"Lunacy, madness, insanity, mental illness—all names for the same phenomenon. Yet as one term replaced another in common usage, the displaced term became looked upon with disfavor.…It is a serious mistake and misreading of history to assume the people working in mental hospitals or those who directed mental health policy more than one hundred years ago were any less concerned and compassionate than we are today." These words, by author William Briska, set the tone for this book, written in celebration of the 125th anniversary of Elgin Mental Health Center and chronicling the history of the second state hospital to open in Illinois. As the Northern Illinois Hospital and Asylum for the Insane, the Elgin facility admitted its first patient on April 3, 1872. On the same date in 1997, Elgin Mental Health Center celebrated its anniversary just months after having received its second consecutive commendation in the accreditation process of the Joint Commission for the Accreditation of Healthcare Organizations. As might be gleaned from his quoted statement, Briska writes not from the perspective of a detached observer or inquirer, but from the deeply empathic and affectionate perspective of one whose career has been devoted to service in the hospital community. His effort is a careful attempt to represent the historical development of a cherished resource for the alleviation of human suffering, and it instills in the reader an appreciation of the possibility that history might have unfolded otherwise.

Noting that during its 125-year history the cycles of change through which Elgin Mental Health Center evolved mirrored the cycles of state and national policy regarding the care of the mentally ill, the author effectively uses local history as a window to the history of mental health care at both state and national levels and, in turn, uses those larger contexts to shed light on and interpret local history. So, for example, rich descriptions of facility buildings and grounds are provided within the context of broader discussions of developments in hospital architecture, their philosophical bases, and their reciprocal links to mental health policy. Elgin, originally built on the Kirkbride plan, a congregate model for managing patient populations, later added cottages more consistent with a segregate plan. The book’s 25 chapters are largely, but not exclusively, organized around transitions in hospital leadership, so that considerable interesting biographical information is provided on the individuals—mostly physicians—who served as hospital superintendent. The book is replete with a variety of illustrations (by my count more than 80), including photographs of people, places, and activities in progress, as well as architectural drawings, maps, and artistic representations.

By Briska’s account, the hospital’s development is roughly separable into five phases. The first period, characterized by stable leadership and gradual growth, ended in 1893. The second phase, during which the hospital more than doubled in size, involved politicization in the forms of patronage and unionization, frequent changes in leadership, and power struggles at all levels of the system. This lasted until nearly 1920 and saw the realization of civil service reform and centralized administration at the state level. The third phase witnessed even more rapid growth and an increase in the geriatric and veteran populations. Divisible into post-World War I and post-World War II periods, this phase drew to a close as the hospital population peaked in the mid-1950s. The fourth phase was associated with the advent of psychotropic medications, a decline in the hospital’s census, the development of community mental health centers, deinstitutionalization, and, finally, the decentralization of authority and decision making. This phase lasted until the late 1970s or early 1980s. The fifth phase—Briska calls it a rebirth—began in 1983 with the hospital’s census at an all-time low and the state’s decision to close Manteno Mental Health Center rather than Elgin. This phase, which carries the reader to the present time, is characterized by physical plant rebuilding, the integration of community mental health center activities into hospital system operations, and the further development of forensic programs. Elgin’s new affiliation as of 1996 with Finch University of Health Sciences/The Chicago Medical School and the associated upsurge in educational activities are also noted.

At about the time of transition from the second to the third of Briska’s phases of the hospital’s development, on its 50th anniversary, superintendent Ralph Thompson Hinton, M.D., wrote

These words are consistent with the theme, articulated by the author and very much in evidence within the book, that similar issues may be seen recurring throughout the hospital’s history.

Elgin experienced the issues of the day—which were experienced by other facilities throughout the state and nation—and the issues of the day are abiding issues. Some might be characterized simply as problems: scarcity of resources leading to overcrowding, understaffed and underdeveloped programs, patient "warehousing," and insufficient wages to attract and retain qualified staff. Other issues are recurrent and ongoing dilemmas, in which opposing arguments often have merit and reasonable people may disagree: congregate versus segregate architecture, long-term and short-term care priorities, the management of addiction and substance abuse disorders, separation versus integration of forensic and civil programs, hospital versus community care, custodial care versus active treatment, the role of patient work or labor and its regulation within the hospital setting, and even the tension between individualized treatment plans and standardized programs. The roles of research and education within the clinical service system are perennial sources of controversy, but these components have been vital in Elgin’s historical development.

Perhaps the recurrent impetus to abolish physical restraint is an issue that falls somewhere between the two: physical restraints are problematic in the sense that everyone would prefer not to have to use them (and in that sense their desirability is not debatable); on the other hand, debate and discussion regarding the appropriate guidelines for their necessary use have never stopped. It is of note that when the board of administration for state hospitals in Illinois abolished the use of restraint and seclusion in 1914, Illinois by Briska’s account became the first state in the nation to take such an action. This action had been preceded at Elgin by such a policy introduced by the superintendent, possibly as early as 1911.

Numerous specific contributions by individuals and programs associated with Elgin Mental Health Center could be mentioned. Of those noted in the book, some that caught my interest in particular are the superintendency, from 1897 to 1898, of John B. Hamilton, M.D., who was editor of JAMA (1893–1898) and president of the American Medical Editors Association (1894–1895); the location at Elgin of the Illinois Psychopathic Institute during the early 1930s and of its laboratory for an extended period of time until the late 1940s; the Biochemical Research Laboratory of Max K. Horwitt, M.D., active from the late 1930s into the 1950s; publication of The Elgin Papers in 1936, 1938, 1941, and 1944, which reflected active research and training programs, primarily under the leadership of Charles F. Read, M.D.; the theological work of the Rev. Anton Boisen, originator of the clinical pastoral education movement and author of The Exploration of the Inner World (1934); and, finally, Elgin’s association with Thomas Szasz, M.D., who interned there in the early 1950s. It is also noteworthy that veterans of both world wars were actively treated at Elgin, which had a special veterans hospital on site and transferred more than 200 patients to the North Chicago Veterans Administration Hospital when it opened, while continuing to operate more than 400 beds for veterans.

The History of Elgin Mental Health Center was for me a delightful tour through the hospital’s history, weaving in and out of the larger state system, the national context, and the development of psychiatry and the mental health professions. Personally, I am grateful to the author for enriching my perspective on the system within which I work. For those less involved with the Illinois system, there is nonetheless much that is interesting about this particular hospital and much that is illustrative of the history of our work.