The Political Economy of Madness: The Expansion of the Asylum in Progressive America

In the United States between 1880 and the 1920s, unprecedented numbers of people were confined in mental hospitals, leading many contemporary observers to conclude that the nation was experiencing an epidemic of madness. I analyze the expansion of asylums as a product of organizational and political forces rather than an increase in insanity. The analysis is based on Grob's (1983) historical argument that asylums were forced to absorb increasing numbers of the aged poor who could no longer be confined in almshouses. This analysis is supplemented by a more comprehensive model that treats political factors especially the fiscal capacities of state governments and the role of political parties as fundamental determinants of institutional policy. This model is tested using longitudinal quantitative data for U.S. states. Results confirm the direct effects of almshouse capacities in an attenuated way, and show further that political organization influenced the production of insanity.