American Experience

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A patient at the Cleveland State Mental Hospital. Photo by Jerry Cooke/Pix Inc./Time Life Pictures/Getty Images

In 1941 five attendants at Connecticut's Fairfield State Hospital were charged with complicity in two separate beatings of patients, one of whom died. Two of these attendants were convicted of manslaughter and one of assault. Early in 1942 two attendants were arrested for abusing five patients at the Middletown State Hospital and one of the attendants received a jail sentence. As a result the Public Welfare Council and the U.S Public Health Service made a thorough investigation of all the Connecticut mental institutions. Yet only last November serious charges of maladministration at the Fairfield State Hospital brought about another inquiry which ended with the resignation of the hospital superintendent.

Hospital administrators do not, of course, countenance beatings in Connecticut or elsewhere. Yet in case after case, instead of bringing criminal charges, they have been satisfied merely to admonish or, at most, discharge the guilty attendant -- leaving him free to move on to other states or even to other hospitals within the same state. A typical instance of this sort came to light in Cleveland last year when Attendant Aaron Copley was tried and convicted in Municipal Court on a charge of assault and battery upon a patient. Copley contended that he was "being made the goat" and that brutality was commonly practiced in the Cleveland hospital. He submitted charges involving seven separate beatings by three other attendants. When the court probation officer investigated these charges he found that Attendant Hunter, one of those accused by Copley, had a record of previous conviction for arson and had been an inmate of the Veterans Administration mental hospital and Perry Point, Md. Yet despite this record, elicited in a single week by a few letters from the probation officer, Attendant Hunter had had no difficulty in securing and retaining employment at the Cleveland hospital. Even after suspicious "accidents" had occurred in his ward while he was on duty. The hospital had never bothered to make even a cursory check of Hunter's character and background.

The fact is that beatings are merely the extreme end product which thrusts upon overworked, poorly trained and shamefully underpaid employees the burden of controlling hundreds of patients whom they fear and despise. Far more frequent than beatings are the endless cruelties involved in the use of constraints. Although some hospitals have managed to dispense with physical restraints entirely and others permit their use only on written order from doctors, the all-too-widespread practice is to leave the decision to tie down a patient or throw him into solitary up to the harassed and fearful attendant.

The investigators of the Connecticut hospitals in 1942 cited the presence of 16 patients in restraint and 32 in seclusion at Norwich State Hospital in February of the year. Deploring this, they expressed the pious hope that "the use of such measures be materially decreased". Yet in a single month in 1945, according to records cited by two "conchie" attendants, 26 patients in this same hospital spent 6,552 hours in canvas lacings, mittens and sheets. Eighty others spent 13,900 hours in solitary seclusion!

One contentious-objector attendant, reporting from a state hospital in New York, gave the following account of the way in which restraints are abused. He wrote:

"We have one patient, E.E., who has been in restraint sheets for a period of several months; often he is not even toileted once during the day ... Another patient, A.H., has been in a camisole for over a month and the only time it is taken off is once a week for bathing."

In Pennsylvania, the state Bureau of Mental Health has issued repeated detailed orders, ever since 1925, limiting the use of restraints. In theory, under these orders, restraints "should be applied only on written order of a physician and for a specified period." In theory a complete and detailed record on the use of restraint is supposed to be kept.

Yet the notes of a conference of about 300 members of the conchie unit at a Pennsylvania hospital in August 1944 read:

Sheet restraints are used considerably but never reported; the usual practice for the first half-day in hydrotherapy (female) is to put patients tautly in restraints with hands above heads, often causing immobility of arms when restraints are removed. ... Towels are frequently used on both male and female sides for temporary restraint. ... Cuffs and straps are in general use, in all combinations, partial and complete; sheets are used to tie ankles, necks and chests to beds, benches and chairs. Hands and feet are often observed in swollen condition because of insufficient supervision in such cases."

"Records show an average of 38 or more in restraint; there are some cases when actual number in restraint is greater than the recorded number. Some have been in restraint in B [building] for the seven months that one attendant has worked there; some are in [restraint] on the female side for weeks and months without the doctors seeing them 'because the doctors don't like to go upstairs.'"

In the more "enlightened" hospitals chemical restraints (i.e., drugs) are used to keep the patients under control so that they will be less trouble to the attendant. In theory these drugs can be prescribed only be physicians or registered nurses. In practice they are often sent up to the wards in batches and administered at the discretion of untrained attendants. A case cited by one conchie at another Pennsylvania state hospital (and corroborated by another from the same unit) illustrates the end result of such "free hand" administration of drugs:

"L. was a young man about 25 ... so quick and strong that they had a great deal of trouble trying to overpower him. He was given sedation -- sodium phenobarbital -- every three hours ... After a while, after I had objected to the doctor, sedation was stopped and he made a serious attempt to save the boy. I made a copy of his sedation record. In 108 hours he received at least 90 grains [sic] of sodium phenobarbital -making no allowances for probable overdoses and a good bit of Hyoscine. The last few shots were given when he had a fever. He had had so many sedatives, however, that it was hopeless and he died."

Male patients at an institution for mental illness in Ohio. Photo by Jerry Cooke/Pix Inc./Time Life Pictures/Getty Images

OVERWORK BREEDS BRUTALITY

When one studies the almost endless parade of cases such as these, the correlation between mistreatment and brutality on the one hand and low pay, long hours and overcrowding on the other hand is immediately apparent.

At Warren, Pa., for instance, the hospital is supposed to have a capacity for 2,074. Actually its average daily resident-patient population is 2.560; a 23% overload. The scheduled number of employees is 500 ... the actual number in recent months has averaged 371. There have been four physicians -- one to every 640 patients -- when the official schedule calls for 12 and any decent standard would require from 18 to 25. The "secret" of these personnel shortages -- which have existed since long before the war -- is readily apparent when one examines the wage scales. Attendants at Pennsylvania state hospitals start at the magnificent base pay of less than $900 a year plus maintenance. By contrast the same state starts prison guards off at $1,950 a year plus maintenance, although the psychiatric attendant's job is more dangerous and certainly far less pleasant than that of the prison guard.

Nor is Pennsylvania by any means the worst among the states. At the state hospital at Howard, R.I., there were approximately 200 vacancies among attendants on Dec. 13, 1945. The starting wage for attendants was $55 a month and maintenance.

The rated capacity of Cherokee State Hospital, Iowa is 1,200 patients. On Dec. 20, 1945 it had 1,725 on its rolls. Yet of 20 "budgeted" nurses only two were on the rolls; of 130 budgeted attendants only 62 were actually employed. Attendants' wages start at $65 a month.

Penny-pinching is not limited to wages. Between skimped budgets and a lack of help scores of hospitals have not been able to maintain even a minimum standard of building maintenance. From one of the Virginia state hospitals comes the following report:

"There is no shower in the infirmary and senile ward ... only two bathtubs for approximately 65 patients ... In one bathroom dirty water from pipes in a bathroom overhead drips into our bathtub and on the patient being bathed, as well as on the attendant doing the bathing."

From a New York state institution:

"On Ward 41 we keep the more disturbed and untidy patients ... who frequently break the windowpanes. During the summer no attempt was made to replace broken panes. When cold weather came there were still no windowpanes put in. For two weeks we attendants called the attention of the supervisor to this condition but [he] merely passed it off as unnecessary, not bothering to even go out to the day room to investigate."

Even the food is skimped. In 1940 the average value of the food consumed by patients in mental hospitals throughout the U.S. was 23.3c per day. Some states were trying to feed patients on as little as 17c a day and even in such high-cost areas as New York the daily food consumption was only 26.8c. In most cases these figures include the food raised by patient labor on hospital farms.

Investigators are often fooled by elaborate menus prepared by dieticians and carefully filed in the hospital records. How deceptive these menus can be is demonstrated by the records kept by one objector-attendant at a Connecticut state hospital.

One morning in August 1944, when the patients' breakfast menu called for Maltex and soft-cooked eggs, the patients got merely Maltex. That night instead of a menu-listed ration of "macaroni, tomatoes and cheese" their supper consisted of nothing but lima-bean soup. A few days later breakfast was supposed to have consisted of "orange halves, corn meal and scrambled eggs." The patients got only corn meal. For dinner that day they were supposed to have "beef stew and steamed rice with raisins." They actually ate frankfurters, squash and potatoes. For supper they were scheduled to get naked beans and coleslaw. They actually got bean soup and nothing else.

From a New Jersey state hospital, an attendant writes:

"At its worst, which we see daily, the plate takes on the appearance of what usually is found in most garbage cans ... I have seen coleslaw salad thrown loose on the table, the patients expected to grab it as animals would ... Tables, chairs and floors are ... many times covered with the refuse of the previous meal."

The inadequacy of the patients' food is often aggravated by the assignment of the finest food to the hospital staffs. The dinner menu for the doctors at a Pennsylvania state hospital on a Tuesday in August 1945 consisted of a "prime rib roast beef with gravy, broiled potatoes, roast corn on the cob, bread (white, whole wheat, rye or raisin) with butter, salad of cucumber, lettuce and celery, apple-apricot pie and coffee, tea, iced coffee, iced tea, or milk." On the same day patients in several buildings got "hard boiled eggs, lima beans, beets, white bread without butter and milk or black coffee."

Pennsylvania state law requires that all milk except Grade A be pasteurized. Grade A milk is required to have a bacteria count of fewer than 50,000 per cubic centimeter. On 22 separate occasions from January 1943 to December 1944 tests were made of the milk served in the patients' dining room at Warren State Hospital. On only six occasions did it comply with the law. The average bacteria count of this unpasteurized raw milk was 398,100. On three occasions it exceeded 1,250,000 and on one occasion it exceeded 3,200,000!

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