In this series
In this series
In 1887, Joseph Pulitzer’s New York World published one of my favorite series in the history of journalism. It sported these headlines: “Inside the Madhouse.” “Feigning Insanity in Order to Reveal Asylum Horrors. The Trying Ordeal of the New York World’s Girl Correspondent.”
The author, Nelly Bly, 23 and brave, wrote about her time in the city asylum on Blackwell’s Island in the East River. “I always had a desire to know asylum life more thoroughly,” she said, “a desire to be convinced that the most helpless of God’s creatures, the insane, were cared for kindly and properly.”
The 19th-century asylum movement had begun with that very compassion. But it turned rancid. Underfunded and overcrowded, without enough food, heat, or competent nursing care, these facilities became places of horror, as Bly would witness. A Psychiatric Quarterly story, “From Beauty to Despair,” tells the story succinctly.
Bly became famous for her reporting on forced ice-cold baths and even colder-hearted attendants. Her stories contributed to a public outcry, an investigation of the Blackwell’s Island asylum, and the installation of new leadership and more money for better nutrition and nurture of its inmates. “I am happy to be able to state as a result of my visit to the asylum and the exposures consequent thereon,” she later wrote, “that the City of New York has appropriated $1,000,000 more per annum than ever before for the care of the insane.”
In the book that came of her reporting, Ten Days in a Mad-House, Bly suggested that many problems were likely to remain, but “I have at least the satisfaction of knowing that the poor unfortunates will be the better cared for because of my work.” In succeeding years, some asylums across America were similarly made more humane, including through improved training for nurses. Others became even more overcrowded and abusive.
By 1955, these state asylums—often simply called hospitals—had 559,000 patients. The better ones had courtyards and gardens. Residents as able participated in gardening, cooking, and laundry, under the care of a psychiatrist.
Many states showed pride in their facilities. Officials in Michigan, for instance, publicized photos of impressive buildings. Near Flint, Michigan, the Lapeer State Home and Training School, originally called the Michigan Home for the Feeble-Minded and Epileptic, housed 4,000 residents in more than 100 buildings spread over 898 acres. Ripley’s Believe It or Not said the school linked its buildings and dorms with the largest covered passageways in the world.
The financial problem was that these hospitals, often the largest single item in state budgets, “absorbed as much as a third of many states’ revenues,” The Mental Health Programs of the Forty-Eight States acknowledgedin 1950. The human problem was that some institutions—including one depicted by Life magazine in 1946 in which many residents had no clothes or bandages for open wounds—continued to offer only crowding and callousness.
In 1962, the Flint ABC affiliate WJRT showed “A Wind is Rising,” a 19-minute report with oration by Michigan Gov. John Swainson about “the responsibility of a democratic society to protect and restore to health those who need protection and restoration.”
The video began, though, with a shot from behind of a girl in a rocking chair eerily similar to Alfred Hitchcock’s introduction of Norma Bates in his horror flick Psycho. The voiceover imitated Edgar Allen Poe, as a narrator called the asylum a land of “hopes blunted and frustrated, and dreams grown cold. … Now a wind is rising and there is a desperate knocking at the door. … The knocking continues and grows louder.” All that was missing was a raven saying “Nevermore.”
Casual viewers were likely to react in horror and call for the hospital to be shut down. That’s what happened. The Lapeer State Home released its inmates into Michigan’s communities. With similar reports and changes around the US, the number of asylum inmates across the US plummeted to 114,000 in 1984, an almost 80 percent drop,
More than half of schizophrenic patients deteriorated within one year of discharge, often because no one made them take their meds.
As historian Andrew Scull notes in Desperate Remedies (2022), many former patients suffered from anosognosia, the disease of having a serious mental illness and being unaware of it. Scull’s summary: “The public was assured that deinstitutionalization constituted a grand reform. Patients who had languished on the back wards of mental hospitals were being returned to the community, thanks to the advent of modern drug therapy.”
The Associated Press reported from one lodging in 1980: “Dozens of men sit around the room—old men with white beards and thinning hair, young men with gaunt faces and thinning hair. … Some stare at each other, occasionally whispering. … The room is entered through a locked mesh gate. … ‘It’s my home,’ one guest mutters to no one in particular.”
Those were the better-off displaced. Others, one 1985 report noted, were on the streets and “often paranoid, manic-depressive or schizophrenic. And they are afraid, according to those who seek to help them, afraid of people they do not know, afraid of large shelters and afraid to leave the benches, alleys and bus stations they use as homes.”
Psychiatrist E. Fuller Torrey—author of 1988’s Nowhere to Go: The Tragic Odyssey of the Homeless Mentally Ill as well as 2013’s American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System—has described “discharged patients … living in skid row … wandering aimlessly in the streets.” He reported that 41 percent of the 301 patients discharged from Napa State Hospital between 1972 and 1975 had been arrested. Incidents related to mental illness in suburban Philadelphia increased 228 percent from 1975 to 1979. Salon and others have excerpted Torrey’s still-relevant work.
Not much has changed in the years since. This year, a mother named Madeline Till asked in a New York Times headline, “Why Is My Son Being Left to Die on the Streets?” Her son Abi was “diagnosed with schizophrenia, but as is often the case, he was unable to perceive that he was ill,” Till wrote. “Abi drifts from parking garages to homeless shelters, panhandling on sidewalks for a few coins.”
At the time of her essay, Till said, her son was in a hospital room. But he would “soon be discharged—with prescriptions he cannot fill, appointments he cannot organize and instructions he cannot follow—and we will lose him again.”
