Tag Archives: Pennsylvania Hospital for the Insane

Why Asylums?

New Pennsylvania Hospital for the Insane Under Construction, circa 1859, courtesy Library of Congress

New Pennsylvania Hospital for the Insane Under Construction, circa 1859, courtesy Library of Congress

Just the word “asylum” conjures up negative associations for most people–we have learned so much about the conditions and abuses in these institutions that it is hard to believe anyone thought they could be a good idea. We may understand that this deterioration was never anticipated by the original asylum advocates, but we still ask the question: couldn’t they have guessed what would happen?

Perhaps not. Here is a description of a lunatic’s dwelling in Little Compton, Rhode Island circa 1845: “The place, when closed, had no source of light or of ventilation. It was about seven feet by seven, and six and a half high. All, even the roof, was of stone. An iron frame interlaced with rope, was the sole furniture. The place was filthy, damp, and noisome.

“. . . –there he stood [the insane man] near the door . . . his tangled hair fell about his shoulders; his bare feet pressed the filthy, wet stone floor; he was emaciated to a shadow. . . . In moving a little forward I struck against something which returned a sharp metallic sound; it was a length of ox-chain, connected to an iron ring which encircled a leg of the insane man.”

Seated Portrait of Dorothea Dix, circa 1849

Seated Portrait of Dorothea Dix, circa 1849

The writer, Dorothea Dix, discovered that the man had been in this little cell for three years, with no heat in the winter. Before that, he was kept in a cage. Dix’s outrage and compassion for the unfortunate men and women held in these conditions spurred her life’s work of urging states to build asylums with decent conditions and amenities.

One Result of Dix's Concern Was the Butler Hospital

One Result of Dix’s Concern Was the Butler Hospital

When Dix saw the day-and-night difference in new asylums and the type of private care she described above, she undoubtedly believed that conditions could never be so bad in an institution as they had been under the haphazard system that spurred her reforms. And though asylum conditions did go downhill, they were never tolerated by society at large the way earlier abusesĀ  had been.

Overcrowding and the Attendants’ Plight

Agnews Insane Asylum Patients Eating Lunch, courtesy Detroit Public Library Digital Collections

Agnews Insane Asylum Patients Eating Lunch, courtesy Detroit Public Library Digital Collections

Overcrowding in asylums created miserable conditions for patients (see last post), but it also made attendants’ workload overwhelming and stressful. They had little time off compared to even today’s harried worker: usually a half day off a month, a couple of evenings off a week, and an entire Sunday off once a month. Additionally, attendants usually lived on-site and could seldom “get away” from their work atmosphere–long hours and stress just added to their own mental burden.

Attendants started their days early in order to get patients up, out of bed, and dressed at 6:00 a.m. or 7:00 a.m. each morning, and perhaps wash and change soiled patients the night shift had missed. They supervised patients’ daily activities, broke up altercations, noted their illnesses or other changing conditions, bathed and/or shaved them, and helped serve meals. Attendants cleaned incessantly, and kept constant watch over their wards for any dangerous conditions stemming from violent, suicidal, or delusional patients.

Male Attendants at Willard Asylum for the Chronic Insane

Male Attendants at Willard Asylum for the Chronic Insane

Attendants also needed to socialize with patients: they gently steered them from obsessive or disturbing thoughts, reassured them when they worried about family and friends, led them into constructive conversation, and so on. Ideally, they could be the trusted friend and mainstay that supplemented the efforts of the asylum’s medical staff.

Attendants at Pennsylvania Hospital for the Insane

Attendants at Pennsylvania Hospital for the Insane

Unfortunately, these important therapeutic tasks were usually the first to go when the work of physically caring for patients overwhelmed attendants. Even worse, their own stress and frustration could spill over into their interactions with patients, making a miserable environment even worse for them.