Imagine a big, welcoming house. Light streams in through the open windows. Surrounding the house are acres of green lawns, meandering footpaths, and sweet-smelling gardens. The food here is nutritious and plentiful. The staff is pleasant and friendly.
You spend your days doing things that give your life meaning. If you enjoy sewing, you sew all day. If you are a carpenter, you build cabinets or tables. If your family is wealthy, you bring in your own servants to take care of you in well-appointed rooms. All of your troubles melt away.
Is this a luxury resort or hotel? No. It is a 19th-century insane asylum.
In the mid-1800s, America built a slew of beautiful, even spectacular, mental hospitals. They called them "asylums" because the word meant “place of refuge.” Asylums were billed as the ultimate escape from the worries of life. “Hospitals,” on the other hand, were associated with poverty and death.
If you had a mental breakdown, or perhaps suffered from crippling depression, you might commit yourself (or your family could commit you) to one of these places. Many were quite grand, with dairy farms, gardens, stables, and workshops. Best of all, according to some of the boastful pamphlets and ads, they had upwards of 99 percent success rates.
Unfortunately, the asylum dream crashed hard. It turned out that the success rates did not include recidivism, and so most patients returned, often again and again. Worse, the treatments did not demonstrably work. Though crafts could be calming, other treatments, such as being sprayed with water, dosed with opium and calomel, and getting veins opened to let out the “bad” blood, did not settle the brain. As asylums grew more crowded and desperate, states paid less per patient. The end result was massive, overpopulated, dirty institutions that were anything but refuges.
The popular attack on asylums began early. Ex-patients and creative novelists used asylums as settings of manipulation and horror. Once-popular but now-forgotten books like An Account of the Imprisonment and Sufferings of Robert Fuller and Dashington, Or the Mysteries of a Private Mad House opened the doors of asylums to the reading public. They revealed dangerous prisons where people were tortured and mistreated. A new fictional trope, the “evil asylum doctor,” emerged.
The gist of these critical books was that asylums were not utopias but instead just the opposite. Rather than healing, you got tortured. Instead of freedom, you got tied down. Instead of happy overseers, you got tyrants. Audiences ate these narratives up. They succeeded, probably, because they tapped a longstanding American fear of control.
The 19th-century asylums were built in an age of reform, when the country was seized with countless utopian schemes. Utopian ideas extended well beyond the asylums. There were “perfect” communities of religious enthusiasts, agrarian dreamers, and sexual renegades. Communes of every shape and type popped up. All of them promised perfection on earth. None of them lasted.
One of the problems of utopianism was that perfection was easier to imagine than to execute. People were just too messy, the outside world too intrusive, and the emerging industrial economy too demanding. The critique of asylums as control centers turned out to be one that could be leveled against other utopian endeavors as well. There was no perfect solution to life’s problems, especially when it involved keeping people pinned to one place.
This realist critique of perfectionism is as old as our republic. In the Federalist Papers, James Madison famously wrote, “If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary.” In other words, in an imperfect world, it is better to rely on thoughtful human systems rather than to hope for paradises that only divine powers could deliver.
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Half-Belief in Superstitions Asylums became known as mental hospitals by the turn of the 20th century. It was a publicity effort, a rear-guard attempt to rebrand them as something less horrible.
More utopian mental health schemes were on the way. These included, perhaps most famously, the “miracle drug” of Thorazine. This pill was hailed as a cheap way of making mental hospitals completely obsolete. Seriously ill patients would swallow them and become calm and happy. Like the utopian asylum dreams, this dream, too, came crashing down on the rocks of reality. In its wake, we were left with abandoned hospitals and homeless or imprisoned ex-patients.
The constancy with which utopian mental wellness schemes have failed imparts an important historical message. It is better to put stock in realistic, imperfect, scientifically-tested improvements, rather than to announce grand solutions of perfection.