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 18^th 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

Born in Berlin to a Jewish father and a Christian mother, Harry Benjamin (1885-1986) became a physician in 1912 at a time when German physiology and medicine had much to celebrate. He ended his days in New York City more than a century later, a much lauded, if controversial founder of the entirely new field of transgender medicine. The path was not easy as his own transitions were often painfully turbulent: bullied as a schoolboy for being neither Jew nor Christian, shunned in wartime America for being German, accused of quackery for being an advocate of glandular therapy. And he transited the Atlantic many times always both at home and alien on two continents. Nevertheless, he kept his faith in the miraculous effects of hormones and held fast to an undiminished will to help people live happier lives. 

Using intimate diaries, letters, and interviews in both German and English, Alison Li has written a sensitive, insightful biography that not only traces this remarkable life, but also tracks the birth of endocrinology and the advent of an unprecedented discursive consciousness that challenged social norms. Her earlier biography of J.B. Collip, biochemist of insulin fame, provided her with extensive knowledge of emerging hormones; she handles the technicalities with deft, accessible prose.  

From witnessing the “resurrection” of a moribund patient with dried thyroid medication, Benjamin was captivated by the potential of hormones to bring even the sickest of people to perfect health. Initially intent on the rejuvenating possibilities, he thought of his work as “gerontotherapy” –treatment of the elderly – not so much to live longer but to live better. He became a devoté of Eugen Steinach and his procedure – which aimed to enhance hormone production of the gonads by suppression (through X-irradiation) of their competing elaboration of eggs or sperm. As the female and male hormones became commercially available as pills, they were added to the protocol. Inevitable slippage led to equating (or reducing) these goals to enhancing sexual prowess and attractiveness. 

Along the way, Benjamin encountered many prominent figures, and we read their impressions of each other. Havelock Ellis, Alfred Kinsey, Robert Masters, and Robert A. Wilson make appearances. The semi-autobiographical novel Black Oxen (1923) of his ever-loyal Californian patient, Gertrude Atherton, proclaimed the power of glandular therapy to a wide public and cemented Benjamin’s reputation for dealing with problems of sexuality. From listening carefully to each patient, he realized that the socially pervasive male/female binary failed to reflect individual identifications and orientations; gender was not a duality but a spectrum. Language had to evolve too and that is another theme of the book.  

Married to a much younger woman, Benjamin consulted Sigmund Freud when his desire for her waned; however, thinking of himself as a courtly ladies’ man, he was offended by Freud’s suggestion that he could be a latent homosexual. The experience conditioned his mistrust of psychoanalysis. Choosing physiology over psychology, both men, we learn, underwent Steinach’s treatment.  

With an office in New York City and later a satellite in San Francisco, Benjamin moved in a heady circle of artists, writers, politicians, and intellectuals—striving to find comfort in their own identities. He viewed the source of what became gender dysphoria as something biological.  Instead of fixing the mind, he sought to repair bodies to match minds. For some, peace came from simply living as one of the opposite sex, for others it was hormones, and eventually, for some, it was surgery. Benjamin befriended Christine Jorgensen and collaborated with a few surgeons willing –even eager–to develop operative interventions that resulted in physical sex change. After their transition, he continued to follow his patients to understand if and how the procedures had helped their quality of life. 

Always in private practice, never associated with academe except through research organizations of his own creation, Benjamin was dismayed by how his work was shunned by the medical establishment. From 1929 to 1935, he waged a lengthy lawsuit against Morris Fishbein the crusty leader of the American Medical Association for having disparaged him and his work. Benjamin wanted a retraction and an opportunity to explain in the pages of JAMA how his treatments were based in scientific research. He never got it. 

Nevertheless, at the end of his long career Benjamin witnessed the establishment of gender identity clinics at universities beginning with John Hopkins University and extending to some twenty sites by the late 1970s. He also witnessed their numerous closures in the 1980s as a struggle was waged between those who saw gender dysphoria as a mental illness– not deserving of physical intervention, and those who followed Benjamin’s pragmatic, biological approach.   

With curiosity and tolerance, Li probes the convoluted path of Benjamin’s career. She recreates the atmospheric ambience of exotic pre-war Berlin and the heady optimism of post-war America. She privileges the stories and perspectives of well-known trans people –Renée Richards, Reid Erickson, Jan Morris and many others. Without defensiveness, she presents the current criticisms of Benjamin and his so-called “standards” that had been generated to guide the medical approach to people with gender dysphoria. She treats the critics with the same attentive balance and consideration that Benjamin gave to his patients.  

As a physician, Benjamin could scarcely formulate solutions to the distress of those who sought his help in any way other than through a disease model. His efforts brought their plight out of the shadows of deviance and crime to the attention of well-intentioned minds who applied pills and procedures to serve their complex needs, empowering them to live openly, and enabling them to eventually reject the disease model entirely. Trans is diversity—one of many to populate the postmodern world. This is a very good book. 

Wondrous Transformations: A Maverick Physician, the Science of Hormones and the Birth of the Transgender Revolution   
Alison Li
Chapel Hill NC: University of North Carolina Press, 2023 

https://uncpress.org/book/9781469674858/wondrous-transformations
https://alisonli.com