Nineteenth-century state mental hospitals across New England and the United States are linked today with images of confinement, forced treatment, torture, abandonment, and family separation. This project does not directly challenge those associations. An ethnographic study in medical anthropology, this study is based on three years of fieldwork observations and qualitative interviews with neighbors, townspeople, former employees, and visitors to the open campus of a decommissioned state mental hospital in Massachusetts. Excavated from that hospital’s annual reports dating back to 1896 and gathered from local memories and storytelling, this projects considers the central place that work once held in the lives of psychiatric patients at Medfield State Hospital and the place that idleness holds for patients living within today’s institution of community care. Participants’ memories track the shifting perceptions and meanings of mental illness that resulted once “industrial therapy” programs were ended in state mental hospitals. This inquiry describes the ways that the loss of work changed psychiatric patients’ experiences of suffering, promoting the use of new chemical treatments, accelerating deinstitutionalization, and catalyzing new patterns nationally of service utilization and psychiatric disability. From participants’ memories and the author’s reflections on clinical practice as an independently licensed social worker (LICSW) in Massachusetts, this analysis uncovers the social functions of staying sick within contexts of unequal opportunity and joblessness. This study reveals the complicated and punishing work of surviving and helping people survive across de-industrialized landscapes as mental health practitioners assist the disenfranchised by recasting social suffering into psychiatric illness with treatment-induced embodiments that simultaneously help to manage poverty and perpetuate risk within disabilized citizens.

The problem with which this study is concerned is that of ascertaining the effects of intensive Remotivation Techniques on institutionalized geriatric mental patients in terms of their ward behavior, self-concept, and visual-motor perceptions and to compare these with the effects of a similar group experience that does not emphasize patient-staff or patient-patient interactions, and a third group which acts a a control. The investigation is designed to answer or obtain information concerning the following questions: (1) Do institutionalized geriatric mental patients in a state mental hospital manifest measurable changes in terms of their (A) ward behavior as defined as raw scores on the Hospital tment Scale (including interpersonal communication and interpersonal relations; self care and social responsibility; level of participation in ward activities, recreation and work therapy; total score), (B) self-concept as defined as Goodenough raw scores on the Draw-a-Person Test, and (C) awareness of environment as defined as Pascal and Suttell raw scores on the Bender Visual-Motor Gestalt Test, as a result of experiencing the social and verbal interactions of intensive Remotivation Techniques? (2) Is the Remotivation Technique more effective in producing these changes than a similar group experience that does not emphasize social and verbal interactions?