Why Mental Illness Has Changed American Views On Mental Health

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 1820, only one state hospital for people with mental illness existed in the United States, by the close of the Civil War, practically every state had established one or more institutions for mental health purposes. Between 1838 and 1898, Ohio alone opened seven asylums, including the Athens Asylum in 1874. As asylums dotted across Ohio and in the major hubs like Cleveland, Columbus, Cincinnati, Toledo and Dayton, a location was needed for an asylum in the southern region of the state. The Athens Lunatic Asylum would serve twenty-nine counties in southeastern Ohio.

However, this was not all that the Act changed. The Lunatics Act in conjunction with the County Asylums Act also regulated asylum construction and compelled counties to provide asylum for lunatics, provided a salary for “the medical and legal Commissioners…created a more detailed medical certification procedure, and establishments had to keep…detailed records of admission, discharge or death, escape or transfer, restraint, seclusion, and injury of those placed in the asylum” (German E. Berrios, Hugh Freeman 92, 93). The significance of the Lunatics/County Asylums Act of 1845 in addition to the mass construction of asylums, the new Lunacy Commissioners, inspection, record keeping, licensing, reporting and certifications is that these Acts “saw

Before the 19th century in the American society, criminals were executed, whipped, and held in dark cells with little food and water. The insane wandered around asylums or were kept in tiny cells and were not treated properly. In incarcerations prisoners were worked without stopping and treated inhumanly. Reformers wanted to establish an official institution for the insane and the criminals that was humane. They believed that reform and rehabilitation was possible in a controlled environment. As part of the humanitarian reforms sweeping through America, asylums and prisons were created for criminals and the mentally ill. The importance of human perfectibility led some reformers to care for the physically and mentally ill. Many people lead this movement, including Dorothea Dix. She traveled the country visiting a large amount of asylums and prisons. Through Dix’s work and others’ the treatment of patients improved vastly.

But with the dawn of the Industrial Age, and its accompanying growth of crowded cities, many people feared people with mental illness were a threat to public safety. That perceived threat provided the impetus for the creation of asylums to confine psychiatric patients. Consequently, by the second half of the century, many states had opened public psychiatric asylums. These sanctuaries ultimately became the hospitals for the poor, since the better-off patients could take refuge in the private philanthropic asylums, such as McLean Hospital in Massachusetts, which required patients to pay their own way”. This led to the first mental health institution, Mclean Hospital, which was built in Boston in 1811, as well

As the issue of mental illness became more prevail, states began to opening Insane Asylums which were intuitions for the mentally insane. Because insanity was viewed as a more social dysfunction, experts at the time believed that the illness could be cure with the creation of a strict daily regimen of activities and limited bad news or notions that excite the indigent and asylum were placed in rural areas to encourage the not disturb the “curing process”. Philanthropy played a center role in creating quality Private hospitals with better doctor -patient ratios, and a better quality of life which is opposite of state facilities which only acted as a confinement centers for the poor mentally indigent. Because of the private dollars, wealth families wished to see their loved one treat with more dignity and wanted them to development skills to better care for

Due to the fact that the psychiatric studies of the era focused on the importance of architecture in the treatment of the insane, many asylums were created to try and combat the illness. However, what I think is very interesting is the stigma left behind on these buildings as centuries went by and these grand institutes were left abandoned, in rubles, or torn down. The Kirkbride website highlighted some asylums that followed the Kirkbride model that are abandoned, torn down, or turned into museums that gain tourist attraction from the stigma of asylums.

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.

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 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.

In early American history, individuals with mental illnesses have been neglected and suffered inhuman treatments. Some were beaten, lobotomized, sterilized, restrained, in addition to other kinds of abuse. Mental illness was thought to be the cause of supernatural dreadful curse from the Gods or a demonic possession. Trepanning (the opening of the skull) is the earliest known treatment for individuals with mental illness. This practice was believed to release evil spirits (Kemp, 2007). Laws were passed giving power to take custody over the mentally ill including selling their possessions and properties and be imprisoned (Kofman, 2012). The first psychiatric hospital in the U.S. was the Pennsylvania Hospital where mentally ill patients were left in cold basements because they were considered not affected by cold or hot environments and restraint with iron shackles. They were put on display like zoo animals to the public for sell by the doctors (Kofmen, 2012). These individuals were punished and isolated and kept far out of the eyes of society, hidden as if they did not exist. They were either maintained by living with their families and considered a source of embarrassment or institutionalized

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

Ken Kesey’s novel One Flew Over the Cuckoo’s Nest depicts a story of a sane man, Randle McMurphy, who decides to escape imprisonment by entering a psychiatric ward instead. The entire story is viewed in the eyes of a schizophrenic patient, Chief Bromden. This novel is set around the 1950’s in a mental asylum in Oregon. Besides the plot of the story, Kesey also manages to illustrate a realistic 1950’s mental hospital. The facilities, therapy and the release of patients in mental asylum in One Flew Over the Cuckoo’s Nest by Ken Kesey realistically depicts the conditions of mental hospitals during the 1950’s.

The work of Erich Lindermann and Gerald Caplan is arguably part of the third of four psychiatric revolutions throughout history (Singh & Singh, 2004, p. 3). Prior to 1800 and the First Psychiatric Revolution, patients in the so-called "insane asylum" were labeled "lunatics," chained and shackled in dungeons, and/or displayed for money (Pinel School, n.d.); (Singh & Singh, 2004, p. 3). In 1796, a New York Quaker named William Tuke founded the "New York Retreat," an asylum for the treatment of mentally ill Quakers that treated its patients with a humane, religion-based "Moral Treatment" that focused on their basic needs (Science Museum, n.d.). Noticeably different from the inhumane insane asylums of the day, Tuke's Retreat greatly influenced others dealing with the mentally ill. In 1801, a French medical doctor and psychiatrist named Philippe Pinel who was impressed by Tuke's Retreat, became the