Menninger Dies; Changed U.S. View of Mental Illness

Dr. Karl Augustus Menninger, the last living pioneer of American psychiatry who radically transformed the nation’s views on the mentally ill, died Wednesday morning of abdominal cancer.

The co-founder of the famed Menninger Clinic in Topeka, Kan., died at Stormont-Vail Regional Medical Center in Topeka, where his cancer was diagnosed June 12. He was 96.

Pat Norris, a clinical director of the Biofeedback and Psychophysiology Center at Menninger, said he was “sending messages and signals to people” during his final night and asked her to sing to him.

The often outspoken, didactic doctor--once called the nation’s “greatest living psychiatrist” by the American Psychiatric Assn.--had battled back from a brain tumor and a stroke to remain active as chairman of the board of his foundation.

At his death he had trained thousands of psychiatrists (an estimated 5% of those practicing in the United States today), demystified psychoanalytic concepts in his popular books and introduced innovative treatments at the farmhouse sanitarium that began with 12 beds in 1925 and grew twentyfold in subsequent decades.

Despite his advanced years, he went to his office daily, meeting with students, having lunch with friends, receiving guests and sometimes fretting about his place in history.

He took no credit for attaining age milestones: “I thank God I lived as long as I did. It’s more his doing than mine. And I had good parents, you know.”

A small-town boy who came home from Harvard to start what would eventually become a leading psychiatric center, “Dr. Karl” was a prairie Renaissance man who was equally at ease with Sigmund Freud, Albert Schweitzer, the wheat farmers of eastern Kansas and the certifiably crazy.

Under his guidance, the sanitarium became an internationally known psychiatric center offering treatment, education, research and preventive programs for adults and children on a 310-acre campus with 1,050 employees and a $58-million annual budget.

Menninger also founded a group of permanent homes for neglected and abandoned children, played a leading role in reforming his state’s mental health and penal systems and preached for more than half a century that mental disorders and criminal behavior are both preventable and treatable.

The Menninger Clinic, later called the Menninger Foundation, was the first psychoanalytic hospital in America--and it was put in the unlikely Midwest locale of Topeka. At a time when mental treatment consisted largely of trying to relieve symptoms and provide humane care, Menninger was delving into his patients’ early life experiences and their reactions to those events to explain what had gone wrong.

“A lot of what we (psychiatrists) are trying to do today, he was trying in Topeka in the 1940s,” said Dr. Milton Miller, who trained at Menninger and is now chairman of psychiatry at Harbor-UCLA Medical Center in Torrance. The Menninger Clinic, for example, was among the first to actively involve the patient’s family and community in his treatment, as well as the entire staff of social workers, nurses and psychologists. Together they formed a socio-environmental treatment that came to be known as milieu therapy.

Menninger was among the first psychoanalysts trained in the United States--he took his training analysis under Dr. Franz Alexander and held Certificate No. 1 from the Chicago Institute for Psychoanalysis. In 1942, he established the Topeka Institute for Psychoanalysis, the first such training center west of the Mississippi, and in 1946 the Menninger School of Psychiatry.

A prolific writer, he was the first American psychiatrist to explain in clear and sometimes brilliant language what made people tick, beginning with “The Human Mind” in 1930, which set forth the principles of dynamic psychology (emphasizing the importance of unconscious motivations). It became one of the most widely read books on human nature ever written.

One of the most successful reformers in the history of American medicine, Menninger concentrated his efforts on the Kansas prison and mental hospital systems, but his writings sparked reform elsewhere, too. In “Man Against Himself” (1938), he examined the dark side of human nature, man’s violent and destructive drive, and he began formulating a philosophy for dealing with it. He found hope in the opposite instinct, explained in “Love Against Hate” in 1942.

His views that vicious cycles are created by punishment and pathological reactions against punishing forces was reflected in his establishment of The Villages in 1966, a series of group homes for neglected children that has since been copied by other cities and states. “You get a tree straightened before it grows,” he explained in a 1981 Los Angeles Times interview. Treatment in adulthood is like “locking the barn after the horse is stolen; prevention is the thing.”

Criminals are harshly treated children grown up, he believed, and most penal systems only perpetuate and breed more of the crime they seek to stem. He advocated sweeping penal reforms in his 1966 book “The Crime of Punishment.”

A deeply moral man and elder in the Presbyterian Church, Menninger had a temperament that did not permit him the objective, detached, nonjudgmental view of man’s behavior espoused by classic psychoanalysis. Instead, he had a penchant for asking, “How about love?” “How about good and evil?” (In 1973, he published “Whatever Became of Sin?”) “Don’t mental and moral health go hand in hand?”

During an era in which the typical psychoanalyst was detached from social issues, Menninger was deeply involved in society while trying to apply psychoanalytic insights to social reform, be it with children’s homes, tree and wildlife conservation, improving the lot of the American Indian, ending racial discrimination or avoiding war.

In an extraordinary, long lifetime, he straddled the enormous gulf between the psychoanalytic couch and the streets in a most unusual way. Not only did he believe that the psychiatrist must leave his ivory tower and involve himself in the real world where his patients lived, but he also insisted that patients plunge into activities aimed at reconnecting them with reality.

Treatment, in his view, meant far more than what formally happened between doctor and patient, far more than the objective dissection of inner conflicts and psychological defenses. Menninger patients were not allowed to sit idly, contemplating their navels; they were required to take part in mundane activities such as gardening, digging on their hands and knees and planting and watching plant life take hold and grow.

His wide-ranging interests and energy were legendary--he painted, read, played piano and chess, gardened, wrote, taught, lectured and saw patients.

“I’ve always been excited,” he said, pointing out that after subtracting the time taken up by eating, sleeping, basic care and a job, about 40 hours a week still remain available to most people--40 hours that can be wasted or enjoyed and used to accomplish something.

He was president of the American Psychoanalytic Assn., a founding member of the American Orthopsychiatric Assn., Assn. of Clinical Pastoral Education and the Central Neuropsychiatric Assn., and the recipient of numerous awards and honors.

With Albert Schweitzer, he was one of only two living people ever to be represented in a stained-glass window in the National Cathedral in Washington. He was a member of more than 35 professional groups, a board member of 22 organizations and a professor at six universities and training centers, and was awarded 13 honorary university degrees.

Despite these achievements, Menninger’s life was not untroubled. The son of a stern, religious woman and a kindly general practitioner father (who often fought with each other), young Karl was diagnosed as retarded at age 7, (a condition “cured” by advancing him three grade levels). He divorced his first wife after 25 years, remarrying six months later. He feuded with his family and his board of trustees.

He sometimes lamented his acrid personality: The clinic’s staff “never loved me the way they loved him (his father, the late C. F. Menninger),” he told a Times reporter, looking wistfully at his father’s framed photograph. “And they were correct not to.”

Schooled at Washburn University in Topeka and the University of Wisconsin and graduated cum laude with a degree in medicine from Harvard in 1917, Menninger joined a group practice with his father, who had envisioned a sort of Kansas-style Mayo Clinic from the time his sons were adolescents.

The story goes that the elder Menninger came home from a visit to Mayo determined that his sons would become physicians and help him start a similar venture. Not so, recalled Karl, who said his father never dictated his children’s careers. “He never demanded, he inspired,” he said. “He was the spirit (of the clinic); I put together the pieces.” The two were later joined by his brother Will, who died in 1966.

Although trained as a neurologist, young Karl developed a special interest in the infant field of psychiatry, having studied and worked under the great neuro-pathologist and early psychiatrist Elmer Ernest Southard in Boston. He remembered being chased off the grounds of the old Topeka insane asylum while gathering walnuts as a boy, and walking to school with a girl whose aunt was kept in an attic. He had some early ideas about better ways to help such people.

What had begun as a general medical group practice soon evolved into a psychiatric team that--with the financial support of the townspeople of Topeka--purchased a farm and accepted its first troubled patient in 1925. As Topeka’s first psychiatrist, “Dr. Karl” used chemicals (such as the “wonder drug” 606 for syphilis, then a common cause of insanity), milieu therapy, psychoanalysis and other new therapies--arriving finally at a folksy mixture of Freud and friendliness.

“There was sort of a Grant Wood Americana quality about him,” Harbor-UCLA’s Miller said. “He had a vision about mental disease, a strange vision that mixed theology and profound energy.” He was impatient with rules--as manager of the Winter Veterans Administration Hospital in Topeka, for example, he abolished regulations with a wave of his hand when he believed that they interfered with patients’ best interests.

Menninger seized on new ideas, extracting their essence and disregarding their trappings--as when he wrote to the great psychiatrist Smith Ely Jelliffe about his approach to a difficult patient, explaining that “I had no (psychoanalytic) couch, but . . . we did have a chaise lounge.”

In later years, he became somewhat cynical about the proliferation of what he called “the psycho-THAR-a-pies,” insisting that if he himself had any “parts that were nuts,” he wouldn’t get near a psychiatrist. “If I were depressed,” he said, “I’d want to talk to somebody else who was equally depressed.” Besides, he added, “the world is more crazy than the patients I see.”

Never an easy man, he became increasingly impatient, dogmatic and cantankerous, bitterly aware that he was more tolerated and indulged than seriously consulted by the Menninger staff. He became mercurial--throwing books at a visitor one minute and offering chocolates the next--and accused anyone who journeyed to Kansas to talk with him of being drawn by idle curiosity--”Come to see the old curmudgeon in his den, eh?” he would ask.

But those who knew him in his prime say he was an authentic genius who changed the face of American psychiatry and the lives of those he touched. He was a much-honored man, both by his profession and the world at large.

In 1981, he became the first psychiatrist to be awarded the Medal of Freedom, the nation’s highest civilian decoration.

But perhaps his most moving honor came at a birthday celebration for a frail, sick and emaciated “Dr. Karl.” Part of the entertainment was a performance by the Kansas Prison Choir, a group made up largely of life-termers under heavy guard. One prisoner stepped forward, looked directly at the old man and introduced the next selection by saying, “Doctor, you have been our spokesman and the man who cried out for us.” The choir began singing “To Dream the Impossible Dream.” There was not a dry eye in the place.

Menninger is survived by his wife, Jeanetta Lyle, four children and nine grandchildren.