In The Curability of Insanity (1876), Pliny Earle, superintendent of the Northampton State Hospital, argued that insanity was not nearly as treatable as was once thought. The late 19 th century was characterized by growing pessimism. Physicians considered a patient’s ability to labor a measure of sanity. Female patients were responsible for making bedding and clothes, operating the laundry, and housekeeping and food service. Male patients worked in agriculture, landscaping, and construction. However, the institution was dependent on patients’ labor. Physicians claimed that the economic value of patients’ labor was secondary to its therapeutic role. Woodward believed that Irish immigrants drove themselves insane by “indulgence of stimulating drink,” and that they were less likely to recover from insanity than their native-born counterparts. Black patients were placed in separate wards. African Americans were underrepresented in the hospital population relative to their numbers in the state, possibly reflecting racism in the allocation of public resources.While women and men were represented equally in the patient population, women tended to recover and obtain release more quickly.Wealthier families could choose to commit their relatives to the private McLean Asylum in Boston, or care for them at home. While later studies would call these statistics into question, at the time they served to reinforce physicians’ confidence in moral treatment and to win public support for the asylum.

The statistics published in the hospital’s annual report in the mid-19 th century appeared to confirm the prediction that a large percentage of patients would be cured by its therapeutic environment. Invigorated by the successes of their European peers, American physicians were incredibly optimistic about the potential of moral treatment, projecting a cure rate of 90% for patients who received prompt care in an asylum. Under the principles of the new “moral treatment,” insanity was thought to be curable if patients were removed to a rural environment with clean air, scenic vistas, and a wholesome diet. The new lunatic hospital offered a humane and progressive solution to a growing crisis of public health. When an 1829 committee of the state legislature discovered lunatics living in dungeon-like conditions with filthy straw for bedding and rags for clothing, reformers were moved to act. In the era of reform and optimism that emerged in the early 19 th century, attitudes toward the insane changed. Some families of lunatics kept their ill relatives at home, while those without support ended up in jails or almshouses, or became homeless beggars. Historically, insanity had been considered untreatable. Additionally, certain diseases and conditions that we would not consider mental illness, such as epilepsy, tertiary syphilis, and traumatic brain injury, were grouped under the label of insanity in the 19 th century. While some diagnoses have parallels, such as melancholia and depression, others – like hysteria and neurasthenia – do not have precise equivalents. Nineteenth-century insanity is not directly equivalent to our definition of mental illness today. The apparent rise in the number of lunatics in the 19 th century was attributed to industrialization and urbanization, which separated human beings from nature and encouraged bad habits. These laws required moderation in work, exercise, diet, and rest, and prohibited overindulgence and immoral behavior. At the time the Worcester State Hospital was built, physicians believed insanity was a disease of the brain that was triggered by the violation of the “natural laws” of health.

Staff of instanity