Gazette editor John Prendergast and author Stephen Fried talked about Fried’s new book Rush: Revolution, Madness & the Visionary Doctor Who Became a Founding Father shortly after its publication in September 2018. What follows is a lightly edited transcript of their conversation.
So just to get it out of the way: Rush and Penn. What was the connection there?
So the schools that came together that became Penn were the original College of Philadelphia, which Benjamin Franklin started in the 1750s, and then an institution called the University of the State of Pennsylvania, which was created during the last years of the Revolutionary War because of religious stuff going on at the College of Philadelphia. The College of Philadelphia is what started the first medical school in the country, which became later Penn’s medical school. So Rush was the first student of the first courses that became that medical school. He was in William Shippen’s original anatomy class, which, even though that was before the school started, is considered the beginning of medical education in the city. Then John Morgan came back [from studying medicine in Europe]. He started the medical school. He and Shippen then started fighting with each other because Shippen thought that he started the medical school, or they started it together.
I tell you that only because I think people view Rush’s life as being part of the politics of America and the fight over that. But in fact the reason he was interested in that, involved in that, lived in that environment is because he lived in this early academic thing—which was incredibly ugly. I mean, Shippen and Morgan hated each other’s guts, even though they had been friends, over this issue of who started what became Penn’s medical school. And then they brought it right into the Revolutionary War. So it all starts from that.
So Rush took those courses. He then went away [for more training]. Benjamin Franklin mentored him when he was in Europe. When he came back, he taught. He was the fourth professor at the College of Philadelphia medical school. He taught chemistry. And then, when the University of the State of Pennsylvania started, he taught there. And he was a chemistry professor all that time, becoming more and more interested in different things. But his job was to teach chemistry. And a pretty old-school chemistry teaching. You know, do the same thing every year.
And then, in the late 1780s, Morgan died. And Morgan had been the god of early medical schools. And then he died. Rush got his job. The schools consolidated. And then, starting in the late-1780s/early-1790s, Rush was teaching the biggest course, which was the overview course that doctors needed to understand all medicine. And he also began giving the annual introductory lecture. So by that time he was the biggest deal at what was not only the first medical school in the country, but because all these schools have consolidated, a bigger university.
And that’s why, even though Penn is very in love with its Benjamin Franklin roots, the truth is that Benjamin Franklin was dead before there was a Penn. And in the last years, as Penn was becoming Penn, Benjamin Rush was the Benjamin who was really kind of leading this intellectual thing, only because Franklin was old. He was being taken care of. Rush insisted that he wouldn’t even have been in the constitutional group for Pennsylvania unless Rush insisted because they thought he was too sick, even though he lived down the street from where they were meeting.
So when Penn became Penn, Rush was kind of the leading intellectual for science, for philosophy, for medicine, from the medical school. And if there were other people teaching at Penn who were big deals, we don’t talk about them very much. Rush is the most identifiable person at Penn early on—he’s a signer, he’s running the medical school, he’s a well-published intellectual, he’s published lots of books. So from 1790-91—which is when the school kind of started—on, until he dies in 1813, I would say he’s the most recognizable member of the faculty.
How did the lectures at the medical school figure into his other writings? Was that an organizing principle for him—do this annual lecture on Subject X, and then write a book about it?
No. He didn’t write books about them, necessarily. What’s interesting about them is that they aren’t caught up in the medicine of the time. They’re more about being a doctor or being an American. One year he gave a lecture on the responsibilities of patients, which included things like how patients should break up with this doctor, and they shouldn’t break up with that doctor. Who was responsible if the patient didn’t take their medication, the patient or the doctor? A couple of them were big, historical ones. He gave a lecture about Hippocrates and what Hippocrates’s ideas meant [in the medicine of the day]. He sometimes gave very practical advice about how hard it was to be in business as a doctor.
But every year it was different. The idea was just to create a different lecture to raise the curtain on the school year, give the students something to chew over. And the lectures were collected once there were six of them. There was a small collection of them. Near his death they collected 16 of them. And that was just something he did on the side. Rush wrote a lot. He published a lot.
It’s hard to even keep track of all the interesting things that he wrote. I did my best to write about the ones that I found interesting. But I’ve only been on book tour for a week, and I’ve already had people come up to me and say, “Did you ever read this? Did you ever read this?” And some of them I haven’t because there’s just so much writing. He wrote really fast. He was a very good first draft writer. He would have fit in perfectly in our digital media.
He pushes Send a lot. And then he figures he’ll fix it.
In reading about, whether it’s medicine or whether it’s politics, it seemed like there were a growing number of different outlets for people to write. There are a lot of competing voices. Nobody was really paying that much attention to sort of sober fact-checking, and there was a lot of invective and stuff like that.
There was no such thing as fact-checking, yeah.
Talk a little bit about the connections between the media world of that time and our own, and how Rush played into that as a target and as a writer.
Since I’m probably the first person to come to Rush and maybe to any of the historical big Founding Father figures who is basically a freelance writer—most people who come to this are academics with full-time jobs—I was interested in the fact that it was very clear that Rush was a freelance writer on the side, and he was exploiting each change in the media.
We might think that the change to the Internet is the biggest change that ever happened. But when you write about history, and you go back and look at the change that TV caused, the change that radio caused, you can realize that [isn’t the case].
Rush lived through three pretty big changes that he exploited as a writer. The first was pamphleting, which didn’t really exist before. But the pamphlet business in America, you know, we look at Common Sense and go, “God, look how many people were involved in independence because of Common Sense. You can also look at it and go, “God, look how many copies they sold of this thing that no one heard of until they put it out there.” And that was true of an earlier pamphlet that John Dickinson [who preceded Rush on the Pennsylvania delegation to the Continental Congress] wrote called “The Farmer’s Letters,” too. So Rush saw that pamphleting was a way to get his opinions across to people.
And then sometimes the pamphlets would be excerpted in the newspaper. Keep in mind, newspapers weren’t daily then yet. So you have pamphleting. You have the rise of magazines, especially after the Revolution. There’s a handful of the first national magazines. And Rush knows the editors of all of them. And he writes some pieces for them. He digs some pieces out of his drawer that are sitting around for them because every writer knows that a new publication with a lot of white space to fill—and a person who owns it who likes your voice—is a pretty cool thing.
And then from 1790 to 1800 Philadelphia is the capital. And also this is when all the daily newspapers in Philadelphia kind of explode. So you go from having a handful of papers that aren’t coming out every day to having a lot of papers that come out every day. Some of them are what we would consider sort of American factual newspapers. Some of them are more in the European tradition of everything’s an essay; and, if you are Swiftian and funny, it doesn’t matter if you make stuff up. Which is not part of our American journalistic tradition, but is certainly part of what Rush had to deal with during that time.
So he benefited from these things as a writer. He got ripped to shreds during and after the yellow fever epidemic for the same kind of freedom. And the thing that is challenging is to make sure that you take into consideration where things were published, when they were published, if they were retracted or changed the next day, but you can’t have access to the retraction. Because a lot of Rush’s things got republished a lot of times.
So in order just to get the version that came out when it came out, we had to work really hard—because you can go on and get digitized versions of a lot of Rush’s writing. But a lot of it is later versions of the writing. And we know that Rush changed things every time he had an opportunity. He was a classic rewriter.
Rush gave away most of the money he made from writing to charity. But there were substantial monies to be made with a big pamphlet. And you can see how the publishing companies advertised them.
We only pay attention to Benjamin Franklin as a printer. But the printers during that time were really interesting. They had a big impact on all this. And Rush was smart about that. His name meant something. And as he became bigger, he would be tied to sales. So people knew that if you put out his book again with a new chapter, people would buy it, and that he would promote it. It would sell in Europe. He was one of the only American writers whose books would sell in Europe.
Sometimes they would have to physically take [books] over. There are letters between him and Thomas Jefferson. Jefferson’s going back to France, and [Rush] is like, “Can you take some books?” But there were companies that printed him in Britain, and he had relationships there and elsewhere.
But the publishing business, I don’t know, my goal in doing these books is to really pay attention to all the characters, not just the main character, to do the family relations, and as much as possible to try to use the opportunity to just go inside whatever thing you’re doing.
So if they’re writing, what does the publishing business look like? If you’re going from being a doctor to being a Continental Congressman, what do you get paid for that? And can you afford to do that if you’re not rich—because I always have to remind myself that a lot of these guys were wealthy and had big plantations. Rush was a hard-working city doctor whose dad was a blacksmith and died when he was five, and whose mom ran a packaged goods store. So even when he married into a wealthy family, he did not have the luxury to do some of the things that some of the wealthier people could do.
Talk about politics a little bit, and how Rush became a signer of the Declaration of Independence. Maybe this is an oversimplification, but as I read the book it seemed like he slipped in with Franklin’s blessing after John Dickinson left?
You’ve got to keep in mind a couple things. First of all, Rush was much younger than these guys. And when the first Continental Congress came here in 1774, Rush was under 30. And on the side of his medical practice, which he was desperately trying to improve, and his writing career, which he was trying to improve, he had gotten involved in some revolutionary activities. He had coauthored the proclamation that led to the Boston Tea Party, which was published here in Philadelphia and then republished in Boston because they thought it was good. They didn’t want to rewrite that. They had other stuff to do.
He had written a very controversial pamphlet—not only against slavery, but against racial prejudice [against] free blacks, as well. And he said, like, “I’m a doctor. Black people are the same as white people. So slavery is terrible. We shouldn’t have slavery. But you also shouldn’t be prejudiced against black people.” He lost a good bit of his business in Philadelphia when people found out that he wrote that. And so he was considered part of the local Sons of Liberty group. Now you see it because there’s been movies made about it and stuff—it’s like they had a whole clubhouse and secret handshake and everything. They were just a handful of people who were known to be interested in independence.
And so when the Massachusetts delegation came, these Philly Sons of Liberty, including Rush, who’s like a kid, went out to meet them and to talk to them about their ideas about strategy for the Continental Congress—because they worried that John Adams especially was going to try to lead everything because the people from Massachusetts were in the most danger. And they were trying to say, “Look, if you don’t let the Southerners have their say, and in fact make them think that they’re in charge, they’re never going to go for this.”
And Rush also wanted to explain to them that a lot of Philadelphians they would meet would seem like they were interested in independence because these guys were kind of like the independence rock stars. But in reality they were afraid of independence, or some of them were just dead set against it. Some of them were loyalists. They truly didn’t want the British to be pushed out. Some of them were Quakers and didn’t believe in fighting. And some people just didn’t want change.
[Rush’s] role in the First Continental Congress was that people came over to his house to eat because the doctors were some of the hosts of the Continental Congressmen. So John and Sam Adams came to Rush’s house quite often for food. The only thing John Adams really had to say about Rush when he first met him was that the food at his house was great. They had wonderful melons. And the view out of his back windows of the Delaware River was really beautiful.
It’s not like in Adams’s original diaries you see this great friendship starting. [Rush is] one of the local docs. And he treated some of them. He gave Patrick Henry a smallpox inoculation when they were there. And he was a gossip. He knew everybody. They would see him at the restaurants. He loved the politics. They would tell him stuff. He was like a local doctor who knew everything. And they all went home, and no one knew what was going to come of the First Continental Congress.
So by the time of the Second Continental Congress, Rush was much more involved. He had been working with Thomas Paine the whole fall of 1775 as Paine wrote Common Sense. So Rush had originally had the idea to write Common Sense, but he was afraid to write it and ruin his medical practice. So he convinced Paine to do it, figuring if the whole thing crashed and burned, Paine had less to lose.
And he actually wrote that later. I don’t know if Paine ever saw that, but [Rush] did write that. And they worked the whole fall. And then as the Continental Congress returned, they were doing this. And this thing came out. No one knew who wrote it. And it drew a ton of attention. And it was the curtain raiser for what then happened that spring and summer when the country decided to declare independence.
And so Rush was really involved in this stuff, but he wasn’t in the Continental Congress. He was a representative for the state. And one of the things I always had to get my head around in this, you know, we always hear about state/federal things, and we kind of dismiss them. But of course there was no federal government at this point. So the state governments and the state constitutions were incredibly important. So Rush was working on the state constitution [for Pennsylvania]. And he was fighting all these people who wanted a totally democratic constitution with no checks and balances. The people should just be in charge. One house of legislature. You get rid of the governor, whatever you want. They also wanted oaths to Jesus. And he fought that, even though he was Christian.
So he was involved in state politics, and he was monitoring local politics. Again, Adams was still coming over to his house. He knew what was going on. He was friends with these guys. I don’t know that he thought that he would be in the Continental Congress. He doesn’t tell us that. He’s a great narrator, I must say. And he narrates some things really in depth. But I don’t know if he was surprised because I don’t know if he was surprised that John Dickinson wouldn’t vote for the Declaration of Independence. I think that they all thought—because Dickinson wasn’t against independence. He was, as a lawyer, he just felt that it was coming too soon. And he still wanted to see if they could make a deal. Because we remember that people wanted independence. But in reality what we wanted was to have these taxes taken back away.
So [Dickinson] expected independence. He just thought that Adams and the rest of them were pushing too hard. And it’s very dramatic. Rush knew Dickinson for a long time. We actually found this old mental health case which was the first time that Rush really spent time with Dickinson. Dickinson’s best friend became manic and Rush was the junior member of the medical team that treated him in his house. So Rush had known Dickinson for a while.
And all we can see is that Adams and Dickinson are fighting. And Adams hated Dickinson because he thought he was holding things up, and Dickinson thought Adams was pushing too hard. And Rush is kind of watching this. We don’t have a ton of information about day-to-day life. The one bad thing about writing about these guys is [that] when they’re not near each other, and they don’t write letters to each other, a lot gets lost, unless they recount it later.
The reason that you see the stories of the Declaration seeming so lightly sourced is because we’ve made a lot out of a little bit of information, because nobody really wrote about it so much in detail. What we know is that Jefferson finished the Declaration. Rush was actually writing the Declaration for the State of Pennsylvania because every state had to write a Declaration of Independence, too, so that the states could ratify the federal thing. And then in the middle of all this, Dickinson—they can’t get the Pennsylvania delegation to agree to it. It’s the last delegation that has to agree. And Dickinson finally agrees to abstain and then quits.
And a week or two later, Rush’s name starts coming up. He’s in there doing stuff before they technically make him a member. But he joins in July, and he is the representative of Pennsylvania when the thing has to be signed, which is on August 2nd. But in his writing we don’t see him going, like, “Oh, my god, I’m in the Continental Congress.” It’s almost like he thought he was kind of an honorary member already. He was very involved. And I think he was very honored to do it, and he wrote really eloquently about what it was like to sign it.
I think his writing is some of the best writing, just [on] what it was like in the room. You see it quoted a lot. And he also made a little joke. He remembered that one of the guys who was very heavy joked to one of the guys who was very thin that, when they were all hung for this, he would go faster because he was heavy, and the other guy would dangle for a while.
So he’s in the Continental Congress. He still has his medical practice. And he is put in charge of the medical committee. And at the very beginning of the Army, the medicine was terrible and he was trying to improve that. And I think he also knew politically—again, we only remember national politics in this, who was involved in independence, but Rush’s ability to be a Continental Congressman was based on his involvement with state politics—and he was in the minority against these Tom Paine people who all wanted this very democratic constitution. So he ended up being voted out of the Continental Congress because of state politics.
But he ultimately was more interested in—or more drawn to—what he could contribute. So at a certain point in the fall [of 1776] he kind of wanders away from Congress, gets on his horse. He takes his his 17-year-old wife, who’s pregnant, away from the fighting, sends her to a family home in Maryland. And he and his assistant—his servant, not a slave—go to the Delaware River, where the Pennsylvania militia is, where Washington’s militia is right above them.
Four different groups are there at the Delaware, wondering if they can stop the British, who have just eaten up New York [and] all of North Jersey, and this is like the first stand. Not the first stand. They’ve already lost all the first stands. And so Rush is there. He’s at the Pennsylvania Delegation. And he’s right in the thick of it. He goes up to see Washington. Washington sees him. They spend an hour together in his tent. And Washington is very nervous, and he sees that Washington is holding pieces of paper in his hand, and he sees one of them says “Victory or Death,” which is a great image that we see everywhere.
It’s funny, there’s a lot of images that just come up in every Founding Father book, every American Revolution history book. The people don’t remember they were captured by Rush’s eye. It’s not like a million people knew these stories. It’s that Rush wrote these stories down, and they proliferated out. In some cases people didn’t even credit Rush with writing them because they knew they were true. So a lot of things that we know about certain interactions come from Rush. People just don’t always know they come from Rush.
But Rush’s descriptions of being involved in the crossing of the Delaware are wonderful, and they really give you a handle on what was this crucial turning point in the war. It was a damn cold night. And they win the Battle of Trenton, and then they go on to win the Battle of Princeton. So Rush is there on the battlefields. The British came and took Philadelphia, so there was no fight at Penn. But Rush went to college at what was then called The College of New Jersey. I mean, Nassau Hall, where he had taken all his classes and where he’d gone to church, the British were using that as their main place. And his wife’s family had a mansion right down the street from there, Morven, and the British had taken that over, too.
So here’s Rush on the battlefield. He’s treating people he knew. And the enemy—because, once the fighting is over, the doctors treat everybody. And he’s looking at Nassau Hall, which is full of cannonball fire on the side, from us taking it back from the British. And then he has to go to his in-laws’ house, which he has great affection for, he’s been going to for a long time because he knew his in-laws before he married his wife. And it’s decimated. And those scenes are great. He describes them beautifully.
And there are other descriptions of that because Princeton—you can tell the places that really did history work on their battles, and thank god for them because it’s not like everybody lists everybody who’s there. But when you’re trying to find out about anybody but George Washington, you’re looking at a lot of sources and just trying to figure out, “Okay, who was where?”
Rush signed the Declaration. He’s in the Continental Congress. But you can already see that his interest in day-to-day work is more medical. He’s interested to have political power. He has some because he’s in the Congress. He has some because he’s friends with Adams and Jefferson and, frankly, Washington. He knows all these guys. He’s had dinner with them a lot. You know, if he sends them a letter, they’ll read it. In a way, no matter where he goes after that, he was there at the signing. He was there at the battles in New Jersey and Pennsylvania. And these guys, I think, view themselves as the people who were together during that time. Because after that they were diffuse. I mean, Adams was sent to France, and Washington was fighting, and people didn’t see him for long periods of time.
So that’s why this group in their relationships are so interesting. And Rush’s relationship with all these guys in some cases has not been paid as much attention to. But it’s incredibly interesting, one; and it’s great connective tissue. I mean, no matter what you think about the controversy surrounding Rush, there’s no question that you can’t really tell the story of the American Revolution unless you take him and what he can teach us into consideration.
And that’s what was so cool about it. I mean, I would say in some cases I was learning things for the first time. It’s not like I didn’t take classes in this in high school. But no one ever makes you go from this battle to this battle to the politics of this. So when you hear it when you’re in junior high school or high school, it’s like, “Okay, we won, that’s good. Red coats, you know, whatever.” But to have to break down the time period and really show what’s happening and see people losing battles and going home after losing battles, that was really cool.
And I have to say, whenever you write a history book, you do get to relive the history that your character lived. And I think you bring to it whatever you become fascinated by. And for some of it, you do research that no one else did before. Some of it you connect some dots people didn’t before. Sometimes you just write about something that everybody’s written about before, but hopefully you bring a little bit more of your own words to it. Because we are immune sometimes to the drama of this; we’ve heard it a million times and a lot of times we’ve heard it from people who kind of droned on. It’s good to be reminded how unbelievable it was that we won this.
Related to that, I was struck by how quickly politics got ugly, and also how conscious all of these guys were about history, about that story being shaped, and all the back-and-forth about, “Well, you know, let’s suppress this letter. Let’s burn these.” It has to do with the notion of this thing in the happening. It’s in the moment. It happened. And then they’re thinking, “Okay, well, now we’re done. And now some people hate me.” So was that surprising to you? The fact that people would be burning things or saying, “Well, no, don’t tell people that I thought that about this thing?”
I will point out that, every time you quote a letter that says “burn this letter” and the person didn’t, you have to ask yourself whether “burn this letter” is also sort of an affectation.
Although sometimes there are copies of the letters. But your point’s well taken. Honestly, yes, I was surprised by it. And I was fascinated by it. And what I tried to do as often as possible is [show] when there was evidence of it in real time. Because again, it’s way too easy to take analysis later on and bring it back to what was happening. And I see that way too much in a lot of history writing. I tried to do really intense reporting, and the students who worked with me, if we had an idea, and we weren’t sure, we would call the editor of the Washington Letters [for examples] and say, “Do you think this was known at this time?” Because it was really important to say, “What did people know then?” So, if somebody wrote a letter at a certain time that says they’re feeling a certain way, then you could prove that. And if not, you’re looking for the media. But you try not to impose “I wonder if they were thinking” kind of stuff. And we tried, as much as possible, to only go to things that we could see people were thinking about.
And what’s nice is that, in the very small world of writing—again, freelance writing and book writing—the first history of the Revolution is written by Rush’s protégé, and one of his first students, a doctor named David Ramsey—who has left Philadelphia, he has a practice in South Carolina—but is writing the first book on this in the 1780s. And everybody knows it. And he’s asking Rush for information. He’s asking other people for information.
I guess you could argue that this is America. This is democracy. As soon as there’s no king, there’s publicity. There’s spin. It’s democratic how history’s going to be retold, too.
I’m not sure people pay that much attention to David Ramsey’s book. It’s not that good. But in the world of these guys who have just lived through this war, went through a pretty quiet period, then finished the Constitution, they’re setting up a government, and then this book is going to come out. And this book is going to be the first word on who did the best things, and who was really in charge, and blah blah blah blah blah.
So it was Rush’s protégé who wrote it. And he actually asked Rush a lot of questions. When it came out, Adams especially was furious. And you could see the letters back and forth between him and Rush because he’s saying, like—you should get the classic quote. I’m not going to do it off the top of my head. But here’s the history of our Revolution, you know. Benjamin Franklin had lightning come down, and George Washington killed everybody, and we won. So implicitly it’s like, well, where’s Adams? Where’s Jefferson? Where’s the rest of these guys?
These guys were very open with Rush. These letters are very personal. It’s like—I belong to the Sporting Club now, and there are certain things you say to somebody in the whirlpool or in the locker room you would never say dressed. There’s a lot that people said to Rush that they would never say outside of these letters. And so I spent a lot of time with these letters, really making them personal. I think a lot of people have spent a lot of time with these letters trying to make them into political theorizing. I’m not uninterested in political theorizing. But I’m more interested in the story. And they really inform the story.
So from that very point they’re thinking there’s a little bit of an idea of what’s posterity. Now, look. All people, when they reach a certain age, wonder about posterity. It’s not like we invented this in America or something. But what’s interesting is that these guys realized they had done something amazing and realized that the story was being written and rewritten.
In the 1790s, when Hamilton started being a player, there’s a great thing where Rush includes Hamilton in one of the lists of Founding Fathers in a letter to Adams. Adams is like, “What are you talking about? Hamilton wasn’t a Founder. He barely was in the war. He just used Washington’s power for his [own gain]” I mean, they did not like Hamilton. And Hamilton did not like them. And Hamilton and Rush really had a thing.
But they did think about how they would be remembered. And keep in mind, as we say, these are personal letters, and you should burn them. Some people look at those letters and go, “You know, letters at that time were more of a form of open communication.” If you sent somebody a letter, you probably expected they might read it aloud to their family. Other people might see it. It’s not uncommon for a letter that you get to then be printed in the newspaper to pass on information.
We think that we invented this world where there’s sort of no rules of privacy, and things can get out. But I would argue that as soon as there was a democratic press, it all was no holds barred. And I think sometimes people liked it that somebody got a letter from overseas and printed it, and it showed that they were really thinking about important things. And other times they’re probably like, “You put that in the newspaper? Are you out of your mind?” Which is no different than you taking an email somebody sends you and forwarding it to people.
So I do think that, in a funny way, in their own world, they were involved in a sort of instant, whatever passed for instant, communication and then in the aftermath going, like, “Oh, geez, I’m really sorry I wrote that or I did that.” So there’s a lot of that. And it’s on subjects high and low. And it was happening for a while.
And then yellow fever happened in 1793. And I think after that the media was so involved in that, so involved in the arguments and the aftermath of it. And in a funny way, just like Trump, they realized, like, it gets ratings if we fight about this in public. Suddenly these medical fights, and the political fights under the medical fights, are more in the newspaper because they sell newspapers. And they’re a way of getting people upset.
And it’s really fascinating and horrifying because, honestly, some of the stuff is written by journalists who don’t think that things have to be true. They come from a more Swiftian higher truth. But I’ve seen some of those things repeated later because you could find them in America’s historical newspaper database. “Oh, it’s a newspaper.” To us, even a very biased newspaper we expect to be sort of factual. And, in this case, not so much.
So I think that posterity was something they all understood. Every letter could be your last. And they were definitely always thinking about how they would be known, especially because America was this real-time experiment in the beginning. They did not know if it would last. They still didn’t know if they were going to be part of history or, truly, that this whole thing would be history.
So it is interesting to see that. And I find the period in Philadelphia the most interesting for that reason, because once the government went to Washington, it’s away from everything. There’s no there there. Right? But when the government was in Philadelphia from 1790 to 1800, it was in the middle of the biggest city in America. Everybody was watching. And it’s so rich what we have from that time period because of that. And you also see President Washington’s entire reign, President Adams’s entire reign, the earliest decisions that the country makes, in a city that’s not that many blocks. Right? We’re going river to 10th Street, Race to Pine.
In this little world, which is the biggest little world that exists in America at the time—New York is catching up, but Philly’s still the center of everything, finance, intellectualism—it’s happening in front of people. Whereas, in a way you could argue that they went to Washington to get away from everybody’s glare, right, and just kind of do their job in the middle of the swamp.
Rush was insistent they not go to Washington. He said, “You’re going to be so unhappy. The weather there sucks. There’s going to be mosquitoes and hot every summer. You’re really going to wish you did not leave Philadelphia.”
You were talking about the yellow fever—another very dramatic part of the book and not a subject that I really had known a lot about beforehand. And two things hit me about it. One is just the heroic efforts of Rush and others to treat people, and his own experience with the disease. But at the same time, just how way off base everything that everybody was trying to do was. That must have been an important part of that world, too—this immense struggle to figure out these kinds of diseases, but really not having any kind of useful tools to do that.
I have to say that section was the most challenging thing to do in the book because it is the part of Rush’s life that has been written about the most. And I think written about most judgmentally, meaning when you have an epidemic of a medical disease that you now know that everything they did to try to treat it was wrong, it’s easy to look at it and assume that they knew it was wrong, and they just willfully did it anyway. And I see a lot of writing that underlying it is that [attitude]. And I don’t think that’s accurate. I think these guys were fighting.
And I think the idea that less treatment turned out to be a little safer doesn’t change the fact that everybody thought that what they were doing was curing the disease. And since there’s still no cure for the disease today, you know, they were all wrong. They didn’t know they were all wrong. And the honest truth is, for over a hundred years after that, they didn’t know they were all wrong, either.
But here’s how it got skewed. And in our Hamilton world it’s an interesting thing. The only thing Hamilton really contributes to the yellow fever epidemic is, in the middle of it, he announces that he had the yellow fever, and he was cured by a doctor who wasn’t Rush—because his treatment was right. And that becomes known as the “Federalist cure.” So no one knew at the time that Jefferson wrote this really funny letter saying, “Well, if Hamilton was cured, that’s because he never had it in the first place, because he’s really a wuss, and he didn’t fight in the wars, either.” I mean, there’s a lot of that kind of stuff back and forth.
But keep in mind that a lot of people who got the treatment for yellow fever were afraid they had yellow fever. They didn’t necessarily have yellow fever because, even though 10 percent of the city’s population died from yellow fever, many people were treated for it who just were afraid they had it. So we don’t have accurate records of what really happened.
But what I wanted to do with yellow fever was two things. One is that I didn’t want to make it the centerpiece of the book because in most Rush-related writing it’s the whole thing. It’s three months in Benjamin Rush’s life. Three months. There were a couple of comebacks of yellow fever after. It’s important. It made a big difference. But you know what, it doesn’t change most of the things that Benjamin Rush did in politics, in medicine, or anything else. But because they were all wrong on yellow fever, because bloodletting—which was a common treatment during that time—a hundred years later, they finally say, “No, we’re not doing this anymore. It doesn’t work.”
That’s the whole story we hear about Rush. Like Rush was this crazy guy who just was treating people, and every time he treated them they were dropping dead in his hands. He didn’t realize that it was because of his treatment. But there’s no evidence of that. That kind of hyperbole actually comes from later writing when the whole thing gets politicized.
So what I wanted to do was a couple things. I wanted to be medically accurate. I wanted to only push the buttons on the things that I thought were truly dramatic at the time, not what became a big deal afterwards. What was Rush living through at the time? And we were also quite happy that we found the letters from Rush’s wife to Rush, which no one had ever published. I don’t think people knew they existed. They’d actually been sitting in the Philosophical Society for a while, but no one had ever published them.
So obviously this book was about Rush, about his family. We were interested to see the relationship between him and his wife during that time. We were interested to see the relationship between Rush and the other doctors, and with the city government.
Also, this is really a story about black/white issues. And you can’t separate the fact that, the night before they realized the yellow fever epidemic was happening, Rush was one of the guests of the celebratory dinner because he had helped the black Christian community build the first black church in Philadelphia. And they were celebrating the roof raising for that. And it was all about the fact that some white people in the city and the African American community had come together to make sure that African Americans could worship among themselves—because they were being pushed to the back in the balcony of the white churches.
And the yellow fever epidemic itself became a black/white thing, because many of the white doctors left. Rush convinced the black clergy leaders—Absalom Jones, Richard Allen—and other people to become [involved in treatment]. They refer to themselves as nurses, the black nurses, who were treating [patients] with Rush, and sometimes when Rush was too sick they would go out and do the bloodletting themselves. Now, people hear it, they go, “Oh, my god, that’s terrible.” Keep in mind that doctors didn’t normally do bloodletting. That was done by, like, a barber. I mean, it was a surgical technique. People were trained who were not doctors who would do bloodletting, the same way they would cut your toenails or cut your hair or something. I think people sometimes get the wrong idea about this.
So I wanted to place it in that racial thing, too, because I think when it’s all said and done, the medical issues involved with that yellow fever epidemic, they become less and less interesting when you realize that no one knew what they were doing. But the racial dynamics become more and more important because it’s really the first playing out of black/white issues in the nation’s capital. And not only do you have the white communities having to deal with a black person coming into their house who has some power, because they’re trying to help save their lives, but then afterwards this book comes out that criticizes the black nurses, saying that they stole stuff from people’s houses and they overcharged them.
And then the most amazing thing happens. With Rush’s encouragement, Absalom Jones and Richard Allen write their own book, the first copyrighted book ever written by African Americans, in which they tell the story through their prism. An amazing book. And at the end, they take the time in their book to try to explain to white people why they shouldn’t be prejudiced against them. And it’s breathtaking how it’s not angry. It’s an honest attempt to say, like, “We know you’re prejudiced against us. This is why you shouldn’t be.” And to me it’s really the beginning of, in America, honest race relations; of people trying to say, “Why are you so prejudiced against us? Can we talk about this?”
Rush had done some writing about that before, but he had encouraged this book to be published. People don’t pay enough attention to it in the history of American race relations. Just because abolition got pushed off the table for a long time—partly because of the deal that made Philadelphia the capital for 10 years, a Hamilton deal—doesn’t mean that the discussions about abolition and the discussions about racial prejudice against free blacks wasn’t incredibly active in Philadelphia, especially during the time that it was the nation’s capital. The abolition side was very active. The Free African Society was very active. There were national conventions in Philadelphia of abolitionists—even though they weren’t getting anywhere with the federal law.
We tend to focus on when laws were passed as [being] when things change. Rush was involved with the Constitution. He was involved in other laws. But he was really the beginning of social action. It’s like, “Maybe a law will get passed to fix this; maybe it won’t. But we as Americans have to fix this ourselves as part of our own responsibility to the Republic.”
He first proposed public education, college education. He created Dickinson University so there could be a school outside of the cities. He created Fwhat became Franklin & Marshall because he wanted there to be a non-English language college. Get your head around that in our world of immigration right now—a German-speaking college, because German-speaking immigrants should be able to learn, too. They are part of America, thank you. A plan to make sure that there’s no religious prejudice, to make sure there’s no language in the Constitution that allows for religious prejudice. A lot of work to make sure that doctors see mental illness the same way that they see other illnesses.
So that work that he does while they’re all talking about a Constitution is the beginning of people [realizing] there are other ways to change the world and to change America besides passing a law that makes Americans do a certain thing. But the history tends to only be written through when the law was passed. But Rush didn’t expect the Constitution to abolish slavery. And he didn’t expect it to do a lot of these things.
But at the same time he was publicly writing mental illness and addiction are diseases. They are not religious issues. They are not because these people are weak or aren’t trying hard enough. They are ill. We haven’t figured out how to completely cure them yet, but we can treat them. And part of it is making sure that you understand that they are ill. We’re about to celebrate the 10th anniversary of the Mental Health Parity and Addiction [Equity] Act. This is the first law ever in America that says that mental illness and addiction are the same as other diseases. But it doesn’t mean they weren’t the same up until 2008.
So Rush is really trying to figure out what are the issues that are going to make Americans better Americans? What is our responsibility to the republic? What is America going to be if it doesn’t have a state religion? It’s good we don’t have a state religion. We fought against that. But where does religion fit in this? And he was, interestingly, a Christian who was afraid that Christians were going to want to make the country Christian. Because he also had many close friends who were Jewish. He had many close friends who were Deists, or atheists. And the country was supposed to be for everybody.
He wrote a lot of religious things. And I think that people who are very religious read those and assume that means that he wanted the country to be Christian. But the basic premise of America is that you have to be able to have your own religious beliefs, and that other people have to have their own religious beliefs. And just because you have power and you believe in Christianity doesn’t mean you have the right to make Christian rules for the country. And he was really focused on those kinds of things all his life, but especially during this period.
And it gives you a real appreciation for [the view that] let’s not only look at the Constitution and the Bill of Rights. They are unbelievably important. They are the bedrock of our country. But Rush was one of the first ones to make very clear a lot of the questions that we are expected to address as Americans are going to be addressed outside of the reductionist laws that we can make by social policy.
And so when you look at those social policies and the efforts that were made to create equality for women in education, equality for blacks, equality for people with mental illness and addiction, and education, that Rush believed that if we didn’t—keep in mind a lot of people could not read and write at that time. So he was like, “Okay, we have our own country now. It can’t just be that rich people are educated. Everybody has to be educated if we’re going to be America. So we don’t have those schools. We don’t have those teachers. We’ve got to do it. And unless the government’s going to pay for it, then we are going to do it the same way that Benjamin Franklin got a bunch of rich people in Philadelphia together to start the College of Philadelphia, to start Pennsylvania Hospital.”
So he was taking that idea that Franklin had used during his most active period—before the war, when he created the Library Company and all those things. Rush was saying, “Okay, what is the post-revolutionary version of what Franklin wanted to do? What are these associations that we’re going to build that are going to try to address these problems that are probably too big for people in the North and South to agree on right now?” And some of them he did through Pennsylvania because of course a state was a piece of government that you could impact.
We’re doing the excerpt from the end of the book, which talks about Rush on the Mind and those things. And there are some of the same issues as with yellow fever, which is that it seems like Rush had some very important and meaningful insights about what mental illness is—and, at the same time, in the struggle to treat it or cure it, also had a lot of ideas that we would not think of as being very accurate.
It’s interesting. I actually have come to feel that I disagree with that statement. A lot of the things that were used to treat what we now know are infections—bloodletting and purging and wine and bark, which were the main treatments—didn’t do a damn thing. But a lot of the things that Rush and some of the early people who were in Rush’s time period and right after who were dealing with in terms of treatment mental illness, some of their treatments weren’t as crazy as using bloodletting for yellow fever.
I had a really interesting conversation with Peter Whybrow, who was the head of the psychiatry department at Penn for years. He had an office with Benjamin Rush overlooking him all his life. He’s now out at UCLA. Very early on in the process of writing this book, I called him. I know him a tiny bit through mental health politics. And I said, “Peter, please tell me if I’m out of my mind for saying this. But if you’re one of the first people to actually try to treat patients with mental illness, and not just put them in a warehouse and chain them to the ground and hose them down every once in a while, and you’re looking at people who are manic, who are psychotic, who do not have control of their minds, and who are people that today we might treat with the most extreme treatments to try to break that cycle of mania or psychosis—we would give them very strong antipsychotics, and before that we used ECT (electronconvulsive therary) for that. We still use ECT to break cycles of mania, mostly depression, that are untreatable with medication—am I wrong in thinking that, in fact, one of the only actual uses of bloodletting that would seem medically reasonable, which is to take out enough blood with somebody that they pass out, which is not so different than giving them a little shock until they have a seizure and pass out, that that wasn’t the most insane way of treating mental illness in that time, even though bloodletting comes with all the political baggage? And frankly, every strong treatment in psychiatry even today comes with that kind of baggage from people who are against really aggressive medical mental health treatment. And, you know, he thought for a second. He was like, “No.” I wasn’t going to quote him in the book saying that. What I wanted to make sure of was, if I wrote about the idea of trying bloodletting as a way of stopping a cycle of mania or psychosis, that I wouldn’t be an idiot.
And so that conversation with him really helped me to understand that it was possible, and that you have to say to yourself, the bigger innovation is deciding to take the medical treatments of the day and use them on mental illness. That is bigger than the treatments themselves. But of all these treatments, bloodletting to lower the blood level and probably cause, if not dizziness, then sometimes the person would lose consciousness, is not dissimilar from the way that we medicate people when they are so manic that we have to sort of knock them out to get them to restart. And I realize there’s a ton of mental health politics involved in all this.
They also created some contraptions that people sat in. And if you show somebody a contraption where they’re in a chair and they spun them around, the assumption is this is terrible and they spun them around until they slammed into the wall. Because that’s the anti-psychiatry view of much mental health care—that everything that they think is used too much, they assume it’s only used too much. So there can’t be antidepressants. There always has to be antidepressants that too many people take.
So you look at a thing, and it’s a chair, and it goes around. Why does it go around? Because Rush believed that mental illness had something to do with blood flow to the brain. And guess what? It kind of does. There are many other things it has to do with, too. But keep in mind, at that time all we knew about anatomy was bones, muscle, and blood. And blood was the only thing that you could influence. You could lower the blood pressure. There were certain medications that made the heart go fast, whatever.
So is it rudimentary? Does it turn out to be wrong? Yeah. We don’t treat mental illness now by trying to influence blood flow. We do do scans of the brain, looking for lots of different things, including the way blood flows in the brain.
All I would say is the issue is, when you’re writing a biography, or you’re writing a history, it’s all about what things you dismiss as stupid. And the reader isn’t going to disagree with you, right? When you dismiss something as stupid as a matter of course, you are making a historical judgment. And as somebody who writes a lot about mental illness and addiction, that historical judgment has hurt a lot of people. A lot of people don’t get treatment for mental illness because of the way that people have historically just gone, like, “Oh, shrinks; it’s all ridiculous. Oh, mental illness drugs; too many people take them.”
So I wanted to make sure that I did not do that with this—even though, look, I described the things he did. Some people are going to just freak out when they think of it because they’re also going to freak out that people were locked in cells. That was their treatment during the time. But what I know to be the situation is that Rush inherited mental illness care during the 1780s. The first thing he did was go to the hospital and say, “You know, you’ve been telling people all these years that people with mental illness can’t feel hot and cold. Well, that’s bullshit. And we need heaters in these cells. I mean, you may not do anything else. These cells are terrible. But at the very least, these people can feel hot and cold. Could we give them heat?” So that’s the first step.
And then he and the other younger doctors who worked with him are starting to just try things. They are trying different medical treatments to see what they do. They also try talking to the patients, which no one ever thought of, and writing down sometimes what they think or remembering what they think, knowing that the things that they say which are imaginary had some value. And they even started developing ideas about how you didn’t try to interact with a psychotic way of thinking, or a thought disorder way of thinking, when the person was very sick. But that at a certain point, when they were better, you could talk about the fact that these things that they were saying were delusional.
So, I mean, it’s very rudimentary, but it’s the beginning of medical therapy for mental illness. It’s the beginning of talk therapy for mental illness. They began doing occupational therapy.
The mental health wing was growing, but there was no room. Mental health was the only part of the hospital that people of all walks of life were in. Pennsylvania Hospital was for poor people, except for the mental health wing. Stephen Girard’s wife was there. Other founding fathers’ relatives were there. Later, Rush’s son was there. So Rush finally said, “Look, you can’t improve these cells anymore. They’re horrible. They’re underground. We don’t even know if our treatments work because where these people live is so bad. So I want you to raise the money to build a new building.”
In the history of Penn we pay a lot of attention to the Institute of Pennsylvania Hospital, because when it was built in 1844 it was the first big asylum. It is the birthplace of the American Psychiatric Association. You’ve written about it. Lots of people have written about it. What people forget is that the first important building in mental healthcare in this country was built and finished in 1796. It was the Ninth Street building of Pennsylvania Hospital. They built a separate building, and they later built that part in the center that has all the beautiful staircases. That was the last part.
But Rush made them build a separate building on the other side of the street that was just for mentally ill patients. And some of them were locked in the basement because they needed to be, and others were not because it’s I think three or four floors. And they had some outdoor space where they could actually let people walk in the garden and stuff during the day. And it’s amazing. Very little is even known about this, even at the hospital itself. I finally had to say to somebody, “Let me just be clear: This was a whole building just for people with mental illness; right? It wasn’t just new cells in the bottom and they used the upstairs.” “No. The whole thing.” So what do we know about it? Well, not really very much, because the history of it turned to the bigger innovation. We know so much more about medicine when we start getting closer to the Civil War. But this was an amazing breakthrough. They were able to do more treatments there.
As I try to explain in the book, the person who gets all the credit for doing anything innovative in mental healthcare during this time is Philippe Pinel in Paris. And Philippe Pinel was a genius and did amazing things. I think that if you had Philippe Pinel and Benjamin Rush here next to each other, and they could actually look at what they did when, Philippe Pinel would probably say, “Wow, he and I came to some of the same conclusions at the same time. But interestingly, Rush was more powerful than me earlier. So he was doing some of the things that we tried to put into place in Paris later in the 1790s, after the Revolution, sometimes well after the Revolution. He started putting them into place in the 1780s.”
It’s not a fight. These are two prominent people in the world who are heroes of mental healthcare. And god knows we need as many heroes as possible. But the American story has been untold, because Rush’s history hasn’t been as well taken, or paid as much attention to, by the medical establishment. And as somebody who lives down the street from [Pennsylvania Hospital] who has spent a lot of my time writing about American mental healthcare, I see this as really significant.
And you can watch each thing—you can see the letters he writes to people saying we tried this, we tried that. You can see the letters he writes back and forth to different prominent people whose kids are there. The letters to Timothy Pickering, who he had known as a young man, who was then the Senator from Massachusetts, his son was there, and they tried—there was a machine that you spun on. They didn’t invent that. That was somebody in England. There was a machine that you laid on your back, and they spun. They did invent that, and Pickering’s son used it.
And then there was a machine, a chair that’s always put in things as a torture [device] because people don’t think, “Well, this chair was used so that people didn’t have to be put in a straightjacket, and that every time they had to go to the bathroom, they either had to take off the straightjacket or they had to let him go in the straightjacket and live in it for a while.” So Rush invented a chair that people could sit in. If they needed bloodletting, they could do it. If they needed to go to the bathroom they could do it. There was like a bucket under them. And their heads were partially covered so that their eyes wouldn’t see light so they would be sensory deprived. Now, the notion that sensory deprivation is something that helps people with mental illness or developmental disease—people with autism spectrum have those kinds of issues, too—there’s nothing unmedical about that. I’m not saying that Rush had all the ideas of why it was right.
But the idea that this chair, somebody could say, “This is torture.” Right? People who say that don’t really understand the challenges of treating people who don’t have full access to their brains. When you compare this to being chained to the floor in a straightjacket for days at a time, this is at least a step forward. It’s saying, “We want to be able to give this person treatment. If they have to go to the bathroom, we want them to be able to go and not soil themselves. And if light and all the things around them is bothering them, we want to be able to shield them from that to see if that helps.” But it’s hard to convince people of that.
So Rush was really interested in [mental health] for a long time, worked really hard on it a long time. It wasn’t his full-time job. I mean, he was like teaching, taking care of other patients at the hospital. In 1807 his son John, his oldest son John—who was a physician; who had been schooled at Penn, wrote his dissertation about suicide; who had had some behavioral issues, but was a functioning naval officer and surgeon—got into a duel with one of his closest friends onboard a ship in New Orleans.
Dueling had been a big issue in the political life of the country. Dueling was a combination of our anti-suicide and our gun control. People at the time were amazed that people were dying in duels. Hamilton’s son, who was friendly with Rush’s son, died in a duel. Then Hamilton died in a duel. Rush’s other kid was in a duel. People were in duels. Whatever you as a parent are worried about right now, the parents of the turn of that century were like, “What if my kid gets in a duel?” Because it happened a lot.
So Rush’s son was in a duel. We found out—this was really hard. It took a long time. But we found out the duel was an argument over Shakespeare quotes. We found it in an obscure letter that went up for auction, and we just happened to get a Google hit on it. It turned out there was an obscure newspaper article during the time that actually made the same kind of reference. Which is funny because we know that Rush was really obsessed with the classics. His kids had to read everything. Of course they cared about Shakespeare. And when it comes to descriptions of mental illness, Rush and his son believed that the descriptions, especially in King Lear, were some of the best descriptions of mental illness.
I don’t know what Shakespeare quote they were fighting about, but they were definitely fighting about a Shakespeare quote. A number of people who were there at the time described it as that. He challenged him to a duel. John Rush went to the duel. He had no intention of shooting his friend. But at the last minute he was told that his friend was going to aim true. And so he had to aim true himself. And he shot him. The people who were there described it. He fell into his arms and died in his arms, with Rush’s son apologizing to him.
So after that, whatever was going on with John Rush got worse. And he became depressed. He became more manic. He became suicidal. And the docs who treated him down in New Orleans, some of them were Penn-trained doctors. So they were like, “Are we going to tell Dr. Rush? Are we going to tell this guy who’s like our god that we can’t treat his son? That we don’t know how to make his son stop trying to kill himself?” And then every time he seemed a little better, they would let him out, and they’d say, “Oh, maybe it’s over.” And then it would get bad again.
And finally, after two years of this, where he was in and out, people were afraid that he was going to take his own life, and he tried many times. Although there was some suggestion that, since he was a doctor, they would say, “He knew where to cut himself so there would be a lot of blood, but he wouldn’t die.” Somebody actually said that. Like, “He cut himself in the neck, but he didn’t cut himself in the neck where he knew we wouldn’t be able to save him.” So they didn’t know what they were dealing with.
A contemporary mental health professional would read this and go, “God, this is just right out of today. “ Because you’ve got to remember that doctors just—they observe what’s in front of them. They wonder what’s going on. And when it comes to the mental health symptoms, it’s remarkably the same. Every person that thinks more people are mentally ill now because of the Internet or because of cars or because of electricity or whatever—these are things that have always happened.
So they finally, reluctantly, after two years of this, they reach out to Rush, and they tell him, “I’m sorry, we have to send your son home because we can’t treat him, and only the great Dr. Rush maybe can treat him.” So he’s picked up in Washington. His hair hasn’t been cut. His fingernails haven’t been cut. Rush describes him as some kind of biblical madman. And these descriptions are from letters he wrote to Adams and Jefferson, I mean, his buds.
And they bring John to the hospital, this hospital that Rush has spent the last 20 years turning into the best mental health facility in the world, but one that they still don’t know how to break the cycles of the disease, which in many cases we still don’t today. And they treat him. He seems to get a little better. They bring him home in the hope that that will be okay. They don’t tell us what happened, but within a couple days he says he wants to go back to the hospital. And then Rush’s heir, who was supposed to take over his practice, his teaching, his Dr. Rushness, is a psychiatric patient for the next 30-plus years of his life. And Rush then has to figure how what’s going to happen with his world.
His next son, Richard, is a lawyer, who he’s much more worried will go into politics. Or leave, because now that John is gone he wants to make sure that his oldest son will be able to run the family if something happens to him. Because he sees himself as a sickly person. Rush was tall. He was good-looking. He had good hair. But he was ill, had stomach issues. Had some kind of tubercular thing every fall. Had a cough. He always gave people the impression, I think, that he was burning his candle at both ends and at the middle, too. Also he barely slept. He spent every non-practicing hour either being with his kids or writing. I mean, he makes you embarrassed every second you spend on the Internet or on Facebook, I’m telling you. Whenever I’m working on this book and I’m on Facebook, I’m thinking, Dr. Rush in that same time would have written four essays.
And so at the last minute these things happened. So John’s in the hospital. Rush thinks he might not live too much longer. He wants to get two things done before he dies. One, he’s been trying for years to get Adams and Jefferson to be friends again. So they haven’t spoken in almost 12 years. And he has been writing to both of them, trying to convince them to be friends again.
I didn’t know about that, either.
It’s really great. People kind of know the one-sentence version of it. But to see all the letters and to see the logic that he uses. First he goes to Adams and says he has a dream, and in the dream his son comes to him with a history book from the—the dream’s in the future. His son comes to him with a history book. He opens the page to now, to when he’s writing the letter, and says, “Well, this year is the year that John Adams and Thomas Jefferson got back together, blah blah blah blah blah.” And he said, “I had this dream. I don’t really know what it means. But wouldn’t it be great if it was true?” And Adams writes back, like, yeah, yeah.
Adams and Rush often sent each other dreams. They loved dream letters. And Adams would go, like, “Oh, a dream letter. We all sat around and read it.” Because the family would sit around and read these letters. And he’s writing to Jefferson, too. And he’s going back and forth. And some of this is about politics because this is the original political breakup; right? This is the political Federalist versus Republican breakup. And we forget, we think of Adams and Jefferson as together because they got back together. But the first serious split of people that it mattered that they had been divided by politics were these guys, election of 1800.
And Rush as a doctor, and like a doctor of America, he wanted to heal the country. He’s like, if the North Pole and the South Pole of the Revolution cannot be brought back together, what does this say about what political divisiveness is going to do to America? Besides the fact that they were just his friends, and he wanted them to be back together. So the letters are fascinating. And this is going on at the same time where his son, when he goes to do rounds at the hospital, he has to see his son in a locked room because he’s so floridly mentally ill. And his son walks back and forth all day, gesticulating like this, so that he wears a groove into the floor, which they call “Rush’s walk.”
So he finally convinces Adams and Jefferson to be friends, in part not because of politics, because he tells Jefferson – okay. Jefferson hears a story that Adams visited somebody and said that beyond everything that he still did, he still loved Jefferson. And that that was the final thing for Jefferson. He still loves me. You know, so it’s still about like guy friends, even though they put themselves through all this terrible stuff. And it just reminds me of every political thing.
The last book I wrote was with Patrick Kennedy, so I spent a lot of time with Kennedy politics—the drama of Kennedy politics, and the drama of Ted Kennedy politics, and the end of Ted Kennedy’s life when these sort of bipartisan people who’d all fought him forever just all said this was the way government was supposed to be. People were supposed to care this much. It seemed like another chapter out of that. You know, like John McCain and Ted Kennedy. And it was really moving to me, even though it’s done through letters, I mean, they never saw each other again. It’s just done through these incredible letters.
And then Rush says, “Before I die, I have to write a book about mental illness.” And so he just sits down and takes all his notes, everything he’s ever thought, and he writes this big first draft book about mental illness, which comes out in the fall of 1812. He only has six months to live. And he’s younger than [Adams and Jefferson], by the way. And so he writes this book, and he’s pissed off that no one is—it’s not changing the world overnight, even though Adams tells him that eventually people will understand that this is incredibly important.
And in the meantime he’s getting ill—partly he’s ill because his son Richard leaves and goes to Washington, which kills Rush because he knows that now his family’s going to be run by his 27-year-old third son, who just got out of medical school. James Rush, who’s a perfectly nice guy but he’s not the favored son or even the second favored son. He’s the third son who’s pretty smart, but nowhere near ready to do this. But Rush is going to go. And the poor kid, I mean, there are tickets that James Rush—when his dad dies, and he inherits his dad’s job at the school and his job at the Pennsylvania Hospital, the tickets that you buy for the lectures, always said, “Come hear Benjamin Rush read about this.” When Benjamin Rush dies, James Rush’s tickets say, “Come to hear James Rush deliver the lectures of his father, Benjamin Rush.” So can you imagine what it must be like to inherit the mantle of Benjamin Rush?
I was interested at the end in these founding fathers’ kids, especially Richard Rush, James Rush, and John Quincy Adams. And Hamilton’s son because they’re all, like, “What are we going to do when Dad started the country?” And then Rush dies. And one of the most incredible parts of this [book] is that Rush’s death has been written about a bunch of times, but it’s always been written about based on a letter that James wrote to somebody in which he very quickly described his father as saying his last words were, you know, “Protect the poor. Take care of the poor.” I’ll get you the right quote. And that’s what’s the end of everything written about Rush.
Well, guess what? James Rush wasn’t with his dad when he died. That was just the last thing he said to him. Okay? So while we were doing the book, we’re watching in real time as new letters get discovered. Not just in Philly. I mean, letters from Rush or from the Rushes are going to be discovered somewhere else. So we’re friends with the folks at the Adams project, the Adams letters project especially, because Mass. Historical had some materials, and we were up there. We were up there a lot. So when they would post things, we were always very interested.
And it’s crazy, because you do a search. You figure it’s history. You do a search. It’s either there or it isn’t. But guess what? You search it again six months later, there might be 10 new letters. And we searched it again, and lo and behold, this letter came up that Rush’s wife wrote to Abigail Adams in June, after Rush died in April. And not only does it show where that scene with James fits in, but it’s like a five-page letter explaining everything that the Rushes went through during Rush’s illness, all the way to the end, in incredible, beautiful detail.
Julia Rush was a smart woman. Her mother was the first American woman published in America. She was a good writer. And her pain and her detailed description, I was able to take—and I had originally written the scene before we found the letter, and it was like two paragraphs, like every other end of Rush’s life. And then one day this thing came up, and I’m like telling the interns—we have a private Facebook page called Rushistas, so whenever anybody finds anything, they put it up there so people will see it—and I’m like, “Fuck, I mean, look, look at this letter.” Because it’s so in-depth.
They all knew a lot of people in my life died during the time this book was being written: my closest aunt, my father-in-law, my wife’s best friend, my mother, my closest aunt’s husband, my uncle, and then another aunt all died during this. So there was a lot of that sort of after-death communication, the way people explain what they went through to the end to people who couldn’t be there, but want to know. And you also do that just as part of your mourning process. I told those stories a lot of times.
And to find this, it seemed just like any friend telling me about the last six months of their dead father’s life. It was that contemporary. It was that detailed. Ironically, Julia even said that Rush wanted to be bled at certain times, and she said, like, “No. Enough. Enough of the bleeding. We’re not bleeding you.” It was just so human. I mean, look, all I want when I interview people who are alive is for somebody to tell you the truth. To tell you a real human emotion. To be able to get that for Benjamin Rush, and in a letter between his wife and Abigail Adams, who I find very interesting. And she’s writing this because John Adams cannot get over the fact that Rush is dead. He’s just broken by this. So they want to know everything that happened.
That was, like, so contemporary to me. Or just more timeless. Not contemporary, it just—it never changes being able to talk about those kinds of emotions. It was just so moving, and you really get excited when you get a piece of research like that. It’s nice because you can retell the story and then other people will know the real way to tell the story. But also just to be able to tell that part of the story first was really great, and really very moving. And at the end of a book like this, when somebody like this dies, you should cry. You know, when he tells his son, “Take care of the poor,” it doesn’t make me cry. When his wife describes every last second and says, “What am I going to do now that he’s gone?” that makes me cry.
And then, I spent a lot of time describing, since people want to know, “Why didn’t I ever hear of Rush before? Why is his story so not known?” We did a lot of research trying to figure how out how Rush’s story got suppressed, and why many of us didn’t know the best parts of it. I didn’t know the answer. I assumed it was because of bloodletting or something like that.
But it turns out that it was a very conscious thing on the part of Adams and Jefferson and Rush’s family to make sure that all the controversial material that Rush had, his autobiography in which he had a description of every person who signed the Declaration and what he really thought of them, and a lot of behind-the-scenes stuff that he didn’t want people to know. All the letters between him and Adams, him and Jefferson, many of which were incredibly personal, about people’s diarrhea, about their religious beliefs—I don’t mean to put those two back to back. But just the breadth of everything. Their political beliefs.
When he died, Jefferson especially said, “A couple of these letters I want back right now.” Including he didn’t want anybody to see the letter in which he told Rush that he and Adams were back together after 12 years because it was embarrassing that two former presidents hadn’t talked in 12 years.
So people didn’t know that for a really long time. And we know that story because we hear it on July 4th every year. But guess what? For the first hundred years of people retelling American history, people didn’t know that. And here’s why I know. Because when [Adams and Jeferson died, famously on the same day, July 4, 1826], I looked at all the clips to see what people said about their relationship, including Richard Rush, who was in the John Quincy Adams administration when Adams died. So John Quincy had to go home to take care of his mom. Richard Rush had to give the speech to Congress to sum up the lives of these two founding fathers.
I think he might have mentioned that they didn’t speak for all that time and got back together—which he knew personally, because he had read all the letters. But no one knew that then. Those were among the secrets that the Rush family was supposed to keep, including the secret that Rush had had a terrible run-in with Washington at the lowest point in the war and wrote something very critical about him to Patrick Henry in another one of these letters, the last line of which was “Please burn this after you read it.” And it was sent anonymously. But it did get back to Washington. Washington never forgave him.
That keeps popping up.
I tracked the letter like a character because I knew Rush is afraid of it. And I want to see where it turns up. So I found this great letter that you would never see because Rush’s name isn’t mentioned in it. But it’s clear that Washington, right before he died, made sure that somebody who was friends with Patrick Henry had the letter, so that if he died, which he did six months later, someone knew that at the lowest point of the war, Rush had written this letter that questioned whether he should be the leader or not.
I’m not sure Rush really thought that. I mean, Rush was a doctor. He was repeating what he heard. But he was well placed. He knew all the generals. That was what they were talking about. We’d just gotten our asses kicked in like 10 battles in a row. It’s not like this was a surprising thing. But I think because Rush was Washington’s friend, because he had been a member of Congress, so [Washington] still sort of saw him as his boss, he just felt even more upset by that.
Rush’s family didn’t want people to know that Washington was pissed at him when he died, because by then Washington was the most famous person in history, in American history. His fame was something that people were trying to get their heads around. Fame in the first democratic country is a new thing. You could say it’s bigger than being a king. Or at least as big. So what’s it going to do to Richard Rush, who wants to be President himself, if people know that at the lowest ebb of the war his dad dissed George Washington and said, well, maybe, you know, if you’re going to lose this many battles in a row, maybe either you should put some different generals in charge, or maybe someone else should be in charge.
So they kept that all quiet. And I was amazed at how long, I mean, most of these materials were not available to anybody who was an historian until they were sold at a Biddle family auction in New York in 1943. And some of them, after the auction, disappeared. And some of them the family didn’t sell. Some of them were donated to the Rosenbach Museum in the late 1970s. Some of them were donated to the American Philosophical Society in the 1980s. Some of them are still in private hands.
I have the notes of the guy who was the world’s expert on Rush, Lyman Butterfield, who was the editor of the Adams letters. He was obsessed with Rush, wanted to write a book about Rush, died before he could write it. I found his notes. And I was the first one to open them. I mean, the Massachusetts Historical Society uses his notes on Adams all the time. But no one had opened the Rush boxes. And so I got to see [this information from] the guy who was the smartest guy in the world on Rush up through 1982 when he died—all the questions he wanted to answer, all the stuff that he thought of. I was able to incorporate his ideas and his questions. We tried to answer a lot of them.
But there were also things that he had seen at the time that went into private hands that the only evidence of them were his notes. And he said, like, “Here’s what was in this one thing.” Like the letter Julia writes listing Rush’s bad qualities, and then Rush writes one back on her good qualities except she uses too much firewood. No one’s ever seen that document. It’s only in the notes of the sale. And so I have the auction catalog, which I bought on eBay.
But Butterfield had at least talked to somebody who bought it or saw it before it left. His versions of them were longer. And they only existed in his notes. I tried really hard to find the person who physically has these things, and we could not find it.
The picture of Rush on the cover was in private hands. I found this. A Rush family member had it hanging over his fireplace in Chester County. No one had ever seen this picture before. There was a black-and-white etching of this image that somebody had done later. But the painting was in family hands and had been sitting in this guy’s house his whole life.
So there were a number of things that we came across that you just didn’t have before. I didn’t invent Benjamin Rush. What we did was bring a lot of different kinds of hardcore investigative reporting—sometimes just students going out on a limb, on something that I wasn’t even sure was interesting, but some of them just got obsessed with certain things and wrote great papers about them. And then I credit them and the work they did.
How did the students’ involvement work?
When we started this, when I first got the contract, I went to the English department. I’ve worked with students before. I’ve worked with multiple students before. usually have three students who work with me, and I’m overseeing writing that they’re doing, and we’re doing work together. This time I said, “Wouldn’t it be cool if we did this like for a whole year, independent study, and we would have the people meet together, and we would break up the subject.” It’s like the beginning of – what’s the famous movie with Kingsfield, the law…
Oh, The Paper Chase
Paper Chase , yeah. We break up the subjects, and we’re going to have a report at the end of the year. So I had these nine incredibly smart Penn students. And we broke up the subjects. And I talked to them about how you do this research, how you do historical research the way a journalist does it, with databases and all the books and everything else. How do you raise questions that seem to be of interest in the old books, even if the people who wrote them didn’t answer them? How do you bring what interests you about this and make that kind of come to life? And how do we build a narrative around a guy whose story has been told a bunch of times, but not interestingly, and in many ways not in depth?
So one person did only Thomas Paine and Common Sense. One person did mental illness. One person did race relations. One person did yellow fever. And we had it all broken down. And some people worked on it for a full year. One of the people graduated, and they became my full-time assistant and was the assistant on Common Struggle and on this. And then after that year I had smaller groups.
But Rebecca Heilweil, who just graduated, she walked in here the first week of her freshman year in college. And she worked on this book for all four years of college and was doing the fact-checking after she finished.
Was that part of her academic work, or was it an independent study, or was she just working for you?
You know, it’s a funny thing. She got two independent study credits out of it. She liked the work. And so she stayed with the work. And what happens often with these students is that they come to do independent study. They want to keep working. We get them money when there’s money. But they also often want to stay with the project because they’re getting good experience, because I edit everything else they write, and I help them with career stuff. We navigate the rules of Penn so that everything’s kosher. And basically they need a better paying job in the summer. I help them get one. So some students do it for longer times.
But Rebecca was really into it. She worked on the Patrick Kennedy book, and then she worked on this. And she led the fact-checking. And this is like a 600-page book. The fact-checking on the notes is in and of itself a nightmare. The fact-checking part is paid. It’s an hourly rate. When you do research in and out, in between your schoolwork, it’s one thing. When you’re fact-checking, the fact-checkers get paid an hourly rate.
But up to the end I had two women, her and Julie Levitan. Each had a different part of the book to fact-check. They were getting to the end of Penn. They were graduating Penn. They were done with Penn. We were still fact-checking up through June. And just this incredibly intense thing because it’s very intense, the fact-checking part, especially of a book this long and this complicated.
But I’ve always been amazed at Penn students. I mean, thank god somebody thought I was interesting when I was a Penn student. And I’ve been very lucky through the years. Every book I’ve ever written has had at least a handful of Penn students who devoted way too much time to it because they got some credit, but some of the work they did uncredited because they wanted the mentorship, and I really value what they do. I make sure that I do everything I can for their careers. And I’m still in touch with many of them because of that.
Mentorship changes. I know we both were mentored by Nora [Magid; see “The Nora Network,” Mar|Apr 2013] And mentorship from a faculty member is a moving thing, depending on what people need and what their careers are like, what the world is like, what the rules are like. In the old days we used to be able to help kids get internships at publications.
For a lot of years I’ve had remarkable relationships with students who worked on these books. And the best things about them are when they do research and come to me and say, “You know, what you’re writing here, it’s like completely wrong.” Sometimes they’re really sheepish because they don’t know how to [express] it.
But in fact what I really try to get them to understand is like, if you think something’s wrong, you’re not doing me a favor by being nice to me because I’m your teacher. We’re working on this together. Some of these things you have read more of the materials in depth than I have. So if it’s wrong, you’ve got to tell me it’s wrong. And I can tell you, every book I’ve done, an aha moment that some student, some Penn undergrad came to me and said, “I know you think this is really tasty writing here, but could we like make it more accurate, because that’s my job.” And that is the joy of people who are good, creative fact-checkers, when you see them get the guts up. And that’s because I teach them, that’s how they become good writers and good editors and good whatever they’re going to be.
But this one, because it lasted for so long and because it overlapped with another book, so many people who worked on this book also worked on the Patrick Kennedy book. Because I sold this book. I started working on this book. The Patrick Kennedy book came, and it had to be done first. Since this book is partly about mental health in the past, and the Patrick Kennedy book is about mental health politics, many of the students were interested. Initially, I used to only work with kids from the English department because that’s where I come from and where I teach. But in this book we had history majors, and we had history and sociology of science majors.
I would say to David Barnes, who teaches about Rush in history and sociology of science, “Who’s your best student who would care about this time period?” And he sent me quite a few who became really important parts of this. So I went from just teaching, just having students in my own department, to having students who were interested in the project for whatever reason. And they’re great.
When Kelly Writers House said, “Do you want to do something with the book for Homecoming?” I said that the best thing would be if we could get a lot of the students who worked on the book over the last five years together, to have them talk about some of their experiences, too. And they were like, “That’s great.” So they said yes, and we’re arranging right now for as many of them to come back as they can.
They are, by the way, an astonishingly accomplished bunch. They’ve all done great. And so it’ll be really interesting. And at the same time, because a book like this is kind of endless—I mean, you have to stop at some point, but there are still questions. Like, I expect to see these people, and some of them are going to say, “Did you ever get this thing solved?” And I’ll be, like, “No.” And then I’ll be calling my editor saying, “When we do the paperback, could we have a couple sentences to do this? Because we were finishing this book in July—and we got new information in July that we had to jam into the book. New information about something that happened 250 years ago. I mean, history is alive.
Are there a couple things that they found out that really shaped the book?
There are different places in the book where I can tell you where they contributed. The very earliest thing that happened was that Zoë Kirsch, who was in that original group, she’s the one who found the letters from Julia Rush back to Rush at the American Philosophical Society. I remember when she came to the meeting and said it. People were like, “Oh, my god. We can discover something in history.”
I would say that Dave Poplar, who’s a philosophy major and was involved with the Writers House and went and got a philosophy degree, was really the person who was most helpful on philosophical and religious issues—because one of the issues is what to do with all the sort of religious writing, what it means today. Does it mean that this person is hyper-religious because today if you read somebody who was writing that much about religion you’d say that, or how do we put that in the time? Even though he was gone, he would still, like on Facebook, say, “Do you see this?” And we gave people drafts if they wanted to read them.
There was a woman who worked with us who now is at the Wall Street Journal, who’s a sportswriter, actually, Laine Higgins. And Laine was responsible for a lot of the race-related stuff, a lot of the African American politics-related stuff, the parts that had to do with yellow fever. And that stuff was really hard to figure out because there isn’t a great time period, there isn’t a lot of information, I mean, there’s not a lot of African American writing before that.
We actually had the good fortune that Richard Newman, who is the world’s expert on Richard Allen, was the head of the Library Company for a period of time. And he invited us to come over, and we would have seminars just for a handful of us. And we would get to ask him questions about slavery and about the black clergy and stuff that—because a lot of this is, you run stuff up the flagpole, see if it makes any sense.
What I really try to encourage the students to do is that, too. So I would say that Julie Levitan was really focused on Julia Rush. And because she’s a poetry major, she actually knew the writer figures. Her first interview she said she knew who Betsy Graeme Ferguson was. I didn’t even know who Betsy Graeme Ferguson was.
So come on in. So she really focused on that. She worked more on the front part of the book. But she was interested in the male/female relations, and I think certainly pushed to make sure that the women characters, that we got as much out of them as we could, given what was available in the record.
Rebecca Heilweil was like the overall, I would say, conscience of the whole book. And she did everything from making sure that the citations were right to going back through the war scenes, which were incredibly hard to piece together. But in every part of the book I can see things that she—it’s about a million reality checks. These two things can’t be true. Which one did you research the hardest, and which one do you need the most?
She was the one who spent the most time with it of any of the students. And I would say that she influenced it the most. She’s very interested in politics, very interested in mental health politics. There’s so many examples of things that she brought up, made me look at, made me change. And keep in mind the students are also working at the same time. My wife Diane, who is my primary editor, is editing, too. And if the students have questions, I say to Diane, “How do I fix this?” And we talk about how to fix it.
And then I was very fortunate. This book had three different editors at Crown—two of whom I loved but I never gave them a manuscript. And my final editor was this woman named Meghan Houser, and she was unbelievable. And she had the same kind of involvement in this. You don’t edit at this level. Usually. Especially about the past. But she was interested in the subjects that we were interested in. There were a lot of questions about how do you get religion things right? How do you get social justice things right?
We would have endless debates about whether you can quote things from the past that seem abhorrent to people with the words they used in the present. Lots of discussions about that. There’s just a lot of choices. And also there were things that maybe I should have been more interested in. And then when someone said, “Could we have a little bit more about that?” then sometimes we would have to go back and re-research stuff. So it was very collaborative over a long period of time.
Also keeping in mind, the students are students. They have other stuff to do besides work for me. And every once in a while one of them goes away for the summer to a different job. There was one other student who’s working with me now, too, whose name is Amanda Rota. And she’s an history and sociology of science student who’s going to go to dental school. But she was interested in the project. She was interested in more the medical side of the project. And she also had the horrific job of helping me organize all the pictures. There’s a hundred images in this book. We had to get high-res copies of every one of them, which was its own nightmare.
But what the students bring to it is, one, you’re not completely alone, which is a good thing. And they’re really smart, and they are willing to challenge certain ideas. And again, I could show you every book I’ve written and not only show you what they contributed to it, but I can also crow about the things that they wrote because they were in it. When I was working on the Fred Harvey book, my main researcher, Jason Schwartz, wrote his history thesis on something that he started researching for me and won the history prize that year.
And actually Lily Young, who did the research on the Macpherson case, that was her capstone project in history and sociology of science. And so she wrote about early days of mental healthcare and really went to task on what is, in America, the first well-documented case not only of treatment, but of a guy saying there’s nothing wrong with me. We know about this case, not because there’s so much documentation by the doctors, but because this guy wrote two privately published books that she found explaining how John Dickinson and all these other famous people made him appear to be crazy when he wasn’t, to steal all his money and because he wanted to have sex with his wife.
And Amanda, who’s working with me now, one of the aspects of Rush, it’s not a ton of it in the book, but it’s interesting. When Rush became really famous, people started, just like we have telemedicine now, early telemedicine, [to ask him for advice.] Write a letter to Benjamin Rush, give him your symptoms, and he’ll write back and solve your problem. And so this happened with Rush. As he became more and more famous, it happened more. So he announced, in the hope that they would stop writing to him, that he would only do it if they paid him. So people starting sending him letters with money in them so that he would send them back information. He always donated the money. But since she as a sort of a pre-dental, pre-medical student was interested in telemedicine going all the way back to revolutionary times, she focused her paper on that and worked on that.
So the idea is I have research that I need help with, but I’m here to give those students an educational experience so they can write a good paper, and they can learn about how to research. Most of the work they do is so based on a quick Google search and whatever they can quickly take in from secondary sources. The standards of what’s interesting and what counts for in-depth research is not what it used to be.
And what I love is etting them to the point where they are doing that kind of in-depth research really instinctively, and they’re challenging things they read even in well-known books and saying, “Well, when was this written? Did these people have access to this? If I do a different search of this now, do I come up with the same sources that this person used?” And seeing that is really cool. And the fact that those students go off and do better work because of that, that’s amazing.