Closing The Asylums

One of the most significant medical and social initiatives of the twentieth century was the demolition of the traditional state hospitals that housed most of the mentally ill, and the placement of the patients out into the community. The causes of this deinstitutionalization included both idealism and legal pressures, newly effective medications, the establishment of nursing and group homes, the woeful inadequacy of the aging giant hospitals, and an attitudinal change that emphasized environmental and social factors, not organic ones, as primarily responsible for mental illness. Though closing the asylums promised more freedom for many, encouraged community acceptance and enhanced outpatient opportunities, there were unintended consequences: increased homelessness, significant prison incarcerations of the mentally ill, inadequate community support or governmental funding. This book is written from the point of view of an academic neurologist who has served 60 years as an employee or consultant in typical state mental institutions in North Carolina and Ohio.

To many, asylums are a relic of a bygone era. State governments took steps between 1950 and 1990 to minimize the involuntary confinement of people in psychiatric hospitals, and many mental health facilities closed down. Yet, as Anne Parsons reveals, the asylum did not die during deinstitutionalization. Instead, it returned in the modern prison industrial complex as the government shifted to a more punitive, institutional approach to social deviance. Focusing on Pennsylvania, the state that ran one of the largest mental health systems in the country, Parsons tracks how the lack of community-based services, a fear-based politics around mental illness, and the economics of institutions meant that closing mental hospitals fed a cycle of incarceration that became an epidemic. This groundbreaking book recasts the political narrative of the late twentieth century, as Parsons charts how the politics of mass incarceration shaped the deinstitutionalization of psychiatric hospitals and mental health policy making. In doing so, she offers critical insight into how the prison took the place of the asylum in crucial ways, shaping the rise of the prison industrial complex.

Closing The Asylum: The Mental Patient in Modern Society. The Covid-19 pandemic has affected the mental health of almost everyone, but it has impacted most severely on disadvantaged groups such as people with severe mental health problems, throwing pre-existing inequalities into sharper and starker relief. Though they had mostly all been closed by the turn of the century, the passing of the old Victorian asylums is still a matter of enduring controversy. In this acclaimed book, first published almost thirty years ago, Peter Barham examines the changing fortunes of mental patients in the era of the asylum and after. He demonstrates powerfully that the closure of mental hospitals cannot meet the real needs of people with severe mental health problems without a profound rethinking of the role, rights and status of the former mental patient in society. In a prologue to this new edition, he highlights the ironies of a post-asylum present afflicted by welfare minimalism, widespread deprivation and impoverishment, and a dramatic increase in the use of coercion and constraint in the delivery of mental health care. Closing the Asylum sets the scene for understanding how the experience of being treated as second class citizens has come about, and the author's forceful warnings of the dangers in the current mental health scene are highly germane to any consideration of what must change in our society after Covid. Veteran mental health survivor and campaigner Peter Campbell also contributes a preface in which he examines the passing of the asylums, and their after-life, in the light of his own experience.

Asylums presents four interlinked essays that explore life in the 'total institutions': the closed systems of prisons, boarding schools, nursing homes and, most importantly, mental institutions. Focusing on the relationship between an inmate and the institution that contains them, Goffman unpicks how lives are managed 'on the inside', and how the setting more often than not works against the inmate's best interests. A radical exploration of the institutions that rule over the lives of men, women and children, Asylums is one of Erving Goffman's most insightful and long-lived works.

Powerful photographs of the grand exteriors and crumbling interiors of America's abandoned state mental hospitals. For more than half the nation's history, vast mental hospitals were a prominent feature of the American landscape. From the mid-nineteenth century to the early twentieth, over 250 institutions for the insane were built throughout the United States; by 1948, they housed more than a half million patients. The blueprint for these hospitals was set by Pennsylvania hospital superintendant Thomas Story Kirkbride: a central administration building flanked symmetrically by pavilions and surrounded by lavish grounds with pastoral vistas. Kirkbride and others believed that well-designed buildings and grounds, a peaceful environment, a regimen of fresh air, and places for work, exercise, and cultural activities would heal mental illness. But in the second half of the twentieth century, after the introduction of psychotropic drugs and policy shifts toward community-based care, patient populations declined dramatically, leaving many of these beautiful, massive buildings—and the patients who lived in them—neglected and abandoned. Architect and photographer Christopher Payne spent six years documenting the decay of state mental hospitals like these, visiting seventy institutions in thirty states. Through his lens we see splendid, palatial exteriors (some designed by such prominent architects as H. H. Richardson and Samuel Sloan) and crumbling interiors—chairs stacked against walls with peeling paint in a grand hallway; brightly colored toothbrushes still hanging on a rack; stacks of suitcases, never packed for the trip home. Accompanying Payne's striking and powerful photographs is an essay by Oliver Sacks (who described his own experience working at a state mental hospital in his book Awakenings). Sacks pays tribute to Payne's photographs and to the lives once lived in these places, “where one could be both mad and safe.”

The last 40 years has seen a significant shift from state commitment to asylum-based mental health care to a mixed economy of care in a variety of locations. In the wake of this deinstitutionalisation, attention to date has focussed on users and providers of care. The consequences for the idea and fabric of the psychiatric asylum have remained 'stones unturned'. This book address an enduring yet under-examined question: what has become of the asylum? Focussing on the 'recycling' of both the idea of the psychiatric asylum and its sites, buildings and landscapes, this book makes theoretical connections to current trends in mental health care and to ideas in cultural/urban geography. The process of closing asylums and how asylums have survived in specific contexts and markets is assessed and consideration given to the enduring attraction of asylum and its repackaging as well as to retained mental health uses on former asylum sites, new uses on former sites, and interpretations of the derelict psychiatric asylum. The key questions examined are the challenges posed in seeking new uses for former asylums, the extent to which re-use can transcend stigma yet sustain memory and how location is critical in shaping the future of asylum and asylum sites.

In the late 1970s, Barbara Taylor, then an acclaimed young historian, began to suffer from severe anxiety. In the years that followed, Taylor's world contracted around her illness. Eventually, she was admitted to what had once been England's largest psychiatric institutions, the infamous Friern Mental Hospital in London

With the advent of care in the community for the mentally afflicted, the self-contained villages for the apparently insane have now been consigned to the history books. These once bustling Victorian institutions were commonly known in the nineteenth and early twentieth centuries as the county asylum or the pauper lunatic asylum , and were an accepted and essential part of society for nearly two centuries. It is difficult to believe that, in 1914, there were 102 such asylums, accommodating over 100,000 patients, the majority of whom lived their entire lives under care and treatment. In 2014, with the exception of those that have already been demolished, these buildings now lie empty and derelict, or have been converted for contemporary living. Through this photographic book, we journey into the inner sanctum of a world of lost dreams, where hope was more often than not unwillingly traded for an uncomfortable acceptance.