In the spring of 1946, readers opening their copies of Life magazine saw a photograph of a large room that looked like a care facility (Fig. 1). The room was filled with a dozen randomly arranged metal frame beds and had no clear passage leading to the door. The bed sheets were untidy and crumpled up, and people seem to be lying in their beds. The room was barren, the floor was bare and dirty, and the walls had no decorations. The most striking and almost salvaging feature of the photograph was a bright ray of light shining through a large window, spotlighting a young man as if he were an unsung hero. His shirt sleeves were rolled up, and he was diligently mopping the floor.

Fig. 1
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Male patients in bed in ward at Byberry, Philadelphia State Hospital (Photo by Charles Lord, Swarthmore College Peace Collection, Swarthmore, Pennsylvania)

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Anyone intrigued by this photograph might have wondered where this picture came from, why the people in it were lying in bed in this dreary room, or why this young man was mopping the floor. Then the viewer would have recognized the title of the photograph, “Overcrowding,” and the accompanying caption, “At Byberry beds are jammed close together with no clear passageway to door in case of fire” (Maisel 1946, 105). The room was one of the wards at Philadelphia State Hospital at Byberry, a publicly-run psychiatric hospital in the City of Brotherly Love.

This photograph was an example of how the popular press used images as a powerful form of testimony in order to reveal the terrible conditions inside state hospitals. Asylum exposé photography began with an act of defiance by a Quaker conscientious objector. During World War II, Charles Lord worked as an attendant at Philadelphia State Hospital at Byberry, assigned to the men’s incontinent and violent wards. He witnessed how asylum residents were left to idle in dirty and overcrowded wards, given no clothes to wear, restrained for long periods of time with no explanation, and even struck by attendants (Taylor 2009, 206).1 In an Exchange Service newsletter article published on May 1, 1945, Lord described how “[a] plant of cabbage in a garden has nearly as much as social life as many of our patients.” These residents lived with no sense of the passage of time, as if they inhabited “the land of the living dead” (Records of the American Friends Service Committee, Swarthmore College Peace Collection). In order to let the outside world know about the asylum’s conditions, he sneaked an Agfa camera into Byberry and secretly took over one hundred photographs, despite the hospital ban on any unauthorized photography of the hospital grounds (Shapiro 2009).

As soon as the war ended, Lord’s photographs ignited a series of reform efforts aimed at improving asylum conditions. His images played a major role in gaining Eleanor Roosevelt’s support in 1945 and appeared on the front pages of various magazine articles, newspaper articles, and organizational reports such as Albert Deutsch’s PM newspaper exposé articles, Albert Q. Maisel’s Life article, and Frank L. Wright’s book Out of Sight, Out of Mind (Taylor 2009, 287). These articles started with such sensational headlines as “Horror Camp, U.S.A.: 4-Page Picture Story of a ‘Madhouse,’” “Filth-Infested Byberry Cured Only Two Out of 5900 Patients in Year,” and “Bedlam 1946: Most U.S. Mental Hospitals are a Shame and a Disgrace” (Deutsch 1946a; 1946b; Maisel 1946). In these articles, photography—somewhat reminiscent of the recently published images of the Nazi concentration camps—served as concrete evidence intended to shock the public into action. As a result, these exposés helped the enactment of the National Mental Health Service Act and the Hills-Burton Act, which stimulated mental health-related research and increased availability of hospital-based care. However, despite the legislative achievements made in the 1940s, their reform efforts were short-lived. Another form of mental health lobbyism in the 1950s gained more public support, which aimed to reduce the number of publicly run psychiatric hospitals by deinstitutionalizing asylum residents (Grob 1991; Parsons 2018; Scull 1984).

Despite well-intentioned goals, these exposé photographs had the unintended effect of portraying asylum residents—especially women and African Americans—as unsettling, anonymous others whose long-term institutionalization was an additional exclusion from the body of the citizenry, signifying their socially dead status. For example, journalist Albert Deutsch frequently mentioned how attendants gathered naked asylum residents together, treating them as if they were animals (1948, 42). His writing was meant to sell a sensationalistic narrative, ultimately aiming to win the public’s approval for improving asylum-based care. He hoped that a series of reforms would transform asylums into hospitals. Thus, he meant to use the photographs of restrained women with no treatment, therapy, or recreation to argue that they deserved medical care so that they could eventually live outside as productive members of American society (Rose 2017). However, these photographs of asylum residents in physical restraints communicated what I call a “visual rhetoric of unfreedom” that elicited a powerful emotional reaction in readers, forcing them to question the validity of the asylum system itself.

Another unintended effect of the photographs was to render the asylum residents as less than human in the eyes of the readers. The editors of the exposé articles blackened the faces of the asylum residents to protect their identities. Unfortunately, this humanitarian consideration made it impossible for viewers to connect to the men and women held in asylums as fellow human beings through facial expressions. Although the text of these exposés reminded readers that asylum residents were fellow human beings who deserved to rejoin the community after receiving appropriate psychiatric treatment, a repellent emotional response associated with looking at censored faces, which I call a “visual rhetoric of anonymity” contradicted this message, suggesting that the asylum environment was so dehumanizing that it was impossible to portray those residing within it without inciting the readers’ sense of repulsion. Thus, while these articles conveyed their intended political goal, they simultaneously may have had a contradictory effect on the general public, encouraging them to view asylum residents as unsettling others. When applied to Black asylum residents, the dehumanizing rhetoric revealed them as not only unsettling but also socially vulnerable racial others. These exposé articles undeniably had a large influence on the popular discourse of asylums, but their reform oriented goals did not succeed in improving asylums.

In examining these exposé articles, the existing scholarship has focused on how reformers’ efforts contributed to bringing asylums to the public’s attention. While also noting the significant role photographs played, they have tended to pay closer attention to the written content of the articles. The photographs served as powerful auxiliaries to the texts they accompanied, reinforcing the message conveyed to the public (Grob 1991; Parsons 2018; Taylor 2009). However, this essay will demonstrate that there was a complex relationship between the written and visual rhetoric in postwar asylum exposé articles. In so doing, I apply theories from disability studies to demonstrate how photographs can perpetuate certain stereotypes of disabled people as being fundamentally different from the rest of society (Bogdan 2012; Garland-Thomson 2001; 2005; 2009). While we perceive photography as an objective tool that creates a facsimile of truth, it often contains a particular visual rhetoric that reflects our conventional understanding of a photographic subject (Sontag 2003). For example, photographer David Hevey explains that the visual representation of disabled people, often created by nondisabled people, frequently stands as a symbol of “otherness.” A visible representation of a disabled person’s impairment in a photographic image functions as a rhetorical device that essentializes his or her status of non-integration into the rest of society (Hevey 2013, 433). Thus, in exposé photography, the asylum residents with their confiscated faces and restrained bodies become merely passive objects upon which their socially dead status could be displayed (Hevey 2013, 432). The exposé articles used photographs to elicit the readers’ sense of patriotic civic duty underlined by pity and charity (Longmore 2016). In this process, the reformers objectified asylum residents’ bodies as mere vehicles for the promotion of their political message. However, due to their sensationalistic tone, the articles inadvertently bolstered the public’s sense of fear regarding disabled or mad people.

In order to demonstrate how this humanitarian effort unintentionally had a stigmatizing effect, I will analyze six exposé photographs, categorizing them into a visual rhetoric of unfreedom and anonymity. Newspaper and magazine articles that included postwar asylum exposés were generally from mainstream, liberal-leaning, or local press who intended to initiate reform efforts through their publicity. The photographs I analyze here are from Life’s May 6, 1946 piece, “Bedlam 1946,” written by Albert Q. Maisel with photographs of Pennsylvania and Ohio asylums taken by conscientious objector Charles Lord and photographer Jerry Cooke respectively. “The Shame of the States” series written by Albert Deutsch ran between April 1947 and February 1948 in New York-based liberal newspaper PM. In addition to Charles Lord, this series used press photographers based in various cities, such as California-based Pulitzer-Prize winner, Joe Rosenthal. My work analyzes photographs taken by Marston Pierce in Michigan and Herman Seid in Ohio.2 Mike Gorman for The Daily Oklahoman ran a ten-part series on six asylums in Oklahoma between September and October 1946, which used images taken by staff photographer George Tapscott. Finally, I analyze a photograph taken by Lord that was included in educational materials issued by the National Mental Health Foundation. Some of this material was later published as Out of Sight, Out of Mind edited by Frank L. Wright. To analyze the emotional reaction of people viewing these asylum exposé photographs, I refer to Susan Sontag, whose encounter with the photographs of Nazi concentration camps left a considerable influence on her essays about photography (Sontag 2001, 19–20).

A visual rhetoric of unfreedom: restraining the “disobedient” female bodies

The postwar asylum exposé was a continuation of existing reform efforts that aimed to improve the quality of hospital-based care. By the late nineteenth century, county almshouses had become the principal institution for holding destitute, elderly people who were regarded as having chronic conditions. Muckraking journalist Nellie Bly’s New York World exposé on city-run asylums in New York led to a public outcry, and the 1890 New York State Care Act determined that residents were to be transferred to state hospitals (Oshinsky 2016, 175). The supporters of the act argued that state hospitals would provide better care, and other states soon followed New York. However, this transition also turned state hospitals into custodial care facilities, and they quickly gained notoriety as de facto asylums or even snake pits (Grob 1994, 121–27). This change was especially unwelcome by the older generation of doctors who believed that their profession was supposed to cure their patients by providing therapy (Dwyer 1987, 211; Tomes 1994, 309; Grob 1994, 124; Yanni 2007, 143). Reform efforts emerged in the early twentieth century aimed to improve the conditions of state hospitals. The most notable example was the work of Clifford W. Beers. Based on his experiences of abuse by staff in a private hospital and in a state institution where he had been a patient, he published A Mind that Found Itself in 1908 in an attempt to create a nationwide reform organization of asylums (Grob 1994, 152, 157). Beer’s work profoundly influenced Albert Deutsch, and he asked Beers to subsidize his history project, The Mentally Ill in America (Grob 1991, 73).

In published postwar exposé articles, numerous photographs and descriptions of restrained bodies turned them into symbols of how state hospitals had fallen from grace. The conditions of publicly run psychiatric hospitals further deteriorated between 1930 and 1945. In 1931, there were 344,000 patients in federal, state, and county hospitals. By 1945, the number had increased by nearly fifty percent (Steckel 2006). State governments during this period focused on alleviating the Depression and participating in the war effort. Due to a lack of personnel, resources, and funding, the hospitals became overcrowded (Grob 1991, 71). Labor shortages in industrial sectors caused attendants to leave hospitals searching for better paying positions in other fields, while the armed forces recruited many physicians (Grob 1991, 72). As a result, the hospitals often resorted to hiring new attendants who would have been unqualified for the job during ordinary times. With less oversight by doctors, this severe personnel shortage caused some of the attendants to use mechanical restraints to control and discipline residents with the result that some residents continuously remained in restraints for weeks or longer (Taylor 2009, 221).

While psychiatrists frowned upon mechanical restraints as “barbaric” forms of control, the exposé articles reported on their rampant use by including multiple photographs of residents in cuffs and straitjackets. Dr. Sielke, the Byberry superintendent, clarified that this kind of mechanical restraint “should be taboo in any good mental hospital…It is a demonstrated fact that no form of mechanical restrain need be put on a patient in a well-functioning mental hospital.” He continued that “the only substitute for mechanical restraint is good, trained personnel. We haven’t enough attendants, so we are forced to use these things” (Deutsch 1946a, 11).

In the eyes of asylum reformers, non-CO attendants were the major culprits behind this rampant use of restraints. In 1944, a young conscientious objector named Robert Hegler was sent to Lewisburg Federal Prison in Pennsylvania after having gone AWOL. During the previous eight months, he had been assigned to the men’s disturbed ward in the VA Hospital Lyons in New Jersey and kept meticulous notes. Disturbed by his experiences in the ward, Hegler began to write officials to detail his concerns. In a letter addressed to Wilson H. Bent at the National Committee on Conscientious Objectors dated September 3, 1944, Hegler described fifty instances of attendant cruelty, including many cases that involved forcibly restraining residents: “15. A patient in a restraining sheet was hit by an attendant more than eight hours after the patient had hit another attendant.” Another incident read: “28. A patient was hit in the face several times in the process of being restrained, and was then kicked by one attendant while he was on the floor being held by another attendant” (Records of the Center on Conscience and War, Swarthmore College Peace Collection). In a letter dated September 28, 1944, Hegler described how on the second day of his assignment, he had witnessed a young WWII veteran bound with a sheet to a chair which was itself tied to a support column of the ward (Records of the Center on Conscience and War). Hegler, a journalism major, was eager to disclose the conditions at Lyons and began contacting journalists, including Albert Deutsch, who were working on reporting the treatment of injured veterans. After Deutsch’s PM articles on state hospitals were published, Albon Man at the Committee for Amnesty sent a letter to Deutsch on June 5, 1946, explaining that Hegler had gone on a hunger strike for over forty days and was demanding amnesty. He had subsequently been force fed (Records of the Center on Conscience and War).

Hegler’s attempt to document what he saw was not an isolated instance among COs. For example, because of Charles Lord’s secret photography, the COs assigned to Philadelphia State Hospital at Byberry led the most organized and influential effort to disclose the poor conditions inside the asylum.3 Journalists soon took notice of the Byberry investigation, and Albert Deutsch and Albert Q. Maisel—both of whom had attempted to cover mistreatments of soldiers in VA hospitals without much public traction—began working on revealing conditions of state hospitals. In these articles, reformers’ experiences of visiting or working in asylums drove the narrative. For example, Albert Maisel reported his observations in Life’s “Bedlam 1946” about how asylum residents lived in a fearful environment: “Hundreds are confined in ‘lodges’—bare bedless, rooms reeking with filth and feces—by day lit only through half-inch holes though steel-plated windows, by night merely black tombs in which the cries of the insane echo unheard from the peeling plaster of the walls” (Maisel 1946, 103). When Deutsch visited the wards at Byberry, he reported that “I was reminded of the pictures of the Nazi concentration camps at Belsen and Buchenwald” (Deutsch 1948, 42). While the photographs also served as a powerful tool for capturing the conditions of asylums, they could not convey the smell of an asylum ward (Taylor 2009, 249; Grob 1991, 75; Parsons 2018, 28). Deutsch described that “a fetid odor so heavy, so nauseating, that the stench seemed to have almost a physical existence of its own” (Deutsch 1948, 42). In a report titled “Reactions to Byberry” dated October 14, 1943, religious CO Roland Smith described how attendants sarcastically called the building housing the incontinent male ward the “Rose Garden” or the “Perfume Box” (Records of the American Friends Service Committee).4

At this time, print media was using the visual imagery of photographs as a powerful mode of communication capable of giving readers a visceral experience of a given subject matter. The combination of photographs alongside text articles became the dominant media for supplying news stories to Americans.5 In 1919, the tabloids newspaper the New York Daily News began using photographs as a tool for increasing the sensationalistic tone of its reportage. Other tabloids soon followed suite. They developed the strategy of including “scoop” images such as the secret photograph that captured the execution of Ruth Snyder, and they focused increasingly on news stories related to criminal activity or impoverished neighborhoods. As a result, the volume of photographs per newspaper increased by 205% in the 1920s (Kozol 1994, 26–27). However, magazines remained a more popular source of information. In 1947, the circulation of periodicals reached almost 400 million, three times as much as the circulation of daily newspapers (Field 2006). General interest magazines such as Fortune, Cosmopolitan, and the Lady’s Home Journal readily used photographic illustrations in a complementary capacity in their articles, whereas photo magazines like Life and Look used visuals as their primary mode of communication (Kozol 1994, 6). After publishing magnate Henry Luce took it over in 1936, Life became the most widely circulated picture magazine. Life’s readership between the 1940s and the 1950s reached about twenty million, while Look sold three million copies per issue (Kozol 1994, 5; New York Times 1948).6

The initial wave of the asylum exposé by Maisel, Deutsch, and Byberry COs had focused on covering the northern asylums, and because they proved to be so influential, the effort spread all over the country. Oklahoma-based journalist Mike Gorman and photographer George Tapscott—a former combat photographer who documented the liberation of the Dachau concentration camp—began investigating their local asylums for The Daily Oklahoman (The Oklahoma Journalism Hall of Fame 1999). When the team visited the seclusion cells for “violent female patients” at Central State Hospital at Norman, they documented the use of seclusion rooms, describing them as a horrific sight.7 An accompanying photograph taken by Tapscott reveals how Norman used multiple seclusion rooms to restrain the bodily movements of asylum residents.

In the photograph, there seem to be infinite rows of metallic barred doors in this corridor (Fig. 2). There is a fenced window at the center of this photograph, indicating that this is an austere space of incarceration. The juxtaposition of the doors gives an orderly impression at first sight, but upon close examination, the viewer of the photograph sees that the doors are not uniform. Each door seems to have undergone countless painting, patches, and repairs. The narrow intervals of the doorways tell that they lead to cell rooms. The lighting fixtures are barely there; there is only one bare bulb, and the viewer might wonder if any light reaches the cells. Because of the symmetrical composition of the photograph, the viewer might think it is a quiet, relatively clean space, but he or she cannot gain a sense of the smell or the sounds of the corridor from this visual representation. Two women wandering the seclusion ward are merely secondary elements in this distant-shot photograph. Their hair is cropped, and they are wearing baggy hospital gowns. Their appearance made for a stark contrast with the idealized images of femininity found elsewhere in the paper, such as a neatly trimmed White woman in an advertisement holding up a product (Sontag 2003, 33). One woman in the foreground of the photograph is cowering, and it seems to make no difference to her whether she is inside or outside of a seclusion room. Another older woman in the background seems to have a better awareness of her environment. She is looking inside a cell, but the viewer does not know why she is standing by the cell door. The viewer may wonder whether she is making sure that her friend in the cell is doing all right or whether she is simply watching the person inside.

Fig. 2
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Ward for violent female mental patients at Central State Hospital, Norman, Oklahoma (Photo by George Tapscott, U.S. National Library of Medicine, Bethesda, Maryland, Courtesy of The Oklahoman)

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The asylum staff used seclusion to discipline or manage asylum residents’ behavior which they regarded as disruptive. It was also meant to protect residents and staff from physical danger (Summers 2019, 164). Historian and psychiatrist Joel Braslow, who examined the use of somatic treatment in California state hospitals during the first half of the twentieth century, explains what doctors regarded as “bad behavior” on the part of female asylum residents was based on their gendered interpretation of proper female conduct. The more improper a woman’s behavior was, the more likely she was to be disciplined (Braslow 1997, 158). In The Daily Oklahoman article, Gorman argued that the seclusion rooms at Norman were primarily disciplinary in nature, detailing how the screams of the women asking to be let out echoed everywhere. He sympathetically describes how the sight was “enough to cause a sane person to break down”:

The seclusion rooms on this floor would frighten even the state legislators who begrudge present appropriations for state mental hospital. Caged in small rooms with a peep-hole slit in the door, many of these patients grovel nakedly about on a cold stone floor. Furnishings in these rooms usually consist of one dirty, night-soil stained mattress (Gorman 1946a, 5).

Dr. Clarence Bellinger, superintendent of the Brooklyn State Mental Hospital supported Gorman’s observations and expanded his criticisms to the entire asylum system which relied on seclusion rooms to manage asylum residents: “I don’t believe in seclusion rooms. They are calculated to turn anybody, sane or insane, into a wild animal” (Gorman 1946a, 2).

The written component of Gorman’s exposé article detailed how the seclusion of asylum residents functioned as an ineffective but rampant practice in the daily operations at Central State Hospital at Norman. Accompanying Gorman’s text, Tapscott’s photograph captured the seclusion ward that was used for women who were regarded as violent. The writing and the photograph worked together to create a convincing case that Norman was in dire need of improvement, arguing that instead of being secluded, these women should receive scientific treatment.8 Therefore, the photograph of secluded women in Norman was meant to portray how this crude method of physical control turned people into wild animals. However, the visual rhetoric of unfreedom contained in the picture also had an unintended effect of reinforcing public attitudes about how these women lacked control over their own bodies, to such an extent that the staff had no choice but to revert to these crude forms of somatic intervention. Even though reform-minded Gorman’s text rejected such a misinterpretation, the arresting visual rhetoric of unfreedom contained in the accompanying photograph suggested the article’s readers to associate state hospitals with the imagery of “bedlam,” making the narrative of asylum reform less convincing.

This unintended consequence associated with the visual rhetoric of unfreedom became more pronounced when the photographs captured women in asylums, and Albert Deutsch did not hesitate to include photos of restrained women in his exposé articles, deploying a gendered visual rhetoric of unfreedom. When his The Shame of the States team visited Receiving Hospital in Detroit, he saw a woman whose hands were both strapped to one side. Marston Pierce took a picture of her, and in the caption, Deutsch urged viewers to imagine how painful it would be to remain restrained for days in this way (Deutsch 1948, 117). In the photograph, the woman is lying on her left side in a bed. The picture was probably taken outside of her room through the doorway. The camera looks down on her from the footboard end of the bed. The headboard end of the bed is pushed against a window, which is covered from inside with a metal screen to prevent her from smashing the glass. On the right side of the bed, there is a dark-colored, wooden chair, which is also strapped by a belt to the window screen. On the chair, there is a white feeding cup, suggesting that the woman has been strapped to the bed for a long period of time. The metal bed frame is painted white, and a white towel is hanging on top of the remarkably tall headboard. In the bed, her body is covered with a white sheet, only showing her dark hair. The most visible part of her body is her left hand, revealing a dark-colored restraint cuff around her light-skinned wrist. In contrast to the white wall, white bed, and white sheet, the viewer may notice the woman’s motionless hand which is adorned with unchipped nail polish. The photograph encourages the viewer to imagine what happened between the time when she was able to have a manicure and the time when she began her commitment in “Detroit’s Bedlam” (Deutsch 1948, 117). This evokes an unsettling thought about the woman’s sudden turn of fate from a state of normalcy and manicures to this state of unfreedom and restraints.

The photograph of the restrained woman at Detroit Receiving Hospital made the visual rhetoric of unfreedom more arresting, evoking imagery of the woman’s body being tamed by leather straps. The contrast between the restraint cuffs and her manicured hand created a visual rhetoric that could have a titillating effect on the viewer. As Susan Sontag observed: “All images that display the violation of an attractive body are, to certain degree, pornographic” (2003, 95). Deutsch intended to argue that only medical professionals should control asylum residents’ behaviors and not restraints used by attendants. However, because Deutsch worked for a popular, commercial media platform, he needed to engage in sensational rhetoric; the photograph of the restrained woman in Detroit Receiving Hospital was meant to promote treatment, but the disturbing allure and the sense of tragedy contained in the photograph also had the effect of activating a dazzling, voyeuristic feeling in the viewer.

Most of the female residents captured in The Shame of the States were primarily portrayed as gender-less, animal-like beings, but the photographs attached to such descriptions nevertheless had the power to incite a morbid fascination based on repulsion (Sontag 2003, 95; Bogdan 1988). For example, the series included a photograph of a nude woman in the female ward of Cleveland State Hospital. In a dark, cramped dining room, a naked, young woman squats on the floor. Petite and emaciated, she turns her back against the camera. Her spine is bent and protruded. Because of her overgrown Buster Brown hair cut and her small figure, she may be a young woman or teenage girl. The other women are clothed and eating from the table and appear to be much older than this young woman. The caption of the photograph written by Albert Deutsch is pitiful and dramatic, decrying how she could have been saved from this dehumanizing misery if there was a proper treatment for her:

Once, long ago, before she was relegated to the back wards of Cleveland State Hospital as an “incontinent” patient, this creature [Italics added] was considered a curable one, or at least hopeful case. Like thousands of other neglected mental patients, she was denied the chance of recovery by a community that didn’t care. When we walked into this dining room, we found her setting her tray on the floor and wolfing miserable food. If given access to active therapy at the outset… . (Deutsch 1948, 53)

Deutsch portrays this young woman as a harmless yet shameful “creature” that has completely lost its humanity; she is “wolfing her miserable food” and does not attempt to hide from the scrutiny of the camera lens. Other women are clothed and dining at the table, but this young woman is naked and eating food on the floor.

While nudity of male residents was prevalent in asylum exposé photographs, they rarely included naked female residents. One explanation was that COs were almost always male and so were assigned to work in male wards (Taylor 2009, 225). However, considering that female nudity in the public sphere was more “shocking” and “indecent” to the public, the naked female body in a state of distress therefore served as a provocative subject, one that could almost make a viewer avert their gaze (Sontag 2003, 41). By arousing such repulsive yet gravitating sensations in the viewer, Deutsch was trying to drive home his argument that a lack of medical treatment had made the young woman become something like an animal, and the accompanying photograph portrayed her accordingly. Moreover, the photograph of her naked body fortified Deutsch’s message, causing the viewer to dismiss any symbolic relationship between this woman and feminine decency. The text description referring to her as a creature was shocking, but it also protected the viewer from feeling guilty about staring at a naked young woman.

Because they published their work in popular media platforms, Deutsch, Gorman, Maisel, and other reformers had the daunting twin task of gaining readers’ attention on the one hand while campaigning for action on behalf of asylum residents on the other. As a result, the visual rhetoric of unfreedom contained in these exposé photographs played on the viewers’ emotional responses towards these uncontrolled mad bodies to some extent, whether that was fear of them or morbid fascination with them. In so doing, the women in these asylums were ideal subjects. However, such impulsive feelings—not based on compassion but rather on a voyeuristic curiosity—could be challenging to transform into reliable support for asylum reform. Moreover, because the reformers did not question the existence of state hospitals, they did not interrogate whether retaining this segregationist system would be the correct strategy for improving the mental health of Americans. As a result, the reformers’ intention of preserving the asylum system doubly stigmatized marginalized populations, especially African Americans.

A visual rhetoric of anonymity: double stigma of being mad others and racial others

The viewer of this hazy photograph can see at first glance that it is not a staged scene (Fig. 3). Because we interpret the picture’s blurriness as proof that it was taken hurriedly from a doorway, the image appears as an accurate snapshot of the everyday operations of Byberry asylum (Sontag 2003, 26–27). Taken in Byberry’s male ward, it shows five men in their beds. They are half-naked, and the viewer can recognize black leather cuffs around the wrists of some of the residents. Even though these men are restrained, their upper bodies are upright, and some are eating meals served on metal trays. The ward is barren, and the small window and radiator are screened off by metal mesh to keep the residents from touching them. The floor of the ward appears clean enough, but the viewer cannot know the smell of the ward. After examining the photo, the viewer may notice that the face of the only White man in the picture is whitened out. Even though the photograph may be too blurry to identify these men accurately, the editorial made sure to obscure this White man’s identity and not the Black men’s.

Fig. 3
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Male patients eating meal while in bed in a ward at Byberry, Philadelphia State Hospital (Photo by Charles Lord, Swarthmore College Peace Collection, Swarthmore, Pennsylvania)

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The reformers juggled between reporting the plight of asylum residents and protecting their privacy. In these asylum exposés, most of the asylum residents’ faces are erased. The reformers were aware that this editorial decision would make it more difficult for the viewer to identify the people being photographed as fellow human beings. For example, in the introductory section of Out of Sight, Out of Mind, Frank L. Wright explained how this editorial choice stemmed from humanitarian considerations: “…no one person, no one place, no one event can be definitely identified by anyone. Names of persons and places, as well as certain identifying details, have been altered for purposes of publication, just as faces of patients have been blacked out in the photographs.” However, Wright hoped this editorial consideration would not hinder readers’ process of identifying the photographed as being people who were worthy of receiving treatment, and he encouraged the reader to imagine the faces of the residents: “I hope you will know that it is real flesh and blood which you are meeting in these pages,” he added (Wright Jr. 1947, 1).

The reformers’ considerations about protecting the privacy of asylum residents created a visual discourse independent from their humanitarian objective. In the Byberry photograph, for example, the visual rhetoric of the faceless White asylum resident in contrast to the Black residents whose faces were not obscured implied that the privacy of Black residents did not matter whereas the privacy of the single White resident did matter. It also validated the idea that the asylum was an institution of social death where residents experienced exclusion from the mainstream American society. For progressive COs assigned to Byberry, this visual rhetoric of racism was an unwanted diversion from their commitment to equity (Head 1995, 157–77). For reformers, the visual rhetoric of social death was equally problematic because it implied that the asylum system was inherently stigmatizing. The censored face suggested that once people are committed to the asylum, their identity is treated as something shameful that must be hidden from the public view. Their anonymity signified their diminished capacity as citizens, an especially dishonorable status considering how highly valued the idea of citizenry was in America in the immediate aftermath of WWII (Jennings 2016, 8, 95). Furthermore, Black asylum residents in the photograph experienced an additional layer of discriminatory treatment because, in contrast to the White resident, their faces were exposed. While we do not know the exact reason behind the choice, the editorial decision of not censoring their faces opened an interpretive space for viewers to conclude that African Americans required less protection of their privacy because of their race, to the extent that the White readership regarded them as already being socially dead. Because some psychiatric discussions during the first half of the twentieth century regarded African Americans as prone to madness, their commitment to asylums appeared less shocking and therefore less “unnatural” to the eyes of readers.

The discussions about African American’s vulnerability to madness stemmed from the “Negro problem” theory that surfaced after the Civil War. During that period, asylum superintendents began noticing more African Americans being committed to asylums and posited that this trend was evidence of the freedpeople’s incapability of adapting to their new civil status (Summers 2019, 72). These doctors argued whether African Americans’ vulnerability was caused by their innate dysfunction or by psychological difficulty in adapting to the modern lifestyle of urban areas. Regardless of which interpretation these doctors favored, this discussion often justified the establishment of racially segregated wards or even the construction of segregated asylums (Summers 2019, 71, 78). This discussion about the relationship between race and madness continued during the early twentieth century. Some American doctors began associating Emil Kraepelin’s dementia praecox as a disease of African Americans, strengthening theories about their biological inferiority. Because doctors generally associated dementia praecox with undesirable traits such as criminality, this reinforced the stigmatized and even socially dead status of African Americans (Metzl 2009, 30–32).

Photographs by Jerry Cooke in Life’s “Bedlam 1946” are the most noticeable application of the visual rhetoric of social death. By employing a kind of visual trick, Cooke’s works align the residents and the built environment in a particular way, making asylum windows and walls appear as if they are the tools of capital punishment. For example, one of his photographs captioned “Tubercular Mental Patient” shows two quarantined White male residents in Cleveland State Hospital (Maisel 1946, 110). They wear white robes and are crammed into a small room. The man on the left is standing. He is barefoot, and his wrists are strapped to the bed frame with leather belts. Because his face is completely darkened by the editorial, the viewer has little idea about his state of mind. The man on the right sits down on the bed. His arms are crossed, possibly by a straitjacket, and he is leaning against the wall looking away from the camera, observing the outside world through a window with no protective metal mesh. The room appears to be clean but Spartan. The photograph suggests that the hospital has given these men no opportunity to personalize the room. In order to craft this photograph’s metaphor of social death, Cooke’s camera aligns the neck of the man on the left-hand side with a vertical shadow created by corner walls, creating a visual illusion as if the shadow has turned into a rope that hangs the man, causing his body to float in midair. The shadow on the wall becomes a symbol of this man’s death. While his body is still alive, Cooke’s visual rhetoric suggests that his personhood is already gone; the photograph guides the viewer—unconsciously or not—to associate the asylum with the idea of it being an institution of social death.9

Cooke’s skillful work visualized the social consequences of institutionalization. Furthermore, the editorial decision to censor residents’ faces made it even more difficult for viewers to see these people as their fellow citizens. While asylum exposés had the intention of progressive reform, these editorial decisions prevented these photographs from having the kind of humanizing impact that other progressive photographic projects had. Starting in 1890, some photographers began documenting the plight of struggling Americans to initiate social reform. Jacob Riis in How the Other Half Lives recorded impoverished neighborhoods, presenting the lives of those living in these places as “sensational disclosures of hidden social facts” (Trachtenberg 1989, 170). In the early twentieth century, Lewis Hine combined social work and photography into a visual version of his casework. He took photographs of newly arriving immigrants at Ellis Island, of factory workers, and of disabled people (Rosenblum 1984, 384). His photographs were close-ups of subjects and on the same eye-level as the viewers, as if subjects were telling the viewers that even though they might be struggling, they were hardworking people who deserved the compassion of others (Garland-Thomson 2001, 364). Thus, these photographers created visual representations of people who the public might view as “worthy” or “desirable” citizens in order to win the support of fellow Americans. These images argued to middle-class viewers that their photographic subjects deserved to live in a good environment where they could eventually become more self-supporting (McGerr 2005; Nielsen 2012, 100).

While postwar asylum exposés belonged to the lineage of this progressive reform effort, in the case of asylum photography, asylum residents appeared as “undesirable” and even less dignified due to censorship of their faces, especially when compared to contemporaneous photographic projects (Taylor 2009, 270). Between 1935 and 1944, the Farm Security Administration’s photographic works established the methodologies of documentary photography by portraying struggling others—sharecroppers, migrant farmers, wage laborers, new immigrants, and others—as dignified fellow human beings (Fig. 4). Such photographers as Dorothea Lange, Walker Evans, and Gordon Parks documented these Americans under the FSA’s objective to improve the living conditions of the rural poor (Stott 1973; Creef 2004; Gordon 2010). These works show close-ups of individuals, their faces looking straight at the camera, refusing to elicit pity. These Farm Security Administration photographs invite the viewer to engage with the inner world of their subjects. Lange explained in 1939 that documentary photography’s intention was “to let the subjects, the ‘living participants’ of social reality, ‘speak to you face to face.’ Having looked at a documentary book, ‘you’ could no longer be ignorant of them. You had seen their faces” (Stott 1973, 214). In these Depression era photographs, men and women eloquently told their everyday experiences, and as a result, they asserted their status as fellow citizens.10

Fig. 4
figure 4

Washington, D.C. Government Charwoman (Photo by Gordon Parks, Library of Congress, Washington D.C.)

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In contrast, men and women captured in asylum exposé photography had a diminished opportunity to tell their stories about asylum life because their faces were obscured. For photographic viewers, the anonymity of faceless asylum residents has created an interpretive space independent from the original political objective of the reformers. As a result, the interpretive void created by these obscured faces became a kind of battlefield for a cold tug of war pitting text against image to determine the exposé reader’s understanding of the given subject. When Jim Crow asylum practices entered into this power dynamic, the juxtaposition of text’s colorblindness and image’s anonymous yet upfront representation of race created a set of discrepant and confusing messages (Alexander 2012). This confusion had the effect of opening up a problematic interpretive space for readers in the sense that while the message contained in either the text or the image may have been clear on their own, the message conveyed by the combined text and image became unclear. This opened up room for prejudiced interpretation. For example, White readers might identify Black asylum residents as being a racial other. Similarly, sane readers would feel inclined to view asylum residents as a mad other.

In the states with more Jim Crow practices, it was an operational norm to segregate Black asylum residents in the separate “negro insane” hospitals where residents with various conditions and of different age groups shared the same wards. In examining racial segregation in Maryland’s state hospitals, historian Ayah Nuriddin has pointed out that while diagnoses determined where White residents were admitted, race was the single determining factor for African Americans (Nuriddin 2019, 91). When The Baltimore Sun ran their exposé series, “Maryland’s Shame” in 1949, their reporter Howard Norton investigated the conditions of Crownsville State Hospital, the state’s only hospital for African Americans. In the article, Norton pointed out that “the ‘sex-offenders, ex-prostitutes, epileptics, and idiots’ housed with young children who were merely mildly handicapped” (Nuriddin 2019, 102; West 1994).

The situations were similar in Oklahoma where asylum residents were also segregated by race. Mike Gorman for The Daily Oklahoman reported on the State Hospital at Taft with the headline, “All Types of Negro Patients Are Mixed at Taft” (Gorman 1946b). George Tapscott took a photograph of a group of Black men and children in a dayroom (Fig. 5). Captioned as “a dreary dayroom scene,” a dozen men, adolescents, and children sit in rows of wooden benches facing the sun. The sunlight creates intense lighting, revealing the details of each one’s behavior. The photograph centers on an adolescent who stares at the viewer. However, the viewer cannot guess the exact intention of the young resident’s gaze because his eyes are covered by an editorial white block. He wears an oversized shirt and overalls, while his left hand is covered by a loose shirt sleeve. To the left of this adolescent, a child seems to be looking at the sun. The child’s hands are crudely restrained by makeshift fabric strapped to his chest. His clothing is heavily soiled. The viewer may think it must be some kind of bodily fluid, but there is no way to tell exactly. Shifting one’s gaze to the back row, the viewer notices that there are adults and even elderly people in this group. In the middle of the back row, a man with a dark-colored cap is holding a child beside him. They are both looking at the camera. While the adult appears to be calmly examining the visitors, the child seems to be excited, raising his fist up in the air. On the far right of the photograph, an old man is holding a cup, helping a child to drink out of the cup. This old man seems to have a warm, fatherly smile; he gently holds the child with his right hand, forming the “helper” pattern where one resident takes care of another resident who is regarded as needing more help from others (Goffman 1961, 279).

Fig. 5
figure 5

Dayroom scene of patients at the State Hospital for the Negro Insane at Taft, Oklahoma (Photo by George Tapscott, U.S. National Library of Medicine, Bethesda, Maryland, Courtesy of The Oklahoman)

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A reader, intrigued by the photo, might turn to the text portion of the article, hoping to learn more about the image. A caption just under the photograph explains that: “Mentally ill children, mental defective, ecliptics, and seniles mix with one another in violation of all state and national psychiatric standards” (Gorman 1946b). The chief concern at Taft, explained Gorman, was not its physical environment or its overcrowding but the idea that “a hundred of mental defectives” were committed to a “hospital for the insane,” violating all the state and national standards. “In many ways, this is the worst of all the indignities heaped upon the mentally ill in Oklahoma,” he concluded. By referring to a comment from Taft superintendent, Dr. E.P. Henry, Gorman further discussed the problem of mixing the resident population: “Mentally defective children, because of this situation, spend most of their time in the company of deranged adults [italics added]. Dr. Henry knows the dangerous consequences of this; these children continually pick up improper language and bad patterns of conduct” (Gorman 1946b).

This observation by Dr. Henry served as a warning to the reader. Thus, this article on the State Hospital at Taft created an uncommon space where text in the photo caption attempted to harness the photograph’s rhetoric independent of the article’s overall message.11 In the case of the old man helping the child drinking from a cup, the expert’s words prevented readers from interpreting the inter-generational interactions captured in the photograph as a display of warm human communication. The photograph on its own displays a moment of goodwill on the part of the old man, exemplifying that these people have spontaneously formed a sense of community akin to that of a family. However, the written text cautions the reader against feeling any sympathy towards the old man. The doctor’s words warn the reader that this old man could be one of the “deranged adults” who will instill socially deviant behaviors in the child. Unable to see the old man’s eyes, the reader will likely feel confused by the conflicting messages between the photograph and the written text. The reader might regard his smile as genuine, questioning the legitimacy of the text, or the reader might look at the photograph again and this time read the smile of the old man as possibly being leering.

Throughout the article, Gorman’s writing does not directly identify the source of the indignity at Taft as racial segregation, only implying that the mixing of the resident population is a practice targeted to Black Oklahomans.12 As a result, Gorman’s Taft article wove a complex set of rhetorics where the issue of race was never openly discussed in the text, even though the photograph accompanying the article documented a racist practice, which amounted to a double exclusion imposed on Black asylum residents. First, because of their race, the state segregated them in a separate asylum where they were committed with residents with a variety of age groups and diagnoses. Secondly, because their faces were obscured, viewers could easily objectify them, exacerbating specious theories of African American madness. This might contradict the Byberry photograph where the sole White resident’s face was obscured while Black residents’ faces were not. This contradiction reveals that the visual rhetoric of anonymity is a relative idea, heavily reliant on how a photograph is displayed and explained. For example, in the case of the Taft photograph, because the colorblindness in the text did not explicitly identify race as an issue, it could not curate readers’ perceptions regarding this double exclusion. The readers could sustain their preconceived, unchallenged notions about Jim Crow practices and the asylum system, with the result that they were able to identify the asylum population as both a racial other and a mad other.

Conclusion

Through the medium of exposé articles, asylum reformers advocated improving the nation’s state hospitals. They hoped that their efforts would direct the public to push for legislation to allocate funds so that asylums could be transformed into hospitals. To attract wider readership, they used photographs as a powerful auxiliary. However, the striking visual rhetorics behind these images also had the unintended effect of stigmatizing asylum residents. The asylum residents in these photographs, whose faces were often erased to protect their privacy, were intended to function collectively as an empty vessel for conveying a political message espoused by the reformers. Devoid of any opportunity to communicate their personal experiences, these asylum residents became illustrations on popular magazines and on the front pages of newspapers, serving as vehicles for eliciting the pity of readers. Because the reformers elicited pity for their cause while simultaneously inciting a morbid fascination in their readership, these photographs had the effect of giving their subjects the status of socially dead other, whether that meant a mad other or a racial other.

As the reformers juggled between readers’ sense of pity and voyeurism, these exposé photographs became an intersection of multiple visual rhetorics. Some visual rhetorics were crafted by the reformers while others were often independent from their control. In the former case, by including images of asylum residents in restraints, the visual rhetoric of unfreedom served to show how this anachronistic, unscientific method of controlling asylum residents drove them into animal-like behavior. Photograph after photograph of these people in straitjackets, cuffs, and seclusion rooms represented this message faithfully and accorded with a similar message conveyed by the written text. This repulsive yet gravitating visual rhetoric, particularly that of women in restraints or in seclusion, not only instilled a fear of uncontrolled mad bodies but also stimulated a voyeuristic fascination in viewers regarding these unfree bodies. These reactions, I argue, were emotional responses that were difficult to transform into long-term, reliable support for compassionate reform of the asylum system.

However, the visual rhetoric of anonymity often created a discrepant message between text and image, and this inconsistency provided exposé readers with an interpretive space independent from the auspices of reformers. The most notable example of such rhetoric was how reformers erased the faces of asylum residents. While reformers occasionally utilized censored faces as blank slates on which to exert their arguments, they seldom gave exposé readers much guidance in terms of asking them to imagine asylum residents as fellow Americans. Moreover, this practice was based on their humanitarian considerations about protecting the privacy of their subjects, but such practices also bolstered the residents’ socially dead status, normalizing their segregation from the rest of American society. This justification of segregationist practices doubly stigmatized Black asylum residents who had been committed to Jim Crow asylums.

The most fundamental flaw of the asylum exposé articles was the reformers’ inability to leave a lasting impact on postwar mental health activism (Taylor 2009, 393). Except for Mike Gorman who would later become a proponent of the deinstitutionalization of asylum residents, most reformers did not question the legitimacy of asylum-based care.13 Reformers failed to address certain fundamental human rights issues in publicly-run psychiatric hospitals such as involuntary commitment. This was particularly true in matters it related to African Americans. In addition to failing to question the practice of involuntary commitment, they also failed to interrogate the premise of the “separate but equal” principle that dominated African American asylums. Overall, instead of criticizing the asylum system, the practice of psychiatry, or the lack of patient voices or the voices of their families in the decision-making process—which would become major discussion points in the 1960s and the 1970s— reformers in the early postwar period focused on prolonging this closed-door system that had produced documented cases of oversight, abuse, and neglect. Ironically, the reformers’ own work assisted in the eventual transition to deinstitutionalization by documenting the copious failures of the state hospital system.

Finally, the large influence of asylum exposé articles on the public discourse exemplified the power of media. These exposé articles had the goal of serving the public good in the emerging postwar society. However, the sensationalistic visual rhetoric contained in the images accompanying these articles had the unintentional yet forceful effect of presenting asylum residents in a polarized way, either as monstrous others or as pitiful subjects, notions which are still prevalent towards disabled or mad individuals in American society even today. Therefore, the history of postwar asylum exposé articles encourages us to acquire basic literacy in analyzing visual rhetoric as well as in critically assessing existing social practices and institutions.