Above artwork created by Jeremy Sicile-Kira, an Autistic non-verbal artist with synesthesia. He uses his synesthesia to create pieces like the one I used above, translating people's emotions and words into colors. You can view more of his work here.
*Some of the below information includes topics and images on psychiatric facilities that might be triggering to readers*
HISTORY!
To better understand the current state of psychiatric wards and hospitals in the United States, it is critical to also interrogate how they were created. Mental illness has been around for as long as society has, however, it was first recorded in further detail in the late 1600s. It wasn’t until 1752, though, that there were organized communities for mentally ill people. Before then, mentally ill people were often taken care of by family members, or in worse scenarios, they were taken to jail. 1752 is the first recorded institution for mentally ill people. Founded by the Quakers, in a suburb of Philadelphia, the newly opened Pennsylvania hospital had rooms for mentally ill people, equipped predominantly with shackles on the walls. A few years later, this institution expanded and created the Pennsylvania Hospital for the Insane, which remained open until 1998. In 1773, the Virginia legislature opened the second known psychiatric facility, for “mentally disturbed people causing problems in the community”. It is still existing today, known as the Eastern State Hospital.
In 1792, the New York Hospital opened a ward for “curable insane patients”. In 1817, Quaker doctors opened “The Asylum for Persons deprived of the use of Their Reason” outside of Philadelphia. It still exists today, known as the Friends Hospital. By 1890, every state had built a psychiatric ward, with a total of 500,000 patients in all of them combined.
In the early 1900s, the amount of patients in psychiatric wards greatly increased, to the extent to which many facilities were very overpopulated. There was a rising belief in the “moral treatment” of mentally ill people at this time, though a lot of these methods were thought to be ineffective. Ineffective methods combined with overcrowded facilities made psychiatric wards terribly difficult places to live. As a result of this, this was also the time period where eugenics and forced sterilization began to rise. Connecticut was the first state, in 1886, to prevent mentally ill people from getting married. Ten years later, it was also the first state to allow forced sterilization of mentally disabled people, if a board of doctors agreed. During this time period, over 65,000 mentally disabled people were sterilized. The last forced sterilization of a mentally disabled person was in 1981 in Oregon.
In the mid 1900s, psychiatric facilities were trying different treatment methods – two of the most controversial were electroconvulsive therapy (ECT) and surgical lobotomies. ECT procedures induce seizures for patients through a series of electrical shocks. While a few patients did feel better after these procedures, the majority had intense side effects that lingered for the rest of their lives. This is occasionally still practiced today.
Lobotomization was developed by doctor Antonio Egas Moniz and also practiced in psychiatric wards for some time. Lobotomies require doctors to drill a hole in the brain to sever the connection between the prefrontal cortex and the rest of the brain. While some patients got better, the vast majority became very ill, died, or were unable to care for themselves after lobotomies. Over 40,000 were performed in the US. It was around this time that documentaries, movies, and books started to come out about the horrific conditions that patients had to live through in psychiatric wards. This, combined with World War Two and the increasing number of veterans with PTSD, shifted the view of mental health care. The National Mental Health Act was signed in 1946, and after that there was a rise in anti-psychotic medications, and funding for out-patient mental health clinics.
The Kennedy administration signed a bill that offered $150 million dollars to states to construct community-mental health centers. These community centers, though, proved to be ineffective for the most part. They were very underfunded and had to send many patients with more significant needs back to state-run hospitals. In the later 1900s, deinstitutionalization began and the number of beds shrunk from 413,000 to 37,679 from 1970 to 2016.
While hospitals in the 1940s, and beforehand, were typically incredibly abusive and had horrific conditions – deinstitutionalization of these hospitals was not a success either. Many patients were left without a place to go, without money for treatment, and without any medical care. Deinstitutionalization was predominantly caused by financial opportunism, with the cost of psychiatric wards being shifted to the state level, and states not wanting to fund these facilities. These policies continue to this day – financial assets drive a lot of the facilities and institutions within the US, as most psychiatric facilities are for-profit institutions.
This is a very brief history of psychiatric wards within the US, there is so much more that can be included here.