RAY, ISAAC (1807—81)

After receiving his medical degree from Bowdoin College in 1827, Ray entered upon a career that was to make him one of the most influential psychiatrists of his time. Energetic and versatile, he became almost equally renowned in Europe and America as an author of over a hundred books and articles, a leader in hospital administration, a pioneer in the study of criminal behavior,and one of the founders of the first psychiatric organization in America.In 1841 Ray was appointed medical superintendent of the State Hospital for the Insane in Augusta, Maine. By 1844 he had achieved sufficient stature to help create the Association of Medical Superintendents of American Institutions for the Insane, which later became the American Psychiatric Association. In 1845 he accepted a position as head of the Butler Hospital in Providence, Rhode Island, one of the most progressive private mental institutions in this country. Within a short time he was commissioned by the trustees to travel to Europe to study architectural innovations in the asylums of Great Britain, France, and Germany. Upon his return he wrote a paper which led to the construction of a new building of advanced design.Some years later Ray collaborated with Thomas Kirkbride in compiling a list of basic tenets for mental hospitals, based on resolutions voted by the Association of Medical Superintendents. These tenets emphasized the evils of overcrowding and unnecessary restraint, and the need for well-built, well-arranged, well-managed, and well-ventilated institutions in which patients would have “abundant means for occupation and amusement.” See KIRKBRIDE, MENTAL HOSPITAL.Ray was a major contributor to the field of forensic psychiatry. He was frequently called upon as an expert witness, and his Treatise on the Medical Jurisprudence of Insanity, written in 1838, was the first book on the subject in the English language, serving as an authoritative text for over fifty years. Among his other works were Mental Hygiene (1863) and Contributions to Mental Pathology (1873), which contained, among other articles, essays on portrayals of insanity by Shakespeare and other writers. His Ideal Character of the Officers of a Hospital for the Insane (1873) delineated the personalitytraits most needed by the head of a mental institution.Ray’s approach was generally an enlightened one. At a time when many others were attributing mental illness to sexual excess, lack of physical hygiene, or even “politics” and “chagrin,” he pointed out that “Many emotions set down as causes, such as religious doubts and anxiety, would often be more justly regarded as its effects.” In spite of the fact that he showed insight of this kind, and was a strong advocate of institutional and legal reform, he did not free himself from belief in the practice of physical restraint which most superintendents considered the backbone of the asylum system. He repeatedly engaged in heated debate on the subject, often advancing emotionally illogical arguments in favor of restraint. It did not seem to occur to him that most patients actually did not need mechanical restraint, as Philippe Pinel in France and William Tuke in England had already shown.Ray’s position on another important issue was more defensible. At the start of the nineteenth century practically all physicians believed that mental illness could rarely if ever be cured, but around 1820 superintendents of asylums began to “prove” their own efficiency by reporting higher and higher rates of recovery. The movement began with a claim of 60 per cent cure by a Dr. Willis, head of a private institution, and before long reports of 80 to 100 per cent recovery rates for “recent cases” were commonplace. Ray was one of the first to question these results, pointing out that no adequate criteria had been set up on what constituted either recovery or recent cases. He also questioned the validity of medical statistics in general, pointing out that some illnesses were periodic, so that one patient could show many recoveries. (Another psychiatrist of the time, Pliny Earle, reported a case where onewoman recovered forty-six times!) This critical approach helped to swing the pendulum back to a more realistic attitude toward curability, and in 1867 a distinguished group of physicians was appointed by the International Congress of Alienists to devise more adequate methods of dealing with psychiatric statistics.