In 1848, the Indiana Hospital for the Insane opened on the west side of Indianapolis, launching a new era in health care that would witness the most progressive innovations and the most heinous abuses.

Historians credit a great social reformer, Dorothea Dix, with persuading Hoosier lawmakers to fund a mental hospital in order to provide more humane treatment to the most vulnerable citizens.

When Dix began her campaign in the early 1840s, society’s understanding of mental illness was crude if not primitive. Idiots and insane — as they were called back then — were housed in county poor asylums or sent to live in foster homes funded, albeit inadequately, by the government. They were chained in closets or dungeon-like cellars with no sunlight and almost no human interaction.

In 1845, lawmakers authorized building a hospital, and the state purchased for that purpose a 160-acre farm two miles from downtown Indianapolis on the National Road.

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The Indiana Hospital for the Insane opened on Nov. 21, 1848, with eight patients. “This achievement marked the beginning of state responsibility which made possible medical care for the insane,” wrote Evelyn C. Adams in the 1936 Indiana Magazine of History.

The site would make medical history many times during its existence, says historian Elizabeth Nelson, director of public programs at the Indiana Medical History Museum located in the hospital’s old pathology building.

“There were certainly dark periods in the hospital’s history,” Nelson observes. “There were also very important innovations by progressive people in charge of the hospital.”

Three innovators stand out:

William B. Fletcher, superintendent from 1883 to 1887, reduced the medicinal use of alcohol, halted secret burials of patients who died in state care and abolished the use of physical restraints.

George F. Edenharter, superintendent from 1893 to 1923, recognized the value of research in understanding causes and treatments of mentally ill and in 1895 opened one of the nation’s first pathology departments, which engaged in groundbreaking research and medical instruction.

Max A. Bahr, superintendent from 1923 to 1952, sought to remove the stigma from the mentally ill. He prohibited lobotomies and instituted an occupational and recreational therapy program that engaged patients in rug weaving, sewing, basket making, checkers, pool, croquet and tennis.

When the legislature authorized three more regional psychiatric institutions in 1889, the Indianapolis hospital changed its name to Central State. It remained the largest with an average population of 1,800 at its height in the early 20th century.

During an active period of building expansion at the turn of the century, the hospital became much like a college campus, adopting Dr. Thomas Kirkbride’s “linear plan,” which featured a large central main building with flanking pavilions and patient rooms with windows looking out on aesthetically pleasing landscapes. Kirkbride was a leading national authority on mental illness who insisted that physical surroundings should be part of any treatment plan.

As with many state-funded services, mental health suffered from repeated cycles of public attention followed by woefully inadequate spending over the years, and chronic allegations of physical abuse, overcrowding and improper treatment.

The development of more effective drugs for treating mental illness led to the deinstitutionalization movement of the 1960s, and Central State discharged many of its long-term patients and became involved in community-based health. In the 1990s complaints of abuse and unnecessary deaths led to the closing of the facility by Gov. Evan Bayh.

Although much of the original campus has been torn down, the pathology building was saved and became a museum in 1969. Appearing much as it did in 1895, the museum preserves patient autopsy records, tissue slides and pathological specimens, including an impressive display of brains. Its focal point is the wood-paneled lecture hall illuminated by skylights used by the Indiana University School of Medicine until 1956.

If you go

The Indiana Medical History Museum is at 3045 W. Vermont St., Indianapolis.

This is part a series of essays about Hoosier history tha

t will lead up to the celebration of the state’s bicentennial in December 2016. Andrea Neal is an adjunct scholar with the Indiana Policy Review Foundation.