In Our Care: "Clarinda and Independence"

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're older now and most of your active life is behind you. You have time to do a lot reading. You've just read an article about insane people in mental hospitals and have stopped to reflect upon your own life. You consider how fortunate you have been to have remained mentally healthy. But what about those less fortunate? You find yourself wondering what it would be like to be a patient in a mental hospital.

Ray Stewart: My name is Ray Stewart. I've found that lots of people wonder what it's like to be in a mental hospital. There are people who know what it's like and there are people who think they know. Well, I decided to see for myself. There are four state mental hospitals in Iowa, and I have visited all of them. Let's look first at Clarinda.

Ray Stewart: This mental hospital, mental health institute, is located in Page County near the southwestern corner of Iowa. The first patient was admitted in 1888 and this institution now houses more than 1400 mental patients from the neighboring 24 counties in southwestern Iowa. If you think that mental health doesn't directly affect you, let me read you a few statistics taken from "The Shame of the State," a book published in 1948 by Harcourt Brace and Company. One out of every 17 Americans is destined to spend some part of his or her life as a patient in a state mental hospital. One million children now in elementary schools of the nation are destined to spend some time in state mental hospitals in later life. Or it is estimated that for every patient now in a mental hospital, there is another one outside sick enough to require care and treatment in a psychiatric institution. We've read a lot about these places and from the Woman's Home Companion in April, we find that the statement that we have talked of state mental hospitals and called them snake pits, but the real snake pit is not a public institution, it is a public attitude.

Ray Stewart: Dr. Norman Render is the superintendent of the Clarinda Mental Health Institute. Dr. Render, I have heard a lot of things and read these exposé type of stories and so forth, and I have been wondering what has happened to the old Bedlam and insane asylum sort of thing that people have come to expect and which, frankly, I didn't find in your institution.

Dr. Render: I'm glad to hear you say that, Mr. Stewart. The Bedlam type of care in the state mental hospitals disappears when the patient is treated as an individual needing medical care, not simply as a monstrosity to be put away for punishment or the forgotten and better done away with. When we realize that mental illness is curable and we realize that doctors and nurses and skilled technicians and ward help tend to produce recoveries in mental patients, then we get away from Bedlam.

Ray Stewart: I see. Well, this idea that you're expressing is something that has been in practice only a few years, isn't it?

Dr. Render: It has been practiced off and on. I will say that the ancients in the Aesculapian times had something of the same idea with the old master's rest and good physical hygiene, sedative treatments, and soothing talks with the disturbed patients, he had something of medical treatment available for them then, although he didn't advance, I may say, so far as we are now. Then, in the interim, there seemed to be a blotting out of scientific knowledge in all fields, including medicine, and the mental illness was considered a kind of visitation by evil spirits or as a punishment that the patient deserved for sin.

Ray Stewart: Then things have gone one way and then changed to another. To answer the question further of what it is like to be in a mental hospital, I might tell you that as a matter of point of view. If you're just a casual visitor to a mental hospital, you might see something like patients working on the lawns or sitting around with the nurses and so forth. This sort of thing a casual viewer would find in a mental hospital.

Ray Stewart: Baseball.

Ray Stewart: If you were interested in volunteer work, as many people are in these hospitals, you would see patients who are gathered around and eagerly interested in what you were doing. And you would say this is a mental hospital.

Ray Stewart: If you were interested in recreation and helping the patients to spend their free time, then you would say the patient playing, perhaps, is a mental hospital.

Ray Stewart: There are people who do other things for the patient such as showing movies, and this is a vital part of their life in the ward. Something is always done to keep them busy.

Ray Stewart: As a dietician, you said it's a lot of mouths to feed because there are 5100 meals per day at Clarinda. These are the obvious things. But what about the others? We must probe deeper. Well, Clarinda has an outpatient department. People can come in to the screening center to be examined. Or sometimes they are committed. The doctor asks questions and tries to find out what their difficulties are. There are many questions to be asked, many things to be found out, and a trained psychiatrist knows how to get out the information and finds the deep lying meanings of the trouble. The social worker has many things to do and he records everything about the background of the family. Then, of course, after the background and the probing, then the psychologist must take over and perform many, many tests to really discover what causes this person's disturbances to try to classify the thing to help the staff in later meetings to know just what can be done for the patients.

Ray Stewart: They want to know lots of things about you and they want to do things for you. And after they have gathered all of this information, they set you out to a group. Now, for instance, if you are having trouble and you became an alcoholic, they might put in an Alcoholics Anonymous group. One thing that our mental hospitals do, in addition to taking mentally disturbed patients, is to also take volunteer and committed alcoholics to try to straighten them out in that respect.

Ray Stewart: Here Dr. Growth is talking with alcoholics group. Then you might be put into what is known as group therapy. Group therapy is actually a sort of elaborate bull session where everyone gets together and talks about their problems with each other and try to help understand each other and thereby themselves. Of course we go further than that, and what you're seeing now is what is known as electroconvulsive therapy. Electricity is induced to the temples of the person and a convulsion or a coma is created, and this is extremely helpful. Shock therapy was developed, not on the basis of theoretical events but upon bases of treatment that were found definitely to work.

Ray Stewart: Another type of shock treatment is insulin, and here we see the doctor injecting insulin into the vein of the patient to induce a coma. The patient sleeps. They are maintained in this state for about two hours under the very careful supervision of the administering doctor, in this case, Dr. Katlin. The nature of the mechanisms by which insulin and electroshock therapy bring out improvement is as yet uncertain. There is increasing evidence that shock treatment alone will not be sufficient to enable a psychotic individual to make a satisfactory adjustment to reality. Some type of psychotherapy must follow up on this. But the fact remains that shock treatment has hastened the recovery of thousands of disordered minds which 25 years ago would have been pronounced incurable. The patient is brought out by the injection of sugar into their veins. They are given orange juice and some syrup.

Ray Stewart: Well, that is the more severe, shall we say, types of therapy and treatment which are given. But, as I said, these things have to be backed up by other types of therapy. And, of course, these people must be kept busy to. And so there is the occupational therapy department, the music therapy department, and so forth.

Ray Stewart: Here we see a patient working with finger painting and doing linoleum block printing. These things are not purely diversional but are something that are deliberately designed to help the patient. There's reading. They can take these books back to their ward. This girl is a patient who is the editor of the Clarinda Clarion, does much art work and much writing for the paper. It's helpful to her.

Ray Stewart: If you were in this hospital, you would see lots of volunteer workers. You would find and you would get the feeling that people are interested in you and your welfare is at heart.

Ray Stewart: There is a chaplain who comes to the hospital twice a week, gets the names of various patients who should have his attention, and goes and visits them. And this is a little more of the personal attention which is available at Clarinda Mental Hospital. And, of course, there is always the Social Service Director who is ready and willing to help in any way with financial matters, personal matters. He is sort of a Red Cross all in one man, in this case, to all of the people who might need his help.

Ray Stewart: Well, we come back again to the question of what is it like to be in a mental hospital. And I would say again it depends upon your point of view. But a good way to find out is to talk with an ex patient. Here with me now is Milton Sanderson of Waterloo, who was a patient at Independence Mental Hospital. Milton, how long ago were you there?

Milton Sanderson: It was about a year and nine months ago. I was out on leave.

Ray Stewart: You've been out almost two years.

Milton Sanderson: Almost two years, exactly.

Ray Stewart: I think people would be interested, Milton, in knowing how you came to find yourself, or maybe we better start back and ask you what your trouble was in the first place.

Milton Sanderson: Well, my trouble was, started out in really a family way, more or less my interpretation of it, from an innomination. It is what's called a smothering affection which developed what is classified, generally speaking, as manic depressive. However there are several pretences that go around that.

Ray Stewart: What was the immediate thing that caused your being committed to the hospital?

Milton Sanderson: Well chiefly, it was drinking that started and came to a head.

Ray Stewart: You had become a community problem, had you?

Milton Sanderson: That's right. I'd caused considerable disturbance in the community.

Ray Stewart: How did you feel about being sent to a mental hospital?

Milton Sanderson: I was very rebellious and hostile about it. In fact, the first time I spoke to psychologist there in the hospital, she asked what I thought of it I said, I thought it was an A1 kind of deal.

Ray Stewart: Did you… were you always aware? I mean, you knew everything that happened in the hospital. You weren't out of your mind, so to speak, at any time.

Milton Sanderson: You can ask me about anything at all. I can recall it pretty well.

Ray Stewart: You felt you were railroaded into this thing, did you?

Milton Sanderson: Definitely, when I first went in.

Ray Stewart: How do you feel about it now, as you look back?

Milton Sanderson: Well, it's like any hospitalization, it was enforcement but I feel like I'm richer for the experience and probably will be a stronger person for it.

Ray Stewart: What in the hospital was responsible for your snapping out of this manic depressive state?

Milton Sanderson: Well, the chief thing, I think was the group therapy and physiotherapy patients with the chaplain and the pastoral psychiatrists with all the people and my physiotherapy after leaving the hospital.

Ray Stewart: I see. Now, on this group therapy, how did it work with you? How did it help you to come out of your state?

Milton Sanderson: Well, it was a matter of discussing common symptoms, and common subjects and facts in mental health and illness with Reverend Bell and then I heard in discussion among the patients. They exchanged ideas. One would give his ideas on how to overcome a certain problem to another patient and in turn if something came up that he felt they get strong in or felt he knew something about, he would contribute. And through this exchange of information, we would all gain insight into what – that we were ill, and what caused our illness and some ideas on how to address this.

Ray Stewart: In other words you realized through this group therapy what your difficulty was and then you brought yourself out of it, were able to control these disturbing influences and symptoms. Is that the way it worked? Well, thank you very much, Milton, for your willingness to come here and talk about it. And I think you helped people to understand just a little bit more of what it is like to be a mental patient. Milton is from Independence Mental Health Institute. This institute is located in Buchanan County in the northeastern section of Iowa. The first patient was admitted here in 1873 and the institution now houses 1500 patients. This is an overcrowded condition here as in most of the mental hospitals in the state, an overcrowded condition of something like 13 to 15%. You'll notice how closely the beds are crowded together. There are four beds in the middle of the floor and the beds around the outside were so close that you could hardly walk between them. Even on the porches, there were crowded conditions. However, there are building plans in the works. The name of this building, incidentally, is Sunny Villa. The building plans will help to alleviate this circumstance somewhat.

Ray Stewart: These are volunteer workers who have come to a ward to put on a party. And the music that is being played for them here, the people who are doing the singing and playing, we have brought to the studio tonight and you will hear them somewhat later. Mr. Ted Flotten, who is at the accordion there, is the music therapist and has brought the group here tonight. Here again we'll get into occupational therapy and I as told you before, these directed activities, something which will help the person gain the… hold the ground which he has gained. It is not purely a diversional activity, but under the expert guidance of a registered occupational therapist, these things can be extremely helpful in their own right.

Ray Stewart: Another very interesting therapy is used at Independence is art therapy. Here the patient is able to put on paper the things that he or she feels within themselves, and sometimes these people do not even talk. Now here the man wanted the model from the girl, he drew the caveman, which might give you an idea of how from the pictures they are able to get some insight into the difficulties of the person. There are other therapies which are used here and at Independence they use what is known as hydrotherapy.

Ray Stewart: In the hydrotherapy department, they have steam baths. These have the usual either stimulating or sedative effects. This is the needle shower spray and so forth not only gives the stimulation or the sedative effects, depending on the type, whether it's wet packs, tubs, jets, or whatnot, but it also gives the patient the feeling that something is being done for him, that he is not just left to sit in a ward and think of his troubles. A very interesting, somewhat new therapy that is going on at Independence is psychodrama. In this case it is unrehearsed drama where the person feels, is put into a certain problem, and according to his feeling, he goes into the conversation and the action of the situation and tries to explore it or reveal his feeling to someone else by that fashion. Now this isn't something that is allowed to go on without any direction, but Mrs. Ruejar, who has recently come to Independence to set up this program, talks with them afterwards, points out the things that they have done. In this case, she asks them to switch their roles. She says, "All right, you were having an argument. Let the wife take the husband's position, the husband take the wife's position. Now go back into your action and see if you can appreciate any more the other person's point of view." You can see from that that a lot of these people's difficulties were emotional, they are in this way able to have some added appreciation of the other fellow's point of view and it becomes a therapy. Perhaps only an interest therapy, but that is the direction it takes.

Ray Stewart: Volunteers are now admitted… Voluntary patients are now admitted to the mental hospitals. And we have some… At Independence, we have a lounge, which you see here, a very nice place, where either voluntary patients or new patients which are coming a screening center, are able to relax between their treatments and various therapies. They have nice homelike surroundings. It's cheerful. This is not true of the entire hospital, but it is true in the screening center portion and in the voluntary patient portions. They have very nice, sometimes private rooms and sometimes ward rooms, but this is a typical room for the voluntary patients. These patients are charged for their care, as far as they are willing to pay. Another thing which they have at Independence is the treating of affiliate nurses. It seems that now it is necessary for nurses, before they can become registered nurses, they have three months training in a mental hospital. This training for Iowa is centered at Independence. These nurses get good psychiatric training there so that they can go out and have more of an appreciation of how these people should be cared for.

Ray Stewart: I would like you now to meet Dr. Witte, who is the Superintendent of the Mental Health Institute at Independence. Dr. Witte, what are you able to do for your patients?

Dr. Witte: Well, in the first place we, as soon as they come in, we start trying to get them to realize that they are not there as a criminal but they are there because they have a mental illness and that mental illness is no disgrace and that if they will try, we will help them to get well. The first thing we want them to do is to realize that their emotions may have been out of hand, or that their mind may have been playing tricks.

Ray Stewart: You said that mental illness is no disgrace. What are your reasons for that?

Dr. Witte: Because they are just as sick as anybody with an apparent physical illness. They are just as sick, but they're sick in their emotions. And the idea of a disgrace goes back from the Middle Ages when we thought they were beset with demons. And we know better now, but there still is that emotional attachment to it. And that's the first thing we've got to get the patient over. So that they won't feel that they have been disgraced and lost all their friends by coming to the hospital.

Ray Stewart: Is mental illness hereditary?

Dr. Witte: No. We used to think so, but now we think that the trouble is if a person has a mother who may get upset, that may be disturbing the emotional life of the child, so the child will have a more tendency to break when they get up. It's got nothing to do with the genes or the chromosomes or the germ cells.

Ray Stewart: I am interested in knowing how you, what you attribute the change between the way that mental patients used to be treated even 10 years ago and the way they're treated now.

Dr. Witte: The change came on because we suddenly started, we would see these people were human beings and we treat them as human beings, and that we could give them a little more responsibility, and that we would make more effort to explain to them the cause of the mental illness, which we know more about now than we used to. And then of course, we have electroshock, our electric treatment rather, and our coma insulin and some brain surgery for those cases where we can't help with psychotherapy.

Ray Stewart: I had heard all of these stories about wild people and so forth and yet at all four of the mental institutions, I made a particular point of going into the disturbed wards and what I found there was men or women, as the case might be, sitting around reading newspapers, magazines, listening to the radio, yet they were called a disturbed ward. What quiets this thing that way?

Dr. Witte: That's a ward we call a maximum security ward. And it is due to the fact in the first place, we took off the restraints. Except for a few wristlets, and even though the attendants in the wards worried, nothing happened. As a matter of fact, the patients get a lot more peaceful than they used to. There is another thing and electroconvulsive therapy again has helped us in that.

Ray Stewart: That has been some sort of a sedative for you in that respect.

Dr. Witte: Yes.

Ray Stewart: Well, I wish we had more time to go into this thing more fully. You can realize that this is a bigger thing than you can cover in a half hour. Next week, we will go on through on these therapies. We will take you into some forms of brain surgery and some other types of therapy. Actually, these programs are units of two each. We cannot be at all inclusive. Everybody, I mean each institution, has more or less the same thing. A few of them of them have some individual matters, but I feel that by the end of the second program, which is the end of next week, you should be able to get a little better picture of just how our patients are cared for. So be sure to watch next week for the second unit of our story of the mental health institutes. As I told you before, we have some patients here tonight who would like to play for you and sing.

(Piano, accordion, and violin.)

Woman singing: The chimes of time ring out the news another day is through. Someone slipped and fell. Was that someone you. You may have long for added strength your courage to renew. Do not be disheartened for I bring hope to you. It is no secret what God can do. What he's done for others he'll do for you. With arms wide open he'll pardon you. There is no secret what God can do.

(Piano, accordion, and violin.)

Woman singing: It is no secret what God can do. What he's done for others he'll do for you. With arms wide open he'll pardon you. There is no secret what God can do.

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

(Voiceover) This has been a public service feature produced in the studios of WOI TV Ames Iowa by Ray Steward. The program was directed by Lamar Smith. Script for In our Care is prepared by Hazel Allen, with production research by Fern Botomy.