By Skylar Davis, VI Form

20th Century Psychiatric Hospitals and the Lasting Impacts of Deinstitutionalization

Editor’s Note: This paper was completed as a part of the History Research Fellowship, a one-semester course available to sixth form students.

I. Introduction

Few institutions evoke greater horror than the “insane asylums” of the 19th and 20th centuries. Given the stigmatizing media portrayals of such hospitals, most people believe that they had uniformly poor living conditions, practiced barbaric treatments, and employed abusive staff. As a consequence, society now views historic asylums as torturous and inhumane places. This image, however, hides a more complex truth about the value of state mental hospitals.

Prior to the asylum era, the only hospitals in America were general hospitals. During the early 18th century, most individuals diagnosed with mental illnesses lived at home under their families’ care. At the time, communities were reasonably tolerant of individuals who exhibited mild symptoms of mental illness. Those deemed violent and disorderly were sent to either public almshouses or private hospitals, depending on their family’s finances, for professional medical care. This was the beginning of institutionalized mental health care.

With the 19th century came the European concepts of “moral treatment” and “asylums.” These ideas were

built on the assumption that those suffering from mental illness could find their way to recovery and an eventual cure if treated kindly and in ways that appealed to the parts of their minds that remained rational. [Moral treatment] repudiated the use of harsh restraints and long periods of isolation that had been used to manage the most destructive behaviors of mentally ill individuals. It depended instead on specially constructed hospitals that provided quiet, secluded, and peaceful country settings; opportunities for meaningful work and recreation; a system of privileges and rewards for rational behaviors; and gentler kinds of restraints used for shorter periods.

University of Pennsylvania, “History of Psychiatric Hospitals,” Penn Nursing, accessed October 24, 2019, https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/.

While many private hospitals wove components of the moral treatment plan into their existing mental health programs, in 1814 Philadelphia’s Quaker community established the first institution dedicated solely to the doctrine. Founded on the vision of moral treatment, the Friends Asylum for the Relief of Persons Deprived of the Use of Their Reason “combined the Quaker religious views of the individual with medical sciences’ developing therapies.” Another Quaker belief is that all people are equal, and after the Friends Hospital was the first to hire women as doctors and nurses, subsequent psychiatric facilities continued to hire women even before general hospitals began to employ them.

Following the founding of private mental health care facilities, reformers began to advocate for state-funded public hospitals to treat mentally ill individuals who could not afford private care. One of the most famous proponents of this was Dorothea Dix, who traveled around America in the 1850s and 1860s making the case for moral treatment. By the 1870s, her persistent lobbying of state legislatures and the United States Congress led almost every state to build at least one state-funded psychiatric asylum.

One such hospital was Medfield State Hospital (MSH). The property was aesthetically designed, self-sustaining, and frequented by journalists, volunteers, and local organizations, and for the first half of the 20th century, patients and staff alike considered it a pleasant place to live and work. Similar in structure and organization to many other 20th century psychiatric hospitals, scholars can use MSH as a lens to review the truth about past mental health facilities across the country. It was not until the end of the 1960s that this atmosphere shifted as psychiatric facilities underwent drastic changes. The following decades were revolutionized by psychotropic drugs, mental health revelations, and federally-funded clinics known as community mental health centers, all of which resulted in state hospitals discharging waves of patients and radically altering the country’s mental health care system. This period is known as the deinstitutionalization era.

While it was popular at the time, the movement failed to create long-term solutions, instead leading to a decrease in affordable mental health care and increases in federal incarceration rates and national homelessness. Fewer than half of American adults diagnosed with mental health problems receive proper care and treatment, and hundreds of thousands of them, if not more, find themselves in jails or out on the streets. However, the only way to combat this issue is by holding states accountable for their mental health care infrastructures. Creating assisted outpatient treatment structures and mental health courts in every state, as well as fixing the federal funding framework in regards to mental health care, are good steps. However, there is a lack of social and political will to repair the system. Politically and economically motivated to make budget cuts or redirect funding, every state in America has ended programs and reduced spending on mental health care, with leading figures everywhere choosing to ignore the detrimental effects these government actions have had on the well-being of their citizens.

In order to comprehend the depth of America’s present-day mental health care crisis, it is crucial to first understand the truth behind state psychiatric hospitals and the value they held in the early 20th century. To build such a foundation, this paper will begin by illustrating the rise of MSH and detailing the decades leading to the deinstitutionalization era, from the hospital’s everyday operations to its partnerships with communities in surrounding towns. This knowledge will then provide a basis to launch into a timeline of deinstitutionalization: what caused it, what happened throughout the movement, and what lasting impacts the period has had on nationwide mental health care. Finally, the paper will conclude with an analysis of how deinstitutionalization has impacted Massachusetts specifically as well as influenced the state’s current mental health care system. Although the era had detrimental effects across the country, it is critical to learn from past mistakes and be proactive, for without a fresh push for social and political change the lack of mental health care programs and subsequent federal problems will only worsen.

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Skylar (Sky) Davis is a VI form day student from Hopkinton, Massachusetts. Her favorite subjects are anything related to politics or the humanities, and she enjoys reading, writing, and photography.