RUSH, BENJAMIN (1746-1813)

Rush, the first American psychiatrist, was born in Pennsylvania and graduated from the College of New Jersey (now Princeton). He then went on to receive his medical degree from Edinburgh University. During his distinguished career he became equally eminent in politics and social affairs, chemistry, general medicine, and psychiatry. As a member of the Continental Congress he was one of the signers of the Declaration of Independence. He also took a strong stand against slavery, capital punishment, and excessive use of alcohol, and helped organize the first Negro church in Philadelphia. During the Revolutionary War, Rush served as Physician- General in charge of hospital patients and wrote a pioneer work on mental hygiene entitled “Directions for Preserving the Health of Soldiers.” He also played an active role during a yellow fever epidemic in Philadelphia, employing the drastic technique of bloodletting and mercury intake, on the theory that debilitation would weaken the fever. Although bitterly attacked for both his medical and political views, his reputation grew to such proportions that he became known as the “Hippocrates of Pennsylvania.”During the first twenty years of his professional life, from 1769 to 1789, Rush held the first professorship of chemistry in America, at Dickinson College; but from that point until his death he turned his attention almost entirely to psychiatry. In 1792 he was instrumental in establishing a separate wing of the Pennsylvania Hospital for active treatment and intensive study of the insane, who had previously been confined to basement cells. During the years that followed, he sought to convince his medical colleagues that insanity was a disease that is essentially treatable. In support of his thesis he published a book, Medical Inquiries and Observations Upon the Disease of the Mind, which became a standard authority in America and Europe for the next seventy years.In his general approach to mental illness Rush was well in advance of his associates, but his specific techniques present quite another story. His basic theory was that “the cause of madness is seated primarily in the blood vessels of the brain,” and his treatments were largely aimed at restoring the blood supply to its proper balance. He held, however, that the two major types of disorder, maniacal states and torpid states, require different types of treatment because one is due to an oversupply and the other an undersupply of blood in the brain.Since he believed that people become maniacal if their brains become “overcharged” with blood, Rush recommended the same general type of treatment he had applied to yellow fever. He attempted to relieve the saturation of the blood in the brain by bloodletting to the point of fainting, and produced a state of debility primarily through purges and emetics. These techniques were often combined with other methods of quieting the patient. One of his procedures was to keep him awake and on foot for twenty-four-hour periods so that “the debility thus induced in those muscles would attract morbid excitement from the brain, and thereby relieve the disease.” He also advocated a psychological approach, and sought to calm the patient through kindness. However, if this did not work, he felt it necessary to employ intimidation, just as one would do with an “unruly animal.” He therefore advised the physician to speak to the patient in a stem, authoritarian voice, and if necessary to apply a kind of “shock” treatment by threatening him with death. If these methods also failed he prescribed punishment, such as pouring cold water down the patient’s sleeve, or the use of his “tranquilizer chair.” This was a heavy wooden affair in which the patient was strapped at the chest, abdomen, ankles,and knees, with his head inserted in a wooden box. Rush preferred this method of restraint to the strait jacket because it did not interfere with the bloodletting. He also believed it served a therapeutic purpose in itself by reducing the flow of blood to the patient’s head.Torpid and melancholic states were treated quite differently, since these conditions were attributed to a depletion of blood in the brain. Rush believed that these patients should be handled gently and leniently. Nevertheless, he devised a piece of apparatus that appears to be anything but gentle. He placed his patients in a mechanical cage, or gyrator, which could be rotated with a crank. The object was to drive out the illness by producing vertigo, perspiration, and nausea, and to employ centrifugal force to move the blood back into the brain and thereby stimulate it to normal activity.As these methods indicate, Rush did little if anything to advance psychiatric treatment. Most of the techniques he ijsed were on the level of the European psychiatry of the time. However, he did much to bring mental illness into the general field of medicine by advocating treatment as opposed to incarceration. And the fact that a leading physician of the day devoted himself wholeheartedly to the problem of mental illness was undoubtedly a stimulus to others. In the opinions of many historians these contributions were sufficient to earn him the title of “Father of American psychiatry.”

Cite this page: Nugent, Pam M.S., "RUSH, BENJAMIN (1746-1813)," in, November 28, 2018, (accessed January 20, 2019).