American Psychosis (8 page)

First, state mental hospitals were said to be “bankrupt beyond remedy.” Second, it said that future psychiatric services should be coordinated by community mental health centers, and the commission recommended one center for each 50,000 population. Third, and most important, the Joint Commission “proposed massive financial participation by the federal government in the care of mental patients who had been the major responsibility of the states.” Specifically, the commission report noted:

It is self-evident that the States for the most part have defaulted on adequate care for the mentally ill, and have consistently done so for a century. . . . As we have seen, it was a historic mistake to make the State alone virtually responsible for public care of its mentally ill residents, relieving the local communities of all further concern and, until recent times, sparing the Federal government anything but peripheral involvement in the problem. Their single source of financial support guaranteed the isolation of State hospitals and the dumping-ground effect that we have stressed.

The proposed recommendation, predictably, was that “Federal aid will be needed, in large sums. . . . The Federal government should be prepared to assume a major part of the responsibility for the mentally ill insofar as the States are agreeable to surrendering it.”
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Felix, Gorman, and their colleagues were very pleased with the recommendations of the Joint Commission and well they might be, as they had written them. Many of the ideas had been taken directly from Felix’s original national plan. Gorman later claimed that the Joint Commission had merely been a public relations exercise, that he had drafted the legislation creating the Commission for Senator Hill, and that its recommendations had been predetermined:

I was very happy to be a member of that [Commission] and really made only one contribution although it was a five-year study; I had the good fortune to write my suggested recommendations for Senator Hill in 1956. Old Chinese proverb—“If you appoint a Commission, have all the recommendations finished before you appoint it.”

If anyone wished to really understand the recommendations of the Joint Commission, it was not necessary to look further than the title of its final report. Although the commission had been officially baptized by Congress as the Joint Commission on Mental Illness and Health, the final report was titled simply
Action for Mental Health
.
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MENTAL HEALTH: TOWARD THE PROMISED LAND

One of the great ironies of American psychiatric history is that during 1955, at the same time that the Joint Commission on Mental Illness and Health was being charged with finding a solution to the mental illness crisis, a totally unexpected solution was appearing. The solution was chlorpromazine, sold in the United States under the trade name Thorazine. It had been discovered in France in 1952 and reported to dramatically reduce the delusions, hallucinations, and manic symptoms of many patients with severe psychiatric disorders.

By the end of 1952, Thorazine was being used in Canada, and in 1953 it was introduced in several American mental hospitals. The first report of its effectiveness in the
United States was published in the
Journal of the American Medical Association
on May 1, 1954. William Winkelman, a psychiatrist in Philadelphia, reported that for 142 patients with varying psychiatric diagnoses, Thorazine was “especially remarkable in that it can reduce severe anxiety, diminish phobias and obsessions, reverse or modify a paranoid psychosis, quiet mania or extremely agitated patients, and change the hostile, agitated, senile patients into a quiet, easily managed patient.” Consistent with the dominant Freudian belief system of that era, however, Winkelman cautioned that Thorazine “should never be given as a substitute for analytically oriented psychotherapy.”
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Felix and his colleagues were aware of these developments. During his testimony in March 1955 in support of the proposed Commission on Mental Illness and Health, Gorman commented on the “reported remarkable results” brought about by Thorazine. It was, he said, “an important new breakthrough in the fight against mental illness.” However, neither Gorman nor anyone else at that time fully appreciated how profound an effect Thorazine and other antipsychotic drugs would have on future psychiatric treatment. This is not to say that the introduction of antipsychotic drugs
caused
deinstitutionalization. The idea that state mental hospitals were therapeutically bankrupt had been growing since the highly publicized exposés of state hospital conditions in the late 1940s, as noted above. In fact, between 1946 and 1955, 17 states decreased the census of their state mental hospitals, although the total census for all 48 states continued to increase. However, 1955 was to be the high-water mark, with 558,922 patients in state mental hospitals; in 1956 there were 7,532 fewer patients, the first such decrease in more than a century. This was the beginning of what would become known as deinstitutionalization. The emptying of state mental hospitals was underway, and although the introduction of antipsychotics had not started the engine, it provided the fuel that initially made it run.
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* * *

By early 1959 the deliberations of the Joint Commission had been completed and the report—
Action for Mental Health
—was ready for release. With Dwight Eisenhower in the White House, however, Felix and his colleagues surmised that Republicans would not be enthusiastic about a plan to essentially nationalize mental health. They decided to delay the release of the report to see what would happen in the 1960 elections. They were especially excited about the candidacy of Senator John F. Kennedy, who was fighting Hubert Humphrey, Pat Brown, and Wayne Morse for the Democratic nomination. Felix and others on the Joint Commission had heard the rumors about Rosemary Kennedy’s mental retardation and mental illness, and they observed the increased activity of the Kennedy family in its support of mental retardation research. Felix et al. therefore put their report aside to see what would happen in the 1960 election. Following Kennedy’s victory, they released their report even before the new president was sworn in.

MENTAL RETARDATION: TOWARD THE PROMISED LAND

Following Rosemary’s lobotomy, tragedy continued to follow the Kennedy family. In 1944 Joe Kennedy Jr. was killed in the war when he was shot down over Belgium on a dangerous mission for which he had volunteered. The victory of Allied Forces in Europe was declared on May 8, 1945; 6 days later, Joe Kennedy incorporated a private foundation, initially named the Mercié Foundation but 5 months later renamed the Joseph P. Kennedy Jr. Foundation. The avowed purpose of the foundation was “the relief, shelter, support, education, protection, and maintenance of the indigent, sick and infirm.” Its first grant was to a Catholic group to establish the Joseph P. Kennedy Jr. Convalescent Home for Poor Families.
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A major impetus to the formation of the Kennedy Foundation was provided by Richard Cushing, then an auxiliary bishop of Boston. The son of Irish immigrants in South Boston, Cushing had been educated at a Jesuit high school and at Boston College, also a Jesuit institution. It was Cushing who, in 1941, had recommended the permanent placement of Rosemary at the Catholic-run St. Coletta’s School in Wisconsin, and thereafter he remained a close friend of the Kennedy family, even officiating at Jack Kennedy’s funeral after he had become Cardinal Cushing. Cushing was said to have been “among the first influential Americans to speak out about the plight of the mentally retarded,” whom he referred to as “exceptional children.” He therefore urged Joe Kennedy to donate to charitable causes, especially mental retardation. As Edward Shorter summarized the relationship in
The Kennedy Family
, “Cushing needed Kennedy as a benefactor, and Kennedy in turn depended upon Cushing for advice, for example, on how to deal with Rosemary.”
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Thus, from the very beginning, the Kennedy Foundation intended to include support for mental retardation among its charities. In 1947 Joe Kennedy made Eunice one of the trustees of the foundation, and the same year it funded a new St. Coletta School for mentally retarded children in Massachusetts; it would later be named the Cardinal Cushing School and Training Center. The foundation also funded many charities not related to mental retardation, some of which benefited the Kennedy family. For example, according to Shorter, “the Kennedy’s Palm Beach house was for many years owned by the foundation.”
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With the death of Joe Kennedy Jr., the political aspirations of the family fell onto the shoulders of Jack, the second son. Accordingly, in 1946 it was arranged for Jack to run for Congress in a strongly Democratic Massachusetts district, which he easily won, although he was only 29 years old. In 1952 he was elected to the Senate, and in 1956 he narrowly lost out to Estes Kefauver in the bid to become Adlai Stevenson’s running mate. Thereafter, it became an all-out push to achieve the 1960 presidential nomination, with the help of many Kennedy family members. Joe Kennedy was determined to
make it happen and did whatever was necessary. For example, in December 1957, he gave Henry Luce $75,000 ($611,000 in 2012 dollars) to put Jack on the cover of Luce’s
Time
magazine.
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Eunice Kennedy, who had married Sargent Shriver, viewed her brother’s presidential aspirations as an opportunity to focus research attention on mental retardation and thus salvage some good from her sister’s tragedy. In 1957 Joe Kennedy gave Eunice complete control of the Kennedy Foundation funds, and she immediately went to work to ascertain what could be done. One of her first calls was to Dr. Richard Masland, director of the National Institute of Neurological Diseases and Blindness. Significantly, she did not go to Felix, director of the National Institute of Mental Health, which theoretically had responsibility for research on mental retardation but had done almost nothing on it. Dr. Masland directed Eunice to Dr. Robert Cooke, chairman of the Department of Pediatrics at Johns Hopkins University, who himself had two retarded children. Eunice was impressed by Cooke and gave him a research grant, and this was followed by grants for mental retardation research at Massachusetts General Hospital, Stanford University, the University of Chicago, the University of Wisconsin, and Georgetown University. In 1957, when Eunice had taken control of the foundation, only 17% of its budget was spent on mental retardation, but by 1960 this figure had increased to 66%.
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Focusing attention of the Kennedy Foundation on mental retardation research, however, carried some risk, because the Kennedys had not yet publicly acknowledged that Rosemary had any problems. In 1957 the family told the
Saturday Evening Post
that Rosemary was “teaching” at St. Coletta’s. Two years later, a biography of Jack Kennedy described Rosemary as “a sweet, rather withdrawn girl” who was helping “care for mentally retarded children” at St. Coletta’s. Even as late as October 1960, one month before the election,
Look
magazine described Rosemary as “a victim of spinal meningitis, now in a Wisconsin nursing home.” Eunice and other Kennedy family members eagerly awaited the opportunity to focus federal attention on mental retardation if Jack won the nomination and election. The question would be how to do so without discussing Rosemary and her problems.
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3
THE BIRTH OF THE FEDERAL MENTAL HEALTH PROGRAM: 1960–1963

The relationship between Jack Kennedy and his younger sister Rosemary was complex. She was the sibling closest to him in age, and from early childhood he had helped to protect her. Her subsequent mental illness and disastrous lobotomy must have been profoundly painful for him. In addition to Kennedy’s interest in mental retardation and mental illness because of Rosemary, he had also developed a special interest in what can go wrong with a growing fetus during pregnancy. Prior to the birth of their daughter in 1957, Jacqueline had experienced a miscarriage and then a stillborn child. One expert on mental retardation recalled a conversation in which the president had expressed an interest in “difficulties of the newborn baby and problems during pregnancy that had some bearing on the development of retardation later,” adding that “this seemed to be a particular concern of his.” Another colleague claimed that among all the issues Kennedy dealt with during his time in office, the issue of mental retardation “was closest to his heart.”
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It is not clear whether, at the time Kennedy was running for president in early 1960, he had visited Rosemary since her lobotomy 19 years earlier. Other family members had, especially Eunice and her mother. Because Kennedy was campaigning for the nomination in Wisconsin, “Jack made a campaign stop in a heavily Republican town a few miles from Jefferson [where Rosemary was living at St. Coletta’s School] as part of a plan surreptitiously to visit his sister,” according to Laurence Leamer’s
The Kennedy Women
.
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Thus, on Tuesday morning, February 16, 1960, Kennedy arrived in Madison, Wisconsin, for 3 days of campaigning. The state was regarded as crucial for Kennedy’s chances of securing the Democratic nomination, and he hoped to defeat Hubert Humphrey there. After briefly campaigning in Madison, Kennedy’s entourage drove directly to Fort Atkinson, 8 miles south of St. Coletta’s, arriving at 10:40
A.M
., “a few minutes ahead of schedule,” according to the local newspaper. Because he was campaigning for the Democratic nomination, the choice of Fort Atkinson, described as a “stronghold of Republicanism,” was an odd choice for a campaign stop unless there
was another reason to be there. Sargent Shriver was directing Kennedy’s campaign in Wisconsin, and it seems likely that Eunice had made the arrangements for her brother’s visit to Rosemary.
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