Pittsburgh; 1980.
Norman Dain; Clifford W. Beers: Advocate for the Insane; University of Pittsburgh Press, Pittsburgh; 1980. (Out of print.)
Albert Deutsch; The Mentally Ill in America: A History of Their Care and Treatment From Colonial times; Doubleday, Doran and Company Inc.; Garden City, NY; 1937. (Out of print.)
Gerald Grob; The Mad Among Us: A History of the Care of America’s Mentally Ill; The Free Press; New York; 1994.
Nina Ridenour; Mental Health in the United States: A Fifty-Year History; Harvard University Press; Cambridge MA; 1961. (Out of print.)
(Michael B. Friedman is Public Policy Consultant for the Mental Health Associations of New York City and of Westchester County. He also teaches courses on health policy and on social advocacy at the Columbia University School of Social Work.)