Strangers to Reason: LIFE Inside a Psychiatric Hospital, 1938

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 and Liz Taylor), as well as other topics that the magazine tackled because, quite simply, they 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 other publications didn’t have the vision or, more frequently, the resources to fully investigate.

In this vein, less than two years after its premier issue, LIFE confronted its readers with a devastating photo essay on an issue that has bedeviled humanity for, quite literally, centuries: 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 a genuine sense of 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 century 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 large hospitals today.