Commitment hearings were held weekly, at the General Hospital (later in the Department of Psychiatry). A clerk and judge from the District Court would preside, with two physicians, each of whom received the statutory fee of $5.00 per case. Physicians with psychiatric expertise were few. Dr. John Llewellyn, an internist with a little training in neurology and psychiatry, Dr. Foster Curtis, superintendent of the Veterans Administration Hospital, and Dr. Reed Harrow, pioneer neurosurgeon, often helped. Any other doctor with a smattering of interest was appointed. The patient was usually seen without prior review in the presence of the Court, and the decision whether to commit was made on the spot, with only a few minutes for each case.

At the State Hospital, custodial care was the major xm. responsibility. Hydrotherapy was a major treatment program, with needle showers for stimulating withdrawn patients and wet pack and special suspension tubs for hours of sedation. Several rooms with iron bar cages were used to keep the criminally insane confined, eliciting the comment of a visiting national expert, “We treat animals better.”

In the late 1930’s, under Dr. Garland Pace, the Hospital moved from compassionate, long-term custodial care to an active treatment philosophy. Manfred Sakel’s new insulin treatment plan for schizophrenic patients was adopted. Physicians were actually TREATING patients scientifically!

The insulin treatment area was a large hall with 40 cots; women to the north, men to the south. Even in coma there was no co-mingling! Six days a week for six weeks, the patients were given regular insulin in doses increasing to 2,000 units, if necessary, to produce coma and sometimes convulsions. If the coma did not terminate spontaneously, transnasogastric orange juice or I.V. glucose was given. Each of us laid claim to an open vein and guarded it jealously! Treatment was dramatically effective in many cases. The mortality rate was one or two percent and some cases had residual neurological damage. The trade-off was considered favorable in the face of such a grim illness.

The expense of that much insulin strained the hospital budget and drained the supply of insulin. There was serious discussion about asking the Diabetic Association to defer casefinding campaigns, to put less demand on the limited supply. The federal government took notice of competing demands and required meat packing plants above minimal size to save the pancreases for insulin extraction.

When the seizure was deemed the therapeutic part of the process, other methods of inducing seizures were tried. In Europe, camphor was injected intravenously for this purpose (venous thrombosis limited the number of injections). A more sophisticated form of camphor, a cardiac stimulant Cardiazole (Metrazole in the U.S.) replaced camphor. The patient could usually be persuaded to take the first treatment but it took six men to persuade him to come for the subsequent sessions. Then electroshock therapy (EST) largely replaced other somatic modalities.

Dr. Owen Heninger, who followed Dr. Pace, introduced the Maxwell Jones Therapeutic Community Model to the Hospital; the milieu became the therapeutic process. Somatic treatment programs were relegated to the Dark Ages Museum along with chains, bars, dunking stool, insulin and EST as used at that time. The Hospital received national awards for the innovative program.

Other forces were bringing profound changes in the psychiatric scene. The development of private hospital facilties, the introduction of effective psychotherapeutic medications, the increasing number of private psychiatric practitioners available, the establishment of the Department of Psychiatry at the University of Utah School of Medicine, the shift of emphasis to the Community Mental Health Centers and the changing patient population from chronic thought and mood disorders to the character disorders all contributed to the successes of the Therapeutic Milieu model at the State Hospital. These shifts also made possible the decimination of the census of the State Hospital from about 1350 in the early 1950’s to under 300 patients during the next decade. Some activists believed that mental illness could be eliminated entirely by eliminating the State Hospital.

Many patients thought to have intractable illnesses unresponsive to other available treatment were considered candidates for the newly developed transorbital lobotomy. While there is no record of these being performed in the State Hospital, over 500 were performed on private patients in Utah in the 1940’s. A few of the more sophisticated psychosurgical procedures, such as the Grantham operation, were performed.

While at the University Medical Center, Dr. Peter A. Lindstrom, Professor of Neurosurgery, developed the Prefrontal Sonic Treatment. This was dramatically effective for some cases of intractable depressions, obsessive-compulsive disorders, certain phobic conditions, and some psychosomatic disorders, with little psychological damage. Unfortunately, it was thought to be a form of lobotomy and did not receive the professional support it warranted.

Dr. C. H. Hardin Branch organized the College of Medicine’s Department of Psychiatry and became its first chairman in 1948. Through his able leadership, communication skills, affability and clinical expertise many physicians were trained in the specialty of psychiatry. He provided strong impetus to the growth of psychiatry in Utah and was later elected President of the American Psychiatric Association.

In the mid-1950’s, the community mental health center concept became the wave of the future. Notwithstanding all the wonderful goodies promised, the State Legislature was very cautious in passing enabling legislation. Opposition came from anti-mental-health persons fearful that psychiatrists were in league with the Kremlin, receiving weekly orders from Moscow, and were a bunch of atheists. Some thought that psychiatrists were plotting a “take-over-day” to commit the officials of the state government, from the Governor and Attorney General on down, to do lobotomies and/or EST on them to establish political control. Only by a compromise was the legislation passed, having to include a paragraph that no one working under the bill was permitted to change anyone’s belief in God (even if the patient believed he were God).

Remarkable progress has been made in the field of psychiatry. We are proud of the accomplishments made by many dedicated psychiatrists and other mental health professionals in Utah.