The history of Psychiatry...

Last week, I took a trip to Jackson, Louisiana. Most people don't know that this town exists and if you blink, you miss it. What is interesting about this town, though, is the East Louisiana State Hospital. This hospital has been in existence since 1890 and for years was the mainstay of psychiatric treatment in the state of Louisiana.

The first part of the trip was to the forensic unit. This unit was so aptly named because it is where patients who are deemed unable to tell right and wrong during their crime or "not guilty by reason of insanity." Also, this is where people who are deemed incompetent to stand trial stay until their competency is restored. The facility was interesting and really was in-between a hospital and a jail. We met a few classic patients including one psychotic patient who had pulled out both of his eyes. Why, you may ask.

Matthew 5:29

"And if thy right eye offend thee, pluck it out, and cast it from thee: for it is profitable for thee that one of thy members should perish, and not that thy whole body should be cast into hell.

He apparently took the bible pretty literally.

Then, we met another patient who didn't realize that he had burned down a local supermarket and another who spoke "French" and "Chinese" but really just spoke jibberish. Interesting place with some really sick patients.

Then, we went to the other side of town to visit the long-term inpatient unit. This side was notable for its history. It was founded in the 1880s and was known as the place where psychotic patients were sent "up the river" from Charity hospital. We live in an age of antidepressants, ECT, antipsychotics and medication management. It's hard to fathom what psychiatrists will think of our practices 50 or even 15 years from now. For some perspective, we visited the dungeons.

The dungeons were in operation until around the Great Depression. When patients became acutely psychotic or manic, they were chained underground and held. There were no bathrooms and there was no air conditioning (temperatures regularly got above 100). There were no medications and there was no use of sedatives. The picture speaks for itself.

We then took a look at the records. They were a very interesting reflection upon the understanding of psychiatry at the time. I know that we use a DSM and that we have standardized ways of looking at patients, but records like these really bring home the point that we don't understand psychiatric processes and that most of what we do is in theory. We know we can help, but we don't really understand how. When looking at these records, remember that these patients were seen by doctors once per year and that their one record is this line. The left column is the "diagnosis" and the right column is the "cause".

"Diagnosis: Acute Mania. Cause: Religion."

"Diagnosis: Dementia, Chronic. Cause: Masturbation"

Apparently your palms grow hair and you become demented.

Lastly, we stopped by to bathe in the solace of the cemetery. It was a nice day outside and we strolled through the graveyard, pausing at the sheer number of patients who died at this facility. So many of these patients' birth names were not known, so these tombs of unknown patients gives this facility an Arlington cemetery-like feel. We stood at the graves, paused in reflection, and went back to New Orleans.

Peace,

Ahmed