The mental hospital is a flexible thing. Not only is it a real place, but it’s also a metaphor. Ever since the large mental institutions went up in the 1800s, they have served as stand-ins for what ails us all.
A popular theme is that America itself is one big asylum. Although this metaphorical reading is fairly common, at times it becomes quite prevalent. This generally happens when two factors coincide: There is great social uncertainty, and mental hospitals experience boom times. Two such moments are the antebellum years and the Cold War.
First, the antebellum years. In the decades leading to the Civil War, America transformed in dizzying ways. The emergent market pushed working people from the hinterlands into cities, where people encountered a strange landscape of crime, dire poverty, and anonymity. Huge waves of European immigrants added to urban populations, ratcheting up fears that America was losing its “character.”
Hand-wringing reformers addressed the chaos by promoting a huge variety of laws, public buildings, medical cures, and utopian experiments. Phrenology, divination, water cures, temperance, free love, and a panoply of rostrums took flight. Edgar Allen Poe groused that reformers could be defined as “Believers in everything Odd.”
One result was a huge boom in asylum creation (the word still reflected the original definition, “sanctuary”). Patients received “moral treatments,” involving careful scheduling of activities, fresh air, crafts, and more dubious therapies like bleeding, purgatives, restraints, opiates, and strong rooms. Some critics saw asylums as worrisome places where liberties were stripped.
Popular writers found asylums irresistible as metaphors for an unsettled landscape. Was not our chaotic, democratic nation just one big asylum, struggling to contain the “madness” of reformers and utopian zealots, subject to wild new cure-alls?
This argument is made most clearly in Poe’s 1845 short story, “The System of Dr. Tarr and Prof. Fether.” Here a visitor to a mental hospital finds a place where the patients run free and the attendants are locked below. In the end, the attendants escape and wage a rebellion. Poe seems to be saying that America, like the madhouse in his tale, is failing to contain its own chaos, that the solutions of the reformers are not really solutions at all. It is telling that the mad ruler of his asylum exhorts a brand-new system of cure just before the rebellion erupts. The narrator remains oblivious throughout.
Fast forward to another moment of worry — the early Cold War. Americans lived under the threat of the Bomb and the Communist Menace, dangers both external and internal. At the same time, never before were so many people hospitalized for mental illness. A full 50 percent of all hospital beds were occupied by sufferers of acute mental illness by 1956, a doubling of admissions since 1940. As with the antebellum years, some people came to see the country itself as one vast institution, in which the mad ones had already taken over. The very acronym undergirding the arms race—Mutually Assured Destruction—was MAD. Wrote Arthur A. Peters in his autobiographical novel, The World Next Door, the world had become an “insane asylum, with an atom bomb for shock treatment.”
The bestselling sociology book of the Cold War was Erving Goffman’s Asylums. Goffman makes the argument that mental hospitals are “total institutions,” Orwellian places where everything is controlled and regulated. In a disturbed society of backyard bunkers, atomic bomb drills, and Red Scares, America started to look like a total institution, where everyone was simultaneously placated and terrified, a place run by Big Brother.
This argument took hold across disciplines. We see it in philosophical treatises like Herbert Marcuse’s One-Dimensional Man (society imbues a “comfortable, smooth, and reasonable democratic unfreedom”), in critiques like Betty Friedan’s The Feminine Mystique (the suburban house is a “comfortable concentration camp” where women take tranquilizers and become "dependent, passive, childlike"), and in novels like Ken Kesey’s One Flew Over the Cuckoo’s Nest (with its all-controlling “Combine” representing not just the mental hospital but all of society). The success of these works speaks to deep contemporary concerns.
Metaphors are important. They help us to make sense of the world, anchoring inchoate worries to concrete, real-world places and things. But metaphors have limits. We must not mistake the compared thing with the real thing. Mental hospitals are physical locations with their own histories, places where people in pain have searched for treatment. America may seem like an asylum at times, but let’s not lose sight of the object of comparison.