In September 1948 the Pinel Foundation was established in Seattle and shortly thereafter it opened a psychiatric hospital at 2318 Ballinger Way in Shoreline. The foundation's core goal was to provide treatment rather than merely custodial care for those suffering from mental illness. The Pinel Foundation hospital worked in close conjunction with the existing Northwest Clinic of Psychiatry and Neurology, which in turn followed treatment modalities pioneered by the Menninger Foundation of Topeka, Kansas. These included extensive use of psychoanalysis, which many medically trained psychiatrists believed was of little or no benefit in treating serious mental conditions. The Pinel Hospital's goal of maintaining a high staff-to-patient ratio was not conducive to financial stability, and the facility was nearly always badly underfunded, despite caring for such luminaries as poet Theodore Roethke (1908-1963). Lack of money, frequent changes in leadership, and ongoing conflicts between hospital staff and referring doctors over treatment philosophies doomed the well-intentioned effort to failure. The Pinel Psychiatric Hospital closed its doors for good in the autumn of 1958.
A Hopeful Start
On September 12, 1948, The Seattle Times reported the formation of a foundation "to raise standards for treatment of mental patients" ("Sanitarium for Mental Cases ..."). The foundation would be named for Philippe Pinel (1745-1826), a French physician who sought to unchain asylum patients from bedposts and hospital walls. Its first president, Seattle businessman George E. Fahey (1910-2011), announced that the foundation would be opening a sanitarium, the first of its kind in the Pacific Northwest, that would "seek to raise standards for treatment of mental patients" and would operate as a "demonstration unit "in conjunction with the Northwest Clinic of Psychiatry and Neurology ("Sanitarium for Mental Cases ..."). Among the members of Pinel's first board of trustees were doctors Douglass W. Orr (1905-1990) and Edward Hoedemaker (1904-1969), who were both founders and part owners of the Northwest Clinic.
Business and community leaders who sat on the foundation's board of trustees included Cebert Baillargeon (1888-1964), an investment banker for Seattle Trust and Savings; James W. Clise Jr. (1900-1961), Seattle industrialist, member of the National Municipal League, and donor to the University of Washington (UW); Mrs. Edwin L. Griffin of Tacoma; and Reginald H. Parsons (1873-1955), Seattle financier and philanthropist. Other members included Orville Robertson, executive director of the Family Society of Seattle; Herbert S. Ripley, M.D. (1921-2015), first chair of UW's department of psychiatry; Raymond G. Wright; Mrs. Joshua Green Jr.; and Herbert E. Coe, M.D., (1882-1968), a pediatric surgeon.
The underlying philosophy of the new psychiatric hospital was based on a concept called milieu therapy, otherwise known as team therapy or group therapy, in which environment and staff interaction determine the well-being of the patient. Milieu therapy includes psychotherapy and recreational therapy, and may be accompanied by insulin and shock therapy. Orr and Hoedemaker were intellectually and emotionally attached to the use of milieu therapy in treating their hospitalized patients. Of most importance for the foundation, these therapies were also supported by the practice of psychoanalysis as promoted by the Northwest Clinic.
Psychoanalysis is imbued with the ideas of Sigmund Freud (1856-1939), who taught that human action is based on unconscious thought. Symptoms and problems in a person's life may be overcome by discovering that which we try to avoid -- events that are hidden in the unconscious. Theoretically, discovery of unconscious thoughts and behaviors occurs when analysand (patient) and analyst confer, usually with the analysand lying on the psychoanalyst's couch.
The Northwest Clinic was defined by a psychoanalytic treatment philosophy, and since Orr and Hoedemaker were the force behind Pinel -- along with business people from the community, with whom they would eventually collide -- the Pinel psychiatric hospital was pressed to apply the Northwest's Clinic's philosophy to patients' treatment plans. This did not always sit well with psychiatrists who were not psychoanalytically oriented, or with families who just wanted their loved ones to get well. The Northwest Clinic and the foundation hospital would become so closely entwined that psychiatrists who did not believe in psychoanalysis eventually refused to send their patients to Pinel. Influential supporters lost hope, leading to the eventual end of what began as a grand dream for superior mental health treatment in the Pacific Northwest.
Following the Menninger Model
Milieu therapy was designed for inpatient treatment and came into prominence at the Menninger Foundation, established in Topeka, Kansas, in 1941 by Charles Menninger (1862-1953) and his sons, Karl (1893-1990) and William (1899-1966). The family foundation oversaw practices in clinics under its control, just as the Pinel Foundation would oversee its psychiatric hospital. Those who were connected with Pinel through the Northwest Clinic, including Dr. Orr, were psychiatrists as well as Menninger-trained psychoanalysts.
Unlike psychiatrists, who have earned a medical degree from a medical college or university, psychoanalysts need not have such training. For example, Anna Freud (1895-1982), daughter of Sigmund Freud, was a school teacher and an author of texts on psychoanalysis and education, and was known as a lay analyst. Psychoanalysts may have earned a doctorate in an unrelated academic discipline. Edith Buxbaum, Ph.D. (1902-1982), who was the second psychoanalyst in Seattle (after Dr. Orr) and an associate of the Northwest Clinic, had a degree in history. Although Buxbaum served on Pinel's board in later years, she could not have practiced medicine at the hospital. Psychoanalysts who are also psychiatrists can prescribe drugs; psychoanalysts without medical degrees cannot. And, as would happen at Pinel, psychiatrists who have psychoanalytical training can come into conflict with psychiatrists who do not.
An article in The Seattle Times on March 27, 1950, noted that Seattle's new Pinel Foundation was "one of the few mental hospitals in the nation designed to apply the modern methods of 'environmental therapy,'" intended to provide "cure or improvement, not custodial care" ("Community Pitches In ..."). At that time there were only 28 patient beds, and the hospital boasted at least one staff member for every patient -- a far cry from the doctor-patient ratio at state mental hospitals, where there was "one doctor for 250 to 400 patients, and only one attendant for seven or eight patients" -- and equally important, according to the article, "Each patient ... is under the care of the individual doctor who sent him there and who prescribes his day-to-day activities and the attitudes that are to be applied to him" ("Community Pitches In ...").
This often proved not to be the case. In fact, psychiatrists who sent their patients to Pinel were confronted with an ideological stance. Psychoanalysis was embedded in the body of milieu therapy as practiced under the Menninger system, and it dominated patient treatment at Pinel. Orr and Hoedemaker had established the prominence of the methodology even before the hospital's doors opened. Conflict was bound to occur, especially when referring psychiatrists discovered that they had less say in the treatment of their patients than they had reason to expect. Pinel's close association with psychoanalysis, as well as the overlapping of staff with the Northwest Clinic, created problems from the start -- for its workers, its board of directors, and eventually for some patients themselves.
Although the Pinel Foundation had non-profit status it was in essence a business venture, and it appears that there simply was not enough money on hand for the successful outcome that the organizers envisioned. According to newspaper accounts, wives, guilds, and neighborhood groups were cooking and delivering food to the patients, who paid $125 per week for treatment at Pinel.
The UW was intimately involved with Pinel's activities. Medical-school members sat on the board, and because the Pinel facility had gained teaching-hospital status, medical students, nurses, doctors, and aides worked there. Garland Lewis, Pinel's director of nursing, was a UW graduate and a "Menningerite" (a term she coined). UW graduate students in social work, psychology, and nursing earned their degrees in part through experience gained at Pinel.
In addition to working with UW, Pinel's staff provided consultation service to the Seattle Children's Home Society and the Veterans Administration hospital, and an outpatient department and day hospital was established. But there was not enough money to support this sort of venture unless public support was aroused and endowments poured in. The hospital's lofty mission might have been fulfilled had there been less turmoil and internecine conflict, both between ideologues and practitioners and among board members.
Meanwhile, there were patients to treat, and poet and UW professor Theodore Roethke, was one of the earliest. In October 1949 Malcolm Cowley (1898-1989), a visiting professor at the university and friend of Roethke's, wrote to a colleague who had inquired about Roethke's well-being:
"He is in a first-rate sanitarium (The Pinel Foundation), denied visitors, all his letters opened, and everything done to keep him in an atmosphere of tranquility and security. The doctors think (I get all this second hand) that perhaps in two months he will be able to go back to Ann Arbor. They also think they can put him on his feet again without shock treatment, which they are trying to avoid" (Cowley).
About Pinel, Roethke wrote to a friend in January 1950: "The rules here are stricter than a Catholic preparatory school plus a certain chaos attendant to a new wing and all that. Things were brought rather indiscriminately in a big box: a Santa Claus routine for the delayed adolescents if you know what I mean" (Roethke to Heilman).
Roethke was always complaining about expenses, including to Pinel doctors, who apparently took up his cause by protesting the UW's denial of his sick-leave pay. To one correspondent, Roethke wrote:
"Your mail to me will be seen only by Dr. W. D. Horton, who is putting the heat on the University of Washington in his own quiet but by no means ineffectual way. Other doctors who will put on the pressure to see that I get my $689 for January (my salary as sick leave): also $689 for February, so help me: are George S. Allison, and even my arch-enemy, E. S. Hoedmaker [sic.]. So things are beginning to work out ..." (Roethke to Pierce).
There were those, including some who worked at Pinel, who disagreed with its approach. Seattle psychoanalyst Eugene G. Goforth, M.D. (1912-1996), also Menninger-trained, worked at the Northwest Clinic but did not agree with his colleagues when it came to the psychoanalytic treatment of schizophrenics, including those at Pinel. In a 1994 interview, Goforth said he never believed that psychoanalysis could help, much less cure, schizophrenics.
Behavioral psychologist Ole Ivar Lovaas (1927-2010) worked for Pinel in the early 1950s as a psychiatric resident while attending graduate school in psychology at UW. He received his Ph.D. in psychology from the university in 1958 and went on to become a leading UCLA psychologist and an authority on autism and applied behavior analysis. His thoughts about the UW psychology department and its relationship with Pinel are discussed in a recent history of autism:
"Lovaas had long been disillusioned with the Freudian theories he had been taught at the University of Washington. His philosophical break with those theories began when he worked for a time at Seattle's Pinel Foundation Hospital. This was a twenty-bed residence, serving primarily well-connected families, where most of the patients were diagnosed with schizophrenia and were treated with psychoanalysis. Lovaas's main role at Pinel consisted of taking the patients on walks around the grounds to calm them when they became agitated. These walks gave him an opportunity to get to know the patients, and he quickly came to the conclusion that psychoanalysis, though well-intentioned, wasn't doing them any good. One summer, two patients, on different days, committed suicide by diving headfirst from an upstairs window. As Lovaas would tell an interviewer years later ... 'I knew them, and they weren't that crazy'" (Donvan and Zucker, 194-196).
There is a prodigious literature discussing arguments for and against the value of psychoanalysis for treating forms of mental illness or mental upset beyond what is sometimes referred to as "normal neurosis," or chronic worry without the presence of delusions or hallucinations. Lovaas fell on the "con" side of this debate: "Lovaas was disappointed in the absence of data or testing that demonstrated the efficacy of psychoanalytic treatment, and even more so by its almost complete failure to help people with more severe forms of mental illness. He began gravitating toward a radically different approach ..." (Donvan and Zucker, 194-196). That different approach was behaviorism, and Lovaas became known for saying, among other things, "If they can't learn the way we teach, we teach the way they learn" and "I could have raised Hitler to be a nice person" (Coplan).
Changes at the Top
As early as 1952 there was a major staff change at Pinel: Dr. Arthur Marshall, a Menninger-trained psychiatrist, replaced Dr. William Horton (Roethke's analyst) as medical director. Marshall had been a colonel during World War II and served as director of hospitalization in the European theater, after which he filled the same role in the Veteran's Administration. He was a good find for Pinel. He had been clinical director at Winter Veterans Administration Hospital in Topeka, Kansas, had developed the idea of veterans' psychiatric institutions in the United States, and was on the Menninger faculty.
Marshall wanted to expand Pinel's educational program, and he wanted an even closer relationship with the UW medical school. In March 1952 he told The Seattle Times, "I am finding the program already underway a very exciting one which offers the staff a continuous challenge to meet its high standards" ("Pinel Foundation Plans to Expand ...").
Marshall's plans included further training of psychiatrists, psychologists, and social workers, as well as the development of a research program, and he announced other ambitious goals. "In the matter of treatment, we envision a day hospital program to augment our in-patient department, and we hope to develop a child-psychiatry program to parallel our adult-psychiatry work" ("Pinel Foundation Plans to Expand ..."). But Marshall's plans were too extravagant for the small facility, and he left his position at Pinel in 1953.
In June 1953 Dr. J. Brooks Dugan stepped in as acting director, and in March 1954 the foundation announced his appointment as Pinel's full-time medical director. At age 29, Dugan became the youngest person to hold such a position. In accepting the job, he said:
"That such a hospital has been developed in Seattle is a tribute to the city and to the Northwest. This is emphasized by the knowledge that cities of greater age, of greater wealth and of greater psychiatric sophistication have not been successful in producing such hospitals" ("Dr. Dugan, 29, Heads ...").
June 1956 saw the resignation of Dr. Dugan, who stepped down from this role exactly three years after his appointment as acting director. Dr. Stanley W. Jackson followed in the directorship. Two months later, in August 1956, the board of trustees, led by Seattle businessman Norman F. Friese (1908-1994), voted to build a new administration building on Pinel's existing campus. Just two years later, the board would vote to close Pinel.
The Dream Ends
Clearly, factional divisions were at play. One side argued that the hospital needed more space for research activities and additional offices for the professional staff. The Ford Foundation had already agreed to help fund the additions, and individual contributions had been pledged. A well-known Seattle architect, Paul Hayden Kirk (1914-1995), was a member of Pinel's board and was enlisted to draw up detailed specifications for the hospital's new addition. But the dream of becoming the best sanitarium in the nation was ending.
In September 1957 Dr. Robert Hugh Dickinson left his position as psychiatry professor at the University of Chicago School of Medicine to come to Seattle as Pinel's newest director. Upon arrival he enthused, "There are relatively few institutions in the country where the whole staff is so concerned about individual patients as here, and, where the ratio of staff members to patients is as high as here," and the The Seattle Times reported that his vision included an extension of the "training program, greater emphasis on research, closer association with the University of Washington School of Medicine. Emphasis on psychoanalytic treatment will be continued" ("New Director at Pinel ...").
But Dickinson was not unaware of the hospital's financial needs, and he noted that endowed beds would be necessary before part-day or no-cost treatment would be possible. It was unclear where he expected those funds to come from; even with the beds that were paid for, the hospital and its foundation were underfunded.
Dickinson held the job for barely a year. On Friday, October 3, 1958, The Seattle Times reported that a court-appointed attorney, Alex Wiley, would be "permanent receiver" and would control all of Pinel's affairs ("Permanent Pinel Hospital Receiver ..."). Wiley paid employees for their previous week's work, hired guards to watch the premises, and had the last patients moved out. The hospital owed employees $80,000 in back wages.
By the end of the month, Pinel Foundation president John C. Laughlin, a Seattle banker, told the paper that he expected the Pinel Foundation to continue in existence after the property was disposed of, and that its guilds planned to serve as volunteer workers for other mental-health organizations. The building at 2318 Ballinger Way was sold to Associated Lutheran Welfare, and according to the Rev. Luther Jansen, "the property would be used as a home for unmarried mothers" ("Court O.K.s Sale ...").
Arthur L. Kobler, Ph.D., a clinical psychologist at UW, had joined the Pinel staff during the Dugan years and later co-authored, with UW social psychologist Ezra Stotland, Ph.D., two books describing Pinel's rise and fall. The first, The End of Hope: A Social-Clinical Study of Suicide, reviewed the facts and discussed the causes surrounding suicides that took place at Pinel over a period of nine months. The second, Life and Death of a Mental Hospital, described the administrative battles and internecine struggles among the institutional players.
Kobler had served on Pinel's staff as a clinical psychologist, then as chief clinical psychologist, and finally, as director of research. By his own admission, he was too biased to undertake the Pinel studies alone. In both books the identities of the parties involved are masked; fictitious names are used for individuals, Pinel is called "Crest," and Seattle is referred to as "Columbia." But the transcripts of the taped interviews the scholars conducted are housed at UW's Special Collections and available to researchers.
Another important source on the history of the Pinel Foundation is "A Study of the Social Characteristics, Diagnosis, and Disposition of Five Hundred Patients Admitted to Pinel Foundation," a master's thesis submitted in 1953 by Mary Leukel, who worked at Pinel as a psychiatric aide while a graduate student in social work at UW. Leukel credits Dr. Arthur Marshall, medical director of Pinel in 1952 and 1953, "for his permission to use closed files, and for his encouragement and interest in this project" (Leukel, Preface).
It was unfortunate that the Pinel Psychiatric Hospital, which had begun with such good intentions, should implode. No doubt many were profoundly disappointed by this ending. One letter lamenting Pinel's closure came to the The Seattle Times with a $2 donation to help pay the organization's debts. The correspondent wrote: "It isn't much, but possibly if there were enough of us, you'll still be in business" ("Help for Hospital ..."). Unfortunately, it did not do the organization any good, but one hopes that the donation and letter were framed and hang today on some physician's still-existing wall.