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History of Science, Medicine, and Public Health


Kelly O'Donnell


Between 1931 and 1941, the United States population over the age of sixty-five increased by over 35 percent. These individuals, however, did not receive increased support. Rather, American politicians and society at large labeled the elderly a ‘burden,’ and passed off their care to the overworked medical personnel of state and federal mental institutions. Sparked by clinical exposure to the influx of elderly patients to mental institutions, Massachusetts psychiatrist David Rothschild identified an erroneous assumption in care practices for senile patients. In many cases, physicians preemptively diagnosed those admitted to state and federal institutions with some form of senile dementia, without considering their personal history. Personal histories unveiled socioeconomic status, racial and gender discrimination, as well as traumatic experiences faced by many of these patients. Psychiatry’s unruly search for the biological underpinnings of mental illness overshadowed a psychiatric framework that considered both biological and social factors. Rothschild was determined to change such a mindset. Through tedious research, confrontation, and public addresses, Rothschild fostered a psychodynamic model for discerning senile psychoses. Promulgating this model, Winfred Overholser—superintendent of St. Elizabeths, the first federal institution for the mentally ill—pushed for increased appropriations, endorsed a national health care program and developed some of the first geriatric psychiatric facilities. Using primary source newspaper articles, government hearings and proceedings, radio recordings, and census data, this thesis explores the rise, and subsequent fall, of social psychiatry through the lens of national health care reform and the path to Medicare. Such an analysis reveals the importance of refocusing psychiatric and political efforts on social structures, rather than exclusively changes in the individual.

Open Access

This Article is Open Access