Hospitals For Sale, Very Cheap?

The article, “Where Asylums Live On,”  in the Sunday Magazine of the New York Times,  from November 1, 2013,  offered a reprise of the history of “insane asylums,” or state psychiatric hospitals in the U. S. that previously dominated inpatient psychiatric care for the better part of an entire century. The decommissioning of scores of state hospitals began in the second half of the 20th Century with the shift in emphasis to “de-institutionalization” of the chronically mentally ill to outpatient settings. This NYT article reveals the typical state of inpatient psychiatric care in the Third World where many countries currently rely on the old model of institutional public psychiatric hospitals for their national systems of psychiatric care.

There are now so many state hospitals closed in this country since especially the 1980’s or so, that there are websites devoted to their history [such as Historic Asylums of Amercia], archival historical photographers have documented their settings for posterity, and some organizations have adopted these institutions and offer “state hospital” tours and vacations for the psychiatrically curious. [I can just see myself NOT taking my family to another state’s abandoned state hospital campus and enjoying the view, isolation, gutted ruins and what not.

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Tobacco Free Hospitals 150 Years Ago!

As a physician and psychiatrist, I have never been a smoker although I have ironically known two oncologists who were heavy smokers (go figure!).

When I am admitting patients to any hospital I have worked within, for the last 30 years, I always answer somewhat bluntly, “I am a doctor, I am death on smoking,” when patients (even now still!) ask me if they could smoke in the hospital.

All joking aside, I trained at Duke Hospital decades ago. I became curious about the history of the tobacco industry as tobacco was grown everywhere in North Carolina and a huge part of the agricultural economy back in those years. I read up on the history of Duke Hospital, its origin with the Duke family and the incredible monopoly the Duke family had on the tobacco industry that was one of the strongest monopolies in this country until the mid 1900’s. I learned that one of the “Duke boys,” my faulty memory says it was James Buchanan Duke III, early on realized they apparently had unleashed a desecration on the nation’s health and dissolved the Duke family’s monopoly breaking up the then American Tobacco Company and moving the family out of the business. That prescient move many decades ago, would be kin to the Royal Saudi family moving the royal family out of oil production!

The many billions that they had earned in those days made the Duke Foundation one of the largest in the world at the time and it still is. From then on the Duke Family and Foundation devoted itself to philanthropy often in health care. For instance the Foundation funded the hospital for the Eastern Band of Cherokee Indians in western North Carolina, and, has continued to fund health care initiatives such as the Women’s and Children’s health services and a beautiful health clinic for just that patient population.

Ironically, I chanced upon a book from an obscure eReader book compendium which I thought would be entirely about my current interest in the history of the state psychiatric hospital movement in this country. [To warn the readers, that will start to be one of my subjects I will cover over time in this blog in the coming months, in order to set the stage for an ongoing discussion and analysis of the failed historical [and present efforts at mental health reform in this country].

The book I downloaded is an oldie entitled: Rules and Regulations of the Insane Asylum of California Prescribed By The Resident Physician, August 1, 1861. Stockton; Armor and Clayes, Printers, 1861.  Believe it or not that is apparently how some book titles were required to appear following some arcane long lost “style rule set” that I think is quite cool, neat, concise and tells you everything you need to know.

A bit of explanation is in order. We think of resident physicians these days as young apprentice physicians who have graduated from medical school and are pursuing their specialty training, such as in internal medicine, surgery, pediatrics, psychiatry, etc. But a “Resident Physician” in those state hospital days were the head boss doctor who LIVED at the out of the way state psychiatric hospital. So the “Resident” was today’s chief of staff. To quote: The Resident Physician, who shall also be the Superintendent, shall be the chief executive officer of the Asylum…” (pg. 1-2).

If you were to obtain this rather quaint and frankly “cute” book as it is quite entertaining to read with all its formal language, you would be most favorably impressed by the comprehensive prescribed confidentiality rules who were most detailed and quite zealous thoroughness in the preservation of respect for the patients! But to the point at hand, on “point” 12, this amusing yet instructive document states:  “…the patients are not allowed the use of tobacco, within the Asylum, the employees are expected not to use it, in any form, in their presence.”

So there we have hit, “state hospital ‘asylums for the insane,'” were tobacco roughly 130 years before modern day hospitals moved ban tobacco and smoking from their premises. I was somehow historically pleased…