The Country Doctor Who Cured Insanity
John Ferguson lost his own mind before revolutionizing drug therapy in mid-20th century America
“If you’re going to write about my work, you kids’d better know and tell right out what’s been bad about me,” Dr. John (Jack) Ferguson said in the spring of 1956 at the lakeside home of one of Michigan’s most celebrated medical writers, Dr. Paul de Kruif. The 29-acre estate’s wildflower namesake, the Wake Robin, bloomed as intensely as the apéritifs.
Multiple times a day, Jack recited a prayer. He had carried a copy, given to him by his mother, in his wallet for years.
God grant me the serenity
to accept the things I cannot change;
courage to change the things I can;
and wisdom to know the difference.
“Who wrote that?” asked de Kruif, the answer almost certainly loitering behind his needle-sharp stare.
“It’s from the AA’s prayer,” Jack answered, his soft-spoken, nasal reply suggestive of a childhood also spent close to the Great Lakes.
“But you’ve never been an alcoholic.”
“That’s right,” said Jack, his dark eyes shining, “but I’ve been worse.”
In 1941, 33-year-old Jack Ferguson was starting his life over as a second-year medical student at Indiana University Bloomington, 50 miles southwest of Indianapolis. He had left his hometown of Monon, 70 miles southeast of Gary, in 1929 to divide his time between medical school and a job as a fireman on the Monon Railroad, but a dislocated knee, followed by the Great Depression, ensured that the work supporting his education and his family was no longer possible, even if it were available.
He spent the 1930s setting records in insurance sales and bartending at speakeasies; at the end of Prohibition, he worked as a whiskey analyst at a distillery. As a bartender at the Fowler Hotel in Lafayette, a fortuitously-timed whiskey discourse resulted in a liquor sales job allowing him to make the acquaintance of Ralph and Al Capone. But his childhood dream of becoming a family doctor refused to be forgotten. His ex-wife, unsupportive of his decision to return to medical school, moved to California with their daughter.
Jack once again found himself in a bartending position, this time at a campus tavern; Mary Tosti, a 28-year-old cashier, was one of his co-workers. She came from a large Italian family in Bloomington that owned a candy shop. In April of 1940, the census enumerator recorded Mary as a married waitress lodging with a thirtysomething divorcée, the woman’s 11-year-old son, and a truck driver in his 60s. The following June, Mary was granted a divorce.
De Kruif remarked that Mary had a “serious, sad face, hinting a not too happy past.” She, too, may have been looking to start over when she met Jack.
Her gray eyes and slow-breaking smile must’ve been difficult to ignore. Jack, broad-shouldered and youthful, had a proven aptitude for sales, perhaps especially, as de Kruif observed, of himself. Mary and Jack married on Sunday, April 23, 1944 in Bloomington.
Following a full day of teaching anatomy to his fellow students part-time, working in the lab, studying, and even doing odd jobs around campus, Jack’s patrons quaffed brews of celebration and escape from late afternoon until midnight; afterward, he would often study most of the rest of the night, earning nearly perfect grades.
But Mary was concerned. “He hardly ever slept more than three hours a night. I worried it was going to break him, but I couldn’t calm him,” she recalled. When Jack failed to show up for dinner, he’d call to apologize and tell Mary that he would catch the next bus.
“When I asked him why, he’d only say: ‘Because I’m a damn fool, I guess.’ But he was good-natured and always kind to me then.”
In May of 1945, wartime shortages of everything from beef to nurses ravaged cities like Indianapolis. A returning soldier’s creative response to the severe housing shortage was to live in a fox hole he had dug in his backyard. Now studying in Indianapolis, Jack was forced to commute on weekends to Bloomington.
We can only wonder if Jack broke out in a cold sweat or experienced chest pain or pressure before the coronary heart attack that left doctors and Mary doubting that he would survive. Sequestered in the hospital for seven weeks, fear of another heart attack and anguish over his lost semester converged to blacken his worldview.
For anxiety and insomnia, his doctors prescribed Nembutal (pentobarbital sodium), a barbiturate, the abuse potential of which was beginning to get attention in popular media. One month earlier, Dr. William Brady warned in his Health and Hygiene column, appearing in The Indianapolis News, that chronic use could result in a number of deleterious consequences, including loss of judgment, ideas of persecution or neglect, depression, and fatal overdose.
Jack boarded the bus, probably with a lungful of late summer humidity laced with the acrid sting of diesel exhaust. Puerile chewing gum and milk advertisements clashed with the stern-looking commuters beneath; most faced forward, some toward the center, and still others stood in the aisle with one hand clasped to a metal bar.
The pushing, the shoving. Jack began to shake. He didn’t have the little yellow capsules.
Was he having another heart attack? Would this be the one that killed him? If he survived, he could forget finishing medical school.
Jack could stand it no longer — he got off the bus. He’d hitchhike to Bloomington.
A car pulled over, its driver’s intoxication apparently imperceptible.
The doctor who responded to the crash was the one, just an hour earlier at his check-up, who had informed Jack that his heart was fine.
“I’ll never forget the expression of the ambulance doctor when he helped lift me out of the wreck and wiped the blood off my face and recognized me.
“‘My God, Ferguson, what you doin’ here?’”
His arm in a sling, Jack began teaching surgical anatomy and biochemistry. Would his heart fail him again? He needed more and more of the little yellow capsules to surmount his anxiety. Mary convinced him to quit, but he began to sleep less and less until he wasn’t sleeping at all. To rest, Jack turned to the capsules; when he needed to be alert, he would counteract their depressive effects with coffee or Benzedrine.
On a rare free evening, Jack and two of his classmates stepped into a tavern with only 35 cents among the three of them. Possibly with mixed feelings about being on the other side of the bar, Jack grabbed a pencil and a piece of paper and drew a caricature of the bartender.
“Is that worth beers for the three of us?” he asked with a smile.
All customers that night received a sketch bearing their resemblance, and Jack and his classmates drank all the beer they could handle. At closing time, the bartender drove them home, the 35 cents still in their possession.
Jack graduated from medical school in June of 1948. A one-year internship was the only thing standing between him and his dream of practicing medicine in Indiana.
Befogged by Nembutal, Jack fell one night on his way to the bathroom, separating his collarbone. Mary wasn’t home, and he was too confused to call a doctor. To dull the pain, he took more Nembutal, then codeine. The next morning, he somehow made it to the hospital and convinced a friend to obtain 25 more little yellow capsules; quickly, his new supply was depleted, plunging him into acute barbiturate withdrawal psychosis.
Jack hallucinated. He was delusional. He believed that Mary was undergoing surgery in the room next to his, and the doctors said she was dying. He was explaining, midair, to Jack Benny and one of his doctors how to place Indianapolis under their control.
“Where are your diamond rings and bracelets?” he demanded, but Mary didn’t own any jewelry.
When Jack threatened to kill an intern, he was transferred to the hospital’s BB ward, more colloquially known as the “bull pen” or the “snake pit.”
An iron door slammed, locking him in with other disturbed psychotics.
Jack was allowed to resume his internship, as long as he stayed sober.
Dr. David McKinley, medical director of Indiana University Medical Center, said, “We believed in you, and knew you’d make it. We didn’t know just when. You don’t know how happy we are — all of us.”
“I was so nervous I couldn’t light a cigarette. I got the okay to go back to work but I couldn’t without the capsules,” Jack remembered.
No one knew that Jack continued to take Nembutal; he swallowed just enough that his behavior seemed perfectly normal — as long as he didn’t take too many.
In June of 1949, Jack was licensed to practice medicine in the state of Indiana.
Hamlet, 30 miles southwest of South Bend, had a population of about 500. The citizens enthusiastically loaned Jack $12,000 (around $130,000 today), built him an office, and bought him a car. Immediately, the inflow of patients began. Mary served as his receptionist, janitor, bookkeeper, and nurse in emergencies.
Jack drove 20 miles to La Porte to perform operations in the early morning, returned for office hours, ate at his desk at noon, made house calls, and typically ended his day at 4:00 a.m. the next morning. No matter how exhausted, he would come when called. Patients began to travel from up to 50 miles away.
The bond between Jack and his adopted village flourished: he used his borrowed funds, and then some, to purchase the most modern lab equipment and medications available. In the summer, he could trip over the fresh produce from surrounding farms; in the fall, cuts of meat overflowed his freezer. Within his first year, Jack’s old Plymouth had been upgraded to a Lincoln, and he was repaying his debts to the Hamlet residents, the equipment companies, and the pharmaceutical houses.
“The first sign Jack was back on barbiturates,” Mary recalled, “was his speech getting a little thick and he’d stumble.” The patients noticed it, too, but they didn’t think he was drinking — perhaps just overdoing it; after all, he only slept two hours a night.
Ohio, Michigan, and Illinois license plates began to appear outside of Jack’s office. “I couldn’t say no, that was my downfall,” Jack said. “I fretted, I worried, I took pills and capsules, then more pills — to sleep, to run away from this foolishness, pills and capsules for no reason at all, more and more of them.”
Repeatedly, Jack would stop and emerge clear headed; why did he keep going back?
In my last medical school years I had lost the Ferguson that wanted to be a country doctor, that wanted to treat people as well as their diseases.
He was making too much money; the antibiotics were saving lives, not him.
I was the product of self-generated false ideas of grandeur. I was THE doctor.
Shots and pills were dispensed on the assembly line that was his practice before he really knew what was wrong with a patient.
I was above the multitude…They could come to me.
Too much of his time was taken by women who liked his smile but lacked a valid medical complaint.
To keep up this front, each time my conscience slipped through I’d take barbiturates until my conscience could no longer be heard.
Why couldn’t he find a drug better than calcium gluconate for his arthritis sufferers?
Though still vitally interested in the human side of medicine, money and power were now my guiding lights.
In July of 1950, Jack was carried into a locked ward of the Indianapolis Veterans Administration hospital, a stately four-story building whose visage could warm a college campus or even a postcard. By August of 1951, he had negotiated the checkerboard tile hallways as a barbiturate psychotic three times, requiring progressively longer stays before returning to his practice.
Dr. Bernard Frazin begged Jack to stay and try psychotherapy, but he refused.
He’d handle it on his own.
Frazin also suggested that he opt for a job “in a more sheltered environment.” Jack knew what he meant — in one of the “loony bins” like the one in which he was confined. No way; he was a great country doctor, and he’d prove it.
One night, Jack received a call from a patient about a half hour away. In a thick voice, he replied that he’d be there. He changed his clothes, stumbled out to his car, opened the door, and fell into the mud. Mary required the assistance of two neighbors to carry Jack into the house.
“I was so humiliated, but the Hamlet people were wonderful. They loved Jack and knew he was sick and forgave him everything,” Mary said.
Jack decided that his fatigue wasn’t caused by his inability to say no or to sleep; his fits of depression weren’t triggered by Nembutal; his manic spells weren’t the fault of the caffeine he used to drive away the despair. Jack decided that Mary was the cause of his problems.
He kicked her out; too ashamed to go to a neighbor, she spent the night in the car. Through tears the next day, he asked for her forgiveness and actually stopped the pills and went back to work. Until he decided that Mary should die.
“You have felt Mary’s devotion, her humbleness through all this,” Jack said. “I thanked her by loading her up on barbiturates…more and more…when she was dying, I came to, and for the first time in months I was a doctor.”
Jack pushed a needle through her skin and into a vein; a stimulant — probably caffeine — flowed in and saved her life.
Jack’s sobriety lasted throughout her recovery.
Lying on the floor, Jack saw the world as if through a kaleidoscope: brightly-colored, spinning fragments, a new picture developing with every movement of his head. Suddenly, the colorful designs were covered in hair. Jack got to his feet, but the room was full of chairs, blocking his exit.
He called for Mary, her voice distant; she eventually succeeded in getting him to bed, but every time he closed his eyes, the Technicolor phantasmagoria returned, sprouted hair, and was followed by more chairs.
It seemed that there wasn’t enough Nembutal in the world to kill him; Jack could add suicide to his list of failures.
“We’ll give him one more chance if you’ll co-operate,” Frazin said to Mary. “You’re not to see him, try to phone him, or even write to him for six months.”
Once again in the VA hospital’s locked ward, Jack was convinced he’d never leave. Scruffy and tear-stained, a simple glance from another person during group therapy would set off fresh tears.
“This time I’d lost all respect for my ability, long after I’d been dried out. I had the personality of a dead fish.”
Jack was thought to be a good candidate for electro-shock treatment, but Frazin disagreed, saying that if he were psychotic, he wouldn’t want it for himself. This kindness slowly began to make an impression on Jack. Griff and Terry, his attendants, treated him like a human being as they helped him to bathe and dress.
Once again, Frazin suggested that Jack speak with a psychiatrist.
“This time I was cornered. I had nothing but Mary and she just about had her fill of my abnormal behavior. There was no way to go but up, I couldn’t sink any lower.”
One of Jack’s doctors gave him a copy of Psychological Types, a book by Swiss psychiatrist Dr. Carl Gustav Jung, who taught that modern man essentially went crazy as a result of the vexing search for his soul.
“What it is or how it happened I’ll never understand, but at this point a power — greater than I — took over,” Jack explained.
“You mean God took over,” de Kruif asked, “the way He does for the alcoholics anonymous? Does Dr. Jung speak of God in his book? Does he think God, a faith in God, may help the kind of hopeless, beat-up mad monster you say you were?”
“Oh yes, Jung recommends it,” Jack replied.
“Toward the end of that six months,” Mary recalled, “Jack tried to phone me where I was living, in Marion, Indiana. He didn’t have any money and tried to phone me collect and it nearly killed me to refuse those calls.”
With a clear view of the destruction he had wrought, Jack simply wanted to tell Mary that he was ready to start over. The former Jack Ferguson was gone.
Like an epistolary hot potato, there the letter sat. A billet-doux it was not. Why else would Jack tell Mary not to read it?
Once opened, she discovered the bombshell within. Jack had asked if, considering his actions, Mary thought she should divorce him.
Mary called Dr. Frazin, who had been updating her regularly on Jack’s progress; he had become increasingly encouraged. “Do you think I should divorce Jack?”
“God damn it, do you want to kill him?” Frazin exploded. “He’d kill himself if you did that. He thinks of you and talks about you all the time. He’d’ve been dead long ago if it weren’t for you. I’m hoping he’ll really be cured. Hang on!”
“I left the hospital to go into psychiatry, as I knew it was the only way to save my life,” Jack explained. “As others gave me a helping hand, I in turn must be only a servant.”
“I’ll kill you! I’ll kill you!” screamed 24-year-old H. B.
After murdering a fellow patient at Evansville State Hospital along the Ohio River, he was transferred to the Hospital for Insane Criminals on the south shore of Lake Michigan; labeled “homicidal,” he was sent about 80 miles to the southeast and admitted to Logansport State Hospital on July 28, 1952, where Jack was employed as a resident psychiatrist.
Surrounded by six or more physicians and surgeons rendered indistinguishable by their stark white surgical caps, masks, and gowns on August 14, a standard prefrontal lobotomy was performed, transforming H. B. into a “good” and “cooperative” patient. Later that same month, he was sent back to Evansville State Hospital to be closer to his mother. He was last known as a “nice, quiet man on work parole” on the hospital grounds.
A neurologist by the name of Walter Freeman had developed the transorbital lobotomy, an adaptation of a technique conceived by Italian surgeon A. M. Fiamberti, which required just ten minutes to complete.
Alone in the ground level morgue, Jack was again working into the night, practicing on the deceased what he hoped would bring sanity to the living.
He reached for the transorbital leucotome, a little over eight and a half inches of cold steel from the top of its curved handle to its beveled point. The lids of one of the cadaver’s eyes held open with an eye retractor, Jack positioned the instrument against the roof of the eye socket, parallel with the nose, and, probably using a mallet, drove it through the delicate bone until the five centimeter mark met the edge of the upper eyelid.
He moved the handle until it almost touched the outer corner of the eye, producing a sound not unlike the tearing of a sheet. He returned it to its original position before advancing it to the seven centimeter mark, the most commonly used depth, according to Freeman.
Again, he moved the handle toward the outside of the head, this time 10–15 degrees, upward until it couldn’t go any farther, then back to parallel with the nose. Next, the handle moved toward the nose, almost touching it before being elevated as far as possible, going back to the middle, and then moving down as far as it would go. Jack moved the handle from side to side, 10–15 degrees each way, before removing it, likely repeating the process through the other eye.
Jack perfected Freeman’s procedure, modifying the transorbital lobotomy so it could be performed in just three minutes.
“He was a tall man with a mustache and a little goatee. He was a pipe smoker, dignified, very quiet and reserved. You had to come to him,” Jack recalled of their meeting at a neurological society meeting in Chicago. “But he was easy on the smile and interested in how I had modified his transorbital. Only he warned me about being too enthusiastic, too soon.”
“Come and see me again, sonny, when you’ve done a thousand,” Freeman said.
Jack wouldn’t have the chance. By 1954, he and his team had performed over 400 lobotomies at Logansport State Hospital, his modified technique bringing sanity to the most “far gone” patients when standard lobotomies (and myriad other treatments) had failed. Jack hadn’t received a dime, but the consultants on his team were collecting fees in excess of the hospital superintendent’s annual salary. Considering this to be unfair, the superintendent put an end to the program.
Jack had vigorously confirmed Freeman’s observation that lobotomy took something irretrievable in exchange for liberation from mental anguish. “It was queer, [patients] couldn’t seem to finesse; they couldn’t plan ahead,” he recalled.
Each sweep severed the connections between the frontal lobes and the thalamus, essentially separating the area responsible for emotions from the portion governing higher functions, such as imagination and foresight.
De Kruif wrote, “Amputating emotions it amputates initiative and the brain power basic to creative work. To this hazard Walter Freeman noted one or two rare exceptions; and while the lobotomy had returned hundreds of mechanics, clerks, and other routine workers to full employment, it had never rehabilitated a doctor to his practice or a writer to his art or a scientific man to his research.”
Look what I’ve escaped, Jack thought.
“At this very time,” Jack remembered, “we were beginning to hear rumblings of a new drug, Rauwolfia. I read how a Dr. Wilkins of Boston said it was psychotherapy in pill form.”
Unlike sedatives, such as barbiturates, Rauwolfia was a tranquilizer; it was basically a reversible lobotomy. Chemically known as reserpine, its trade name was Serpasil.
“We found these Serpasils worked better than lobotomies on disturbed patients,” Jack said.
How did they know this so quickly?
“Well, you see, in the hospital we had quite a number of patients who hadn’t got any better, despite their lobotomy. We put those lobotomy failures on Serpasil and it calmed them down, and damn if some of them didn’t get so much better we could send them home.”
In addition to hundreds of post-lobotomy patients, Jack cared for the chronic and the disturbed, some so intractable that they were, as he put it, “the bottom of the barrel.” In the T-shaped wards, iron bars stood between the ends of the T and the center portion.
“I felt those patients should be treated more like humans, so I took down those grilles,” Jack said.
“All the attendants petitioned the head man saying they’d quit unless I was taken off the service and the grilles replaced.” Jack was called into the superintendent’s office. He’d apologize to the attendants, or else.
“I apologized to each attendant, but I also succeeded in getting every one of them to go along with me on leaving down the grilles…just for a trial.”
Soon, the equivalent of an entire ward behaved well enough to eat dinner in the main dining room. This was unprecedented.
“As it came time for them to leave the wards for the dining room, it was Ferguson and his attendants against the whole hospital. It was like walking the last mile. It was the first time in years for many of the patients.
“I saw something wonderful,” Jack continued, “The attendants, who’d wanted me fired, had stationed themselves all along the route.
“It was the first evidence of real progress. I saw a new hope that the hopelessly mentally ill could be helped. Why? I’d had to work myself out from behind the same type of iron doors. I knew they could do it too. With help as I’d been helped.”
Jack was frustrated. The wrong types of patients were being scheduled for the small number of lobotomies still permitted at Logansport. The Serpasil was gone, and there was no money to obtain more.
But he didn’t even consider the little yellow capsules. Instead, he started looking for another place to continue his lobotomy-Serpasil program followed by something utterly unscientific: the humane treatment — the “tender loving care” — whose phenomena he had witnessed firsthand in himself and others.
In September of 1954, Jack obtained a residency a few hundred miles north at Traverse City State Hospital.
“The first time Mary and I went to Traverse City, we drove round the hospital grounds,” recalled Jack.
From US 31, they would’ve turned left onto West Eleventh Street, a two-lane road that eventually became Silver Drive, one of many smaller streets framing and radiating from the hospital campus, including its men’s and women’s cottages and numerous outbuildings. Building 50, one thousand feet in length, was old but well maintained, its rusticated stone foundation, Italianate cornice brackets, and Gothic spires typical of its Victorian provenance.
“A crew of patients was working on the lawn, and we watched them, they not seeing us. First one and then another would do something wrong, or fail to do something right. It was curious the way their attendant went to each one, not bawling him out. Just helping him. As if each one was human.”
Dr. Sheets, the superintendent, informed Jack that there was no money in the budget for Serpasil or Thorazine, the new medicines, but there were hundreds of hopeless patients to evaluate as candidates for lobotomy.
“While I was screening Traverse City State Hospital patients to see if lobotomy might help them, and while I was waiting for lobotomy equipment to come, I found a small supply of Serpasil and Thorazine in the hospital pharmacy.
“Then I found each staff member had a supply of samples. I conned each one of them and then I began getting refills from CIBA [Pharmaceutical Products] and SKF [Smith, Kline & French] detail men. And I was in business.” Jack smiled.
In the autumn of 1954, 500 of the 1,003 “incurably insane” women under Jack’s care began to receive Serpasil three times a day from his 107 nurse attendants, who recorded daily and even hourly behavioral changes after each dose. Spontaneous recovery was believed to be impossible for these patients, so any improvement would be attributed to Serpasil.
Serenity mercifully took the place of hallucinations and delusions, but, within a few months, a peculiar type of lethargy developed: patients could be awakened easily, but they would go right back to sleep. Hoping it was temporary, Jack kept some on Serpasil, but they drifted into a depression followed by Parkinsonian trembling. Some attempted suicide.
Unsuccessfully, Jack tried numerous substances to counteract these effects: coffee, pure caffeine, amphetamines, and more. Then CIBA’s Dr. Frank Mohr came to visit.
Mohr had come to see Dr. William Funderburk, Traverse City State Hospital’s research pharmacologist. He wanted to show him a video starring a couple of rhesus macaques.
Funderburk introduced Jack to Mohr, and the three watched as the need for scratch- and bite-proof equipment vanished; an animal known for its ferocity was transformed by Serpasil into a peaceful, attentive creature that cuddled like a lapdog. It even tolerated being tossed into the air!
Just imagine the possibilities in humans.
With an apologetic smile, Jack showed Mohr the behavior profiles of his patients. He described lucidity inevitably followed by jerking hand movements, drooling, and depression.
Mohr’s gray eyes watched Jack. What could CIBA do?
Along with an unlimited supply of Serpasil, CIBA sent Jack two compounds: one was BA-14469 (desoxypipradrol). Jack gave it to several catatonic schizophrenics.
“BA-14469 took ’em up off the floor, all right, but next thing we knew we were picking ’em off the ceiling,” Jack recalled.
More than a week after their last dose, two began twitching and jerking uncontrollably. “Man I was worried. I could see deaths, disgrace, lawsuits,” Jack said.
Then there was BA-4311 (methylphenidate). It was so relatively unimpressive that CIBA didn’t think it had much of a future, although they had named it Ritalin.
In 1948, Ritalin was produced in Basel, Switzerland. It had invigorated dogs and rats and other lab animals, and fatigue after increased activity seemed to be the only side effect.
At the time, Jack was aware of only one experiment on human beings: CIBA scientists had given phenobarbital to a group of volunteers to cause them to fail at basic math. But when Ritalin was given along with the phenobarbital, they were once again able to complete the calculations.
“I couldn’t believe it. There she was, sitting in a chair. It’s something to be sitting in a chair when you’ve been lying on the floor for years,” Jack observed of a patient who had been taking Ritalin. Two months later, this same patient was feeding herself, going to the restroom unaided, dressing with just a little assistance, and even going to the movies.
A patient who had tied her dresses into knots for years had stopped. Others stood up from their chairs or joined the line for the dining room. Some wanted to shake Jack’s hand.
For those depressed by Serpasil, Jack added Ritalin. It chased away the blues without touching the calming effect of Serpasil.
“It seemed like a mental awakening, an awakening toward reality,” Jack said.
On February 3, 1955, Jack approached the arched oak door of the former Woolworth Mansion at 2 East 63rd Street in New York City. Stepping onto the black and gold Italian marble of the main hall, he may have felt a bit apprehensive, but more than likely quite proud, now that he would be more than a mere observer during this two-day conference of the New York Academy of Sciences titled Reserpine in the Treatment of Neuropsychiatric, Neurological, and Related Clinical Problems.
The day before the conference, snow fell as Jack met with Mohr’s colleague and conference co-chairman, Dr. Fritz Yonkman, and his staff at CIBA headquarters in Summit, New Jersey.
“I showed them our records. Here was the lowdown — Ritalin eliminates the stuffy nose and the drooling and the shakes and the deep blues resulting from Serpasil. Especially when you’re using Serpasil in big doses long enough to tranquilize the chronic, agitated mentally ill,” Jack said.
If CIBA wanted private practitioners to prescribe Serpasil, the blues and the shakes had to be eliminated.
Jack was asked to share his story during an informal discussion period. “He meant with no holds barred,” Jack recalled. “I had to admire Dr. Yonkman’s courage to make such a tough decision.”
Bellevue Medical Center…Rockland State Hospital…The Institute of Living…University of Zurich…as Jack reviewed the conference agenda, he must’ve realized that 30 practitioners representing some of the world’s leading medical schools, hospitals, and pharmaceutical companies would be looking expectantly — eagerly — at him, Serpasil’s harshest critic.
Afterward, they asked for his manuscript. With a smile, Jack replied that he had only his clinic notes and a lot of ideas. At first, he’d been invited simply to listen.
Lobster Thermidor awaited Jack as he huddled with a CIBA staffer, Mr. Harris, in the annex to the banquet room, assembling his article. “Treatment of Reserpine-Induced Depression with a New Analeptic: Phenidylate” appeared in the Annals of the New York Academy of Sciences in April of 1955.
Gudrum was 71 years old in the autumn of 1955. She had been a patient at Traverse City State Hospital for 52 years.
She had arrived good-natured but delusional, asking her doctor to marry her. Over time, her mental condition worsened; in 1921, she was categorized as “destructive, denudative, incontinent, mute, a feeding problem and a troublemaker.” No treatments were available for such a patient, so she spent most of her time sedated in a seclusion room.
In 1942, Gudrum received 28 metrazol shock treatments (“like grand mal epilepsy, only worse,” according to de Kruif) with no lasting effects. The following year, she was given neural pack treatments during which she was tightly bound and dipped in cold water; these were found to be ineffective and were stopped after 420 attempts.
Also in 1943, she underwent 68 courses of electroshock therapy. Yet she remained bellicose and naked until 1954 when, on Christmas Day, she began to receive half a milligram of Serpasil crushed up into her breakfast, lunch, and dinner.
By January 13 of the following year, she kept her clothes on for the first time in three decades.
Predictably, continued use of Serpasil caused the Serpasil blues; Ritalin corrected this quickly, but her aggression returned. Ritalin was stopped, Serpasil was increased, and she became depressed again. This time, after Serpasil was withdrawn and Ritalin was given again, Jack added a little Serpasil as the blues disappeared, but before she could become manic on Ritalin alone.
Finally, in April of 1955, a prescription had been found that worked: three milligrams of Serpasil and 15 milligrams of Ritalin three times a day. Gudrum could go for walks along Grand Traverse Bay, and she could buy knickknacks at the hospital canteen. In July, she was transferred to a semi-open ward, and she ate in the main dining room.
“Gudrum needed almost no help except to be reminded to keep her shoes on,” said her nurse attendant.
Gudrum hadn’t worn shoes in 30 years, and she hadn’t been off the disturbed ward in over half a century. She was so greatly improved that the medication was stopped.
“But we put her back on it on a lower dose to check a mischievous streak that was starting,” Jack explained. “Gudrum cannot be called mentally well, but we are sure she is enjoying life for the first time in many years.”
She was well enough to go home, but the last letter from a relative was dated 1907; she had no home to return to and no known relationships outside of Traverse City State Hospital.
When Jack presented at the Midwest Research Conference of the American Psychiatric Association concerning his Serpasil-Ritalin combination, the psychiatric world wasn’t intrigued by the novel merger of the two medications, although this was notable owing to the comparative gentleness of both. The patients’ abject prognoses were what had them paying attention.
“The combination of Serpasil and Ritalin has brought new life to our institution and may be instrumental in changing our hospital from a custodial home to a communal treatment center,” Jack reported.
Not so long ago, Traverse City State Hospital had a long waiting list for admissions; now, over 100 of its 3,000 beds were empty.
By the autumn of 1955, 16 clinical investigators had confirmed Jack’s original observation of Ritalin’s potential.
A catatonic patient was brought into a staff meeting. Despite having been subjected to every treatment available, he had been mute for months.
“This patient doesn’t need tranquilizing medicine. At least not now. He’s too tranquil right now. Why not try waking him up with Ritalin?” Jack asked.
I’ve had no luck with Ritalin in tablet form, taunted one of the doctors. Surely you’re overrating it.
Calmly, Jack asked, “Gentlemen, would you mind my showing you, right here, right now, what Ritalin can do for this patient?”
Jack turned to Dr. Frank Linn, one of the young residents, and asked him to bring a syringe and 10 milligrams of injectable Ritalin.
Linn depressed the plunger, and the solution traveled into the man’s arm. Within five minutes, he was alert and answering questions coherently. Some of Jack’s colleagues sat red faced.
“What am I, compared to these nurse attendants? I’m nothing. All I’ve done is give them the new medicines to give their patients. And then they give the patients the love without which the medicines would be nothing,” Jack said, smiling.
Over 150 patients had been sent home or to their families, and another several hundred were ready. Jack estimated that he could send about half of his “incurable” patients home, but many of them didn’t have homes.
Meanwhile, his fellow physicians were ratcheting up the pressure; Traverse City State Hospital was developing a reputation for its ability to salvage the most abysmal cases, which meant that more abysmal cases were being sent their way, creating much more work in the admitting ward.
Jack was told to stop it, or else.
In the early summer of 1957, Jack sat at his desk, on top of which rested a veritable pyramid of accordion files, loose pages, and envelopes bearing exotic postage and markings. Slightly hunched forward, two pens clipped to the pocket of his button-down shirt, Jack gazed downward as he listened carefully to Ilse Adler, who was seated next to him, translating a letter Jack had received from a German doctor describing his work.
Her matching necklace and earrings — large, flat beads made of Venetian glass or Thermoset plastic — might today be called “vintage”; at the time, their boldness stood in contrast to the somberness of the preceding decade. A loopy bow adorned the sleeve of her white t-shirt, belying her severe, yet pretty, expression.
The doctor had written in response to Licht feur die Umnachteten (“Light for the Ones in Night”), the German translation of the Reader’s Digest condensed version of de Kruif’s book.
Over 2,000 letters would arrive from every US state, Canada, Mexico, Norway, Israel, Italy, and elsewhere. About 10 per day implored diagnosis or admittance for the writers themselves or their loved ones; some sent money for the patients’ benefit fund. Jack had more speaking requests than he could possibly entertain, and people he’d never heard of were proclaiming their kinship.
One day, over 100 pleas to be admitted found their way to Jack. Even if he could only offer a referral to a family doctor, he responded to them all.
The previous year, Jack had only six or seven drugs to give his patients; now, he had about 40. Pharmaceutical companies sent $200,000 worth of drugs free of charge and $30,000 in cash for the patients (around $1.8 million and $270,000 today, respectively).
“We used some benefit fund money for colored Easter eggs, chocolate rabbits and candy eggs,” Jack recalled. “The patients made their own Easter baskets by stapling wallpaper samples into Easter baskets and had a happy time doing it.”
The money also purchased parakeets, curtains, magazines, and record players, among other niceties unheard of in other state hospitals.
“If we can give the patients something to do — something to attract their interest — then we can treat them successfully. But all the drugs in the world aren’t any good unless they’re administered with human kindness.”
“To me, a psychiatrist is not a man who simply knows big words or directs the lives of others. He is a man who admits his own limitations. He is a man that can temper his judgment of a bad act with a form of charity. This gives mixed-up people an understanding that will cast out fear. I’d like to get to be that kind of man.
“I don’t feel we have the answer to insanity all wrapped up in one package,” Jack continued. “And I do feel all therapeutic measures are usable. No one approach can handle all cases.
“Mental illness is like pain. Some pains can be stopped with pills. Others by putting the patient at rest. Others by reassurance. Others by removing the pain producer. So it is with mental illness — it’s an anguish of the mind.”
Jack sat on the hardwood floor in Hall Eleven, the one remaining disturbed ward at Traverse City State Hospital, his arm around a drooling, unresponsive woman, a maneuver likely made more difficult by the weight in the pockets of his beige sport coat: dimes on one side and mints on the other, future gifts for patients he’d encounter on his ward rounds.
“I’ve had to fight my way out of a ward like this. I had to go back four times before I came out okay. I had to go back because I wouldn’t listen to the doctors. Please open your mouth and let the nurse give you this new medicine. I’m still taking my own medicine. You know what it is, Jean?” he whispered.
“You know what’s my medicine, Jean? It’s helping you to come back the way I came back.”
“Doctor, you never were locked up in a place like this?” some would ask, once the medicines had begun to work.
“Yes, five times in a place like this, and worse,” Jack answers.
“So I look at my patients. I look at them and I think that if, here standing before me, was a very important person that could do me some good, it would be very easy for me to spend the time learning his language.
“But this patient, this poor woman cannot help me. What would I want if our positions were reversed?” Jack asked.
After just three or four hours of sleep, Jack was alone but surrounded by his article drafts and chemical structural formulas, hand-hewn in his left-handed, back-sloping style. He was toying with a new puzzle.
“I ask you in all sincerity, what are we going to do to help grandma and grandpa and poor old Aunt Mary?”
Jack would set out to create “a much better world in which to grow old.”
“The patients we like to get from the receiving ward are the ones whose charts carry notations like this — prognosis poor…recommend custodial care…typical degenerated old senile…
“Boy, those are the ones we sink our teeth into. We don’t like that word ‘incurable.’”
Sally Ann, 70, was diagnosed with senile psychosis. She needed assistance with the most basic of needs, she wandered at night, and she had been transferred from ward to ward.
Serpasil sent her into a depression; Ritalin caused her to climb the walls. Her nurse attendants adjusted the doses of both, and she began a gradual, monthslong recovery. Ultimately, she took herself to the bathroom and dressed without assistance. She was caught looking in a mirror.
“For the first time in years, she knows me,” said a family member.
One day, Sally Ann got a perm.
“That was a turning point,” Jack said. “She ate up the compliments.”
Eventually, Sally Ann went home to her family, continuing to take small doses of Serpasil and Ritalin three times a day. The nurses, the medicines, and the support of her family seemed to have reclaimed her lost mind.
In the years following de Kruif’s book, Jack continued to make headlines, although in less conspicuous ways: he posed for a photo with the candy and wrapping paper donated for Mother’s Day in 1958; he helped to establish the first Boy Scout troop ever formed at a state hospital in 1962; and he assisted in bringing a sheltered workshop program, intended to return patients to their communities, to the institution in 1967.
On Friday, March 1, 1968, the fire alarm sounded at Traverse City State Hospital.
Almost two decades earlier, a repairman cast a cigarette into one of the ventilating spires of Building 50, igniting paper and other combustible debris. Malfunctioning systems frustrated all attempts to pinpoint the fire while the smoke continued to rise and patients on the locked wards of the upper floors cried out from the windows. Extinguishment of that fire had required the efforts of hospital and city fire departments, and this one would probably be no different.
Jack, director of the geriatrics program, was helping to direct traffic at the tree-lined intersection of Eleventh and US 31 on this freezing, overcast day, just steps from his house at 730 West Eleventh.
We can only wonder if Jack broke out in a cold sweat or experienced chest pain or pressure before he collapsed. This heart attack would claim his life before he reached Munson Medical Center, not even a mile away.
Mary T. Ferguson passed away at the age of 75 on the cold, foggy evening of Sunday, March 13, 1988 at Munson Medical Center, just one month after the Michigan Department of Mental Health announced the closure of Traverse City Regional Psychiatric Hospital, the institution’s most recent appellation in its 103 years of operation.
Three days later, no sunlight brightened the stained glass windows as Mary’s funeral services began at All Faiths Chapel, built with community donations on the grounds of the state hospital a decade after Jack and Mary’s arrival in Traverse City.
Author’s Note
This article was made possible by Paul de Kruif’s A Man Against Insanity, long out of print but recently rereleased by Mission Point Press. Without it, the obituaries, articles, and other material created by and about Jack would prompt even more answerless questions than currently exist.
It was Serpasil that facilitated the meeting of Jack and de Kruif. After beginning to take Serpasil in 1954, de Kruif experienced what he described as a “slow revolution”: impatience and unrest were replaced by an ineffable imperturbability. By mid-1955, however, de Kruif was on his second Serpasil depression. Dr. Yonkman, a mutual acquaintance, suggested Jack as someone who might have an answer.
This story isn’t about de Kruif, but I find it interesting to consider why he decided to write about Jack. In many ways, Jack was de Kruif’s opposite. Jack’s conscience could only be quelled by Nembutal, but de Kruif’s remained elusive despite deliberate searching. Jack’s apparent secret in the practice of medicine was “tender, loving care,” while de Kruif revealed in his memoir that he chose bacteriology over medicine “partly because there was not the love in [him] that’s the driving force in good doctors.” Jack had not only successfully entered but also flourished in medicine, which was the profession de Kruif had sharply criticized for its ineptitude in some of his earliest writing. De Kruif had commented that those working in state hospitals may be doing so to make expiations; I wonder if A Man Against Insanity, his penultimate book, was in some way expiatory for de Kruif.
Why did I feel compelled to write about Jack? Was it his refusal to give up on his dream? Was it his exceptional vulnerability? Was it the fact that his untimely death was brought about by the event whose prospective occurrence was at least a contributing factor in his struggle with addiction decades earlier? Was it the lesson in humility that his story undeniably radiates? Was it my determination not to allow his achievements to be permanently buried under succeeding decades of newer therapies, medications, and attitudes? A little of all of these is the likely answer.
A question I’d love to see considered is what Jack might think of the current state of mental health care. He envisioned a world in which state hospitals would be largely replaced by community treatment centers; he also hoped for interception of mental illness and prevention of institutionalization through early intervention by family practitioners.
Other indispensable resources include Newspapers.com, Ancestry.com, and those that couldn’t have been consulted without the expert help of the librarians and archivists of Logansport State Hospital, the Monroe County (Indiana) Public Library, the Indiana State Library, the Traverse Area District Library, the Traverse Area Historical Society, the Archives of Michigan, and the National Archives and Records Center.
Sincere thanks must go to readers of early drafts and to listeners of emergent cogitations, many unsuspecting and almost all involuntary.
