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We're All Mad Here: Going to the Loony Bin: A Brief History of the Asylum

The institution is perhaps the most recognizable, enduring, and terrifying symbol of mental illness in popular culture. Whether a character is sent to the funny farm, madhouse, loony bin, asylum, or a plain old mental institution, consumers of pop culture know exactly what to expect. Padded walls, straitjackets, screaming patients behind locked doors, and depressing or creepy scenes, depending on the genre. Perhaps patients will amble zombielike through the day room, zoned out on pills. The crazies contained therein howl and drool and mutilate themselves, loom in the hallways to terrify the main character, whisper harsh warnings after lights out. Maybe the patient will be subjected to horrific psychiatric experimentation that turns her evil. And oh yes, it's usually a her.

Asylums are ancient; by the fifth century CE, many societies were isolating people with symptoms of mental illness in facilities designed primarily as warehouses to keep them out of public spaces. The infamous Bedlam asylum was founded in the 13th century, housing at first a handful of "lunatics." The asylum really started to come into its own with the 18th century, and in some cases these facilities were closely tied in with the poor laws that were used for social control of low income people in society.

A woodcut of Bedlam Asylum, showing scenes of horror and misery

The 19th century brought about a shift in the framing of asylums in the public eye. While they had traditionally been designed as facilities for the "care" of people with mental illness, many failed to have a rehabilitative aspect and people could be trapped in them indefinitely. Reformers pushed for rehabilitation and release, as well as more humane treatment, even as the numbers of people sent to such facilities began to rise. Many of those people were not mentally ill at all, but were simply undesirable; pregnant teens with no husbands, for example, or troublesome female relatives who spoke their minds. Some had intellectual and cognitive disabilities, rather than mental illness, and received inadequate care as society shifted from a culture where people were supported at home to one where disabled and sick relatives were hidden away. Sisters and brothers might disappear overnight, never to be seen again.

With the rise in the numbers of patients came corresponding rises in abuses, some of which were perpetrated in the name of rehabilitation. Psychiatric patients were subjected to torments like water dropping, lobotomies, and solitary confinement. In the 20th century, tools like insulin comas and electroshock therapy came into prevalence, along with sterilization. Needless to say, informed consent for these activities was not considered necessary because they were done for the "benefit" of the patient. The scenes in mental health facilities could be grim indeed. Some of these "treatments" persist to the present day.

Even now, some mentally ill people are denied agency through capacity laws. In a capacity hearing, people debate the patient's ability to make decisions, to understand medical issues, to reenter society. At the hearing, the end ruling may be that the patient lacks capacity and needs a guardian, a person who will have the power to make decisions on the patient's behalf, without consulting the patient. This can include permanent institutionalization, if the guardian thinks it is necessary.

Straightjackets on display at a museum

Despite documenting abuses in the institutional environment in a way that might seem like a condemnation of institutionalization, pop culture often makes a point of separating out the hero from the actual crazy people. They may drift through the narrative as sources of inspiration and general interest; think of the Wise Crazy Person who advises the hero while he is trapped in the mental hospital, or the Gentle Suicidal Girl who makes the lead character sad when she finally succeeds in taking her own life.

In pop culture, the asylum is a frightening place because it is filled with crazy people. The theme of "sane" person condemned to a mental institution arises again and again in pop culture. We see things like the capacity hearing abused to make sure that our character is powerless, for instance, we see psychiatrization used as a political tool to lock someone up. What we don't see is a challenge to the institutional system itself; often the underlying story is that institutionalization is a problem only when it happens to characters who are not mentally ill.

The asylum is shorthand, a symbol creators of pop culture can quickly slot in when they want to quickly convey something that will be almost universally understood, even by consumers who are not familiar with the history of mental health facilities. Familiarity with the history would actually spoil the image; the underlying idea is that such facilities provide a needed service in the form of helping mentally ill people, but it's bad when "normal" people endure the environs of the asylum because they don't need treatment.

A still from Girl, Interrupted, show two pale women in a state of agitation

Familiarity with what life is actually like in institutions might also ruin the image. The conditions in real-world mental health facilities are highly variable. Not many fulfill the cartoon caricature seen in pop culture; many are in fact very ordinary, dull sorts of places where patients receive inpatient therapy and support. Others may be everything you have imagined in pop culture—and worse—because that nonconsensual electroshock "therapy" is happening to a real person.

Related Reading:

Dictaphone Diaries: An interview with the director of Must Read After My Death

Previously:

We're All Mad Here: Inception & Dom Cobb's Crazy Lying Dead Wife, We're All Mad Here: Mental Illness and Celebrities

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Comments

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Much appreciated...

Thank you for an unusually sympathetic post on a fraught topic. For what it's worth, I would love to see a whole series here devoted specifically to visual (especially film) representations of life inside asylums.

Human Rights in Mental Health

Thank you for writing this. I work for a nonprofit that focuses on winning human rights for those abused by the mental healthcare system. To learn more, check out www.mindfreedom.org

I've been rewatching

I've been rewatching Dollhouse lately, and this really nailed down for me why the super rapey Sierra/Priya episode bothers me so much (besides being so rapey, obviously). Placing troublesome women in mental institutions is a historical practice, as you pointed out, right on back into the 19th century, but Dollhouse frames this episode as an anomaly, something so terrible it needs a very special episode and a special amount of drama. Not only that, but the other "crazy" people in the ward aren't even on our radar; Priya's madness is our focus the whole time we're there, lest we lose our conviction that what's wrong with this scene is that she's not crazy. The problem is that the institution operates in a way that takes away consent, but Dollhouse doesn't seem to address this, even though it's perfectly willing to do so *for the Dollhouse.*

institutions

The article fails to mention conditions of "hospitals" in parts of the developing world. In India, mentally ill patients are shackled to the floor. Recently all the patients of a hospital that were basically left there twenty for hours a day, chained were all burned to dealth in a fire. They were unable to flee and no one was able to help them in time. In Vietnam, a pyschotic patient (and this is happening now) is chained round the waist to a neurotic patient in the hopes that the neurotic, more fuctioning one will have a positive impact on the psychotic one. Which of course is ridculous. The psychotic would need medication and therapy and the neurotic possbile both as well. There were many laws in America were unlike being poor "unsighly" peoples were locked up with the unmedicated mentally ill. And even know you do have people screaming in instituions, it's not a happy place where everyone moves onward and upward.