Pride of Indiana

Victims of mental illness have had many champions since 1795, when Philippe Pinel boldly bucked the revolutionary city government of Paris and began to treat inmates of the Salpetriere as human beings rather than criminals or animals. But the bedlams of the 1800s gave way only to the unspeakable "back wards" of the 1900s, where men, women and children languished in filth and darkness. Now, many states in the U.S. are striving to live down that shame. As late as 1948, Indiana ranked 40th among the states, judged by the crude yardstick, of the amount of money spent on mental patients ($1.11 a day). But last week Indiana was in the midst of a "total push" to bring itself to top rank.

Petty Principalities. The push began when burly Republican Lawyer George North Craig was campaigning for the governorship in 1952 and pledged himself to reform the state's mental institutions. When he took office, Craig found them in chaos. There were ten mental hospitals, each run as a petty principality by an autonomous board of trustees. Craig got the legislature to put all state hospitals under centralized control and to vote an extra $4,400,000 (a 21% increase) for running them the first year, and $6,700,00 the next. Then the real work began.

As overall director of the department of health, Craig imported Rear Admiral (ret.) Bertram Groesbeck Jr., former commanding officer of the famous Naval Medical Center at Bethesda, Md. As the state's first commissioner of mental health, Craig picked an unlikely looking candidate: a handsome, 41-year-old blonde with grey-green eyes, Dr. Margaret Elaine Morgan, a topnotch Indiana psychiatrist. Governor Craig was not deterred by the fact that her brother, Ivan H. ("Jack") Morgan, was feuding with him in G.O.P. councils (he has since booted the brother out of party office, kept the sister on at a higher salary than his own--$20,000, highest on the state payroll).

Governor Craig and Drs. Morgan and Groesbeck went through Indiana's mental hospitals like ferrets through a rabbit warren. At Indianapolis' Central State Hospital, an ancient, overcrowded firetrap within sight of the Statehouse, they found the men's infirmary as bad as any storied bedlam. The 55 patients were nearly all incontinent, and spent day and night lying naked on their beds in their own excrement. "Meals" consisted of cold slop, eaten with a spoon. None ever left the "infirmary" except to go to the morgue.

At the Village for Epileptics in New Castle, the reformers found almost 1,000 patients kept on a food budget of 17-c- a day each, plus some of the village's own ill-distributed farm produce. The village had never had a registered nurse, a dietitian or a social-service staff. Most of its patients had never had a proper examination, and many should never have been admitted in the first place--their cases had been sloppily misdiagnosed.

At Muscatatuck State School for the Mentally Retarded. Dr. Groesbeck saw his first case of rickets in 36 years as a licensed physician, so bad was the malnutrition. Expensive new medical and dental equipment was found crated in basements, where it had rusted for ten years or more --nobody was interested enough to unpack it, and anyhow, there was no technical staff to use it.

Spend More! At the urging of Dr. Morgan, Indiana's executive and legislature have adopted the policy that the best is the cheapest in the long run. For the present, the state's mental hospitals pride themselves not on how much money they can save but on how much they can spend --as an index to their efforts in treating, and perhaps curing, their patients so that they can be sent home and cease to be a charge to the state.

In little more than a year, Dr. Morgan's department has added 28 doctors, 31 social workers, 51 nurses and 560 attendants to its payroll. Ideally, says Dr. Morgan, Indiana should hire 150 M.D.s and 1,595 registered nurses, but there is not that much trained personnel for hire in all the U.S. The cost of patient care is up to $2.86 a day (still well below Kansas' $5.85 and California's $3.53) and should top $3.75 in 1956.

And that, holds Dr. Morgan, will be sound economy. Under the old system of hopeless "custodial care," the average stay in a state hospital was more than twelve years; nowadays that would cost $13,152. By intensive treatment, the average stay has already been cut to less than ten years. And at the new Larue D. Carter Memorial Hospital in Indianapolis, where patients play shuffleboard or work off their aggressive impulses on a punching bag (which has to be replaced once a month), the average patient's stay is only 85 days and costs about $1,275. The explanation: Carter Hospital gets cases promptly after diagnosis and treats them promptly; untreated, they would wind up, years later, in the hopeless wards.

In the men's infirmary at Central State, patients have been retrained and sent to more open, hopeful wards. All are out of bed, wearing clothes, and lining up regularly for a hot meal. Throughout the hospital, drugs such as chlorpromazine (TIME, June 14) are used along with music therapy to bring patients out of their withdrawn states. Straitjackets. "camisoles" and irons have vanished; solitary confinement has been cut to a minimum.

Last week Governor Craig announced that Indiana will soon begin building a $1,000,000 center for research into the causes of all mental illness. From this type of research, eventually, may come preventives and cures for mental illnesses that now keep state hospitals full.

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