Hollman, Suzanne Nortier; (2020) White’s Restraint and Progressive American Psychiatry at St. Elizabeths Hospital 1903-1937. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This dissertation represents the first systematic study of William Alanson White’s tenure between 1903 and 1937 at The Government Hospital for the Insane, later known as St. Elizabeths Hospital in Washington, D.C. White’s influential position as superintendent of the largest hospital in the United States had a significant impact on the practice of psychiatry, and the solidification of the technique and language of the psychoanalytic method, in the hospital setting. Historians of psychoanalysis have largely neglected this contribution, alternately portraying White as a populist and unoriginal thinker, or neglecting his contribution altogether. White was most widely known as a hospital administrator. This role appears to have obscured a more nuanced view of his personal involvement in the field of psychiatry and psychoanalysis, and also the significant contributions to the evolution of psychiatric practice that can attributed directly to his administrative policies related to the treatment of patients. There has been no methodical study of archival case material and primary sources as it relates specifically to White and his stewardship of St. Elizabeths. I utilize this material to analyze the formative personal, theoretical, and philosophical influences that contributed to White’s view of hospital psychiatry with particular emphasis on the operationalization of psychoanalytic language and practice. I argue that White was a product of the Progressive Era that embodied an optimism in which the principles of the scientific method, and the emphasis on the importance of environmental adaptation, stood alongside the psychoanalytic method. For White, these ideas were not in conflict, and coexisted effortlessly in the inpatient ward. Case notes by treatment teams, as well as White’s personal correspondence and scholarship, support this broader view in which the intrapsychic and the environmental have mutual influence. Optimism in the scientific method did not, however, always dominate White’s narrative. His personal papers also offer a glimpse into the struggles and complexity of overseeing the magnitude of human suffering found in a large hospital, and reveals a more multifaceted, and more personal representation of White’s life and his work. I argue that twentieth-century American psychiatry, and psychoanalysis, was practiced in parallel tributaries, in both the private consulting rooms, but also in the hospital setting. White’s psychiatry, and his views on the analytic method was informed mostly by the challenges and opportunities of the latter, and the excerpts of the lives of patients documented in the National Archives helps to reconstruct a piece of psychiatric history that has been overlooked.

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