and the Devil himself...

and the Devil himself...
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Monday, October 31, 2011

A Haunted Halloween With the Inmates of Hopkinsville Asylum - A Look at Mental Health Care in the 1800s

Western State Lunatic Hospital

Mental health care in the 1800s wasn’t quite as bad as it was in the preceding centuries or, in fact, in the greater part of the next century, though standards certainly varied from place to place. Following investigations of abuses of patients, who were often kept chained and/or in deplorable conditions reform of places for the mentally ill was undertaken on a widespread basis, (and, again, this unfortunately followed after reforms as well, particularly in the case of conditions for the residents, but the use of restraints was severely curtailed.)

Reforms were part of what was called ‘The Moral Movement’, where patients were, essentially housed and given work to do, along with strict schedules. Outside of sedatives, (including the widespread use of marijuana with reported huge success), drugs were not generally administered and treatments like electro shock and lobotomies, fortunately, did not yet exist. There were, however some cruel and unusual ideas about the treatment of the mentally ill that were unfortunately sometimes practiced; cold baths, for example.

One striking thing about mental institutions in this period is the percentage of people housed there who were not crazy. Asylums generally doubled as a poor house, and the majority of the inmates were often paupers not the mentally ill. Patients appear to have been, with the exception of the extremely and dangerously ill, housed altogether – the poor, the elderly and infirm, those with mental and physical disabilities and, of course, those suffering varying degrees of temporary or permanent insanity. Keep in mind that many diseases of the time, typhoid and syphilis most primarily, also often caused mental illness. So, many people there did not suffer genetic or life-long mental illness.

Women could be institutionalized by their husbands or fathers with no grounds or proof and unfortunately this seems to have happened quite often. Asylums were also home to many unwed mothers and other women committed for ‘immorality’. Also sad to read are the number of women and children there because their husbands and fathers had severe alcohol problems and could not support them. Alcoholism was one of the leading causes for commitment and, combined with the secondary admissions of families of alcoholics, may have even been the primary cause.

The treatment of the poor was almost as gruesome in the preceding century as the treatment of the mentally ill. There were no social welfare programs, not even for the elderly or disabled. There were also, prior to the Moral Movement, not poor-houses or asylums to go to, undesirable as that choice may have been it was, at least, a choice. In the preceding era the impoverished and disabled were auctioned off to the community in a system a little like foster care. Citizens bid on the various people, listing the amount they felt they could take care of them in exchange for and the individuals were then given to the lowest bidder for care.

One can only begin to imagine the abuses that this led to and the system was highly criticized and, of course, ultimately terminated. An Overseer of the Poor was appointed and it was his job to check in routinely on the people placed and to make sure they were properly cared for. Of course, the success of this no doubt depended on the honesty and integrity of the supervisor. The same, of course, applied to the Overseer once the Asylum system was implemented but one imagines that, by removing the number of people involved the room for abuse was at least minimized.

The Asylum in Hopkinsville, Kentucky, inspiration in part for John Carpenter’s famous ‘Halloween’, seems to have been one of the better ones during this time period. Asylums were often training grounds for physicians, (as I said, medication was not generally administered for the patients mental illness, at least not with much variation, however, the large number of people housed there needed a wide variety of medical care, thereby providing good and broad experience.) I was particularly surprised by the number of female doctors listed on staff, a far greater percentage than one generally imagines working in the era.

Reports of conditions in Asylums of the time vary from the horrifying to relatively happy farm life, again, depending on the place’s administrators. Inmates who had money or who’s families did remanded it to the Asylum and inheritances for inmates were often donated, again, creating opportunity for abuse. The greater majority of people housed there, however, appear to have been poor, as pointed out earlier this was, in fact, often the reason they were there. Charlie Chaplin spent part of his childhood in one and left some tragic writings about it behind. Another notable figure of the time was Elizabeth Packard, a woman wrongfully committed who not only fought back but fought upon release to change laws for the mentally ill across the country.

Mental Health trends shifted back to community integration over the next century, with increased use of medication playing a large part in facilitating this. Fortunately, social service programs prevented a return to the auctioning off of the poor for community sponsorship.

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