Asylums in the West: A short analysis of historical western asylums and a reflection on their impact on current mental healthcare

A quick Google search of the term ‘mental asylum’ brings up sites dedicated to shocking their viewers with images of small children in cages and offers nighttime tours of these abandoned institutes, claiming that the horrors that happened within these once-grand buildings make it haunted, the perfect Halloween adventure. But to take that view, that all asylums were just places of suffering and that the patients housed within were scary, inhuman, and unknowable because their mental illness is reductive and helps perpetuate a harmful stereotype. Mental healthcare is a hot topic for many reasons, from its sensationalized roots to current treatments and therapies, and where it is going in the future. This paper will examine the historical context of western mental healthcare and the systems it found, where mental healthcare is currently, and where it should go.

The middle of the 17th century in the western world saw the advent of what is currently known as ‘the age of enlightenment.’ This age was a push for science, measurable results, and reasoning, a rejection of the mysticism of the past. This movement would create the foundations upon which almost every scientific institute would be built. These new methods of thinking and examining things are the catalyst for change concerning mental healthcare. The 1830s and ’40s saw the creation of a new scientific field called psychology, a revolutionary way of looking at people who were mentally ill. As prolific writer John Conolly, who worked with asylums for much of his career, put it, “A lunatic asylum is intended to be not merely a place of security but a place of cure” (2). Before this, the insane were often dubbed incurable, and therefore often unworthy of basic human dignity, making a statement such as Conolly’s revelatory thesis’ just a few years prior. It was during this time, in the 1840s, that laws were created to provide for the humane care for society’s mentally ill, or lunatics to use the term of the time, in England, with the rest of the west following suit shortly after that. From that point on, until the 1980s, the asylum reigned supreme as the default system of care for the mentally ill in the English speaking world.

While asylums were meant to be places of healing and sanctuary, the fact of the matter was that not all asylums were equal. Such as in the Toronto Asylum (Wright, Jacklin and Themeles), located in Canada, which showed that quality of life, as determined by study of death records, was quite good for the patients and rose with quality of life outside of the asylum, comparatively speaking. In England, Grove Place Asylum (Carpenter), provides a positive working example of an asylum, with a good quality of life offered to those housed within. This view is substantiated by both literature from the time, and later by Carpenter’s retrospective look. By comparison, the American Weston State Hospital, or as it’s often known today, Trans-Allegheny Lunatic Asylum, had some truly inhumane conditions by the time the 20th century came around. The disparity in care from asylum to asylum was due mainly to differences in funding, changing ideology in care, and in demand. While all three asylums are in different countries, all three were based upon the same model, the Kirkbride model.

Dr. Kirkbride was a Quaker medical doctor who specialized in psychiatric care, and is best known for his asylum buildings (Jacks). Taking a very detailed approach, he advocated for large, beautiful and spacious buildings meant to hold only a small number of patients and was a strong opponent of negative reinforcement and restraints. His theory was if the patient was removed the environment causing or at exacerbating the issue, such as the family home, as so to be removing primary causes of the insanity, recovery could begin. This plan also included lots of free time, learning, time spent outside in peaceful parks, which was often very effective. Kirkbride speculated that his plan would see a rate of recovery of 80%, albeit the fact that this number fell somewhat short in reality (Bristow). These large, beautiful buildings, which were usually only built to hold 250 patients, were quite successful at improving the both the mental and physical state of the patients, given the tools of the time. Patients were taught useful skills, such as baking, sewing, woodworking, and other productive skills, to provide a sense of purpose, while still allowing time for leisure. In a time with little to no scientific understanding of mental illness, and even less in the way of helpful, proven drug treatments, this system was able to treat and care for patients, in a way that some could argue matches our current system. Unfortunately, this was not to last.

The decline of the asylum was a preventable issue, created by underfunding and overcrowding. Despite new asylums being built almost constantly in America, the demand quickly outstripped demand. Kirkbride’s Architectural Stigma of Mental Illness explains with rather well:

“Many facilities soon surpassed the new limit of 600 patients. This high demand for psychiatric care supported claims that the prevalence of psychiatric illness was increasing, and these patients could not be adequately cared for in the home… [S]ick patients were entering the asylums quicker than recovered patients could leave.”- (Bristow)

With funding drying up and not enough room, asylums quickly became something closer to a prison, where the nurses and doctors could do little but act as wardens. The ratio of staff to patients could sometimes be up 1:100 (Monroe). Patients would sometimes be restrained almost all the time, in some cases, or locked in ‘cribs’, that were little more than raised cages. Pellagra was common, as food for patients for substandard and barely enough to keep a human alive. This is where asylums gained the reputation for being places of suffering instead of sanctuaries for healing, revealed to the public by undercover journalism, such as media sensation Nellie Blyth and her article called “Ten Days in a Mad House” (Bly) which inspired some reform in New York. In 1949 there was a piece on Weston State Hospital in Gazette which covered the deplorable conditions there and lead to better funding for Weston (Jacks 55). In 1968, NBC10 aired a piece called “Suffer the Little Children” which showed in full color and sound to the American public a multi-part series the life of the inmates at Pennhurst. Readers were titillated by the images of emancipated children and adults caged and bound, side by side, of the haunting pictures of unwashed, blank faced people forced to live in unfathomable squalor.

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