The History of Institutionalization in Maine. Part 1: The Promise and Failure of State Care (1820-1890)

Published: December 4, 2025

Brittany Lorance, Outreach Coordinator at CCSM

“The failure of state care was a betrayal of trust, turning a promised sanctuary into a site of suffering that would set the stage for decades of institutional trauma.”

The story of state-run psychiatric care is not one that begins with grand hospitals. It begins in the dark corners of the local almshouses and poor farms of early 19th-century Maine. Before the towering bricks of the Maine Insane Hospital (MIH) were even laid, this was how the state warehoused its most vulnerable citizens.

When Maine achieved statehood in 1820, its system for caring for the poor, sick, and mentally distressed was based on the principle of local responsibility. This took several forms.

Such as the pauper auction, where the town would literally auction off individuals who could not support themselves to the lowest bidder. To the person who would agree to care for them for the least amount of public money. This was done under a guise of compassion, but was simply legalized exploitation, forcing people who were mentally or physically disabled into a form of indentured servitude.

Imagine being stripped of your autonomy, your struggle with illness or disability laid bare before your neighbors. Imagine being a young widow, perhaps battling “melancholia” after a loss, or an elderly man with dementia, standing exposed in the town square with your body, your very existence, becoming an item on an auction block. You hear the shouts of men haggling over the price of your care, not debating what treatment you need, but how little money they can manage to keep you alive and useful. Every gaze is a judgment; every whispered bid seals your fate as a burden, purchased by a fellow townsperson whose only incentive is profit. This was not a medical transaction or an act of charity; it was public legalization of exploitation, reducing a human life to a cost-saving commodity. You were not a patient awaiting care; you were a piece of livestock being sold into servitude.

There were also town poor farms (Almshouses). These places were repositories for those that society deemed undesirable. Such as the elderly, the physically and developmentally disabled, the poor, orphaned children, and the “lunatic” or “insane.” These poor farms were run by local town officials whose primary goal was to save the taxpayer money, with little or no focus on therapeutic care.

Unlike the large, manicured, and architecturally hopeful State Hospitals of a later era, the town poor farm was usually nothing more than a large, run-down farmhouse adapted to house as many people as possible. There were no specialized wards; instead, you would find crowded, common rooms with thin beds lined up end-to-end. For the “lunatic” or “insane,” specific confinement was often relegated to the cheapest, most isolated spaces, such as small, unheated wooden outbuildings, dank cellar rooms, or hastily converted sheds on the property. These structures lacked any medical or therapeutic design, they were built only for containment and cost savings.

The conditions in these facilities for those suffering from mental distress were often horrific, setting a tragic precedent for what was to come. Patients suffering from acute episodes or behavioral challenges were not treated, they were isolated. Accounts from the era describe individuals kept in cages, cellars, outbuildings, or small, windowless cells on the poor farm property. The lack of heat, sanitation, and human contact was deliberate, a form of crude containment and isolation.

Being committed to an almshouse was a total loss of dignity. You were a pauper, a public burden. The lack of care and hygiene was often viewed as a consequence of the patient’s own moral failing, making cruelty easy for keepers.

For women, often struggling with postpartum depression (then called “puerperal insanity”) or the mental strain of an abusive life, the poor farm offered no relief, only deeper isolation and control by male overseers.

It was against this backdrop of widespread, sanctioned abuse that work of reformers like Dorothea Dix took hold. Having investigated jails and almshouses across New England (and a native of Hampden, Maine, herself), Dix saw the atrocities committed against the “indigent insane.”

She lobbied state legislatures, arguing that the state had a moral and medical obligation to provide a humane alternative. The creation of the Maine Insane Hospital in Augusta (later called the Augusta Insane Asylum), opening in 1840, was heralded as a victory, a sanctuary built on the promise of Moral Treatment. The state was finally stepping in to save its citizens from the horrors of the poor farm. But, as we will see, the promise of state care would soon give way to the same failures as the system it replaced.

The philosophy of Moral Treatment was a stark rejection of the brutality of the almshouse. It rested on the belief that mental health concerns were a treatable disease, not a spiritual curse, and that recovery depended on humane, therapeutic engagement.

For the first few years, patients and their families believed they were receiving sanctuary based on the principles of non-restraint, structured routine, tranquil environment, and individualized care.

This was supposed to look like the use of mechanical restraints (shackles, chains, cages) largely being abandoned. Dignity was to be paramount. The patient was to be treated as a suffering individual, not a criminal.

Patients were supposed to have a highly organized daily life, including walks, light labor, reading, and moral instruction. Which was meant to re-establish order in the mind. The goal was to distract the patient from their distress.

Hospitals were deliberately built in pastoral settings (like the bank of the Kennebec River in Augusta) to provide a restful, aesthetic environment away from the stresses of urban life. Hospitals were originally to be set up with a high ratio of dedicated staff who were essential to provide one-on-one attention, counseling, and medical supervision.

For a time, the MIH was a genuine source of pride and hope. Maine was committed to providing a cure, not just confinement. Unfortunately, the noble ideal of Moral Treatment was rapidly extinguished by a grim, predictable reality: The State refused to adequately pay for it.

The period from the 1850s onward saw the promise of the MIH quickly devolve into a nightmare of warehousing, and the systemic mistreatment of patients became unavoidable. The most powerful force destroying the MIH was overcrowding driven by inadequate legislative funding.

As Maine’s population grew and more citizens were deemed “insane” (often because they had no family to care for them), commitment rates soared. By the 1870s, the MIH was constantly operating at far above its intended capacity.

State budgets for the hospital were chronically insufficient. Rather than building new, properly staffed facilities or funding the required number of attendants, the legislature chose the path of least resistance: stuffing more people into existing wards.

One of the keys to Moral Treatment is individualized attention and that had vanished. Attendants became drastically outnumbered. A single, poorly trained attendant might be responsible for controlling, feeding, and supervising dozens of acutely ill patients.

With staff overwhelmed and Moral Treatment impossible to administer, the hospital reverted to the methods it was founded to abolish. The focus shifted entirely from rehabilitation to custodial control. The only way to manage large, restless, and distressed populations with minimal staff was through coercion, restraint, and chemical suppression.

Physical restraints returned as standard practice. Straps, cribs, camisoles (straitjackets), and locked cells became the tools of the understaffed attendants. This was not the attendants’ failing alone, it was the inevitable result of a failed system that demanded order without providing the resources for humane care.

Mistreatment wasn’t always a malicious act; often, it was simply negligence. A patient left alone for hours in a soiled bed, a fever going unchecked due to limited staff oversight, or a hungry individual overlooked during a hectic mealtime.

For the patients trapped within those walls, the environment was indistinguishable from a prison. They were no longer the recipients of a hopeful, new medical science, but objects to be managed. The failure of state care was a betrayal of trust, turning a promised sanctuary into a site of suffering that would set the stage for decades of institutional trauma.

By the late 19th century, the hospital’s administration realized they could use the massive patient population to offset crippling operating costs. The hospital farm and maintenance departments became entirely dependent on uncompensated patient labor.

The MIH was entirely self sustaining and maintained large farmlands, livestock, and the sprawling gardens necessary to feed hundreds of patients and staff. Instead of hiring adequate staff, patients were compelled to do the back-breaking, full-time labor: plowing, harvesting, tending animals, and preparing food.

This labor was always justified publicly as “therapeutic” or “useful occupation.” However, the patient’s perspective tells a different story. It was mandatory, uncompensated, and often performed under strict, non-therapeutic conditions that resembled indentured servitude.

The state essentially created a system where the hospital’s financial survival was prioritized over the patient’s recovery. The patients became the unpaid workforce that kept the institution running, a form of economic exploitation hidden under a medical veneer.

For the patients forced into this system, the “cure” felt like a continuation of the oppression they faced outside the hospital. The work was often monotonous, dangerous, and performed under constant supervision, removing the very dignity that Moral Treatment was supposed to restore.

Unlike paid staff, the patients had no say in their tasks and received no wage. Refusal could, and often did, lead to punishment, including isolation or physical restraint, demonstrating that this was coerced labor, not free choice.

The more productive the patients were as laborers, the less incentive the hospital had to discharge them. The labor kept the institution financially stable, creating an insidious cycle that ensured patients remained confined. The work was not designed to send them home; it was designed to keep the hospital solvent.

The story of Maine’s first venture into state-sponsored psychiatric care is a tragic narrative of betrayed hope. The founding of the Maine Insane Hospital was proclaimed as a sanctuary built to replace the cruelty of the past. Yet, by the end of the 19th century, the MIH had become precisely what it was created to abolish, a massive, cold institution of custody, confinement and isolation.

The system was broken not by a sudden shift in philosophy, but by chronic neglect from the state government. The refusal to properly fund the staff and resources necessary for genuine Moral Treatment led to inevitable outcomes.

The idea of individualized care was drowned by overcrowding, resulting in a profound loss of dignity and frequent neglect for those trapped inside. The virtuous goal of therapeutic labor devolved into forced, unpaid servitude on the hospital grounds, keeping the institution solvent while trapping patients in a cycle of confinement.

The 19th century in Maine established a destructive pattern where institutionalization became the default response to mental health concerns, poverty, and social deviance. As we turn to the 20th century in Part 2 of this series, we will see these issues of overcrowding and chronic underfunding deepen, leading to the construction of sister institutions like the Eastern Maine Insane Hospital (later Dorothea Dix Psychiatric Center) and the rise of new, often controversial, methods of control and treatment that would define institutional life for decades to come.

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For further information, please reach out to us at info@maineccsm.org or contact Brittany at blorance@maineccsm.org

Consumer Council System of Maine: A Voice For Consumers of Mental Health Services

Phone: 207-687-6035

Website: https://maineccsm.org/hopefulhorizons/