Care, Not Incarceration, for the Mentally Ill

As a pathologist and medical editor, I know little about psychiatry. As a physician, a forensic toxicologist, and a broad observer, I know a lot. These are my personal observations of 70 years of American psychiatry.

In 1951, my first girlfriend in college was the daughter of a medical missionary who had moved from Africa to Tuscaloosa, Alabama, to work as a physician at the Bryce Hospital, built in 1851 as The Alabama Hospital for the Insane. The subliminal message from him to me, as a pre-med student, was: Stay away from there ("there" being not his daughter but the clinic).

As a medical student in Birmingham, my most vivid memory of psychiatry was a respected professor in Tinsley Harrison's great department of medicine telling us that psychiatry as a field was roughly like microbiology before Louis Pasteur discovered that microbes cause disease. Then, in 1954, came chlorpromazine, the first antipsychotic that allowed some patients with psychosis to reside in the community.

As a rotating clinical intern in 1957 and a 4-year resident in pathology into the 1960s, psychiatry hardly crossed my mind. In pathology practice in Texas, autopsying successful suicide victims was commonplace, as was autopsy of gay homicide victims.