Essay: Maintaining Madness

Maintaining Madness:

Adjusting Society to Include Undesirables

via Asylums and Private Care Facilities

by A.D. Shaffer

{Graduate Studies; originally written for History 557 Fall 2014}

“Maud with her venturous climbings and

tumbles and childish escapes,

Maud with the delight of the village, the ring-

ing joy of the Hall,

Maud with her sweet purse-mouth when

my father dangled the grapes,

Maud the beloved of my mother, the

moon-faced darling of all, – “[1]

Madness offers escape for the creative or confused mind as well as the genetically deficient. Societal standards are excused of those whose minds are not rationally sane – modernly allotting the absurd behavior within the confines of the individual whose lacking in average capabilities. Insanity occurs for variant reasons in the minds of humanity, and often results in inexplicable and unusual actions on the part of the insane. Without means to permanently rid humanity of insanity, containing said victims of mental diseases are preferable for the comforts of society – whether by private or state funding, asylums act as corrals to house the mentally and criminally insane so as to shield the mass population from the undesirable unfortunates. I intend to examine through architecture, medicine, and environment, the pros and cons of maintaining madhouses or common residence homes in lieu of allowing the insane to venture the streets of the city at their leisure. New Personal Care Facilities do not require grand structures like the state asylums, nor do they house constant doctors. The facilities are state run businesses constructed inside homes to replicate a family environment living arrangements for those unable to live independently.

For the safety of the grand population as well as the inmate population, the criminally insane are separated from the average criminal. Special housing, in more secure asylums, confine the criminally insane individual for the safety of himself as well as the general population. The criminally insane typically adopt a delusional state of mind which defines the harsh anti-social tendencies, Bowers notes: “Their delusions, when organized generally, concern society, with whom they have always been at war, but the definite fabric of their false beliefs is woven about {public officials. Preparing} long statements replete with legal terms setting forth their grievances and complaints against the world at large.”[2] The criminally insane often believe they are slighted by society and should revolt to restore autonomic authority. As this upsets the heteronomy of modern society, secluded confinement is deemed the safest method in regards to the insane mind.

Inside asylums capable of housing the criminally insane, the noted patients are again secluded from the hospital population. In Weston State Lunatic Asylum this was the west wing of the fourth floor, Ward F for men and Ward C for the women.   A particular incident involving the murder of patient Charlie by patient Joe was related to me during a History Tour of The Trans-Allegheny Lunatic Asylum as well as discussed on the Travel Channel – Joe, with the assistance of other patients, first attempted to hang Charlie, a recent lobotomy patient; when that failed they lowered his body to the floor, and using the leg of an iron bed, crushed Charlie’s head by jumping on the bed.[3] The staff primarily blamed overcrowding of the hospital for the violence which occurred. Separating the classes of lunatics were means of preserving the less disturbed from the demons of the seriously tormented. Or, the seriously tormented could be reduced to the vegetate state.

As many as 440 lobotomies were conducted at one time at Weston State Lunatic Asylum. Dr. Walter Freeman rolled through on the lobotomobile leaving quiet, unaffected patients in his wake. Lobotomies were the go to cure in the early 20th century as means to destroy the frontal lobe – the area of the brain that controls emotions and creativity. The lobotomy removed the urge to rage inside the unstable brain; lobotomized patients were easier to deal with than raging psychotic minds: “Those who did survive might be left in a permanent vegetative state.”[4] The state hospital was shut down in the mid 1990s with high records of murder, occasionally that of a staff member, as well as rape and violent abuse. Weston Asylum was not the only benefactor of Dr. Freeman, his patient Howard A. Dully received more than one lobotomy at his hands, the first being at Doctors General Hospital December 15, 1960. Dully writes that while he holds no recollection of the events, Dr. Freeman’s notes entail the use of electroshock therapy to sedate and revive Dully – a paper receipt said, “Transorbital lobotomy. A sharp instrument was thrust through the orbital roof on both sides and moved so as to sever the brain pathways in the frontal lobes.”[5] Electroshock and lobotomies were useful tools to internally restrain the patient, scramble and/or fry their brains so that they no longer display passionate bouts of madness.

Mechanical restraints were older means of harnessing a patient before Dr. Freeman discovered the oriental method of lobotomies. Chains, bonds, and constructed means of metal and iron were utilized by insane asylums to prevent a patient from harming oneself or another human being, Bucknill notes the usage of mechanical restraints as necessary evils needed to bend the will of the unfortunate creatures – those not socially acceptable, therefore demanding seclusion and treatment.[6] A lessening of humanity is offered to said individuals; once deemed ‘insane’ the mass populace issues allowance for improper behavior, labeling the unfortunates as ‘poor unfortunate souls.’ Here enters the acceptance for otherwise immoral treatment – doctors could not understand the ingredients of insanity or how to address the illnesses so they physically restrained the patient to prevent the ability to harm oneself or another. By 1793 Philippe Pinel of Paris “embraced the progressive thinking of the Enlightenment. If insanity was a mental disorder, it had to be relieved through mental approaches. Physical restraint was at best an irrelevance, at worst a lazy expedient and an irritant. Treatment must penetrate to the psyche.”[7]

Doctors of the mind evolved as Alienists, and the field of psychology developed from the need thereof: “The private madhouse served the ‘trade in lunacy’, but it also became a forcing-house for the development of psychiatry as an art and science. The asylum was not instituted for the practice of psychiatry; psychiatry rather was the practice developed to manage its inmates.”[8] Bucknill notes on the American’s lack of Commissioners of Lunacy as advisors which directed them to rely heavily on the advice of the medical specialists – using the skills of the alienist to determine the needs of the patients from architectural design to room temperature.[9] The role of alienists, and the extreme authority placed upon them, brought fear and terror to any suspect of lunacy, Carr captures the fictitious presence of the doctor: “{…} the usual sounds of madness gave way to an eerie attempt at coherent communication on the part of most of the inmates. {…} Indeed, it was in some ways worse on the nerves, for one knew that the attempt at order was a strained one, and that the sounds of anguish would soon return…”[10] Feigning normalcy, the patients worked to convince the doctors of their sanity – frantic attempts at release. As patients of the asylum the inmate held societal worth in forms of entertainment, experimentation, and manual labor.

Bucknill remarks pointedly on the humane and considerable demonstrations of Dr. Thomas Kirkbride, specifically in relation to The Pennsylvania Hospital for the Insane in Philadelphia. Concluding with a plea to American institutions to accept the embarrassing oddities, mechanical restraints, and undesirable components of the institution for the insane instead of secreting the actions away and hiding the truth; let the insane be insane as they know no other path: “They are men, as I most willingly testify, animated by the highest motives of humanity, but ignorant and mistaken in their application of means to the furtherance of that great end to which we all press forward – namely, to the care and cure of the insane with the least amount of suffering.”[11] American institutions prevent the exposure of the activities of the insane to the population to create a false role inside the city of progressive elegance of the manipulations in the mind.

For the city opinion to tolerate the inclusion of an asylum, or more often, private care facilities among the sane individuals of the community, an illusion of control of said lunatics must be maintained. Avoiding the high costs of excessively expensive facility fees of grand state asylums, modern society eagerly welcomes the inclusion of private care facilities incorporated into homes scattered throughout common neighborhoods inside the city/town. A single family home is remodeled to accommodate grown individuals who stay a percentage or all of the day living inside the created home environment. Hospitals themselves, such as McLean, offer continuing care options outside of the physical hospital such as Appleton Continuing Care Program, in Boston Massachusetts.[12] Direct Support Professionals replace the role of doctor – another cost reduction as little to no skilled training is required to qualify for the job description – with the daily nurse stopping by to ensure medical standards are maintained. Doctors are still available, simply at a more detached sort of connection. The salary of a DSP is laughable compared to that of a well-educated doctor of medicine. Removing the luxuries and grandeur allotted top dollar facilities like McLean, more affordable and efficient organizations offer small scale living inside the community such as “Community Passages,” Resources for Human Development located in Gibsonia, Pennsylvania which offers care for mentally challenged adults. The mission statement of Community Passages clearly addresses the slide from asylum living to community inclusion:

Community Passages is a community based residential program, designed to provide a home/family like environment for individuals with developmental disabilities and/or dual diagnoses, many of whom present significantly challenging behaviors and most of whom previously resided at State Schools and Hospitals.  Our mission is to offer creative and innovative supports promoting community skill development, increased self-esteem, self-determination and personalized budgets to foster individualized programs in a safe and open environment, while encouraging consumer empowerment and personal growth.[13]

The surroundings being altered, from that of a castle-like secluded state to average immersion into the community, raise concern for the patient/inmate as well as the public. However, reduction of fellow patient/inmate status is greatly reduced; Community Passages houses only thirteen individuals. With at least two DSPs monitoring and encouraging self-development, the individuals are provided with a more modern lifestyle. Humanity is progressively returning to incorporating the insane amid the sane, an accepted tolerance of the community implies that society is able to embrace the follies of madness as a part of natural occurrences. David Rothman heads the school of thought that asylums are required to restore order: “their further development drew strength from the combined effects of a humanitarian reform movement, appealing new models of medical entrepreneurs and asylum superintendents who advocated an institution-based therapy known as “moral treatment.””[14] Late eighteen century philosophers freed madmen of their chains, Pinel’s traitement moral “{…} meant rather that the new therapies applied to the mind, not the body, of the patient. Traitement moral referred to a benevolent approach to caretaking, in which reformers called for patients to develop self-control under the guidance of paternalistic doctors.”[15] Moral concerns display the mentally challenged populace as deserving of more humane treatment. While seclusion inside the elegant asylums afforded a sense of grace to insanity, incorporation back into society allows a clearer voice of acceptance for natural dispositions of madness…and a means to rehabilitate the individual back into society. Esquirol, a follower of Pinel, broadened on the original theories and “pressed the reforms further, transforming the asylum into a therapeutic community where doctors and patients lived together, and at his private clinic, certain patients even dined at the family table.”[16] Modern enlightenment of equal humane living acceptance follows the philosophy of the eighteenth century and broadens it to include non-doctors and home-like institutions. A sense of belonging is granted to the individuals permitted to leave the institution for monitored care. A place is to be incorporated for them to find purpose inside society. Dr. Thomas Kirkbride’s asylums offered an embracing nature, not only encouraging local participation but actually developing society from the institution.

Weston State Lunatic Asylum was a self-sufficient facility for the insane maintained by the patients themselves. Hospitals held their own value for the city structure: “Henceforth, hospitals became tools for both physical and moral recovery. The former, secular goal led some institutions to accelerate the ongoing medicalization process by hiring more members of the medical profession for their caregiving staffs.”[17] Two personas thrived inside the hospital: the patient/practioner and the practioner/patrons: “The hospital in ante-bellum America can thus be more usefully seen as a battleground for the conflicting values of traditional stewardship and the priorities of an emerging profession than as the coherent expression of a carefully articulated vision of society. {…} maintain[ing] a degree of psychological autonomy despite the pain and deprivation which might characterize his external life.”[18] Weston patients each held responsibilities inside the facility, and were harnessed with chores that the institution required to function.[19] No outside assistance or employment was rendered as the patients pulled the work yoke. Patients, dependent on their physical limitations, worked in the kitchen, the morgue, the laundry room, and the grounds. Weston came complete with a lumberyard, stone quarry, and cemetery where deceased patients and town folk alike were buried. In contrast to the park-like cemeteries, the Weston cemetery was secluded behind the hospital. Niceties were not afforded as costs prevented luxurious burials. The majority of patients were incinerated in the crematory. The Great Lawn offered peaceful reflection with landscape comforts which space did not permit for in the hospital’s cemetery. Menial tasks such as cleaning and restoration fell on the patients – not just as ‘free labor’ but also as a means to let the patients feel included in the asylum family. Positions the asylum needed filled by sane individuals attracted such a following that the town of Weston formed from the individuals working or being treated at the hospital.

Community involvement at Weston State Lunatic Asylum borders on questionable in terms of society sanity – since 1869 until the facility closed in the 1990s, the high school prom as well as other social events were held in the asylum: “It must have been strange, and certainly a subject of dark humor to attend a prom, knowing that only a couple doors away, there were over a thousand lunatics.”[20]In 1871, a new auditorium hosted dances known as the Lunatic Ball, where the inmates were able to enjoy social dances viewed by the public for entertainment. The fun had to be reigned in as the social activities between normally segregated male and female patients ended explicitly: “When the first dances were held there were immediate problems, caused by couples disappearing. Their whereabouts became clear when the switchboard lit up with calls complaining that naked patients were out on the front lawn engaged in lewd behavior.”[21]Football games for Weston High School took place on the asylum’s Great Lawn, and baseball became tradition at the hospital; Dr. Kirkbride supported physical activity as means for balanced living, outdoor fairs, sports, and a variety of events held Weston State Lunatic Asylum as an esteemed social venue for Lewis County.[22]The community of Weston thrived as a result of the asylum the patients were welcomed members of society.

The sense of inclusion offered the patients of Weston State Lunatic Asylum is in stark contrast to the model set by Bedlam: “If one knows anything about Bethlem, it is probably that the place operated as a kind of freak show and human zoo, with paying customers gaping at the inmates. Although visiting was a popular pastime, recent scholarship has revised and tempered the famous myth.”[23] Scholarship details that the spectacle was partially the magnificence of the architecture of the asylum itself, the intricate detail and beauty demonstrated through stone, windows, and causeways. America did not have many castles like Europe – but asylums were formed after the castle design incurring gothic old world romanticism into modern design to fully rehabilitate and soothe the patients. The public also benefited from the refreshing structures, and the fee they paid was returned to the facility as means of simple profits. Like the nostalgic benefits of monuments and arts, spectacle was satisfied through community display: “To the degree that the Gardens embodies their home city, they function like other works of public art and monuments, providing a lens through which to explore larger themes, revealing changing community values, power relations, institutions, and historical change.”[24] Public art soothes the community, when paired with structures of grandeur such as the asylum, society enjoys the spectacle provided by the city institution.

The architectural design of insane asylums has long been conducive to treatment and care of affected individuals. Great care was taken to induce the patient to reside only in their rooms for sleeping, and for them to spend the majority of their days with other patients for social interaction. Bucknill, however, addresses the exact opposite in regards to the elite hospital of Boston – McLean: “It struck me, however, that these patients lived too much by themselves in their own rooms for their therapeutic welfare, and that smaller structures with smaller rooms, and with common rooms for meals and social intercourse, would have been better suited to promote the cheerfulness and happiness of the patients.”[25] Interestingly enough, McLean housed numerous depressed and suicidal patients – those of which did not survive on the methods found agreeable with the institution such as insulin shock treatments. Famous poetess Sylvia Plath, an extremely depressed individual, sought the healing walls of McLean yet offed herself shortly after leaving the hospital: “Like most McLean patients, Plath was dosed up on the antipsychotic drug Thorazine, which contributed to her affectless behavior.”[26] Weston Asylum, currently known as The Trans-Allegheny Lunatic Asylum, is spacious and constructed with extreme purpose in regards to windows, ventilation, structure, and open non-confining grounds.

An accepted air of community involvement graced the inmates of Weston State Lunatic Asylum. The fence which surrounds the Great Lawn is three feet high and for aesthetic purposes only as it easily could be navigated by any wishing to escape. While the facility was operational, patients would occasionally leave the hospital but were retrieved by the employees: “Weston residents can still recall how it would be announced on the local radio station that an inmate had escaped. {…} Besides their normal duties attendants were expected to be ready, at a moment’s notice, to form a posse and go round up escapees.”[27] The local response to the escaped inmates may merit the locking of the public’s doors, but rarely was the community alarmed by the outings of the patients of the asylum. By the 1950s, however, medication would sweep through the asylum framework, numbing the populace with Throazine to reduce delusions and hallucinations while vegetating the nervous system, disabling the patient. Less attention would be applied to ‘moral treatments’ with the rise of narcotics and anti-psychotic medications. Like the lobotomy, anti-psychotic drugs would re-educate the mind into tolerable and acceptable existence, allowing society to breathe a sigh of relief for the quelled rage of madness. If madness is not seen then it is rarely heard, drugs and lobotomies may quiet outburst but none may escape their dreams. Freud describes madness as being trapped in a dreamlike state unable to rationalize, he quotes philosopher’s theories on madness: “Kant writes {…}: ‘The madman is a waking dreamer.’ Krauss {…} declares that ‘insanity is a dream dreamt while the senses are awake.’ Schopenhauer {…}calls dreams a brief madness and madness a long dream.{…} Wundt {…} writes: ‘We ourselves, in fact can experience in dreams almost all the phenomena to be met with in insane asylums. ”[28] Anyone is subject to dreams, and Freud’s concerns expose the threat of lunacy as a common thread easily torn. Societal understanding is required for a blended community of sane and insane individuals intermingling together for the betterment of all.

Realization of the tender balance between sanity and insanity equates authentic opportunities for the mind to comprehend. While reducing the almighty ego by allowing the unreasonable to exist equally with the reasonable, the individual is reduced to reincorporate the necessary value for the whole community. Insanity does not humanity remove; the bold stance of inclusion into society of their insane will greatly enrich America’s admittance to the flaws of morality. Bucknill notes on America’s refusal to admit that problems and oddities do in fact occur in American asylums. Being English, Bucknill naturally feels defensive for England – who is known for the tortures of Bedlam: “Abuses occur, as they will occur everywhere; but they are remedied, and, if need be, punished, in the most public manner, and the records of them are displayed to the eyes of the world.”[29] There are no records of American abuses or violations to relate, according to public record, and Bucknill is greatly concerned with the American persistence of false perfection: “the great stumbling-block of the American superintendents is their most unfortunate and unhappy resistance to the abolition of mechanical restraint. {…} I was again and again informed that the system of non-restraint had proved quite a failure in England, and that we were rapidly returning to the old practices.”[30] The issue for Americans lies more in the public demonstration of institution practices than for moral concerns in regards to utilizing mechanic restraints – American asylums did use mechanic restraints, they just did not publicly admit to the actions. Nowadays, America is surging ahead with communal living – the moral understanding of variant human nature. With further understanding and acceptance of the duality of mankind, sane and insane, modern America will move forward together to properly define humanity’s impact on existence.


Beam, Alex. Gracefully Insane: Life and Death Inside America’s Premier Mental

Hospital. New York: Public Affairs, 2001.

Bowers, Paul E. “The Dangerous Insane.” Journal of the American Institute of

Criminal Law and Criminology. Vol. 12, No. 3 (1921): pp. 369-80. JSTOR. Accessed on December 19, 2014.

Bucknill, John Charles. Notes on Asylums for the Insane in America – Primary


Source Edition. London: J. & A. Churchill, 1876.

Dully, Howard and Charles Fleming. My Lobotomy – A Memoir. New York: Three

Rivers Press, 2008.

Freud, Sigmund. The Interpretation of Dreams. Trans. James Strachey. New York:

Avon Books, 1998.

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Lunatic Press> USA: 48HrBooks, 2014.

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Treatment of the Insane.” Rev. Jack D. Pressman. The William and Mary


Quarterly, Vol. 45, No. 3 (1988): p. 606-08. Accessed on December 19, 2014.

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University Press, Incorporated, 1999. Accessed on December 19, 2014.

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Century America.” Journal of Social History, Vol. 10, Iss. 4 (1977): p. 429. Accessed on December 19, 2014.

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1916-2006.” Journal of Social History, 2010. pp. 327-50.

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The Riverside Press, unk. date. pp. 323-43.

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Minneapolis, MN: University of Minnesota Press, 2007.

[1] Alfred Tennyson, “Maud,” The Poetical Works of Alfred Tennyson, Cambridge, MA: The Riverside Press, unknown date, p. 325. Accessed December 19, 2014.

[2] Paul E. Bowers, “The Dangerous Insane,” Journal of the American Institute of Criminal Law and Criminology, Vol. 12, No. 3 (1921): pp. 371-72. Accessed December 19, 2014.

[3] “Mysterious Murders in the Asylum,” Ghost Adventures, Travel Channel,, 1:40-2:30. Accessed on December 19, 2014.

[4] “Mysterious Murders in the Asylum,” Ghost Adventures, Travel Channel,, 3:25-3:31. Accessed on December 19, 2014.

[5] Howard Dully and Charles Fleming, My Lobotomy – A Memoir, New York: Three Rivers Press, 2008. p. 99. Accessed December 19, 2014.

[6] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. pp. 68-75.

[7] Roy Porter, Madness A Brief History, Oxford, New York: Oxford University Press, 2002, p. 105. Accessed December 19, 2014.

[8] Roy Porter, Madness A Brief History. Oxford, NY: Oxford University Press, 2002. p. 100.

[9] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. p. 20.

[10] Caleb Carr, The Alienist, New York: Random House, 2006, p. 29.

[11] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. p. 87.

[12] Mental Health Communities of Health and Healing, American Residential and Treatment Association, Accessed on December 19, 2014.

[13] “Community Passages A Division of RHD,” The Provider Alliance: Sharing Ideas, Resources and Purpose, Accessed on December 19, 2014.

[14] Mary Ann Jimenez, Changing Faces of Madness: Early American Attitudes and Treatment of the Insane,” Rev. Jack D. Pressman, The William and Mary Quarterly, Vol. 45, No. 3 (1988): p. 606. Accessed on December 19, 2014.

[15] Carla Yanni, The Architecture of Madness: Insane Asylums in the United States, Minneapolis, MN: University of Minnesota Press, 2007, p. 24.

[16] Carla Yanni, The Architecture of Madness: Insane Asylums in the United States, Minneapolis, MN: University of Minnesota Press, 2007, p. 26.

[17] Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals, Oxford University Press, Incorporated, 1999, p. 626. Accessed on December 19, 2014.

[18] Charles E. Rosenberg, “And Heal the Sick: The Hospital and the Patient in the 19th Century America,” Journal of Social History, Vol. 10, Iss. 4 (1977): p. 429. Accessed on December 19, 2014.

[19] Historical Asylum Tour, Trans-Allegheny Lunatic Asylum, October 4, 2014.

[20] Edward S. Gleason, Lunatic The Rise and Fall of an American Asylum, <self published Lunatic Press> USA: 48HrBooks, 2014, pp. 69-70.

[21] Edward S. Gleason, Lunatic The Rise and Fall of an American Asylum, <self published Lunatic Press> USA: 48HrBooks, 2014, pp. 70-72.

[22] Edward S. Gleason, Lunatic The Rise and Fall of an American Asylum, <self published Lunatic Press> USA: 48HrBooks, 2014, pp. 70-72.

[23] Carla Yanni, The Architecture of Madness: Insane Asylums in the United States, Minneapolis, MN: University of Minnesota Press, 2007, p. 20.

[24] Mark Tebeau, “Sculpted Landscapes: Art & Place in Cleveland’s Cultural Gardens, 1916-2006,” Section 1 Arts and Cities, Cleveland State University, p. 328. Accessed on December 19, 2014.

[25] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. p. 9.

[26] Alex Beam, Gracefully Insane: Life and Death Inside America’s Premier Mental Hospital, New York: Public Affairs, 2001, p. 153.

[27] Edward S. Gleason, Lunatic The Rise and Fall of an American Asylum, <self published Lunatic Press> USA: 48HrBooks, 2014, pp. 75.

[28]Sigmund Freud, The Interpretation of Dreams, Trans. James Strachey, New York: Avon Books, 1998, pp. 121-22.

[29] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. p. 65.

[30] John Charles Bucknill, Notes on Asylums for the Insane in America – Primary Source Edition, London: J. & A. Churchill, 1876. p. 67.

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