Forced Institutionalization
Although substantial progress had been made to improve the treatment of individuals with mental illness since the late 1800s, by the 1950s it was still acceptable to delegate decision-making over the placement of mentally ill individuals to doctors and even the public. In addition to voluntary commitment, Texas had three pathways for involuntary commitment at mental institutions: temporary commitment by a judge, indefinite commitment by a jury, or emergency admission by a doctor.
Many people were admitted to hospitals for medically unnecessary and abstract reasoning, i.e., simply because a doctor or judge signed off on the paperwork. Some parents abused this process to commit their "morally delinquent" children to the care of the state. Additionally, public stigma and intolerance for mental conditions, xenophobia, and racism resulted in unjustified, unnecessary commitments by juries.
Patients that were committed to institutional care were fully deprived of their civil rights. They could not vote or incur debts, nor enter into contracts. When families could not or refused to bear legal responsibility for the patient, the responsibility of guardianship was often shifted to the institution's superintendent, leaving the door open for unchecked abuse. Many patients were made to perform unpaid labor at their institutions, being subject to excessive sedation and other non-consensual procedures, and stripped of their identity with uniform smocks. They were subjected to a strict, military-like schedule, and punished for being late or refusing to partake in the day's activities.
Each mental institution had its own culture and set of unwritten rules that patients were forced to assimilate into. At the Texas State Lunatic Asylum (now the Austin State Hospital), the threat of medically unnecessary electro-shock was sometimes used to discipline unruly or unsubmissive patients. "Good patients" received placement in better wards with more access to doctors, while "bad patients" were stuck in the back wards with little access to doctors and a diminished social status at the institution. There was a feeling of superiority among patients in the good wards, who often distinguished themselves from the "crazy people" in the back wards.
Treatments at the institutions were not uniform and depended heavily on the personal judgements and beliefs of the attending physicians. Patients were subject to experimentation with new medical techniques without informed consent. In the Certificate of Medical Examination displayed above, a doctor in the 1970s documents his use of chemotherapy on a patient with schizophrenia, despite decades of research on the effectiveness and safety of other, less harsh drugs on patients with schizophrenia.
Patients involuntarily committed to state institutions were subject to denials of their civil liberties, extreme medical paternalism, and human rights violations. Thankfully, the wrongs perpetuated in the institution began to come to light through the work of mental health organizations and prodding journalists, which set the stage for meaningful reform.