William C. Menninger, M.D—A Personal Memoir

I first met Bill Menninger in July, 1940 when I arrived in Topeka to continue my residency training at the Clinic. For the next two years until World War II separated us, I, along with others, was with him every day beginning at 8:30 A.M., when we would convene to discuss each patient in the hospital. One day, after the war, Bill, having read a report of the day hospital at McGill University, suggested to me that we start one at the Foundation. He felt that it would improve our care of patients, particularly those who were ready to leave the hospital but still needed to remain in Topeka for a while as outpatients. But the concept he had in mind was based on his ideas of psychiatric hospital treatment. Bill, along with Karl and Bob Knight, had for many years given thoughtful consideration to how the total experience of hospitalization could be used more effectively to enhance each patient's recovery.

He drew heavily upon his knowledge of psychoanalysis and gave particular attention to the ego's adaptive as well as maladaptive operations to develop a therapeutic approach which would involve all aspects of the patient's life in the hospital and all personnel with whom the patient came into contact. This treatment plan was seen not only as useful for the patient while in the hospital, but also as helpful to him in developing new and more effective patterns of living, which together with the insights he might acquire from his psychotherapy would insure a better and more enduring result.

This concept was expressed in the statement: "Psychiatric hospital care should afford specific and continuous treatment, specific in that it is directed toward meeting the conflict of the individual and continuous in that every contact that the patient makes throughout every day should guide him toward the same therapeutic goal."

I have quoted this repeatedly and it has been the basis of my own efforts and teaching over the years. What today are discussed as milieu therapy and the th