Dr. Isaac Ray was one of the fathers of American psychiatry. Born in Beverly, Massachusetts, on January 16, 1807, he was the son of Captain Isaac Ray and his second wife, widow Lydia Symonds. Ray graduated from Phillips-Andover Academy and attended Bowdoin College in Maine, but he left before graduation. Returning to Beverly, Ray served a medical apprenticeship with a local doctor and then enrolled at Harvard Medical School. He eventually concluded his studies at the Medical School of Maine, receiving his degree in 1827 at age twenty.

From 1827 until 1841, Dr. Ray engaged in private practice in Maine while developing a specialty in mental illness. In 1838, he published a significant work entitled “Treatise on the Medical Jurisprudence of Insanity,” which went through five editions by 1871. In that volume, Ray expressed the belief that court proceedings affecting the insane should be the particular province of the medical expert witness. Ray maintained that only the testimony of such a trained professional could distinguish between simulated and genuine insanity. The book established Ray as an expert in this field, leading to his appointment as medical superintendent at the Maine State Hospital, where he presided from 1841 to 1845. While at his Maine post, Ray, along with twelve other medical superintendents of public and private hospitals for the insane, founded an organization in 1844 that evolved into the American Psychiatric Association, making psychiatry the oldest medical specialty in the United States. 

During his tenure at Maine’s major mental facility, Dr. Ray accepted the directorship of Butler Hospital in Providence, then just in its planning stage. He had returned from a survey tour of European mental hospitals by December 1847, when Butler Hospital admitted its first patient. For the next two decades, until he departed for Philadelphia in 1866, Ray zealously operated the hospital in its tranquil pastoral setting on the west bank of the Seekonk River. A private facility, the hospital was an early example of the “asylum” approach to the treatment of the mentally ill and a vast improvement over the prison-like facilities then prevalent for housing the insane. Ray knew that as an employee of private philanthropists, he would be free from the political intrusions of state government.

Butler Hospital was also an outstanding example of local philanthropy. Nicholas Brown II made a then huge $30,000 donation toward the effort to establish it, only to be outdone by Providence merchant and real estate developer Cyrus Butler (1767–1849), who advanced $40,000 on the condition that $40,000 more should be contributed from other sources and that an additional $50,000 should be raised and kept as a reserve fund. These financial goals were achieved, and the state-of-the-art hospital opened in 1847; it was named in Butler’s honor less than two years before his death, on August 22, 1849, at the age of eighty-two.

By 1860, the facility consisted of about 140 acres (since reduced), much of it used for farming, plus several architecturally beautiful and well-arranged buildings designed by James C. Bucklin and his apprentice Thomas Teft, with a total capacity of 108 patients. The hospital included no laboratory or surgical work facilities, reflecting Dr. Ray’s belief that clean air, spacious quarters, and comfortable surroundings were more productive in producing a cure. Ray was so proficient in hospital design that in 1863, the Rhode Island Medical Society appointed him to head a committee to advise the trustees of the newly created Rhode Island Hospital on the construction and arrangement of its buildings.  

Ray continued to write and lecture on the professional care of the mentally ill during his period of superintendency, earning an international reputation for his insights on both the legal aspects of confinement for mental illness and the treatment of this disease, as well as gaining for Butler a reputation as an outstanding psychiatric hospital. At the outset of his tenure, he promoted a vision of universal hospital care for all those who suffered from mental illness. In 1851, the Dorr Democrats heeded this vision; motivated by a humane report on the poor and insane written by reformer Thomas Hazard (profiled herein), the General Assembly made Butler Hospital the primary Rhode Island institution for the care of the insane.

Legislative allowances for treatment and establishing a liberal and flexible commitment standard immediately gave Butler more referrals than it could accommodate. After the Know-Nothing campaign of the mid-1850s, however, xenophobia directed at Irish Catholics overcame the legislature, Butler Hospital, and Ray himself. In 1857, Butler instituted a restrictive admissions policy that effectively excluded many foreign-born seeking asylum. By the time Ray departed in 1868, he had embraced the then-current trend toward a segregated system of institutional care in which wealthy or curable patients would be the beneficiaries of treatment at upscale places like Butler, while the poor, the incurable, and the immigrant would be relegated to large, impersonal and custodial public facilities. His benevolence did not match Ray’s brilliance, so in 1870, a Rhode Island State Asylum opened at the former Howard Farm in Cranston for the custodial care of those mentally ill paupers deemed to be “incurable.”

Ray was the quintessential professional, a prolific writer, and an eloquent educator. His peers made him president of the National Psychiatric Association from 1855 to 1859. In 1863, while at Butler, he published a book called Mental Hygiene “to present some practical suggestions relative to the attainment of mental soundness and vigor,” and in 1873, he published an anthology entitled Contributions to Mental Pathology, consisting of many previously presented papers and excerpts from annual reports that he issued as Butler’s superintendent, a position from which he resigned in 1868.

Ray spent the last decade of his life in Philadelphia, where his physician son Benjamin Lincoln Ray had gone to set up a general practice of medicine. Here, Isaac remained active and enjoyed a lucrative practice as an expert psychiatric witness. He now began to see flaws in the two-tier psychiatric system he had advocated. He presented a public paper to the Philadelphia Social Science Association in 1873 that exposed and decried the terrible conditions at the Philadelphia Almshouse. On March 31, 1881, only weeks after his son Benjamin died of a stroke, Isaac also passed away silently in his sleep.

According to one historian of the psychiatric profession in America, “Isaac Ray was one of the outstanding intellects among the founders of the American Psychiatric Association, and by example, as well as by his prolific and articulate writings, did more than any other American psychiatrist of his time to advance the medical professionalization of the care of the mentally ill.”

Dr. Isaac Ray was admitted into The Rhode Island Heritage Hall of Fame in 2002.

For additional reading:

• The Makers of Modern Rhode Island, By Patrick T. Conley, History Press, 2012.
• “Isaac Ray 1807–1881”. Rhode Island Medical Journal, p. 425.
• Association of Medical Superintendents of American Institutions for the Insane (1876,”  Philadelphia
• Diamond, B. L. (1956). “Isaac Ray and the trial of Daniel McNaghten,” American Journal of Psychiatry. 
• Hader M. (1965). “Isaac Ray, forensic medicine and geriatric psychiatry”. Gerontologist, 268–269.
• Payne H.; Luther. (1980). “Isaac Ray and Forensic Psychiatry in the United States”. Forensic Science International. 15 (2): 115–127
• Quen, J. M. (1977). “Isaac Ray and mental hygiene in America.” Annals of the New York Academy of Sciences. 291: 83–93. 
• Adapted from text at “19th Century Psychiatrists of Note”. Diseases of the Mind: Highlights of American Psychiatry Through 1900. US National Library of Medicine. Retrieved 2007-09-03.