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Leadership Spotlight
Heidi M. Dunniway, MD, was the 134th President of the Indianapolis Medical Society serving in 2007-2008.
Dr. Dunniway received her undergraduate degree in Biochemistry from the University of Iowa, where she graduated with College Honors and Distinction. She also earned her Medical Degree, with Academic Honors, from the University of Illinois at Urbana-Champaign.
Dr. Dunniway completed her General Surgery Internship at Riverside Methodist Hospital, and her Otolaryngology Residency at The Ohio State University, both in Columbus, Ohio. She is a Board Certified Otolaryngologist, having received her certification in 2000.
She has been a member of the IMS Board of Directors since 2001 and has most recently served as the Chair of the IMS Commission on Professional Affairs. She is cochair of the ISMA Women in Medicine ad hoc committee.
She is currently a member of the American Academy of Otolaryngology-Head & Neck Surgery, is a Seventh District Trustee with the Indiana State Medical Association, as well as currently serving as Chair, ISMA Commission on Constitution and Bylaws, and has been an active participant at the American Medical Association.
Dr. Dunniway is married to Rich Gustafson, a retired Marine, who, served 21 years on Active Duty. Rich holds a degree in Industrial Design from Purdue and works in product design.
President's Message September 2010
History of Psychiatry in Indiana
As I indicate in my leadership profile, (page 8 of this issue) I am planning on focusing in the IMS Bulletins the subject I know best: psychiatry and its many facets. There are obviously financial, national, and legislative matters that could be covered in these monthly statements, but for those you have the AMA News, ISMA Reports, and the like providing much more in depth analysis than I could convey.
This month I would like to review the history of psychiatry in Indiana and follow its progression to psychiatry as we know it today. Psychiatric illness is documented even in the writings of Plato and Socrates. The Greeks and Romans, however, ignored such illness and banished those afflicted into the countryside. Psychiatric hospitals per se actually date back to 750 AD in Arabia. Indiana saw its first psychiatric hospital constructed in 1841. It was referred to as "The Indiana Hospital for the Insane." This was one of the first fifteen asylums in the country and until its demise in the mid 1990's, it was the oldest state hospital west of the Alleghenies. It was later to be known as Central State Hospital and provided 160 acres for its 2600 residents. The philosophy of treatment was that of "moral therapy." Keep in mind psychiatric diagnosis was primitive and treatment involved confinement of patients in hospitals with large acreage, which was heavily landscaped so as to provide a sense of peace and tranquility where one could address the conflicts of the mind. This was indeed the standard of care in the poorly understood science and subspecialty of medicine called psychiatry at that time.
Fifty years later, the Pathology Building was constructed on the grounds of the Indiana Hospital for the Insane. The building was dedicated in 1896 and was devoted to research and the quest for the causes of mental illness. It was regarded as one of the finest research labs in the world devoted to psychiatry. Interestingly, the building would not have been constructed had the hospital superintendent not deviated funds against the state legislature's wishes from the general operating expenses to the construction of the "Old Pathology Building." This building is the only surviving structure on the former Central State Hospital grounds and is now 114 years old and is on the national historic registry of buildings. Central State Hospital was the new name given to the hospital in 1927. It was also referred to as "Seven Steeples" because of its classic Gothic architecture. In reality, however, there were actually eight steeples even thought only seven could be seen from any single vantage point.
Other state hospitals followed in due course with specialization of some. Norman Beatty Hospital was for the criminally insane. Muscatatuck State Developmental Center was primarily for those with mental retardation and epilepsy. The Fort Wayne Developmental Center was for younger patients with mental retardation and developmental disabilities. In total, there evolved eleven state hospitals the most recent of which was Larue Carter Hospital, which was devoted to "clinical care, student education and research." This was the last state hospital to be constructed and opened in 1951.
Private psychiatry began to emerge in the 1940's. The old Norway's Hospital on the near east side of Indianapolis functioned from the mid 1940's through the mid 1950's. As this facility faded, Methodist Hospital developed prominent psychiatry services and was a leader in the specialty until the early 1980's when the St. Vincent Stress Center came into prominence. An unsuccessful marriage between the Stress Center and Community North left the Stress Center in decline with Community North picking up the gauntlet for psychiatry. Significant also was the year 1955 when Thorazine became available. That was also the year when patients in state hospitals nationwide peaked at half a million. That number has been declining ever since and slowly, but certainly, state hospitals also began diminishing. This closure of state hospitals began accelerating further then with the Mental Health Center Act under John F. Kennedy in the early 1960's. One by one state hospitals began fading. Their large populations of patients, many with several thousand each, began declining. At present there are only five state hospitals remaining in Indiana with only one to two hundred patients each. This has occurred due to multiple factors: changes in treatment philosophy, development of mental health centers with wrap-around services, psychopharmacology, and improved understanding of and acceptance of the mentally ill by the general public so they can be folded into the community.
In our own backyard, another significant event occurred which advanced the specialty of psychiatry. After 22 years in development, Lilly introduced Prozac and by serendipity the timing was perfect. Suddenly, psychiatric illness was not by choice but was chemically mediated. Suddenly, it was appropriate to seek treatment and to even talk about one's psychiatric illness. A hundred years later, the "research" for which the "Old Pathology Building" at Central State Hospital had been constructed was finally producing results three miles east off Washington Street in another lab pioneered by another researcher, Colonel Eli Lilly.
Like every medical specialty, psychiatry has its own history and this history varies some and yet has some similarities also from state to state. There is much more history I could add to the bare bones of Indiana psychiatric history that I have by necessity only glossed over lightly. I hope that what I have provided, however, conveys the fact that psychiatry is an evolving science that began rather crudely, but has advanced over the last 150 years to stand alongside the shoulders of all the other medical specialties as well.
In the next IMS Bulletin I will review the development of the mental health centers and the philosophy and variety of services they provide.