I cannot apologize for the things that catch my interest. I'm about to read not one but two books about 19th-century asylum care for the mentally ill, for a project of my own, and the larger issue of inpatient psychiatric treatment fascinates me.
As a species, humans have never been particularly good at dealing with the mentally ill. For every folk tale you've heard about how this tribe or that one treated its mentally ill as shamans or prophets, the historical record gives us uglier stories: trepanning, exorcism, physical abuse, imprisonment or malign neglect. Even major advances in the treatment of mental illness have come with blunders and abuses, from lobotomies to the overmedication of the unhappy housewife.
Deinstitutionalization began when medications made it possible for many residents of mental hospitals to return to some kind of normal life. It accelerated in the 1960s, as returning patients to their families and communities became an increasingly realistic treatment goal. By the late 1970s this strategy, too, had unintended consequences, as city streets filled with mentally ill people (mostly men) who simply weren't able to take care of themselves.
Now inpatient psychiatric care tends to focus on acute case management, hospitalizing people who are an immediate danger to themselves or others for periods of time that usually last no more than a couple of months. Halfway houses and group homes provide support to the chronically mentally ill, but I still see people on the streets of Augusta and Washington, DC who would be better off in some kind of long-term care facility. Those don't seem to exist any more, at least not in the way they once did, and I don't know whether that's good or bad.
1. Bedlam. Its formal name is the Bethlem Royal Hospital, and it is still in operation, the world's first and oldest institution for the mentally ill. Founded in London near Bishopsgate, It was originally a religious priory, and became a hospital in 1337. Sometime around 1357, it began to take in mentally ill patients. By the end of the 16th century it was primarily a holding facility (you couldn't call it a treatment facility) for the insane. Conditions were horrifying, despite periodic efforts to reform the place and make it more humane. The hospital moved to larger quarters in Moorfields, in outer London, in 1675, and in the 18th century the hospital started admitting spectators, at a penny a visit. Visitors were allowed to bring long sticks to poke at the lunatics, and they came by the thousands. Circumstances improved in 1815, when the hospital moved again, to St. George's Fields, on a site that is now the Imperial War Museum. Bethlem Royal Hospital moved to its current location in an outer suburb of London in 1930. It's now a large complex of buildings on 250 acres, and is part of the South London and Maudsley NHS Foundation Trust. It is a postgraduate psychiatric teaching hospital, and welcomes visitors to a museum on the grounds.
2. Broadmoor Hospital. Americans know about Broadmoor from British crime fiction, and BBC mystery series. It is a high-security psychiatric hospital, founded in 1863 as the Broadmoor Criminal Lunatic Asylum. It housed both male and female patients/inmates until 2007, when the remaining female patients were moved to a new facility in Southall and elsewhere. Today it houses approximately 260 male patients, most of whom have been convicted of serious crimes or found unfit to be tried for those crimes by reason of insanity. Broadmoor includes a special unit for patients with "dangerous severe personality disorder," deemed to present a grave and immediate danger to the general public. Daniel M'Naghten, the paranoid Scotsman whose trial established the insanity defense, was one of Broadmoor's first patients, committed there after serving 21 years in Bethlem; he died there in 1865.
3. Danvers State Insane Asylum. Massachusetts' largest and best-known treatment facility for the mentally ill closed in 1992, after 114 years, and is now the site of a controversial apartment complex. Everything good and bad about the American mental health system can be found in the history of Danvers, which was probably the inspiration for H.P. Lovecraft's Arkham Asylum. It was built to take in patients who had been in a hospital in South Boston that closed, and to alleviate overcrowding in asylums around the state, but by the late 1930s it held four times the number of patients it had been designed for. It became a training and research facility early on, and was among the first mental hospitals to stop the routine use of mechanical restraints. It was also, according to rumor, the site of the nation's first prefrontal lobotomy.
4. St. Elizabeths Hospital. The official name of the hospital never had an apostrophe, which says something in itself. St. E's, as Washington, D.C. residents call it, was the first federally-funded, large-scale treatment center for the mentally ill, opening in 1855 as the Government Hospital for the Insane. It was the result of a major effort by the social reformer and advocate Dorothea Dix, a Maine native who spent most of her life lobbying for the humane treatment of the mentally ill. It sits on a vast campus (300 acres) bisected by Martin Luther King, Jr. Avenue. Much of it has fallen into serious disrepair, although it still serves as the District's public psychiatric facility, and construction is just ending on a new hospital building. Over its 155 years as an active mental health facility, St. E's has housed more than 125,000 patients, including Ezra Pound, the actress Mary Fuller, and would-be Presidential assassin John Hinckley, who still lives there. The Department of Homeland Security is in the process of turning the western campus into their consolidated headquarters; the snarky commentary almost writes itself, doesn't it?
5. Weyburn Mental Hospital. Students of the unfortunate consequences of good intentions need look no farther than the history of Weyburn Mental Hospital, a research and treatment facility in Weyburn, Saskatchewan. It was built in 1921, and designed to house 950 patients; by 1946, it held 2,600. Determined to place itself on the "cutting edge" (no pun intended) of psychiatric treatment, it not only made full (and sometimes excessive) use of treatments such as insulin therapy, hydrotherapy, lobotomy and electroshock therapy, but also experimented extensively with the use of LSD, including by staff volunteers who tried it in order to experience the effects of schizophrenia. Weyburn used LSD in the treatment of chronic alcoholism, with a success rate that would demand attention if the side effects hadn't been so disastrous. It officially closed in 1971, though some portion of the site was used as a treatment center until 2005.