From the Archives - by Henry V. "Hank" Guhleman, M.D.

The crisis that the state of Missouri was struggling with in the fall of 1961 was like none it had ever faced before. There existed widespread, well-publicized and active deep-seated animosity toward the governor and his newly appointed Mental Health Commission. His adversaries were the citizens of Missouri, who desperately wanted to improve the state’s mental health system, and members of their families, who were the state’s hospitalized patients (some of whom were veterans of over 20 years of inadequate institutional care). Finally, there were the unrelenting editorial writers and reporters of the state’s most respected newspapers, who continued to write critical articles and exposés of the state’s mental health services.

As I followed these developments at the time, little did I know or suspect that I would become a participant at some critical point in this crisis, although to a very minor degree. Nor did I ever intend to try to tie together the events and circumstances that lead up to the 1961 crisis. However, as far as can be determined, no one has attempted to present the facts as they developed during that year. I will try to fill this gap to the best of my recollection and ability with the materials I have at hand in my personal archives.

My involvement started on a Saturday afternoon in November 1961, a great day for a Missouri University Football game, where I had planned to spend the afternoon. I had timed my office departure and driving time to Columbia from Jefferson City in order to miss the early heavy traffic and tailgaters and arrive at the stadium just in time for the kick off. Just as I started to leave, the telephone rang. After a few moments hesitation and a second seemingly more-insistent ring, I turned to answer. The voice on the other end of the line was unmistakably that of Dr. Henry Hardwicke, deputy director of the Division of Health. Without any words of formal introduction, he commanded “You are to meet and pick up the candidate for the director of the Division of Mental Diseases at four o’clock in the lobby of the Missouri Hotel. Bring him to the Hardwicke Horse Farm just off Highway 63. The governor, who is attending the football game, will have his driver duck in quickly, drop him off here, then proceed with the governor’s car on to Jefferson City. This is to avoid any public suspicion of this meeting. You are to tell no one of this meeting, nor where you are going. Goodbye.” As the psychiatric consultant to the State Mental Health authority assigned to the Division of Health at that time under the direction of Dr. Hardwicke, I had no choice but to follow orders.

But before proceeding, it will be helpful to review the background of the organization and operation of our state mental hospitals at that time.

A Growing Census and Changing Management

It had now been 110 years since the Fulton Lunatic Asylum, as it was then called, had accepted its first patients.

Although the Fulton “Asylum” was built to initially accept less than 100 patients, it quickly outgrew its bed capacity by the hundreds and then the thousands. This rapid increase in population necessitated the construction of additional hospitals throughout the state. St. Joseph State Hospital opened in 1874, Nevada in 1887, Farmington in 1903, and the Missouri School for “Feebleminded and Epileptic” in Marshall in 1901.

The overcrowding and increasing pressure over the years resulted in the need for new institutions. As late as the 1950s, the average census in each hospital was over 2,000.

Initially, a separate Board of Managers, comprised of five members and one secretary, was appointed by the governor to oversee each hospital as it came on line. In 1921 the General Assembly passed an act creating the State Eleemosynary Board to become effective June 19, 1921. On that date the previously designated Board of Managers for each of the state hospitals was abolished. The newly created Eleemosynary Board consisted of six members appointed by the governor. One member, appointed president of the board, devoted his entire time and duties to the central office of the Eleemosynary Board.

The individual institutional Boards of Managers, abolished by an Act of the 63rd General Assembly, established the Division of Mental Diseases of the Department of Public Health and Welfare, created July 1, 1946, in provision with the Missouri Constitution of 1945. The law provided that the chief Administrative Officer of the then Division of Mental Diseases of the Department of Public Health and Welfare, “…shall be a person recognized for his knowledge of mental hygiene and the care and treatment thereof, and also known for his business and executive ability.” Initially, the qualifications as chief executive of the Division of Mental Diseases called for a psychiatrist, but typical of political practices of the time, the 65th General Assembly eliminated the requirement.

Many surveys and investigations, both within the state and in other state hospitals throughout the United States, were called for and authorized. State hospitals of Missouri were no exception and investigations with their findings and recommendations were instituted over the years by appropriate authorities. By and large the findings and recommendations were ignored.

Two surveys are of particular note and deserve quoting. The 1920 survey The Care and Treatment of the Insane in Missouri, by S.W. “Hamilton, M.D., was clear in its first recommendation.

The State should immediately take steps to make tenure of office in state institutions absolutely independent of political considerations. Superintendents should hold office as long as they remain efficient. Every employee should have assurance of permanence in his work which comes only with the knowledge that the policies of the hospital are determined by its superintendent and that his orders are carried out without fear of interference from other sources.

Another survey, conducted by the Mental Hospital Survey Committee of the American Psychiatric Association in 1939, included these recommendations:

The Board of Managers, the Eleemosynary Board, which has control of the state institutions, is supposed to deal with the institutions through its President to the Superintendent, but as a matter of fact any member of the board will issue orders directly to the Superintendent. Going further, a board member sometimes issues verbal orders to the Steward, or even to a Mechanic… “In the past 38 years there have been 36 changes in Superintendents in the four mental hospitals.”

[This later report comes from a single copy of an extensive 1939 report, retained by Mrs. Elizabeth Rozier, who served as chief clerk to the Eleemosynary Board from 1937 to 1941. It is not known if other copies still exist. This one will eventually be deposited to the State Archives.]

By the middle and later part of the 1950s, the realization was finally beginning to emerge that if Missouri was to ever enter into the 20th century of caring for the mentally ill, drastic measures would be needed. The public, the various mental health organizations, and families as well as patients demanded that humane treatment changes be made. Leading the way in the Missouri legislature was Senator Albert Spradling, working along with Warren Hearnes, who would later become governor. In the 69th General Assembly, Senate Bill 59 was enacted, creating a State Mental Health Commission to become effective August 29, 1957. This commission was to be comprised of five members, at least three of whom were to be “…physicians skilled in the treatment of nervous and mental disorders.” The commission would appoint the director of the Division of Mental Diseases, who was to be competent in mental diseases, administration, and program planning.

A Commission in Charge

This new structure was clearly drawn to transfer the appointing power of the governor to the Mental Health Commission, protecting the director from political patronage and enabling him to plan and administer his programs without interference. Governor Sam Blair, in total support of the new law, appointed an outstanding group of civic leaders and psychiatrists to the first commission. The most outstanding was Powell McHaney, president of the General American Life Insurance Co. of St. Louis, elected chairman. McHaney, with his long-time interest in providing good mental health services, assumed the duties in August 1957. Unfortunately, he was killed in an automobile accident in December of that year. Francis Smith, a well-respected former senator and attorney from St. Joseph, replaced him.

The commission met monthly in Jefferson City and immediately began a nationwide search for a qualified director of the Division of Mental Diseases. They finally chose Dr. Addison Duvall, a man well-known nationally and highly respected by his psychiatric colleagues. He was deputy director of St. Elizabeth’s Hospital in Washington, D.C., perhaps one of the finest psychiatric hospitals in the nation at that time, and an innovative leader in instituting new treatment techniques. Dr. Duvall was treasurer of the American Psychiatric Association and an active member of several other national organizations. There were, however, two stumbling blocks to overcome in hiring Dr. Duvall. First was his salary. To interest him in the position, he was paid $25,000 a year, the same as the governor. Secondly, he would not be available full time until the following year. The commission agreed to these terms. During the ensuing year, Duvall made numerous trips to Jefferson City from Washington, D.C., gradually building up his central staff to about 10. Among his recruits were well-trained psychiatrists, a social worker, a physician to head the mental retardation program, a public relations person, and a chief of Hospital Management Services.

By the time Dr. Duvall was able to move to Jefferson City and assume his position full time, he had developed a 10-year plan to upgrade the treatment and maintenance of all Missouri institutions and bring them up to the prevailing standards of the time.

With Governor Blair’s support of the new director and the commission he appointed, along with the prospect of strong and capable state leadership devoid of political interference, there were reasons enough for those interested in better mental health services to look to the future with anticipation.

Bumps in the Road

On assuming full-time leadership, Dr. Duvall submitted his first budget for the division. This was promptly cut by the newly elected governor, John Dalton. Duvall, assuming he had sufficient public and political support, stuck to his original figures. In his decision to hold to his original request, a particular highly placed and respected state senator supported Duvall. Unbeknownst to Duvall, this particular senator was not only supportive of the original budget, but a sworn political enemy of the new governor. This increased the dislike the governor had for Duvall, who praised the senator in a speech, drawing the battle lines tighter and tighter. Dalton then appointed a long-time friend to head the commission, thus reminding commissioners that they were beholden to him politically as governor.

In the midst of this, Dr. Duvall’s wife had a heart attack and he accompanied her out of state during her recovery. While he was away, a headline proclaimed “Dalton Probe of St. Louis Mental Health Facilities Centers on 2 Administrators.” This secret investigation was obviously ordered by the governor, as the Mental Health Commission had no knowledge. Two questionably qualified members of the State Highway Patrol conducted it. In one instance, the superintendent of the St. Louis State Hospital, a bachelor with living quarters on hospital grounds, brought his mother back to his apartment during her recovery period following surgery. She had fractured her hip during a visit from her home in Pennsylvania and the superintendent had asked that hospital attendants look in on her from time to time.

In the second instance the superintendent of the State School and Hospital in North St. Louis asked staff members and patients to carry chairs to his home where a wedding reception for his daughter was to be held. A division official termed both incidents to be “…not out of the ordinary, as superintendents, who are psychiatrists, have traditionally been given fringe benefits in lieu of larger salaries.” A comment also was made that the investigating officer “…went far afield…” and began making inquiries not relevant to the investigation.

On Dr. Duvall’s return from his wife’s convalescence, he was shocked to hear from Russell Sexton, chairman of the Mental Health Commission, that the governor no longer wanted him as director of the Division of Mental Diseases and the commission had asked for his resignation. In essence, he was fired. This was not publicized at the time. As a matter of fact, no record of the minutes of the October meeting of the Missouri Mental Health Commission indicating a formal vote was taken to discharge Dr. Duvall was ever uncovered.

With no other choice and nothing to be gained from fighting back, even though any number of people encouraged him to do so, Dr. Duvall submitted his resignation November 14, 1961, effective on November 30. Newspapers across the state carried the headline: “Dr. Duvall Submits Resignation as Mo. Mental Health Director.” There was immediate and unanimous criticism of the governor and commission. The president of the Missouri Association for Mental Health expressed complete disgust on behalf of the organization. Mental Health leaders vocalized surprise, shock, and anger, as well as resentment at the treatment accorded a man of such impeccable reputation as a leader in the field of mental health reform. The chairman of the Citizens Committee of the Missouri Mental Health Conference and his group were extremely critical of the investigations of two St. Louis mental health facilities ordered by the governor.

The following day’s newspaper headline, “Dalton Says He’s Glad Duvall Has Resigned,” added fuel to the fire. The governor as quoted, “…had nothing personal against Duvall,” insisting that politics was not involved in the long-standing feud. He said he had repeatedly tried to get Duvall to correct what he called “administrative defects,” but nothing was done. When asked to explain what he meant, the governor cited “…people on the payroll not working,” saying doctors should be barred from private practice. Private practice had been the only way the state could attract capable psychiatrists, and it had been allowed for years.

Dalton was left without a mental health leader. He stood alone. One unforgettable cartoon in a metropolitan paper of the times was a doctor’s office with one person, unmistakably the governor, with a forlorn look on his face, staring at the inner office door on which hung a sign – “The Doctor is Out.”

To save face, Dalton’s administration needed to recruit someone as soon as possible to alleviate the intrusive pressure that continued to grow. There was no time to begin another out-of-state recruiting campaign. Names of possible in-state candidates began to surface, and one rose above all others: Dr. George Ulett. He was a Stanford University graduate who received his M.D. degree from the University of Oregon, interning at Boston City Hospital and Barnes in St. Louis. He was well known to the Missouri psychiatric community as a diligent researcher, innovative with new treatment methods, firm leadership, and a dedication to improving public mental health. At the time, he held a staff appointment to Washington University Medical School and was medical director of Malcolm Bliss Hospital in St Louis.

The Rest of the Story

It was George Ulett I was to pick up at the Missouri Hotel. I had known Dr. Ulett for a number of years and knew he would be a good person to reform the state mental health system, but I did not know if, under the circumstances, he would be interested in the position. Early that Saturday afternoon, George had circled the state, meeting with the various superintendents. When I met him at the Missouri Hotel with his lovely wife Pearl, we spent time discussing the pros and cons of his consideration of the position, “…should the governor offer it to him.” After all, this would provoke a big change in his life that he and his wife needed to carefully consider.

At the appointed time, George and I drove over to Hardwicke Horse Farm. It was November and the days were getting darker earlier. As we entered Dr. Hardwicke’s house, for some reason I said in really too loud a voice, “ Well, where is the big shot?” From a dark corner, a compact figure replied, “I guess you must mean me.” To my horror and embarrassment, it was Governor Dalton. What an awful thing to say to the state’s highest officer! I wanted to slink away and disappear, but that was not possible. Years later, as I thought back over the incident, the only explanation I can arrive at is that I managed to express my disappointment and disgust with the governor’s mishandling of the Duvall situation and I could no longer restrain myself, even though I was, at that moment, in the midst of trying to help the governor save face.

For the next hour and a half, Dr. Ulett and Governor Dalton carried on their negotiations. Dr. Hardwicke and I stood discreetly out of hearing range. Finally both stood up, signaling the end of their discussion. Dr. Ulett had made no commitment at that point. The governor, arising from his chair, said he had no way back to the mansion, since he’d sent his car on as a decoy. Ah, I thought, I have found a way to make up for my unforgivable comment. As graciously as possible, I asked if I might take him back to Jefferson City with Dr. Ulett. Now these were the days of the little American Motors cars, and I had an American Motors station wagon with only one front seat. The three of us managed to squeeze in. Not much was said on the way home. When we arrived at the mansion, the gates, usually closed to the public, magically opened and up the driveway we went. As Governor Dalton got out of the car he said, “I’d be glad to invite you to dinner, but I’m not sure what is on the menu.” We gracefully declined, accepting a rain check for his invitation. I never collected mine and I’m not sure whether George ever did his.

Word was soon out that Dr. Ulett had been offered the position as director of the division and that he was well-qualified to accept the post formerly held by Dr. Duvall. In response, the then 43-year-old psychiatrist, Dr. Ulett, said, “I have to consider not only what is best for me, but what is best for the state. I have to consider what kind of man should direct the state’s vast mental health programs, and whether or not I am qualified to do so.” A few days later Dr. Ulett agreed to accept the position of director of the Missouri Division of Mental Health, thus bringing to an end the Mental Health Crisis of November 1961. Dr. Ulett would go on to successfully lead the division and oversee many positive and innovative changes.

NOTE: The writer is indebted to Jack Stapleton and the Dunklin County Democrat, where parts of the archival material used was first published.

The author, Dr. Henry V. Guhleman, was the first director of the Division of Comprehensive Psychiatric Services in the Department of Mental Health.