One of the oldest mental hospitals in the US is the still-standing Friends Hospital in Philadelphia. Founded in 1813 by Quakers, the institution did not always have such a brief name. It was originally the Asylum for Persons Deprived of the Use of Their Reason, and it sought to house and treat the severely mentally ill. For much of the 1800s, institutions like this were a common sight in communities including Portland. They eventually gave way to much larger, warehouse-like institutions, which in turn were shut down in the mid-20th century. This is a primer on how we got to where we are today: a country that once locked away the severely mentally ill, to one that now sees them, daily, on the street.

The House of Hawthorne

In the US, the earliest attempts at grappling with mental health were not really about treatment. They were about sequestering the mentally ill away from society at large.

“People with mental health issues were put in courthouses or jails, and just left to vegetate there,” says David Pollack, a professor of public policy at Oregon Health and Science University’s Department of Psychiatry, and former Medical Director for the Office of Mental Health and Addiction Services in the Oregon Department of Human Services. According to Pollock, medical facilities in early America were not much better. Poor conditions in existing facilities led to a reform movement for safer, regulated government facilities.

One notable advocate in the early 1800s for better mental health treatment was Dorothy Dix.

“She was appalled by the conditions she saw,” says Pollock, “so she went with colleagues to 37 state legislatures and convinced them to build hospitals to care for people. These were the asylums.... Then she convinced Congress to pass a similar bill. That bill passed, but it was vetoed by Franklin Pierce prior to the Civil War, because he was concerned about pushback from advocates of state’s rights. Federal involvement in mental health policy was set back by a century.”

Despite the lack of federal involvement, though, state hospitals cropped up throughout the country. Oregon’s first go at housing the mentally ill was the Hawthorne Asylum near what is now Southeast 12th and Salmon.