Mental Institutions in America: Social Policy to 1875 examines how American society responded to complex problems arising out of mental illness in the nineteenth century. All societies have had to confront sickness, disease, and dependency, and have developed their own ways of dealing with these phenomena. The mental hospital became the characteristic institution charged with the responsibility of providing care and treatment for individuals seemingly incapable of caring for themselves during protracted periods of incapacitation. The services rendered by the hospital were of benefit not merely to the afflicted individual but to the community. Such an institution embodied a series of moral imperatives by providing humane and scientific treatment of disabled individuals, many of whose families were unable to care for them at home or to pay the high costs of private institutional care. Yet the mental hospital has always been more than simply an institution that offered care and treatment for the sick and disabled. Its structure and functions have usually been linked with a variety of external economic, political, social, and intellectual forces, if only because the way in which a society handled problems of disease and dependency was partly governed by its social structure and values. The definition of disease, the criteria for institutionalization, the financial and administrative structures governing hospitals, the nature of the decision-making process, differential care and treatment of various socio-economic groups were issues that transcended strictly medical and scientific considerations. Mental Institutions in America attempts to interpret the mental hospital as a social as well as a medical institution and to illuminate the evolution of policy toward dependent groups such as the mentally ill. This classic text brilliantly studies the past in depth and on its own terms.

Elizabeth Packard's story is one of courage and accomplishment in the face of injustice and heartbreak. In 1860, her husband, a strong-willed Calvinist minister, committed her to an Illinois insane asylum in an effort to protect their six children and his church from what he considered her heretical religious ideas. Upon her release three years later (as her husband sought to return her to an asylum), Packard obtained a jury trial and was declared sane. Before the trial ended, however, her husband sold their home and left for Massachusetts with their young children and her personal property. His actions were perfectly legal under Illinois and Massachusetts law; Packard had no legal recourse by which to recover her children and property. This experience in the legal system, along with her experience as an asylum patient, launched Packard into a career as an advocate for the civil rights of married women and the mentally ill. She wrote numerous books and lobbied legislatures literally from coast to coast advocating more stringent commitment laws, protections for the rights of asylum patients, and laws to give married women equal rights in matters of child custody, property, and earnings. Despite strong opposition from the psychiatric community, Packard's laws were passed in state after state, with lasting impact on commitment and care of the mentally ill in the United States. Packard's life demonstrates how dissonant streams of American social and intellectual history led to conflict between the freethinking Packard, her Calvinist husband, her asylum doctor, and America's fledgling psychiatric profession. It is this conflict--along with her personal battle to transcend the stigma of insanity and regain custody of her children--that makes Elizabeth Packard's story both forceful and compelling.