Madness 2: Out of Sight

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Madness 2: Out of Sight

Heights some uncanny rather perplexing about a building as large and as empty as this one especially when it doesn’t seem to be all that old just over a hundred years in fact and although it’s a frightful mess now it doesn’t seem to have been abandoned and all that long it’s not what you call a ruin certainly not an archaeological one so who was it meant for where are they all gone and why well while it may not be all that easy to tell from the inside I’m sure that you could see the exterior of this building you’d recognize it at once as a lunatic asylum and although it’s not serving that function now the memory of such places is still so vivid in the popular imagination we all know the names which express or perhaps conceal our fear it was a loony bin it’s a crazy house a laughing Academy a bug house or even a snake pit the paradox is that although such institutions still loom rather threatening Lee in the public imagination they’re actually quite recent inventions and after a comparatively short existence they seem to be on their way out and yet you only have to walk a few yards down this abandoned corridor to find that that’s not quite the whole story the custodial care of the insane is still a going concern here as in mental hospitals throughout the Western world the resident population 600 is a small remnant of the 6,000 who once occupied these enormous premises the patients who remain are the survivors of a therapeutic regime which has somehow lost confidence in itself unless what makes the unlikely assumption that the incidence of mental illness has fallen dramatically one can only conclude that the reduction in asylum population is the result of changing attitudes to how we care for the mad the advent of the psychotropic penetration yeah such a significant then you answer that the fact that you had the advent of the civil rights legislation which occurred under the kennedy administration and then the legislation basically decreed that individual has the right to be treated no least restrictive environment now by definition inpatient hospitalization has to be the most restrictive environment an individual is treated here he’s able to leave the hospital is discharged okay well in order to be readmitted gotta meet three critical criteria we don’t need all three legally we’re not permitted to admit you the three criteria are number one you must be suffering from a mental illness as diagnosed by a physician number two that illness must be sufficiently severe that treatment in a less restrictive environment is not appropriate least restrictive environment notion and third the individual must be dangerous to himself or others if you fail to meet those three criteria we cannot legally admit you so in other words the people on the streets are not necessarily a symptom of a system which no longer cares you’re dealing with the notion of least restrictive environment the paradox is that in yielding to the unprecedented demand for patients rights and to the strict statutory limitations under which people may be admitted and held against their will asylums throughout the Western world

have made an unintended contribution to the growing throngs of the homeless and yet confronted by the unrestricted environment of the streets it’s hard to visualize it as a Liberty and for those who would be quite unable to survive the comforts of custody now in order to understand how things got to this point you’ve really got to cast your mind back to the time when such institutions were completely unimaginable has to say when the fate of the insane was perhaps even more uncertain than it is now well as often happens it’s Shakespeare who provides some interesting evidence about the image of insanity in the early modern era in his play King Lear Shakespeare shows us the tactics of a character Edgar who wishes to conceal his identity and of madness my face our grime with filth blanket my loins elf all my hairs and knots and with presented nakedness out face the winds and persecutions of the sky the country gives me proof and president of bedlam beggars for with roaring voices striking their London mortified bear arms pins wooden pricks nails sprigs of rosemary and with this horrible object from low farms poor pelting villages sheep coats and mills some time with lunatic bands some time with prayers enforced their charity quarterly guard poor Tom that’s something Edgar I’m nothing ham Edgar I nothing am in a play which is preoccupied with the themes of madness and loss Shakespeare constantly repeats the word nothing so perhaps it’s not surprising that much of the action happens in a place which once represented nowhere at all in the Middle Ages and probably until the beginning of the 17th century the image of lunacy was metaphorically associated with the kind of uninhabited desolation that spreads out as far as the eye can see on either side of this road in an age when towns and industrialized agriculture have covered so much of the surface of our world it’s quite hard to recapture exactly what the word Heath once meant and to realize that a now picturesque road like this was once seen as a perilous tightrope stretched across the no man’s land that surrounded the towns villages and low pelting farms of human habitation in visualizing lunacy has a state of nothingness our predecessors didn’t think of it as a condition of no existence or of no longer being anything at all but as something perhaps more terrible of being alive but no longer human no better than the wild beasts that once roamed these unknown and uninhabited stretches of Heath within the community madness could be valued in different sorts of ways of course it could be seen as little better than being a wild beast but within the traditional culture madness could also be esteemed it could be seen as a form of innocence a kind of child likeness that was virtuous in itself it could even be seen as a direct communication with God there could be a kind of divine madness as well as a diabolical madness

and the madman his hallucinations her voices might be seen as as it were the supernatural directly communicating important messages there’s a romantic notion of the treatment of the mad in medieval period according to which folly was a form of wisdom as a mad were left at Liberty and indeed tolerated as part of xiety I find this in most respects a very misleading and set of notions in fact it seems to me wherever the mad were troublesome there wasn’t the least compunction about whipping them beating them chaining them off finding some way to dispose of them get them out of harm’s way where they were less troublesome they might be left to roam the countryside lefts if need be to rot now you may have noticed that any speech Edgar uses the phrase bedlam beggars now apart from the fact that this implies an affinity between poverty and lunacy and that’ll turn out to be a vital issue in the whole history of the subject the word bedlam of course indicates the existence of anatta Stein of a specialized institution for dealing with insanity the word bedlam is simply a corrupted version of Bethlem and it refers to a small establishment sumerian Bethlem under monastic patronage that had devoted itself to housing the mad since the late Middle Ages now in spite of the fact that this word is now virtually synonymous with custodial treatment of madness the number of insane people who were housed in Bethlem at this time no more than twenty or thirty there were only a tiny fraction of those who were afflicted the rest were almost invisible in the vast mass of rogues vagabonds ruthless unemployable and so forth amongst whom Edgar hoped to hide himself these people began to pose an acute problem to those who were responsible for the policing of parishes and local communities as Europe began to emerge from the medieval feudal system an aerial view of England today discloses few signs of that medieval world and the grandiose layouts of the greater states that superseded it are themselves little more than relics nonetheless this landscaped formality epitomizes a civilization that was increasingly intolerant of behavior which conflicted with order and reason you could say that the centuries mad people were largely dealt with in the community in the home by the family and that really changes during the course of the latter half of the 17th century and then through the 18th and into the 19th centuries where they become institutionalized in large numbers for the first time historians have debated at great length that often with tremendous acrimony as to why that sort of process took place and some have said this was a response to capitalism other people have argued that the development of the nation-state the powerful prince was important some people say that it was a response to the enlightenment of the way in which reason in the Enlightenment becomes so important those people who are unreasonable therefore cannot be accepted as citizens any longer they have to be shunted out of society into institutions some of these were quite small others grew to a considerable size so that by the end of the 18th century there were two or three in which conditions were quite appalling rent running to perhaps two or three hundred inmates instruments of confinement were quite commonly used patients were kept in conditions that were quite terrible in many instances with no glazing on the windows for instance with shackles tying them up to the walls with straw on the floor sometimes naked through the winter as far as treatment is concerned the profession relied on the traditional remedies of bleeding purging and vomiting in spite of the fact that the humoral theory on which they were all based had already retreated in favour of a growing interest in the role of the brain meanwhile reformers were beginning to express misgivings about the physical conditions under which the mad were held and one of the earliest reforming initiatives took place in France against

a background of revolutionary enlightenment Philippe Pinel the medical superintendent at the Salpetriere has become an almost mythical figure in the history of psychiatry the famous picture of him striking the chains from the inmates of the asylum still hangs at the head of the stairs leading to the medical library in fact this event never actually took place but Pennell did fundamentally change the whole therapeutic attitude to the insane he addressed his treatments to the mind rather than to the body preferring to view the deranged as being at one end of a human continuum in which there were imperceptible gradations between health and insanity in England where there have been no revolution most of the reforming initiatives took place under the auspices of existing parliamentary institutions you have before you drawings of knowledge in this state of confinement you admit they are a correct representation of the manner in which knowledge was confined I think the apparatus is all correct in fact one of the most significant events which set the stage for the great asylum building program which took place in the middle of the nineteenth century was the establishment of a series of parliamentary subcommittees appointed to take evidence from witnesses of some of the more outrageous successes of the existing systems the recommendations of the 1815 subcommittee laid the foundations for far-reaching public legislation I did not approve it but knowing the situation of mr. Crowder at the time I paid no attention to it mr kraler was generally insane and mostly drunk he was so insane as to have a straight weskit September 28 1814 I visited a private house at Bob’s about six miles from bath in it there were four women I saw lying on straw two of the women nearly naked the place in which they are confined is entirely dark and I think that in the course of my visiting I never recollect to have seen four living persons in so wretched estate I never smelled such a stench in my life it was so bad but the friend that went with us said he could not enter the other room I said I would go in if the patients could survive the night I could at least inspect it the stench was so bad I almost suffocated him and four hours after if I ate anything I still remember the same smell it was originally a pigsty it was built up high especially for her I have seen her combined there are three weeks together was she iron she was ironed there in the crib with wrist locks and leg locks and a chain two or three times across her body was there an iron bar placed between her legs in order to prevent her joining her feet together yes there was mr. Tolbert had it made on purpose for it was confined to each ankle with a chain going up between her legs which was attached to her handcuffs dr. Munro what are the forms of treatment well in order to be bled the latter end of May the following months we are administering medicines we don’t do this in the winter season what’s the house is so excessively cold and after they’ve been bled they take vomits once a week for a number of weeks are you aware that many consider the practice of vomiting unfeasible yes I am but the practice continues notwithstanding yes people differ in their opinions freely meanwhile in York a program of practical reform had already been inaugurated by a group of philanthropists who undertook improvements on their own behalf the instigator of this reform William took a Quaker gave evidence to the parliamentary subcommittee and I’ve always taken an active part in the attendants on committee meetings and everything that has been done respecting

it from the beginning do you know enough of the medical treatment of the patients at the retreat toward able to inform the committee whether the patients in the House have periodically physics bled vomited and bath no such thing with respect to bathing the bath is most frequently used and I think the warm bath rather than the other in fact very little medicine used I do not mean to boast but I could find fifty or a hundred former patients well and happy with in the mornings ride of my house final person change in New York why the men who behaved amiss they’re subject to no further punishment than to be put on the air in ground and they Thank You mr. Chu in order to appreciate the significance of what had happened it’s very important to understand the extent to which the medical profession had succeeded in gaining an almost exclusive monopoly over the custody and treatment of the mad and that this otherwise inevitable process had been interrupted they’re not permanently as we will see by someone who resolutely refused to acknowledge the psychiatric authority of the doctor those are the case loops but you also have the Admissions register which is much more organized beginning in 1796 first record is unrequited love how soon did it acquire the reputation of being a good place to be I mean quite evidently is now you walk into it and you would say well be [ __ ] if I went mad I’d like to be here how soon do you think it had got that reputation in the community in your instance they consist mostly of letters from physicians sending patients for treatment at the retreat to know that the surgeon involved who has the wonderful name of John Edgerton killer a very good name for surgeon he’s but he’s using the quake establishment because he knows it’s very good as with the other Puritan sects which flourished during and after the great religious upheavals of the seventeenth century the theatre in which the distinctive Quaker virtues were practiced and perfected was the god-fearing household so that in the effort to restore and strengthen what have been weakened by insanity Chuck and his associates did everything they could to construct a convincing replica of the Quaker home the theory was that by providing the patients with a persuasive reproduction of the decor in which they had lived they would automatically revert to the decorum from which they had lapsed infractions resulted in loss of privileges less comfortable rooms perhaps whereas good behavior was rewarded by approval and by full participation in the repertoire of daily activities but the most noticeable feature of the little household was the fact that the patient was addressed as a potentially reasonable person and not as an unreasonable brute so that what was once a menagerie had become a menage it was this more secular aspect of the to Cantor prize that was taken up and Exploited elsewhere when McClain Hospital was established in New England at the beginning of the 19th century it was one of a small group of asylums in fact there were only 500 patients in custody in the whole of the country in Pennsylvania in Connecticut in New York and also here in Massachusetts the founders had been almost unanimously inspired by the model of the retreat at York although Rufus Wyman who was the first medical superintendent appointed in 1816 was not himself a Quaker there’s no doubt that he too was inspired by tooks idea of moral treatment in fact this is his personal copy of Jukes description of the your retreat well the odd thing is that Jukes idea was received and adopted here in the United

States with much greater enthusiasm than it had been in England and one reason I suspect is that there was not as there had been in England a sort of Gulag Archipelago of private and public mad houses whose medical superintendents fought a rearguard action against the encroachments of non-medical treatment but I think there’s probably a more important positive reason and that I think is to do with the fact that this was a new country so that there weren’t a lot of old ideas clogging the mind I think the point is that the founding fathers had recently established their new country on the enlightened principle but human beings were essentially perfectible individuals and that if only social arrangements could be fair and reasonable then happiness and prosperity would follow inevitably the assumption was that passion could somehow be reconciled with rational self-interest by appealing to right reason and it’s easy to understand how Chuck’s idea that one could address the residual rationality of the Madeleine would have appealed to these socially optimistic Americans the influence of the new humanitarianism meant that even in hospitals where restraint apparatus was still used to control patients it underwent a subtle change when you first cast your eyes over these early 19th century instruments of restraint it may be quite hard to see that they reflect and express a completely new attitude to insanity under the influence of the english philosopher john locke madness was regarded as the invasion of orderly thought by false ideas and the theory was that if only the mind could be curtain’d and quietened it might spontaneously revert to its natural orderliness and obey its normal tendency to associate ideas in a rational manner in fact even that revolving wheel or drum had a psychological rationale behind it once inside as long as you remain still you would avoid the vertiginous discomforts of rotation so the assumption was that by appealing to his residual Reason the patient would be taught that there was nothing to be gained and in fact everything to be lost by his maniacal behavior as the inventor of the apparatus itself put it it would reawaken his sense of responsibility in this new age of therapeutic optimism the asylum was now regarded as the sovereign remedy for the social problem of lunacy it was to all intents and purposes a factory for reconstructing sanity like the great prisons which began to appear in the same period these custodial establishments for the mad were built in every state in county in America one of the most emblematic examples of the new initiative was the Pennsylvania Institute for the insane whose Quaker superintendent Thomas Kirkbride wrote an influential treatise entitled the construction management and general arrangements of hospitals for the insane you think one of the hardest experiences to recapture for us in the late 20th century is the impact that a building like this would have had on a person in the 1860s being a scale now when we’re used to such large buildings the scale is something like this seems relatively small for its time this was an extremely impressive building I plan on that as often happens when the excesses of a derelict regime are identified and overthrown the alternative plans visualized by the Reformers assumed a recognizably utopian character the reformers designed establishments whose architectural format expressed intelligible regularity assuming the by living in premises which represented order and reason the inmates would repossess their own an image was created that here was not a prison but a healing institution that it had the capacity by the use of bricks and mortar by the use of therapeutic regimes to cure people and an enormous amount of energy was invested by early 19th century asylum keepers to try to I guess one could say improve the quality of life in the asylum but just to make it more humane but to create occupational opportunities

work in the fields to improve the social interaction of lunatics to improve staff patient ratios to create harmony within the asylum and one of the sort of classic examples of that is the asylum ball it’s very well documented by people like Dickens that at Christmas or New Year there’d be a great party a celebration are coming together if you like of staff and patients and the outside world showing that recuperation was actually happening this is not a world of punishment this is a world of retraining people for outside in some ways the nineteenth-century asylum was the victim of its own success or at least its propaganda more and more of them were built more money was invested more public hopes were placed upon the asylum and of course these hopes were dashed Morrow treatment once it got into the state-sponsored asylums was rapidly diluted and transformed into something very different it became quite quickly a mechanism form repressive Lee managing large numbers of patients Jukes retreat had contained only 30 or 40 patients the new county silence from the outset had one or two hundred and very quickly that rose to five hundred six hundred a thousand and then several thousand the conditions of that sort what became of prime importance was simply managing the patients and developing techniques to keep them Placid and from causing undue trouble like so many of the other reformers Thomas Kirkbride lived to see his utopian scheme on the edge of ruin I think he died not brokenhearted but aware that his his life’s work was threatened and that the validity of his ideas was being questioned on all sides a younger generation a young turks as they called themselves had come along and insisted that another illness was strictly semantic in origin that had to be dealt with from a semantic standpoint and in fact what we’re very pessimistic about the power of medicine moral medicine to cure the insane so at the time that he died in 1883 I was a full-scale revolt against moral treatment in his hospital plan the Kirkbride plan came to symbolize that that old style blend of religion and science and the younger generation didn’t want to have anything to do with it confronted by a growing population whose sheer size meant that moral treatment was inapplicable the incentive to find alternative methods of treatment proved almost irresistible now the point is that since there had always been a lurking suspicion that insanity was the result of an organic disease the treatments that were eventually seized upon especially in the middle years of the 20th century predictably assumed a drastic physical form medicine in the early 20th century had made great strides in both understanding and to some extent in treating disease and as a result had accrued considerably more social prestige than if it had to enjoy by contrast psychiatrists presiding over a ramshackle Empire of decaying asylums that really were seen as failing to cure completely felt very much left behind and one can see I think efforts on their part to catch up with the rest of Medicine and to import some of the advances that seem to have had such dramatic effect there beginning in the early 20th century we see the emergence in institutional psychiatry of a range of treatments which in retrospect looked quite peculiar giving patients with tertiary syphilis malaria operating on them pulling teeth removing tonsils and perhaps going into the abdominal cavity and starting to remove stomachs and colons and so forth justified on the basis that these people were victims of an infectious illness was poisoning

their brains the use of insulin electroshock Metra’s all his ways of shocking the system perhaps into some former sanity as an almost inevitable consequence of the belief that lunacy was caused by something going wrong in the brain surgeons began to undertake direct assaults upon the cranial contents meanwhile in Nazi Germany an even more radical solution was proposed I don’t think it takes a particularly vivid imagination to reconstruct and even relive the experience of the ten thousand mental patients who spent the last agonizing moments of their existence in this small tiled room in Hatami a few miles north of Frankfurt perhaps the whole process took Warne a few moments the carbon monoxide which was used to asphyxiate the victims 60 or 70 at a time wasn’t all that efficient in any case there was the problem of disposal soiled with the vomit and excrement which would have been voided during the death throes the bodies which were not destined for dissection in the next room were loaded onto trolleys and transported down a short corridor to the incinerators it strikes me as a paradox that a people so obsessed with cleanliness and with beautiful sunlit bodies were prepared to wade through fathoms of obscene filth on their way to a Teutonic millennium but then not sysm always projected an image curiously comprised of Abel bison by the time the invasion of the rest of Europe was underway German doctors were violating the civil rights of their own citizens by rounding up epileptics mental defectives and indeed anyone whose mental disorder could be identified as a threat to the genetic purity of a nation which was otherwise destined for heroic precedence even at the outset there were misgivings about the social acceptability of the scheme and even about its moral propriety and although the records were kept with an almost pedantic accuracy much of the operation was conducted in a somewhat underhand manner and more often than not the victims relatives were either misinformed or kept completely in the dark in any case for one reason or another the program came to an official conclusion by the end of 1941 although by that time 70,000 people had perished I think the Christian woman wants answered is not how did it come to an end but how on earth did he get started in the first place as we’ve already seen the management of the mentally ill had always posed a vexing problem so one can only suppose that their readiness to adopt such a lethal solution for it this time was that the problem was conceived in completely different terms not just as one of management and expense but in terms of something much more fundamental as to say in terms of the biological destiny of the human race I think in that sense what the Nazis were prepared to do was an extension of a movement which was already underway at the turn of this unforgivable century that is to say a belief that biology offered a way of permanently rectifying the hereditary imperfections of the human race

what this had to do with marrying Alice was that apparently some of her relatives had been residents here at the local Asylum and that meant that Alice had inherited and might even pass on this degenerate taint the theory of degeneration has applied to Asylum inmates well simply one aspect of a biologically based suspicion which had begun to grow in the 19th century the idea was that even amongst ordinary people has to say outside the asylum one could identify lower orders of humanity epileptics mental defectives one sort or another Crichton’s criminals and even some racial groups well behind all this lay the assumption that the human race was undergoing and hereditary changed for the worse and whatever the reasons for this deterioration programs of artificial selection we’re recommended as a substitute for the frustrated force of natural selection and so if we want to maintain the race at a high level physically and mentally everybody sound in body and mind should marry and have enough children to perpetuate their stock and carry on the race not all mental deficiency is hereditary but heredity accounts for more of the mild feeble-minded types these are children who are helpless in every way and need constant attention once such children have been born we must do the best we can for them but it would have been better by far for them and for the rest of the community if they had never been born well in the early years of the 20th century many intellectuals throughout the Western world became enthusiastic exponents of these eugenic policies and although they were often vigorously opposed by politicians and scientists who suspected what this could lead to it was only under the auspices of narcissism that the world was brought face to face with what would happen if these ideas were taken to their logical conclusion he’s in fleet of inaudible in 1.8 tediously concurrent sentence doctrine and land salmon on file for thought or skinny-fat work in 1946 not much more than a year after the Allies had liberated the death camps of Europe the American journalist Albert undertook a nationwide investigation of American mental hospitals like the photographers who accompanied him on this dreadful Odyssey Deutsch was horrified to discover that the condition of the patients bore an unsettling resemblance to that of the survivors of belsen Buchenwald in Dachau I entered buildings swarming with naked humans herded like cattle and treated with less concern I saw hundreds of patients living under leaking roofs surrounded by moldy decaying walls and sprawling on rotting floors for want of seats or benches many of the attendants I was told were vagrants recruited directly from courts and police stations where they were reportedly given the choice of a jail sentence or of going on the asylum payroll apart from the heart-rending spectacles themselves I think what disturbed Deutsche as much as anything else was that whereas the conditions in the concentration camps where the expression of a deliberate policy to torment and exterminate the unwanted the atrocities which he witnessed in the American mental hospitals were quite unintentional far from being the expression of a policy they were the result of a conspicuous lack of policy made all the worst by political indifference and by an almost breathtaking economic stingy onus on the

part of those who were responsible for the welfare of the insane it was in deutsches own words euthanasia by neglect well to be strictly fair the term euthanasia or to be taken with a pinch of salt as there was no large-scale elimination of mental patients all the same there’s no getting away from the fact that the rates of both morbidity and mortality were much higher than they should have been and that both of them we’re the result of neglect like the softly overgrown hammocks of Auschwitz more than 40 years after the liberation the unalarmed rista city of the scene betrays almost no sign of the victims who lived and then died in these dreadful conditions but if you brush away the undergrowth here you soon become aware of the fact that you’re standing here in a vast unmarked Cemetery each of these numbered stakes represents a grave and if we go back to the hospital records it soon becomes apparent that in this hospital alone patients were dying at the rate of 10 a day it’s almost impossible to tell except by the number who this might be go back to the white males 3 9 4 it could have been someone called Robert Kevlar look at colored males 3 9 4 and it could be Moses Smith and then we can go further and look at the colored females 4 it could be Susan McKee slim in fact we’ll never know now as I say it would be both misleading and unjust to regard these deaths as an atrocity but there’s no doubt that the lives of the victims we’re and it’s quite hard to get ones mind around the idea that anyone let alone the afflicted should have had to endure such conditions especially in a country which prided itself on being the land of the free and the home of the brave in fact by the 1950s there were almost a million people incarcerated in asylums in the United States alone it’s often been claimed that what reduced the asylum population in the 1950s onwards was the introduction of new treatments and indeed with the introduction of drugs such as tor promazine or Thorazine there was yet another period of therapeutic optimism perhaps the most eloquent spokesman on behalf of this new optimism was the English psychiatrist William sergeant when I first walked into an asylum had to work there I actually walked out I just couldn’t read it bear it Sargent prophesied that organic medicine would eliminate insanity along with all the other scourge –is that had already yielded to drugs and surgery with a six year history of abdominal pains and blackouts and depression six years yes six years and she’s done very well with the combined drugs and 5ec to intervene in just over fortnight you should pay much better lead the point of these new keep was about which has been so much discussion is they’ve meant that these old asylum pieces are now treated in General Hospital’s and you can see how well worthwhile it’s been and without these new treatments we did have psychotherapy psychoanalysis you know 30 years ago where we hadn’t got any new treatments out these new treatments I think we would still be in the old mental hospital atmosphere this department here has 20,000 and you know the tens of a year and I think that with the methods we’ve shown here if you really use them intensively you can treat the most acute schizophrenic the most severe depression in a General Hospital atmosphere without any need for locked doors and and I believe that we’re just the start of our revolution and as I said very I hope in the next 20 years time the old mental hospitals will be things of the past as things turned out apart from the fact that the side effects of drugs threatened to create as many problems as they solved if one looks carefully the timing of these events there’s plenty of evidence to show that the process of D car serration was already recognizably underway well this can only mean that some other factor was at work and it’s possible that this had something to do with a suspicion or misgiving which had already been expressed by the English psychiatrist John Connolly at the

inception of the public Asylum movement early in his career Connolly had warned the profession that institutional confinement was a risky maneuver and that it might create as much insanity as it was intended to cure now for him this was nothing more than a prophetic intuition but in the 20th century sociological investigators such as Erving Goffman recognized that by assigning patients the role of lunatic launching them as it were on an irreversible career of lunacy the asylums were simply fulfilling their own expectations and thereby guaranteeing their own futility as it happens these convictions ran parallel to many other currents in favor of social Liberty and liberal opinion at large identified a deep affinity between people who were imprisoned for insanity and other social groups whose freedom had been unfairly limited blacks and other minorities we’re not the only people who had their eyes on the prize throughout the 1960s and although the mad didn’t have any charismatic spokesman amongst their own members men such as Martin Luther King who were able to convince their fellows that they had a dream there’s no doubt that the spirit of civil rights in general had an important part to play it was all this as much as drugs that helped to alleviate the condition of the Asylum inmate and put the asylum virtually on notice of dismissal and even if the institution was not exactly disestablished the conditions under which patients were now admitted and held were much stricter the irony is that the yoke retreat upon which so many of the subsequent institutions were modeled is one of the few which has remained an asylum in the best sense of the word the one is left with these suspicions but it has done so by continuing to limit its clientele not to the Quakers for whom it was originally intended but to those who for one reason or another can afford the private fees however in hospitals that relied on public funds and which were therefore unable to resist the overcrowding that prevented them from fulfilling their early promise an exodus has already begun the inmates have increasingly in the somewhat effeminate term used by the administrators been returned to the community it’s almost 150 years since free and hospital was opened with all the high hopes that characterized an age that so often referred to itself as an era of improvement now as the 20th century draws to its close the function of such places no longer seems as clear as it must have done to its optimistic founders indeed it’s quite hard to tell what somewhere like this should before if anything the problem is that it’s easy to read so many different arguments into a desolate spectacle like this the fact that the last patients moved out of this ward only a few weeks ago could be interpreted as yet another step towards the abolition of an institution that should never have existed in the first place and that it’s emptiness reflects the success of modern treatment and the realization that custody created as much mental disorder as it was intended to cure alternatively it could be seen as a catastrophe visited upon the insane by a society unwilling to bear the fiscal burdens which are necessary for the upkeep of such establishments because although the word asylum has acquired almost universally negative connotations there’s no getting away from the fact that in spite of the advances in treatment there are still people for whom asylum spells refuge and sanctuary and many of the people who left here a few weeks ago would have very little chance of surviving in the outside world although the large public Asylum has been tried and found wanting the Liberty

which is now inflicted on some of its former inmates is no solution either the homeless limbo into which so many ex mental patients are now thrown is little more than a concrete version of the medieval Heath upon which their predecessors are supposed to have roamed if it’s a girl yet yes but I don’t stay