Throughout the Western world, the emergence of insane asylums during the nineteenth century marked a significant change in the public perception as well as the medical treatment of mental illness. Mad Yankees tells the story of one of the earliest such institutions in the United States, the Hartford Retreat for the Insane. Opened in 1824, it was the first hospital of any kind in Connecticut and the only private mental asylum in the nation founded by a state medical society. Although conceived as an elite institution, for many years the Hartford Retreat cared for the indigent insane and paying clients alike.
A number of remarkable physicians associated with the Retreat shaped early psychiatry in Connecticut and placed the state in the vanguard of treatment for the mentally ill. Dr. Eli Todd's ethic of a "law of kindness" toward the afflicted and claims of extraordinary cure rates gained the hospital an international reputation. A coterie of doctors associated with Todd—including Mason Cogswell, Samuel B. Woodward, Amariah Brigham, and John Butler—became prominent advocates of "moral" treatment that led to caring for the insane with respect and dignity.
Yet as Lawrence B. Goodheart explains, care of the mentally ill in nineteenth-century Connecticut was not without its ironies. The faith of the Retreat's founding generation in the restorative ability of the asylum gradually waned, as the burden of providing extended custodial care to the chronically ill produced outcomes that were not originally anticipated. During the Gilded Age, the contrast between the state-funded Connecticut Hospital for the Insane, which opened in 1868 in Middletown, and the elegant Hartford Retreat made clear the class and associated moral differences between public and private care. Less was heard about "the law of kindness" and moral treatment of patients and more about moral unfitness and the benefits of eugenics. As the precepts of one era became problems for the next, the idealism of antebellum reformers shriveled into a fin-de-siècle fatalism.