The Rise and Fall of Mental Asylums in the U.S.
In 1752, due to the dire need for better care for mentally ill patients, the Quaker community in colonial America funded the Pennsylvania Hospital to build specialized rooms for mentally ill patients. Located in the basement and equipped with shackles to confine patients, these rooms foreshadowed an uncomfortable era ahead for the mentally ill in the United States of America.
In all fairness, the stigma against mental illness was carried to the States by European settlers, most of whom knew of the famous Bedlam in London. Decades later, American hospitals applied the same stigmatization and the traditional treatments for the mentally ill: fear-inducing tortures, social isolation, and physical pain. Like in Europe, these wards and hospitals aimed to minimize the troubles a lunatic could cause to society, not to cure or care for them.
But when the nineteenth century came, European immigrants brought the “moral treatment” system with them, which had proved to be successful in England. It gave the Americans the idea to build specialized hospitals for “lunatics” instead of rooming them up with the physically ill. In 1817, the Quaker community opened the first asylum – The Asylum for the Relief of Persons Deprived of the Use of their Reason – in Philadelphia. It is still in function today under a different name: The Friends Hospital.
State after state followed Philadelphia’s example and opened their own asylums. However, unlike the privately-funded one in Philadelphia, state-funded institutions were often underfunded and understaffed. As a result, the rich invested money into private institutions to ensure their insane relatives a pleasant life, away from chains and whatever nightmare hidden behind the walls of state-funded asylums. The nightmare was for the poor, who could not afford the advanced treatments of private asylums.
Asylums for the rich were described as “a home away from home”, where relatives of wealthy people were well cared for. While the main treatments were still hydrotherapy, electrical stimulation, and rest, the wealthy patients still generally enjoyed luxurious life with private parks, greenhouses, and even sun parlors. At the same time, the poor folk huddled in overcrowded public asylums, were chained to their beds, and cruelly abused.
The vast difference between private and public asylums prompted Dr. Thomas Kirkbride to revive the whole system. After a few years working with the moral treatment in a private-funded asylum, Kirkbride began to sketch his own plan, which he put into practice in his own asylum – the Philadelphia Hospital for the Insane. His book was published in 1854 under the title On the Construction, Organisation and General Arrangements of Hospitals for the Insane With Some Remarks on Insanity and Its Treatments. It was later referred to as the Kirkbride Plan.
The Quaker doctor believed nature played a huge role in curing mental illness, and that he could harness that power through architecture to help his patients. His asylum imitated an imposing Victorian home to create a homely environment for patients. There should be no more than 250 patients in an asylum, divided by gender, conditions, and level of needs. Their rooms were filled with sunlight with a view of the parkland surrounding the asylum. Combined with the moral treatment model from England, the asylum should be able to not only care for but also cure mentally ill patients.
The Kirkbride Plan was supported by The Association of Medical Superintendents of American Institutions for the Insane (AMSAII). At the same time, a Boston woman named Dorothea Dix began to investigate the current state of public asylums. Believed to have her own mental struggle, Dix dedicated her life to advocating for the mentally ill. For more than thirty years, Dix petitioned state governors to spend more funds on lunatic asylums with the hope to improve their quality of life. Together, Kirkbride and Dix convinced many states to refine their public asylums. As a result, from 1840 to 1880, the number of mental asylums in the United States increased from 18 to 139, and most of them followed the Kirkbride Plan.
For a few blissful decades, mental asylums appeared on podcasts as a symbol of a thriving community where the ill were well-cared for. But just as how the Hanwell model failed in England, the Kirkbride Plan failed for the same reason. In the 1860s, the number of patients in asylums far exceeded what state asylums could afford. While Kirkbride intended the maximum number of patients to be 250, in reality, the number usually doubled or tripled that while the treatment quality plummeted. The reason: the lack of a clear definition of mental illness.
In 1887, a young and courageous journalist named Nellie Bly disguised herself as a lunatic to infiltrate the New York City Lunatic Asylum on Blackwell’s (now Roosevelt) Island in the East River. Her book Ten Days in a Mad-House exposed the horrendous treatments and cruelty that befallen the poor women who found themselves trapped in Blackwell. Many of them were not even insane, having no idea why they were there. One simply spoke a foreign language and no one bothered to find an interpreter. “Yet strange to say, the more sanely I talked and acted the crazier I was thought to be”, Bly concluded. Her investigation forced states to review their spending on asylums and how the money was exactly spent. Followed-up investigations revealed many residents in public asylums were not insane but just elderly senile. Superintendents of public asylums were found either turning a blind eye to the worsening reality or directly aggravating the situation.
The reality of public asylums led to a reputation downfall for AMSAII. The association was heavily criticized and challenged by the American Public Health Association and the Association for the Protection Prevention of Insanity, later by the New York Neurological Society. It should be noted, however, that neither side fought with patients in mind. What they achieved was a heavily negative connotation to the word “asylum”. In the end, there was no compromise between the two sides. The system of public madhouses rapidly deteriorated. In 1946, the deinstitutionalization of public asylums began, putting an end to state-funded asylums.
The Quaker community played a huge role in the foundation of the mental health system in the US, starting by funding the first mental wards in 1752.
There was a huge difference in care between private-funded and state-funded asylums.
A surge of mental asylums opened in the mid-nineteenth century.
At the end of the nineteenth century, investigations revealed the true state of public asylums, which called for criticism.
The deinstitutionalization of public asylums in 1946 signaled the end of public mental asylums in the US.