Am J Psychiatry 1992; 149:1526-1533
Copyright © 1992 by American Psychiatric Association
A historical perspective on the role of state hospitals viewed from the era of the "revolving door"
JL Geller
Department of Psychiatry, University of Massachusetts Medical Center, Worcester 01655.
OBJECTIVE: By focusing on the functioning of a state hospital throughout
its existence, the author provides a historical perspective on the nature
and causes of "revolving door" admissions. METHOD: Northampton State
Hospital was chosen as a prototype, and data on characteristics of patients
and patterns of hospital utilization were analyzed from three 10-year
periods: 1880-1889, 1930-1939, and 1980- 1989. The data for the first two
time periods came from the hospital's admission and discharge logbooks and
its annual reports; the material for the most recent decade was obtained
from unpublished yearly reports generated by the hospital's medical records
department. RESULTS: The hospital operated very differently in each of the
decades analyzed, but only in the 1980s was recidivism a major finding.
This was not, as has often been thought, due to problems or populations
unique to the state hospital in the 1980s nor to the fact that in earlier
eras the state hospital rarely discharged patients. The once-large asylum
has been replaced by a facility rapidly admitting and discharging patients,
many of whom have accumulated more than 10 lifetime admissions, in a
pattern of care not previously noted. CONCLUSIONS: State hospitals have
functioned in different yet questionable ways throughout their history.
Their current role of providing a revolving-door pattern of care to a
considerable population is rooted in a contemporary shift in ideology. This
role for state hospitals appears to make no more sense than did their
earlier role as neglected and neglectful asylums, and it should be
reevaluated.
