Recovery From Schizophrenia: Psychiatry And Political Economy

MADNESS AND THE INDUSTRIAL REVOLUTION 119At last Dickens had come upon an American asylum as depressing as he was tofind St Luke’s in London a few years later. 90 And the reason for the melancholyconditions at the New York City Asylum? Perhaps, as he says,New York, as a great emporium of commerce, and as a place of generalresort, not only from all parts of the States, but from most parts of theworld, has always a large pauper population to provide for; and labours,therefore, under peculiar difficulties in this respect. 91The New York State Hospital, over 200 miles north at Utica, escaped theproblem of overcrowding with foreign-born paupers from which the city hospitalsuffered, 92 and became recognized as a model state institution. The rare instance ofunenlightened hospital conditions was to be found where poverty andunemployment were beginning to appear within the shores of the United States.REHABILITATIONNot only were conditions generally humane in the public institutions, they werealso genuinely rehabilitative. Work therapy was strongly emphasized at such statehospitals as Worcester, Massachusetts; Utica, New York; and Brattleboro,Vermont. 93 Patients were released on parole from the Eastern Virginia Asylum toseek work in local towns, and some were also boarded out with families in orderthat “the accustomed life of the lunatic shall be less essentially at variance with thatpertaining to persons generally of sound mind.” 94 Several hospitals, includingUtica, instituted the measure for which Conolly in England was unable to obtainfunding—classes for patients. A variety of subjects was taught, including musicand drama. Most hospitals had libraries for the patients. In addition, links with thecommunity at large were strengthened by encouraging the participation ofteachers, ministers and other visitors in the day-to-day operation of thehospitals. 95The rehabilitative emphasis appears to have been associated with reasonablyhigh discharge rates. As Table 5.3 shows, the proportion of patients discharged“recovered” from public hospitals in different years compared quite well withfigures for private hospitals. (No doubt, of course, hospital superintendentsattached different meanings to “recovered,” but there is no reason to believe thatpublic-hospital doctors were particularly optimistic in this respect.) We see veryrespectable recovery rates not only at South Carolina Asylum, as previouslynoted, and at such hospitals of repute as Worcester and Utica, but also at the NewHampshire Asylum, the Central Ohio Asylum and the Vermont Asylum.Recovery rates at these hospitals through the 1850s were at least equal to those(given by Thurnam) for the best British county asylums. Table 5.5, drawn fromThurnam’s statistics, shows that recovery rates at the American corporate hospitalsand at the Worcester Asylum (admittedly the best of the state hospitals) allexceeded average cure rates at British institutions through the mid-1840s. Such