Out Of Bedlam Book Review

Wright, D. (1997). Getting out of the asylum: understanding the confinement of the insane in the nineteenth century. Social History of Medicine, 10, 13

In reply to questions six and seven, several pros and cons exist towards deinstitutionalization. Factors contributing to hospital closures and deinstitutionalization could be summarized as follows:

As you will see in this paper, mental illness has been a serious situation for many years. Over the years, there have been different thoughts relating to the causes of mental illness including what the actual situation is and observance of how to treat the mentally ill. This paper will inform you of three different historical periods: Colonial America, Depression & the New Deal and War & Prosperity in which an important aspect of mental health happened in each. I will include some religious and economic information for each period due to the relationship that religion and economy had to the way mental illness was viewed and treated in those periods.

The first colonists blamed mental illness on witchcraft and demonic possession. The mentally ill were often imprisoned or sent to poorhouses. If they didn’t go to one of those they were left untreated at their home. Conditions in the prisons were awful. In 1841, a lady named Dorothea Dix volunteered to teach a Sunday-school class for the female inmates. She was outraged with the conditions of the prisons that she witnessed. Dix then went on to be a renowned advocate for the mentally ill. She urged more humane treatment-based care than what was given to the mentally ill in the prisons. In 1847, she urged that the Illinois legislature to provide an appropriate

This paper will give a description of the Disability Insurance Policy with a focus on the mentally disabled, giving rise to the Community Mental Health Act of 1963. It will describe the problems that made it necessary to create the CMHA policy, giving the pros and cons of deinstitutionalization. It will give a historical account of the policy and finally will give an analysis of the policy.

It was during the 1700s, that occupational therapy began to emerge. This period was called the “Age of Enlightment”. Revolutionary ideas regarding the “infirmed” and mentally ill began evolving during this period. During this time, the mentally ill were treated like prisoners. They were locked up in prison and considered to be a threat to society.

Bachrach, the author of dozens of articles on mental health, reports on the development deinstitutionalization in “Deinstitutionalisation: promises, problems and prospects” (1995). Bachrach argues that deinstitutionalization is not a perfect solution to the problem of the treatment of PMI and supports her argument with discussions about both the drawbacks and “positive legacy” of deinstitutionalization. She explains that deinstitutionalization has three parts: the release of patients into the community, the diversion of possible new patients and the development of newer community programs; Bachrach logically explains that the last process is “particularly important” because it impacts the entirety of the patients new independent life in the community. Multiple sources remarked that the third step of deinstitutionalization had not been properly handled (SOURCES?), one author going so far as to call the last step, and deinstitutionalization as a whole, an “abject failure” (Kara, 2014). While the author supports this claim with the consequences that things such as the lack of community resources has had on the population of PMI, she does not concede any of the positive outcomes of deinstitutionalization making her argument somewhat one sided. The article explains that while institutions began closing, “hundreds of vulnerable people were displaced” to communities that were not properly equipped to support them. An article from the Canadian Mental Health Association website by Diana Ballon supports this claim with a more concrete figure stating that since 1950s and 60s and the beginnings of deinstitutionalization there has been “the closure of almost 80 percent of beds in psychiatric hospitals” (n.d.). This increase of PMI living in communities with a lack of proper housing lead to a disproportionally large number of PMI being homeless or living in poverty which “greatly increase[s] the odds of PMI

brain, or sending patients to institutions, doctor prescribed pills to try and treat mental conditions. In addition mental health patients were no longer being institutionalized due to the poor conditions in mental institutions (History of Mental Illness”)

During the 1800s, treating individuals with psychological issues was a problematic and disturbing issue. Society didn’t understand mental illness very well, so the mentally ill individuals were sent to asylums primarily to get them off the streets. Patients in asylums were usually subjected to conditions that today we would consider horrific and inhumane due to the lack of knowledge on mental illnesses.

Unfortunately, asylum founders could only guess at the causes of insanity. Patient after patient was admitted into the state hospitals, but the cause of their disturbance was often a mystery. Many were inflicted with various organic diseases, like dementia, Huntington’s disease, brain tumors, and many were in the third stage of syphilis. With no treatments available, providing humane care was all that could be done. In the years following the civil war American cities boomed and the asylum began struggling to keep up. Soldiers, freed slaves, and immigrants were stranded in a strange land. The asylum became organized more like a factory or small town. There were upper and lower classman, bosses and workers, patients with nothing, and patients with privileges. Sarah Burrows, a schizophrenic and daughter of a wealthy doctor had a ten bedroom house that was built for her on the hospital grounds. Burrows home was just a stone’s throw away from the hospital’s west wing, where over sixty black women slept side by side. (Asylum: A History of the Mental Institution in America). The hospital began to rely on the free labor the patients provided. However, isolating the hospital from the community meant there was no way of knowing what was happening inside the asylum. The asylum became a world apart. In the 1870’s, Elizabeth Packard, a former patient of St. Elizabeth’s, wrote about her mistreatment and abuse

Institutional care was condemned, as in many cases patients’ mental conditions deteriorated, and institutions were not able to treat the individual in a holistic manner. In many state institutions, patients numerously outnumbered the poorly trained staff. Many patients were boarded in these facilities for extensive periods of time without receiving any services. By 1963, the average stay for an individual with a diagnosis of schizophrenia was eleven years. As the media and newspapers publicized the inhumane conditions that existed in many psychiatric hospitals, awareness grew and there was much public pressure to create improved treatment options (Young Minds Advocacy, 2016). .

The mentally ill were treated very inhumanly in the early insane asylums. Some of the

The United States has never had an official federal-centered approach for mental health care facilities, entrusting its responsibility to the states throughout the history. The earliest initiatives in this field took place in the 18th century, when Virginia built its first asylum and Pennsylvania Hospital reserved its basement to house individuals with mental disorders (Sundararaman, 2009). During the 19th century, other services were built, but their overall lack of quality was alarming. Even then, researchers and professionals in the mental health field attempted to implement the principles of the so-called public health, focusing on prevention and early intervention, but the funds were in the hands of the local governments, which prevented significant advances in this direction.

During the mid-1800’s the mentally ill were either homeless or locked in a cell under deplorable conditions. Introduction of asylums was a way to get the mentally ill better care and better- living conditions. Over a period of years, the admissions grew, but staff to take care of their needs did not. Asylums became overcrowded and treatments that were thought to cure, were basically medieval and unethical

The mentally ill were cared for at home by their families until the state recognized that it was a problem that was not going to go away. In response, the state built asylums. These asylums were horrendous; people were chained in basements and treated with cruelty. Though it was the asylums that were to blame for the inhumane treatment of the patients, it was perceived that the mentally ill were untamed crazy beasts that needed to be isolated and dealt with accordingly. In the opinion of the average citizen, the mentally ill only had themselves to blame (Surgeon General’s Report on Mental Health, 1999). Unfortunately, that view has haunted society and left a lasting impression on the minds of Americans. In the era of "moral treatment", that view was repetitively attempted to be altered. Asylums became "mental hospitals" in hope of driving away the stigma yet nothing really changed. They still were built for the untreatable chronic patients and due to the extensive stay and seemingly failed treatments of many of the patients, the rest of the society believed that once you went away, you were gone for good. Then the era of "mental hygiene" began late in the nineteenth century. This combined new concepts of public health, scientific medicine, and social awareness. Yet despite these advancements, another change had to be made. The era was called "community mental health" and