Abstract Asylums such as The McLean Asylum for the Insane located in Boston, The Worcester Lunatic Asylum, and The Northampton Lunatic Hospital have been around for many years. Since the 1800s through the 1950s asylums have drastically changed in appearance, treatment, diagnosis and many aspects of the asylum such as the food patients are given to eat, and what work the patients get to do while being treated. The grounds and buildings of asylums have made significant improvements. Treatment has become more moral and orderly as the decades progress.
Each asylum has different forms of recreation and work that the patients are allowed to do while being treated in the early asylums. Asylum Changes in Massachusetts The main and earliest asylums in Massachusetts in order include the McLean Asylum for the Insane located in Boston, The Worcester Lunatic Asylum, and The Northampton Lunatic Hospital. McLean Asylum for the Insane was founded in 1818 originally located in Somerville, then moved to Belmont, Massachusetts. In 1895. It is famous for its groundbreaking neuroscience research and for the large number of famous people who have been treated there such as Ray Charles and James Taylor.
This asylum was the first psychiatric hospital In the U. S to make sure it had basic clinical laboratories. The hospital studied biological factors in mental illness patients. The McLean Asylum was also a division of the Massachusetts General Hospital and followed the Quaker principles of moral treatment. The Worcester Lunatic Asylum was founded in 1832 in Worcester, Massachusetts. It was the first of its kind in Massachusetts. During the first year that it was opened 164 patients were received. The Northampton Lunatic Hospital was founded in 1858 and located in Northampton, Massachusetts.
This hospital was later added to the National Register of Historic Places. The Northampton Lunatic Hospital and Worcester Lunatic Asylum were both part of the Kirkbride Plan. This plan was a 19th century building style that was put into effect for many asylums. There have been many improvements since the 1800’s until the 1950’s in buildings and grounds, diagnoses, demographics including leisure, work, food, and patient treatment in all of these asylums in Massachusetts. Previous to the 1800s, patients suffering from mental illness were hidden and housed in jails before asylums.
Benjamin Rush, also known as “The Father of American Psychiatry. ” contributed a great amount to the treatment of patients. Patients were restrained to Benjamin Rush chairs; His treatment methods also included bleeding, purging, and hot and cold baths. (Ozarin, L, 2006). 1800s: Buildings & Grounds The Worcester Lunatic Asylum consists of a center building and two wings, the basement is designed for storerooms, a kitchen and laundry room. Pipes have been laid for water supply. The buildings were plain, strong and made of brick with a zinc roof.
The buildings had separate apartments for patients, which were warmed in winter and highly ventilated. They had rooms for tenants as well as cooking establishments. For the grounds, excavation and stoning for the cellar done as well as construction of a road. High fences were put up to separate the different yards. (Massachusetts General Court Senate, 1837). Recreation Patients are encouraged to take exercise in the farms available in the grounds for them. They are allowed to roam in the carpenters’ shop, walk in the gardens, take excursions, and participate in in-door games as well as other forms of entertainment. American Psychiatric Association, 1895). Treatment Bloodletting was not always used in treating the insane patients (American Psychiatric Association, 1895). At the Worcester Lunatic Asylum, In terms of system of treatment, employees of the asylum need to pay special attention to cleanliness, bodily health of patients, clean air and suitable diet. Moral treatment was used and highly recognized, they used to believe that humanity is the law of love. (Massachusetts General Court Senate, 1837). Patients are examined for cures yearly.
The patients at Worcester have been more highly selected. Those considered “incurables” have no selection of diet and receive little medical treatment and nursing help. However they do require a substantial amount of food. 1850s Buildings & Grounds In 1888, The Northampton Lunatic Hospital made many changes and improvements in their buildings and grounds. Yards of concrete walk have also been laid by the patient as well as excavating. for the animals were erected. The stable for cows and cattle are now in the basement.
The barns were built because the demand in milk increased from the incoming amount of patients being admitted to the hospital. A cold storage building was added as well, this storage building mostly containing apples, potatoes, dairy products and vegetables. In terms of improvement, the addition to the south wing of the hospital was worked on. There was a high need for the addition because of toilet and bath purposes. A spacious pavilion with a large fireplace mainly for the use of the patients was constructed on the hospital grounds. This building was a gift of Miss Martha Eastman of Amherst.
Many of the patients used the buildings and grounds for a temporary home, an environment to work in and for recreational and exercise reasons. (Northhampton Lunatic Hospital, 1907). Many other improvements have been made such as men and women are now in separate comfortable quarters in their own buildings. The laundry room is now much more capacious and modern. The kitchen departments were now doubled in size. The interior of the female wing had been rebuilt. The wing has larger windows for light as well as new wire-lath ceilings that are protective from fires.
A new chapel was constructed; it would be two and a half times larger than the one they currently had. Treatment In terms of treatment, Most of the patients, eighty-two percent, are considered to be incurable Taking the average of the patients that now present themselves in Massachusetts, eighteen percent are supposed to be curable, and need active treatment, and eighty-two percent, incurable, and require principally general management and soothing custodial guardianship. It is believed that moral and medical treatment is essential. (Jarvis, E. 1855). Food
At The Northampton Lunatic Hospital, the sleeping, eating, personal hygiene, exercise, recreation and occupation routines are highly ordered and monitored. Private patients get to eat from a larger variety of food. The patients are served bread, cereals, cheese, eggs, fruit, meats, beans, tea, coffee, and vegetables with their meals. (Northampton Lunatic Hospital, 1907). In another example, if the food is not considered ‘good’ many patients will be come angry or harder to control and manage. The patients also require good attention and monitoring from the hospital’s employees. Jarvis, E. 1855). Work At The Northampton Lunatic Hospital, patients help out in areas such as in the kitchen, sewing, laundry, carpentry shops, painting, masonry, electricity work, plumbing and in the gardens barns and stables. The patients make brooms, tin ware, clothing, mattresses, and bedding and upholster chairs. These activity are mostly carried out in the industrial room, wards, their activities have even been in exhibits at the hospital for everyone to see. The work men and women do for the asylum and during their off hours are much different.
Men were allowed to work in the farms, do garden work, grading, and fencing. For women, it was normal to do household work, knit slippers, stockings, making rugs, basketry, and gardening as well. Employees of the asylum are supposed to learn how to do the work and teach the patients the correct ways before the patients are expected to do it. (Northampton Lunatic Hospital 1907). These activities are carried out for the main purpose of giving the patients a type of therapy, many are much more happier because they are given work which makes the idea a success. 1900s Buildings & Grounds
Since the 1900s, many more improvements and changes have been made in the buildings and grounds. For example for the Northampton Lunatic Hospital in 1910, the buildings were remodeled and many additions were made. The “Day Barn” had been remodeled to help accommodate 30 calves and the basement floor was mainly to house the 40 steers. Eight acres of land was cleared, plowed, and fenced for the farm. The infirmary building for women was only one story high. Passageways between the buildings on each floor were necessary. A sunroom on each floor was also being provided.
Cement walks from the highway up until the entrance of the hospital have been laid making accessibility easier for patients. (Hurd, Drewry, Dewey, Pilgram, & Blumer, 1916). A new kitchen was built; it was now big enough for the employees to cook food for a larger amount of patients. Is it well ventilated, and has all the modern improvements. There is an up to date butcher’s room, where the meat is received and cut up. The food, when cooked, is carried on cars through passages in the basement then passed to the ward where the food is then set up in the dining halls.
In 1898, progressive changes and additions have been made. A new building to accommodate the heating plant, machine shop, and carpenter shop, made room for enlarged kitchens, sewing and mending room, and above them a beautiful assembly hall for religious services and for amusements. The old chapel’s space was now used as a small laboratory, an operating room and library on the second floor. There was also a gymnasium added mostly for the use of recreation for the patients. (Hurd, Drewry, Dewey, Pilgram, & Blumer, 1916).
Windows have been enlarged, new heating; ventilating and lighting systems were installed. In 1900 a cold storage plant was installed where eggs, beef and other foods could be stored. A new stable for the carriage horses was built as well. In 1903, a new barn was built, accommodating 70 cows, 14 oxen and other animals. In 1911, a reception building and infirmary for women patients was built, another similar building was built for the men in 1905. Later in 1911, a new laundry room was built, in 1914 a fire pump house and a stable for the horses was built.
Two new buildings were erected for the purposes of entertainment and recreation of the patients. There is an operating building, which includes a surgical ward, operating rooms, rooms for general diagnosis, anesthetizing, and for instruments. In another example, the grounds at the Worcester Insane Asylum were growing more and more attractive. Young trees had been planted; many patients work about the grounds, and receive great benefits from the side jobs. The work not only helps the patients but also helps the attractiveness of the grounds. Recreation
Patients were allowed to use the bowling alleys, billiard rooms inside a clubhouse. For the women there is a pavilion. There are weekly moving picture and musical entertainment shown to the patients. There are religious services and occasional dances offered as well. The patients show appreciation by wearing better clothing, which helps establish the improvement of living conditions. At the McLean Asylum, patients were allowed to do arts and crafts while they were institutionalized. (Stein & Cutler, 2001). Food For several years a dietician has had general overviewt of the foods and their preparation.
Each day’s food distribution is arranged. Foods are prescribed for the weak and the sick and are specially prepared for their needs. An entire new diet is prepared every two weeks. The food distributed mostly consists of tea, coffee, milk cheese, resins, cereals, canned goods, peaches, berries, vegetables, eggs and other dairy products. (Worcester State Hospital, 1899). Treatment The McLean Asylum was changed to the Mclean Hospital, in 1892, which was symbolizing the philosophy in the therapeutic physician-patient relationship for moral treatment.
It is a rule of the hospital that treatments consists of a generally quick reduction in the amount of alcohol or drugs used, depending mostly on the patient’s condition. Hydrotherapy is used when possible to improve the patient’s physical and mental health. The following are considered part of a patient’s routine everyday; regular habit, discipline, work, eating, recreation and visiting their physician. When a patient is admitted, they are received by a doctor, then bathed, fed and put to bed. Preliminary history is checked and presented within two weeks and diagnosis is then made. Bragg, T. & Cohen, B, 2007). Many other examinations are done such as staining slides, bacteriological by culture, preparation of vaccines are all employed when indicated either in diagnosis or treatment. At the McLean Asylum in 1880, chloral hydrate was given as one of the drugs as well as opium and morphine. Cannabis indica was given to some older patients who were suffering from distress or melancholia. There was also the use of hypnotics to treat patients. At the Mclean Asylum in 1900, occupational therapy and other mental health professions came into existence.
This era was also known as the occupational therapy and the mental hygiene movement. This movement was an effort to bring progressive change in the care of those with mental illnesses. An important factor that changed the course of psychiatry from the 1900s to 1950s was psychoanalysis and psychotherapy. The Electric Convulsive Therapy was another new form of treatment rising. (Stein & Cutler, 2001). Work Patients are allowed to do certain labor and work tasks such as carpentry, painting, plumbing, laundry, baking, and shoe repairing.
These tasks give the patients something to do while keeping them occupied. By doing these tasks, they are helping the hospital enormously. It was believed that the work patients do at the McLean Asylum must be interesting, it should have some usefulness to it, it should be carried on with other patients and encouragement should be given to the workers. (Stein & Cutler, 2001). Demographics In 1900, there were a total of 482 patients, 240 men and 242 women at the Worcester Insane Asylum. During this time many of the patients were suffering from dementia and were being actively treated for it. 950s Buildings & Grounds During the 1960s, Northampton State Hospital housed 2,657 patients. Since 1890, state mental institutions were now being turned into old-age homes. More than half of the population consisted of 65 year olds or older. Most of the patients had no one else to care for him or her, so they were sent to the hospitals. Northampton was too big and hard to tear down since it was made of stone. It had asbestos-coated pipes fitted in the 1950s. Radical changes were going on in this period of time for asylums, many became much more custodial. (Levin, A. 005) At the McLean Asylum, a new library and cafeteria were erected as well as many expansions to the research laboratories. The McLean Hospital was transforming into the illusion of a country club, a much more pleasant environment. The buildings were now separated into floors I, II, and III. These three levels were a series of graded behavioral institutions. “I” was for the lowest-disturbing patients; “III” was for the highest-disturbing patients. (Pressman, J. 1998). Treatment During this time, psychiatric drugs like chlorpromazine were introduced to asylums and patients.
Patients could now be treated on an outpatient basis, meaning they would not have been living in the asylums. This was very good improvement because now patients were not limited to being contained between walls and bars. Psychopharmacology was also introduced as well as Freudian therapy. Freudian therapy was the experiences of conscientious objectors who worked in asylums during World War II. This period was the beginning of the antipsychiatry movement. This movement helped promote community mental health centers, which would help steer the focus of mental health treatment away from the hospitals. (Levin, A. 2005).
In the early 1950s, the McLean Asylum, now known as the McLean Hospital practiced lobotomies as a form of treatment. There was a new procedure called the ‘icepick’ procedure, which helped enable psychosurgery to be performed quicker and for outpatients. Patients were treated with shock therapy as well. Psychosurgery peaked in 1948, The McLean Asylum was also known as a psychotherapeutic hospital. Shock treatment was established and used. This was a form of ‘active treatment’ (Pressman, J. 1998). In 1953, Willis Bower tried to prove that the drug, chlorpromazine would be capable of influencing a course of psychiatric illness.
He published a study, which he conducted at the McLean Asylum in the New England Journal of medicine on the sedative. After the article came out, this drug became adopted in the hospitals. Chlorpromazine started a new revolution in psychiatry, compared to the penicillin used in general medicine. It did not cure psychosis, however it did help eliminate some symptoms of schizophrenia. This drug helped patients live everyday lives. (Shorter, E. 1997) Diagnosis In 1952, there were one hundred patients at an average age of seventy-seven who were diagnosed as senile. Food
The McLean Hospital during this time was able to serve quality food if the patients requested it. For example one patient did not like the lamb that was served, they wanted lobster, the hospital actually served the patient lobster instead. They treated the patient as if it was “Ritz Carlton” service. This hospital was recognized as having a hotel-like atmosphere, which the patients enjoyed. (Pressman, J. 1998). Recreation At the McLean Asylum environmental factors were important for patients and their activities they got to do. All patients at the asylum were allowed to be in the outdoors.
Middle class and upper class patients were able to do different activities. Middle-class patients were allowed to read, and play games. Working-class patients were allowed to work on the farms and at the print shop. (Levin, A. 2005). Overall, The McLean Asylum for the Insane, The Worcester Lunatic Asylum, and The Northampton Lunatic Hospital all have gone through major changes in buildings and grounds, diagnoses, demographics including leisure, work, food, and patient treatment. After the 1800s period, many improvements in buildings were made, and extensions of the building were added.
Barns, chapels, larger kitchens were added. Barns were very important because farm animals could now be housed on the grounds. The animals provided food and milk for the patient’s food supply. Repair has been made to the farm, new stables were added and new mangers made for the yard. Fencing was added all around the grounds. Pavilions were added for recreational use. Grounds were made more attractive; for example trees were planted by patients, this work gave the patients something to do as well. At the Northampton, a gymnasium was added for recreational purposes.
Treatment in the asylums progressed and got significantly better as the decades went on. Moral treatment was highly recognized. In the beginning, many patients were considered ‘incurables’ more patients were also being admitted into the asylums since there was more room from the extensions and additions to the asylums. In the 1950s, lobotomies were now practiced. Psychopharmacology was also introduced as well as Freudian therapy. At all of the asylums, recreation and work was a part of the lives of the patients. Patients were allowed to do activities such as reading, walking around the grounds.
Certain work patients were allowed to do consists of carpentry, painting, plumbing, laundry, baking, and shoe repairing, working in the farm, and sewing. The work not only occupied the patient’s time but also gave help to the buildings and grounds of the asylums. The farm work and food collected from the farms was then fed to the patients. This system was very useful and necessary. In 2007, the Worcester Lunatic Asylum and Northampton Lunatic Asylum were demolished. Both were also part of the Kirkbride plan, which referred to the improvements, made in the mid-19th century. The buildings were typically Victorian era style and larger.
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