#inpatient

He proved so by arranging a team of eight field participants, including himself, who would sneak themselves into asylums and see how long it took before they were given leave. All of him, and his patients were mentally sound, but discovered not only was it a near impossible tasks, that also they were all treated horribly.

Even funnier, or sadder, depending on your outlook, Rosenhan ran another experiment later on where he told asylums that he snuck imposters in again. 41 suspects were found to be these imposters, when in fact Rosenhan hadn't actually sent any at all.

He was very passionate about how diagnostic material can be very unreliable in the right circumstances, and that its not uncommon for authority figures in these facilities to fake witnessing signs of insanity to avoid admitting mistakes.

Often times too, in order to leave such facilities, there's rigid requirements, such as forced medicine ingestion or meeting impossible "normal" standards.

Funding & Family Names

Many major institutions were private, and therefor funded by wealthy families, donations, and organizations (mostly often religious ones). It wouldn't be crazy for a wealthy family to even own the said institute.

Meanwhile public institutions relied on national/state funding, and donations. These places were often the first to receive less in economic crisis, and other such events that stress the economy, like war.

Religious organizations are usually hand in hand with these kinds of things, so expect them to be pulling a lot of the strings. In fact many of the reasons I never got psychiatric help IRL is because all of the nearest inpatient facilities were religion ran with deplorable reviews that you would typically expect.

Moral Treatment Facilities

There are of course instances of moral facilities, that actually care about the patients. While a lot of these places are gray in terms of alignment, containing things, some good, some bad, even in terms of the old asylums these places did exist.

Rarely, is everything going to bad at these facilities without raising some sort of alarm or being part of a grander scheme. Horror stories do manage to pour of these places, either by caring family members, bystanders, and perhaps even escaped patients.

Laws and regulations are meant to keep psychiatric hospitals clean, humane, and effective at their job. Depending on the environment and government at play, such worries could be more maintained compared to, let's say, 1950s America.

I also like to think of the kind of characters who would fall into this line of work with good intentions. Why did they choose this path? Why do they stay? What does their day to day look like?

Who might look at such a depressing environment and see the potential for recovery and health?

Ward Divisions & Structure

If the facility is large, like an expansive complex, there is likely to be various kinds of wards you'd find the hospital broken into. These can range from types of patients, kinds of temperament, severity, needs of treatment, or level of doctor/nurse.

These complexes can span out like schools, with various buildings, several floors, and rooms of all kind. They have to be able to feed patients, or have some sort of past time location (like a park or living room). If these accommodations don't exist as places, they have to be provided directly to the patients in their separate confines.

That typically means a schedule and more workers...

Religion

Yeah, I'm going to talk about religion again. Historically religion/spirituality and medicine went hand in hand in a variety of cultures. Also religion and spirituality has been used to demonize the mentally ill, and attempt to exorcize problems that were barely understood.

Knowing the role religion played in these things makes the cruelty make more sense, as these same religions also ran boarding schools, orphanages, and old folk homes where atrocities were also being committed under the guise of godliness.

Many turn to religion to find answers or cope when it comes to the pains and mysteries of life. People of course would depend on religious psychiatric facilities to help their family members, but often times this has lead to greater excuses on ill treatment towards patients.

They weren't torturing that woman who has schizophrenia, they were ridding her of her demons... etc.

Political Imprisonment & Discrimination

Who needs prisons, camps, or gulags when you can just label your enemies as mentally ill. That's one of the various ways the USSR disappeared people, and often was a way that famous families have hidden away their less popular relatives.

I could make an entire post alone getting into the ableism in the history of psychiatric hospitals, but I want to dedicate this part talking more about the other kinds of discrimination that followed the decision to put one's family member away in a giant brick building labeled "asylum".

The three biggest kinds of bigotry outside of ableism were homophobia/transphobia, sexism, and religious discrimination. For awhile society worked in a way that if a family wished it so they could rid themselves of their social norms breaker by proclaiming that person insane and sending them away.

Whether that person was a woman who preferred to wear pants instead of skirts, a boy who enjoyed "feminine" hobbies, or a teenager refusing to go to church; you could label them insane and hope that the torture would sort them out.

There's a fine line between whether or not people truly believe such factors make their children insane, versus knowing its a fruitless effort but taking the malicious approach anyway.

I mean just look at the Kennedys, or the dark stories surrounding England's royal family.

From Asylum to Institute

Big word: deinstitutionalization.

Doctors who were in their right mind couldn't stand the injustice occurring in the traditional asylums, and there was a movement pushed by scientists and human rights activists that worked to take down these large residential institutes for the mentally ill and developmentally disabled, and replace them with something more community built.

It was a very simple effort, metal hospitals were cruel and inhumane, and antipsychotic medicines offered new insight on curing mental illness. Money could even be saved, by keeping people free and cared for through medicine.

It wasn't perfect, we have a better understanding of psychiatric medicine compared to its start in popularity during the 1950s.

The mental institutes we have today are much smaller, and more community driven, which has its major pros and cons. Mental institutes still pose a lot of the problems that the originals did, but affect people on a much smaller scale.

There is also places around the world that still work on the asylum-based system.

We're witnessing change still in the psychiatric community, from shifting away from paper scrubs, to more comprehensive understandings of the disorders at hand, and people being more forward about how/when they're mistreated by the medical community.

Final Thoughts

Doctors and people of the psychology community are actively working to better the care for mental illness and developmental disorders. Studies made within the last few years are investigating malpractice and human rights violations in inpatient care, and medicine is constantly being improved and monitored.

It's a very gray situation in all honesty

I did really like this study going into the modern issues with inpatient psychiatric care, so if anyone is interested I'll leave it right.... here.