Review: ‘The Crusade for Forgotten Souls,’ by Susan Bartlett Foote

Star Tribune (Minneapolis, MN)

April 16--Over the past few years, as stories of people with mental illnesses languishing in jails and prisons have accumulated, a destructive narrative has begun to take shape.

A number of respected bioethicists and psychiatrists have lamented that America's massive effort to deinstitutionalize mental hospitals went too far, too fast, and they have issued frank calls for bringing back the asylums that were mostly shuttered by the 1960s. President Donald Trump echoed their arguments this year when he suggested that mass shootings like the one in Parkland, Fla., could be prevented by building and reopening more psychiatric facilities.

But those pining for a return to an era when more than half a million Americans were confined to segregated mental hospitals -- often for life -- should at first confront the institutions' tragic history, and the monumental effort it took to dismantle a discriminatory system that was responsible for decades of abuses.

If these modern-day reformers wish to understand the perils of isolating people in controlled environments, they should begin by reading an extraordinary new book on the history of mental health care reform in Minnesota, "The Crusade for Forgotten Souls" by Susan Bartlett Foote. Her exhaustively researched book gives compelling evidence that even by the standards of the time, Minnesota's system of segregated mental institutions was backward, barbaric and particularly resistant to social change.

Setting her story against the backdrop of the enormous stigma attached to mental illness in the early 20th century, Foote describes the arrogance of an entrenched elite of psychiatrists and state administrators who resisted the input of outsiders and stuck with barbaric methods, including prefrontal lobotomies, long after they were discredited. Foote also weaves a dense and rich narrative about how a small group of selfless citizens defied these elites and built a statewide social movement.

Many of the official historical accounts of the postwar reforms to Minnesota's mental health system focus on politicians such as Gov. Luther Youngdahl, who famously lit a giant bonfire of straitjackets and other restraints on the grounds of the state mental hospital in Anoka while condemning the "barbaric devices" as "witchcraft."

Foote breaks new ground by unearthing the grass-roots origins of the postwar reforms to Minnesota's mental health system. Drawing heavily from primary documents, Foote argues that the seeds of change were laid by a little-known daughter of poor Norwegian immigrants, Engla Schey, who took a job in a mental hospital as a low-paid attendant.

Schey's name does not appear in the many press accounts and official records of the time. Yet it was Schey who became indignant at the inhumane conditions in the hospitals, and persuaded a group of reform-minded Unitarians to make it a central focus of their efforts to improve the human condition.

Fortunately, Schey kept detailed personal journals during her time working at the Rochester and Hastings state hospitals from 1946 to 1954, and Foote deploys excerpts from these journals in heart-rending fashion. Schey described women strapped to wooden benches, "like dogs in a kennel," their hair shaved off and left unattended for days at a time. Many of the patients were not even diagnosed with mental illnesses, Schey found, but were sent away by family members for personal reasons.

The prevalence of experimental treatments was astounding. In the early 1940s, nearly 800 of the more than 1,500 patients at the state mental hospital in Rochester had undergone electroshock therapy, which suggests that they received the treatment regardless of their condition.

Schey's relentless effort to call attention to these abuses would pave the way to more humane care and one of the great policy achievements of the past century -- a commitment to treat people in their homes and communities, rather than institutions.

Even so, as Foote points out in her epilogue, much of Schey's work remains unfinished: The state and the nation have yet to create a comprehensive system of care that responds to a person's evolving needs at each stage of life.

Chris Serres is a Star Tribune reporter. On Twitter: @chrisserres

The Crusade for Forgotten Souls

By: Susan Bartlett Foote.

Publisher: University of Minnesota Press, 304 pages, $22.95.

Events: Book launch, 6 p.m. April 24, Cowles Auditorium, Humphrey School of Public Affairs, 301 19th Av. S., Mpls.; noon May 6, First Unitarian Society of Minnesota, 900 Mount Curve Av., Mpls.; 7 p.m. Unity Church, 733 Portland Av., St. Paul; 6 p.m. May 24, Anoka County Historical Society, 2135 N. 3rd Av., Anoka.