Tag Archives: asylums for the incurable insane

The Incurable Insane

Chapin House at Willard Asylum for the Chronically Insane

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.

Cures and Controversy

Insane Asylums Could Be Beautiful, Architecturally

Insane Asylums Could Be Beautiful, Architecturally

Though it took years to make asylum care acceptable to the mainstream public, ordinary citizens did eventually begin to believe in the professionalism and experience provided by these institutions. After that, they began using asylums in increasing numbers. Asylums definitely relieved family members from the anxiety of caring for mentally ill loved ones, and took the drudgery and constant attendance that some patients required off family caretakers’ shoulders. Eventually insane asylums became popular enough to become overcrowded, and the question of how to manage “incurable” patients arose.

Many alienists believed that if they could intervene in a case of insanity soon after it manifested (an acute case), they stood a good chance of curing it. However, when families kept mentally ill members at home until they ran out of time, money, or the physical ability to continue providing care, the situation was less hopeful. These long-standing cases, alienists feared, were incurable.

What should be done with such patients? Superintendents hated to divert money and time from their more acute (and therefore curable) patients to the chronically insane who were nearly impossible to cure. Yet, these long-term patients still needed care. The idea of special asylums for “incurables” soon came up for consideration. My next post will discuss the position that many in the profession took toward asylums for the incurably insane.