If hospitals were terrible, did care providers know they were terrible? Or were care providers doing the best they could with practice recognized by the public then and now as terrible (in the same way that chemo and radio therapy today are pretty horrific, but they're often the best we have for certain cancers)? Or a little of both?
On the subject of differences between public and professional perspectives, how much did they differ? Was the public opinion of institutions overwhelmingly negative while the institutional opinion was overwhelmingly positive? Or did things vary more? Is my understanding that actual mass de-institutionalization didn't occur until much after this era correct?
Finally, the spectre of the punitive lobotomy pops up several times in literature and film during this period (One Flew Over the Cuckoo's Nest, Planet of the Apes). Was phenomenon a frequent fear of patients within the institutional setting? What about other punitive "treatments" using, say, electroshock therapy? Can we detect these patient fears in sources? What would be our sources if we wanted to study them? I assume given that many of the people who would be subject to punitive medical treatment would fall under multiple categories of vulnerable that we might not have much to go on. How often did this sort of thing occur if at all?
Thanks!
I can also address the question of punitive lobotomies. They, as well as two of the three “shock” therapies - insulin and cardiazol - were not as common punitively as public perception purported them to be, for the sole reason that to perform those three treatments you almost universally had to get a doctor involved and in public hospitals, doctors generally weren’t as involved in the day to day nitty gritty of life on ward, which lowered their perceived need for punitive measures. In plain English, doctors generally tried to stay out of wards as much as possible, so they didn’t experience things that they would want to retaliate against, and for the most part, you needed a doctor for a lobotomy. That being said, many did use lobotomy, particularly transorbital lobotomy, as a behavior management tool. Significant “misbehavior” - particularly behavior that upset and unsettled the ward - was seen as a symptom of a deranged mind, and that was considered a valid reason for lobotomy.
Of course, while nurses and other ward staff in most hospitals did not perform lobotomies themselves, that didn’t stop them from threatening it to try to get unruly patients to fall in line. And since there were nearly always horror stories to point to, those threats packed a punch.
I don’t want to completely leave doctors off the hook. Punitive lobotomies did happen and punitive “treatments” like electroshock and other treatments were used for social control with regularity in many hospitals. Hell, if you were at Trenton State Hospital in New Jersey and under the care of Henry Cotton, you could lose body parts, although he was convinced he was helping.
I hope this is helpful. I recommend the book The Lobotomist by Jack El-Hai, it’s thorough and an easy read. Great and Desperate Cures is really the best book on the subject and it covers almost all of the extreme treatments of the time.
While it doesn't tackle all your questions /u/rbaltimore has written previously specifically on lobotomies, their high point, and their decline, in this thread, so I expect you may find it relevant.