How old records from a psychiatric hospital could help inform modern mental health care
Experts in the field agree that some old methods of treating mental illness belong in the past. But one may be due for revival, a professor at Western Michigan University said.
The Kalamazoo Psychiatric Hospital was cleaning house. It was about to shred thousands of old patient files, when Western Michigan University professor Ann Chapleau intervened. Chapleau teaches occupational therapy and wanted to know what the records might reveal about mental health treatment 70 years ago.
In the 1940s and 50s, mental health care was heavy on activities. Scientifically, this calming and focusing work was known as occupational therapy. Things like basket weaving, working with clay or even tending to farm animals were used to treat patients with severe mental illness.
Occupational therapy was popular at the Kalamazoo Psychiatric Hospital, then called the Kalamazoo State Hospital. Greta Decker worked in the children's unit in the 1970s and 80s.
“I didn't know one student there that did not want to go to occupational therapy. It was a safe haven for the kids. They were able to explore things that they were interested in. It was a one-on-one for the most part," Decker told Chapleau in an interview.
“For someone who has a lot of anxiety and agitation, that’s the kind of a natural way to channel some of that," Chapleau said of occupational therapy, which aims to address a patient's physical and psychosocial needs.
Chapleau said she didn’t ask for complete charts. Instead, she requested access to patient admission records, which the hospital kept on index cards.
“The index cards have a lot of information about admission and discharge, family history, diagnoses, any repeat admissions,” Chapleau said.
Chapleau and her colleagues pored over 5,600 records obtained through the stop order. They also reviewed memoirs of former KPH workers, photos of the hospital, and old interviews. One featured Clarence Schrier, KPH’s medical superintendent from the mid-1950s through the mid-70s. Schrier remembered when the hospital had farms.
“The patients lived there,” Schrier said. “They worked on the farms. They had their activities on the farms. They had their own little gardens at times; flower gardens, vegetable gardens.”
Chapleau and her team even did some additional interviews, such as the one with Greta Decker. She also talked to Rosie Coy, who was an occupational therapy student at the KPH in the 1950s. She worked in the hospital’s “broom room," where patients made brooms and other crafts.
“It was amazing. Some of them made beautiful pictures,” Coy said. “And so then they would get framed. And I think they got sold, or maybe their family got them.”
Chapleau put the oral histories on YouTube. But she’s not just documenting the past. She wants to know how old methods could inform mental health care in the future. Chapleau’s focused on the years 1945 through 1954, before tranquilizers or the powerful antipsychotic drug Thorazine.
”I joke about, you know, we all drank the Kool-Aid that life was horrible before Thorazine, and everybody was running around in straitjackets and being tortured. And now everything's great. 'Thank goodness we have all these medications.' When I think the picture is so different than that," she said.
Chapleau admitted there were some horrifying aspects of mental health treatment in the mid-20th century - such as lobotomies (though they fell out of favor by the late 1950s) and forced sterilizations. But studying the KPH files, Chapleau said modern treatment may have moved too much toward drugs and away from occupational therapy. She argued OT was used to successfully treat patients with even severe mental illness.
"They had shorter lengths of stay than we anticipated and success at acclimating into the community," said Chapleau. "And that, we know that during that time, that they were engaged in occupation-rich activities."
Jeff Patton is more enthusiastic about today’s treatment model. Patton's the head of Integrated Services of Kalamazoo, the primary agency for mental health services in the area.
“They don't just prescribe medications in hospitals,” Patton said. “They have occupational therapy, they have social work, they have psychology, they have education, they have all kinds of things, psychosocial rehabilitation programs, and hospitals. I mean, it's a comprehensive set of supports and services.”
But after viewing a summary of Chapleau’s research, Patton said it was "interesting." Especially since drugs don’t work for everyone.
“I think if she’s making the case that occupational therapy can be used more broadly than what it is, she might be right about that,” said Patton.
Chapleau stressed that her findings are preliminary but she hopes they’ll inspire other researchers to follow up. Right now, she’s in the process of putting her work online so other scholars will have access to it.