Maine History Online

Asylums for the Unwell

Before institutional healthcare emerged, midwives, physicians, and healers of all sorts bound wounds, provided nostrums, and birthed the next generation. These semi-professionals did what they could for their patients, and families coped with what life threw their way, sometimes with grace, more often with grudging acceptance, occasionally with rage and despair.

Not every situation could be met with sanguinity; severe mental illness, deafness, blindness, communicable diseases and other special needs challenged the resources of families and communities.

Growing recognition of mental illness as a treatable condition, and the deaf and blind as educable individuals called forth specialized institutions to treat specific conditions and more formally deal with what many saw as disabling afflictions.

Asylum building began in earnest across the country in the 1830s and 1840s as part of a general reform movement to improve the care of the mentally ill, indigent, and legally lax. Penitentiaries, mental institutes, tuberculosis sanitariums, and schools for the deaf and blind came into being as both private and public institutions. Some were started with state and local funding, while others were sponsored by charitable societies; many combined public and private authorities. Maine had some of each.

Maine had a unique tie to one of the nation's leading reformers on care of the mentally ill. Dorothea Dix, although raised in Massachusetts, was born in Hampden in 1802. After suffering a breakdown in her 30s, she went to England and experienced a government active in social welfare. She brought her ideas about care for the mentally ill back to the United States and became a noted reformer, advocating for removing the mentally ill from prisons and almshouses and for more humane treatment in asylums.

The Augusta Insane Asylum began in 1840 as the Maine Insane Hospital. Dix consulted on the project, applying many of her theories about the care of the mentally ill stressing the importance of fresh air, constructive activities, and removal from what she blamed most for their disorders, "the temptations of civilized life and society."

The hospital, later known as the Augusta Mental Health Institute, closed in 2004, replaced by the Riverview Psychiatric Center. Like most institutions, it came under intense criticism for abuse and warehousing of patients, among other charges. Despite the optimism of Dix and others in the 1840s, institutional care was not a panacea.

The alternative, community mental health treatment, also was not a panacea. As "deinstitutionalization" began across the country in the 1950s, community treatment alternatives did not always follow or were not always adequate to meet the needs of those released into the community. Maine continues to struggle with the issue as do other states.

By 1885 Maine had established a State Board of Health to oversee public health policies and related agencies. According to an 1891 report to the legislature, the Board was "doing most excellent work and has fully justified the wisdom of its establishment." State appropriations for the "deaf, dumb, and blind" amounted to $15,500 in 1885, compared to only $1500 allocated for "idiotic and feeble-minded persons."

State support expanded over the decades. A sample of state subsidies for public and private asylums from the legislative record of 1903 listed the following among many such institutions, with the larger figures indicating nearly complete state support: Maine Home for Friendless Boys, $1,250; Maine School for the Deaf, $23,500; Society of the Sisters of Charity, for Healy Asylum, $2,000; Eastern Maine Insane Hospital $30,425; Saint Elizabeth's Roman Catholic Orphan Asylum $1,500.

Changes in terminology reflected changed in philosophy about treatment: lunacy became insanity became mental illness, feeble-mindedness became mental retardation became developmentally disabled.

Whereas states institutionalize the insane, feeble-minded, and disabled with near abandon in the 19th and much of the 20th centuries, treatments were more often decided on and applied with greater attention to individualized care by the end of the century.

As with all such special care centers the question becomes one of treatment for the individuals in their custody. "Asylum" or "home" or "school" evoke a different image than "institute." The first suggest refuge, or family, the latter brings to mind a laboratory of scientific applications.