The second Worcester State Hospital, opened in 1877, was located in the eastern side of the city, in a rural area far from its industrial and business districts. Constructed on the so-called linear or “Kirkbride” plan – named for superintendent of the Pennsylvania Hospital for the Insane, Dr. Thomas Story Kirkbride – the building consisted of two symmetrical wings that receded from the central administration building in a distinctive zig-zag pattern. The structure reflected many of the early century’s beliefs about mental illness, when therapeutic optimism was at its height, and was conceived quite literally a medical instrument; not just a place of cure, but a curative place. However, this influence was undercut by many variables, including the turning of the tide away from therapeutic optimism, the continued inadequacy of state appropriations, and the realities of severe overcrowding.
Over the next few decades, the second hospital faced a variety of struggles. While state-of-the-art at the time of its construction, its infrastructure quickly fell into disrepair. Administrators complained of the failing water supply and overburdened sewage system, inadequate facilities for bathing and dining, faulty electric wiring that posed the constant risk of fire, and a lack of sufficient refrigeration. An ever increasing amount of land was needed to meet the hospital’s agricultural needs, yet the city continuously encroached on the hospital property from the west, leading administrators to purchase a large farm in the neighboring town of Shrewsbury. Low wages and long work hours contributed to a high turnover among hospital staff and culminated in a nurses’ strike in 1902. In addition to their own grievances, the strikers remonstrated on behalf of their patients, citing inedible food, lack of bedding, the proliferation of vermin, and neglect owing to insufficient staffing. The crowded hospital, which lacked the space to impose a proper quarantine, was vulnerable to infectious disease, and was continuously ravaged by outbreaks of diphtheria, smallpox, influenza, scarlet fever, measles, and dysentery.
Throughout the last decades of the 19th century, administrators complained that the “hospital is now so crowded with patients that officers are overwhelmed with routine duties,” making it “impossible to give individual cases special care and attention.” Under such conditions, the character of the institution inevitably shifted away from the curative and towards the custodial. The recruitment of Dr. Alfred Meyer as the hospital’s first pathologist in 1895 was intended to reinvigorate the mission of the hospital through a new empirical approach to insanity. Under Meyer’s brief but impactful leadership, the hospital established research laboratories aimed at studying mental disease and its treatment. Administrators reported that as a result of this “new departure,” a “scientific spirit and atmosphere pervade[d]” the hospital. While research at Worcester would continue into the 20th century and ultimately make significant contributions to the science of mental health, the new ethos of the hospital served to dehumanize patients, who were treated largely as guinea pigs, subjected to experimental testing and treatment against their will.
After Meyer’s departure in 1902, Worcester experienced further difficulties. By 1908, the building was packed with over 1,200 patients — more than double the number it was originally designed to accommodate. Under these conditions, administrators adopted a disorganized and ad hoc approach, encompassing a variety of therapies that were applied with little understanding of whether or how they might work. These included hydrotherapy, shock therapy, hormone therapy, lobotomy, and psychoanalysis.
As early as 1914, administrators questioned the scale of the hospital’s inpatient population, stating that “many persons now in institutions, while obviously insane, may profitably be returned to the community.” Over the next few decades, they hired social workers and organized public programs and outpatient treatment centers to foster connections between the institution and the community, facilitate the reintegration of patients into society, and prevent the necessity of hospital treatment through early intervention and moral hygiene education. Despite these efforts, the patient population continued to grow, even as its public image began to decline. By the mid-20th century, the Worcester State Hospital and many similar institutions were experiencing a crisis of identity in a world that increasingly viewed them as retrograde and barbaric “human warehouses.” The emergence of the first antipsychotic drugs further undermined the perceived necessity of inpatient treatment. Fueled by public protest, scandalous investigations, and a growing anti-psychiatry movement, the 1960s and 1970s witnessed the release of hundreds of thousands of patients and the shuttering of state hospitals across the country.
The first state to institute a systematic program of institutional treatment for the insane, Massachusetts was also one of the last to deinstitutionalize. Between 1991 and 1993, ten institutions were shuttered. While the Worcester State Hospital continued to operate, absorbing a portion of the patients who remained in state custody after the closure of other Massachusetts institutions, it did so on an increasingly smaller scale.
Even before the negative consequences of deinstitutionalization became evident, patient advocates and mental health professionals questioned the decision to dismantle the country’s state hospital system. While acknowledging the faults of the system, they pointed to the failure of state and federal governments to provide for the hundreds of thousands of former patients who have been shuffled from “back wards” to “back alleys.” Some of these individuals had lived in institutions for years or even decades and lacked the skills and resources to function in society. Once released, many became homeless or were incarcerated. Today, the majority of inpatient mental health care in the United States takes place in prisons, rather than in hospitals. Critics of deinstitutionalization argue that the repudiation of the asylum model has resulted in a “collective amnesia” whereby the hard-won lessons of years of institutional practice have been lost. In the words of Oliver Sacks, “We forgot the benign aspects of asylums, or perhaps we felt we could no longer pay for them.”
Bibliography and Further Reading
- El-Hai, J. 2005. The Lobotomist: A Maverick Medical Genius and His Tragic Quest to Rid The World of Mental Illness. Hoboken, NJ: John Wiley & Sons, Inc.
- Etzioni, A. 1975. “Deinstitutionalization: A Public Policy Fashion.” Human Behavior 4 (9): 12-13.
- Grob, Gerald N. 1966. The State and the Mentally Ill: A History of the Worcester State Hospital in Massachusetts, 1830-1920. Chapel Hill: University of North Carolina Press.
- Morrisey, Joseph P., Howard H. Goldman, Lorraine V. Klerman, and associates. 1980. The Enduring Asylum: Cycles of Institutional Reform at Worcester State Hospital. New York: Grune & Stratton.
- Sacks, Oliver. 2009. “Introduction.” In Asylum: Inside the Closed World of State Mental Hospitals, by Christopher Payne. Cambridge, MA: Massachusetts Institute of Technology.