Out of Sight, Out of Mind: 19th Century Almshouses and Poorhouses

By Xander Evans

Public social services administered by the government help millions of Americans in their everyday lives. These people tend to be living in poverty or near-poverty or experience mental disabilities that prevent them from taking care of themselves. State governments eventually settled on a solution: poorhouses and almshouses. These were places that, in theory, provided food and shelter to those who could not provide it themselves in exchange for their labor. Very frequently, however, these places would be ripe with abuse and methods of shaming those who found themselves within the walls of a poorhouse. These places were pushed out of public view, making it very clear that the true purpose of these buildings was to keep the less fortunate and the disabled out of sight, for the comfort of the rest of the town [1].  

Almshouses served a double purpose, reforming the poor and disabled and preventing those groups from “ruining” the rest of society. In the 19th and early 20th century, poverty and mental disability were seen as moral failings in nearly all cases [2]. There was, as Professor Gunnar Dybwad put it, “no clear concept of a [disabled] personality,” with Almshouses dealing with “people who were inadequate. And were outcasts. And inconvenient. And uncomfortable.” [3]. The general view of the mentally disabled was not indifference or discomfort, but disdain. They were inconvenient to have around, uncomfortable to see, and ought to just be put away somewhere so no one had to look at them. With many sources from the time that almshouses found use describing the mentally disabled as “the insane,” it is made abundantly clear that the general public did not want to have the mentally disabled interacting with the rest of society. A solution as cold as putting the disabled “out of sight, out of mind” begins to make sense when placed in this societal context.

Keeping the “insane” out of sight did not keep them out of mind for social reformers like Dorothea Dix. An educator who retired after work strain causes a total physical breakdown, Dorothea found herself curious about the conditions of an English jail, and was horrified to find the conditions that the mentally disabled were subject to. Upon touring prisons and almshouses across England and the United States, she found that horrific physical abuse was common. Her solution to this problem was to have the states fund hospitals for the disabled rather than simply tossing them aside, writing to the Massachusetts legislature: “Poorhouses, converted into mad- houses, cease to effect the purposes for which they were established, and instead of being asylums for the aged, the homeless, et cetera, are transformed into perpetual bedlams…” [4]. Dix, along with numerous other social welfare advocates, pushed for the creation of proper asylums with treatments for the mentally disabled, rather than tossing them aside as unwanted people. 

The Great Depression fundamentally changed how America and the world interacted with their most vulnerable people. For the United States, the Great Depression told them that the federal government has a role to play in the betterment of their least fortunate citizens, and that the poor and mentally disabled cannot be simply thrown aside. This realization by the federal government was a part of a trend started by activists like Dorothea Dix (who had passed away before the Depression) to transfer the mentally disabled from almshouses and poorhouses to mental asylums. As understanding of mental disabilities and neurodivergence and the federal government’s involvement increased, mental health became more treatable and more manageable for American communities [5]. Mental asylums have their own history of abuse, and even modern mental hospitals do not always have perfectly clean hands. What is very evident, however, is the trend towards understanding the neurodivergent rather than pushing them to the side. As understanding increased, abuses decreased. As acceptance of neurodivergence as something more than a “broken brain” becomes more widespread, the less people will feel like putting people outside of the neurotypical spectrum “out of sight, and out of mind.”

Under the Trump presidency, the US government has made very clear its intentions to make cuts to social services. Almshouses and poorhouses are a stark example of the dangers of what can happen to social services if the federal government does not have a hand in them. Under the guise of providing help, the mentally disabled were tossed aside and hidden away in almshouses so that the public would not have to be bothered by them. If social services are cut, will history repeat itself and recreate almshouses to just put the disabled and poor out of sight? I cannot say for certain. The attitudes about mental disability have changed, thanks in no small part to neurodiversity activists, and doctors have a far greater understanding of mental disabilities than those during the time of the almshouse. Regardless, cuts to social services must never result in the “out of sight, out of mind” kind of solution that almshouses provide, and proper social services for the mentally disabled must be made available.

Sources

[1] Blakemore, Erin. (2023, Sept. 14) “Poorhouses Were Designed to Punish People for Their Poverty” History.com https://www.history.com/news/in-the-19th-century-the-last-place-you-wanted-to-go-was-the-poorhouse

[2] Watson, Sidney. “From Almshouses to Nursing Homes and Community Care: Lessons from Medicaid’s History: Published in Georgia State University Law Review.” Georgia State University Law Review, 1 Mar. 2010, https://gsulawreview.org/article/16387-from-almshouses-to-nursing-homes-and-community-care-lessons-from-medicaid-s-history/stats 

[3] Gunnar Dybwad on Poorhouses” Parallels in Time, A History of Developmental Disabilities https://mn.gov/mnddc/parallels/four/4a/gunnar-poor-house.html 

[4] Deutsch, Albert. “Dorothea Lynde Dix: Apostle of the Insane.” The American Journal of Nursing, vol. 36, no. 10, 1936, pp. 987–97. JSTOR, https://doi.org/10.2307/3413570. Accessed 1 Feb. 2025.

[5] Morrissey, Joseph P., and Howard H. Goldman. “Care and Treatment of the Mentally Ill in the United States: Historical Developments and Reforms.” The Annals of the American Academy of Political and Social Science, vol. 484, 1986, pp. 12–27. JSTOR, http://www.jstor.org/stable/1045181. Accessed 6 Feb. 2025.