Conclusiones

Some contemporary observers formed the impression that American mental hospital treatment and cure rates were superior to those which existed in Britain. Like Dickens, Captain Basil Hall was a British visitor whose impressions of America were generally somewhat uncomplimentary. In the published account of his travels, however, he waxed lyrical over the patient management at the Hartford Retreat, which he witnessed in 1827, and contrasted the high recovery

Table 5.5 Recovery and mortality rates in British and American mental institutions before 1845

rates at that hospital with current British results. During the previous year, 25 of the 28 “recent” cases admitted to the Hartford Retreat—89.2 per cent—had recovered, he reported, but “at two most ancient and celebrated institutions” of the same type in Britain only 25.5 per cent of “recent” (acute) cases were cured.96

Hall’s claims attracted a great deal of attention on both sides of the Atlantic and were widely quoted in the press. Soon, other American hospital superintendents reported similar rates of success. Samuel Woodward at the Worcester State Hospital claimed recovery rates for “recent” (acute) cases of 82–91 per cent for the early years of the hospital’s operation between 1833 and 1840. John Galt, superintendent at the Eastern Virginia Asylum, announced 92 per cent recovery in acute cases and 53 per cent recovery overall in new admissions in his report of 1842. Around the same time, William Awl, superintendent of the Ohio State Asylum, reported cure rates of 80–100 per cent for cases of recent onset, and 48 per cent recovery for all cases of up to ten years duration admitted over a four-year period.97 _{Heads of corporate and public asylums alike argued that recovery from}

insanity was the rule, incurability the exception. As stated by Amariah Brigham of Utica State Hospital: “No fact relating to insanity appears better established than the general certainty of curing it in its early state.”98

It is easy to dismiss such claims as American bombast and typical of the entrepreneurial audacity of the New Republic. The claims were, indeed, extravagant and clearly motivated, in part, by a wish to impress state legislators with the value of investment in hospital care. Dorothea Dix used these reports of the benefits of modern treatment in her successful campaign to establish public mental hospitals throughout the United States. The episode in American psychiatry has subsequently been disparaged as the “Cult of Curability.”99

Obviously, statistics may have been molded somewhat to improve the effect. Galt’s 92 per cent recovery figure was, like many other reports, based on a small sample—13 admissions. Criteria for defining “recent” cases and “recovery” were subject to manipulation; and patients who relapsed, were readmitted and subsequently discharged again, might be counted as “recovered” more than once.100 _{Despite such statistical flaws, nevertheless, we cannot rule out the}

possibility that cure rates were outstandingly good at the time. Indeed, it seems quite possible that recovery rates for acutely ill patients admitted to American public and private mental hospitals throughout the first half of the nineteenth century were distinctly better than in the decades that followed or in contemporary Britain. Two points emerge clearly from the reports of the period. The emphasis on curability was largely an American phenomenon, and it pervaded public psychiatry as extensively as it did the private institutions. In Britain, George Burrows reported similarly high recovery rates in 1820 for “recent” cases admitted to his madhouse, as did the proprietors of other private establishments.101 _{The same degree of universal optimism, however, did not}

develop in British public hospitals of the period.

The enthusiasm of the American hospital superintendents was, in fact, based upon the observation of distinctly superior rates of recovery. Table 5.6 allows us

to compare separately the cure rates for acute and chronic patients admitted to several British and American hospitals before 1842. The American recovery rates for acute patients were substantially better than the British. It may reasonably be assumed that these figures for recent cases are more comparable than those for total admissions. Undetermined numbers of chronically psychotic and demented patients, epileptics and mentally retarded amongst the general admissions largely determined the overall recovery rate, which, as we may see in Table 5.6, bore little relationship to the cure rate in acute illness. Significant differences in the causes of acute mental illness, however, could conceivably have accounted for the disparity in recovery rates. Thurnam argued, for example, that more of the American hospital admissions were suffering from alcohol-related psychoses and delirium tremens, which ended either in early recovery or death.102 _{If this}

opinion were correct, we would expect to find higher death rates in the American asylums (in fact, as we have seen, they were lower) and higher recovery rates in male patients (which was true at Bloomingdale Asylum, but not at Worcester103_{). Whatever the causes, it is clear that there was a distinctly better}

Table 5.6 Percentage of admissions discharged “recovered” from British and American asylums according to duration of illness

Source: Thurnam, Observations and Essays on the Statistics of Insanity, p. 57. Statistics for Ohio Asylum are added from Grob, Mental Institutions in America, p. 182.

Notes:a _{Private patients only.} b _{Private and pauper patients.} c _{Cases of 1–10 years duration.} d _{Cases of up to 10 years duration.}

course and outcome to acute mental illnesses in early nineteenth-century America, which needs to be explained.