The Quakers & Mental Health portal launched in the summer of 2015 as an iterative website to hold scholarship about the history of mental health in Philadelphia, in the 19th and 20 centuries, and in particular of Friends Hospital, the first private mental health institution in the United States. This multi-year project combines archival research and writing with digital scholarship to create and support scholarship on the history of mental health, to analyze data and create visualizations from that research. The Friends Hospital records, which are on loan to Haverford College Quaker & Special Collections, offer a wealth of information on Quakerism, the treatment of the mentally ill, and the development of American psychiatric hospitals in the 19th and 20th centuries.
The Friends Asylum for the Relief of Persons Deprived of the Use of their Reason was founded in 1813 by a group of Philadelphia Quakers who were concerned about the state of mentally ill Quakers. The Asylum was established upon the Quaker idea that there is that of God in every person, and that mental illness does not change that fact. Under the leadership of Isaac Bonsall as the first superintendent, and a group of other influential, soon-to-be Orthodox Quakers, the Asylum started accepting patients in 1817. The touchstones of life at the Asylum were community and religious life, and these were to become part of its unique take on moral treatment.
Anonymity in Friends Hospital Records
Over the course of the past six years of this project, we have talked many times about how much personal data we should be sharing and, for instance, whether or not we should anonymize the data.
On the whole, we have decided that materials up until the 1920s should not be anonymized, and that we will evaluate any projects we do with data post-1920. This will be a rolling 100-year anonymization.
There are two ways to work through this conclusion: legally and morally.
What is the legal obligation of the Haverford College Quaker & Special Collections to anonymize or restrict Friends Hospital records? In the United States, HIPAA is the health privacy rules followed by covered entities and business associates.1 There is also a difference between different kinds of information. As the records in the collection are progress notes, having these non-anonymized is acceptable.2 Progress notes are created by a provider with the intention of being able to be shared with their client, and insurance providers.3 The information created is separate from any direct medical record. According to both these standards, the Quaker & Special Collections is not obligated to restrict any Friends Hospital records or abide by HIPAA.
The moral obligation to anonymize or not is, of course, more complex. There are two key aspects when considering what to anonymize: respecting patient privacy and helping destigmatize mental health. Records at Friends Hospital detail highly personal information, often covering some of the most difficult periods of patients’ lives. As the vast majority of patients researched as part of the Scattergood internships are deceased, they cannot consent to having their information publicly shared. Given this, we regard choosing to share patient information very seriously. However, we also feel that it is important that we do as much as possible to destigmatize mental illness. Mental illness, both historically and currently, has often been accompanied by severe stigma: those with mental health problems can face social ostracization, which makes it difficult to live, work, and build relationships.4 However, this stigma can be addressed and mitigated when people have contact with those living with mental illness. This is most effective when the contact is direct, but disclosure and contact of any kind can help decrease stigma.5 Thus, publishing the full names of patients at Friends Hospital contributes to the creation of a culture in which mental illness can be discussed more openly.
To attempt to balance both patient privacy and destigmatization, we decided against anonymizing pre-1920 data, and will determine whether to anonymize more recent data on a case-by-case basis, as mentioned above. We do not make these decisions lightly, and will continue to carefully consider questions of privacy, stigma, and anonymity.
1. Office for Civil Rights (OCR), “Covered Entities and Business Associates,” Text, HHS.gov, November 23, 2015, https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
2. “Psychotherapy Notes vs Progress Notes - Key Differences,” ICANotes, June 8, 2018, https://www.icanotes.com/2018/06/08/the-differences-between-psychotherapy-notes-and-progress-notes/
3. “Attorney Articles: On Writing Progress Notes.” CAMFT, www.camft.org/Resources/Legal-Articles/Chronological-Article-List/on-writing-progress-notes
4. Stacey M. Carroll, "Destigmatizing Mental Illness: An Innovative Evidence-Based Undergraduate Curriculum," Journal of Psychosocial Nursing & Mental Health Services 56, no. 5 (05, 2018): 50-55.
5. Carroll, "Destigmatizing Mental Illness,” 51.
Binary Language Explanation3>
Many of the essays and information on this website use a binary when discussing patient gender: patients are referred to as “male” and “female,” and data visualizations have also used these two categories. These categories have been used because they reflect the language used by the Friends Hospital records, and because they have allowed us to analyze differences in diagnosis and treatment on the basis of assumed sex. Despite its historical precedents, we recognize that this language does not capture the full spectrum of gender identity and contributes to the erasure of historical persons who were intersex and/or identified outside of the gender binary.
Note About Slavery Language
Friends Hospital was founded before the Civil War when the institution of slavery was still thriving in the United States. When it comes to language around enslavement, we have opted to use the terms “enslaved people” and “enslavers” instead of slaves and slaveowners. To call someone a “slave” suggests an inherent quality or status and does not accurately reflect the involuntary nature of being enslaved. “Enslaved” and “enslavers” more accurately convey the loss of humanity that results from being captured and held in bondage, as well as from the act of enslaving another human being. The site is in process of being updated to reflect this language.
Discrepancies Between Archival Records
There are many different sources in the Friends Hospital collection that contain patient records, including admission records, annual reports, and medical records. Some of these records contain discrepancies between them. The records of Anne Verree are particularly interesting, as she was the only known patient of color admitted into the asylum in the 19th century. Most of the information in her records was consistent, such as her date of admission and date of death. However, Verree’s age upon admission was listed as either 70 or 80 years old depending on the source. In the Admission Committee records, the Superintendent's Record Book, and the Contributors’ Minutes, her age is listed as 80.1,2,3 In the Admission books, the Annual Reports, and the Medical Register, her age is listed as 70.4,5,6,7 Her name was sometimes spelled differently, either Annie or Anna.8,9
Moreover, while there were multiple records stating she was a person of color, she was mistakenly listed as white in the Admission Book from 1817-1911.10 In fact, every patient was listed as white using the letter “W” and ditto marks in the book. There were a few patients whose races were not listed, and when patients’ demographic information was cross-referenced with different records, no information about their races was found. It was assumed that they were white, but it is difficult to know for certain. The handwriting and the tone of the ink was consistent throughout the whole book, thus, it is credible that one person recorded the information all at once, possibly copying from a different source.
With this in mind, the reliability of the information in these admission books is called into question. The discrepancy between the books complicates the research that can be done, as the information may be incorrect. It is uncertain how old Anne Verree was, and it is also uncertain whether she is the only person of color admitted to the Asylum. Since she was mislabeled as white, then anyone in the admission book from 1817-1911 could theoretically be a person of color who was simply mislabeled. It is unlikely that there were other patients of color at the time, but if there were, then the admissions records have erased their experiences. The mislabeling of Verree and potentially others, whether intentional or not, whitewashes her experience. In light of this issue, more research needs to be done to paint a better picture of Friends Asylum. It is possible to cross-reference patient information with other records, such as Meeting records or diaries, to determine whether there were more patients of color during this period.
History is intertwined with power. The writers of history have the power to include and exclude information based on their biases and agendas. At Friends Asylum, the superintendents, managers, and physicians, all of whom were white men, held the power in directing the Asylum’s narrative, while the patients had little to no say in what was recorded in history. That’s not to say that it is impossible to do justice to these patients. With more research and the knowledge of these biases, it is possible to shed more light on information that wasn’t included in the records.
1. Minutes and Register, Volume 1, 1817 - 1856 Item 29, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
2. Superintendent's Record Book, 1817 - 1844 Item 229, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
3. Contributor Minutes, 1812 - 1828 Item 27, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
4. Admission Book, 1817 - 1885 Item 31, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
5. Admission Book, 1817 - 1911 Item 32, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
6. Annual Reports, 1821 Box 1, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
7. Medical Register, 1817 - 1820 Item 36, Friends Hospital Records, Quaker and Special Collections, Haverford College, Haverford, Pennsylvania.
8. Admission Book, 1817 - 1911 Item 32.
9. Medical Register, 1817 - 1820 Item 36.
10. Admission Book, 1817 - 1911 Item 32.
Kate Scully '22, Seattle, WA
Major/Minor: History/Education and Health Studies
This summer, I focused on how race influenced patient acceptance/treatment and hiring practices at Friends Hospital from 1870-1948, with a particular focus on the exclusion of Black patients. I also wrote shorter essays on commitments processes at the Asylum, how nymphomaniacs were diagnosed and treated, and on unusual causes of death in the Asylum in the late 1800s. In addition to my papers, I collaborated to create data visualizations illustrating and analyzing different causes of death.
Anita Zhu ‘22, Bryn Mawr, PA
Major/Minor: Psychology/Health Studies
This summer, I did research on Friends Asylum’s policies and practices regarding race in the pre-Civil War era. Because of the lack of records on patients of color and Asylum policies, I focused on how the origins of the Asylum and its pre-Civil War practices connect to ideas of race and the institution of slavery. For my smaller essays, I wrote about the discrepancies in the archival sources, the use of physical restraints, and a patient Hannah Jones.
Colin Battis '21, Chapel Hill, NC
Major/Minor: Environmental Studies/Creative Writing
I worked this summer to research and write an essay on how patient care at the Asylum changed and was influenced by new developments in medicine during the late decades of the 19th century, a period that hadn’t previously been the subject of much focus. I also worked to write several new pieces for the website that would expand on this research and fit in with the website redesign, and together with Yuying worked on a visualization of how management of the Asylum changed over time.
Yuying Rong '20, Chongqing, China
With guidance from the team, I renovated the Quakers & Mental Health website from back end to front end: tidying up directories and files, rewriting scripts, unifying templates and layouts, fixing bugs, making the webpages responsive to different screen sizes, and rebuliding Bokeh-served data visualization with Plotly.js. Colin and I also created new contents. The website is now easier to navigate and more accessible to a wider range of audience.
Ben Kaplow '18, California
This summer I wrote a major essay on Universalism & Particularism in Quaker Philanthropy: 1770-1830. I also write three smaller essays around these topics: Quaker theology and familial socialization, Moral treatment and the family, and philanthropic networks. Also, I collaborated with Yasmine on visualizations to support these essays.
Yasmine Ayad '19, Upper Darby, PA
Major/Minor: Computer Science
For the summer, I completed several projects for the QMH portal. I worked with Ben on visualizations to support his essays. I also worked on a framework to streamline the process for publishing short essays to the website. I created a data visualizations dashboard, which researchers can use to create their own graphs and charts of the data. Finally, I also published tutorials to explain these features to share with the broader community.
Alison Rosenman '20, Mercer Island, WA
Major/Minor: Computer Science/Economics
I worked with Claire this summer to understand the Asylum's patients in closer detail. I created the visualizations throughout the website which focus on religious diversity and how gender affected patients' treatments and experiences, as well as the map of patient hometowns. I hope that these visualizations bring the data from Haverford's Friends Asylum collection to life and that future scholarship can come out of our work for the summer.
Claire Michel '18, New York, NY
I have been working, along with Alison, to research and describe what it was like for individuals of different religions, genders, and races within the asylum. I conducted research in Haverford’s Special Collection on the different experiences of unique individuals in order to paint a more complete picture of life in the asylum. The research I have been doing has become part of a essay on what it was like to live in the asylum with different identities.
James Truitt '17, Washington, DC
Along with Maddie, I did research and wrote labels for Deprived of the Use of their Reason. In addition to curating the exhibit, I wrote a short piece on patient employment and amusement. I hope that our exhibition will encourage others to explore the rich history of Friends' Asylum.
Madison Arnold-Scerbo '18, Red Lion, PA
Major/Minor: History/Museum Studies
I worked alongside James to curate and write labels for the physical exhibit Deprived of the Use of their Reason that will be on display in the Sharpless Gallery of Haverford's Magill Library. We spent most of the summer reading through materials in the collection and writing labels for them. I also created data visualizations about the type and causes of mental illness at Friends' Asylum which can be found throughout this website.
Abby Corcoran '17, Greensboro, NC
Along with Lindsay, I spent the summer researching the early history of the Friends' Asylum. I looked at how the founders' Quakerism influenced their ideas about the curability mental illness, and wrote an essay using this research. The research that Lindsay and I have been doing will create a framework for future projects about Quakers and mental health, which will be housed on the website that Lindsay has created.
Lindsay Silver '15, Hingham, MA
Major/Minors: English/Computer Science, Spanish
Working in conjunction with Abby, I am creating a website which focuses on the framing research she has been doing all summer. For the website, I am also looking at ways we can extract data from the collection which can then be included in interesting and interactive visualizations online. I also hope to create the website in such a way as to lay the groundwork for future digital projects related to Quakers and mental health.
- Mary Crauderueff, Curator of Quaker Collections
- Darin Hayton, Historian of Science
- Sarah Horowitz, Head of Quaker & Special Collections
- Alison Sielaff, Project Archivist
- Terry Snyder, Librarian of the College
- Emily Thaisrivongs, Metadata Librarian
- Mike Zarafonetis, Coordinator of Digital Scholarship and Research Services