In pursuit of its mission to cure mental illness and enable patients to return to their lives, Friends Asylum for the Insane became one of the first American institutions to use the model of a residential home for its patients. In 1885, it opened a convalescent home[1] on the shore in Atlantic City, New Jersey, called Gurney Cottage. The Board of Managers believed that such a home was necessary due to the “many cases of nervous prostration brought on perhaps by overwork, or temporary excitement, which do not amount to insanity, but are liable to run into it unless proper and timely care is exercised[2].” The Cottage was intended to house patients who had significantly recovered during their time at the Asylum, but who were not ready to return to outside life, as well as people who had been admitted to the Asylum with mental illnesses or nervous disorders that were less serious than those usually treated there. To provide a treatment option specifically for this class of patient was seen not only as being in line with the Asylum’s curative mission, but as a shrewd business move. There were few hospitals suited to treating these kinds of mild cases, and in Pennsylvania and nearby states there were none that offered the comfortable residential living available at the Cottage. Residential care was only available to the wealthy citizens who could afford their own arrangements for home care. Accordingly, the Contributors to the Asylum predicted that the high demand of paying patients for treatment in a convalescent home would easily make the Cottage self-sustaining without additional donations, and that the Cottage likely would even generate a profit[3]. The Contributors to the Asylum believed that being able to receive treatment at the Cottage would make people with “the milder forms of nervous afflictions” more willing to enter the care of the Asylum and less afraid of the stigma that might come with institutionalization.
Gurney Cottage offered the removal from normal life that was a major part of moral treatment’s curative ability, but without the controlled schedule and close supervision found in a moral treatment asylum. As the Managers described it, “Many of the patients have shown an appreciation of, and have been much benefited by the change from the somewhat monotonous life at the Asylum to the pleasant and home-like surroundings at Gurney Cottage, and the invigorating air of the sea-shore[4].” Patients had relative freedom to spend their days as they wanted and to come and go from the cottage -- most activities were conducted in groups, but they were trusted to do things without supervision that would have been carefully watched or entirely disallowed back at the main asylum in Frankford. Patients were trusted to go out in public and socialize, and often went into town with the Cottage’s head nurse to buy food for the cottage, or even went fishing or crabbing with neighbors, with the catches from their excursions contributed to the Cottage’s kitchen. Patients and staff often came together to prepare food, such as deviling crabs after a group of residents went crabbing, or making quince jelly when the head nurse gathered fruit near the cottage[5].
A doctor in Atlantic City named Dr. J.E. Sheppard was appointed as attending physician for the Cottage, and made weekly visits to check on the wellbeing of the patients, as well as coming to the cottage whenever his services were needed. The cottage was officially under the supervision of the superintendent of the asylum, Dr. John C. Hall, who visited the Cottage once a week, typically accompanied by his wife or daughter and spending the night in one of the available rooms[6]. The fact that the superintendent only made his rounds once a week is further evidence of the relatively relaxed environment at Gurney Cottage. These weekly visits often appear to be congenial -- some weeks, Dr. Hall would take patients on fishing excursions, or on his trips into town[7]. Along with the superintendent, staff or managers from the Asylum visited frequently, often with their families.
There was still attention paid to the mental health of the patients. In the early months after the opening of Gurney Cottage, the head nurse expressed concerns that some patients might become overexcited or sick if left to decide their own activities[8]. Eventually, after the early weeks of the convalescent home’s operation, the head nurse seemed less worried about this, or at least expressed less concern at the idea in the diary she kept of her work and the patients lives at Gurney Cottage. This doesn’t mean, however, that the staff at the home did not monitor the condition of the patients. Nurses were always present, and patients were readily returned to the central asylum if they were judged to be not benefiting from the residential environment[9].
Part of the reason for the location of Gurney Cottage in Atlantic City was due to the Board of Managers desire to expand the clientele of the Asylum to people with mild nervous conditions -- Pennsylvania laws that required a physician’s certificate to admit someone into a psychiatric institution did not apply to the outlying ward in New Jersey, and New Jersey had no laws of its own applying to this class of patients. Most residents of the Cottage were admitted directly and expected to have longer stays as they recovered from mild nervous conditions. Some others were patients from the Asylum, rotated out to the Cottage in order to receive a respite from institutional life. This second group tended to be watched more carefully, and typically remained at the Cottage for shorter periods of time. The Board of Managers later found, after corresponding with the Pennsylvania Lunacy Commission, that if patients with mild instances of mental illness or other nervous problems chose to voluntarily enter Friends Asylum and weren’t restrained or compelled at any point, that they did not have to go through the typical legal requirements of being committed to a psychiatric hospital, which meant they could continue to treat and advertise the services of the Asylum to patients with nervous conditions even after Gurney Cottage closed in 1889[10].
The use of Gurney Cottage to increase the variety of conditions that Friends Asylum was capable of treating was part of a trend in the moral treatment movement that became more pronounced later in the 19th century -- the desire to better classify patients. It was feared that allowing too much interaction between patients in different stages of recovery might be harmful to them and make it more difficult to cure their illness[11]. Developing more distinct methods of cure for different severities of mental illness was a natural outgrowth of how moral treatment sought to cure individuals through managing their environment. Though the Cottage was closed in 1889 after the Asylum lost the lease to the property, the Corporation and the Board of Managers sought a replacement in 1890, hoping “that at no distant day similar provisions may be made at some point on the coast[12].” In 1899, Friends Asylum opened a convalescent home for women patients called Oxford Manor opposite the main grounds of the Asylum, and in 1901 the Corporation purchased a property called Stanley Farm for use as another such residential home. These homes have since closed, but the use of a residential home model for patients unsuited to treatment in the main wards continued to be used all the way to the modern Friends Hospital.
