DM: Aside from the bad reputation that the asylums had gained, and the obvious inhumanity of the new methods adopted in the twentieth century, what else drove deinstitutionalization?
AS: The nineteenth century solution to the problems of criminality, poverty, and mental illness was to build big institutions, and that persisted well into the middle of the twentieth century. In New York state in 1950, if you looked at the state budget, 30% of it went to New York state's mental hospitals. They were a huge expense. There were conferences of governors in the late '40s and '50s, where they all asked, “What are we going to do? This is a huge problem.”
It was becoming more expensive, and thus a more pressing problem, for a couple of reasons. First of all, many of these institutions had been built 50, 100 years before and were decaying, particularly because they hadn't been invested in during both the Great Depression and World War II. Also, after World War II, union strength was growing. The attendants in the mental hospitals were unionizing. Work weeks had been 80 or 90 hours a week, and you lived on the premises. If you were an employee, you were trapped every bit as much as the patients. But now work weeks became 50 or 55 hours. That added to the expense of things.
There were also a lot of journalistic exposés of the mental hospital, later supplemented by the work of sociologists and anthropologists. Right after the war, a number of American journalists had been to the death camps in Germany and in what's now Poland. These returning journalists came back and visited America's mental hospitals and said, “These are America's death camps.” Due to the wartime shortages of food, attendants, and physicians, the hospitals were probably at the nadir of their status in those years. So Albert Deutsch, for example, was a journalist who'd written the first positive history of mental illness in America. He went around and produced a series of newspaper articles that were published in a book called The Shame of the States, where he explicitly compared what he'd seen to Belsen and Buchenwald. He wasn't alone in making that comparison.