Should We Reopen the Asylums?

Christopher Payne
An abandoned ward at Kankakee State Hospital, Illinois; photograph by Christopher Payne from his book Asylum: Inside the Closed World of State Mental Hospitals, 2009

In 1939 the British physician Lionel Penrose published an article that described an inverse relationship between prisons and asylums—the so-called Penrose Hypothesis. Widely respected in medical circles for his pioneering work on Down syndrome and other hereditary disorders, Penrose was better known for applying mathematical formulas to nagging social issues. Using statistics gathered from eighteen European countries, he determined that the convict population in a given locality went up or down depending on the number of occupied psychiatric beds. As one group grew in size, the other declined at a similar rate.

The article didn’t make much of a splash. A world war intervened, and Penrose moved on to other things. (His much-discussed Penrose Method, devised in 1946 to aid the formation of new international bodies, called for voting rights based on the square root of a nation’s population.) Upon his death in 1972, the Penrose Hypothesis was little more than a footnote to a brilliantly eclectic career.

Times have changed. In recent decades, studying the relationship between prisons and asylums has become something of a cottage industry for social scientists interested in the impact of “deinstitutionalization,” a term commonly applied to the widespread closing of state mental hospitals. It’s no secret that the number of institutionalized psychiatric patients in the United States has dropped precipitously in the past fifty years, while the nation’s prison population has exploded. At first glance, mass incarceration appears to have filled the void created by the virtual abandonment of our asylums—the Penrose Hypothesis writ large. A mentally ill American today is “far more likely to be treated in jail or prison,” a Stanford Law School study concluded, “than in any healthcare facility.”

The cruel irony is that America’s asylums were created, in large part, to separate the insane from the criminals and prostitutes who constituted the “unworthy poor.” There is no better example of this than nineteenth-century New York City, where large sums were expended to build a cluster of distinct institutions on a deserted spit of land known as Blackwell’s (now Roosevelt) Island. Opened in 1839, Blackwell’s would eventually house multiple asylums, prisons, workhouses, and hospitals. By law, “lunatics” in New York could no longer be confined with “any person charged with, or convicted of, any criminal offense.”

The new asylums, purposely designed to “be as little like the Penitentiary as possible,” contained tidy single rooms with few physical restraints. Blackwell’s seemed a reformer’s paradise—a place of justice and healing, where idleness was forbidden and the word, and fear, of God prevailed. “Even the marginalized and maligned would have it better here,” writes Stacy Horn in Damnation Island, a searing account of good intentions gone awry. “What could be more restorative…than the peaceful,…


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