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History of Mental Health Asylums

History of Mental Health Asylums

The history of the care and treatment of the mentally ill represents an endless journey between two extremes

  1. Confinement in a mental hospital
  2. Living in the community

Starting in the 17th Century society was in a rural and agricultural state. Communities were small and scattered through out rural areas focusing on agriculture. Mental illness was seen as an individual’s problem to be handled by the family and not a societal issue.

Moving to the 18th Century and the american colonialism era. Populations started moving into cities ultimately increasing the proportion of sick and dependent persons. Medical advisors gave little efforts to the mental ill because the bigger issues at the time were economic and public safety. Some undifferentiated welfare institutions did arise during this time, but were mainly for treating aged, infirmed, children, and few mentally ill patients. These hospitals were set up for wealthy families who would not mix with racial and ethnic minorities, for whom almshouses remained the only place. By the 1820s it became clear that the wealthy asylums could not care for the poor who were overwhelming the almshouses and urban streets. In 1841 the Institute of the Pennsylvania Hospital was established. Where a superintendent of the institute, Thomas Kirkbride, create a plan that described how hospitals devoted to moral treatment should be structured. This plan became known as the “Kirkbride Plan” and influenced the establishments of more institutions like it. By as late as 1873 there were 178 hospitals in the U.S. (1/3 of which were for the mentally ill) with a total of fewer than 5,000 beds. Today there are about 15,000 hospitals in the U.S. alone, with approximately 1.8 million beds.

As we came into the 19th century, the responsibility for the insane slowly fell under the jurisdiction of the state asylums. This movement went on for about 100 years and led to the development of the programs we have today. Asylum populations hit their peak in 1955 (roughly 600,000 patients at the time) and with it the growth of professional psychiatrists. This rapid growth of asylums was more of an accident than a proper plan. A symbiotic relationship between asylums and psychiatrists developed, each conferring legitimacy upon the other. Psychiatrist worked hard to establish itself as the proper leader of asylums, medicine was an unstable career and there were lots of non-allopathic healers who challenged the primacy of MDS.

Life in asylums rapidly became a real mess and by the end of the 19th century asylum legitimacy was being questioned. It was believed that insanity was due to two causes:

  1. Lesions in the brain
  2. moral causes, meaning willfully violating the natural laws that governed human behavior
Because physical causes could not be treated in asylums, they focused on the moral causes (masturbation, alcohol abuse, excessive ambition, jealousy, pride, etc.) Treatment for this was a synthesis of medicines, religion, and morality all of which required a small setting to be successful, but with patient numbers constantly increasing, it made it impossible. This overcrowding lead to asylums having 5x as high mortality rate than the general population.

This led to the development of ‘Home care plans’ and the states attempted to push it in to the primary way of care in an effort to decrease costs to the states. However, families either couldn’t or wouldn’t manage their sick relatives at home and overcrowding in asylums continued with less and less money available to take care of the infrastructure. After the war, healthcare underwent major changes. Federal initiatives, 3rd party insurance programs, and a commitment to medical technology and specialization was made. The National Institute of Mental Health (NIMH) was established and so ended a long period of federal passivity in mental health policy. With continuing healthcare improvements, the asylum era came to a close and psychosis or major mental illness was no longer a reason to hospitalize someone.

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