Self/less and transplanting (ID)entities

by Karen Rommelfanger



I recently sat on a panel discussion for an early screening of the movie Self/less. I'm quoted (mostly correctly) with my name (mostly) spelled correctly here.

In Self/less, an aging business tycoon with a terminal illess (played by Ben Kingsley) pays to "shed" his skin for a new, younger, fitter body (played by Ryan Reynolds). See trailer above.



The film, despite the futuristic theme, revisits mundane themes of the Faustian tradeoff or a deal with a devil, ultimately conveying the message that the costs, even for the rich, are too high when trying to cheat death. The title of the movie implies that for the greater good the selfless thing to do is to just die as nature intended.



While the film would surely be categorized as science fiction, there are entrepreneurs quite dedicated to making such a possibility a reality.



For example, the 2045 Initiative promises, for the starting price tag of $3 million, that your brain can be downloaded and that downloaded information can be used to animate or be “transplanted into" a personalized avatar or robotic copy of a human body remotely controlled by a brain computer interface or, if you fancy, a hologram (just press the immortality button on their site). Among its supporters, the website claims, is the Dalai Lama.

And, for the first time in human history, the neuroengineer Miguel Nicolelis recently connected two brains, rat brains, with one brain able to transfer electrical activity to another to facilitate learning a task. In this experiment, one rat learned through trial and error to press the correct lever for a reward. Electrical activity from one rat brain was sent to another through a wireless connection, allowing the other, untrained rat to choose the correct reward delivering lever without any training. This was followed up by studies connecting a human to a rat brain and then two human brains. Most recently, this month, Nicolelis connected more than two brains, either 3-4 rat brains or 3 monkey brains. In these experiments the animals were able to synchronize their brain activity to complete tasks. In the case of the monkeys, they operated an avatar.

Head transplants are also being touted as a near reality. While not as fancy as downloading electrical activity to an avatar or robot, such a transplant might allow an intact head to receive a new body. In this case one might ask who is receiving the transplant. Is the head receiving a body transplant or is the body receiving a head transplant?



All of these experiments and even the movie Self/less interrogate the question, where does the self originate and exist? And can we have a meaningful existence in any way that might be unfamiliar to ourselves? Is living forever a human right as some transhumanist groups might say? Or are we somehow designed by biology or some greater creator to have our bodies and maybe our minds along with or inside those bodies expire?



What we never learn in Self/less, perhaps because it would be too complex to address, is what *exactly* is transferred from Ben Kingsley to Ryan Reynolds’s body? It seems they simply transferred or transplanted an essence and the essence of Ryan Reynolds was held back through suppressive drugs designed by the entrepreneur-inventor Albright. Self/less leaves the viewers to their own devices to grapple with these issues.



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Rommelfanger, K. (2015). Self/less and transplanting (ID)entities. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/07/selfless-and-transplanting-identities.html

Why I teach with an English professor

by Krish Sathian, MD, PhD

Dr. Sathian is Professor of Neurology, Rehabilitation Medicine, and Psychology at Emory University, and directs the Neurorehabilitation Program in the Department of Neurology. The recipient of Emory’s 2001 Albert Levy senior faculty award for excellence in scientific research, he is Executive Director of the Atlanta VAMC Rehabilitation R&D Center for Visual and Neurocognitive Rehabilitation and immediate Past President of the American Society of Neurorehabilitation.

Editor's note: The following post is the second of a pair of essays about interdisciplinary teaching we will feature on the blog. Please see its companion piece from last week, Dr. Laura Otis's "Why I teach with a neurologist." It is often said that academic fields are becoming increasingly siloed as specializations become more and more detailed and jargon-filled with each new peer-reviewed paper. The classes co-taught by Professors Otis and Sathian were unique interdisciplinary spaces where students across traditional disciplinary divides were able to wrestle with topics shared by the humanities and sciences: perception, imagination, and art. Is this kind of interdisciplinary inquiry a necessary counterbalance to the siloing of the disciplines? Or could it even be seen as part of the ethical practice of science? Might having more of such classes improve the science literacy of those in the humanities, and keep scientists in touch with the depth of expertise that other fields can contribute (as I have argued in an earlier post)? Should we begin to find ways to institutionalize more of this type of work into the higher education system, or provide more movement between the disciplines? Or is interdisciplinarity merely a fad? Readers: what do you think? 

I consider myself very fortunate to work both as a clinical neurologist in academia, and as a neuroscientist investigating fundamental questions about the brain that may in time have an impact on how we treat people with neurological disorders. My own research over many years has concentrated on studies of perception, but I recently began to study how the brain handles metaphor.

This may seem like quite a jump, but it turns out that sensory and motor regions of the brain are involved not only in the expected sensory and motor functions, but also serve to “ground” metaphors relating to particular sensory or motor processes. For example, when we hear the sentence “She had a rough day,” the part of our brain that is important for judging roughness by touch actually becomes active. This kind of finding supports the idea that metaphors begin as conceptual abstractions from our experience.

Literature, of course, has an abundance of metaphors, as well of sensory images that are evoked by the words on the page. My background in perception had taught me that the experience of imagery depends on activity in much the same brain areas as are relevant for sensory experience, e.g., when one visualizes, the visual cortex, which is necessary for vision, gets engaged. Thus, one can conceive of literary writers as people who have mastered the ability to trigger the neural processes underlying imagery and metaphor (and other literary devices) in the reader, albeit not necessarily with the neuroscientific facts in mind. And of course, I should emphasize that our study of the underlying neural processes is still inchoate.

The Center for Mind, Brain and Culture (CMBC) at Emory University brings together scholars from a variety of disciplines to examine specific issues from multiple perspectives. One of the ways they do this is a call for interdisciplinary course proposals. With my interests in the neuroscience underlying literary images and metaphors and the expertise of Professor Laura Otis in teaching English in relation to cognitive science, it seemed to us that an ideal course to propose would be one that intertwined literary and neuroscientific readings.

The CMBC agreed to sponsor our course, and I can honestly say that the course we ran in 2012 and its successor in 2014 were the most fun courses I have ever been involved in! In both, we had a good mix of students from various aspects of the humanities and sciences, keenly interested in the material, and the classes saw a host of animated discussions from a range of viewpoints. I went into the first course confident that it would be a good one, especially because Professor Otis, while being an expert in literature and its pedagogy, also has a background in neuroscience. I thought, however, that we would have to work very hard to eke out a few intersections between the language of storytelling and poetry on the one hand, and that of cognitive neuroscience on the other. Boy, was I wrong! I was simply blown away by the profusion of connections between disciplines. Professor Otis had a knack for bringing in just the right creative works, and just the right writer-scholars to talk about them, to match up with the relatively fledgling attempts to tackle how the brain works to enable the glorious acts of literary writing, and the consumption of the products of these acts by readers at large. These pairings really made the courses tick.

Based on my experiences, I highly recommend joint teaching of interdisciplinary courses. It takes some thought and care to select the best topics and generate the appropriate blend of approach and content, and of course the right chemistry between the professors, and a willingness of students to be open and participatory. When all these work out, as they miraculously did in our courses, a splendid time can be guaranteed for all, to paraphrase John Lennon.

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Sathian, K. (2015). Why I teach with an English professor. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/08/why-i-teach-with-english-professor.html

Why I teach with a neurologist

by Laura Otis, PhD

Dr. Otis is a Professor of English at Emory University. Although she ultimately obtained a PhD in Comparative Literature and now teaches English literature, she holds a BS in Molecular Biophysics and Biochemistry and an MA in Neuroscience, and she worked in research labs for years. She was awarded a MacArthur fellowship for creativity in 2000 and is currently working as a visiting scholar at the Max Planck Institute for Human Development in Berlin.

Editor's note: The following post is the first of a pair of short essays about interdisciplinary teaching that will be featured on the blog. Stay tuned next week for Dr. Krish Sathian's "Why I teach with an English professor." It is often said that academic fields are becoming increasingly segregated as specializations develop more jargon and become more detailed with each new peer-reviewed paper. However, the classes co-taught by Professors Otis and Sathian are unique interdisciplinary spaces where students across traditional disciplinary divides are able to wrestle with topics shared by the humanities and sciences: perception, imagination, and art. Is this kind of interdisciplinary inquiry a necessary counterbalance to the segregation of the disciplines? Or even part of the ethical practice of science? Might having more classes like this improve the scientific literacy of those in the humanities, and keep scientists in touch with the depth of expertise that other fields can contribute (as I have argued in an earlier post)? Should we begin to find ways to institutionalize more of this type of work into the higher education system, or provide more movement between the disciplines? Or is interdisciplinarity merely a fad and a buzzword? Readers: what do you think? 

In teaching, there are few things worse than realizing you’ve told your students something wrong. The jolt may come a year, five years down the line, but you can’t issue a retraction. They’ve dispersed to medical schools, where they’re now propagating your error. It’s been thirty years since I studied Neuroscience at UCSF, and a few things have changed since then. The human genome has been sequenced. Scientists analyze data on computers. I try to keep abreast of what’s happening, but this is hard while teaching Victorian literature. In this climate of near-worship for Neuroscience, I worry that I could say anything about the brain, and people would believe me. With a neurologist in the room, this can’t happen.

At Emory University, Krish Sathian and I have taught two courses together: “Images, Metaphors, and the Brain” (spring 2012) and “Language, Literature, and Mental Simulation” (spring 2014). Both times we were blessed with a mix of bright, open-minded graduate students in Neuroscience, Psychology, English, and Comparative Literature as well as some gifted undergraduate Neuroscience majors. Nothing dissolves stereotypes like familiarity, and it did all of us good to exchange ideas with intelligent, well informed people who saw the world differently. Professor Sathian himself was a vital role model for the students in English, since this high-energy person who healed patients, ran a lab, and wrote grants knew a great deal about literature and was eager to learn more. He saw it as related to his work.

In our two courses, we read scientific and literary works that explored creative metaphors and sensory imagery. We studied Dedre Gentner’s “career of metaphor” theory in parallel with Jean-Dominique Bauby’s The Diving Bell and the Butterfly, and Italo Calvino’s Invisible Cities with David Kemmerer’s “The Semantics of Space.” I learned the most from the course when the students disagreed, and I think that they did as well. Behavior was good, but people came head to head over the issue of whether science is a cultural narrative or an all-out effort to learn how the world works. In these situations, it was helpful to be teaching with a colleague who is a doctor as well as a scientist. Before coming to class, he had worked for hours in a place where “aphasia” and “paralysis” aren’t just words. Tell a patient at the VA his seizures are cultural constructions, and he’ll tell you something about your mother. Professor Sathian’s clinical experience, as well as his work as an experimentalist, helped those from other fields to appreciate what scientists do.

When I did make a mistake, my colleague from Neurology corrected me tactfully and unhesitatingly. Our aim was to teach, not perform, and our “hybrid” courses on metaphors and imagery have given me some of the best teaching experiences I’ve ever had. I urge everyone in the humanities to try teaching with a scientific colleague. In my experience, scientists are eager to learn from scholars whose critical eyes scan language and culture. Aren’t all of us trying to figure out how the world works?

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Otis, L. (2015). Why I teach with a neurologist. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/08/why-i-teach-with-neurologist.html

Meeting ethological needs: Conflicting data on orca longevity in captivity

by Frans de Waal



Editor's note: Frans de Waal, PhD, is the Charles Howard Candler Professor of Primate Behavior at Emory University and the Director of the Living Links Center at the Yerkes National Primate Research Center. He is also a member of the United States National Academy of Sciences and the Royal Netherlands Academy of Sciences and a member of the AJOB Neuroscience editorial board. His research focuses on primate social behavior, including conflict resolution, cooperation, inequality aversion, and food-sharing.



de Waal, a leading primatologist, makes an argument here for thinking seriously about the captivity of certain animals such as orcas. Of course, the orca also has a sophisticated mammalian brain. Is the defining criterion of our responsibility to other animals their ecological needs, as de Waal suggests, or is it their cognitive function? What do you think?



There is so much to-do about orcas (killer whales) in captivity, with a drumbeat of voices against humans keeping this species, that it was about time we got some data on longevity. Not that longevity is the only measure to consider with regards to the ethics of keeping these fascinating animals, but since there is the claim out there that orcas in human care live short, stressful lives, there is a need to know the truth.

Source: flickr.com

I am interested in this issue since I support animal keeping for educational and conservation reasons at zoos and aquariums. There are many facilities at which the care for animals is taken very seriously by a dedicated staff. I am not going to defend substandard zoos, but feel there is a place for good zoos that bring urban human populations closer to the animal kingdom and teach the value of wildlife conservation.



Nevertheless, it is clear that some species fare better at zoos than others. Baboons kept on a large island or rock, for example, may be in excellent health, breed successfully, and be able to express many of their natural social behaviors, from squabbling to grooming. Despite the complaint that these animals are not free, there is actually no evidence that they are any less happy or healthy than their wild counterparts. But what about species that cannot express their natural behavior in captivity, such as large birds of prey and vultures, which are prevented from soaring high up in the sky? Zoos have played an invaluable role in preventing the extinction of the California condor, yet putting such a magnificent bird in an aviary still seems far from ideal. This is known as the “ethological needs” argument, named after “ethology,” the study of natural or naturalistic animal (and human) behavior. It is about the expression of species-typical tendencies. A chicken needs to have a surface in which it can scratch and dust bath, a pig needs mud in which it can wallow, and so on.



As an ethologist myself, I am sensitive to this argument, and always wonder which species are so curtailed by captivity in their natural behavior that it applies. Apart from large birds, it may apply to elephants, orcas, other cetaceans, perhaps large felines. How to provide these animals with the appropriate environment? It is much easier to offer a troop of baboons or an otter family a stimulating enclosure that shows off their natural tendencies than a herd of elephants or a pod of dolphins.



Longevity is one way to look at this question. Many primates, for example, live on average considerably longer in captivity than in the wild. For elephants and orcas, however, the same cannot be said. On the contrary, they die prematurely compared to their wild counterparts. This may be due to inadequate care, inadequate environments, or chronic stress. But how solid is this longevity data?



We now have two studies, both published in 2015, intended to answer this question. Unfortunately, they contradict each other. In the Journal of Mammalogy, a study compared Sea World’s orca record with what we know about the same species in the North Pacific. It was found that calf survival to two years of age was better in captivity than in the wild and that overall survival at Sea World has steadily gotten better, probably owing to improved husbandry and veterinary care. The study claims that survival is presently indistinguishable from that of wild populations. A second study, published in Marine Mammal Science, also notes improvement in captive survival, but claims substantial differences in the upper age range. In captivity, only 7% of females get older than 40 years, whereas in the wild this proportion is said to be between 41 and 75%. If true, captivity still negatively affects health, at least physically, but probably also psychologically.

Source: Wikimedia Commons

Even if one day we could extend the lives of large cetaceans in captivity, however, this still doesn’t solve the issue of ethological needs. One could still argue that so long as we are unable to provide these animals with a species-appropriate environment in which they can live in large pods, travel distances, and employ their echolocation capacities, it is unethical to keep them. Despite being a zoo supporter, I could live with such a conclusion.



References



Jett, J., & Ventre, J. (2015). Captive killer whale (Orcinus orca) survival. Marine Mammal Science. doi: 10.1111/mms.12225



Robeck, T. R., Willis, K., Scarpuzzi, M. R., & O’Brien, J. K. (2015). Comparisons of life-history parameters between free-ranging and captive killer whale (Orcinus orca) populations for application toward species management. Journal of Mammalogy. doi:10.1093/jmammal/gyv113



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De Waal, Frans. (2015). Meeting ethological needs: Conflicting data on orca longevity in captivity. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/08/meeting-ethological-needs-conflicting.html

Liberating brains from bodies by capturing them with brainets?

by Karen Rommelfanger



Miguel Nicolelis is dedicated to liberating the human brain from the physical constraints of a body.



Recently, brain-machine interface engineer extraordinaire Miguel Nicolelis connected nonhuman animal brains in a modern-day mind meld called the brainet. For those who don't already know him, Nicolelis is an innovator, dedicated to pushing the limits of what is possible with neurotechnology, and a media darling to boot.



One focus of Nicolelis' work has been developing neural prostheses whose function is mediated through wired or wirelessly transmitted electrical activity from arrays of electrodes implanted on the surfaces of nonhuman animal brains. One well-known experiment from the Nicolelis lab involved monkeys that learned to feed themselves a marshmallow  or even operate a robot on a treadmill via direct connection electrodes implanted in their brains and a prosthetic arm. For extra flash, Nicolelis had a 12-lb monkey (based out of a Duke laboratory) operate a 200-lb robot on a treadmill in Tokyo by transmitting its brain activity through an Internet connection. In this same 2013 interview he waxes philosophical, “Our sense of self does not end at end of the cells of our bodies, but it ends at the last layer of the electrons of the tool that we’re commanding with our brains.”

His work has intended applications for humans. One recent media stunt involved a "Mind-controlled robotic exoskeleton"  donned by an individual who was paralyzed from the trunk down. 29-year-old Juliano Pinto kicked off the first ball at the World Cup in 2014 through an electrode studded cap on his head that transmitted recorded electrical activity from his brain to a robotic suit. Hailing from

Brazil, it's no surprise that Nicolelis chose to embark on this project the year the World Cup was hosted by Brazil.

While connecting one brain to a machine or computer is pretty impressive, many would attest that there is still no better computer than the human brain.  Nicolelis's most recent book even advances the notion that the brain cannot be simulated by a Turing machine. In fact, central to the much of the EU's Human Brain Project and the US BRAIN Initiative is the goal of understanding the complex connections of the brain that might enable us to recreate one from scratch.

It only seems only natural then that Nicolelis' group pioneered the connection of the first brain-to-brain interface wherein two rats were able to exchange tactile and motor information. In brief, one rat (the encoder rat) learned a task such as a nose poke or lever press. Choosing the correct lever resulted in the delivery of a reward such a sip of water. After the encoder rat learned the task, electrical activity from electrodes implanted in its brain were transferred to another untrained rat (the decoder rat). The decoder rat, through receiving signals from the encoder rat's brain, was able to correctly choose the lever that would deliver the reward. This study has also been discussed in more detail on this blog here. This study was followed by the connection of a human brain to a rat brain pioneered by a group at Harvard wherein electrical activity via an EEG cap worn by the human participant was transmitted to a rat through focused ultrasound to elicit a rat tail flick. And more recently researcher at the University of Washington connected two human brains with the goal of playing a video game (which in truth boiled down to having one brain transmit electrical activity to another brain to elicit a finger press of a hand carefully positioned over a keyboard.)

And that brings us to Nicolelis' most recent endeavor: brainets. In these recent experiments 3-4 rats were connected and without external training or stimuli the rats synchronized their electrical activity to engage in problem solving. Perhaps more impressive and closer to home in translation to humans was the experiment where Nicolelis and his colleagues connected 3 nonhuman primate brains to collectively operate an avatar.

Nicolelis was quoted recently in Vice saying, "This is the internet of brains. In a sense, when people are already using the internet, you're synchronizing your brain already—but in the future, that same thing could happen without you typing or using your mouse."



Is a brain truly liberated from a body when we bypass the peripheral system either through connecting multiple brains or connecting a brain directly to the Internet? Individuals like Matt Nagle, paralyzed from the neck down after being stabbed (featured below) may say yes. Nagle was the first recipient of a device called BrainGate, a device that connected his brain and its electrical activity through an Internet connection to a computer, making Mr. Nagle the first individual to have his brain directly connected to the Internet. One important consideration is whether that was a secure, protected Internet connection. Shouldn't such a connection be at least protected through a https line? Neural privacy issues abound. See this previous blog post to read more about those trenchant issues.

Perhaps the bigger question is whether we are liberating minds from bodies and whether a mind can exist without the conduit of a body. Is the brain simply a filter for the mind as neurosurgeon Sergio Canavero (who by the way intends to conduct the first head transplant) says the brain is for consciousness? Or will we find that networking our brains directly – without the body as mediator – will somehow constrain our minds and our existence? Is the brainet (rather than an inter-net) capturing or expanding who we are?



Further Reading:



I recently discussed some of the ethical implications of such technologies here in The New York Times and in our article on the ethical issues of brain-to-brain interfaces that can be found here.



If you're interested here are the links to the primary research article on the rat brainet and the monkey brainet.



Michael Chorost also wrote a relevant book entitled World-Wide Mind



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Rommelfanger, K. (2015). Liberating brains from bodies by capturing them with brainets? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/07/liberating-brains-from-bodies-by.html

Bring back the asylum: A critical analysis of the call for a "return to 'modern' institutionalization methods"

By Cassandra Evans

Cassandra Evans is a Ph.D. student in Disability Studies at Stony Brook University. She studies mental disabilities and ethics surrounding treatment, services, and access for individuals with mental disabilities. She is currently examining the history of institutions in Suffolk County, Long Island (New York) and what shape the “way forward” from institutionalization will take in the new millennium.

This post is a shorter version of a talk Cassandra gave at the Society for Disability Studies’ national conference in Atlanta, Georgia, June 11, 2015.

In early June, 2015, I visited Pilgrim Psychiatric Center in Brentwood, New York, (Suffolk County, Long Island). As I drove onto the Pilgrim campus, I felt as if I could be entering any of the other scores of institutions around the country—the pictures I’ve seen all look so similar and convey the same eeriness: high rise brick buildings with plain numbers on them, grass growing up all around, broken and barred windows, some areas with trash heaps on the grounds and graffiti on the walls. The names were different, but during their official operations, the treatments and results were similar—many individuals stayed longer than they ever wanted, many died and few were “cured.”

This photo shows a brick high-rise institutional building with a 

gravel road leading away from its parking lot, green grass and 

fresh tire tracks nearby.  Toward the front of the building several 

cars are parked outside the front of the building at the bottom 

floor of this 10- or 12-story, double-winged ward.  “Building 82” 

at Pilgrim Psychiatric Center in Brentwood, New York, is still 

home to many individuals with psychiatric disabilities.  Though 

three out of four institutions in Suffolk County, Long Island were 

closed and their residents deinstitutionalized, others with more 

severe  disabilities or who were more geriatric ended up here.

Photo by Cassandra Evans

While there, I saw pictures and news clippings in the museum that demonstrated how, in the era when institutions were being built and filled—toward the late 1800s and early 1900s until about the 1950s, consensus was that these facilities and the treatments inside of them were “state-of-the-art.” Text describing the 1938 LIFE Eisenstaedt photo essay noted that the pictures are “showing the dark world of the insane and what scientists are doing to lead them back to the light of reason” (Long Island Psychiatric Museum, 2015). While that rhetoric was common then, I wonder if it is similar ableist thinking, this need to normalize that still prevails today, driving new calls to “bring back the asylum.”

It was a recent ethical argument on this topic in the Journal of American Medical Association (JAMA) that prompted me to visit the Long Island Psychiatric Museum. This article, “Improving long-term psychiatric care: bring back the asylum,” by Sisti, Segal and Emanuel (2015) made major waves in both academic and lay literature. In it, the authors argue that because of “transinstitutionalization”—the failure of deinstitutionalization to guarantee appropriate placements for former residents of these homes—the “way forward” for severe psychiatric patients is a return back to the asylum (Sisti et al, 2015).

This photo shows the outside of “Building 93” at Kings Park 

Psychiatric Center, originally called “Kings Park State 

Asylum” in Kings Park, New York.  There is an ominous 

darkness to the background sky of this 13-plus, story brick 

building, with a sky of grey clouds, dead grass, and bare

trees all around the abandoned surroundings.  This 

asylum was completely closed in 1996, but many buildings

 like “Building 93” remain on the property unused and

withering. As I neared the turn off for the Pilgrim Psychiatric 

Center, I had visions of a scene in the film Kings Park: Studies 

from an American Mental Institution. The decaying buildings 

of Kings Park Psychiatric Center or “Kings Park State Asylum,” 

as it was originally christened in 1896, sit some 11 miles to the 

north of the facility I would enter this day, and looks almost 

identical to the hundreds of Goffman-esque and Foucaldian 

brick wards built on Pilgrim’s campus. 

Photo by Rick Jones

While I am not categorically opposed to in-patient treatment for many health needs, and I do agree that the streets, emergency rooms, and jails or prisons are not safe nor appropriate places for people with mental disabilities, I argue that prudence and caution must guide newer service delivery decisions as well as humane and person-centered care. We must also remember that some individuals do in fact choose to be homeless and are quite happy doing so. Asylums, prisons, and streets are not the only answers—community-based mental health services have yet to be fully actualized. And, if, in some cases, a long-term institution is necessary, I wonder, how do we guarantee its benevolence and efficacy? The consumer/survivor/ex-patient/mad or “c/s/x/m community,” as its often described today, and their families deserve an answer to this question.

This black and white postcard, dated Oct. 4, 1964, found 

in the Long Island Psychiatric Museum, touts Pilgrim 

State Hospital’s own infamy: “largest in the world.” 

The photo showcases another high-rise brick building of 

at least 10-to 12-stories with turrets and hundreds of 

uniformly shaped small windows. LIFE Magazine 

clippings at the Museum also described Pilgrim as,  

“A city of the insane.  It grows every day.” 

Photo of the postcard by Cassandra Evans, 

taken at Long Island Psychiatric Museum, June 2015

We must also consider the possibility for non-medical motives for institutionalization. Some have argued large asylums were not only part of the medical system, but were also integral parts of local economies. While Pilgrim’s claim to being the “largest in the world” was true—no institution was physically larger nor housed more patients than Pilgrim—it was also grand in terms of job creation. As Liat Ben-Moshe argues, housing bodies in institutions like these historically (and in present day) created thousands of jobs (2011). Citing Russell’s logic of “handicapitalism,” Ben-Moshe calls our attention to the risks of making the “unproductive” or non-working bodies lucrative when we place them in institutional beds—whether that means jails, nursing homes, psychiatric centers or group homes. The four large institutions built in the late 19th century to mid 20th century in Long Island, in fact, brought the region thousands of jobs, fostered an entire economy based on psychiatric “care,” and created what are now the numerous towns in the area. As institutions in cities like New York became overcrowded, states looked to rural areas to create “work farms” or silos to warehouse patients. Thus, an entire industry was designed, built, and sustained around mental disabilities for decades.

This graphic is a Google map of Western Suffolk County in Long Island, 

showing major interstates and parkways and the proximity of four of Long 

Island’s asylums with their names and numbers in terms of chronological 

appearance in Suffolk County, written at each site:  1.  Kings County 

Asylum in Kings Park, New York; 2. Central Islip State Hospital in 

Central Islip, New York; 3. Pilgrim State Hospital in Brentwood, New York;

4. Edgewood State Hospital in Deer Park, New York. All sit within a 12- to 

15-mile radius. New York State built four large psychiatric hospitals in western 

Suffolk County between 1885 and 1942, housing anywhere between 20,000 to 

40,000 patients at one time between the four of them.  Pilgrim State remains the 

last functional institution of the four today, and now has about 300 individuals 

who live on campus long-term.

As I looked at black and white photos of men in straightjackets, I also thought of the “O and O” or “R and R” that James Trent writes about in Inventing the Feeble Mind (1994). These “work farms” were supposed to promote “Oxygen and Occupation” or “Rest and Relaxation.” The proposed philosophy behind institutionalization of both mental patients and “the feeble minded” through the end of the 19th and early 20th centuries touted outdoor experiences, fresh air, and acres of open land. The design of these rural farms (all over the country) would allow for shipping family members with serious mental disabilities off to safer, more controlled environments in picturesque areas where they could be a part of pastoral life—planting and tending crops, milking cows, sewing, and cooking country meals. While some of these activities did become part of some patients’ days, we now know, in the case of the individuals in psychiatric hospitals, they were still subjected to prolonged and significant physical restraints, experimental lobotomy surgeries, shock treatments, hydrotherapy, insulin, isolation, and testing of Thorazine. In addition, as Trent notes, “the feeble-minded” were commonly sterilized at their “work farms” (1994).

This black and white 1938 photograph was part of a series in an expose 

about a day in the life of “residents” at a number of asylums in the 

United States—Ohio, Pennsylvania and New York were featured. 

In this scene, six men in Pilgrim State Hospital are confined to 

straightjackets.  They sit in front of a brick wall with a barred 

window next to them.  Three of six of the men are sitting looking 

blankly into the camera.  One is standing in the corner with his mouth 

wide open—either yawning or yelling.  Two others are seen sitting 

looking away from the camera.  Each straightjacket has wide and 

bolding number on it, such as “4-2” or “I-8” in what looks like 

some form of identifying the patients. This photo is also found 

in the 1938 LIFE Magazine expose on “state-of-the-art” treatments. 

Photo by Alfred Eisenstaedt

I looked at the expansive grounds surrounding this particular parcel of land (at its height 1000 acres), and wondered how many of its 10,000 to 16,000 residents (the largest number of patients varies depending on the source) were actually participating in the “O & O” or “R & R” the institutions touted and for which the state or their families paid.

Sisti, Segal and Emanuel describe the asylum as a place of “retreat and security; shelter” (2015). They point to Worcester Recovery Center and Hospital in Massachusetts as a new, model asylum. It has electronic health records, 320 private rooms for “patients with chronic, serious mental illness,” and a fully integrated health system as a possible model for reform (244). They note that centers like this one are more desirable than the default treatment centers of nursing homes, jails, and prisons.

Coincidentally, Pilgrim Psychiatric Center, the last remaining institution of the four original asylums in Suffolk County, houses only about 300 long-term psychiatric patients now—about the same number for which Worcester was built. Pilgrim’s registry shrunk from a capacity of between 11,000 and 16,000 to a mere 300. The hospital says there are no longer direct admits and its goal is to only have patients stay for a maximum of six months of treatment, then discharge. However, currently, because there are still residual residents who have spent their entire lives in institutions, “the official average is eight years and one-third months” (Kalvin, 2015).

This photo (taken inside the Long Island Psychiatric Museum in color) 

shows a brown, wooden chair with leather arm straps, a leather waist 

strap, and a cranium-sized wooden box at the top of the chair that 

appears to fit over a human head—also equipped with leather restraint 

straps.  In the seat of the chair is a large round hole with a metal or tin 

pot underneath it, presumably to collect waste while an individual is 

restrained for long periods of time.  In the left side of the photograph, 

directly next to the chair, appears a portion of a beige-colored 

straightjacket—possibly just an arm or the groin straps—hanging 

from a pole right next to the chair. This chair was designed in the United 

States by physician Benjamin Rush, who is sometimes referred to 

as the grandfather of psychiatry.  Rush’s “tranquilizing” chair was 

considered state-of-the-art from the early 1800s through early 

1900s for subduing “insane” patients with chronic hallucinations 

and outbursts. LIPM notes that name later evolved into the “coercion chair.”

Photo by Cassandra Evans

Of course there are far more than 300 people in Suffolk County, Long Island that need long-term care. While I agree, YES (emphatically), neither streets nor jail are proper places for long-term care (in some cases, it could be argued that those spaces may actually make recovery or community re-integration less likely when prison staff are not properly trained or equipped to be mental health providers), we must interrogate what it means for an asylum-like hospital to be a “safe haven,” or a “refuge.” The question of how long “long-term” is bears pondering as well. In order to be truly “patient-centered,” perhaps there is a way forward that includes the c/s/x/m community in designing these havens, asking these questions and providing answers.

Additionally, when Sisti, et al dismiss community-based mental health services as failures while admitting they were never well-funded, they leave more stones unturned. Further inquiry is needed to answer how community-based mental health services can become more effective and well-funded. Do parents and professionals still prefer asylums because they are more convenient and cost-effective? And, finally, it is worth noting that some individuals will continue to choose the streets as alternatives to asylums, prisons, or community care centers.

In the end, there were no self-identified c/s/x/m on my tour of the asylum—only two nurses who had lived on the Pilgrim campus attending nursing school and a couple who was taking the tour with their baby as “urban adventurers.” The nurses were celebrating their 40th anniversary of graduating from nursing school and the urban adventurer couple was trying to visit as many asylums across the country as they could. The baby was could not tell me why he was there, but he was screaming loudly, restrained in his chair, crying, and acting like he wanted to get out.

REFERENCES

Ben-Moshe, L. (2011). Disabling incarceration: connecting disability to divergent confinement in the USA. Critical Sociology doi: 10.1177/0896920511430864.

Foucault, M. (1965). Madness and civilization: a history of insanity in the age of reason. New York: Random House.

Foucault, M. (1977). Discipline and Punish: The Birth of the Prison. Translated by Alan Sheridan, London: Allen Lane, Penguin. First published in French as Surveiller et punir, Gallimard, Paris, 1975.

Goffman, E. (1961). Asylums; essays on the social situation of mental patients and other inmates. Garden City, N.Y.: Anchor Books.

Kalvin, S. (2015, June 3). Volunteer museum tour operator and employee of Pilgrim Psychiatric Center. In person interview at Long Island Psychiatric Museum.

Kings Park: stories from an American mental institution [Motion picture]. (2011) Wildlight Productions (Lucy Winer).

Merriam-Webster Dictionary (2015, June 2). Retrieved from http://www.merriam-webster.com/dictionary/asylum.

Montross, C. (2015, February 18). The Modern Asylum. The New York Times. Retrieved from http://www.nytimes.com/2015/02/18/opinion/the-modern-asylum.html?_r=0.

Russell, M. (1998). Beyond ramps: disability at the end of he social contract—a warning from an uppity crip. Monroe, ME: Common Courage Press.

Sisti, D.A., Segal, A.G., Emanuel, E. J. (2015). Improving long-term psychiatric care: bring back the asylum. Journal of American Medical Association, 313(3): 243-244.

Trent, J. (1994). Inventing the feeble mind: a history of mental retardation in the United States. Berkeley: University of California Press.

Want to cite this post?

Evans, C. (2015). Bring back the asylum: A critical analysis of the call for a "return to 'modern' institutionalization methods". The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2015/07/bring-back-asylum-critical-analysis-of.html