Give Us Your Poor, Your Weak, Your Feeble-Minded -- We Have Just The Place For Them

Like many people, I'm fascinated by abandoned insane asylums.  Unlike many, I want to know the deepest histories of them.  I want to know why.


When you look at the beginnings of what would eventually become a horror-show of abuse and murder, you find the finest of intentions.  You see what humans can do for each other, before you see what they do to each other.


Each asylum that I've researched started out with noble design.  Those huge "scary" buildings were constructed to house, protect, heal, and teach.  Most of them included features found now in luxury resorts:  pools, saunas, gardens, tennis courts, libraries... The amenities were calculated to engage body and mind, and the medical models drove care that should have brought comfort, even if the patient could never be truly healed and recovered.


So what went wrong?


Committees. 


Men rendered faceless by their presence around a table, sharing responsibility so that none shouldered any blame.


They cut budgets, proclaimed treatment options too expensive, and congratulated each other for the savings.  They allowed increasing populations while decreasing funding.  They turned what could have been a cocoon of protection into a straitjacket.


And when the horrors were revealed, they denied knowledge.  That is believed because they had not one bit of actual awareness of the conditions, since they never visited or even communicated with the facilities they purportedly oversaw.  Why would they?  All they were concerned with was the budget.


Committees are man's way of controlling without responsibility.


Because the idealistic dreams of mental health experts were ground beneath the heels of anonymous bureaucrats, asylums are closed.


That leaves us with people who have no home, no protection, no hope.  They also are overseen by ... nobody.  They are nobody's problem, and everybody's problem.


Could we, at this time and with our current "advanced understanding," bring back to life the idealistic centers of care?


No.


Because we are no more advanced than we were 100, 75, 50 years ago.  I know that.  Shining buildings of glass and steel, rather than stone, could be built, clean lines and soothing colors, ambitious compassionate teams assembled, mission statements developed and binder after binder of policies and procedures printed, patient-based care plans implemented, and still, within five years, the slide would begin.  It's unavoidable.  Because every Tuesday, people would sit around a table to discuss the budget.  Or every fourth Tuesday, or quarterly.  A representative of that table would sit at another table for each interdisciplinary meeting, analyzing the plan of care, the interventions, the cost.


Bonuses would start for cutting costs, for increasing census, for "right-sizing" staffing.


No, we have learned nothing from the past, because we are not forced to learn.  The blame has always been placed on the direct caregivers, the providers, and never on the reasons behind the short staffing and decrease in care provided.


And the committee members moved on to other committees.