Life at the Texas State Lunatic Asylum 1857-1997, as the title suggests tells the story of a Texan mental hospital, specifically the Austin State Hospital (ASH). However beyond the descriptions of everyday institutional life, Stitton’s book questions the relationship between society and those who society designates insane, provokes inquiries regarding the validity of medical treatments, and speaks of the nature of institutions in general.

Life is an accessible book, written without jargon, with the voice of a sensitive, sympathetic, humorous, and sometimes ironic story-teller. The stories weave through everyday life, recounting daily schedules, eating routines, and cleaning deities. The stories bear witness to nearly a century of medical treatments, to the icy hydrotherapy treatments, to the cup sizes doses of early sedatives such as paraldehyde, to the horrors of electro-shock therapy and to the benefits of modern anti-psychotic drugs. The stories describe the layout of the asylum and the hierarchy of ward structure. And most of all the stories of Life animate the asylum with the characters of the doctors, the attendants, and the patients.

Life could be read as just that, as a story, as a collection of stories about life at a particular place in particular times. However Life raises a series of provocative questions, questions that lead one to reflected on and probe into the nature of social life in general. Anecdotes of doctors, demonstrably insane, of patients becoming staff and of fully sane people falsely committed, raise questions regarding the categories of sanity and insanity. The descriptions of out of date medical practices, the retrospective horror and absurdity, force a reflection on the status of current medical treatments. Finally, the story of ‘the clan’, an inner circle of attendants and hospital staff who lived at and spent their entire lives, from birth to death at the hospital, provoke a questioning into the nature of institutions.

At the Austin State Hospital, doctors were barely sane and patients were not always insane. It was difficult, especially during the wars, to find doctors and staff willing to work at the hospital. Desperate, officials would hire doctors without license, doctors who were alcoholics, doctors with hand washing compulsions and doctors with a range of extreme eccentricities. “One doctor was as psychotic as any patient. He was tall and thin and always wore a pith helmet and rubber raincoat and a mask…He would sit in his office and hallucinate and talk. He would take three steps forward and one step back as he walked across the grounds…”. As the doctors as ASH pushed the boundaries of sanity, the patients also refused to fit neatly into their category. Many patients were merely elderly. Others were addicted to drugs or alcohol and some hid out at the ASH just to avoid the repercussions of the ‘hot cheques’ they had written.

With doctors not quite sane and patients not necessarily insane, the doctor/ patient, sane/insane distinction becomes unclear. We are forced to ask, what are the dynamics of the doctor/patient relationship? Who is healing whom? The existence of an objective measure of sanity becomes doubtful. Sanity — is to some degree — a question of social position and functionality. The insane are those without power and those who do not function within a given social apparatus; the sane are those with power and those who function.

Life at the Texas State Lunatic Asylum recounts a history of medical treatments, many or most of which, now sound extremely archaic. Sleep therapy, was used to treat mania -patients would be sedated for a month, awaken only for bathing and feeding. After a month of sedation the mania was supposed to be cured — it never was. Electroshock therapy was a common form of treatment until the 1950’s. The horrifying spectacle of electroshock therapy was used as a fear tactic for controlling patients: “The patient’s convulsions often resemble those of an accident victim in death agony and are accompanied by choking gasps and at times a foaming overflow of the saliva from the mouth. The patient slowly recovers without memory of the occurrence, but he has served the others as a frightful spectacle of what may be done to them.”

The treatments used throughout the past seem both absurd and horrific. However at the time they were heralded with optimistic conviction. The recognition that our medical ancestors were so far off, calls into question the status of current medical theories and treatments. Perhaps, even likely, a hundred years from now, Prozac will sound as absurd as hydrotherapy or lobotomies. We are thus forced to recognize that our current treatments are not the answer, merely the latest attempt.

At the Austin State Hospital boundaries blurred. The clan blurred the traditional, or expected boundaries, between the institution and the institutionalized, between society and the asylum. Clan members wielded an informal power, and official institutional rules and regulations waned in the face of this power. Hospital patients often graduated to become hospital staff and eventually might enter into the clan. The asylum, with a bakery, a shoe-maker, a dress maker and vegetable gardens, was a world unto itself -and as such it drowned out the external world. The society that had established the Hospital as excluded, that had positioned the institutionalized as ‘Other’ and ‘over-there’, faded.

The story of the Austin State Hospital and of its inner clan challenges Foucault’s famous theory of the relationship between the asylum and society. For Foucault 19^th and 20^th century asylums were forms or mechanisms of social control. Foucault further theorizes that the modern subject was constructed negatively, as identical with itself and different from the Other and thus that the asylums, in cordoning off the Other, functioned as a necessary moment in the creation or emergence of the modern rational subject.

At the Austin State Hospital, with boundaries between society and institution, between the officials and the inmates blurred, it becomes unclear how to understand the asylum as a mechanism of social control. One is forced to ask, who is controlling and who is controlled? What is suggested is a silent and two-way power relation enacted between officials and clan members, between doctors and patients, between sane and insane. If one were to discern in this dynamic the emergence of the subject, it would need to be a subject that is created not simply out of a negatively defining relationship of difference but rather a subject that is born and reborn in the blurriness and ambiguity of a social space configured in terms of blood and unwritten power.

The story of the Austin State Hospital, challenging Foucault, supports the current new wave of French liberal thought. This French neo-liberalism, articulated by Gauchet and Swain in Madness and Democracy, suggests that asylums must be understood, as founded in humanitarian ideals, which ultimately could not be achieved. The optimistic utopianism that founded the asylums met its undoing in an insidious corruption rooted in the very nature of institutions.

The clan of Austin State Hospital attests to the organic life of social organizations. Despite the sterilization of institutions, despite the formalities and procedures, human beings grouped together taken on a life of their own, they make friends, they fall in love and have children, they get comfortable and grow roots, and they fight to protect their ways and lives. And thus the Austin State Hospital speaks of the very position articulated in neo-liberal thought i.e., that the problem with state institutions in general and with the 19^th and 20^th century insane asylums in particular, was not located in the wielding of the state’s power but rather in the impossibility of creating, with human parts, rational, institutions that would function like well-oiled machines; and the Austin State Hospital attests that despite ideals and dreams, despite rules and controls, despite the strength of the antiseptic, human beings make poor machines.

Kathryn Walker is a doctoral student in York University’s Social and Political Thought program. Her work is focused on the relationship between moods, rationality and politics. Kathryn is also part of the j_spot editorial collective.

Categories: Philosophical, MentalHealth