The ambivalent role of the institution in the history of child and adolescent psychiatry: a case study of the Hawthorn Centre in Michigan, USA.

Historians have examined the role of psychiatric institutions in the USA and addressed whether this form of care helped or harmed patients (depending on the perspective of the time period, historical actors, and historians). But the story for children's mental institutions was different. At the time when adult institutions were in decline, children's mental hospitals were expanding. Parents and advocates clamoured for more beds and more services. The decrease in facilities for children was more due to economic factors than ideological opposition. This paper explores a case study of a hospital in Michigan as a window into the different characteristics of the discussion of psychiatric care for children.

'As syllable from sound': the sonic dimensions of confinement at the State Hospital for the Insane at Worcester, Massachusetts.

As the first state hospital in the USA, the Worcester State Hospital for the Insane at Worcester, Massachusetts (est. 1833), set a precedent for asylum design and administration that would be replicated across the country. Because the senses were believed to provide a direct conduit into a person's mental state, the intended therapeutic force of the Worcester State Hospital resided in its particular command over sensory experience. In this paper, I examine how aurality was used as an instrument in the moral architecture of the asylum; how the sonic design of the asylum collided with the day-to-day logistics of institutional management; and the way that patients experienced and engaged with the resultant patterns of sound and silence.

Beyond the asylum and before the 'care in the community' model: exploring an overlooked early NHS mental health facility.

This article discusses the Admission and Treatment Unit at Fair Mile Hospital, in Cholsey, near Wallingford, Berkshire (now Oxfordshire). This was the first new hospital to be completed in England following the launch of the National Health Service. The building was designed by Powell and Moya, one of the most important post-war English architectural practices, and was completed in 1956, but demolished in 2003. The article relates the commission of the building to landmark policy changes and argues for its historic significance in the context of the NHS and of the evolution of mental health care models and policies. It also argues for the need for further study of those early NHS facilities in view of current developments in mental health provision.

Psychiatric Jim Crow: Desegregation at the Crownsville State Hospital, 1948-1970.

The Crownsville State Hospital, located in Maryland just outside of Annapolis, provides a thought-provoking example of the impact of desegregation in the space of the mental hospital. Using institutional reports, patient records, and oral histories, this article reconstructs the three phases of desegregation at Crownsville. First, as a result of its poor conditions, lack of qualified staff, and its egregious mistreatment of patients, African American community leaders and organizations such as the NAACP called for the desegregation of the care staff of Crownsville in the late 1940s. Second, the introduction of a skilled African American staff created unprecedented and morally complex issues about access to psychiatric therapeutics. Last, in 1963, Health Commissioner Dr. Isadore Tuerk officially desegregated patients in all Maryland state hospitals. Though desegregation brought much needed improvements to Crownsville, these gains were ultimately swamped by deinstitutionalization and the shift towards outpatient psychiatric care. By the 1970s, Crownsville had returned to the poor conditions that existed during segregation.

The Final Years of Central State Hospital.

There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana's Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients' civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana's only large urban mental hospital, but to no effect.

Through a glass darkly: patients of the Illinois State Hospital for the Insane at Jacksonville, USA (1854-80).

The State Hospital for the Insane at Jacksonville, Morgan County, Illinois, was the first public hospital of its kind to be established in the state and among the earliest to be built on the 'Kirkbride Plan'. It opened for patients in 1851. We describe the background to the establishment of the hospital and, so far as is possible from publicly available sources, its catchment area, the nature of the patients held there up to 1880, its mechanisms of discharge, and supposed causes of death. We end with a plea that after over 150 years, the release of hospital casebooks and similar records in digital form would be of considerable benefit to historians of psychology, scientific biographers, genealogists and demographers.

[Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966)]. / Zwangsmaßnahmen in der Kinder- und Jugendpsychiatrie in der Nachkriegszeit am Beispiel der Pflege- und Beobachtungsstation des Psychiatrischen Landeskrankenhauses Weissenau (1951-1966).

Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966) The patient admissions at the children's ward of the State Psychiatric Hospital Weissenau in the years 1951, 1956, 1961 and 1966 were analyzed regarding documented coercive measures. Shortage of staff, mainly inadequately skilled personnel, a mixing of age groups in the patient cohort, neurological and psychiatric disorders and of patients who were in need of nursing and of those who needed treatment constituted the general work environment. Coercive measures against patients, mostly disproportionate isolations, were a constant part of daily life on the ward. This affected in particular patients who had to stay longer at the hospital and whose stay was financed by public authority. The uselessness of such measures was known, which can be seen e. g. in the Caretaker's Handbook of that time and the comments in the patient files. The situation still escalated in some cases (for example by transfer to an adult ward). For a long time, coercive measures against patients were part of everyday life at the children's ward of the Weissenau; the actual figures are suspected to be much higher.

Malariablood in the pocket. / Malariablut in der Westentasche.

For the first time on June 5, 1919, at the Hamburg State Hospital Friedrichsberg, two paralytics were artificially infected with malaria, subjecting them to the new malaria fever treatment according to Wagner-Jauregg (1917). This article examines the life stories and medical histories of these patients, an opera singer and a yardmaster, and provides an interpretation based on their medical files. Relevant contemporary medical publications contextualise the specific configurations of their hospital stay. In both cases, a detailed comparison between each medical file and the published case history reveals remarkable.discrepancies. A specific concept of remission, mainly determined by the level of restoration of a patient's working power, i. e. the ability to work, was implemented. Finally, the article considers the question of why the new therapy method was introduced in Hamburg specifically on June 5, 1919.

The Birth of a New Branch of Medicine: Psychiatry.

Psychiatric treatment prior to 1955 seemed to be at a standstill. All kinds of treatments, including surgical ones, were used ineffectively. Then suddenly, out of nowhere, a new treatment -chlorpromazine - created a worldwide revolution. Here is what we saw in Delaware. It was not much different in the rest of the world. Patients improved and were rapidly dischargedfrom mental institutions causing workforce reductions. I was sitting on a state employee job application evaluation committee and witnessed these events. It was also exciting to see rapid changes in administration at the state hospital. Since what happened in Delaware also happened nationally, this was a national event and should be recognized as such. The following few pages are to remember the details. Major changes made psychiatry more of an accepted medical specialty. Psychiatrists are no longer "outsiders." I would be glad to answer any questions about the information presented here.

[Forced sterilisation based on the Law for the Prevention of Hereditarily Diseased Offspring. The role of the Heil- und Pflegeanstalt (State Hospital) Günzburg]. / Zwangssterilisationen nach dem Gesetz zur Verhütung erbkranken Nachwuchses. Die Rolle der Heil- und Pflegeanstalt Günzburg.

OBJECTIVE: From 1934 to 1945, 350,000-400,000 human beings were sterilised by force in the German Reich. Forced sterilisation was based on the Gesetz zur Verhütung erbkranken Nachwuchses (Law for the Prevention of Hereditarily Diseased Offspring). The Heil- und Pflegeanstalt (State Hospital) Günzburg was one of the institutions where compulsory sterilisation was practised. METHODS: Data evaluation was based on patient documents and annual reports of the archives of today's district hospital at Günzburg. Patient records were analysed with respect to predefined criteria. The municipal archives of Günzburg provided further historical sources and data. RESULTS: Between 1934 and 1943, 366 patients were sterilised in the Heil- und Pflegeanstalt (State Hospital) Günzburg. Age, sex and diagnosis were found to be criteria relevant for selection of patients for sterilisation. CONCLUSIONS: The study was able to show the active involvement of the Heil- und Pflegeanstalt (State Hospital) Günzburg in the compulsory sterilisation programme.

[Sterilization surgeon and researcher: life and career of Benno Ottow (1884-1975)]. / Sterilisierungsoperateur und Forscher: Leben und Karriere Benno Ottows (1884-1975).

The activities of the gynaecologist and member of the Erbgesundheitsgericht Benno Ottow (1884-1975) in the "Third Reich" have been described in a couple of publications. During the Nazi dictatorship Ottow demonstrated great commitment to putting the ideological and legal demands into practice. Drawing on sources from private and state archives in Estonia, Germany and Sweden, this paper investigates the biography of Benno Ottow: from his time as a junior physician period in Estonia and Russia to his directorship of the Brandenburg gynaecological state hospital in Berlin-Neukölln and the postwar-years in Sweden.

[Neuropathological research on organs of patients of the "Heil- und pflegeanstalt" (state hospital) Günzburg]. / Neuropathologische Forschung an Organen von Patienten der Heil- und Pflegeanstalt Günzburg.

BACKGROUND: The two Kaiser Wilhelm-Institutes (KWI) in Berlin (1914, new building 1931) and in Munich (1917, new building 1926-28), specialized on pathologic anatomical as well as psychiatric genetic research, were set up before times of National Socialism. METHODS: Data evaluation is based on patient documents and annual reports of the archive of today's district hospital Günzburg and on patient documents (copies) of the historical archive of today's Max-Planck Institute of Psychiatry. RESULTS: The KWI in Munich was indirectly provided with brain material by Bavarian "Heil- und Pflegeanstalten" (state hospitals) including the state hospital Günzburg. CONCLUSIONS: During National Socialism patients' organs were sent from the "Heil- und Pflegeanstalt" (state hospital) Günzburg to the KWI in Munich for the purpose of conducting research. Commemorating patients' fates and clarifying what happened defines a place of remembrance.

The end of the asylum (town): community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn.

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.

From cure to custodianship of the insane poor in nineteenth-century Connecticut.

Connecticut was the exception among the Northeastern and Middle Atlantic states in not founding a public institution for the insane until after the Civil War when it opened the Hospital for the Insane at Middletown in 1868, a facility previously neglected by scholars. The state had relied on the expedient of subsidizing the impoverished at the private Hartford Retreat for the Insane that overtaxed that institution and left hundreds untreated. Despite abundant evidence to the contrary, well meaning officials oversold the idea that the Middletown site would promote cures and be cost effective. A number of unanticipated consequences occurred that mirrored fundamental changes in nineteenth-century psychiatry. The new hospital swelled by 1900 to over 2,000 patients, the largest in New England. Custodianship at the monolithic hospital became the norm. The hegemony of monopoly capitalism legitimated the ruling idea that bigger institutions were better and was midwife to the birth of eugenic responses. Class based psychiatry--the few rich at the Retreat and the many poor at Middletown--was standard as it was in other aspects of the Gilded Age. Public policy toward the insane poor in Connecticut represents an outstanding example of the transition from antebellum romanticism to fin de siècle fatalism.

From beauty to despair: the rise and fall of the American State Mental Hospital.

The American State Hospital has survived over 200 years. Society once viewed state hospitals as an absolute necessity and each state constructed numerous hospitals. Over time, the image of the state hospital as a means to cure the mentally ill changed drastically. The public perceived state hospitals as snake pits that warehoused the mentally ill and the state hospital was nearly destroyed. Nevertheless, the state hospital remains today with purposes similar to its ancestors and some that are very different. This paper examines the many influences that created the state hospital. Additionally, this paper addresses the Kirkbride Model, treatment methods and practices over time, and how the state hospital fell into disfavor as a means to treat the mentally ill. The paper concludes with comments on the mental health system today, in relation to the state hospital's role in treatment.

Hydrotherapy in state mental hospitals in the mid-twentieth century.

This research describes nurses' experiences in administering "the water cure," hot or cold wet sheet packs, and continuous tub baths in state mental hospitals during the early twentieth century. Student and graduate nurses were required to demonstrate competence in hydrotherapy treatments used to calm agitated or manic patients in the era before neuroleptics. The nurses interviewed for this study indicated that, although labor intensive, hydrotherapy worked, at least temporarily. Although no longer used in state hospitals, hydrotherapy is regaining popularity with the general public and may serve as an adjunct to pharmacological treatments to calm hospitalized patients in the future.

Creating order. A quantitative analysis of psychiatric practice at the Swiss mental institutions of Burghölzli and Rheinau between 1870 and 1970.

This paper analyses the concepts of order and normality underlying the daily psychiatric practice of two Swiss mental health institutions between 1870 and 1970, based on a representative random sample of 1330 patient records from the two state institutions in the Canton of Zurich. The quantitative analysis covers the types of psychiatric measure taken in these cases, as well as the rationales behind them. It is concluded that the order of the institution, of society and, above all, the order of gender played an important role in the choice and implementation of various measures.

David Shakow and schizophrenia research at Worcester State Hospital: the roots of the scientist-practitioner model.

As Chief Psychologist and Director of Psychological Research at Worcester State Hospital (WSH), David Shakow (1901-1981) made substantial contributions to the scientific study of schizophrenia and by extension to the study of psychopathology in general. His methodological innovations--particularly on issues of diagnosis and conditions of testing-set a new standard for experimental rigor in the field. Shakow helped to establish many of what are considered basic facts about schizophrenia. His empirical work at WSH-specifically on the crossover effect--provided the scientific foundation for his theory of schizophrenic cognition, known as segmental set. Moreover, Shakow's schizophrenia work informed his developing ideas on the synergy between clinical practice and research.