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.

Athens Lunatic Asylum (AKA The Ridges), Athens Ohio

The Athens Lunatic Asylum, later renamed The Ridges, is located in Athens Ohio. The institution was open from 1874 to 1993 and remains the only Asylum still standing in Ohio. This 544 patient room facility was once the largest employer in Athens and is best known for being the original site of the controversial Lobotomy. Recovered documents revealed common practices within the Asylum included; hydrotherapy, electroshock therapy, the Lobotomy and use of psychotropic drugs.

In the annual report of 1876, common reasons for admission included; masterbation, intemperance and dissipation in males. In the early years, females were admitted for mental illness treatment caused by; puerperal conditions, change of life and menstrual derangement. Epliepsy, menopause, alcohol addiction and Tuberculosis provided adequate criteria to be classified as mentally ill and requiring institutionalization.

During the late 19th century, modeled after European standards of care and due to the great efforts of progressive leaders, treatment for mentally ill persons in the US began to shift. Lobotomies and other harsh treatment modalities were banned and much like the Tukes philosophy, patients were given working roles within the Asylum. Patients earned rights to roam the grounds, attend church services, plays and tend the farms and orchards. This movement created a sense of confidence and assurance in the general public. People quickly became comfortable with sending aging parents or teenager that were difficult to manage to institutions to receive what was known as great care, which quickly lead to over crowding, exhausted resources and decline in care. The pendulum continues to swing and the work remains in finding a balance.

Eastern Maine Insane Hospital

The Eastern Maine Insane Hospital know known as Dorothea Dix Psychiatric Center opened on July 1, 1901.  It was built on 150 acres on a pastoral hill named “Hepatica Hill” and overlooked Bangor and the Penobscot River.  The hospital had a campus setup. The reason for this location was to allow the patients to rest from an increasingly bustling society as well as society feared people with mental illness. Due to the expense of the hospital, patients were expected to carry out maintenance as well as the daily chores or tasks to continue operating.  Nursing staff and attendants were also required to live at the facility with the patients.
Eastern Maine received great praise from the Bangor Daily, who reported, “Everything is as cheerful and homelike as possible” The whole building, in fact, has rather the appearance of some big hote.”
The patients were individuals with mental illness, and the preferred treatment was first rest, and, hydrotherapy.  As the hospital began, advancing it soon noticed other treatment modalities such as electroconvulsive therapy and lobotomies. Psychotropic medication became available later on.
The hospital also had recreational things for the patients were they played games with others as well as activities based on the seasons.
The hospital became overcrowded, and the quality of care diminished. Single beds were used as doubles and double-rooms were used for as many as six beds.  It was also stated that patients were sleeping in the halls or the basement due to the overcrowded hospital.
In 1906, the hospital was granted construction for a women’s wing and eventual a men’s wing.  The hospital was averaging 600 patients.
The hospital discontinued using having patients doing chores because they needed compensation for their time/work. Also, patients were allowed to admit themselves voluntarily to the State Hospital on July 1, 1919.
On August 26, 2005, BMHI was changed to Dorothea Dix Psychiatric Center.  The hospital's mission is to, “collaborate with individuals with severe and persistent mental Illness and their community and personal supports to provide recovery-oriented, respectful, compassionate, and effective psychiatric care and treatment in the least restrictive safest and most therapeutic environment they can create”.Dorthea Dix Psychiatric - Maine.gov. (n.d.). Retrieved from http://maine.gov/dhhs/DDPC/mission.shtml
Patients who died while in Eastern Maine Insane Hospital was not recorded, and their burial was unknown. However, information that did come up was over the Augusta Mental Health Institute in the early 1960's.   The Augusta hospital closed in 2004 and was open for 165 years in which 11,647 people died and how they believe some of the patients had been buried on the hospitals 800-acre campus on the Kennebec River.
Today Dorothea Dix is licensed for 51 beds and admits on average 300 patients a year.  Although they are experiencing budget gaps where employees needed to be laid off however still employing 188 positions.  Closing the doors has been discussed although has not happened yet.
   

New Jersey State Lunatic Asylum (by Barbara)

<p>I chose the New Jersey State Lunatic Asylum, founded by Dorothea Dix May 15, 1848 because the video we watched stated that Dix spent the end of her life in private quarters here. When she retired at the age of 80, she took a private apartment at the asylum and remained there until her death five years later. I was expecting something rather grand and certainly very humane. This was the first of Dix’s asylums in the country, and it was clear that she intended it to be a place of humane care and treatment.</p>

 <p>It was the first American asylum built on the Kirkbride plan, an architectural style developed on the moral treatment philosophy in which the building itself is part of the cure and included privacy, easy access to sunlight and fresh air, and expansive grounds. Dix excited interest in this asylum by stressing the particular case of an elderly gentleman who had been a member of the state Legislature but in his old age became “insane” and was left to suffer first in a jail and later in an almshouse. Despite her ceaseless efforts, she had to apply pressure for several years before the asylum became a reality. Intended to take a portion of residents from each of the New Jersey counties, the asylum was self-sufficient with its own kitchens, gardens, laundries, livestock, and so on. There were separate dorms for males and females, with a capacity of about 200 patients. Separate buildings provided housing for staff. In 1855, additional buildings were put up that increased the capacity by another 250 patients and caregivers. Additional buildings, some intended to house patients and others intended for more scientific purposes, such a laboratory, or for better functioning of the asylum, such as a bakery, continued through the 19th century. There were different facilities for the wealthy patient than for the penniless ones, particularly around the quality of food, and an entirely separate facility was dedicated to those who were deemed incurable. At the end of the century, the asylum was recognized as having the largest library of any asylum in the country.</p>

<p>When the asylum opened in 1848 under superintendent Dr Buttolph, it housed 86 patients. Dr Buttolph is remembered for instituting occupational therapy and the elimination of physical restraints. Dr Ward replaced Dr Buttolph and served for 40 years, leaving a rich legacy of service and ability. In 1961, John Nash (A Beautiful Mind) was admitted to this hospital as a patient, and it is fortunate that he was not admitted even a single year earlier because Dr. Ward’s successor, Dr Henry Cotton, was convinced that mental illness was caused by infection and began the practice of removing patient’s teeth, tonsils, and other body parts (including legs, arms, and organs) to remove infection or to prevent its spread. The practice of removing a patient’s teeth persisted until 1960 despite hundreds of fatalities and thousands of maimings at the hospital. Dr Cotton was truly a mad doctor and, despite the high number of fatalities that occurred under his stewardship of the asylum, no one stopped or even spoke out against these involuntary and barbaric maimings and murders. Even more shocking, the removal of patient’s teeth remained a commonplace procedure for thirty years after he had left the asylum even though science clearly did not support the ‘focal sepsis’ theory of mental illness. In 2007, Andrew Scull published the real story of Dr Cotton’s horrendous practices and exposed the professionals through the years who participated in the cover-up. I found it interesting to discover that when Dr Cotton became ill in 1925 and took a temporary leave from the asylum, he had all of his own teeth removed and later returned to his duties at the asylum. I also noticed that the scholarly online sources focus on Dr Cotton’s modernity and advances, fail to mention his barbaric practices.</p>

<p>The Trenton Psychiatric Hospital, as it is now known, is a modern 450-bed institution - rather an alarming increase over the the 80-plus patients it originally housed, and even more so when you realize that many of the original buildings have been closed off and left to decay in place. The hospital’s website proclaims “compassionate care” and “human response” while ignoring its dark past. Recently, the hospital has been in the news for an attack by one inmate on another that left the attacked patient permanently blind and missing an eyeball. In recent years, families of patients at Trenton Psychiatric Hospital have called it a zoo, and published analysis shows that from 2005 to 2010 it had the “highest rates of violence and patient restraint compared to New Jersey's other four state psychiatric hospitals.” </p>

<p>I wasn’t able to find out how many people had passed through the doors, either as patients or as staff, because the hospital has been through several reincarnations and continues to operate today.</p>

<p>The asylum, originally intended to humanely house and care for people whose mental illness made it impossible to be cared for safely in a noninstitutionalized setting, had promising beginnings. During the 19th century, a great deal of effort was put into creating a place that was welcoming, light, and hospitable. Unfortunately, the hospital became very large, at times housing double and even treble the original 200 inhabitants planned for. Although there were buildings enough to house everyone and the campus was expanded to house more caregivers and buildings were built for water supply, food storage and processing, etc., I maintain that it is not to the benefit of the patient to be one of so very many. Smaller scale, more attention to each individual, is necessary. The asylum - and mental health professions at large - suffered terribly due not only to Dr Cotton’s horrifying practices but also due to the cover up within mental health circles. When questions led to concerns great enough to send investigators to the asylum, the reports that were made failed to reveal what was really going on. This cover up continued until the present century and even now, online sites may fail to reveal the true scope of Dr Cotton’s actions and the hospitals perpetuation of his practices for thirty years after his departure.</p>

<p>http://www.asylumprojects.org/index.php?title=Trenton_State_Hospital http://www.the-line-up.com/trenton-psychiatric-hospital/ http://www.nj.com/mercer/index.ssf/2014/10/trenton_psychiatric_patient_accused_in_attack_that_left_roommate_blind.html http://www.lehighvalleylive.com/hunterdon-county/express-times/index.ssf/2011/08/trenton_hospital_records_show.html</p>

Module 5 Bedlam Redux Blog Post Directions / Prompt

Dorothea Dix was VERY successful in her advocacy for people with mental illness. Asylums were built in every state, originally to support the humane care of people with mental illness. These institutions grew exponentially over time, in part due to Dix's advocacy, from the 1850s into the 1960s.  In the late 1940s and early 1950s, journalists started exposing, once again, the horrible conditions that existed in institutions (A Dorothea Dix Deja Vous, 100 years later)  Some of these institutions were also segregated by race, particularly in the South (as were their cemeteries).

Choose one of these infamous institutions in another state. Research and briefly summarize it’s history, using the prompts in this template below. CREATE A NEW POST (not just a reply). In the upper right of this blog screen it has a link "new post." That is where you will create your post. In the Title box, list the name the institution and State is was located in. (for example, Pineland - Maine). Then just type up the answers to the prompts and post / publish.

When was this "asylum" opened, and what did it look like?
What was it's original intent?
Who were the patients there?
What was the patients' experience like in that institution, and did that change over the course of the institution's history?
How did the institution, its services, and patients change over time? 
How many people lived and worked and died there? 
Were bad conditions ever exposed to the public? How?

Comment on at least 2 of your classmates' posts / research. Please do this early in the week so that other students will have time to read what you post.

100 Years from now.....

As I read about historical "scientific" approaches to mental illness, I can't help but reflect on today's practices. For example, Moral Treatment, began in part, as a backlash to the harsh treatments of the time. Pinel and Pussin both believed that people deserved to be treated with kindness. I see similar parallels in today's treatment approaches. On one hand, there is the medical model of diagnosis, and treatment -- with the physician as expert. In many ways, like Benjamin Rush's residents, psychiatrists today are taught to not let their sentiments get in the way, as they know best. Forced treatment happens with regularity. Unfortunately, the "patients" are right much of the time...about the negative effects of their treatments, and are legitimately resistant and noncompliant. Yet, somehow, their perspectives are disregarded, as they are "irrational," and obviously not as smart as the expert psychiatrist. I see recovery and psychiatric survivor movements as a backlash (in part) to this medical model, repeating patterns of the past. (Opposing forces -- Mad Doctors v. Moral Treatment)

It's easy to look back and be critical of the treatments that were considered "cutting edge" at that time -- for example, drowning, spinning, drinking concoctions, bloodletting, flogging. Often people with mental illness experienced these "treatments" negatively, yet these perspectives were disregarded, and "science" prevailed over human experience. Residents were taught to not let their emotions cloud their judgment.

What are we doing today (cite a specific practice or treatment) that YOU think will be criticized harshly when seen through the lens of history, 100 or even 200 years from now? To what degree are we disregarding patient experience now, and why do you think that happens?

Reply to this post and at least 2 of your classmates' replies.

During Week 2 of the Course, you will be participating in discussions on this blog. Stay tuned!