Forced Institutionalization

Life On The Wards: Back Wards

A photograph of one of the back wards at Austin State Hospital. Back wards were reserved for patients who misbehaved or who were deemed to be incapable of making progress with their treatment.

Behind the Scenes in a State Hospital

A 1956 Texas newspaper article criticizing the use of a jury to commit individuals to state mental institutions.

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.

72 Years in a State Hospital -- And She Was NEVER CRAZY

A 1956 Texas newspaper article about unnecessary commitments to state hospitals. Describes instances of a woman who was committed to a state hospital for 72 years for no medically necessary reason, and of a Danish immigrant who was committed because he could not speak English.

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.

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.