The Discovery of Mental Hospital Patients:A Historical Epidemiology of Institutionalization in the American North, 1880–1920

Abstract

Historians of the American mental hospital still do not firmly grasp who mental hospital patients were. Although the field's signature debate on the nature of the mental hospital as “repressive” or “humanitarian” involves the characterization of the patients —based on their demographic traits—as victims of repression or beneficiaries of humanitarianism, there has actually not been a thorough demographic analysis of the patients. This article ascertains and examines the defining characteristics of the patient population within the context of that enduring debate. It first identifies demographic groups that were more prone to institutionalization than would have been expected from their susceptibility to insanity. They symbolized the patient population in the late nineteenth century when insanity did not necessarily result in institutionalization. This article then discovers essentially the same demographic groups ended up in mental hospitals in both the hinterland and metropolitan areas of the North from the late nineteenth to the early twentieth century. It also finds a protective effect that marriage had against institutionalization operated in a socially conservative way. Finally, it weaves together the demographic traits of the patients deemed indicative of the mental hospital's repressiveness and the ones considered reflective of its humanitarianism into a panoptic portrayal that presents the patients as both victims and beneficiaries of the mental hospital. This article's analysis of the patients as a complex, multifaceted population helps transcend the binary framework of the debate on the nature of the mental hospital and deepen our understanding of who they were.