Lead Shoes and Institutional Peonage
by patricia.deegan on Tuesday, August 30, 2011 - 2:58pm

    During my study of consumer/survivor/ex-patient history I took these photographs at Vermont State Hospital. The staff person who gave me a short tour of the old hospital told me that in the late 19th and early 20th century, these heavy "lead shoes" were routinely attached to patients feet when they worked on the hospital's farm. The lead shoes were strapped over the feet and then a chain was inserted through the round holes, tethering both feet at no more than a stride's length apart. In effect, the lead shoes stopped patients from running away from the hospital while working in the fields. 

     It's hard to believe that decades after the 13th Ammendment to the U.S. Constitution banned slavery and involuntary servitude, these shackles were used as part of the widespread practice of unpaid patient labor in state institutions. Historically, state hospitals relied on unpaid patient labor to operate. For instance, in 1969 the Pennsylvania Department of Public Health found that approximately 11,900 patients in state facilities were working as unpaid laborers and that 3,300 paid staff would have to be hired to replace their labor at a cost of more than $11 million dollars!  

     In 1973, a federal district court ruled in (Souder v. Brennan) that patients in mental health institutions must be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938 whenever they performed any activity that confered an economic benefit on an institution. Following this ruling, insitutional peonage was outlawed as evidenced in the Pennsylvania's Institutional Peonage Abolishment Act of 1973. 

     Many assume that the advent of modern psychotropic medications was the catalyst for deinstitutionalization in the U.S. However, large numbers of patients began leaving state institutions only after new laws made unpaid patient labor illegal. In other words, when patients no longer worked for free, the economic viability of many state institutions ceased and this led to the closing of many state hospitals.  In an ironic twist, patients' unpaid labor had, for decades, helped prop up and support the existence of the very institutions that held them captive.


Wow, thanks for posting this! For a second there, I wasn't sure if you were talking about psychiatric institutions or prisons. More proof that it's a very thin line that separates the two.

Pat, thank you for sharing this information with people. I've long believed that it was exactly this court ruling against unpaid patient labor that was the real catalyst for deinstitutionalization, not the advent of psychotropics. The end of involuntary servitude at state hospitals made these huge institutions financially unfeasible. Unfortunately, policy change is almost always about money!

Hey Darby. Thanks for your comment. I agree that it's critical for us to examine the economic forces behind policy change. For instance, there are clearly powerful economics behind merging mental health services with physical health services.


This post/article of yours is a wonderful educational tool for us who are recovery/lifespan advocates! Our work towards promoting evidence based practices and facts of how far we've come continues and reminders like "lead shoes" fuels us as there is still much work to be done! This story/post reminds me of my personal journey spanning 4 decades as an ex-patient/survivor/employee/advocate here in Oklahoma! While I blessedly began my journey after the era of lead shoes and special jackets I did not miss the 6 point traumatic methods such as physical or medical restraints yet I celebrate a couple of decades of positive evolving treatment modalities..one of which (I am so glad we are now using) your program "Common Ground" piloted at the very hospital I first entered into recovery back in the 70's.

I do have a question - although we are continuously in the process of becoming there are still many who have and perpetuate the 'us vs them' mindset. This mindset sadly continues to rear it's disparaging head - in spite of millions in transformative dollars!

I've even been personally told "When it comes to whether you are an 'us vs them' you are a 'them' referring to when I was employed within the MH system. I cannot nor would not ever deny being a consumer/survivor/ex-patient because to do so in my opinion says that I am ashamed of having a diagnosis. Having multiple health diagnosis - I continue to advocate for total community inclusion for all 'differing abilities' and respectfully ask your thoughts on how to mitigate this attitudinal barrier?



The history provided in this article is wonderful and a great help to me as a Human Services student. Thank you.

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