New Hampshire Asylum for the Insane -- Concord, New Hampshire (Lisa Lavoie)

The New Hampshire Asylum for the Insane, now known as New Hampshire State Hospital (NHH), opened in 1842, after 12 years of planning.  Located in Concord, NH, the asylum was funded by a $9500 grant from the city which was utilized to purchase 120 acres.  Originally, the Asylum was not a state entity; patients who could afford to paid $2.25 per week and those who could not afford payment had their fees paid by their home communities.  The Asylum also accepted patients from neighboring states who paid an extra $.25 per week.

After reading about the Asylum on several websites, including the 2012 History of Psychiatric Hospitals by Paul Shagoury, Director of Psychology, NHH, (https://www.dhhs.nh.gov/dcbcs/nhh/documents/nhh-history-shagoury.pdf) and New Hampshire’s Department of Health and Human Services’ website (https://www.dhhs.nh.gov/dcbcs/nhh/history.htm), it appears that this Asylum was indeed built on the Kirkbride premise.  Photos on the NH website demonstrate a central administration building flanked by two wings.  Male patients resided in one wing, female patients in the other.  Also, the Asylum was located in a rural location, and patients were encouraged to work on the farm.  This work was considered “congenial healthy outdoor activities that characterized the program of care” (Shagoury, p. 3); again, another tenet of Kirkbride’s model.

 

Image from NH DHHS Website

The Asylum’s founding premise was to relieve the pain and suffering of the mentally ill and to provide them with love.  Shortly thereafter, the premise expanded to “energetic restoration” of the mentally ill.  Shagoury describes the original intent of the asylum as such, “The therapy consisted primarily in taking patients away from the stresses and worries of their environment, attending to their physical needs, occupying their time in useful and pleasant activities to prevent excessive self-absorption, and providing a “benign atmosphere” marked by kindness and respect” (p. 3) – all tenets of Pinel and Pussin’s traitement moral.

 With the exception of describing the Asylum’s first patient – a 35-year-old farmer who remained for 2.5 months and was presumed cured – Mr. Shagoury does not discuss specific patients.  I have searched for specific patient narratives and have been unable to discover any, although I doubt the treatment at this hospital was all “sunshine and puppies” as described by Mr. Shagoury. 

 From its inception in 1842-1843 with a total of 47 patients to 225 patients a decade later, NHH burgeoned to over 1,000 patients in 1917.  In 1903, NHH began the process of becoming a state institution.  Moreover, the launching of chloral hydrate, described by the medical director, Dr. Jesse Bancroft, as a ‘boon to sleepless sufferers’, in 1871 metamorphosed the care of patients.  Although several new buildings were constructed over the ensuring years, construction could not keep up with the number of patients needing care, and by 1939 with over 2,000 patients at NHH,  the hospital was very overcrowded.  By 1955, 2,700 patients resided at NHH and the overcrowding became untenable.  With each psychiatrist having 250 patients to treat, the institution’s premise of individual care become impossible.  Moreover, the shift in societal attitudes -- less humane treatment -- towards the mentally ill was reflected in patient care at NHH.   In short, NHH in the mid-20^th century was a much different institution than the Asylum had been a century earlier. 

By the 1950s and 60s, care of the mentally ill had once again been metamorphosed by medications, such as Thorazine, and the Community Mental Health Centers Act, which paved the way for people with severe mental illness to reside in the community.  Deinstitutionalization was not necessarily the panacea that was promised, however, and NHH, in a much-changed capacity, still provides care to the mentally ill.  According to Shagoury, the hospital is a national leader in the innovative treatment of mental illness.  The average daily population of NHH is now 145 patients and, like throughout much of the United States, cutbacks and limited funding have adversely affected access to treatment with patients waiting longer for necessary services.  Although the tenets of respect, dignity, and commitment to helping patients live a meaningful life are still promulgated, limited resources makes attainment of these goals increasingly challenging.

My research did not uncover exactly how many people worked and how many died at the Asylum; however, over time, as funding decreased, it is likely that the number of employees became inadequate for the number of residents.  Too, like many other institutions of its nature, it is likely that many folks died there as well. 

The websites that I viewed were mostly positive, and I was unable to discover any “bad conditions,” although Mr. Shagoury, in Part I of his History addresses a Report that provides “lurid descriptions of the various conditions of New Hampshire’s “insane” that are recounted in the Report (the kind of reading that you can’t stop yourself from continuing, no matter how much it horrifies)” (p. 1).  I have searched for this Report but have been unable to find it.  I would welcome reports from any of you who might search and find this Report.    

Finally, although the Asylum conditions described might have made treatment acceptable to me, as time wore on, it seemed that treatment at NHH became progressively worse and overcrowding and underfunding adversely affected treatment.  Consequently, what began as a concerted effort to truly help people, over the course of a century, became mired in economic and political quicksand that negatively impacted patient care.

 Other websites of interest: http://1037thepeak.com/this-will-give-you-chills-up-your-spine-tour-this-1842-insane-asylum-in-concord-nh-watch/

 http://www.asylumprojects.org/index.php/Concord_State_Hospital