ABSTRACT Title of Document: MENTAL ILLNESS IN MARYLAND: PUBLIC PERCEPTION, DISCOURSE, AND TREATMENT, FROM THE COLONIAL PERIOD TO 1964 Robert William Schoeberlein, Ph.D., 2006 Directed By: Dr. Lawrence E. Mintz, American Studies This dissertation is an overview of the public perception of, discourse concerning, and treatment of Maryland’s mentally ill citizens from the Colonial Period to 1964. The present day view of the mentally ill in the early colony is, at best, fragmentary. The numbers of such Marylanders were small and little information exists to frame a picture of what constituted their daily life or the level of care until about 1785. The decision to confine individuals at home or at an institution entered public discourse. Certain families entrusted their relatives to hospitals. Mentally ill people constituted a highly visible presence during the first half of the nineteenth century. A vacillating public interest and tepid financial support for their cause, however, prevented access to higher quality care for the majority. County almshouses and jails continued to house the “pauper insane” in a regressive manner. During the second half of the nineteenth century, the rights and well-being of mentally ill citizens came to public notice. The possibility of a sane individual being unjustly confined within a mental hospital fired the public imagination. Court cases and patient exposés persuaded legislators that some laws and formalized state oversight of institutions were required. The first three decades of the twentieth century marked an epoch of progress. A reform campaign resulted in the transfer of all patients from the county almshouses into modern, newly-constructed state mental hospitals. The insular settings, however, ultimately made them less visible. The Great Depression and Second World War era induced shortages that adversely affected state hospital patients. Many such patients languished in sub-standard conditions. A troubling 1949 photographic exposé ultimately pressured state officials to bring system-wide improvements. The 1950s ushered in a new era for Maryland’s mentally ill citizens. The advent of psychotropic drugs allowed patients to leave the hospitals. Programs to assist in the transition back into the community were developed by the State and public advocates. Members of a once faceless, inarticulate group came to be perceived as individuals who could contribute to and enrich the life of our communities. MENTAL ILLNESS IN MARYLAND: PUBLIC PERCEPTION, DISCOURSE, AND TREATMENT, FROM THE COLONIAL PERIOD TO 1964 By Robert William Schoeberlein Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2006 Advisory Committee: Dr. Lawrence E. Mintz, Chair Dr. George H. Callcott Dr. John L. Caughey Dr. Edward C. Papenfuse Dr. Nancy L. Struna © Copyright by Robert William Schoeberlein 2006 ii Foreword In the fall of 1999, I resigned from a curatorial position to assume similar employment at the Maryland State Archives. At the previous institution, I had performed research and published on early Maryland amateur photographers and my first intention had been to explore similar collections at the Archives. I thought, perhaps, my dissertation topic might be developed from this continued line of investigation. Fate, of course, sometimes intervenes with our best-laid plans. One now forgotten day, while inspecting the Archives photographs stacks to familiarize myself with the holdings, I opened an innocuous gray box and fixed my eyes upon some images unlike any that I had seen before. My first thought was that the contents appeared to be the only existing photographs of county almshouses in Maryland. That fact alone made them unique. One folder held the image of a bare interior of a ramshackle building (see below figure). iii Another featured a group of African American men bedded down, some without pillows or blankets, within a cramped hallway. The sight aroused my curiosity. What I viewed next, however, turned my rapt attention into outrage. The image depicted an elderly African American male lying upon a thin mattress on the floor of what appeared to be a prison cell. A chain, attached to the grating of the window, led to his manacled wrists. How could such a fragile, sickly man warrant this treatment? Further, how could Marylanders allow this to happen? iv I eventually found the answers to these questions. Research on the origins of what I termed the “almshouse photographs” prompted my initial investigation into the history of mentally ill persons in Maryland. As the reader will discover it was these powerful images that had earlier influenced the state General Assembly to pass the first major legislation to improve the lives of these their fellow citizens. My first research foray only yielded additional questions. The lack of any comprehensive body of historical research on Maryland’s mentally ill population fired my desire to investigate and “recover” aspects of their history and culture. It is my hope is that this dissertation will provide a starting point for others interested in researching aspects of this still marginalized group. Fortunately, a solid foundation of historical research existed on the general topic of the mentally ill in America. The prolific efforts of Gerald Grob provided me with a comprehensive overview as to the general development of theories relating to mental illness, the changing public perspectives regarding patients, and the rise of institutions for their care. Grob, for over thirty years, explored the history of mental hospitals in a series of books with an emphasis on policy. His work has done much to refute the general revisionist theories of Michel Foucault, Andrew Scull, and David Rothman that such institutions existed primarily as centers of social control and to suppress deviants. Grob’s painstaking research revealed that hospitals attempted to cure and care for individuals in spite of demographic and financial forces beyond their control. Yet, much of Grob’s work drew upon the work of Massachusetts, a state that stood on the forefront of enacting progressive legislation. Maryland generally followed another path. Still, Free State bureaucrats would have had to have provided much more funding and had built many v more state hospitals to have effectively orchestrated any state-engineered conspiracy to mass its deviant population. That is not to say that the social control theorists do not have some merit in their argument. The mental hospital simply may not have been the venue. In the course of my own research, I was struck by the fact that county almshouses apparently acted as centers of concentration for the poor and those persons considered to public nuisances, often homeless mentally ill individuals. I differ with Grob’s general opinion, however, that most southern state hospitals existed as backwater institutions. Maryland, besides founding one the country’s earliest state institutions, early embraced the nineteenth century “moral treatment” philosophy of patent care and pioneered an innovative patient foster care program in the twentieth century. I must say a few words about the parameters and limitations of this study. Given the nature of available archival resources, I chose to focus largely upon the administration of Maryland state and county institutions, with an emphasis on the public and not private institutions. The records of the most important nineteenth private facility, the Catholic- run Mount Hope Asylum, simply do not exist. Material from the smaller, specialized private facilities has also suffered from the vicissitudes of time. Tragically, the recent bankruptcy of the Chestnut Lodge, a private psychoanalytical institution, prompted the administrators to immediately shred its records due to patient confidentiality concerns. The Maryland State Archives was able to save the residue, which encompasses very little historical or useful research material. Some may ask why did I not look into the Sheppard-Pratt or Johns Hopkins institutions? Simply because these well-funded elite facilities served a relatively small population, drawing patients from around the country. The patient experience in these facilities stands as an anomaly as to what the majority of vi mentally ill Marylanders witnessed. The private institutional model made little difference to the state hospitals, where after a certain time, the base needs of the patient drove the daily routine of the facilities. I concluded my study at 1964 for several reasons. First, few archival resources exist to take the paper up to the present. Much material is still held by the state hospital system and access is not granted easily. Our litigious society and the HIPPA laws have combined to restrict access to records, even for scholarly pursuits. Second, a very fine dissertation already exists on the period of 1964 forward. Jonathan Engel’s work details the development and administrative changes the brought forth the new era of deinstitutionalization and community-based healthcare. Individuals interested in the post- 1964 era would do well to review Dr. Engel’s work. My dissertation necessarily draws heavily from archival sources. Simply stated, few quality secondary sources on Maryland of any length or depth exist. Mining various repositories for manuscripts and photographs has been both challenging and, sometimes, frustrating. First is the matter of identifying records where