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From the Snake Pit to the Supreme Court: the Collapse of the Insane Asylum in Mid-20Th Century America

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From the Snake Pit to the Supreme Court: the Collapse of the Insane Asylum in Mid-20Th Century America From the Snake Pit to the Supreme Court: The Collapse of the Insane Asylum in Mid-20th Century America Lauren Amos Advisor: Dr. Steven Noll 2 Acknowledgements My sincerest thanks to Dr. Noll, who let me borrow all of his books and take up all of his office hours. Thank you for introducing me to Phi Alpha Theta, the students at Sidney Lanier, and the entire field of disability history that I didn’t know existed. Thank you to my parents, friends, and Michael, who had to listen to me talk about asylums for a year and read countless drafts and re-drafts. A special thanks to Colleen, who let me stay at her house while I visited the Tallahassee archives. Lastly, I would like to thank the University of Florida History Department for the best undergraduate major I could have asked for, and a wonderful four years. 3 Table of Contents Introduction: A Predictable Pattern ......................................................................................... 4 Chapter 1: Shaping the Stigma ................................................................................................. 7 Chapter 2: Common Oversimplifications for Deinstitutionalization ........................................ 13 Chapter 3: An Internal Attack on Psychiatry .......................................................................... 16 Reform Rhetoric from the 1890s-1950s .......................................................................................... 16 The Rise of Anti-Psychiatry Literature ............................................................................................. 25 Chapter 4: External Pressure from the Civil Rights Movement ............................................... 44 Changing the Strategy of Reform .................................................................................................... 44 Personal Connections to the Civil Rights Movement ....................................................................... 48 Chapter 5: Two Movements Intersect through Bruce Ennis .................................................... 55 Conclusion: Why Combination was Key ................................................................................. 65 Epilogue: Where Are We Now? ............................................................................................. 68 References ............................................................................................................................ 74 Primary Sources ............................................................................................................................. 74 Secondary Sources ......................................................................................................................... 77 4 Introduction: A Predictable Pattern In 1843, Dorothea Dix, “the apostle of the insane,” wrote the following to the Massachusetts legislature: I come to present the strong claims of suffering humanity. I come to place before the Legislature of Massachusetts the condition of the miserable, the desolate, the outcast. I come as the advocate of helpless, forgotten, insane and idiotic men and women … of beings wretched in our prisons, and more wretched in our almshouses … I proceed, Gentlemen, briefly to call your attention to the state of insane persons confined within this Commonwealth in cages, closets, cellars, stalls, pens: chained, naked, beaten with rods, and lashed into obedience!1 Appalled that the mentally ill were being kept in prisons and poorhouses, Dix went on to found more than 30 mental hospitals across the United States.2 Yet when making a second and third tour of the country, she found that many of the hospitals she established herself were plagued with the same suffering and neglect she so vigorously condemned a decade before.3 She embarked on another campaign of reform, this time one of improving her own hospitals. In 1887, investigative reporter Nellie Bly went undercover and committed herself to the Blackwell Island Insane Asylum for ten days, detailing every abuse she saw in the “human rat- trap.”4 Her report of the brutality, cruelty, and neglect she experienced first-hand at Blackwell launched a grand jury investigation. The grand jury condemned the conditions they saw, increased the budget, and vowed to have more detailed examinations in the future. In 1908, former mental hospital patient Clifford Beers published a book imploring Americans to aid the mentally ill he saw “abandoned to filth and unbelievable misery.”5 He sought to improve the situation of the “helpless thousands” who suffered “needless abuse” in the 1 Albert Deutsch, "Dorothea Lynde Dix: Apostle of the Insane," The American Journal of Nursing 36, no. 10 (1936): 987-97, doi: 10.2307/3413570. 2 id 3 Ivan Belknap, Human Problems of a State Mental Hospital (New York: Blakiston Division, 1956), 14. 4 Nellie Bly, Ten Days in a Mad-House (New York: Ian L. Munro Publisher, 1887). 5 Clifford W. Beers, A Mind that Found Itself: An Autobiography (Garden City: Doubleday, 1908). 5 nation’s asylums.6 His impassioned plea, supplemented by graphic descriptions of his own time as a patient, produced a mental hygiene movement that momentarily brought the mentally ill into the spotlight. In 1947, author Frank Leon Wright Jr. published a book one reviewer called, “So forceful and graphic, it cannot fail to shock us, to awaken us, to impel us to action.”7 The book consisted of over 2,000 reports from conscientious objectors working in mental hospitals during the Second World War, who were sure that their exposés would shake the American public out of apathy. From Dix to Wright, over 100 years had passed and dozens of reformist exposés published. Yet when read side by side, the two works bookending this period could easily pass as a single text. In fact, the publications of Dix, Bly, Beers, Wright, and dozens of other advocates for the mentally ill are so similar that readers could easily believe the authors were contemporaries, rather than spread over a century. The problems uncovered year after year were so persistent, so unchanging, that each round of exposés seemed the same as the last. All condemned the overcrowded, unsanitary, and inhumane conditions of American mental hospitals, and passionately called for reform. Each activist spoke with righteous conviction, sure that they were the crusaders the mentally ill so desperately needed. They were certain that with just a little more money, some slight building renovations, and a few more attendants, they would finally reform the hospital system for good. All fell far short of their goal, yet it did not stop the next generation from attempting the same futile task. A predictable pattern emerged. Horrific conditions were revealed by some well-meaning activist, and public outcry drove a 6 id 7 Frank L. Wright, Out of Sight, Out of Mind ... A Graphic Picture of Present-Day Institutional Care of the Mentally Ill in America, Based on more than Two Thousand Eye-Witness Reports, (Philadelphia: National Mental Health Foundation, 1947), ix. 6 brief, intense period of reform. Once the public felt satisfied that they had “fixed” the problem and done their civic duty, interest quickly died, hospitals were neglected, and conditions rapidly deteriorated back to what they were before reforms were implemented. A new generation of reformers continued the cycle, writing new exposés on the same poor conditions. The familiar pattern seemed to start up again in the 1960s, with a new round of literature condemning asylums. In many ways, these mid-1960s pieces tread familiar ground. There was nothing particularly unique about the circumstances documented or the photographs published. However, a subtle new nuance gained popularity. These exposés and reports uncovered more than dirty floors and subpar meals. Critics started condemning the entire concept of asylums, rather than focusing solely on the poor conditions inside them. Then, in stark contrast to years past, no widespread reform effort followed these exposés. Instead, over the next decade, the asylum model was abandoned altogether. Public mental hospitals were emptied en masse, and by 1980 most states adopted deinstitutionalization as their official public policy. A 100-year old pattern was suddenly broken. For more than one hundred years, the medical and lay communities tried to improve the mental hospital system. Then in the 1960s, an almost unanimous consensus emerged that it was irredeemable. By the 1980s, asylums were all but extinct. How did an institution so firmly embedded in American society suddenly crumble in less than 20 years? What factors made this time period so unique that it caused the United States to abandon a model it had aggressively expanded for over a century? 7 Chapter 1: Shaping the Stigma To fully comprehend the gravity of the changes that occurred in the 1960s, it is important to understand the historic public perception of the mentally ill. Public perception has played a crucial role in how the mentally ill were treated, and much of the underlying stigmas found in the mid-20th century can be traced back to the roots of the public mental asylum. Early American reactions to mental illness stemmed from European predecessors. In the 17th-century, the European medical community held the belief that health, both mental and physical, was the result of a balance between man and the natural law. Madness was not accidental, but could only result from willfully breaking nature’s rules. As such, the mentally ill were seen as equivalent to criminals: both groups
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