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Strangers to Reason: LIFE Inside a Psychiatric Hospital, 1938

Alfred Eisenstaedt's photos from Pilgrim State Hospital in the late 1930s blended clear-eyed reporting with an almost palpable compassion.

For all of the lighthearted and often downright frivolous material that appeared in LIFE through the years—and there was, thank goodness, a lot of lighthearted, frivolous reporting and photography in most every issue—the magazine was always at its best when addressing, head-on, the thorniest, most resonant issues of the day. That coverage included features on the era-defining people and events for which LIFE, all these decades later, is most clearly remembered (World War II, the Civil Rights Movement, the Space Race, Vietnam and, of course, pop culture legends like Marilyn, JFK, Sinatra and so many more), as well as other topics that the magazine tackled because, quite simply, those topics mattered.

The magazine’s archives are filled with countless stories and photo essays that, at the time they were reported, helped drive (if only for a while) the national conversation around explosive and frequently under-reported issues. LIFE covered the post-war rise of the Klan; the struggles of returning WWII veterans; the quiet heroics of a midwife in the rural South; and other stories that most publications, then and now, simply lack the resources to tackle.

In this vein, less than two years after its debut, LIFE confronted its readers with a devastating photo essay on an issue that has bedeviled humanity for, quite literally, millennia: namely, how to treat those among us who suffer from debilitating, and often frightening, mental disorders.

Even today, three-quarters of a century after they were shot, Alfred Eisenstaedt’s photographs from the grounds of Pilgrim State Hospital on Long Island are remarkable for the way they blend clear-eyed reporting with an almost palpable compassion. But what is perhaps most unsettling about the images is how terribly familiar they look.

The treatment of mental illness—in all its confounding varieties and degrees—has come a long, long way since the 1930s, and in most countries is now immeasurably more humane, comprehensive and discerning than the brutal approaches of even a few decades ago. Advancements in psychiatric medications alone have helped countless people lead fuller lives than they might have without drugs. And yet . . . the grim, desolate tone of the pictures in this gallery will feel eerily contemporary to anyone familiar with psych wards in countless large hospitals today.

The tone struck by LIFE, meanwhile, in its introduction to the Pilgrim State article—while employing language that might seem overly simplified to our ears—is at-once earnest and searching:

The day of birth for every human being is the start of a lifelong battle to adapt himself to an ever-changing environment. He is usually victorious and adjusts himself without pain. However, in one case out of 20 he does not adjust himself. In U.S. hospitals, behind walls like [those] shown here, are currently 500,000 men, women and children whose minds have broken in the conflict of life. About the same number, or more, who have lost their equilibrium, are at large. Their doctors say they have mental diseases. Their lawyers call them insane.

Mentally balanced people shun and fear the insane. The general public refuses to face the terrific problem of what should be done for them. Today, though their condition has been much improved, they are still the most neglected, unfortunate group in the world. [This photo essay features] pictures showing the dark world of the insane and what scientists are doing to lead them back to the light of reason.

The magazine, even in its infancy, clearly saw that its responsibilities included standing up for the afflicted, and shining light on inconvenient truths—roles to which, eight decades later, the best journalism still often aspires.

Ben Cosgrove is the Editor of LIFE.com

Liz Ronk, who edited this gallery, is the Photo Editor for LIFE.com. Follow her on Twitter at @LizabethRonk.

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