Dr. Cassandra Clark, "Landscapes of the Mind" (Season 2 Ep. 4 - Part 2)

**Brad Westwood** (0:09)
Welcome, this is Brad Westwood, and you're listening to the podcast Speak Your Piece. This is the second half of our podcast where we are talking to Dr. Cassandra Clark about mental illness in the Western States and also Utah.
Welcome back, Cassie.

**Cassandra Clark** (0:26)
Thank you, I'm glad to be back.

**Brad Westwood** (0:29)
Cassie, in the previous segment, we were talking about this ideal and how it actually occurred in the treatment of the mentally ill. We're moving in a time in the 19th century where the institutions of first insane asylums and then later they're changed to state hospitals. There's this constant changing. But for a good, what, 75 years, the way you treated the mentally ill was through institutions, large state-run institutions.
Tell me more about that. Just how did the whole institutional idea take hold and stay so stable for so long?

**Cassandra Clark** (1:14)
So in the pre, so before the Civil War, as I mentioned previously, Dorothea Dixon, Thomas Stroy Kirkbride, as well as a whole bunch of reformists, pick up on this broader movement in America that there is a way to perfect society by instituting state-funded institutional type things. So even like the ideas of prisons in the 19th century are not the same as even the way that we would identify them today. They were seen more as rehabilitative as opposed to just places where people who have committed criminal acts are removed from society.

**Brad Westwood** (1:52)
And punished.

**Cassandra Clark** (1:53)
Yes, and so how institutionalization plays a role is a lot of reformists believe that the reasons why people had a mental illness before the Civil War, and even a lot of people afterwards, they believe that people were like that because they were exposed to very severe negative consequences of industrialization or maybe grew up in bad homes or something like that. And that if they remove them from the negative environments in which they lived, they could help them to develop the skills needed to eliminate their mental illness. The one thing to emphasize that they didn't believe, most people did not, and Kirk Bright himself, and as well as Orson Fowler, who was the phrenologist that we mentioned earlier, did not promote the idea of environmental determinism. So it's not like you were a product of your environment. It was more your environment influenced you or exacerbated issues that you already had. And that by removing you from that environment, you could give people the skills to be able to better develop themselves better. And that is one thing, one vein that I see that runs across the medical communities as well as phrenologists and eugenicists later on in the century, is this idea that environment can exacerbate issues. And by removing someone from a specific negative environment, like a very dirty city, like a very poor place that had no windows and had no access to adequate food or air or something like that would make their situation worse.
And so creating these institutions pops up, they begin dotting throughout the United States during the 1840s.
And then by the late 1800s, these institutions are on their way, they have developed a bad reputation by the end of the 1800s.

**Brad Westwood** (3:43)
So they're not this ideal, idyllic setting of health and fresh air.

**Cassandra Clark** (3:48)
I think that they are, to be honest, if you look at designs of Insane Asylum's back east, even the ones that are in the Intermountain West, Utah's original Insane Asylum, even if you go to the state hospital now, which is where the original Insane Asylum was in Provo, the grounds are very well designed. It is a very peaceful place to be.
But the problem is, as I mentioned earlier too, is overcrowding. And so these institutions do not function ever the way that they're supposed to.

**Brad Westwood** (4:18)
So there's always this struggle between the medical and psychological community who's trying to take care of people and really create ideal environments. And then there's just a lack of funding and constant overcrowdedness.

**Cassandra Clark** (4:32)
And attitudes, definitely. And attitudes by people in society who see, overwhelmingly over time, view people with insanity as something that they just have, as something that is chronic or inherited, and that they need to be removed from general public. And a lot of times, I mean, I don't want to make it seem like everybody who's in insane asylums are like these innocent people who don't deserve to be there. A lot of times they really did need to be there. Like they had, they did have tendency towards violence, or they did have, they had done something that was, that scared their family members or their communities, and they needed to be removed.