APA’s 13 Founders Were Dedicated to Specialty Still Trying to Find its Way

The Association of Medical Superintendents of American Institutions for the Insane, the forerunner of APA, began its organizational life in Philadelphia on October 16, 1844. In the room were medical leaders from 13 of the nation’s 31 public and private hospitals for people with mental illness. All had trained as physicians, in some combination of apprenticeships or medical schools, but had only on-the-job experience in what today would be called psychiatry. Who were these men who were driven to create the country’s first medical organization?

Samuel Woodward (1787-1850) was the first president of APA and head of the Worcester Lunatic Asylum in Massachusetts. Woodward believed that insanity was a somatic disorder, a disease of the brain with natural causes, and that the stresses of life could induce insanity in vulnerable individuals. He also helped establish the Hartford Retreat and was an early proponent of specialized medical treatment of alcoholics.

Samuel White (1777-1845), a surgeon, was APA’s first vice president. In 1830 he established the private Hudson Lunatic Asylum near Poughkeepsie, N.Y. In an address on insanity to the New York State Medical Society in 1844, White argued for humane treatment and minimal restraint of patients. White was the oldest of the founders and died just four months after the association’s first meeting.

Thomas S. Kirkbride (1809-1883), also a surgeon by training, was the first secretary-treasurer of the Association. In 1840 he was named physician in chief of the Department of the Insane at Pennsylvania Hospital in Philadelphia and never left. He is best known for popularizing the standard architectural design for psychiatric facilities in the 19th century. The Kirkbride Plan called for a central building with wings to house patients stepping backward on either side.

William Maclay Awl (1799-1876), APA’s second president, walked from his native Pennsylvania to Columbus, Ohio, in 1826. He was the first superintendent of the Ohio Asylum in Columbus. He later worked at the Ohio Institute for the Blind and helped organize the Ohio State Medical Society. Typifying one of the chief problems on the founders’ minds, Awl was forced out as superintendent for political reasons.

Luther Bell (1806-1862) was no stranger to the political system. He served as a state legislator in New Hampshire before establishing the State Asylum at Concord. Bell was also superintendent of the McLean Asylum in Massachusetts from 1837 to 1856. He volunteered as a surgeon in the 11th Massachusetts Regiment during the Civil War and died in 1862 while serving as medical director of General Hooker’s division. He was the Association’s third president from 1851 to 1855.

Isaac Ray (1807-1881) was the Association’s fourth president. In 1838, while practicing in Eastport, Maine, he published A Treatise on the Medical Jurisprudence of Insanity, the first book in English on forensic psychiatry and one that remained a standard for decades. He served as medical superintendent of the State Hospital for the Insane in Augusta, Maine, beginning in 1841 and became head of the Butler Hospital in Providence, R.I., in 1845.

Amariah Brigham (1798-1849) was the founder and first editor of the American Journal of Insanity, predecessor of the American Journal of Psychiatry. Brigham emphasized early detection and treatment of mental illness and development of occupation skills among patients. He was skilled enough in general medicine that he taught anatomy and surgery at the College of Physicians and Surgeons in New York City. In 1842, he became superintendent of the State Lunatic Asylum at Utica, which under his leadership became a training ground for superintendents.

Nehemiah Cutter (1787-1859) ran the Cutter Retreat, a private asylum in Pepperell, Mass., starting in 1834. The asylum was demolished by fire in 1853, and Cutter returned to private practice. He held no office in the Association and left no published works; however, his death notice in the Journal of Insanity noted that he was an active discussant of papers presented at annual meetings.

Charles H. Stedman (1805-1866) was an accomplished surgeon, honored as the translator of a standard German text on brain anatomy. Perhaps that’s why he was appointed superintendent of the Boston Lunatic Hospital in 1842. The foray into psychiatry lasted nine years, until 1851, when he resigned to return to surgery and serve in the state senate.

John Butler (1803-1890) served as vice president of the Association from 1862 to 1870 and president from 1870 to 1873. A Massachusetts native, he practiced for 10 years in Worcester before being named superintendent at the Boston Lunatic Asylum in 1839. He resigned in 1842, disgusted with the politics that governed hospital leadership. However, he soon found a position at the Hartford Retreat, where he stayed for the next 40 years. During his time, the Retreat shifted to caring for wealthier, private patients rather than those whose care was supported by the state.

Pliny Earle (1809-1892) served as Association president in 1884-1885. He was superintendent of the Bloomingdale Asylum in New York City from 1844 to 1849, and spent brief tours in Washington, D.C., at the forerunner of St. Elizabeths Hospital. Earle was skeptical of claims by Woodward and others of high rates of curability of mental patients, saying they had ignored readmission numbers. He also noted that increasing numbers of long-term, custodial patients were consuming space and staff time that might have been more productively spent on patients who might indeed get well enough to live on the outside.

Francis Stribling (1810-1874) was the first graduate of the University of Virginia Medical School in 1830. He became superintendent of the Western Lunatic Asylum in Staunton, Va., in 1836, serving until his death in 1874. He worked closely with Dorothea Dix to advance humane care for people with mental illness, but he was also well known for rejecting racial integration of his asylum.

John Galt (1819-1862) was the first superintendent of the Eastern Lunatic Asylum in Williamsburg, Va. He was only age 22 at the time, and, at age 25, was the youngest of APA’s founders. Galt was a voluminous writer. He read several languages and synthesized much European research in his 1846 book, The Treatment of Insanity. He advocated for moral treatment, as well as occupational, recreational, and music therapy. He also thought patients could benefit from spending time outside the institution. Unlike Stribling, Galt accepted a small number of free black patients in his asylum across the state. He is buried in the Bruton Parish Church in Colonial Williamsburg. ■