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WHEN STATE HOSPITALS WERE COMMUNITIES the Golden Age of These Facilities Left a Legacy Still Seen in Mental Healthcare by STEPHEN M

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WHEN STATE HOSPITALS WERE COMMUNITIES the Golden Age of These Facilities Left a Legacy Still Seen in Mental Healthcare by STEPHEN M IN RETROSPECT WHEN STATE HOSPITALS WERE COMMUNITIES The golden age of these facilities left a legacy still seen in mental healthcare BY STEPHEN M. SOREFF, MD, AND PATRICIA H. BAZEMORE, MD n the 21.st century we 1797, what is now the second Itake it tor gratited that we oldest and contmuoiis mental treat tnentally ill people in hospital in the United States programs in the communities opened in Baltimore, Mary- where they live. Yet in an- land, as Spring Grove, later other age, we cared for them to become The Maryland in state hospitals. These hos- Hospital in 1834, and now pitals were self-contained vil- the Spring Grove Hospital ldges and communiries. They Center. In 1844, for its 143 often were called asylums and patients, it listed the causes of offered a way of life as well insanity as follows: as total medical and psychi- atric care. A New York stare • intemperance hospital descrihed a patient s • ill health life there in Atigtist 1853 in • masturbation these four lines from "Asylum • constitutional Life; Or, The Advantages Of • domestic trouble A Disadvantage": • religious excitement IN THIS DEPARTMENT of each state's landscape. The • pecuniary loss I have no care for copper or superintendents of 13 state we take a look at some • love affair coin, hospitals founded the Ameri- of yesterday's treatment, • puerperal I have no tear of any one's can Psychiatric Association in reimbursement, and technol- • loss of friends frown; 1844. Every state had at least ogy trends—and where they • disappointed ambition Im fed by rhe hand chat one hospital for the insane; stand now. • mortified pride feedeth the best, for example, by 1930 Mas- • remorse And seldom molested is my sachusetts boasted ot 12 state • political excitement sweet rest.' hospitals: • Metropolitan State Hospital. • want of employment 19302 • unknown^ The golden age of Ameri- • Worcesterlnsane Asylum. 1830 can state hospitals hegan in (figure) These state hospitals varied For the same popula- the early 1800s and lasted • Boston Lunatic Hospital. 1839 in size. The Westborough tion it listed the following until the early 1950s. In this • Taunton State Hospital for the Insane Hospital had a census psychiatric diagnoses: mania, article we look hack on that Insane, 1851 of 1,000 patients in 1909; monomania, dementia, and era to show what they were, • Lunatic Hospital at Northampton, by 1918, 1,500 patients; and idiocy.^ where they were, whom they 1856 by 1954, more than 2,000 At the time, rhese hospi- served, and what services they patients. Eloise Mental Hospi- • State Lunatic Hospital at Dan- tals provided scate-of-the- provided, including psychiatry, tal, on a 903-acre compound vers, 1873 art treatment in what they medicine with its specialties, in Westland, Michigan, dur- • Westborough Insane Hospital, believed to be a humane rehahilitation, education, ing the Great Depression had 1884 and compassionate manner. and even what they offered a peak of more than 10,000 • Massachusetts Hospital tor Early on they offered a wide as a final resting place. We patients! Dipsomaniacs and Inebriates at variety ot somatic psychiatric conclude with their rich and Foxborough, 1889 In their inception these treatments, including calm- relevant legacy to the current • Medtield Insane Asylum, 1892 hospitals offered hope, refuge, ing hydrotherapy, sensory practices of American mental • State Colony for the Insane at and treatment to the mentally deprivation chairs, twirling healthcare. Gardner, 1900 ill. Dorothea Dix urged that chairs, needle cabinets (steel cabinets in which staff would State hospitals had a cen- • Grafton State Hospital, 1901 people with mental illness be lock patients and then insert tral role in American psychia- • Psychopathic Department ot moved from almshouses and needles to put water directly try and were very much a part Boston, 1912 jails into state hospitals. In 10 JULY/AUGUST 2005 WWW.BEHAVIORAL.NET in their skin), straightjackets, State hospitals prided newspapers, and bicycles and many of their patients. Per- and shackles.'* Later they themselves on their educa- places to ride them, as well haps because of the persistent made available shock therapy tional focus. They offered as patient dances. Madison nature of mental illness, with in the form of insulin and professional training and State Hospital annually host- protracted hospitalizations Metrozol, as well as electric schools for nurses, aides, ed a Fourth of July party, and family abandonment, shock; fever cabinets; malaria social workers, rehabilitation welcomed cemeteries treatment; and prefrontal workers, physicians, dentists, performances were cre- lobotomies. chaplains, psychologists, and THE MAJORITY of by the Phil- ated on the psychiatrists. They provided these hospitals were As self-contained com- harmonic grounds. classes for the patients, too; located near or In popu- munities these state hospitals Orchestra of Patients indeed, a number of patients furnished their own medical Indianapolis, lation centers rather were buried earned a GED during their care. Staff included physi- and prided than being placed out in in simple inpatient stay. In 1885, the cians, dentists, podiatrists, and Itself on its the country. graves each Central State Hospital of In- pathologists, with neurologists own Army marked only diana opened separate schools and neurosurgeons on consul- surplus bus hy number. for female and male patients.' tation status. Still visible today to take patients to off-cam- Eloise Mental Hospital has This hospital also offered in some Massachusetts state pus activities. Furthermore, 7,100 patient graves in an area educationai programs for hospitals are the operating it is a myth that state hospi- across the street.** Currently people residing in the vicinity, rooms used tor general surgery, tals were isolated and away these cemeteries are being such as having speakers on neurosurgery, oral surgery, from population centers. rediscovered and rehabilitated mental health issues. orthopedics, and obstetrics. Regular community interac- by patient advocates. Take, for example, a sample of In addition, state hos- tion and involvement were In the 1970s, deinstitution- procedures done at Manteno pitals admirably addressed the norm. The majority of aiization became the focus of State Hospital, in Manteno, their patients' social and these hospitals were located mental health efforts. This Illinois, in 1941: hysterecto- entertainment needs in many near or in population centers movement arose from the mies, lobotomies, exploratory ways. There were beauty rather than being placed out work of Dr. Nathan Kline in iaparotomies, and ileostomies.'' parlors, bowling alleys, pool in the country. the 1950s and 1960s and from State hospitals emphasized tables, swimming areas, State hospitals also became a series oi legal challenges rehabilitation through work picnic places, libraries. the final resting places for to the svstem. From this in two major areas: cot- tage industries and farming. Cottage industries included weaving chair seats, sten- ciling, sewing, furniture upholstering, and woodwork- ing. In 1958, the Madison State Hospital in Madison, Indiana, sewing room turned out 10,000 stitched items.'' Incidentally, the same hospital also boasted of its own fire engine, further indicating its self-sufficiency. Farms were a major fea- ture of many state hospitals. In 1907, Worcester Insane Hospital produced 35,000 pounds of cabbage and 100 bushels oi turnips, and in 1910 Wcstborough State Hospital produced 376,745 quarts of milk. Numerous state asylums Figure. Aerial photograph of Worcester State Hospital (formerly ttie Worcester Insane Asylum) in the 1940s. Note raised cows and pigs. the large size of the campus. BEHAVIORAL HEALTH MANAGEMENT 11 IN RETROSPECT time forward, state hospitals at Boston University, Fisher College, decreased in population and Worcester State College, and South- gradually began to acquire ern New Hampshire University. services for patients from the Patricia H. Bazemore, MD, is an Associate Professor in the depart- larger community. Today ments of Family Medicine, Com- ...Guaranteed. most state hospitals have writ- munity Medicine, and Psychiatry ten agreements with general at the University ot Massachusetts hospitals for the emergency Medical School in Worcester. She is care and acute medical care of also Chief of Medicine at Worcester State Hospital. their patients. The declin- To send comments to the ing patient numbers and the authors and editors, e-mail uicreasmg high-tech nature [email protected]. To of medicine have combined order reprints in quantities of 100 to make this arrangement or more, call (866) 377-6454. What is your measure of success? necessary.'' References It is important to recognize For teamLWSI, it is ensuring that our customers can I. Asylum l.ifc; Or, 1 lie Advamagcs the legacy from the golden Of A Disadvaniage. The Opal enjoy an unparalleled return on their investment in age of state hospitals. They 18'i3;3:228. Disability Hisiory our solutions. were centers for the most Museum. Available ac: www. diiabiliiymuseum.org/Iib/ Quickly. compassionate and advanced psychiatric care available in 2. 1856.org. Mass. State Hospitals: It is the result of wbat happens when people use our their time, although some Social History. Frotn the Mas- solutions to improve operations by: hospitals did have less than sachusetts Historic Commis- sion. Available at: www. 1856, adequate treatment as depicted org/socialhistory.html. • Increasing reimbursed services; in the
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