The first dictionary definition of "asylum" is "an institution for the care of people, especially those with physical or mental impairments, who require organized supervision or assistance"; the second is "a place offering protection and safety; a shelter." The first meaning highlights control, confinement, and supervision (under the rubric of "care"); the second is a synonym for "refuge," connoting freedom and security. The founders of American almshouses, lunatic asylums, and orphanages all faced the problem of how to justify the confinement of the impaired and the destitute with the ideals of freedom and equality that underpinned the Revolution and the birth of the new nation.
Poverty was not uncommon in the colonies and the new nation. Many theologians in the eighteenth century believed that poverty, like mental illness, was simply a part of God's design; thus most of the needy were cared for in community households, where they were not stigmatized as a "problem" population. However, vagabonds or the "wandering poor" were made ineligible for all kinds of relief and were "warned out" of town, as the towns' responsibility for poverty extended only to the community within a town's boundaries.
A few communities did establish separate institutions to serve the needy. Many cities, primarily in the North, built almshouses throughout the eighteenth century. The earliest almshouses were often minimally renovated farmhouses. Residents, who wore no distinguishing clothing, had undergone some personal crisis or illness, or had faced insurmountable difficulties as a result of periodic wars, economic fluctuations, and especially the turn-of-the-century transition to commercialized agriculture and early industrialization. Women consistently far outnumbered men: the special burdens associated with single motherhood accompanied by the paucity of economic opportunities for women made them especially vulnerable to all of the other social forces that induced downward mobility.
By the Jacksonian period, the almshouse had gained a dominant position in public policy toward the poor. In 1821 and 1824, Massachusetts and New York conducted formal studies of the causes of poverty and the condition of the poor; both studies recommended a formal network of almshouses where work, especially farm labor, would be compulsory for all the able-bodied. (A number of almshouses dating back to the late eighteenth century had made this a requirement of residency.) Other states followed suit: approximately sixty new almshouses were constructed from 1820 to 1840, and dozens of existing ones were refurbished and expanded. In keeping with the reform movements that led to the construction of penitentiaries and insane asylums, proponents of these new institutions stressed that poverty was not a divinely ordained condition, and that individuals were, under the right social conditions, perfectible. Accordingly, each of these institutions emphasized discipline, order, and cultural reprogramming that led inmates away from the slothful and vicious behavior (with drink at the top of the list) thought to be responsible for their degraded condition.
Throughout most of the eighteenth century, the mentally ill who could not be cared for at home were often housed in almshouses or jails and were sometimes chained in attics or cellars if they became unmanageable. But these "mad" inmates were increasingly viewed as a bad influence on—or worse, a physical threat to—the virtuous or reformable sane inmates. Eventually, mental health crusaders like Dorothea Dix (1802-1887) insisted that the poor treatment and unmet medical needs of the mentally ill in the almshouses made separate institutions for the insane a national imperative. The rather undifferentiated population of the almshouse inmates began to be sorted out, and from the early 1830s onward the insane were systematically removed to the new state-run institutions that specialized in treatment of the mentally ill. The roots of this practice reach back to the eighteenth century, both in Europe and America.
Insanity, like poverty, was not considered a "social problem" through much of the 1700s. Those whose behavior was considered sufficiently odd often came under the care of doctors, who might bleed them or subject them to a regime of purgatives or laxatives; but these procedures were typically conducted in the home, unless the patient was violent enough to warrant confinement elsewhere. In Europe, however, a new medical paradigm known as "moral treatment" took hold. This system purported to restore sufferers to reason and light by immersing them in a carefully controlled environment where they would be under the supervision of a physician and where all perverting influences were expelled. The leading exponent of this movement, the French physician and asylum-keeper Philippe Pinel (1745-1826), claimed that his new field of asylum medicine was a logical outgrowth of the French Revolution, in that it guaranteed all the mentally ill the right to humane treatment rather than neglect or abuse.
The first American hospital established exclusively for the insane was the Virginia Eastern Lunatic Asylum, founded in Williamsburg in 1770 to house thirty-six patients. Pennsylvania's experiment, however, was better known. In 1751, under a petition of civic leaders including Benjamin Franklin, the newly formed Pennsylvania Hospital began receiving a large number of vagrant, and violent, "lunatics." In the first decades, patients were often restrained by chains and straitjackets; but, at the urging of the physician Benjamin Rush, they were moved in 1792 to a separate wing, where they could be cared for more effectively and humanely. Rush, though, still favored "heroic" medical treatments—bloodletting, purging, physical restraint, chastising, and stimulation of terror as shock therapy—over the holistic "moral" ones being developed in Europe.
In the early nineteenth century, a number of religious and charitable organizations founded private asylums, generally run on the moral treatment paradigm, that catered primarily to elite populations who were afflicted with insanity. (Each did, however, have provisions for caring for a certain number of indigent patients.) In such asylums as McLean (Massachusetts, 1818), Bloomingdale (New York, 1821), and Hartford Retreat (Connecticut, 1822), the moral treatment took hold, with reportedly spectacular effects. Physicians claimed cure rates as high as 90 percent; this, along with the vigorous campaigning of Dix and others, persuaded many state legislatures to fund state institutions. Beginning with Massachusetts in 1833, almost every Northern state allotted major funding for elaborate institutions to care for patients from all social ranks. However, the cure rate was later exposed as exaggerated, and the actual treatment of patients was considerably more harrowing than the stated ideal.
Unlike insane asylums and almshouses, throughout the eighteenth and nineteenth centuries orphanages remained strongly associated with private and religious organizations. And whereas the other institutions were managed exclusively by men, women tended to run orphan asylums, where they were expected to take on mothering roles with their young wards. But as with the response to poverty and insanity, the relief of large numbers of bereft children took place within institutional settings only after the 1830s. In the colonies, two orphan asylums, one Lutheran and one Methodist, opened in what is today Georgia in 1738. The first to be publicly managed was established in Charleston, South Carolina, in 1790, but by 1830, when approximately fifteen orphanages had been established, the overwhelming majority was still religiously oriented. Not all of the children were strictly parentless: some had one living parent, and some had been abandoned.
In orphanages, as in other types of asylums, managers emphasized the importance of developing daily routines and rudimentary training in how to live as productive, law-abiding citizens. Several orphanages, including the Boston Female Asylum (established 1800), provided more regular and rigorous schooling than would have been available to poor children on the outside. There, school was held six hours a day, six days a week, and featured lessons in arithmetic, reading, writing, sewing and domestic skills; Sundays were given to religious worship. Play time, however, was not considered important to development.
Almshouses and insane asylums suffered a downward trajectory through the nineteenth century. These institutions deteriorated as their utopian mystique was eroded and the public lost its faith in them. Conditions at orphanages, by contrast, tended to improve.