in
Traverse City, Michigan, U.S., in operation from 1881 to 1989 Psychiatrist
Thomas Szasz in Hungary has argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. Historian
Michel Foucault is widely known for his comprehensive critique of the use and abuse of the mental hospital system in
Madness and Civilization. He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a
bourgeois family. It was a microcosm symbolizing the massive structures of
bourgeois society and its values: relations of Family–Children (paternal authority), Fault–Punishment (immediate justice), Madness–Disorder (social and moral order). Within the limitations of psychiatric hospitals during this period, individuals were mainly admitted due to social nonconformity, vulnerabilities, and social control. Asylums aimed to manage those deemed socially disruptive or considered “inconvenient.” This group primarily consisted of women, impoverished people, or those with language barriers.
Erving Goffman coined the term "
total institution" for mental hospitals and similar places which took over and confined a person's whole life. Goffman placed psychiatric hospitals in the same category as
concentration camps,
prisons, military organizations,
orphanages, and monasteries. In his book
Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; in turn, it reinforces notions of chronicity in severe mental illness. The
Rosenhan experiment of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients. Rosenhan’s research questions the reliability of psychiatric diagnosis by showing how unstable the concept of insanity can be. In his pseudopatient experiment, Rosenhan demonstrated that once someone is labeled with "
schizophrenia,” staff interpret all their behaviors through that diagnostic perspective. This underscores how institutional settings and biases influence mental health definitions. Interestingly, Rosenhan’s work revealed that real patients often recognized their own sanity more accurately than trained staff. This vulnerability in psychiatric authority raises the key issue of who holds the power to define sanity in institutional contexts and how this label affects the treatment individuals receive. Once someone was labeled as “insane,” they were placed in environments that were often harsh, overcrowded, and neglectful. Patients were typically confined to small, prison-like cells and frequently subjected to verbal and physical abuse by staff. These dehumanizing conditions extended to unsanitary living spaces and poor or rotten food, emphasizing the neglect characteristic of early institutional care. Accounts from later periods reveal that such conditions persisted into the mid-20th century, with routine abuse, long-term confinement, and lack of stimulation only coming to light through scandals and medical revelations.
Franco Basaglia, a leading psychiatrist who inspired and planned the
psychiatric reform in Italy, also defined the mental hospital as an oppressive, locked, and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. American psychiatrist
Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the
degradation ceremony, authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve. The
anti-psychiatry movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The
psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time. While there is a lot of criticism to the set up and the form of care psychiatric hospitals provide, there is the more prominent issue of stigmatization from other individuals and the communities surrounding these hospitals. There has been an increase in the stigmatization towards individuals who receive professional mental health care in psychiatric hospitals. Stigmatization has a major impact on not only the patients in these hospitals but also the clients of so-called alternative settings. Having this stigma can cause future patients and individuals who need this care to be more hesitant to get the care due to the fear of future judgement and being a victim of this stigmatization. For example, Janna Herron, a previous patient at a psychiatric institution argues that psychiatric institutions are harsh and inhumane to patients and only cut them off from the outside world. She also says that psychiatric patients are stigmatized and that nobody wants to talk about the issues patients face. Some other criticism that can occur is by peers. This can have a direct impact on the patients. This alone can cause them not to feel as they can share or seek help from a professional mental health provider. Historical criticism of psychiatric hospitals reveals that during the nineteenth and early twentieth centuries, women were admitted at disproportionately high rates. Women who diverged from traditional domestic roles, exhibited emotional expressiveness, independence, or were deemed unmanageable were quickly labeled insane and institutionalized without thorough assessment. Often, these women were hospitalized due to social nonconformity, issues like marital conflicts, poverty, or language difficulties, rather than genuine mental illness. These patterns highlight how psychiatric institutions served not only as medical tools but also as mechanisms of social control, with the pathologization of women’s behavior influenced by a male-dominated authority. This dynamic resulted in a higher rate of institutionalization among women whose actions challenged gender norms. A pattern of social regulation is evident in the way individuals engaging in same-sex relationships are treated, with sexuality often seen as a psychiatric disorder rather than a valid aspect of identity. Between 1910 and 1935, society regarded homosexuality as a fluid identity that could be altered through treatment. Due to this perception of same-sex relations, families and clinicians often chose institutional care for individuals experiencing conflicts with their same-sex desires. Many men were committed due to family pressure, reflecting how homosexuality, like women’s nonconformity, was seen as a deviation needing medical intervention. Early psychiatric institutions played a role in the historical mistreatment of LGBTQ people by pathologizing their identities and reinforcing the notion that deviation from heterosexual norms indicated mental illness, subjecting them to harsh and neglectful treatment in asylums.
Undercover journalism Alongside the 1973 academic investigation by
Rosenhan and other
similar experiments, several journalists have been willingly admitted to hospitals in order to conduct
undercover journalism. These include: •
Julius Chambers, who visited
Bloomingdale Insane Asylum in 1872, leading to the 1876 book
A Mad World and Its Inhabitants. •
Nellie Bly, who admitted herself to a mental institution in 1887, leading to the work
Ten Days in a Mad-House. • Frank Smith in 1935 admitted himself into a
Kankakee hospital, leading to the articles "Seven days in the Madhouse" in the
Chicago Daily Times. • Michael Mok, who investigated similarly in New York 1961, winning the
Lasker prize. • Frank Sutherland, who received coaching from a psychiatrist in order to accurately feign symptoms, and spent 31 days in late 1973 to early 1974, leading to a series of articles in the
Nashville Tennessean. • Betty Wells, who investigated in 1974, with the articles titled "A Trip into Darkness" for the
Wichita Eagle.
Undercover journalism has played a role in highlighting issues in psychiatric care and advocating for people with mental illness. These investigations revealed conditions that included instances of abuse, neglect, and dehumanization. By reporting on social control, physical abuse, and the overrepresentation of marginalized communities in admissions, the coverage questioned the fairness of current institutional practices. This journalistic work contributed to changing public perceptions, supporting advocacy for patient rights, and promoting discussions around deinstitutionalization and improvements in psychiatric treatment. == Criteria ==