It seems as if there is a man named Benjamin Rush who follows me everywhere I go. He was one of the founding professors at the medical school I attended. He was on the staff of the hospital where I did my training. He was one of the initial fellows of the College of Physicians of Philadelphia where I’m now a fellow, and where a medicinal plant garden now bears his name. He appears on the seal of my professional organization, the American Psychiatric Association. At one point, apparently, he even came within spitting distance of my future home when he made the famous crossing of the Delaware River along with Washington and the troops.
But who was this person, really? That is what I was wondering when I picked up Stephen Fried’s biography Rush. He seems to have known everyone who was anyone, yet Rush himself is one of the least well-known of our country’s Founding Fathers. It turns out that the answers are complicated.
Rush has been called the father of American Psychiatry. When he began to work at Pennsylvania Hospital, he was appalled to discover the “lunatics” chained up and below ground in unheated cells, receiving no treatment. The public could come in and gape at them for four pence. Although Rush made wide-ranging contributions to medicine in his long career as a physician (such as guiding Philadelphia through a series of yellow fever epidemics), he returned repeatedly to the problem of the patients in the basement.
In an era when madness was frequently seen as a moral failing, Rush put forth the theory that it was a disease. (He believed that about alcoholism too.) He spoke to the mentally ill like human beings, and when they had delusions, which he called “errors of thinking” (Fried, 2018, p.269), even tried to understand them. He banished the public from the basement, had heaters installed in the cells, and petitioned the hospital to supply the patients with “exercize and amusements” (Fried, 2018, p.450). Although Rush wrote prolifically throughout his career, he finally published his magnum opus on the subject just a few months before his death. In Medical Inquiries and Observations, upon the Diseases of the Mind, he sought to bring mental diseases “to the level of all the other diseases of the human body…. Time I hope will do my Opinions justice. I believe them to be true and calculated to lessen some of the greatest evils of human life.” (Fried,2018, p.469)
All of this is admirable. However, the other side of the coin is that some of Rush’s treatment methods were questionable. True, he was far from being the only physician at the time to use bloodletting for…just about anything and everything. However, even among his contemporaries, he was known as being so aggressive a bloodletter he was parodied as Doctor Sangrado (a reference to an evil physician in a popular novel who bled patient dry). He also comes off, at least in Fried’s book, as having as a character flaw an inability to ever admit he was wrong. So, in defiance of his detractors he persisted in using bloodletting to the end of his career. And although his recommendations about diet and exercise were indisputably helpful ones, his Tranquilizing Chair and Gyrator (they sound like rides in an amusement park, but probably weren’t very amusing) did not turn out to be.
In addition to his stubbornness, Rush had a tendency to say things that perhaps he might have thought out more carefully. He never lived down a foolish criticism he had made of George Washington. He made outrageous pronouncements as a physician based solely on observation. In what Fried calls “the most spectacularly wrong-headed address of Rush’s career” (Fried, p. 389), he conjectured that the dark skin of black people comes from leprosy. A man of profound contradictions, Rush was an abolitionist who also turns out to have been a slaveowner. While this may not have been unheard of in the 18th century, it is disturbing today considering some of his statements. In 2021 The New York Times published an article entitled “Psychiatry Confronts its Racist Past, and Tries to Make Amends” which sees Rush’s leprosy theory as one source of the structural racism in psychiatry that has led to the pathologization of African Americans for hundreds of years.
Back in 1894, when the American Psychiatric Association unveiled its official seal, it included a likeness of Benjamin Rush’s profile: “The choice of Rush…for the seal reflects his place in history…Rush’s practice of psychiatry was based on bleeding, purging, and the use of the tranquilizer chair and gyrator. By 1844 these practices were considered erroneous and abandoned. Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry.” But today, Rush is evidently no longer considered to be a role model. in 2015, the APA adopted an entirely new logo that did away with Rush altogether, although the organization would “continue to use the seal…for ceremonial purposes and for some internal documents.” (“American Psychiatric Association,” Wikipedia)
In conclusion, although we can not necessarily hold historical figures to task for making comments that were considered acceptable at the time, we also need not put them on a pedestal. Fried’s book Rush depicts its subject as a brilliant man with weaknesses. The more I read about Rush, the more interesting and complex I find him to be.
References
Fried, Stephen. Rush. New York, Broadway Books, 2018
Warner, Judith. “Psychiatry Confronts its Racist Past, and Tries to Make Amends.” The New York Times, April 30, 2021 (updated May 21, 2021)
“American Psychiatric Association,” Wikipedia, updated July 3, 2024, https://en.wikipedia.org/wiki/American_Psychiatric_Association
