Bedlam in Penn’s Woods

Pennsylvanians have been concerned with the welfare of the insane since the earli­est provincial days. Indeed, as befits the Commonwealth’s humanitarian Quaker heritage, Pennsylvania has made pio­neering efforts in the field.

For most of the pre­Revolutionary period, care of the mad was restricted to physical support and occa­sional confinement for public safety. Victims’ families and communities took principal responsibility for their suste­nance. But by the end of the eighteenth century, emphasis had begun to shift to treatment and institutionalization. and the Commonwealth became increasingly involved in the matter.

Insanity often renders its victims incapable of support­ing themselves financially, and the poor whose wits become impaired may be unable to work. The prosperous who become mentally deranged may lose their property as a consequence of their dimin­ished judgment. Thus, if for no other reason, the insane came to public attention through concern for the poor.

Legal provisions for the impoverished – and, indirectly, the insane – were made practi­cally from the beginning of British colonization of Amer­ica. The earliest European-­established poor laws operating in Pennsylvania were contained in the Duke of York’s Laws. This body of statutes, already in effect in New York, was applied in 1676 to what was to become Penn­sylvania. It was superseded by William Penn’s Great Law of 1682 which included a chapter specifically alluding to relief of the poor:

That if any person or persons shall fall into decay and poverty, and not be able to maintain them­selves and children, with their honest endeavors, or shall die and leave poor orphans, that upon complaint to the next justices of the peace of the same county, that said justices, finding the com­plaint to be true, shall make provi­sion for them, in such way as they shall see convenient, till the next county court, mid that then care be taken for their future comfort­able subsistence.

Plainly, such a law would have benefitted both Pennsyl­vanians who suffered financial reverses brought on by mental disability. It also would have provided relief to minor heirs of those who lost their finan­cial substance through mad­ness and subsequently died.

On the whole, seventeenth century Laws did not lead to any distinguishing form of treatment for the mentally unbalanced. Rarely was any thought given to cure in those days, so colonists would have seen little they could do for the insane besides feeding, cloth­ing and sheltering them. Un­less the mad posed a danger to themselves or others, the public was inclined to leave them at large. Institutionaliza­tion was uncommon m a sparsely populated rural coun­try during an age in which insanity was thought some­thing as natural and as beyond human alteration as floods and droughts.

Even when the insane were committed to some form of institution, treatment was not the goal. The earliest establish­ments dealing with the insane were neither mental asylums nor hospitals, but usually served other functions as well. If they were constructed spe­cifically for the insane, they typically were intended to restrain victims, not treat them. Albert Deutsch, author of The Mentally Ill in America, reported that “the first known provisions for the mentally ill in Pennsylvania, mentioned in the Upland Court records of 1676, took the following form: ‘Jan Vorelissen, of Amesland, complayning to ye court that his son Erik is bereft of his natural senses is turned quyt madde and yet, he being a poor man is not able to main­tain him; Ordered: yet three or four persons be hired to build a little block-house at Amesland for to put in the said madman.'”

Quieter lunatics frequently were housed in private dwell­ings at public expense, through a process called “out­door relief,” as opposed to sending them indoors to some building set aside specifically for housing the dependent. Frequently they were kept in their own homes or boarded with other families or tovm officials.

Many a lunatic repaired to an almshouse, which provided “indoor relief” to the indigent. Never so numerous in America as in England, almshouses were, nonetheless, authorized in the New World. They pro­vided refuge for the insane, as well as for victims of poverty. Pennsylvania, too, perceived merit in the almshouse idea. The Pennsylvania assembly in 1766 empowered a group in Philadelphia to raise funds for the poor. When the organiza­tion had collected fifteen hun­dred pounds, the city was to lend it two thousand pounds, secured by a mortgage on the old almshouse, to build a new one. Historian David Rothman contended that the driving motive behind the almshouse idea was the public view that almshouses “benefit the poor and the taxpayer alike, giving better treatment at a reduced rate.”

How much better treatment the demented denizens of almshouses actually received is questionable. Rothman argues that the insane “were usually supported at home … only when they were uncontrolla­ble, threatening the safety of relatives and neighbors, did towns seek alternatives. Those equipped with an almshouse put lunatics in an empty attic or cellar to suffer alone.”

When a distinction was made between the two, work­houses were worse than alms­houses. Although labor sometimes was performed or encouraged in almshouses, it was mandatory in work-houses. ln workhouses, labor often was meant to be punitive as much as productive. Even worse were prisons, where some of the insane were incar­cerated, either out of criminal­ity, because they were perceived as threats or nui­sances to society, or because there simply was no other place for them.

Conditions were aggravated for the insane in almshouses, workhouses and prisons be­cause of the prevailing notion that the mad either were un­aware of, or impervious to, many physical hardships. It was widely believed, for in­stance, that lunatics felt nei­ther extreme heat nor cold. Some theorists attributed the supposition to an increase in the animal power of the in­sane, which occurred simulta­neously with the diminution of human, mental power. As a consequence, deranged in­mates often were provided no heat in winter and no escape from intense heat in the sum­mer. Frequently they were chained in dank and gloomy subterranean cells which sometimes had no windows for ventilation or, alternately, had windows without panes for protection from the elements.

By the eighteenth century. however, new ideas were com­ing into play. Philippe Pine! in France, Benjamin Rush in the United States and William Tuke of England held different views, and adopted different approaches to the care of mad­men.

Pine! took charge in 1792 of the notorious Bicentre, a Pari­sian institution for male luna­tics. He literally struck the chains from his charges and employed an approach called “moral treatment.” Pinel pre­scribed kindliness and activity for his patients, engaging them in intellectual and reli­gious activities to distract them from their delusions and help them control their irrational conduct. His intent was to improve their state sufficiently to enable them to return to society. Pinel’s research led him to conclude that the harsh discipline usually applied to the more agitated madmen exacerbated their conditions, rather than improving them.

Rush, a Philadelphian of Quaker descent, became a member of the staff of the Pennsylvania Hospital in 1783. Although he too advocated interest in and kindness to his patients, some of his medical techniques would strike mod­em observers as anything but humane. He bound violent patients and advocated blood­letting and the administration of emetics and purgatives. He devised a new version of a swing he dubbed a “gyrator,” which rotated patients at great speed, sending blood rushing to the head. Contrasted with the standard techniques of the time, Rush’s methods were actually humane and ad­vanced.

Tuke, a Quaker, took these concepts even further. He advanced the concept of treat­ing the mentally ill as human beings who are sick, rather than as animals or criminals, with the 1792 establishment of the Retreat in York, England.

The real significance of the work of Pinel, Rush and Tuke goes beyond the greater kind­ness they extended to the insane. What is most impor­tant is that they concerned themselves with more than just the sheltering or incarcera­tion of lunatics. They advo­cated not just better treatment of the victims, but also medical treatment of the condition. That position encouraged the formation of hospitals for the mentally ill, places where treatment might be applied.

The first institution in the English-speaking colonies established to care exclusively for the sick was Pennsylvania Hospital, Benjamin Rush’s establishment, founded in 1752. The hospital was notable because of its provision for mental patients; even the assumption that they should receive medical attention was expressed in the original act of the Assembly that granted financial aid to the undertak­ing. Of the two patients admit­ted on the first day the doors were opened on February 11, 1752, one was insane.

The first American hospital created expressly for the treat­ment of the insane was founded about fifteen years later, in Williamsburg, Vir­ginia, which provided a sys­tem susceptible to more humane influences, in line with the thinking of Rush and other influential critics.

The first private mental hospital, the Friends Asylum for the Relief of Persons De­prived of the Use of Their Reason, opened in 1817 near Philadelphia. Interest by mem­bers of the Society of Friends in humane institutions for the insane dates at least – to 1671, when the society’s founder, Quaker George Fox, proposed, “Friends seek a place wherein persons distracted or troubled of mind” might withdraw. Such a refuge was quickly founded, but it did not last long. Tuke revived the idea in expanded form, and the result was the Retreat at York, which remains in existence.

The concepts employed at the Retreat were familiar to American Quakers. Quaker minister Thomas Scattergood of Philadelphia visited the Retreat in 1799, and in 1812 was one of group of Philadel­phia Friends who agreed to subscribe to a plan “to make provisions for such of our members as may be deprived of their reason.” Copies of a book by William Tuke’s son, Samuel, Description of the Re­treat at York, were read by Pennsylvania Friends, and promoted interest in the new hospital.

Both public and private hospitals followed. From the mid-nineteenth century to the end of the period of signifi­cance, mental – both state­-sponsored and local – hospitals were erected in Pennsylvania in considerable number. Har­risburg opened in 1851, fol­lowed by Western Pennsylvania State Hospital in 1853 (and its separate mental hospital in 1862), Allegheny in 1854, Hillside in 1862, Danville in 1868, Warren in 1873, Nor­ristown in 1876, Wernersville in 1891, Marshall Sea in 1893, Fairview in 1905, City Farms at Byberry in 1906, Dixmont in 1907, Allentown in 1912, Torr­ance in 1915, and Western State Psychiatric in 1931.

While the Commonwealth continued to build state asy­lums for the insane, it estab­lished in 1897 a dual system of care for the mentally ill. The legislature authorized counties and subdivisions of counties to build their own mental hospi­tals. These hospitals were to augment the state institutions, accepting patients committed by the courts or transferred from state asylums, for which the state would pay a weekly stipend.

The proliferation of institu­tions resulted from several changing philosophical, politi­cal, demographic and eco­nomic factors. America was ripe for intellectual revolutions in the eighteenth century. The rebellion against Great Britain was partially ;s revolt against old ideas, and the establish­ment of the republic was the embodiment of philosophical concepts. The belief that in­sanity could be cured was new in those days, and under­standably attractive. It is not surprising that it might have been embraced with particular enthusiasm by a nation that was itself new and formed on avant-garde principles.

Once the concept of curabil­ity was accepted, it naturally followed that there would be momentum for establishing a structure to provide curative treatments. Other social devel­opments also encouraged the growth of mental hospitals. With the insane already con­fined in almshouses or jails, it was easy for American doctors to accept the idea of institu­tionalization and to work to­ward shaping an asylum into both a humane and therapeu­tic environment. The growing notion of governmental re­sponsibility for the disadvan­taged provided further impetus for hospital construc­tion in the United States.

Occurrences within Penn­sylvania encouraged hospital construction. First, the sparsely populated, chiefly rural province of the seven­teenth and eighteenth centu­ries had changed. Population was greater. Pennsylvania, which had an estimated total population of 433,611 in 1790, could boast of 1,724,033 resi­dents in 1840, and 5,258, 113 by 1890. Assuming the ratio of insanity to sanity remained stable, the sheer number of the insane increased significantly. Further, the development of towns and cities concentrated this increased population, including the mentally dis­turbed. Not only were there more people, both sane and insane, but they also were living more densely. Both these conditions – total popula­tion increase and population concentration – made the insane more visible, emphasizing the problem.

Pennsylvania also was a far wealthier place in the nineteenth century than it had been before. Farms were pros­perous, and Pennsylvania’s famed industrial strength was beginning to form. Philadel­phia was an important international port and center of commerce. The state could afford the costs of building and staffing more institutions.

In 1869, Pennsylvania’s legislature established the Board of Public Charities to inspect all voluntary charity agencies in the Common­wealth. Board members esti­mated that one Pennsylvanian in eight hundred was insane, constituting a group of some 4,375 mentally ill state resi­dents. In its first annual re­port. the board announced that, of this number, 1,112 were in hospitals, 1,284 in alms­houses, and eight in prisons. That left 1,971 unprovided with any institutional care; furthermore, the board was not satisfied with the institu­tional treatment the insane received in almshouses and prisons. The board’s 1870 annual report emphasized its concerns.

Resolved, That the Board of Public Charities, having witnessed the evils which result from the connection of insane asylums with almshouses, and believing that a wrong is done to the insane by classing them with paupers, hindering the public from estimating aright their claims to sympa­thy and remedial treatment, disapprove of such an alliance, and believe that the best interests of this afflicted class of people, and the duly of the State, concur in the establishment by the State, within a reasonable time, of sufficient accommodations far the maintenance and treatment of all the insane who may not be cared for in private hospitals.

Several prominent re­formers, apart from those on the board, worked for the construction of mental hospi­tals throughout the Common­wealth, pressuring officials and private philanthropists. The mental hospital approach and its promise of mental restoration gained the- support of important citizens and seemed to suit the optimistic, self-improving tone of the day.

Specialists in the field added to the movement’s momentum. Medical superin­tendents of the new hospitals proclaimed impressive cure rates and fought efforts to overcrowd existing institu­tions. Their association long maintained that two hundred and fifty was the maximum number of patients that could be properly treated by one hospital chief. Mere additions to existing hospitals were not adequate to deal with growing population, the superintend­ents insisted; new institutions had to be built if the moral treatment they espoused was to continue to yield the superb results they reported.

Chief among the promoters of the mental hospital were an alienist from Pennsylvania, Thomas Kirkbride, and a former New England school­teacher, Dorothea Lynde Dix.

An early physician at the Quaker institution which became known as Friends Hospital, Kirkbride, a member of the Society of Friends, m time would become one of the most important American psychiatrists of the nineteenth century. Kirkbride left Friends Hospital when Pennsylvania Hospital detached its mental ward from the main building and built a new institution exclusively for the treatment of the mentally ill in 1841. Kirkbride, a University of Pennsylvania Medical School graduate, became the first superintendent of the estab­lishment, a post he held for forty-three years.

Apart from his psychiatric practice and extensive experi­ence as medical superintend­ent of a mental hospital, Kirkbride is significant for three accomplishments which had both statewide and na­tional impact on the treatment of the insane. Each of those accomplishments affected the development of mental hospitals.

The first of these was Kirkbride’s association with the physically frail investigator and publicist who led a decades-long crusade through­out the eastern United States on behalf of the insane: Dorothea Dix, the most nota­ble reformer of the day in the care of the insane and, per­haps, the greatest social re­former in American history. Dix first encountered the suf­ferings of the insane during a visit to the jail in East Cam­bridge, Massachusetts. That experience occurred in 1841, and prompted a forty year campaign for better provisions for the mentally ill.

Beginning in her native New England, she worked her way south, petitioning legisla­tures and recounting the hor­rors she had seen. In 1844, she arrived in Pennsylvania, where Kirkbride became her ally. Her memorial to the state legisla­ture prompted the 1845 autho­rization of the founding of the Pennsylvania State Lunatic Hospital, still in operation as Harrisburg State Hospital.

The second of Kirkbride’s major contributions started with a meeting he called in Philadelphia’s Jones Hotel in 1844. Invited were twelve of Kirkbride’s fellow medical superintendents of mental hospitals. They discussed the administration of such estab­lishments, and formed an organization they christened the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). The association exercised enormous influence on mental hospitals in America and eventually evolved as the American Psychiatric Association.

Kirkbride played his third major role in psychiatric his­tory as a direct outgrowth of the creation of AMSAII. For that body he headed a com­mittee charged with setting construction standards and devising plans for mental hospitals. The result was his landmark book, On the Con­struction, Organization and General Arrangements of Hospi­tals for the Insane, With Some Remarks on Insanity and Its Treatment.

The ideas he expressed were not all exclusively his own, and elements of his hos­pital plan can be seen in the earlier Pennsylvania Hospital for the Insane, designed by an English architect. Nonetheless, he and his committee refined the concept of the physical structure of mental hospitals. So strongly associated with Kirkbride was the plan he described. that it commonly is known as the “Kirkbride Plan.” To the end of the nineteenth century, the “Kirkbride Plan” of hospital construction prevailed in mental institutions throughout the country.

Another scheme for mental hospitals did emerge to chal­lenge Kirkbride’s, the so-called “cottage plan.” The contro­versy between adherents of the rival formats was furious and intense, although it may be hard to fathom today. The similarities between the ap­proaches seem far greater than the differences, and the goals identical. Both were intended to provide comfort, privacy, air and sun to patients as part of the “moral treatment” ap­proach. Both tried to keep groups of patients small enough for individual atten­tion. They only differed in that the Kirkbridean patient was housed in a single large build­ing; cottage plan inmates in­habited smaller, separate houses. Both types were con­structed in Pennsylvania.

Mental institutions in Penn­sylvania also tended to resem­ble each other in their generally extensive sites. Moral treatment required removing the patient from his stressful environment to wholesome, pleasing sur­roundings and sheltering him from the harassment of the curious public. Planners and administrators of these hospitals hoped to make them self­-supporting, to limit possibly disruptive contact with the outside world, to provide inmates with therapeutic agri­cultural and craft activity, and to reduce costs by providing some of the hospitals’ needs internally. Space was needed not only for residences and subsidiary buildings but also for farmland. The board of managers of the Friends Hos­pital described its theory in an 1818 report to contributors.

… the healthfulness of the situation, the opportunities for recreation furnished to the pa­tients in the spacious yards con­nected with the house, as well as their using the exercise of walking upon the premises and of riding in the vicinity; with employment of the men in the garden and fields … The retired situation of the farm, and the intervention of prohibitory rules afford to the patients a protection from the gaze of idle curiosity … a privacy calculated to inspire their troubled minds.

American mental hospitals continued to follow this pat­tern. Kirkbride agreed that, “It is desirable that the pleasure-grounds and gardens should be securely enclosed, to pro­tect the patients from the gaze and impertinent curiosity of visitors … ” He also maintained that, “Every hospital for the insane should possess at least one hundred acres of land, to enable it to have the proper amount for farming and gar­dening purposes, to give the desired degree of privacy, and to secure adequate and appro­priate means of exercise, labor, and occupation for the pa­tients, for all these are now recognized as among the most valuable means of treatment.”

Several noted architects participated in the planning of Pennsylvania mental hospitals. Englishman Isaac Holden, who spent twelve years in the United States, was retained to design the Pennsylvania Hos­pital’s new building devoted exclusively to the insane. Holden’s career is not well documented, but it is known, however, that he was em­ployed for a time by the archi­tect and architectural writer John Haviland and designed the Chinese Museum in Phila­delphia, circa 1836-1838, before receiving the mental hospital commission. Haviland, one of the most prominent Philadel­phia architects of his period and a leading prison designer, was given the commission for the Pennsylvania State Lunatic Hospital in Harrisburg.

Under Kirkbride’s supervi­sion, a new building was erected for Pennsylvania Hos­pital’s mental institute. The architect for the project was Philadelphian Samuel Sloan, one of the leading architects of the mid-nineteenth century. The author of several articles and books on architecture, Sloan also designed the Ala­bama Insane Hospital in 1851, and is believed to have de­signed the U.S. Government Hospital for the Insane in 1852 and the west wing of Illinois State Hospital for the Insane in 1858. Jn 1855, he made addi­tions to New Jersey Lunatic Asylum. Both by himself and in association with others, Sloan designed or contributed to the design of many build­ings, including municipal buildings and high-style residences.

John McArthur, Jr., the architect of Philadelphia City Hall, which at its completion was the tallest and largest public building in the United States, designed the Pennsyl­vania State Hospital in Dan­ville, 1870-1874. He created several important government buildings, banks, religious buildings and houses, and in 1874 was offered the post of supervising architect of the Treasury Department, which he declined.

The golden age of therapeu­tic mental-hospital construc­tion was ended largely by disillusionment and financial pressure. Doubts arose about the high cure rates proclaimed by the profession. Hospital construction and maintenance costs climbed, and yet there never seemed to be enough room for all those who seemed in need of institutionalization.

The psychiatric community had led the public to expect too much. Some professionals recognized the error in pro­claiming great cure rates and went along with it, perhaps because they thought it a means to a desirable end. So long as the public had great faith in mental hospitals, such hospitals would be built, and some patients would be helped, even if not at the ex­pected rate. Other psychia­trists enhanced their own reputation by inflating their cure rates. In turn, their col­leagues did the same, raising the ante.

The mechanism for report­ing the rates of cure implied greater success than actually was achieved. Superintend­ents released figures on the percentages of cures obtained among new patients dis­charged, dearly neglecting chronic cases in their computa­tions. However, the superin­tendents’ quandary is understood easily. Hospital construction failed to keep abreast of population growth and the lengthening lifespan, which meant more and more chronically ill patients occu­pied the hospitals. Cure was unlikely in these cases, and an honest account of actual recov­ery rates was bound to grow more disappointing each year – perhaps obscuring the superintendents’ genuine successes. In addition, pa­tients sent home as cured often were readmitted.

In 1875, Dr. Pliny Earle revealed a series of such inci­dents occurring in the nation’s mental institutions. In the annual report of Northampton State Hospital in Massachu­setts, of which he was superin­tendent, Earle published an account of forty persons who were discharged as cured a total of four hundred and eighty-four times, an average of more than twelve cures per patient. That case was merely one of many such instances of repeated supposed recoveries.

Earle was an inside critic, and not the only one. The comments of dissident asylum superintendents tended to be carefully worded, however, and shared primarily among the AMSAil membership. Non-institutional psychiatrists also joined the fray, but in contrast, they went public with their criticisms. They often had valid and serious objections, but they also may have been goaded by the near-monopoly on psychiatric treatment held by the hospital superintend­ents. So long as hospitals were thought the ideal places for insanity cures, private- practice specialists were disadvantaged.

Dr. William A. Hammond in 1879 presented to New York State Medical Society a paper entitled “Non-Asylum Treat­ment of the Insane.” Ham­mond’s paper, accused of containing serious inaccura­cies, and his character were attacked at the time. Nonethe­less, Hammond’s contention that the mentally ill could be treated at least as well at home as in mental hospitals caused a furor. Two years later, Dr. Dorman B. Eaton wrote “Des­potism in Lunatic Asylums,” published in the widely-read North American Review, which charged that insanity was increasing in the country, and mental hospitals were failing to keep its growth in check Asylum directors re­sponded, quite fairly, that much of the problem was due to conditions beyond their control. Their limits on hospi­tal population were no longer respected, and their institu­tions were filling with ever­-increasing numbers of chronically insane patients who required time and atten­tion, but who had little hope of recovery. Yet, the hospital image, already tarnished by press exposes and books about patient mistreatment, dimmed further.

The “cult of curability,” the optimistic belief in medicine’s ability to generally cure insan­ity, did not fade overnight, despite these developments. Some psychiatrists and others continued to espouse its cause and to encourage the construc­tion of therapeutic mental institutions. Indeed, there was genuine evidence of the suc­cess of some mental treatment to support their positions.

Still, the tide was turning; mental hospitals as institutions for social reform lost the pub­lic’s confidence. That develop­ment did not end hospital construction, however. The guiding principle of society’s responsibility to the helpless did not completely evaporate with the loss of faith in hospi­tal’s ability to cure madness. Rather, the purpose of the buildings changed. More and more, the new hospitals were conceived as retention centers, as warehouses for human beings. Their function evolved to shelter the insane, relieving the public of the burden and embarrassment of their pres­ence.

These new institutions exceeded the size limitations suggested by AMSAII mem­bers. The association had raised its figure from two hun­dred and fifty to six hundred beds in 1866, but some new institutions had many times that figure. The State Lunatic Asylum in Harrisburg origi­nally was built to accommo­date three hundred patients, and four hundred after addi­tions. By 1890 it housed nearly eight hundred residents.

Giant hospitals lacked the resources to provide full-scale moral treatment to numerous inmates. That reduced the chances of cures being af­fected, adding to public disillu­sionment with the hospitals. Despite their greater size, mental institutions became more crowded, as population continued to outstrip construc­tion. Potentially harmful in itself, overcrowding also en­couraged neglect and abuse. Revelations about conditions in some hospitals in the twen­tieth century contributed fur­ther to public revulsion.

The municipal mental asy­lums seemed particularly unsatisfactory. Funded under the “dual care” system, they accepted patients committed by the courts or transferred from state hospitals to reduce crowding, but the membership of the Board of Public Charities considered these establishments incapable of meeting proper standards. In 1913, the previously powerless board was authorized to recommend changes following its inspec­tions, and to apply to the district attorney for legal action if those alterations were not made within ninety days. The following year, the private, non-profit group, The Public Charities Association, hired a New York expert to survey all Pennsylvania’s state and county mental hospitals. He reported inadequacies in the county institution’s provisions for the chronic insane. A pam­phlet endorsing state care was then produced by the associa­tion’s executive secretary and members of the Board of Public Charity’s Lunacy Committee.

Eight years later the board was replaced by the state De­partment of Public Welfare, which continued to echo the old board’s call for ending county care for the insane. Finally, in 1938 the legislature passed the “State Care Act,” a law that specifically forbade any county, city or poor dis­trict from operating any insti­tution for mental patients. Local mental hospitals were transferred to state ownership, and the Department of Public Welfare was ordered to deter­mine which of these institu­tions were suitable for operation and which closed. Eight became state hospitals; five were put out of operation.

Today, the Commonwealth operates fifteen mental hospi­tals, ten of which – Allentown, Danville, Fairview, Harrisburg. Haverford, Norristown, Torr­ance, Warren, Wernersville and Eastern State School and Hospital – were established as state institutions. Clark’s Sum­mit, Mayview, Philadelphia (which is in the process of closing), Somerset and Wood­ville were formerly county establishments.

The closing of several of the hospitals resulted from a par­tial reversal of the trend from county to state control, which reduced hospital population. In 1963, Congress passed the Community Mental Health Facilities Act, stressing local mental health services. Penn­sylvania altered its statutes three years later. It shifted responsibility for mental health treatment from the state to the county level, on the theory that would provide care more quickly and to a wider group, and without the stigma attached to commitment to the state mental hospitals. Coun­ties were encouraged to de­velop contracts with mental health clinics and practitioners in private practice. General hospitals expanded mental wards or created new ones under the influence of the new law, with the state picking up the tab.

Commitment laws were changed in 1976, making it more difficult for a second party to involuntarily commit another person to a mental hospital. A 1978 amendment of that law permitted the non­-dangerous mentally ill to be committed to outpatient programs.

For Further Reading

Barnes, Harry Elmer. The Evolu­tion of Penology in Penn­sylvania: A Study in American Social History. Montclair: Patterson Smith, 1968.

Bond, Dr. Earl D. Kirkbride and His Mental Hospital. Philadel­phia: J. B. Lippincott Co., 1947.

Deutsch, Albert. The Mentally Ill in America. New York: Co­lumbia University Press, 1949.

____. The Shame of the States. New York: Harcourt, Brace, 1948.

Foucault, Michel. Madness and Civilization: A History of Insanity in the Age of Reason. New York: Pantheon Books, 1965.

Grob, Gerald N. Mental Institu­tions in America, Social Policy to 1875. New York: The Free Press, 1973.

Hall, J. K. General Editor. One Hundred Years of American Psychiatry. New York: Columbia University Press, l944.

Heffner, William Clinton. His­tory of Poor Relief in Penn­sylvania, 1628-1913. Cleona: Holzapfel Press, 1913.

Kirkbride, Thomas S. On the Construction, Organization and General Arrangements of Hospitals for the Insane, With Some Remarks on Insanity and Its Treatment. Philadelphia: J. B. Lippincott and Co., 1880.

Roby, David S. Pioneer of Medi­cal Treatment: Isaac Bonsall and the Early Years of Friends Asylum as Recorded in Bon­sall’s Diaries, 1817-1823. Philadel­phia: Friends Hospital, 1982.

Rothman, David J. The Discov­ery of the Asylum: Social Or­der and the New Republic. Boston: Little, Brown & Co., 1917.

Philip Michael Clark is a former daily newspaper education editor and editor and publisher of two local weeklies. He has taught college English at Harrisburg Area Community College, tutored Penn State/Harrisburg students in writing, and is the author of editorials syndicated to U.S. and Canadian newspapers. A member of the Society of Architectural Historians, he recently spent six months on contract to the Penn­sylvania Historical and Museum Commission as a consulting editor/writer working on National Register of Historic Places pro­jects. This article was adapted from research undertaken for a National Register nomination.