Beacon Street Diary blog

A look inside a 19th century mental institution

Range 2 of the library shelves, deep in the back of the stacks, is a tough neighborhood. Between tomes about white supremacists, the box of sermons about "Murder, dueling, etc." and the quarantine for damaged books, the range  contains stacks of pamphlets and reports about institutions with evocative names like, "The Church Home for Orphan and Destitute Children", "Relief of Aged Indigent Females", "Prevention of Pauperism", and "Consumptives Home". Among those pamphlets are two board reports from the Retreat for the Insane at Hartford, Connecticut, dated 1848 and 1851. Since May is Mental Health Awareness Month, we decided to page through the reports and get a snapshot of mental health treatment more than 150 years ago.

Opened in 1823, the Hartford Retreat for the Insane was the third mental institution in the United States and represented a new era of mental health care. The dungeon-like "lunatic asylums" of the past were falling out of favor, and the focus was on trying to improve patients' conditions. The Retreat started as a fifty-bed facility for upper-class patients. The founders were interested in "moral treatment" more than the pharmacology of the day, which still involved bleeding and herbal remedies. The two reports reflect this focus on therapy. The superintendent physician, John S. Butler, wrote both accounts to the Retreat's board. He writes about patients participating in walking and riding groups in the Retreat's grounds, reading circles, and cultural activities in Hartford. Despite the Retreat’s growing indigent population, Butler's writing makes it clear his focus was still on therapy.

Budgets provide another window into the operation of the Retreat. Both reports include detailed lines about how much was spent on staff salaries and wages, different types of food, and maintenance. Tellingly, "Wine and Medicine" were aggregated into a single line item that accounted for just a few hundred dollars of the Retreat's $25,000 operating budget. Butler's report also discusses an expansion completed in 1848, necessary to keep up with the Retreat's growing population.

Perhaps most interesting are the statistical tables at the end of each report. They organize the patients by county of origin, gender, profession, age, and cause of illness. Eyebrow-raising tidbits emerge. Common causes of illness included "Intemperance" and "Over-work", as well as the rarer "Religious excitement" and "Erroneous education". "Farmer" was the most common profession for men entering the hospital in both years, while for women it was "Domestic pursuits".

 

In some cases, Butler editorialized on the statistics. Hartford and New Haven counties produced the most patients, and Butler wrote in the 1848 report that urban areas are not conducive to physical health, and therefore cannot support mental health.

Butler also remarks on the frequency with which young women come through the doors of the retreat, suffering from an affliction that Betty Friedan, writing a hundred years later, might call "the problem with no name". Butler pins the blame on their husbands, who he says did not recognize the labor involved in domestic pursuits, and take advantage of wives' free labor to make more money. In Butler's estimation, many of these women just needed a break. He believed all mental illness could be cured with enough rest, exercise, talk, and patience.

The medical establishment's belief in the ability to cure mental illness withered over the next decade. Butler claimed a 52.5% recovery rate in 1851, but also describes a growing number of patients who are not helped: those who died in the hospital, shortly after exiting the hospital, and patients who leave the Retreat unimproved, most likely for financial reasons.  

The reports make it clear that a stay in the Retreat was not possible for everyone. The minimum length of stay was three months, and the cost put it out of reach for impoverished patients. Butler recommended the creation of economical accommodations for less well-off patients in the 1848 report, but by 1851, they had not yet materialized.  But the number of low-income and chronically ill patients grew over the next two decades, and Retreat devoted more and more of its resources to custodial care for chronic patients.

Connecticut's state mental hospital opened in the late 1860s. The new facility relieved pressure on the Retreat, which had until then been the only mental health care facility in the state. The Retreat returned to its role as an upper-class haven. It is still in operation today, as the Institute of Living, and is part of Hartford Hospital, a large teaching hospital. A little part of its history is in our Range 2, among other small fragments of mental health care history and a puzzle of American history stretching across the stacks.

 


engraving of the Hartford Retreat for the Insane courtesy of the National Library of Medicine