Dr. Osmond’s new deal for the insane
This renowned psychiatrist wants to tear down our mental hospitals give patients back their self-respect find a pill that will cure insanity
In Saskatchewan business circles the discovery of oil has been the most intriguing event in recent years. In psychiatric circles, in the same province, a comparable stir has been created by the discovery of Humphry Osmond, a forty-year-old psychiatrist who came to Saskatchewan from London, England, six years ago. Osmond occupies the somewhat prosaic post ot superintendent of the sixteen-hundred-bed provincial mental hospital at Weyburn. near Regina. But. according to Osmond's boss, Dr. Sam Lawson, director of Saskatchewan's psychiatric services. "Osmond is no ordinary superintendent—he's got a streamlined hyperactive mind.
At first appearance, Osmond belies this accolade. His height and weight are average; his face is pleasant and mild and his light-blue eves peer from behind rimless glasses. But Osmond in action—-which is most of the time--presents a different picture. He bubbles forth a torrent of original, stimulating and usually controversial ideas on the subject of mental health and illness. He insists, for example, that most mental hospitals — including his own—should be torn down. "They're ugly monuments to medical error and public indifference,” he says. To take their place, Osmond and his colcontinued over page ^
Osmond studies anything that might hold the key —Indian rites, women’s fashions and ghosts
leagues have blueprinted what he calls “sociopetal” hospitals, which combine the warmth of a private home, the compactness of a railway roomette and the conveniences of a high-class hotel. One is now' being built in the United .States under the guidance of Osmond and Joe Izumi, a Regina architect.
Osmond frequently strays from the path of medical orthodoxy. He clashes with the psychoanalysts who believe that mental illness, in the main, is caused by the patient's unhappy past experiences. “Most cases of mental illness have a physical cause.” Osmond argues. He underlines his point in an unusual way. On at least a dozen occasions he has taken hallucinogenic drugs, which temporarily turned him into a psychotic. These included mescaline, made from cactus found in New Mexico; ololiuqui seeds, the favorite narcotic of the ancient Aztecs which still grow's in Central and South America; LSD. a fungus found on rye; peyote, a flower found in
the southern United States; and adrenochrome and adrenoleutin, two substances chemically related to the hormonal excretions of the adrenalin glands.
As a result of these psychotic episodes, Osmond has an intimate knowledge of the w'orld of the insane. Jane Osmond is unenthusiastic about her husband's excursions into insanity. “I sometimes dream that Humphry’s taken the ultimate drug—the one that makes him permanently schizophrenic.” she says. Nonetheless, four new and exotic drugs are on Osmond's list for future trials. One of them is cohoba, a narcotic snuil used by the natives of Haiti to empower them to communicate with the dead. On a less personal level Osmond has engaged in a wide range of research as a member of the Saskatchew an Committee on Schizophrenia Research. He’s the spark plug of this remarkable group, which has published the impressive total of seventy-five papers in the past five years. The committee’s
chairman, Dr. Abram HofTer, describes Osmond as “a real pioneer in research ideas.” The committee's latest project concerns the use of niacin or nicotinic acid in the treatment of schizophrenia. Niacin is one of the B complex vitamins and the average person requires about 50/1.000 grams in his daily diet. Schizophrenics have responded well when given up to two hundred times this amount of niacin daily. A patient who had been in hospital for fourteen years and had smashed furniture, heard imaginary voices and attempted suicide recovered after niacin treatment. She's now living and working in the community and stays well as long as she takes a daily dose of the vitamin. It's been found that discharged schizophrenics, kept on a maintenance dose of niacin, are six times less likely to return to hospital during the following year.
Osmond carries the spirit of research into his job as superintendent of the Saskatchewan Hospital at Weyburn, which, in competition with
He’ll even turn himself insane
institutions throughout North America, won an award from the American Psychiatric Association for having shown the greatest improvement in the last three years. No facet of patient care has escaped Osmond’s inquiry. He wondered, for example, why his 629 female patients tore or wore out 440 dresses a month. He concluded that much of the destruction was motivated by the patients’ resentment of the cheap unattractive garments they had to wear. Osmond did two things calculated to make the women take greater pride in their appearance: he gave them stylish, expensive nylon gowns, and brassieres. “A woman w'ith flabby breasts has no morale,” he explains. The destruction of gowns dropped to a couple a month.
Osmond has solved the psychiatrist shortage in his hospital in a novel way. He selected outstanding psychiatric nurses and turned them into “nursing oflicers.” They now spend their full time in the wards, working with patients.
Osmond is a firm believer that the sexes in the hospital should not be segregated. Female nurses are no\V in the male wards and wards are being reorganized so that male and female patients have common dining rooms and lounges.”
“When there arc women around, the men will shave, watch their language and mind, their dress and manners,” says Osmond.
He recalls laboratory experiments that showed that when male rats were kept far from females, they grew thin, scraggy and apathetic. When cages of female rats were moved nearby, they grew sleek, active and healthy. “The same happens with human beings,” he says.
Changing things around in a hospital, of course, costs money. The annual budget of Osmond’s hospital now stands at an all-time high of two and three quarter million dollars. Osmond is unperturbed. “My job’s not to keep the hospital budget down,” he explains. “It’s to get people better and send them home.” However, in the long run, Osmond is convinced that providing a high standard of care is an economy.
When he took over in 1953 the hospital population was about two thousand; now it’s down to sixteen hundred. This is only a start. He hopes to reduce the figure to thirteen hundred within three years.
“If we used all the skills we have.” he says, “Saskatchewan mental hospitals could save fitty million dollars in the next thirty years or so.”
Osmond doesn’t confine his inventiveness and curiosity to the psychiatric field. On at least two occasions he forwarded to car manufacturers suggestions for promoting traffic safety. On the first occasion he came up with a device that would make it impossible for a drunk to drive his car. A sensitive breath-o-metcr on the steering wheel would analyze the driver’s breath. If it were beyond the safety threshold, the engine w'ould automatically be rendered useless for sev-
eral hours. The second device consisted of a small brain-wave machine, which could be easily clamped on the head and attached to the engine.
If the machine registered waves that indicated the driver was sleepy or otherwise impaired, again the engine would conk out.
Unlike most medical men Osmond takes extrasensory perception, clairvoyance and similar phenomena seriously. “Many people have unusual powers,” he insists. “There’s a need to investigate them scientifically.” He likes to tell how in Uos Angeles his friends, the Aidons Huxleys, once took him to a medium. Osmond claims she foretold that he would have a book published within a year (a tact unknown to Osmond at the time); that members of his family w'ere in a plane crash three thousand miles away; that he had almost lost his life by drowning in the blue grotto in Malta; and that his grandfather had been a whaler. “It was most uncanny,” says Osmond. “These things all actually happened.”
He has no explanation for such phenomena but doesn’t find them too hard to accept since, he explains, we don’t yet understand those exact chemical and electrical processes that occur in the brain which enable us to perceive and remember.
Never one to shy away from a fight, Osmond is currently interested in the dispute between the Indians who belong to the Native American Church and the federal government. The argument revolves about the Indian consumption of peyote buttons—dried flowers that produce mild hallucinations. The Indians claim that eating peyote enables them to have visions and thus reach up and feel close to God. Government officials feel the drug is harmful. Osmond doesn’t agree. To prove his point he and some of his colleagues chewed peyote and took part in a recent all-night religious ceremony at Fort Battleford, Sask. Later he found it difficult to explain his sensations. “It was a beautiful, unusual, powerful religious experience,” he says. “I felt that every beat of the drum had a special meaning.” He feels it would be wrong for the government to ban peyote buttons, w'hich, he says, are far less harmful than alcohol.
Like most of his other experiences, Osmond's sensations while under the influence of peyote were recorded in one of the many notebooks or clipboards that he carries around with him. He usually takes notes to the accompaniment of other activities. Recently he sat in on a threehour negotiating meeting with the union of hospital employees. He took a leading part in the discussion, at the same time scribbling furiously. When the meeting was over, a neighbor glanced at Osmond's sheaf of notes and discovered that what he’d assumed to be a record of the proceedings was in fact a complete rough draft of a long article for a medical journal on the
role of the nurse, a favorite Osmond theme.
To speed up his writing, he uses italic handwriting and employs a shorthand system known as Long Shorthand. Thus, the chairman becomes “chair11,” between is “betn” and would is “wd.” “I save exactly one hundred hours of writing a year by this system,” says Osmond.
Osmond’s notes cover anything he sees, hears or thinks which might be of psychiatric use at some future time. A sampling of recent items includes the following:
Re couches. Get rid of all the old type wooden-frame construction couches in the hospital. Because of construction, patient can’t read on them or sit and talk comfortably to others. He can only lie down and stare at ceiling. Thus patient can effectively isolate himself from all other people. In a sense, it becomes a self-made padded cell. This docs not encourage him to interact with other people,
continued on page 41
Dr. Osmond’s new deal for the insane continued from page 11
“Science-fiction should be taken more seriously. The nonsense of today is tomorrow’s truth”
Re green stain. Letter from mother ol recently discharged schizophrenic. Says that patient's perspiration stains the sheets light green. This is a mystery, perhaps worthy of investigation. Adrenochrome and adrenoleutin are also dyes.
Re predicting suicides. On the basis of existing data one can say that a married Irish Roman Catholic woman of twenty is sixty times less likely to commit suicide than a German, atheist lawyer in his sixties who has been divorced. Using large mass of existing data it should be possible to work out useful suicide predictions.
Re taboos. Dr. Nolan C. D. Lewis (Columbia University psychiatrist) told me about an African explorer faced with a serious problem on a safari. His bearers had eaten taboo food and were lying about, seriously ill, convinced that they would die. To those who were depressed, he gave apromorphine (an emetic); those with convulsions, he flogged. They recovered. Lewis decided to study this tribe and a millionaire friend agreed to underwrite the project. A minute before signing the cheque the millionaire died in his office.
Re the menace of “the practical, common-sense” man. In working out solutions to problems, these people are a menace; they’ll be the death of us. They're nearly always wrong because their judgments are based on their own past experiences. If they’re sixty years old — and many political leaders and executives are — these experiences are forty years old. But things are moving swiftly today: we need solutions based on what the world will be like forty years from now. Thus, the “practical man" is eighty years out of date. My grandfather was “a practical man.’’ In 1892 he said, "Man can't travel sixty miles an hour and survive. The air would squeeze him to death.” Science-fiction writers should be taken more seriously. The nonsense of today is the truth of tomorrow.
To Osmond, building huge impersonal hospitals is a tragic manifestation of the practical man” at work. Most Canadian mental hospitals have thousands of patients. One or two hundred are crowded together in wards. They have no privacy. Unable to withdraw to a quiet spot when they want to. they withdraw psychologically. Shortage of staff means that they lack intimate, human contact wáth people who might help them. This impersonal mass living leads to social deterioration. “They’ve forgotten how to eat. dress and converse properly,” says Osmond. “They're disqualified from living in the outside world."
Osmond believes in "sociopetal" mental hospitals—that is, hospitals that encourage personal relationships. The manner in which he evolved this new concept from an idea to working blueprint is characteristic of the way that he works.
It was Dr. D. G. McKcrracher, chief of psychiatry. University of Saskatchewan, who began talking about the need for smaller hospitals. Osmond was fired
by the idea. He latched on to the concept of sociopetal design, and found the best examples of this to be the tepee, igloo and the Zulu kraal. "The occupants here meet in small, face-to-face groups,” Osmond explains.
How much space does a patient need? Osmond searched the literature on the subject. He read the reports of animal psychologists who have studied the space needs of high-strung animals in zoos. The details of the hospital’s interior were
dictated by the schizophrenic’s concept of his surroundings.
“Timepasses more slowly for the schizophrenic.” says Osmond. “Thus, if he has to walk across a large room or down a long corridor, it appears to be
“We spend millions on research of livestock, but less than a nickel per person on the human mind”
twice life size or more. That’s probably why you see patients in cavernous hospital wards huddled against the walls. They’re there for security. We feel the new hospital should be made up of small, well-defined spaces.”
,Other features were tailored to suit the schizophrenic’s hypersensitive senses of touch, hearing and smell.
Osmond enumerated these principles to Joe Izumi, a young Regina architect. Izumi then designed a sociopetal hospital. One is now being built in the state of Pennsylvania: Saskatchewan hopes to
start one in a few years. The hospital consists of one large building and a cluster of ten smaller circular buildings, each containing twenty - four private rooms, six feet by ten in size. They are furnished warmly like a bed-sitting room. To make the most efficient use of space, Osmond consulted the manufacturers of railway* roomettes and compartments. Every four rooms lead to a common parlor, every two parlors to a larger lounge and the lounge areas to a large central day room. Thus, the patient can withdraw to the privacy of his own quarters or gradually become part of a twenty-four-person group.
The lighting, which Osmond worked out with William Trott, a Winnipeg engineer, becomes brighter as the patient moves from his own room to the central day area. “We're children of light,” says Osmond. “This will encourage patients to move toward areas where there are other people." Each of the small buildings will have its own 200-300-bed hospital, food will be brought from a kitchen in the main building, which will also contain larger rooms for certain types of activities and recreation.
Asylums to “nice places”
Osmond is convinced that the sociopetal hospital will remove much of the stigma now attached to the mental patient. Since each community or region will have its own 200-300-bed hospital, it won’t be necessary to whisk the patient away to a mysterious “lunatic asylum” several hundred miles away. The patient can thus keep in touch with family, friends and his own doctor, and he can return home for visits. Hospitals will be thrown open to the public who will get to know them as “nice places." Living in small groups, patients will have the chance to retain their social skills and have intimate contact with their doctors and nurses. In spite of these advantages, says Osmond, the sociopetal hospitals won’t cost more than the conventional type.
I recently spent a week with Osmond at his hospital in Wcyburn. While waiting for the Saskatchewan government to build sociopetal hospitals — which may come about in a few years—he and his stall are doing what they can to introduce some of the new features in their forty - year - old building. Everywhere there's evidence of change. The heavy awkward hospital furniture, for example. has been replaced by lightweight items made out of canvas, plywoods and aluminum. “The manufacturers at first refused to sell me this stuff for hospital use," says Osmond. “They said it wouldn’t last for more than a day. They were wrong.”
Osmond finds many virtues in light furniture. “If the hospital is equipped with heavy furniture, the patient gets used to banging into it; he knows nothing will happen. Then he goes home and
acts the same way, with the result that he’s likely to do a lot of damage. He’s lost his skill in living with ordinary furniture.”
Damage to the light furniture has been negligible because, unlike heavy furniture, it’s not broken by its own weight when toppled over.
To break up the huge wards and day rooms, portable “room dividers” are coming into use. This innovation enables patients to meet informally in groups of approximately seven. Walls, floors and ceilings have been painted in combinations of warm yellows, browns, greens, blues and pinks. Osmond has encouraged patients to decorate some of the rooms, then copied their color schemes in other parts of the hospital. “We’ve got a lot to learn from patients about the therapeutic use of color,” he says.
Mirrors, flower pots and pictures adorn the wards. “They don’t destroy them,” says Osmond. “Patients realize they help make the place more comfortable.” Mirrors seem to have a therapeutic effect. “Patients look at themselves frequently and are thus encouraged to improve their appearances.”
To help patients recover their skill in eating, Osmond is abandoning the practice of limiting patients to a bowl and spoon, and is allowing them a complete table service. In some of the female wards there are stoves on which patients prepare snacks for themselves. “Some of the patients are learning how to cook after a lapse of fifteen years,” says Osmond. “A woman who can’t cook isn’t much of an asset around a home.”
Visiting between the sexes now goes on in some of the wards. “The women become coquettish; the men gallant,” says Osmond. “It’s a refreshing sight.”
Carefully tutored by Osmond and his clinical director, Dr. Ian Clancey, every Weyburn employee now accepts the fact that his job is to help the patient get out of hospital as quickly as possible. This calls for the abolition of the “peon system,” which exists in most mental hospitals. Under this old system the hospital depends on patients to carry on essential jobs. “This dooms a patient to hospital for life." says Osmond. “If he’s well enough to hold a steady job in hospital, he should probably be out working for his living.”
To make sure that a minimum amount of patient help is needed, Osmond encourages his staff to streamline their operations. Gib Emard, the superintendent of maintenance, for example, has acquired a floorwashing machine, which does the work of fifty human floorwashers. To help ex-patients fit into the community, Osmond has six social workers and soon hopes to increase the number to twentyfive. “Social workers are money savers,” he says, pointing out that one social worker, working half time, was able to rehabilitate thirty-tw'O chronic patients —a direct saving to the hospital of $73,600.
But Osmond concerns himself with more than rehabilitation; he devotes what “spare” time he can find to searching for the causes and cures of mental illness. He’s the most articulate member of the Saskatchewan Committee for Schizophrenia Research whose members include Drs. Abram Hoffer, D. G. McKerrachcr. F. S. Lawson, Duncan Blewett, Maurice Demay, Charles McArthur and Dean Wendall Macleod. There are two main theories about the cause of schizophrenia, the most serious of all mental illnesses, which afflicts about half
the patients in mental hospitals. The first is that the patient withdraws into a dream world because he can’t cope with the pressure of living. The second theory is that the body, because of malfunctioning, produces small quantities of a substance “X,” which poisons the system. Other theories incorporate both these approaches. Osmond takes his stand with those who believe that the causes of mental disease are primarily physical, not mental.
At the moment the hottest clue the committee has as to the cause of schizophrenia is a light, yellowish-green substance known as adrenoleutin. It is related to adrenalin, the hormone excreted by the adrenalin glands. “We can show that in the schizophrenic, adrenalin turns into adrenoleutin more quickly and in larger quantities,” says Abram Hoffer, head of the committee.
Both Hoffer and Osmond have taken adrenoleutin and it produced marked personality changes. The condition lasts up to two weeks and resembles the clinical picture of the somewhat orderly, chronic schizophrenic. Osmond, who is usually talkative, remained silent even when with his closest friends. He wrangled with members of his hospital staff. He suffered mild hallucinations. Hoffer became jittery, irritable and indecisive. It once took him twenty minutes to make
up his mind whether to have coffee or tea after his dinner. He refused to talk to his wife or children. He was so depressed that he would sit brooding in his office all day, wondering whether or not to quit his job. Once, he imagined he was being followed in his car by police officers. L.ike real schizophrenics, both Hoffer and Osmond became extremely secretive under the effects of adrenoleutin; they refused to reveal their inner sensations until long after the effect had worn off.
Osmond has made a solemn pact with his wife Jane that he will always tell her when he’s about to test a new drug. This agreement was the upshot of an experiment that Osmond made a year ago at home. One evening, after supper, he secretly inhaled vapors of adrenoleutin. Osmond’s seven-year-old daughter Helen was disturbed because her usually friendly father would have nothing to do with her. Jane was also frightened: her husband spent the entire night walking about, behaving strangely and at times, doubled up with pain. He refused to an-
swer when asked what the trouble was.
In less dramatic fashion Osmond and the schizophrenia research committee have conducted numerous experiments with LSD, the drug that turns a normal person into a schizophrenic-like psychotic for twelve hours. And they’re studying a new drug, LSM—a relative of LSD— which produces the same effects though lasting only an hour or two. It’s planned to administer the drug to groups of normal healthy volunteers to learn something about the group life of schizophrenics. “LSM may give them a kind of extrasensory perception—the ability to communicate feeling without words,” says Osmond. “This seems to be happening all the time in our wards.”
The search for substance “X”
A variety of additional projects are under way. Elderly patients are now taking their food with a sprinkling of glutamic acid and niacin; these substances appear to increase their mental alertness and sociability. Further experiments are under way with niacin: the results seem to be encouraging in the treatment of schizophrenia, arthritis and heart disease. Virtually every cell of the schizophrenic’s body is being searched for the mysterious substance “X,” which causes his illness —his blood cells, blood serum, spinal fluid and how his reactions to a variety of drugs differ from those of the normal person.
Osmond and his colleagues believe that out of such research will ultimately come the pill that will prevent and/or cure mental illness. They deplore the fact that psychiatric research is being held up by a combination of public apathy and government penury. “We spend millions on the health research of livestock but we’re spending less than a nickel per person on research of the human mind,” says Osmond.
He’s critical of federal research grants, which are made on a yearly basis, with an unofficial guarantee of continuation for three years. “You can’t assemble a research team or guarantee results in such a short time,” he says. “The committee operates on an annual budget of $141,000 with $70,000 coming from the federal government, $35,000 from the province. $35,000 from the Rockefeller Foundation and $1,000 from the Canadian Mental Health Association.
Regardless of the difficulties, Osmond wouldn’t contemplate any career other than psychiatric research. But he didn’t plan to spend his life that way. Born in Surrey, England, in 1917, he graduated from secondary school at eighteen determined to become a banker. He fainted while being interviewed for a job by a bank official. “My guardian angel must have been watching over me,” he says. He went to work for an architect, an experience that is proving valuable in the planning of the sociopetal hospitals. Encouraged by his father, he went to the Guy’s Hospital medical school. London and entered the Royal Navy as a surgeonlieutenant when he graduated in 1942. After sailing in several convoys, he took a special course and became a navy psychiatrist.
Osmond's most unforgettable patient during this period was a burly sailor who confessed that he had recently murdered a cab driver in London. "This posed a very knotty ethical problem.” says Osmond. He finally got in touch with Scotland Yard who confirmed the murder and informed him that two other men
had just been hanged for the crime. They had gone to the gallows protesting that they knew nothing about the cabbie’s death. However, there was indisputable proof that these same two men had murdered another person only a short time before. “That made me feel a little better,” says Osmond. Following his discharge from the navy in 1947, Osmond resumed his studies in psychiatry and married Jane Roffey, a strikingly attractive London nurse.
By 1951, Osmond was first assistant in psychiatry at St. George's Hospital, London. There he met John Smythies and the two young doctors had a burning desire to get into psychiatric research. They had just started planning a few projects when Jane Osmond noticed an advertisement in the London Times, which stated that the Saskatchewan government wanted psychiatrists. Once assured that there would be research opportunities. Osmond came to Canada in 1951 with his wife and daughter.
When not in his hospital, laboratory or en route to a psychiatric conference, Osmond can be found in his comfortable two-story house on the hospital grounds. His wife Jane quietly reigns over the household, which consists of — besides daughter Helen—three Chihuahua dogs, an undetermined number of alley and Siamese cats, a hypermanic budgie bird and thousands of records and books. The library reflects Osmond's wide range of interests—everything from fifteenth century witchcraft and Zen Buddhism to science-fiction. Osmond is a devotee of the latter, explaining, “The nonsense of today is the truth of tomorrow.” '
When not talking to visitors, Osmond sits in his easy chair, writing. To date he has outlined some two hundred short stories, plays and novels. The themes are off-beat: the schizophrenic is the new species of man evolved by gene mutation: in future, present-day “normals” will be a rarity. Another plot describes how a colored race in Africa discovers a superlethal spray that kills whites but is harmless to colored people. A colored representative goes to the United States, asking why it shouldn't be used.
Osmond also carries on heavy correspondence with people all over the world. His letters to and from Aldous Huxley —which he keeps filed—would fill several books. For amusement of a semiserious sort he has carefully analyzed the personalities of his three dogs. “Whiskey, the second dog,” he explains, “is always currying favor. This is caused by a basic insecurity. When we got hint. Brandy, the first dog, was already firmly entrenched in our affections.”
Since his passion for psychiatric research is indulged, Osmond is quite content to remain in Saskatchewan and has ignored invitations from several large American psychiatric centres. While the Saskatchewan Committee for Schizophrenic Research is unusually poor in facilities and cash, he says, it is unusually rich in creativity, initiative and morale. Out of this amalgam may come, some day, “the pill to cure insanity.”
“Diabetes, leprosy and TB were hopelessly incurable fifty years ago.” says Osmond. “Now they’re under control. The same thing is about to happen in mental illness.” ★