In Our Care: "Cherokee and Mt. Pleasant"

Ray Stewart of WOI-TV Ames, Iowa along with Iowa State University, produced "In Our Care," a 13 week series of documentaries filmed inside Iowa's state institutions. The series won the 1952 National Sylvania Television Award for Production Excellence.

(Voiceover) You suddenly come to feel the despair, the anguish, the profound misery which can bubble up from the depth of a sick mind. You feel it and you don't like it. Your misery spring from dark recesses of an unbalanced mind. You've retreated from reality into a world of delusions and dreams. In your lucid moments, you wonder if anything can be done to help you or if you must remain this way forever.

Ray Stewart: Fortunately, something can be done these days for the mentally ill. The state of Iowa maintains four mental hospitals. I've briefly examined two of them, and tonight we can finish our tour. Let's look first tonight at the one in Cherokee. This mental institute, mental health institute is located in the northwestern section of Iowa on the outskirts of the town of Cherokee in Cherokee County on US Highway 59 approximately 50 miles from Sioux City. The first patient was admitted to this institution just 50 years ago. These and other buildings now house around 1450 patients including some alcoholics chiefly from the 27 counties of northwest Iowa. Like the other Iowa mental hospitals, this one at Cherokee is overcrowded and understaffed. Before I show you the films about activities of this institution, I would like you to meet Dr. Willard Brinegar, who is the superintendent of the mental health institute at Cherokee. Dr. Brinegar, how long have you been at Cherokee?

Dr. Brinegar: About four and a half years Ray.

Ray Stewart: I suppose in that four and a half years you have found many problems and things that come up that give you headaches and so forth.

Dr. Brinegar: Yes, there are many problems in the administration of a hospital of that size. However, we have no real troubles that money wouldn't cure.

Ray Stewart: I see. Well, how about your staff, how many registered nurses do you have?

Dr. Brinegar: We have eleven right now.

Ray Stewart: How does that compare to the other institutions in the state?

Dr. Brinegar: As far as I know, we have more than any of the other mental health institutes.

Ray Stewart: How about your doctors. How many of those?

Dr. Brinegar: There again, I believe at the present time we have more than any other mental health institutes. We have 14 including myself.

Ray Stewart: And of course, another valuable link in this business is the attendants. How many attendants do you have?

Dr. Brinegar: Right now, we have about 190.

Ray Stewart: And how does that compare to the others?

Dr. Brinegar: There again, I believe it's a few more than any of the others at the present.

Ray Stewart: Well I come up now with a natural question. If you have more nurses and more doctors and all of that than the others, what are your problems?

Dr. Brinegar: We have more than some of the others, but still our number of personnel is entirely inadequate for the problem we have.

Ray Stewart: Is there any standard of how many you should have before you're inadequate?

Dr. Brinegar: Yes, the American Psychiatric Association sets up standards for hospitals of this type.

Ray Stewart: How many nurses should you have?

Dr. Brinegar: According to the minimum standards of the American Psychiatric Association, a hospital the size of ours should have 156 registered nurses.

Ray Stewart: And how about doctors?

Dr. Brinegar: Thirty-one.

Ray Stewart: Thirty-one doctors. And attendants?

Dr. Brinegar: About 500.

Ray Stewart: Five hundred doctors. And you have…

Dr. Brinegar: No, 500 attendants.

Ray Stewart: Oh, 500 attendants. And you have how many?

Dr. Brinegar: One hundred and ninety.

Ray Stewart: Hundred and ninety. What is the problem here then? Are doctors and attendants and nurses hard to find?

Dr. Brinegar: Yes, they are hard to find. However, we have a surplus of applications at the present time. Our problem is finding the money to pay them and places to house them.

Ray Stewart: So more attendants are available if you could pay them, if you had the money to pay them. Is it a question of they want more money than you're willing to pay or you just don't have the money to hire any more?

Dr. Brinegar: Both. At the present time, we do have quite a few applicants who aren't willing to work for the salary schedule.

Ray Stewart: Well, are you then able to do anything beyond just the normal care of these patients?

Dr. Brinegar: A little but not near as much as we would like to. We are able to do some research work. We've done quite a little psychosurgery. We do quite a little active treatment. We can do very little psychotherapy, which is one of the most important things that a mental hospital should do, because it's so time consuming. To do adequate psychotherapy for one patient takes about an hour a day of a doctor's time. And with 1450 patients and only three or four doctors who are trained in psychotherapy, it's obvious that only a very few can receive the benefits of this type of treatment.

Ray Stewart: We have some films which we are going to show you tonight about your institution. But I was interested in the fact that you have more people than some of the other institutions and you're still inadequately staffed.

Dr. Brinegar: Yes, I'm afraid we must admit that.

Ray Stewart: So I think the people can realize then what the problems are with the other institutions. I like to remind you that these institutions that we're talking about – although we talk about them one at a time – their problems are generally the same in most respects. Thank you Dr. Brinegar. And I'd like to show the people some of the motion pictures I took at Cherokee with your permission and cooperation. Whether a person comes to a hospital as an outpatient or a voluntary inpatient or when one is committed, certain admission procedures are necessary. I believe at Cherokee it is necessary before a voluntary patient can be admitted for him to have been there as an outpatient. Here we see Dr. Roneger who is the assistant superintendent getting some of the necessary papers for voluntary patient or outpatient to receive treatment at the place. In other words, permissions must be obtained and there are some charges that are necessary before these things can come about. Of course they don't turn anybody away if they can't pay but if they are able to pay, they do. Here they meet before the staff of doctor's to help with diagnosis.

Ray Stewart: I have a picture here of electrotherapy. I show you the entire thing here as a matter of comparison. You will notice this patient, although she is being treated after the electric shock has been introduced, which is harmless, as far as permanent is concerned, she goes into certain convulsions. Now, as you can see from the shaking there, these patients do have momentary periods of soreness in the muscles. This machine that you see now is a new machine which has been developed at Cherokee. I once again, show you the entire shock treatment so that you can tell there are no convulsions, there is a contraction of all muscles during a very brief period. There are not as many attendants necessary as in the other method. This machine has been in use about three months that up to now apparently the method, the results of this method, are exactly the same as with the other machine and you can see much less trouble than the other kind.

Ray Stewart: Another type of treatment is given here in extreme cases is what is known as a lobotomy. Now a lobotomy is an operation to the prefrontal lobe of the brain, roughly this area of the brain. One of the more common types of lobotomy is known as a transorbital, in which the instrument goes in past the eye, not damaging the eye in any way, but just goes in past the eye. I have some films here, which we'll show you some of these, if surgical pictures bother you don't look. Now we have… I say that seriously. You will notice that there is an instrument that resembles a little bit an ice pick, which goes in and it severs certain designated portions of the of the prefrontal area of the brain. The purpose, one of the purposes is to separate the emotions from thinking. This can cure or relieve some of the symptoms of mental illness. Now sometimes this transorbital lobotomy which is a very precise operation, sometimes it is not successful. And so we have the other type, which is known as the prefrontal lobotomy, it is a full-scale surgical operation, psychosurgery once again, in which they remove portions of the brain, portions of the skull, and go into the brain that way when the transorbital didn't work.

Ray Stewart: Now the machine you are now looking at is an electroencephalograph. This is for reading the brain waves. You notice the patient sitting there. He has certain electrodes on his head and those electrodes are connected to this machine, which will record the brain waves in each of the areas where the pictures are shown. You will notice here the recording going across the screen. Now the frequencies and the heights of these things and their general pattern will tell an experienced doctor just exactly what the trouble is.

Ray Stewart: Now we are going into radioactivity. This woman, this nurse, is looking around laboratory to be sure there is no spare radioactivity. Stray, I should say, radioactivity. And with the aid of a Geiger counter, which measures the amount of radioactivity That will go over the brain of person who has been fed certain radioactive iodine. This iodine will center in certain tumors or scar tissue of the brain, and you can see here the Geiger counter which is counting madly, which would indicate when the counter was in a certain place. That is where the tumor was located, or scar tissue, as the case might be. This is a more advanced method and it is more or less experimental, but it is workable and has been proven to a general degree.

Ray Stewart: Now there are other things, of course, that a patient needs who is in a mental hospital. He has needs just like you and I. He must eat and he has medical needs and he has toothaches, and that sort of thing. Here we see a dentist working on the patient. And then again, music therapy. These patients love to sing and this fulfills one of their needs as you and I have.

Ray Stewart: This is a therapy too. Beauty treatment has been found to be a great help to these mental patients. Of course, they're always done for the great day. When I was there at Cherokee, I found a patient who was ready leave. It's the man there, and his wife came after him. They were both very, very happy at the opportunity to finally be going home.

Ray Stewart: One of the very important people in a mental hospital is the attendant. I thought you would be interested in talking with an attendant in the ward so, I have brought to the studio tonight Mrs. Blanche Smith. Who is a ward attendant at Mt. Pleasant mental hospital. Mrs. Smith, how long have you been there?

Blanche Smith: Well, I've been there about 12 years altogether, I took time off five years ago, so I haven't worked there continuously.

Ray Stewart: I see. I think the first question the people would want to know is what is it like to work in a mental ward?

Blanche Smith: Well, at first, you hardly know what to do and then you get so, you get so interested in your patients that you want to do what you can for them and you get immersed in your work, and it's just like any other job. You just do what you can from day to day from then on.

Ray Stewart: Have you worked in most all types of wards?

Blanche Smith: Yes, I have. I've worked in every ward at the mental health institute at Mt. Pleasant.

Ray Stewart: What about the so-called disturbed or violent ward - have you worked there?

Blanche Smith: Yes, I have.

Ray Stewart: What is that like. Is there trouble?

Blanche Smith: Well, yes. Sometimes everything runs smoothly, and then again you have flare-ups. And, of course, you have to deal with these just the best way you can. As you get to know the patients you know how to handle them, and you can help a lot by just controlling your patient. Of course the main thing is to get them in seclusion so they can not harm themselves or anyone else and then they can get alright.

Ray Stewart: Are you able to tell sometimes in advance?

Blanche Smith: Yes, when you know your patient well, sometimes you can tell when a patient is getting more sick and you can avoid a very bad flare-up by getting treatment in time.

Ray Stewart: In other words, your job is very important for the correct treatment of these people. You can tell the doctor sometimes how you felt or what you observed.

Blanche Smith: Yes, the doctor depends on what we tell him because we work with the patients throughout the day and they know we'll understand.

Ray Stewart: Well now in the number of years you've been working there, you must have seen some changes?

Blanche Smith: Yes, and they have been welcome.

Ray Stewart: Could you give us an example?

Blanche Smith: Well, I think the main thing has been in the attitude of the public toward mental illness. Years ago, it was kind of a hush-hush business. Now they recognize it as an illness just like any other illness and it is treated as such.

Ray Stewart: Do you think that this change in attitude of the public has been a help to the patients themselves?

Blanche Smith: Yes, it has. And then, of course, we have advance in medicine in the last 25 years.

Ray Stewart: Have you seen a difference in the conditions?

Blanche Smith: Yes, we have more occupational therapy, which is a very good thing for the patient. If a patient is kept busy, why that helps a lot. We try to avoid these vacant areas where there's nothing to do.

Ray Stewart: In other words, you try to keep them busy and keep them doing something.

Blanche Smith: That's right, something constructive.

Ray Stewart: Does that help them to recover?

Blanche Smith: Yes, it does. It takes their mind off of themselves and gives them an effort outside themselves.

Ray Stewart: You must see more patients going out improved or cured now than you did a decade ago.

Blanche Smith: Oh, a good many more than many years ago. That's right.

Ray Stewart: Well, that is encouraging that from all of these things that we know. As I told you, Mrs. Smith, and thank you very much Mrs. Smith for coming in and talking with us. Mrs. Smith is from the mental health institute of Mt. Pleasant. The Mt. Pleasant institution is located in the southeastern corner of Iowa. In the city of Mt. Pleasant, which is in Henry County on US Highway 34 about 28 miles from Burlington, Iowa. This is the oldest of the state mental hospitals, although this middle portion burned out some years back and has been replaced by a new fire proof structure. The first patient was admitted here on February 27, 1861. This institution now houses about 1430 patients. This is a new building here, you see, that hasn't been occupied yet. Patients come here from the 24 counties of southeastern Iowa, which incidentally includes Story county right here… Ames… the county that Ames is in.

Ray Stewart: We want to show you first and tell you about the activities of the ward attendants. One of their jobs, as you see here, is to give them the medication on the doctor's orders. Of course, when her days work is finished, she is relieved by another attendant. Many of these attendants are registered or practical nurses. This attendant you may recognize as Mrs. Smith whom we have just talked to. She sits down, she checks with the other attendant, and the very first thing that happens is some of the patients on the ward come in to try to see what they can get out of the fresh attendant, in that case trying to get a smoke. Then we check the record and see what must be done next. Making beds and all types of ward activities are a very important part. Here Mrs. Smith is helped by a patient. Many of the better patients can work through the wards. Now all patients there are not bed patients. These films were made in the admission ward at Mt. Pleasant. When newly admitted, patients are always kept in bed for a short period of time for observation and so forth. When you multiply this by many, many patients, even in the admission ward, you can see that an attendant is quite busy. Of course the new patient… another part of the new patient routine when she comes in is to have blood type and other laboratory tests. All of these things help tell the physical condition of the patient while other tests detect the psychological and otherwise to tell the mental condition. Many laboratory tests and, of course, visits by the doctor. Many questions, many things need to be answered. The chaplain comes in to talk and tries to comfort the new patient. This is a very important period with many new patients.

Ray Stewart: There are other people coming into the room, and sometimes they bring food. At first, of course, the patient would eat in bed, and some patients are sick enough to eat in bed. But of course… many of the wards have their own dining room. When they do have their own dining room, the food is brought up into a kitchen from a central kitchen into a serving kitchen where many patients help. Here you see the patients helping Mrs. Smith bring these things out from the dumbwaiter and put them onto dishes which are put through the window there and carried into the dining hall. There are many, many meals throughout the hospital. Of course, there are always the bed patients who have a tray taken to them.

Ray Stewart: Family style here with Mrs. Smith always around to help. You can see that the hours spent in a day are not exactly leisure hours. The attendant fits in many ways and many activities. For instance, when electroshock, which we have told you about, is given with the aid of the ward attendant. Electroshock is given in many forms, as we told you before, and, of course, this is a conventional machine. The preparation is put on the temple so it can make a good contact. And then these caliper type things are put on the temples and a gag is put in the mouth for protection of the patient to keep them from biting their tongue or doing damage to themselves. Then they are taken out after their session, usually while they are sound asleep. This is a view of the very small machine.

Ray Stewart: Mrs. Smith talked about occupational therapy. Now there is a regular occupational therapy department at Mt. Pleasant, as at the other hospitals. And they do many things, making dresses and the like to keep them busy, to teach them. You'll notice that this man had only one arm, yet he can take very good care of himself. This man is an artist.

Ray Stewart: The leisure ward can go out there back in the ward the attendant helps keep the patients busy, trying to keep their minds occupied and their time occupied.

Ray Stewart: Well, the coordinator of these and all other activities at the institution is the superintendent. I would like you to meet Dr. Wayne Brown, who is the acting superintendent of the Mt. Pleasant Hospital. Dr. Brown, I was looking at these pictures and I saw some very nice private rooms there and lots of attention to the patients. Could it be that you don't have any troubles?

Dr. Brown: We have many troubles at Mt. Pleasant. The wards that these films were taken on is our receiving ward and we there find the accommodations better than in other parts of the hospital. We do have dormitories where many patients sleep together, and, incidentally, this receiving ward was something that was recently fixed up and modernized to a certain degree.

Ray Stewart: I see, was that out of this extra funds, the screening center funds I heard about?

Dr. Brown: Yes, that could not have been done out of our regular funds. It was done with special screening center funds.

Ray Stewart: What about the rest of your institution then – is it overcrowded?

Dr. Brown: The institution is very overcrowded. It's very old. It had its start over 91 years ago and all of the buildings housing patients with the exception of one has been outdated many years ago.

Ray Stewart: Well, how about your attendant problems? I centered on the work of the attendant, and I believe the people realize it's a very important job.

Dr. Brown: The attendant situation at Mt. Pleasant is rather critical. At the present time, I only have about 155 attendants.

Ray Stewart: One hundred and fifty five for how 1400…

Dr. Brown: About 1430 patients.

Ray Stewart: Well, what happens if you run out of attendants?

Dr. Brown: Well, we've never exactly run out completely, but we've been awful close to it. And we have so many wards to cover for 24 hours a day that it is necessary for us to oftentimes have one attendant in charge of two wards or sometimes even more than that.

Ray Stewart: Now how many people are in a ward?

Dr. Brown: The number in the ward will vary anywhere from about 25 on up to 60.

Ray Stewart: So if you had one attendant for two wards, that could be up about 100 patients.

Dr. Brown: At two at a time.

Ray Stewart: That one attendant would have to take care of.

Dr. Brown: Yes. At times they do take care of 75 or more patients.

Ray Stewart: Do these people need a lot of special attention and so forth?

Dr. Brown: They do require a great deal of attention and we would like to give them more attention and care than we are able to do at times under the circumstances.

Ray Stewart: Well, I hate to bring up the situation with the people and then just leave it hang there. Why are you so short of attendants and workers?

Dr. Brown: Well, it seems that we cannot employ a sufficient number of attendants at the amount of salary that I am able to offer them. And many of those who come, will only work a very short period at that salary and then go elsewhere where they can get more money.

Ray Stewart: Your solution, your only solution is more money?

Dr. Brown: Well, that's not the only solution. I think it's an important factor and one that would help us a great deal if there were a little more adequate funds provided.

Ray Stewart: In the case of money, if you were to put your institution knowing your own problems there, in the next period that comes up, how much more money would you say it would take to put on adequately.

Dr. Brown: To I think really give the care, the patents the care that they deserve and we would like to give them, I think we should have in the neighborhood of 70% more money than we've been getting in the past.

Ray Stewart: A 70% increase, then, on the amount of money that is spent. Well, thank you very much, Dr. Brown. I appreciate your frankness in talking about these problems because we have shown the four mental hospitals. We have shown that lots of treatment is done. But I think, I continue to think, that it's very important that the public know that everything we show on this program is not, I mean the things we show in the program are not everything about the institution. I have considered that the patient and what was being done for them is important and tried to center on that, but I would also like you to know that there are many, many problems that we can't bring out here and you can realize that. Well, I have a patient here from Mt. Pleasant who would like to sing for you. So now let's lean back and listen to a very beautiful song "When Irish Eyes are Smiling."

Woman singing: There's a tear in your eye, and I'm wondering why, for never should be there at all. With such power in your smile, sure a stone you'd beguile, so there's never a teardrop should fall. When your sweet lilting laughter's like some fairy song, and your eyes twinkle bright as can be; you should laugh all the while and all other times smile, and now, smile a smile for me. When Irish eyes are smiling, sure, all the world seems bright and gay. In the lilt of Irish laughter, you can hear the angels sing. When Irish hearts are happy, all the world seems bright and gay. And when Irish eyes are smiling, sure, they steal your heart away.

(Voiceover) The worst sin towards our fellow creatures is not to hate them but to be indifferent to them. That's the essence of inhumanity.

(Voiceover) This has been a public service feature produced in the studios of WOI TV Ames, Iowa by Ray Stewart. The program was directed by Lamar Smith. The script for In Our Care was prepared by Hazel Allen. The production research was by Ferne Bonomi. The technical director was Charles Hawley. Portions of the program were on film.