American Experience

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MOST U.S. MENTAL HOSPITALS ARE A SHAME AND A DISGRACE
by Albert Q. Maisel

The author of this article, through his previous writing and his testimony before a congressional committee, helped instigate important improvements in the Veterans Administration's mental hospitals. The Ohio photographs were taken by Jerry Cooke with the permission of Frazier Reams, Ohio State Commissioner of Public Welfare, and the cooperation of the Ohio Mental Hygiene Association, an affiliate of The National Committee for Mental Hygiene.

A patient lies unattended at Cleveland State Mental Hospital. © Jerry Cooke/CORBIS

In Philadelphia the sovereign Commonwealth of Pennsylvania maintains a dilapidated, overcrowded, undermanned mental "hospital" known as the "Dungeon," one can still read, after nine years, the five-word legend, "George was killed here, 1937."

This pitiful memorial might apply quite as well to hundreds of other Georges in mental institutions in almost every state in the Union, for Pennsylvania is not unique. Through public neglect ad legislative penny-pinching, state after state has allowed its institutions for the care and cure of the mentally sick to degenerate into little more than concentration camps on the Belsen pattern.

Court and grand-jury records document scores of deaths of patients following beatings by attendants. Hundreds of instances of abuse, falling just short of manslaughter, are similarly documented. And reliable evidence, from hospital after hospital, indicates that these are but a tiny fraction of the beatings that occur, day after day, only to be covered up by a tacit conspiracy of mutually protective silence and a code that ostracizes employees who sing too loud."

Yet beatings and murders are hardly the most significant of the indignities we have heaped upon most of the 400,000 guiltless patient-prisoners of over 180 state metal institutions.

We feed thousands a starvation diet, often dragged further below the low-budget standard by the withdrawal of the best food for the staff dining rooms. We jam-pack men, women and sometimes even children into hundred-year-old firetraps in wards so crowded that the floors cannot be seen between the rickety cots, while thousands more sleep on ticks, on blankets, or on the bare floors. We give them little and shoddy clothing at best. Hundreds -- of my own knowledge and sight -- spend twenty-four hours a day in stark and filthy nakedness. Those who are well enough to work slave away in many institutions for 12 hours a day, often without a day's rest for years on end. One man at Cleveland, Ohio -- and he is no isolated exception -- worked in this fashion for 19 solid years on a diet the poorest sharecropper would spurn.

Thousands spend their days -- often for weeks at a stretch -- locked in devices euphemistically called "restraints": thick leather handcuffs, great canvas camisoles, "muffs," "mitts," wristlets, locks and straps and restraining sheets. Hundreds are confined in "lodges" -- bare bedless, rooms reeking with filth and feces -- by day lit only through half-inch holes though steel-plated windows, by night merely black tombs in which the cries of the insane echo unheard from the peeling plaster of the walls.

Worst of all, for these wards of society we provide physicians, nurses and attendants in numbers far below even the minimum standards set by state rules. Institutions that would be seriously unmanned even if not overcrowded find themselves swamped with 30%, 50% and even 100% more patients than they were built to hold. These are not wartime conditions but have existed for decades. Restraints, seclusion and constant drugging of patients become essential in wards where one attendant must herd as many as 400 mentally deranged charges.

Paid wages insufficient to attract able personnel, even by prewar standards, and often working 10- and 12- hour days, these medical staffs have almost ceased (with some significant exceptions) to strive for cures. Many have resigned themselves, instead, to mere custodial care on a level that led one governor to admit that "our cows in the hospital barns get better care then the men and women in the wards."

Thus thousands who might be restored to society linger in man-made hells for a release that comes more quickly only because death comes faster to he abused, the beaten, the drugged, the starved, and the neglected. In some mental hospitals, for example, tuberculosis is 13 times as common as in the population at large.

Such conditions cannot be explained away as a result of wartime personnel shortages; the war merely accentuates long-existing failings. Most hospitals have never had enough personnel, even by their own low schedules. Wages have always been desperately low. Even a year before Pearl Harbor we had already crowded 404,293 patients into buildings built to hold 365,192.

Nor can any of these horrors be excused on the grounds of "common practice" or as "the best that can be done for the insane." For some states have managed to eliminate overcrowding. Some states discharge, as cured or improved, three and four times as high a proportion of patients as others. A few, notably tiny Delaware, have managed to secure an adequate number of doctors, nurses and attendants.

Even within individual states some outstanding superintendents have managed to raise their institutions to a decent level despite low pay scales and heavy overloads. By ingenuity, leadership and hard work some have succeeded not merely in discountenancing beatings and restricting the use of restraints and solitary confinement but in elimination these relics of the dark ages entirely.

The sad and shocking fact, however, is that these exceptions are few and far between. The vast majority of our state institutions are dreary, dilapidated excuses for hospitals, costly monuments to the states' betrayal of the duty they have assumed to their most helpless wards.

Patients in a hospital for the mentally ill, circa 1946. Photo by Jerry Cooke/Time & Life Pictures/Getty Images

Charges such as these are far too serious to be based solely upon observations of any single investigator. But there is no need to do so. In addition to my own observations on a dozen hospitals, in addition to court records and the reports of occasional investigating commissions, there is now available for the first time a reliable body of data covering nearly one third of all the state hospitals in 20 states from Washington to Virginia, from Maine to Utah. A by-product of the war's aggravation of the long-existing personnel shortage, this data represents the collated reports of more than 3,000 conscientious objectors who, under Selective Service, volunteered for assignment as mental hospital attendants. The majority are still in service and, with Selective Service approval, these serious young Methodists, Quakers, Mennonites and Brethren have been filling out questionnaires and writing "narratives" for use in the preparation of instructional material for mental-hospital workers.

One may differ, as I do, with the views that led these young men to take up a difficult and unpopular position against service in the armed forces. But one cannot help but recognize their honesty and sincerity in reporting upon the conditions they found in the hospitals to which they were assigned. Supported as they are by other official data, their reports leave no shadow of doubt as to the need for major reforms in the mental-hospital systems of almost every state.

Consider, for instance, the shocking data on brutality and physical abuse of the patients. One report form a New York State hospital reads as follows:

"... The testimony revealed that these four attendants slapped patients in the face as hard as they could, pummeling in their ribs with fists, some being knocked to the floor and kicked. One 230-pound bully had the habit of bumping patients on the back of the head with the heel of his hand -- and on one occasion had the patient put his hand on a chair, the striking his fingers with a heavy passkey..."

From a state hospital in Iowa comes the following report:

"Then the 'charge' (attendant) and the patient who had done the choking began to kick the offender, principally along the back, but there were several kicks a the back of the neck and one very painful one in the genitals which caused the victim to scream and roll in agony. ... Sometimes more than 20 kicks must have been administered. Finally e was dragged down the floor and locked in a side room. When I asked the 'charge' how it started, he said 'Oh, nothing. That ------- ought to be killed.' The victim was in handcuffs all the time; had been in handcuffs continuously for several days."

From an Ohio state hospital:

"An attendant and I were sitting on the porch watching the patients. Somebody came along sweeping and the attendant yelled at a patient to get up off the bench so that the worker-patient could sweep. But the patient did not move. The attendant jumped up with an inch-wide restraining strap and began to beat the patient in the face and on top of the head. 'Get the hell up...!' It was a few minutes -- a few horrible ones for the patient -- before the attendant discovered that he was strapped around the middle to the bench and could not get up."

These are but examples among score upon score of cases described and corroborated in the records of the National Mental Health Foundation. The ultraskeptical may feel that they represent the exaggerated views of impressionable conchies with a moral ax to grind. But this idea is fully refuted by the facts concerning other cases which have broken into the newspapers and reached the courts.

The state hospital at Nevada, Mo. Was investigated as a result of a death of a patient, Cordell Humphrey, last July 6. An autopsy performed by Dr. Van Urk of Carthage, Mo. Showed that Humphrey had been beaten severely a short time before his death. "There were marks on the arms, legs, chest, abdomen and head, and injuries to the brain that could have caused the death," Dr. Van Urk reported. As a result of this incident Attendant Massey Cloninger was sentenced to five years in the state penitentiary and another attendant is awaiting trial on charges of assault.

At Hastings, Neb., in February of this year, former State Hospital Attendant William L. Skelton was convicted of assault in connection with the death of Alfred T. Anderson, a patient. Skelton helped hold Anderson down while another attendant hit him with a blackjack.

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