The story was shocking enough as text, but it was the images that burrowed into the American imagination: Patients huddled naked in freezing, concrete wards; men and women strapped to wooden benches for hours on end, left to shit themselves while the staff ignored their pleas; one photo, less explicit but particularly haunting, of a woman in a gown lying in the fetal position, alone on a sterile floor. “Bedlam 1946,” published in the spring of that year by LIFE, documented conditions inside of two public mental hospitals: Ohio’s Cleveland State and Pennsylvania’s Byberry, where “thousands spend their days—often for weeks at a stretch—locked in devices euphemistically called ‘restraints’… hundreds are confined in ‘lodges’—bare, bedless rooms reeking with filth and feces … by night merely black tombs in which the cries of the insane echo unheard from the peeling plaster of the walls.” On “the stone wall of a basement appropriately known as the ‘Dungeon’, one can still read, after nine years, the five-word legend ‘George was kill here 1937.’”
The story’s author, Albert Maisel, insisted that these two hospitals were not outliers. He quoted a report from another hospital, where attendants “slapped patients in the face as hard as they could” and “pummeled them in their ribs with fists”; he relayed the testimony of an attendant who had “seen coleslaw salad thrown loose on the table, the patients expected to grab at it as animals would.” As a result of “public neglect and legislative penny-pinching,” Maisel wrote, “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.” This was no idle charge: It had only been about a year since Americans had first seen photos from the Nazi camps, and the comparison stuck.
The story triggered congressional investigations and forced the resignation of hospital superintendents. Similar exposés followed: Mary Jane Ward’s novel The Snake Pit (really a thinly veiled memoir about the abuses she experienced in Rockland State Hospital) and Albert Deutsch’s The Shame of the States, a book of his own extensive reporting on wretched conditions inside American mental hospitals. The anti-asylum movement had struggled to gain traction for years—suddenly, images of its depravities were everywhere. Outrage grew and movements formed. Within two decades, widespread political opposition to the American asylum system led to the period of bipartisan cooperation now called “deinstitutionalization.” Hospitals were shuttered and patients were released. Commitment laws became far narrower in their scope, and the mad rejoined the community.
“Bedlam 1946” was not Maisel’s first investigation. Earlier in his career, he had helped expose abuses in Veterans Administration hospitals, ultimately testifying before Congress in favor of reform. He was no doubt sincerely horrified by what he saw at Cleveland State and Byberry. But it is difficult to believe that underneath his anger and disgust, he didn’t feel a certain kind of vindicated satisfaction, something akin to the quiet thrill that many feel when they learn a hated politician has been caught in a particularly compromising scandal. It is one thing to know that asylums resemble concentration camps. It is another to have stories and photographs so devastating that they will brook no opposition, will sway the public in a way that goes beyond mere argument.
It is the same secret, guilty pleasure that was no doubt felt by many who favor a return to the asylum this past week, as the story—and the surveillance footage—of the schizophrenic Decarlos Brown stabbing a young woman to death on a North Carolina train began to spread across the country.
Like “Bedlam,” the details of the Brown case are potent, perfect. Decarlos was diagnosed with schizophrenia but it is, according to CBS News, “unclear what kind of treatment he received, if any” as a result. He has a long criminal history: over a dozen convictions for misdemeanors and felonies including larceny and armed robbery, the latter of which resulted in a five-year prison term. But he was always eventually released. He became violent at home. When he got out after yet another arrest last January, his own mother believed that he should have been held against his will in a hospital. The system is “broken,” she told local news. It “failed.”
Against these facts, what can the usual liberal peans about civil rights and medical autonomy and “stigma” against the mentally ill do? By now, millions of Americans have watched Brown rise from his seat and loom like some strange beast over the unsuspecting Iryna Zarutska before stabbing her in the throat. In light of these images, what can the usual tedious correctives about the mentally ill more likely being the victims rather than perpetrators of violent crimes—however true—hope to achieve?
The Brown case is only the latest in a genre of story that has picked up steam in recent years—sensational headlines about psychotics stabbing people on the sidewalk, always refusing to take their medication, always with a history of violence, always nonetheless released from a string of ineffective psych holds—but this one may prove to be the most enduring. Untroubled by nuance or complications, the Brown story has dominated the news for days—at one point, The Free Press had four separate stories about the case on its front page; the New York Post ran at least 17 separate items related to the murder in the course of a single week. The story has been a coup for the faction of pundits and policymakers who believe that deinstitutionalization was a mistake, that public safety is under siege by dangerous lunatics, and that in order to “get serious” about the “mental health crisis,” we must return to involuntary holds, to permanent confinement, to forced medication—to the asylum. Buoyed by stories and images more powerful than any counterargument, their cause may soon prove impossible to resist.
Madness moves in cycles—mania, then depression; psychosis, then the residual phase—and so too the problem of madness in America. In the early republic, lunatics were often held like zoo animals. In the 18th century, visitors to Pennsylvania Hospital would come to gawk at the patients and “witness their episodes.” When concerns over the decency of such arrangements began to trouble the public, dedicated facilities for the insane were largely abandoned. By the 19th century, the American mad lived at the mercy of almshouses and general hospitals. When they ran afoul of the law, either through nuisance or real crime, they often found themselves in prison, restrained by manacles, often beaten, tortured, and starved.
In 1841, a Massachusetts teacher named Dorothea Dix volunteered to teach a Sunday school class in the East Cambridge House of Correction. Inside, she found the condition of the lunatic prisoners so appalling that she dedicated her whole life to reform. Over the next decade, she traveled thousands of miles by stagecoach, visiting hundreds of almshouses, jails, penitentiaries, and hospitals. Dix lobbied state governments across the country to provide suitable sanctuaries for the insane, leading to the establishment or expansion of more than 30 mental hospitals. In June 1860, one of those hospitals received an Illinois woman named Elizabeth Packard. Railroaded into treatment by a husband who was tired of her religious nonconformity and politics (and perhaps just of his wife), she spent three years in Jacksonville Asylum before suing for her release. Over the next several decades, Packard published several books; the most famous, The Prisoner’s Hidden Life, recounted her own mistreatment in the hospital. She founded the Anti-Insane Asylum Society and successfully lobbied several state governments (as well as President Ulysses S. Grant) into narrowing commitment laws, reforming hospital conditions, and releasing patients held unjustly or for too long.
By the early 20th century, though, the explosion of the urban population of the United States provoked a new wave of concern over public lunacy and “mental defect.” Inspired by the new scientific field of eugenics, the U.S. committed hundreds of thousands of its citizens to newer and larger mental hospitals where they were sterilized, lobotomized, and subjected to cold water treatments and electric shocks. By the middle of the century, the population of the institutionalized American insane exceeded 500,000, many of them housed in buildings that had begun to fall apart.
Then came Maisel, LIFE, and “Bedlam.”
Perhaps, in the coming years, we will return to the asylum. There will be hurdles: civil rights laws to overturn, medical standards to reform, capacity to build, huge sums of money to spend. It’s far simpler to write a quick op-ed calling for all the dangerous lunatics to be locked up again than to actually do it, but with enough dedicated energy and zealous citizens committed to reform, we can no doubt figure out how to return some several million American lunatics to the hospital, to pay the hundreds and hundreds of billions of dollars annually it’s likely to require, and to do it right this time: forcible medication and long holds, but no starvation or lobotomies, no patients chained naked to the floor if we can help it. The rate of violent crime committed by unmedicated schizophrenics will no doubt plummet; the stories, once haunting nearly every other issue of the New York Post, will cease.
For more than two centuries, America has not known what to do with its insane. We lock them up, then pity them, then let them out, then fear them, then lock them up. We torture them. They murder us.
The construction, maintenance, and operation of a new asylum system will be a tremendous undertaking, far more expensive, vastly more logistically complex, and intensely more dependent on the good behavior of many thousands of employees than the average American may realize. Inevitably, we’ll realize that if you want to prevent murders, you can’t wait until a patient commits a murder to hospitalize them for life. Who to place in indefinite detention will have to be a judgment call, one that some clinicians and some authorities will approach with an attitude of better safe than sorry. Inevitably, some troubling lunatics who did not actually pose a threat will be caught up in the dragnet. Some lunatic deemed compliant and stable will leave the asylum after a long stay, go off their medication, and commit a murder. Inevitably, hold times will have to be increased, release conditions narrowed. As the sheer fiscal demands of a new asylum system begin to trouble a nation prone to fits of budget hawkery, we will have to cut costs; inevitably, conditions will deteriorate on the inside. Because you cannot hold so many difficult people against their will and expect their keepers to act with perfect honor, there will inevitably be beatings, tortures, accidental deaths.
The tortures of the new asylums will be different from last century’s—it is unlikely that we will return to extracting teeth on the theory that an infection of the gums is the cause of psychosis. But one only needs to look at our remaining psychiatric hospitals, our day programs, our nursing homes, our prisons to know how these things go. For those who will still be able to clearly remember Decarlos Brown’s face, these inevitabilities will be worth it—the price of public safety. But inevitably, the horror stories of the new asylums—the accounts and exposes, the photographs and scandals—will implant themselves in the minds of a new generation, and it will be time to once again throw open the doors of the asylums.
Brown apparently told his sister that he attacked Zarutska because he believed she was reading his mind. But the contents of one individual’s psychosis are rarely interesting or original. Schizophrenics imbibe the culture; they assemble their certainties from the phantasmagoria of their civilizations. When religion dominates, the madman believes he is Jesus Christ. When conspiracy theories reign, he insists the CIA is watching him. The “Truman Show Delusion”—wherein patients believe their lives are being broadcast to an audience of millions—did not exist before the culture that could imagine the film for which it’s named did. Lunatics drink what’s in the water, half-digest it, throw it up. Recent research has suggested that the hallucinations of American schizophrenics are far darker—harsher, more threatening, more prone to inspire rage and fear—than the voices heard by the mad of other cultures.
Psychoanalysis, that ancient mystic sect of psychiatric medicine, does not deal with schizophrenics. But it does have a theory of the repetition compulsion. In Beyond the Pleasure Principle, Sigmund Freud observed how certain patients, unable to resolve some prior trauma, simply recreate its circumstances over and over, acting out the same destructive melodrama with small variations. Untreated, the repetition compulsion is perilous. It deepens the original wound, creates new ones, locks the patient into an unbreakable cycle, accruing damage that can never be repaired.
For more than two centuries, America has not known what to do with its insane. We lock them up, then pity them, then let them out, then fear them, then lock them up. We torture them. They murder us. We tell one another that they are a threat to be contained. They hear, in the voices of their daemons, how we are out to get them, how they must strike first or be destroyed. Both claims are true. Americans stagger, terrified and angry, through a squalid old house in the dark, fleeing from their shadows. Frightened by a sudden glint of light, we turn around and flail, punch the mirror, recoil in shock. Exhausted and bleeding from the broken pieces, we look into the damaged glass and demand that our reflection stop screaming, stop crying, stop looking back, so frightening and ugly.
