Chapin House at Willard Asylum for the Chronically Insane

Alienists believed that early intervention in recent cases of insanity led to high cure rates–at least 40% and perhaps higher. However, patients who did not receive treatment until their cases were advanced or of long standing, were much less likely to recover. (See last post.) These latter were exactly the kind of patients that most families eventually wanted to turn over to asylums, and superintendents were eventually faced with the dilemma of how to use their limited resources most effectively.

Some of those who were interested in this growing problem suggested that special asylums just for the incurably insane be built. Caretaking for such individuals would be cheaper than including them in an establishment that were designed for more acute cases, and wouldn’t drain the staff manpower away from patients who stood a better chance of being cured. Though asylum superintendents didn’t like to spend their resources on the incurably insane, some of them were quite vocal about not building asylums just for these patients.

An article in the American Journal of Insanity (1844) made one superintendent’s position very plain:

— No one can predict which patients might be cured; of the people in that particular asylum, fully one-third couldn’t really be placed into one category or the other.

— Many incurables were simply “monomaniacs” (deranged only on one or two subjects) and sane on all others. Why should they be denied the comforts and amenities given to those who are hopeful of being cured?

— It would be impossible to make sure incurables weren’t abused or neglected. The author of the article said in particular: “In all Asylums, the fact that some are well and soon to leave the Asylum is the greatest safeguard against abuse.”

— If asylums for incurables didn’t have proper staffs of doctors and other appropriate caretakers, how would they be any better than poorhouses?

Others pointed out that to send someone to an asylum for incurables would destroy the individual’s last shred of hope and might well cause him or her to never be cured.