Suffer Little Children
The history of hospitalizing minors for mental health issues is deeply entwined with that of youth incarceration. Sometimes the two share a room.
*See end for author’s note on anonymization of the child patient-detainees who appear in this essay.
I was born in the maternity ward of a hospital that had once been the first institution specifically for the mad: Philadelphia’s Pennsylvania Hospital. Exactly fourteen years and one month later, I was incarcerated in a psychiatric facility after breaking the first and only rule of safe psychiatric disclosure.
My psychologist had asked me if I had recently hurt myself. I said yes. She said how? I said a safety pin. She said where? I rolled up my sleeve and showed her the shallow marks that read, in the pre-irony parlance of early adolescence, Life sucks. She teared up and asked if I would do it again. I said sure; as long as life sucks, this helps. She asked me if I’d thought about suicide. I said yeah. She asked me if I’d ever try. I said probably not again soon. She cried and asked when I had tried. I said a few weeks ago. It was then she told me I would have to be “admitted,” but she would do her best not to have me go through the emergency department. She called in a special favor at a private clinic in the bedroom suburbs of Philadelphia, and my mother, having good insurance, took me there the following day.
The admission process took well into the evening. When I was finally escorted to my unit on the evening of the 1st of _____ in 2003, they gave me the “Welcome to the Child and Adolescent Unit” guide. I had been assigned to Adolescent I, a unit consisting solely of teenage girls, but maybe there was only one general “patient admission guide”. A few pages are now missing (it was not stapled; staples are contraband), and the fourth remaining page reads, in part,
125 points per day
1. Confined to the unit.
2. One phone call per day to or from parents only. Calls must be made during scheduled phone times and are limited to ten minutes.
3. Can be in TV lounge area during scheduled activities only.
— Ages 5–8: 8:30 PM
— Ages 9–13: 9:00 PM
— Ages 14–17: 9:30 PM
After remaining in good standing on level 1 for at least 2 full days, an increase may be requested at community meeting.
I’ve also kept my diary from my time there. We were given composition books and required to journal. There was not much else to do during free time, and I loved to write, so I filled most of the pages. I devoted as much felt-tip marker ink to my feelings as I did to observations about rules, norms, and other people. Often these observations stood in for events.
2nd of _____: We can’t go outside. I miss the trees. This place is like a prison. [Accompanied by a photo, carefully torn from a magazine without the aid of scissors, of a butterfly chained to a stake in the ground]
I recall with clarity what happened this first morning, the 2nd of _____. I was on Level I, unable to leave the ward to be escorted across the grounds to the cafeteria. My breakfast was brought to me in the common room, and I was reminded not to keep any of the food and certainly not to take it to my assigned bedroom. I instinctively bristled. When no one was looking I took half a croissant, wrapped it in a napkin, and shoved it up my sleeve. I claimed I needed to pee, which we did in the en-suite bathrooms. Out of the orderlies’ eyesight, I cached the pastry in the top drawer of my dresser. I returned for it during free time, ostensibly going to the bathroom again, and opened the drawer with a burning anticipation. I uncovered a croissant crawling with ants. I took them to the bathroom and flicked them into the toilet, several at a time. Then I ate a small piece anyway and smuggled the rest back to the common area to throw away.
2nd of _____: ‘SIP’ — It stands for “self injury precaution” or something to that extent. There are 3 levels of it: 1. Might injure yourself. They check on you every 30 minutes. 2. Crisis. I’m on that now. Checked on every 15 minutes. 3. You injure yourself – watched even when you pee and shower. Back to Level I.
2nd of _____: Shanika – Fairly short. [Born in] the Dominican Republic. Has long, thin dreadlocks. [...] She told us a story about how this guy (she was 15, he 19) who lived in the apartment across from her dumped his long-time girlfriend and asked her to marry him. She was freaked out and he came after her so she hit him with a vase. She was transferred to Adolescent II. We don’t know why.
3rd of _____: Kendra – I thought she was anorexic. She would sit at the table and just stare at food. Or pick it, pull it. Then she started eating. It was just cucumbers at first. Then toast. Then orange juice. It escalated to ice cream! I was so proud of her, so happy. “I don’t trust her,” Molly said. I asked if she’s bulimic. “Yea. But I keep an eye on her.” [...] I believe she had been abused by her father but I can’t remember. She left yesterday and might be going to [eating disorder clinic]. I wish her the best of luck.
[No date:] Brit – Brit has been here a month and five days. She came in for drug problems. [...] She’s the one who has ‘problems’ with Mr. L [an orderly]. She’s only 13. [...] She’s been molested by her brother. I’m not that close with her but I’m growing closer because we’re both freaked out by the Tasha-Tiffany thing. They might put her in a group home. She’s been here so long because they’re looking for a foster home for her. I do hope it’s a good one and they find it soon.
[No date:] Alicia – She’s from Alabama and African-American. She’s great, she really is. She’s not like the rest of the people in here [at this point, incarcerated mostly for drug use] – she’s like me.
One night a week or so in, I awoke sitting up and breathing fast, staring at the shadows of the bars above Tasha’s bed. I scurried to the bathroom. Throughout my confinement I had been aware of the toilet tank: its lid was bolted down in the center, as was every heavy thing. I had laid something on the lid the second night and the bolt wobbled. I had pulled on it and it’d come clean out, each ridge a sixteenth of an inch of iron and rust. Amazed, I’d put it back, feeling just as I’d had when I’d eaten the piece of croissant. Now I removed the bolt. I squeezed it in my fist. I dragged it lightly across my arm. I thought of the SIP – watched while you pee, back to Level I, at least another four days until release – and I marched down to the nurse’s station to drop the bolt in front of the shatterproof plastic barrier.
“This came off the toilet,” I said. “I had a nightmare, and I can’t sleep.” K. was my favorite nurse. She emerged from behind her barrier to collect the bolt with only a hint of suspicion.
“If the nightmares are keeping you up, you can have a pill, or you can try what Alicia’s doing.”
I turned to see Alicia’s soft figure bent over a Dixie cup. She was inhaling deeply and with focus, but her chin quivered.
“What is it?” I whispered to K.
“Peppermint oil,” K. said.
I sat next to Alicia, holding the cup uncertainly. It cradled a strong-smelling cotton ball. I inhaled. I fidgeted.
Quietly, Alicia spoke. “It works for me sometimes.”
I don’t know how she disclosed; intimacy was so easy there, with no privacy and no social pretense. But she told me what her uncle did.
“I’m so sorry. I... I haven’t been... There’s a teacher at my school, though. I don’t know how to explain – Like with Brit and Mr. L?“
9th of _____: My mom told the school nurse, Mrs. P, about HIM [my junior high history teacher] when she was explaining why I was absent (it is part of the reason). I asked my mom what Mrs. P said, hoping for something like “it’s happened before.” She just said she wouldn’t say a word. I WANT her to say a word, more than one would be nice. I need her to tell [the principal]. No, I need to. I’m not sure if I’m right [anymore] but I’m going to. A lot of people here aren’t sure if they’re right. Jessica... Alicia... I’m not alone.
The advent of the modern psychiatric hospital was also the advent of the modern orphanage, and, too, the modern prison: the poorhouse. Paris’s Hôpital Général was the first such institution constructed for the purposes of undifferentiated confinement. Founded in 1656, it was described by historian Fernand Braundel as a “‘great enclosure’ of the poor, mad, and delinquent, as well as sons of good family placed under supervision by their parents” (Civilization and Capitalism, 15th-18th Century: The Structure of Everyday Life, 76). His turn of phrase here obscures the prevalence of young female patients, who were institutionalized along with the young men. A youth wing of the Hôpital was decreed in April 1684, alongside a pronouncement – here reported by Foucault – “that work must occupy the greater part of the day” (Madness and Civilization: A History of Insanity in the Age of Reason, 55). The poorhouse – the orphanage, the prison, the hospital – was also the workhouse.
The same year the Hôpital announced a youth wing to increase the general confinement of the “poor, mad and delinquent,” a treatise was published urging a specialized approach to madness. English physician Thomas Willis’s “XI. Two Discourses Concerning the Soul of Brutes,” in The Practice of Physick (1684),had its inspiration in the works of Francis Bacon and John Locke; it claimed that reason was the unique characteristic of mankind, and so to lose one’s reason was to lose one’s humanity. Willis proposed that to restore the human soul to the maniac would require specialized treatment rather than general work-penance. And that treatment would need to address the maniac in its present state, as “animal Spirit.” Willis writes, “The first Indication, viz. Curatory, requires Discipline, viz. threats, bindings, or stripes, as well as Physick; and therefore the mad Person, being put into a House fit for that purpose, let him be so managed ... that he be kept in a manner always in his due behaviour ... and is reduced to order” (482).
Over the next century, Willis’s ideas were elevated into the Western treatment paradigm for madness, and incarceration itself became – on its face – more specialized. Enter Pennsylvania Hospital in 1756, this first institution for the confinement of the insane, who were kept in a ward located apart from the others down in a cellar. Of this development, journalist Robert Whitaker writes, “Society needed to be protected from the insane, and it was this second function – hospital as jail – that had taken precedence when [Pennsylvania Hospital] opened” (Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, 4).
Soon there were numerous public hospitals and private madhouses on both sides of the Atlantic. In public hospitals, the cells went to the most obviously deviant, but in private spaces it was all about who was willing to pay, and for the right sum a husband could have his wife committed; a father, his child. No diagnosis of insanity was necessary for psychiatric imprisonment in a public or private facility (this was prior to the law decreeing one must be ‘certifiably insane’). And in both types of institutions, the treatment hewed to Thomas Willis’s standard: confinement in cells or chains or ropes, neglect of human abilities and desires, and whippings. The one major operational difference between hospitals and madhouses was the use of public humiliation. In private facilities, Whitaker writes, “most of the mad and the not-so-mad came from better families,” who presumably would not have tolerated the humiliation by proxy (9). Meanwhile, in London’s Bethlehem ‘Bedlam’ Hospital, inmates were displayed to anyone with fourpence, and by 1762 this practice was in place at Pennsylvania Hospital as well.
Then came Benjamin Rush. Best known as a signatory of the Declaration of Independence, Rush is still widely celebrated as a social reformer. He was key supporter of the Young Ladies’ Academy of Philadelphia who advocated for the education of upper-class women so far as it would be useful in the education of their children, and a member of the Pennsylvania Abolition Society who owned but one slave, a man named William Grubber. Rush was also a physician, and the one to introduce the medical treatment of insanity to Pennsylvania Hospital when he joined its staff in 1783.
Under his direction, and over a leisurely thirteen years, the inmates were moved from their cells into rooms with mattresses. If they behaved, they could roam the hospital grounds. That privilege was contingent on treatment compliance, and treatment hewed to the outrageous pseudoscience of its day. Rush prescribed and administered in his time the sort of “treatments” that will get you committed in ours: long courses of purgings, emetics, and bleedings. His applications of these supposed remedies were often extreme. According to Whitaker, Rush once personally bled a patient forty-seven times and recommended removing up to 80 percent of the blood in patients’ bodies. Rush’s colleagues harshly and publicly criticized his bleedings. According to medical historian Richard Harrison Shryock, one contemporary, a Dr. Kuhn, called it “a murderous dose,” while a Dr. Hodge referred to it as “a dose for a horse!” (Medicine and Society in America: 1680–1860, 31–32). Rush dismissed their admonishments as the talk of the envious. He even invented a new treatment: the Tranquilizer Chair, which allowed for complete immobilization of the inmate for periods so extensive a bucket was placed beneath the seat. Rush’s face is still on the seal of the American Psychiatric Association.
It was 2004, and I was still 14. I didn’t remember until I read the diary from this confinement that I’d asked to be admitted this time. I fought for it. My father had moved back in with us. The violence at home bled into the violence at school, and bled out of my arms and breasts and legs, my body parts the only things I could occasionally control. I cut myself every day with razors, multiple times a day, sometimes in the school bathroom and, on the days I skipped school, even more frequently. I told my father I wanted to kill myself – an idea he’d once derisively encouraged, going so far as to hand me the knife – and he told me to wait. So I called the police on myself. If it wasn’t abundantly clear by now, I am white.
I thought the first confinement hadn’t been so bad – a relief, even, from the interpersonal violence of my daily life – and I assumed this one couldn’t be worse. I learned, however, that when one is admitted via emergency services, the placement process is much different. You are unlikely to wind up in a private clinic, which are filled by patient-detainees with private referrals and connections. You are instead kept in the general emergency department of the local hospital until a psychiatric bed opens up somewhere in the region. Wherever it was, I had to go. I had waived my right to refuse upon general admission, and I’d waived my right to refuse admissionupon calling the cops.
After a 24-hour wait, I was placed in a small hospital in semi-rural New Jersey, in a unit of children and adolescents of mixed gender. My diary from this stay is not written in a composition book but on loose-leaf held together with rubber bands, the writing cramped in order to take up as little space as possible. I have only one hospital-issued paper in my possession still, a copy of the Client Bill of Rights. It reads, in part,
“YOU HAVE THE RIGHT TO:
1. Privacy, dignity and respect
7. Freedom to accept or refuse medication except in life threatening situations and when required by law or court order.
14. Freedom from being detained involuntarily for assessment and treatment for more than 24 hours unless involuntary commitment procedures have been initiated.
15. Receive prompt and adequate medical treatment as necessary.
16. Keep and wear your own clothes, except as necessary for medical examinations.
17. See visitors.
18. Have reasonable access to and use of a telephone to make and receive confidential calls.
19. Practice the religion of your choice.
Rights 8 through 13 may not be denied to you for any reason. Rights 15 thru 19 above may be denied to you only for good cause when the treating physician considers it imperative.”
Of rights number one, seven, fourteen, nothing further is said. My current psychologist informed me that those rights are not legally guaranteed to minors.
On my first day in the hospital, I was assessed by Dr. R, an older woman with a cold demeanor who immediately changed my medication. I found this out the following morning at meds time. I recorded it on my loose leaf:
2nd of _____: “They decided to take you off Klonopin – did Dr. R tell you? You’re on Seroquil now – did they tell you?”
“I don’t even know what that is.”
“It’s an anti-psychotic, but it’s used a lot as a mood stabilizer. You know, for people with Depression...”
Later that same day, I wrote, “Oh man I’m tired. No more drugs. NO MORE SEROQUEL (that’s how you really spell it – I know because it’s on every pen, clock, and clipboard around here).”
I don’t know if I protested the Seroquel to Dr. R. The evidence that I did not adds up to the fact there was no ‘outside’ on this ward. There was no cafeteria to be escorted to across a verdant field as there had been in the first clinic – all meals were brought to us in the common room. Once one progressed through the levels, she was allowed onto an enclosed wooden deck adjoining the art therapy room.
The evidence that I did protest taking Seroquel comes from the simple fact that Dr. R disliked me – maybe she had this as one reason. But it is equally likely she had no reason at all. She seemed to disbelieve my stories about what happened at home and at school. During my time there, I stopped writing, and so I don’t know what happened in what order, but over the course of my 14-day incarceration (an unusually long time for someone in my position), Dr. R did two things that followed me for years. She diagnosed me as having Borderline Personality Disorder, the scarlet letter of psychiatry that can only be assigned to adults,a condition whose diagnostic criteria notoriously relies on sexual promiscuity. I had only ever made out with one boy, but perhaps this, too, seemed like a lie.
Dr. R also informed me that she had advised my parents to search my room for my diaries, to read them, to make copies of them, and to bring those copies to her. That’s when I stopped writing. For a long time. I can only tell you from memory that I broke down crying, and rocking, and gasping for air, trying all the while to steady myself so I wouldn’t be hauled into “The Quiet Room.” In response to this reaction, she cocked her head and calmly asked (I quote here only from memory), “Why does that make you so upset? Do you have something to hide?” “My! My... crushes, my thoughts about things? About – my – everything, my, my privacy?” She dismissed me back to my room.
As I stumbled down the hall in tears, I passed The Quiet Room. It was occupied by Ignacio. He was there more frequently than anyone else, throwing himself again and again against the padded walls. Like Brit, from my first incarceration, he was being held until a foster placement could be arranged. Unlike Brit, he had most surely not been admitted for drug use; he was seven. I later overheard the staff remark that he had been here – hopefully sometimes on the deck? Never on grass or under a tree or even down a sidewalk – for three months. After ten days I fantasized my slippers were grass and pressed my nose to the barred window to stare at the real thing, to wonder what it smelled like, and to remember what it felt like when it was wet, and to imagine what it would be like to touch it again. I cannot imagine what happened to Ignacio. I don’t even remember what I said to him; we didn’t interact with the younger children much. This is why I was so surprised by what happened my final night.
The other bed in my room had opened up earlier that day. As I settled into my own, eagerly anticipating my release the following morning, the other bed remained unassigned. Then they brought in the girl, clinging to her mother. The two were given a few minutes together, and I did my best to give them privacy, burying my face in a book. Then her mother was escorted away, and I was left alone with my book and a sobbing child. There was a beat. “It can be... hard... your first night,” I said. “My name is Emily,” I said.
“I’m Mary-Beth!” she cried.
“It’s not so bad here,” I said. “It can be kind of like a sleepover,” I said.
“I’ve never had a sleepover!”
“How old are you?”
“I just turned nine!” I asked if it would be okay if I sat with her on her bed and she said yes. Her ringlet curls gave off a smell, sweet like overripe fruit. When she began to pass out, she reached for my hand, and I let her hold it until I heard her breathing slow, then deepen, then hiccup in sleep. The whole process couldn’t have lasted longer than five minutes – whatever they had given her had worked.
A few months later, while I was searching the basement for wrapping, I found a garbage bag full of papers. They were the photocopies of my diaries. As soon as my parents were gone, I dragged the garbage bag upstairs and dumped its contents into the fireplace. I doused them with rubbing alcohol, lit a match on the stove, and threw it on top. Then I pulled the original diaries from their new, non-obvious hiding spots around my bedroom and ripped off their covers. I burned the covers too, but only halfway, so that their destruction would be evident. Finally I removed the Lord of the Rings poster from next to my bed, took a hammer, and bashed in the drywall. I filled the space with the remaining diaries and replaced the poster. Random papers – like whatever else had been given to me during my second hospital stay – I couldn’t fit. I burned them too.
Children and youth of the late 18th and early 19th centuries whose behavior identified them as “delinquent” were cycled among hospitals as well as reformatory schools, orphanages, jails, and work colonies. These all functioned in similarly penal ways and as part of what Foucault called an “institutional web.” It is hard to determine in what numbers and to what extent youth were impacted by the violent “treatment” practices of psychiatric hospitals, but given the circulation of both inmates and methods through these “webs,” it is safe to say that they were. Especially as the treatment of lunatics moved away from the medical and into the ‘moral’– a philosophy easy to export and adapt.
While Benjamin Rush was bleeding out the insane, the French National Guard was bleeding out Louis XVI, and soon a physician named Philippe Pinel was appointed to run Paris’s Bicêtre and Salpêtrière Hospitals. Pinel was perhaps the first physician to conclude that the horrid behavior of the confined madman or madwoman was at least partially a result of his or her horrific medical treatment and also – possibly! – influenced by unfortunate life events. He used an early form of talk therapy in lieu of removing four-fifths of the inmates’ blood. He did not give them freedom.
Pinel was a mentor to Jean-Marc Gaspard Itard, who famously worked with Victor of Aveyron, the ‘feral child’ captured and forcibly detained in order to be ‘re-civilized.’ Of Victor’s well-documented outrageous behavior, childhood disability scholars Phillip and Elizabeth Safford write, “no doubt some readers have observed reactions not unlike Victor’s in a young adolescent just brought to a detention or treatment facility” (52). Pinel himself thought Victor a lost cause. But his more general application of ‘moral treatment’ was not.
It supplanted the ineffective brutality of medical treatment in the United States by the time Benjamin Rush was nearing his own end. In 1813, the same year Rush died, the Quakers founded their own psychiatric hospital based on ‘moral methods’. They cannot be said to be directly inspired by Pinel; if anything, the ‘moral method’ for the Quaker reformists was an ethic rooted in their religious traditions and triggered most immediately by the death of a young Quaker named Hannah Mills in 179She died of neglect in York Asylum in England.
This tragedy prompted English Quaker William Tuke to found an alternative ‘York Retreat’. Later came its American counterpart in Pennsylvania, The Asylum for the Relief of Persons Deprived of the Use of their Reason. This Friends Asylum was located in what was then an early suburb of Philadelphia: the village of Frankford. Like all mainstream treatment methods before and since, its moral method called for segregation and seclusion.
I was 15 when I was admitted later in 2004, to what is now called Friends Hospital in what is now Frankford, North Philadelphia. It is one of the 401 remaining psychiatric hospitals in the US (out of a total 5,352 total non-federal hospitals), and it is also the oldest. I still wasn’t writing, so I can only do my best to remember my third confinement.
I recall some of the preceding circumstances. I had stopped going to school because a second teacher had begun making advances at me, and even I did not believe it. Most days I felt physically sick and stayed in bed. My parents had remarried and the violence at home became less frequent but still came in waves, especially when my father came home and found me in bed. I wanted to run away but I couldn’t leave the secret buried in the wall; they would find it when they looked for me. I needed another way out.
I don’t know how I got to Friends. I know I was placed on a ward for adolescent girls again. I know I was one of only two white girls. The rest of the patient-detainees were black and from the poorest neighborhoods of Philadelphia. Many had come through court mandate instead of voluntary admission or a doctor’s demand. Unlike previous wards I’d been detained in, we weren’t brought our homework, maybe because most of us were not attending school. We were instead assigned busywork. I remember that most of the girls had great difficulty writing; they couldn’t translate the fluency of their speech to the paper. Certainly no one there would help them do it, so they disliked ‘school’ time more than children in prior wards had. They disliked art therapy, too, and when they vocalized their reasons, I found myself agreeing. Draw a happy scene. “Why?” “From when?” I don’t remember meeting with a doctor, but I’m sure I had to. I remember our designated outdoor area wasa basketball court and a bench, but I don’t remember if we were allowed to play, or if I just didn’t want to. Maybe I was told to and refused.
I rebelled against this incarceration openly. My fellow patient-detainees mostly ignored me but some outright disliked me for it. I didn’t care. When we had to have ‘group’ with an orderly in the hallway, and he said it was okay for our parents to hit us, I told him “no.” I might as well have cursed him out.
With great restraint and grave intensity he said, “You girls need discipline.” I said, “We’re not children, and it’s not about discipline.” He said – his voice rising – “You need to be kept in line.”I said, “My father hit me last time because we were in the car and he wanted to talk about abortion, and I said I didn’t want to do that, and he kept pushing me to, and I kept refusing, and then he hit me right there in the car, right while he was driving, for not wanting to talk about politics!” And he said, flustered by the oddness of this anecdote, “You should do what your father wants you to do, and if he wants you to talk, you should talk.” I stood up and I told him no. No!
“NO! You don’t know what fucked-up shit kids’ parents ask them to do!” I turned to the other girls and I said, “You don’t have to let them hit you!” There were one or two nods but when I was told, in no uncertain terms, to go to my room or be dragged there, the mass protest I anticipated did not materialize. I went, and they stayed, and it didn’t occur to me until years later why that was.
For most of its history, the US had no need to confine racialized children or adults in brick-and-mortar institutions such as hospitals or prisons. As Angela Davis succinctly puts it in Are Prisons Obsolete?, “Since slaves already performed hard labor, sentencing them to penal labor would not mark a difference in their condition” (28). During the centuries of US American slavery, a black youth who exhibited the same behavior that would land a white youth in some sort of asylum would sooner be killed than confined. But upon the official dissolution of chattel slavery – indeed, written into the very text of the Thirteenth Amendment – chattel slavery was replaced with slavery “as a punishment for crime.” The US criminal punishment system quickly became heavily racialized, with “former slave states [passing] new legislation revising the Slave Codes in order to regulate the behavior of free blacks in ways similar to those that had existed during slavery. The new Black Codes proscribed a range of actions [...] that were criminalized only when the person charged was black,” Davis elaborates (28). These actions included many of those same behaviors that were medically ‘treated’ in white people, including houselessness and rude public behavior. Black individuals who broke the new Codes were sent into the growing convict leasing system, not into hospitals.
Indigenous peoples, too, endured outright slaughter for centuries under the white supremacist settler colonial legal doctrine of terra nullius. Scholar Chris Chapman traces what he calls “social elimination practices” from these earliest genocidal massacres to the 1900s and identifies in the 18th Century a slow shift in how white settlers controlled Indigenous peoples. At that time, there was “a cross-referencing in political rationality across geography and population, among European colonizers and ruling classes. This cleared the way for [...] racism and colonialism [to] first [mobilize] confinement in Indian Residential Schools” (“Five Centuries’ Material Reforms and Ethical Reformulations of Social Elimination,” 33). He links this (citing Davis, among others) to the same shifts in ‘political rationality’ that moved the US from chattel slavery to a racialized punishment system and identifies the mid-1800s as the period when both Indigenous and black peoples were decided “ ‘in need’ of incarceration and institutionalization. With few exceptions, these historical incarcerations did not take place inthe hospitals and asylums.
They were especially unlikely to be present in the new asylum opened by Pennsylvania Hospital out in the countryside west of Philadelphia in 1841, Pennsylvania Hospital for the Insane (later the Institute of the Pennsylvania Hospital). It was, in the words of Whitaker, an “opulent place” surrounded by “pastoral comfort” run by a Friends Asylum-trained physician named Thomas Kirkbride (31). Kirkbride gave his patients everything but their freedom: a greenhouse, a concert venue, a bowling alley, a museum, a library, a lecture hall, and a guilt complex. He urged them to choose sanity, for he believed it was a matter of will, of moral turpitude.
Kirkbride’s funding couldn’t be replicated, but his attitude was, and the nastiness of the latter blossomed like rot in the underfinanced institutions that were built by the hundreds across America over the following four decades. Many of those admitted at mid-Century were young women, “treated as dependent children, incarcerated against their will [...] released from the family of the state only if their own promised to care for them” (Safford and Safford, 227). In 1840 there were 18 mental hospitals in the US; in 1880, 139. And where there are carceral institutions, there must be people to fill them: not just the young and unruly but, once again, the senile, and alcoholics, and criminals until, in 1890, the population in mental hospitals reached a stunning 74,000. And then there were those wounded in the Civil War.
The mass casualties of young white men of the 1860s spurred an interest in the study of the anatomical disorders of the brain and pushed the treatment of mental illness back from the moral to the medical. This was the rise of neurology as a profession. It coincided with the economic crash of the 1870s, a time when psychiatric hospitals of ‘moral’ missions fell deeper into disrepair and outright neglect. By 1892, the staff of Kirkbride’s institution officially moved away from what Whitaker calls “the art of healing” and towards “scientific approaches to treating the mad” (37- 38). The science that was in ascendancy at this point was eugenics, and thus came the advent of mass psychiatric institutionalization.
Were there enough space I’d write it all: the growing horror of hospitals intended to warehouse psychiatrized youth from admission till death, which continued unabated throughout most of the 1900s until the deinstitutionalization movement of the 1970s; how this deinstitutionalization was really a decentralization of incarceration that scattered the psychiatrized into group homes and rotating through treatment centers and also into prisons, and how, of the psychiatrized people in prisons, it is disproportionately the black and Hispanic individuals who fill them, and how these prisons produce psychiatric distress in turn. I’d delineate all the ways the psychiatric institution persists separately from the prison in decentralized centers and programs, and how now more than ever the prison and psychiatric institution are part of the same “institutional web,” or what we now call the carceral network, feeding each other inmate-patient-detainees and patient-detainee-inmates and methods of control and containment – all in a way that remains starkly racialized. This network extends past total incarceration into the carceral methods embedded in modern medicine and modern child welfare and also in modern education. These social institutions, too, become part of the carceral network: think the school-to-prison pipeline for black children; think the psychiatric-ward-to-school-program pipeline for white ones.
What Whitaker called the “opulent place” of Thomas Kirkbride’s Pennsylvania Hospital for the Insane still exists today as the run-down Kirkbride Center. It is operated by the same owners of the flagship Pennsylvania Hospital: University of Pennsylvania. And of course it is no longer located in the countryside but in the desolate corner where the West Philadelphia neighborhoods of Dunlap and Mill Creek abut. In one wing, overseen by U of P and staffed in part by their grad students, is a program called the Mill Creek School. After my stint at Friends, this was where I attended high school until I graduated in 2007.
Aside from the wildly dilapidated grounds and the odd and imposing structure, the Mill Creek School did not feel like a psychiatric hospital. Nor did it feel like a school. In many small ways it had more in common with outpatient treatment facilities than educational facilities, and that was by design. We had our two floors of the wing and nothing else: no track and field but the small baseball diamond shared with the adult drug treatment center in another wing; no cafeteria, only a food truck that pulled up outside – and which was our only option beside home-brought, because we were not allowed to leave the grounds. I ate my lunch on the worn-down couches in the hallways with my 59 schoolmates. In my three years there, only two of my schoolmates were from the majority black school district of Philadelphia itself, and one of those Philadelphians was white. The racial make up of our student body had as much to do with the criminalization of poor, black, psychiatrized youth as it did with the wealth of our suburban school districts, which could pay to send us somewhere besides a prison. We all arrived with Individualized Education Plans, which means we were all officially psychiatrized, and segregating us was so simple there was already a network set up to do it.
Each morning we were bussed from our districts to the Kirkbride Center, and each afternoon we were bussed out. We were not allowed to transport ourselves to and from school, and neither were our parents. Once we left at day’s end (there was no bell, nor after-school activities), the gates locked behind us. Confidentiality protocols prevented us from taking photos of each other on our low-res Razr phones. We were allowed yearbooks, unofficially; I believe it was a sort of concession from the administrator (there was but one) who wanted to give us a semblance of the normal high school experience. Nowhere in its pages are our last names given, and our faces are shown mostly on field trips, or in our small garden, or in close-ups – nothing to definitively place us in Kirkbride. The pages are full of signatures and well wishes and kind words and promises to add each other on Facebook before we forgot each other’s last names. But there is very little of the place itself.
When I want to see what my high school looked like, I go to the Wikipedia page for the Institute of the Pennsylvania Hospital and scroll down to the second historical photo, labeled ‘Interior, first floor hall.’ I imagine the hardwood floors replaced with industrial carpeting and the spaces along the walls filled with the worn-down, lunch-stained couches, and then I look fondly at the first door on the right: my English classroom for nearly three years. Officially, I never attended; my high school transcripts are from my district.
It was in such a non-place I was voted Most Likely to Succeed. Ten years later and underemployed due largely to chronic mental illness and its inextricable social causes and consequences, I find this fucking hilarious – also, bittersweet. Despite everything, I am free. I wonder how many children today are not. There is no way to count how many psychiatrized minors are detained in and controlled by all our carceral networks, as those statistics don’t exist. We only have our stories of solidarity and resistance, tales taken out of the walls and brought into the light.
I don’t know if I should include Sally’s story. I don’t know if I could bear not to.
I know that historically there’s often been little distinction between ‘insanity’ and ‘idiocy’ (and epilepsy, too). At times there has been none. At others there was an attempted separation – Pinel, the French physician who pioneered ‘moral treatment,’ classed “idiotism, or obliteration of the intellectual faculties and affections” as a kind of insanity, according to scholars Safford and Safford (48). Even now, in the DSM 5 there is a Neurodevelopmental Disorders category that includes both Intellectual Developmental Disorder and ADHD. There have been endless arguments as to whether the category should include schizophrenia, too.
It is thus difficult to say if those with intellectual disabilities have ever not been psychiatrized. The closest we came to a separation was with the rise of the eugenics movement at the end of the 19th Century, when distinct institutions were developed for those with IQs judged well below average. But Safford and Safford write that “[patient] classification based on institution ‘type’ is highly misleading, for placement was more often based on the kinds of facilities available than on a child’s needs” (252-3). And so perhaps Sally’s story does indeed fit here. I don’t know.
I don’t know her at all except from one picture that used to nestle among countless other family photos in my grandparents’ sitting room. She was maybe four, wearing a red romper and leaning on a chair. She looks at the camera with startled blue eyes. No one else in our family was a blue-eyed blonde except my new baby cousin, much younger than four. I asked my mother who the girl in the photo was.
“Sally was my sister.”
“Donna is your sister.”
“Sally was my other sister.”
“Where is she?”
I don’t remember when I learned, or if I learned all at one time.
Sally was my grandmother’s last child. When she was pregnant with Sally, the doctor prescribed something he shouldn’t have (the doctor later lost his license for being an alcoholic.) Something wasn’t right with Sally when she was born. She was very quiet.
Then she was very loud. As soon as she could sit up she slammed her head into the bars of her crib. They thought it was an accident, but she kept doing it, and as she grew it the problem got worse, because she couldn’t be confined to a padded crib anymore. Sally had the IQ of a dog, words that come from my mother who must have heard them from my grandmother who must have heard them from a doctor.
My grandmother was already very ill, in and out of hospitals receiving shock treatment. My grandfather was working to take care of five kids and a sick wife. My mother was the oldest girl, six years Sally’s senior; she took care of Sally. Until Sally became too much. Then they put Sally in an institution.
“It was the 1960s,” my mother said, “it was what you did.”
The rest comes in even smaller fragments. “When we visited,” my mother said, “she was so sad.” And when they left, my mother said, “she called after me. Only me.”/ “When we visited again I knew something was wrong.” /“She wasn’t eating.” /“Why didn’t they make her eat?”/ “She was so sad.”/ “She called after me.”/ “I told them she wasn’t eating.”/ “Why didn’t they listen?”
Sally starved to death in the institution in 1969. She was seven.
Each night of psychiatric incarceration I talked to my mother, she would ask, “Are you eating?” Each time I stole a piece of food and put it in my room and ate it later, even when I wasn’t hungry, even when it was covered in ants, I did it for her, and for my grandmother, and for Sally.
I am indebted to Erick Fabris and Katie Aubrecht’s collaborative piece “Chemical Constraint: Experiences of Psychiatric Coercion, Restraint and Detention as Carceratory Techniques” in Disability Incarcerated: Imprisonment and Disability in the United States and Canada for providing guidelines for the terminology used in this essay. Fabris defines a ‘detainee’ as someone lacking the (de juro if not de facto) legal rights of an ‘inmate,’ as all the child patients in this piece would seem to. Fabris and Aubrecht reject the label of patient altogether to make an understandable political statement, but it is not a statement with which I wholly agree. Rather, I wish to acknowledge the official medical contexts in which these interactions take place and to highlight the ironically cruel experiences of those designated as receiving medical care. I have otherwise tried to use historically appropriate terminology, whether that be ‘patient,’ ‘inmate,’ ‘madman’ or something else, and I do so with the knowledge that the label is most likely being applied externally by contemporary physicians and/or later historians.
All names and other identifying characteristics of child patient-detainees have been changed except for age and race, as these are vital components in analyzing the psychiatric incarceration of children. Exact dates are not used in order to further obscure possible identification but locations are given – either general ones that indicate the socioeconomic make-up of the patient-detainees (another vital component in analysis) or names of specific institutions, used for the sole purpose of demonstrating the material persistence of carceral values over time. When specific institutions are identified, I do not reference individual stories of other child patient-detainees.
In deciding whether to share such intimate fragments of other children’s lives without being able to gain their consent, I repeatedly returned to these sentences from Syrus Ware, Joan Ruzsa and Giselle Dias’s essay, “It Can’t Be Fixed Because It’s Not Broken: Racism and Disability in the Prison Industrial Complex” (also published in Disability Incarcerated):
“[W]e rely on stories from our work in prisons and other stories collected by prisoners about their experiences of racialization, disability, and prison. We use these stories as our data because it is so rare to actually hear about prisons from prisoners themselves” (164).
“It is unfortunate that some of these stories were not written in the first person or could not be told by the individuals in their oral tradition; however, without Peter’s work with these individuals their stories may have been lost, as has been the case with so many others” (179).
I thought also of the second-hand stories of psychiatric incarceration that do exist in contemporary personal narrative, perhaps most famously in Girl, Interrupted, where they are used to uphold the carceral status quo. It was with such consideration I decided to relate anonymized fragments of the deeply personal stories of other child patient-detainees, who I hope against the odds are all adults now. I hope they would understand.