THE ANTIPSYCHIATRY CONTINUUM

Some practitioners have been publicly critical (and then ostracized) for their antispsychiatry views. In your readings, you have encountered Loren Mosher and Peter Breggin.  Recently, the Director of NIMH came out against the DSM V, saying that the organization should no longer fund research based upon DSM diagnostic categories. Some of the origins of the recovery movement / psychiatric survivor movement resulted from people with mental illness generating alternatives for themselves (e.g. Fountainhouse).

In my opinion, there seems there is a continuum of support for the medicalization of mental illness. One one end of the continuum there are anti-psychiatry folks like Breggin (who are totally opposed to using diagnoses AND medications), and some psychiatric survivors like Ted Chabasinski.  Others take more moderate approaches (Anthony, Deegan, Chamberlin) and may question the validity of diagnoses, but in general, don't object to the use of medication, if it is helpful for folks. they would be in the middle of the continuum.  On the other end of the spectrum are folks who take the recipe-book approach to diagnosis and treatment with medications, ECT, cingulotomy, and capsulotomy. "This diagnosis gets this treatment." These folks clearly see mental illness as a disease of the brain, a "chemical imbalance" that needs to be medicated or cured.

Not all psychiatric survivors are radically anti-psychiatry, and not all practitioners are pro psychiatry.  Do pro-recovery principles automatically qualify as anti-psychiatry? Can someones be pro-recovery AND pro medicalization/psychiatry? Or is this a false dichotomy?

Review the figure below. If you had to place Recovery on this continuum, where would you place it? Where do you think your beliefs fall on this continuum of "antipsychiatry?" Describe your rationale, then comment (respectfully) on at least one of your classmates' replies.

St. Elizabeths Hospital Washington D.C.

When was this "asylum" opened, and what did it look like?

The asylum was opened in 1855, organized by Congress. The martials used to build this place was used from the property. They used the wood on the property and clay to make the bricks. They used different species of tree for the woodwork in each ward; there was cherry ward and beech ward for example. There is a brick and stonewall along the campus roads and walkways that still exist today.

What was it's original intent?
The original intent of St. Elizabeths was to provide care of the mentally ill in the most humane way as possible to the army, navy, and the district of Columbia.  
Who were the patients there?
The patients at first was individuals of the army, navy, and the District of Columbia. Then it was opened to all others.
What was the patients' experience like in that institution, and did that change over the course of the institution's history?
The institution was founded around the philosophy of care known as moral treatment. Dorothy Dix worked hard to uphold the proper care in the institute although not perfect it grew and changed with the time.  They used treatments such as lobotomy and hydrotherapy.

 

How did the institution, its services, and patients change over time? 

They used a lot of new methods in this institute and did a lot of research there. After the civil war they temporarily turned it into a hospital for the wounded soldiers. In 1990 they only housed 850 people the condition of the building was falling down and not in good shape for people to live in they have but since declared it a historical place and have torn down a lot of the building there.

How many people lived and worked and died there? 

In the early years it housed more than 7,000 people they have became over populated that they kept building on to continue to hold more people. As of today, there is less than 400 there. At the end of war world IIthere is an estimate of 7460. There is a cemetery there where there is about 300 union, confederate soldiers who died there, and approximately 160 civilian patients from St. Elizabeth’s. 
Were bad conditions ever exposed to the public? How?

The bad conditions were exposed and under went change by Dorothy Dix.

http://www.gutsandgore.co.uk/infamous-asylums/st-elizabeths-hospital/

http://stelizabethsdevelopment.com/history.html

http://www.archives.gov/publications/prologue/2010/summer/institutional.html

http://www.nlm.nih.gov/hmd/medtour/elizabeths.html

 

 

 

 

Danvers State Insane Asylum - Danvers Massachusetts

The Danvers Insane Asylum was opened in 1878. The hospital originally consisted of two main center buildings, housing the administration, with four wings attached and over the years other buildings were constructed, such as a new auditorium. 

The original intent was to house 500 patients with mental illness. In 1930-1940 there were over 2,000 patients.

Patients living there consisted of having mental illnesses. Over time there were patients that were intellectually disabled and and people with substance abuse issues. Each diagnosed person would live in a building or wing that fell into a specific category such as a place for the intellectually disabled. 

There were also expansions of education for those in the medical field within the facility, including a training program for nurses in 1889 and a pathological research laboratory in 1895. In the 1920's the hospital was operating school clinics to help determine mental issues in children.

Upon my research this hospital's philosophy was based upon humane treatment. There was said to initially have been no restraints and that doctors wanted to help cure patients rather than have them hidden from society. Over the years practice changed and restraints were used such as lobotomies, straight jackets and shock therapy. 

Property changed over time as well. Initially over 40 buildings were built on the property, including buildings for tuberculosis patients, two nursing homes, staff housing, the Bonner medical building, machine shops, pump house, a cemetery, several cottages as well as underground tunnels connecting all of the buildings.

From my research there is not an identified amount of people located in the Danver's State Insane Asylum's Cemetery, but there are hundreds of patients buried within and most of the graves are marked by a number, not a name. I found in 1939, 278 patients died. On an average, after about the 1930's, there were as many as a 1,000 patients admitted annually. In the beginning of the asylum patients helped with creating gardens and farming which led to harvests that fed the staff and themselves. There were also opportunities for exercising. Overtime, however, the asylum began to overcrowd and patients were given less therapy and more restraints.  


The hospital (it was later called Danvers State Hospital) shut down in 1996 due to lack of funds to support it essentially. There were reports written about allegations of abuse and the maltreatment of restraints onto the patients which were publicly scrutinized. It is unclear if these allegations are true or where the information was founded. 

Harrisburg State Hospital

When was this "asylum" opened, and what did it look like?
The Harrisburg State Hospital, formerly the Pennsylvania State Lunatic Hospital and Union Asylum for the Insane was Pennsylvania's first public facility for the mentally ill and disabled. The hospital was founded on April 14, 1845. The hospital served 12 surrounding counties on its 101 acre farm in West Philadelphia.


















What was it's original intent?
The original intent for this asylum was to care for individuals with mental illness since facilities previously were not equipped to treat patients with mental illness. With the Industrial Revoultion came many people from rural areas into the cities, and with the expansion of the city came an expansion of mental illness. Government control over many services, such as banks, railroads, hospitals also came about, along with the idea that the care for those with mental illness should be handled by the state government. With the help of Dorothea Dix and her lobbying efforts, the hospital was created in 1845.
Who were the patients there?
Patients from all parts of the state would be accepted at the hospital, at the expense of the counties that they belonged; or, if able they would pay for themselves at a cost of $2.50 per week. This cost included board and medical attention. The boarding charges for private patients were scheduled to vary between $3.00 and $10.00 based upon ability to pay. Depending on the time, patients from other hospitals overcrowded or shut down would inhabit the hospital,victims of the Civil War in need of medical attention, and criminals were listed as staying at the hospital.
What was the patients' experience like in that institution, and did that change over the course of the institution's history?
Life at the hospital during the early twentieth century was a community environment, the hospital had grown into  a small city. Patients worked all over the hospital as part of their occupational therapy. During the warm months they would care for the grounds, mowing grass and tending to flower beds. In the winter months they would shovel snow from the walkways. Patients worked on the farm, which supplied the hospital with all the food it needed, everything from meat, dairy, fruits, and vegetables were produced. The Central Kitchen stored and prepared all the meals for the patients and staff. Broom making and chair caning took place in the basement of the Chapel and a "toy factory" was established in the basement of the Male Chronic Building. Small shops in other buildings around the hospital produced mattresses, pillows, awning, window shades, and "indestructible" blankets. In 1926 a tailor shop was established, it produced suits, pants, and coats. The practice of patients working at the hospital was called occupational therapy, the work was meant to keep an excited mind busy and it was thought to give meaning to patients that would otherwise be sitting idly somewhere in a dayroom. Most of the items that were made at the hospital were used at the hospital and if there were excess items they would be sold at local markets, the money made was put back into the hospital budget.When patients were not working or undergoing treatments they often participated in hospital activities. There were weekly dances in the Sun Parlor a moving picture show in the Chapel, and a hospital band and orchestra made up of both staff and patients. Each ward had it's own organ or piano. Many patients also had radios or phonographs. There was also a library that could be visited by male and female patients at different times.
How did the institution, its services, and patients change over time?
The early 20th century was a time of great change for the Hospital. Between the years 1893 and 1912 the hospital was completely rebuilt following the newly developed cottage plan design. In the early years treatment was focused around fresh air, rest, good food, and hydrotherapy. In the 1930's when the Department of Public Welfare was created there came new treatments, shock treatments and surgery. The hospital was crowded, but conditions were still good. New buildings were established for different types of treatment on the grounds. At its peak the hospital consumed over 1,000 acres and included more than 70 buildings.Like other institutions Harrisburg State Hospital’s patient population began to fall in the late 20th century. This was due to new medicines being developed and finally deinstitutionalization.
How many people lived and worked and died there?
The original capacity was 250 patients, but at one time there was 2,441 patients, There were three cemetaries in total, but I could not find a record of how many people died or were buried there.
Were bad conditions ever exposed to the public? How?
I did not come across any information about bad conditions, just overcrowding and the use of radical treatments. Most of the information I found agreed that the hospital really tried to make the stay for patients comfortable and home like, offering many sorts of jobs and activities for the patients.

http://www.asylumprojects.org/index.php?title=Harrisburg_State_Hospital
http://hsh.thomas-industriesinc.com/Building_Kirk_2_Firstdays.htm

Butler Hospital - Ri

Butler Hospital for the Insane was founded in 1844 and opened in 1846.  It was designed in the Late Gothic Revival Style/Colonial Revival Style, and includes a 1731 farmhouse that stood on the property when it was acquired by the hospital (Wiki, n.d.).

After the visit from D. Dix, and further funding, a 2 story building, 290 feet long, divided into a main building with east and west wings was built.  This accommodated 100 patients. 

I chose to research Butler Hospital because it’s in my home state but was surprised and delighted to read that Dorothea Dix was involved shortly after it was opened and highly praised.  Their present day campus was purchased with her support.  Local citizens donated as little as a dollar each (which would be approximately $28 in current money) to see the hospital construction through to completion.  Butler was Rhode Island’s first exclusively Mental Health Hospital.  A sum of $30,000.00 was left by Nicolas Brown (d. 1941) to be appropriated towards the establishment of a hospital for the insane, “where that unhappy class of our fellow-beings who are, by the visitation of Providence, deprived of their reason, may find a safe retreat, and be provided with whatever may be most conducive to their comfort, and their restoration to a sound mind.” (Ray, I., 1948).  The initial charter application to the state was for the “Rhode Island Asylum for the Insane.” (Archives, 1926, p. 5)

Cyrus Butler, an industrialist, donated heavily to the hospital, thus the naming of the hospital in his honor.  Dr. Isaac Ray was the first Superintendent at Butler and a “national champion for the legal rights and humane treatment for the mentally ill.” (Asylum Projects, n.d.)

As this hospital is still in operation, patient confidentiality is of utmost importance and highly guarded information.  The most I could glean of previous patients is some names of family members from benefactors back in the late 1800’s, early 1900’s.  There is a publication from 1926, entitled “The Butler Hospital, Its Story”, (Archives, 1926) published by the Trustees and Superintendent listing all the benefactors from 1844-1926, which includes statements such as “A gift of $2,000 from W.H. Sanford for the building was significant, in that the sum was given to express Mr. Sanford’s appreciation of the care given his wife when she was a patient at Butler Hospital.”  All financial gifts are listed in the writing but it’s difficult to distinguish which were from families of patients.

There is a comment within “The Story” that when Dorothea Dix arrived in RI, she found that “there existed in the City of Providence a small asylum, conducted on wise and humane principles, but totally inadequate to the demands made upon it.” (Archives, 1926, p.6).  With her help, and the philanthropy of Cyrus Butler and others, they expanded the facility.  At Butler, they felt that outdoor activities such as Tennis and Horseback riding were beneficial to convalescence. 

The pervading atmosphere at the hospital is described as rest.  For all patients arriving, the first three days, the prescription is “rest.”  The halls are quiet, the view is delightful; everything inside and outside is designed to calm you while you are monitored closely by a nurse.

            There is great care taken to ensure there is no feeling of confinement.  When patients are new and unknown, they are constantly monitored but no mention of restraint of any kind is used.  They prefer to keep the patient in his/her ware by persuasion rather than by mechanical means and state that the results have proven well worth the additional care and expense.

            Jump nearly 100 years into the future and I’ve got an article published by a Recupero, et al., (2015) at Butler Hospital addressing R&S (restraint and seclusion); discussing strategies to minimize risk.  It might appear their treatment strategies changed with the prevailing models, however they do address this treatment on their website, and state: “Mental health providers that value and respect an individual’s autonomy, independence and safety, seek to avoid the use of restrictive interventions at all times.” (Butler.org/Quality, n.d.)  I’m glad I took the time to check their website before I lost all faith in their humanity.

In the early days at Butler, it sounded much more like a place of rest, as if you were going to a Spa to relax.  It was not just for the wealthy though; patients were asked to contribute financially to their care, even if only partially because they felt that if the patience was invested in their care, they would participate more fully.  Back in 1926, “The Story” indicates they offered recreation that included a putting green, a horseshoe court, a baseball field and tennis courts outdoors as well as a well-equipped gymnasium indoors.  Upon searching the current website, there is no indicating of any recreation facilities at all.  Previously hydrotherapy was thought to be an effective treatment as well, but not even that is offered any longer. 

With regard to their patients, Butler no longer has children’s programs as those were taken over by Bradley Hospital in East Providence.  All else remains the same.

Current reports give no indication of any numbers or statistics.  Thanks to “The Story”, I can share with you that in at the end of 1921 they had 136 patients and at the end of 1925 that number had risen to 150.  Also in 1925, 131 patients were discharged from the hospital.  Of these 131, 37 were “recovered” and 57 were “materially improved.”  This begs the question of the stability of the remaining 37 in my mind at least.  Was there no hope for them and they just wanted to go home? 

Currently, Butler Hospital employs approximately 950 full-type and part-time, clinical and non-clinical staff, in addition to more than 50 volunteers who assist in nearly all areas of the hospital (Wiki, n.d.)

I found it difficult to find any negative information.  They’ve done an excellent job controlling their media releases; they are uniform across all fronts.  I did find a snippet about lobotomy’s still being performed sometime near 2003 in an article entitled “The Brain-Butchery Called Psychosurgery” by Ramsay, W., J.D. (WayneRamsay.com); “According to Dr. Benjamin Greenberg, professor of psychiatry at Brown University and chief of outpatient services at Butler Hospital in Providence, R.I., "We don't like to call it psychosurgery anymore ... It's neurosurgery for severe psychiatric illness" (quoted in Benedict Carey, "New surgery to control behavior", Los Angeles Times, August 4, 2003, & mindfully.org)”.  This is fairly appalling and I found no further information to indicate if this has been discontinued or continue to this day.  However, thankfully, this was the only negative I found and I searched high and low.

Perhaps one of the reasons I'm so vested in this institution is that one of my aunts stayed there on more than one occasion having been diagnosed as manic/depressive back in 1976.  She passed away about 10 years ago.  Her son now works there as a drug and alcohol counselor, having recovered there himself many, many years ago.  

Butler Hospital in 1850 and today:

References:

Butler Hospital, n.d.. Retrieved from: https://en.wikipedia.org/wiki/Butler_Hospital

Ray, I. (1948). American Journal of Insanity. Retrieved from Psychiatry Online: http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.5.1.1?journalCode=ajp

Butler Book. (1926)  The Butler Hospital, It’s Story.  Retrieved from:  https://archive.org/stream/butlerbook/butlerbook_djvu.txt

Recupero, P. et al., (2015). Journal of the American Academy of Psychiatry and the Law Online.  Retrieved from http://www.jaapl.org/content/39/4/465.full

Butler Hospital. ( n.d.). Quality, Restraint and Seclusion, retrieved from:

                http://www.butler.org/quality/Restraint-and-Seclusion.cfm

Topeka State Hospital

Topeka State Hospital opened in 1872 originally called the Topeka Insane Asylum until 1901. The hospital was shut down in 1997 due to lack of funding and community integration movements. The original intent of the hospital was to treat the mentally ill in sanitary conditions, that would replace the unsuitable homes/prisons that they were living in. The hospital aimed to occupy people with mental illness with more appropriate tasks such as employment within the hospital which would hopefully make them happier. The hospital only took in people who were court ordered to be committed, the hospitals notion was that people are sick not criminal, therefore they wanted them to have appropriate treatment. In 1948 the true conditions of the hospital were exposed due to lack of funding, paperwork could not be found on many of the clients, and there were even people who had no identity at all, no one knew their names or why they were committed. During this time many people had been committed without being evaluated by a psychiatrist to see if they really needed to be committed and many people were found chained, naked, for months some even years. After hearing of some of the awful conditions the governor decided to create a panel of five people to examine the conditions of the hospital and decide what needed to change. Because of this the hospital gained more staff, and even opened a training center for staff so they would know how to appropriately treat their patients. Rocking chairs were also banned from the hospital. Out patient services even started in 1951. Unfortunately in 1958 the conditions began to go downhill again because of cutbacks, staff members left and patients went untreated. This hospital was known for physical and sexual abuse of patients, as well as neglect. Sterilization was also a popular form of treatment at this hospital, in the state of Kansas 3,032 people had been sterilized, a majority of them at Topeka State Hospital. There are 1,157 people buried at the hospital in unmarked graves.

Resources:

https://www.kshs.org/p/topeka-state-hospital-records/11317

http://www.asylumprojects.org/index.php?title=Topeka_State_Hospital

http://www.uvm.edu/~lkaelber/eugenics/KS/KS.html

Dix Hill Asylum/Dorothea Dix Hospital, Raleigh, North Carolina

In the Autumn of 1848 the champion of the cause, Dorothea Lynde Dix, made North Carolina the focus of her efforts. In North Carolina Dix followed her established pattern of gathering information about local conditions which she then incorporated into a “memorial” for the General Assembly, but in spite of appeals to state pride and humanitarian feeling, the bill failed. However, Dix had been staying in the Mansion House Hotel in Raleigh during the debate where she went to the aid of a fellow guest, Mrs. James Dobbins, the wife of a leading Democrat in the House of Commons, and nursed her through her final illness, and her dying request of her husband was to support Dix's bill. James Dobbins returned to the House and made an impassioned speech calling for the reconsideration vote and on the 29^th day of January, 1849, the bill became law.

Dorothea Dix refused to allow the hospital to be named after herself, but did permit the hill on which it overlooked Raleigh to be named Dix Hill in honor of her grandfather. But, one hundred years after the first patient was admitted the General Assembly voted to change the name of Dix Hill Asylum to Dorothea Dix Hospital.

The original building was started in 1851, and began admitting patients in 1856. It was a large Romanesque structure designed by prominent NY architect Andrew Jackson Davis. A second building containing a kitchen and apartments for staff was soon added. The site of the hospital on a hill over looking Raleigh offers remarkably pleasing vistas, reflecting the treatment ideology behind the hospital's founding: to provide clean air, advantageous views, and plenty of sunshine to help restore patients to good health. The acreage surrounding the hospital also provided therapeutic farming and gardening to feed the patients and staff. Movies were loaned free by local merchants, and annual barbecues, tennis courts and a ballpark added to the lives of the patients.

It's original intent was to provide humane treatment for the mentally ill. The original building accommodated 274 patients. As a result of the Civil Rights Act of 1964 requiring designation of public facilities, Dorothea Dix Hospital no longer served the eastern counties of NC for the white and indian mentally ill, they now accepted the mentally ill of all races in 22 counties in South Central North Carolina.

Daily life at Dix Hill was structured around the “moral treatment” philosophy designed around the belief that fixed schedules, development of routine habits, calm and pleasant surroundings, proper diet, some medications, physical and mental activities carried out in a kindly manner with a minimum of physical restraints, would cure the patients. Ornamental gardens and landscaped grounds with walks were developed. Work in the gardens and on the farm was also considered beneficial to the over all wellness of the patients. Vocational work was also available to the patients. Females made baskets, clothing, rugs, artificial flowers, and linens. Male patients made mattresses and brooms as well as assisted on carpentry projects. Some cleaned wards, or worked in the kitchen or sewing room. Recreational activities included tennis, croquet, reading, dancing and concerts. Patients, attendants and nurses assembled twice a week to enjoy dancing. Dancing lessons were given to attendants and nurses so they could give them to the patients. The hospital superintendent stated in his report that “all of them thoroughly enjoy the music, the effect is so apparent that music should be credited as one of the most potential remedies for the insane.” In 1858 a wooden chapel was built. The four ministers of Raleigh took turns leading services weekly, and editors of the state newspapers furnished their papers to the hospital. Movies were loaned free by local merchants, and annual barbecues, tennis courts and a ballpark added to the lives of the patients.

During the Civil War troops occupied the land around the hospital. They used the wooden fences for firewood, helped themselves to the grains and livestock, and socialized with the patients by attending their dances on Saturday night.

After the war, admissions continued to mount with the public's confidence in the asylum and the increased understanding of mental illness as a disease. Additional diagnoses were added to the asylum admissions such as those persons with mental retardation. In the 1870's mentally ill criminals were transferred from Central Prison to the asylum. However, when the state hospitals began admitting alcoholics, drug users and epileptics as patients, the legislature mandated the transfer of the insane criminals back to the central penitentiaries in the 1890's. Then, the Insane Law of 1899 revised the code for admission of the mentally ill to hospitals and for the first time there was voluntary admission, so in the early 1900's citizen pressure forced the NC legislature to increase capacity at all state hospitals. An epileptic colony was established to the rear of the hospital on 1,550 acres of land. The colony was known as Spring Hill Farm and Oregon Farm. By 1911 a training school for the retarded in Kinston, NC removed these patients from the hospital. Over the decades, the hospital grew with many buildings added through the late nineteenth and early twentieth centuries and various new therapies became available to patients. By 1974 the complex had grown to 282 buildings on 2,354 acres, plus 1,300 acres of farmland, patient capacity was 2,756. However, demand for long-term hospitalization of the mentally ill declined as out-patient care was emphasized. In addition, other state hospitals and private institutions offered mental health services that were closer and more convenient for many citizens. By the early 2000s Dix hospital had 120 buildings and accommodated a maximum of 682 patients.

In 2012, the last patient was transferred to another state facility, and Doroty Dix hospital was closed due to lack of funding.

There is a cemetary located on three acres containing 958 graves which serves as the final resting place for the many impoverished patients who were laid to rest on the grounds of the facility which treated them. Marble posts with a chain along the line of graves were erected, and a tag with the name of each person over his or her grave with the date of death. The hospital carpenter made the coffins until 1945.

I was unable to find out how many people lived, worked, and died at the Dorothea Dix Asylum, or if there were any reports of bad conditions over its 156 years of service.