PSYCHOTICVISITORSTOGOVERNMENTOFFICESINTHENATIONALCAPITAL

JAYL.HOFFMAN,M.D.,1

WASHINGTON,

D.C.InitsissueforApril

21,

1835,

theWash-ington,D.

newspaper,

TheIntelligencer,

observed,“Itisanotoriousfactthatthiscity,beingtheseatofgovernment,isliabletobevisitedbymorethanitsproportionofinsanepersons

“

Thisobservationisasvalidtodayaswhenitwasmademorethanahun-dredyearsago.Thenumberofsuchpersonshasbecomegreaterwiththeincreaseinourpopulation

and

theimprovementinourtrans-portationfacilities.Ithasfluctuatedaccord-ingtotheintensitywithwhichthechangingproblemsofgovernmenthaveoccupiedpopu-

larinterest,and

ithasvariedalsoaccordingtothepersonalityofthepresidentialincum-bent.Theneed

and

thedriveofpsychoticpersonsthroughoutthenationandoveraperiodofyearstoexpressthemselvesasde-scribedinthispaperhasapparentlyre-

mainedessentially

unchanged.Ofthesepsychoticvisitors

Washing-tonacertainnumber-butnotall-arecom-mittedtoSaint

Elizabeths

Hospital.Herethewriterhashadtheopportunityofex-aminingalmosteverywhitemalepatientin

this

category

admittedduringthepastfiveyears.Inaddition,andtoserveasacheckonhisobservations,hehascarefullyreadorre-readthecaserecordsofallsuchpa-tientscommittedtothehospital-irrespec-tiveofsexorcolor-duringthe

twoarbi-

trarilyselectedyearsof

1927

and‘937.Itisonthisbasisthatthepresentreportismade.AtSaintElizabethsHospitalwehavecometorefertothisgroupofpatientsrather

looselyas“WhiteHouseCases”becauseso

manyofthemarehospitalizedfollowingef-fortstoseethePresidentathisofficialresi-dence.ActuallyonlyalittlemorethanhalfofthepatientscometoseethePresidentbuttheothers,whoarecontenttovisitwithlesserfunctionariesofthegovernment,are1FromSaintElizabethsHospital,Washington,D.C.,Dr.Winf

red

Overholser,Superintendent.Readatthe

meetingofthe

American

Psycho-pathologicalAssociation,Boston,Massachusetts,May

17,1942.

indistinguishablesymptomaticallyandother-wisefromthegroupwhogototheWhite

House.

Theavowedpurposesofthevisitsofthesepsychoticpersonshavevariedovertheyearsincorrespondencewiththevaryingproblems

engagingpopularattention.Forinstance,oneoftheolderhospitalrecordsdescribes

amanwhowenttotheWhiteHousetocom-pelPresidentClevelandatthepointofapis-

to!

torecognizetheKnightsofLabor.For

severalyears

afterthelastwarpsychotic

ex-soldierscameto

WashingtoninfairlylargenumberstoseethePresidentortheDirectoroftheVeteransAdministrationaboutobtainingapensionorincreasingthe

amountofapension

alreadybeingreceived.Inrecentyearswehaveseenanincreasing

numberofpatients

who

havecometo

Wash-ingtontoofferadvicetothePresidentaboutsolvingtheeconomicproblemsofthenation

orof

theworld,oraboutpreventingorwin-ningthewar.Butitisonlythecontentof

thedelusionthatchangesduringthe

years-the

patient

otherwise

essentiallythesame.Of

patientswhosecaserecordswerereviewedforthepurposeofthispresenta-

tion,therewere

whocametoseethePresidentandonlyonewhoaskedtoseetheVice-President.Theothersexpressedde-sirestoseetheSecretaryoftheTreasury,theSecretaryoftheNavy,theDepartment

Justice,theChiefsoftheFederalBureauofInvestigationandoftheUnitedStatesSecretService,theChiefJusticeoftheUnitedStatesSupremeCourt,theDirectoroftheVeteransAdministration,thePatentOffice,theirrespectivecongressmen

and

senators,ormerely“thegovernment.”WhiletheirpurposesincomingtoWash-ingtonwerevariouslyphrased,usuallytheyhadtodowiththeobtainingofmoney,thegivingofadviceastohowbettertorunthegovernment,ortheobtainingofrelieffromallegedpersecution.Twenty-oneinthegroupstudiedcametodemandfederalinvestigationofclaimedpersecution,itscessa-tion,andpunishmentoftheallegedpersecu-57’

572PSYCHOTICVISITORSTOGOVERNMENT

OFFICES

[Jan.

tors.

Inthisnumberwereseveralwhode-mandedredressformentalhospitalizationintheirhomestatewhich,theyclaimed,was

unjust.

Afewwantedtolearnwhytheycouldnotobtainorholdemploymentor

wanted

presidentialaidinobtainingemploy-

ment.

Fiveofthe53cametocollectfabulous

sums

whichtheybelievedwereduethem.

Notevenapatientwithgeneralparesisis

moregrandiosethansomeofthesepatients.Onewoman,a32-year-oldnativeofRussia,hadbeeninthiscountryfori8years,hadmarriedattheageof

5andseparatedayearlater.Allherlifeshehadworkedin

factoriesatameagersalary.

ShecametotheTreasuryDepartmentinWashingtonde-

manding$300,ooo,ooo

which,sheclaimed,wasbeingkeptthereforher.SheclaimedthatherfamilyhadoriginallyloanedthismoneytotheEnglishgovernmenttohelpthempaytheirwardebttotheUnitedStatesandthatQueenMaryofEngland,towhomsheclaimedrelationship,hadnowbrought

thissumtotheUnitedStatestobeturned

overtoher.Anotherpatient,whosegrandi-osityhadareligiouscoloring,cametoWash-ingtontogetpresidentialassistanceinobtain-ingapatentforaflame-throwerwhich,heclaimed,coulddestroyalltheenemiesoftheUnitedStates.WithamarkedSlavicac-centhewouldpatientlyexplainwhohewas“There’sGodwhoisNumber

andJesus

Christwho

Number

andme,IamNum-ber3.”Therewere5

inthisgroupwhocame

toseeaboutobtainingpatentsforbizarrein-ventions.Sevencametoobtainpensionsortohaveexistingpensionsincreased.SevenwishedtooffertothePresidentortosomeothergovernmentofficialadviceastohowtoimprovetheconductoftheaffairsofthenation-domesticandforeign.TwoclaimedthattheyhadbeenelectedtotheofficeofthePresidentoftheUnitedStatesandcametoWashingtontobeswornin.TwocametojointheFederalBureauofInvestigationasoperatives.Themissionsof4otherswerevaguelyandincompletelydescribed.Mypurposeinreadingthecaserecordsofagroupofconsecutiveadmissionswas,inpart,todeterminewhethertheadditionofthefemalesexandcoloredracetothestudywouldalterthegeneralpicturewhichIhadformedfrommyexaminationsmadeonlyonwhitemales.Ifound

that

there

wasa

greatdegreeofsimilarityinthesepatientsirre-spectiveofraceorsex.However,Ididfindthatthemalesex

and

thewhiteracepre-dominatedinthegroupsince

ofthe53patientsweremenand47werewhite.This

ahigherproportionthanwhitemenforminthetotalofcivilianadmissionstothehospital.Theageonadmissionofthesepatientsvariedfrom

19yearsto70

years,withamedianof44years.Forty-threewere35

yearsof

ageorolderwhenadmitted.This

isinagreementwiththecommonfindingthat

theparanoidtypesofpsychoses(asthesearegenerallydiagnosed)tendtooccurlaterin

life.

Themaritalstatusofthemembersofthegroupisstriking.Ofonly5(outof53)pa-

tientswas

itrecordedwithoutqualificationthatthey

weremarried.Fivewerewidowsorwidowers.

There

were15divorces

and

separationsinthegroup

and

had

never

beenmarried.Frequentreferencesweremadeintherecordsindicatingfrustration

insex

lifeandpovertyofsex-experience.Delusionsandhallucinationsreferringprom-inentlytosexfunctionsandsexorganswerecommon.Notonlyweremaritalpartnerslackinginmanyofthesecasesbutalsofrequentlytherewerenorelativesorfriendssufficientlyinterestedinthepatienttorespondtocor-respondencefromthehospital.Anumberofpatientswereorphansraisedinorphan

asylumsorfosterhomes.Mostofthoseof

foreignbirthhadnorelativesinthiscountry.Sixteenofthe

53-30percent-wereborn

outsideofthecontinentalUnitedStates.Ofthese,9wereoftheSlavicrace-borninwhatwasonceImperialRussiaorintheSlavicportionofwhatwasformerlyAustria.There

were

nativesofGermany

andoneeachfromSyria,Greece,PuertoRicoandCanada.Inadditiontothese,therewere8patientswho,whilebornintheUnitedStates,hadoneorbothparentswhowereforeign-born.MostofthesepatientshadbeenmentallyillformonthsoryearspriortotheircomingtoWashingtonandtheiradmissiontoSaintElizabethsHospital.Twenty-twohadpre-

‘943]

JAYL.HOFFMAN

573viouslybeenhospitalizedformentaldisease.Therewascommonlyahistoryofunsettleddomicileandpooroccupationaladjustmentformonthsoryearspriortohospitalization,andthismaybepresumedtobeevidencealsooftheexistenceofmentalillnessintheseindividualsduringthisperiod.Only3ofthepatientswerenativesoftheDistrictofColumbia.Thelastextendeddomicileofthemembersofthegroupin-cluded

differentstates.AlthoughCali-forniaisthemostdistant,thenumberofpatientsfromthatstatewasexceededonlybythenumberfromNewYork.Mostofthepatientshadnevermadea

very

goodoccupationaladjustment.Whileafewhadatonetimehadfairlygoodand

regular

employment,practicallyallwereir-regularlyemployedornotemployedatallforaconsiderableperiodimmediatelypriortohospitalization.Theoccupationslistedwerealmostinvariablyintheunskilledtrades-laborers,clerks,domestics,janitors,min-ers,porters,farmers,apants-presser,achambermaid,ashoemaker,aweaver,apeddler.Overhalfthegrouphadlessthananeighthgradeeducation.Two-thirdsofthegrouphadnotbeenself-supportingformonthsoryearspriortotheirhospitalization.Itisofsomeinteresttonotethat,withref-erencetotheirexpressedreligiousaffiliation,therewasonlyonepatientwhoexpressedadherencetoasect.Possiblyadherencetoareligioussect-initselfevidenceofmental

instability-.-obviatestheneedforthis

par-ticularmethodofsolvingone’sconflicts.Twenty-ninepatientsweremembersof

variousProtestantdenominations,19were

Catholics,

wereJewish.Oneclaimedtohavenoreligion,andthereligionofanotherwasnotrecorded.Therearefewtypesofpatientssocom-pletelyandsopermanentlylackinginin-sightasthemembersof

this

group.Yetinspiteoftheirverbalinsistenceupontheva-lidityoftheirbizarreandfantasticdelusionalideas,fewareaggressiveinexpoundingthem.Itistherulethatthesepatientsare,withcertainnotableexceptions,quiet,pleas-ant,congenial,

cooperative

andwellbehaved.Theyaccepttheirenforcedhospitalizationwitharemarkabledegreeofpassivityandfrequentlywithoutevenverbalcomplaint.Theyrarelyattempttoleavethehospitalwithoutpermission.Only3oftheentiregroupwererecordedasbeingfrequentlycombativewhilepatientsatSaintElizabeths

Hospital.Nevertheless,becauseoftheir

completelackofinsightcoupledwiththeirbizarredelusionalideas,theseindividuals

must

beconsideredandtreatedaspotentiallythemostdangerouspatientswehavetocare

for.

Asmightbeanticipated,thediagnosisin

themajorityofthesepatientswithaso-calledfunctionalpsychosiswaseitherde-

mentiaprecox,

paranoidtype,orparanoiaandparanoidconditions,paranoidcondition.Theformerdiagnosis

was

madein

pa-tientsandthelatterin6.Twelvemoreweredesignatedassufferingfromtypesofde-mentiaprcoxotherthantheparanoidtype.Manic-depressivepsychosis,manictype,wasthediagnosisof3more.Fourreceivedthediagnosisofpsychosiswithcerebralarterio-

sclerosis,

andoneeachthediagnosisofepi-lepticpsychosis,alcoholicpsychosis,psycho-siswithmentaldeficiency,psychosiswithpsychopathicpersonality,andpsychosiswith

organic

changesofthenervoussystem(pa-ralysisagitans).Thegenerallyunfavorableoutcomeinthesecasesmightalsobeanticipated,bothfromthediagnosesrecorded

and

fromthe

other

datamentioned.Onlyoneofthe53recovered(apatientwithmanic-depressive

psychosis,

manic

type).Fourmoremadesomeimprovement,buttheremainder-48

number-wereunimproved.Only

thegroupwereconsideredeligible

fordis-chargefromthehospitalandtherest-43-

eitherremainedat

SaintElizabethsHospitalorweretransferredtootherhospitals.TheattractionthatWashingtonholdsforthesepatientsisnotfullyexplainedbythefactthatitcontainstheofficesofthehigh-estrankinggovernmentofficials.Forsome