History of the Treatment of the Mentally Ill

The treatment of mental illness has a long and sordid past.  My basic understanding of the history of the treatment of mental illness started with knowing about hysteria and electroconvulsive therapy.  As someone who has gone through multiple types of treatments, I wanted to learn more.  How would I have been treated had I been born 50 years ago?  What about a century or more ago?  Mental illness is not a modern phenomenon, but the treatment is still in it’s infancy.

There is evidence back as far as 5000 BCE that mentally ill individuals were believed to be possessed by demons.  To “cure” someone of this, their skulls were trephined, which means that there were holes drilled in their skulls.  It was believed that by doing this, there would be a way for the demons to escape.

Ancient Egypt had a more humane way of dealing with the mentally ill.  The Egyptians encouraged them to engage in recreation, such as dance or painting.  They believed the recreation would help alleviate the symptoms.  This is something that is still seen practiced today, albeit in conjunction with talk therapy and/or medication.

In 400 BCE Hippocrates, the namesake of the Hippocratic oath, spoke of mental illness as a disease.  Hippocrates believed that those who were mentally ill had an imbalance of their humors.  Humors were liquids in the body, which included blood, yellow bile, black bile, and phlegm.  Hippocrates believed that certain moods and emotions were caused by an excess or lack of these humors.

Moving forward to the middle ages, it was believed that those who were mentally ill were witches, or as was believed in 5000 BCE, were possessed by demons.  In the 8th century, however, Muslim Arabs established asylums, believing that God loved the mentally ill, and therefore they needed to be treated humanely.

After the French Revolution in the late 1700’s, French physician Phillippe Pinel took over Bicetre insane asylum and forbid the chains and shackles that had previously been customary practice.  Pinel also removed patients from dungeons, and encouraged time spent in the sun.  I can imagine that this made a tremendous difference for many people.

In the 1840’s, when women had little political say, Dorthea Dix saw the atrocious conditions in which the mentally ill were kept in the United States and abroad.  Dix believed that with humane treatment, individuals could be cured, however, the common belief of the time was that the “mad” could not feel pain and that they were more animal than human.  In response, Dix gave up teaching and lobbied for the United States to fund state hospitals for the mentally ill, allowing them to be treated in a hospital instead of held in a jail cell with criminals.  Directly due to Dix’s hard work, 32 asylums were established, including St. Elizabeth’s in Washington DC.

The first patient at St. Elizabeth’s was a man named Thomas Sessford in 1855.  Sessford was diagnosed with dementia and was believed to be ill due to masturbation.  Unfortunately, Sessford did not recover and died while at St. Elizabeth’s.

Patients at St. Elizabeth’s were brought to the hospital for treatment, however, the hospital quickly began to rely on the free labor the patients provided.  Every hour was planned for the patients, and the hospital began to resemble a small town.  There were different classes amongst the patients, and one patient, Miss Sarah Burrows, a schizophrenic woman, had a 10 bedroom house on hospital grounds.

In 1883 German psychiatrist Emil Kraepelin became the father of scientific psychiatry.  Kraepelin distinguished between manic-depressive (now known as Bipolar disorder) and schizophrenia.  Kraepelin’s distinctions hold today.

In the late 1800’s, U.S. psychiatric hospitals were becoming over crowded, and treatment inhumane.  One patient at St. Elizabeth’s died from a strike to the head, and it was believed to have been from a member of the hospital staff.  The staff member was let go, however, the hospitals reputation was damaged.  Around this time, journalist Nellie Bly posed as a mentally ill woman and became a patient at a hospital.  Once released, she wrote about her experience, which led to increased funding to improve conditions.

As the 1900’s rolled around, talk therapy was developed by Sigmund Freud, Karl Jung, and others.  Freud argued against the biological theory of mental illness of the time, saying that the unconscious mind was what truly caused the illnesses.  As Freuds psychoanalysis became more well know, William A White became one of the first psychiatrists to try talk therapy in a hospital setting.

In the 1930’s, doctors began trying different treatments on their patients.  Drug therapy was introduced, as was electroconvulsive therapy (ECT), surgery in the form of a lobotomy, heat and cold therapy, radiation, and insulin induced coma/seizures.  Today, drug therapy and ECT are still possible treatments, however, they have been drastically altered.

As soldiers came back home from fighting in WWII, 1 in 5 suffered from shell shock.  These individuals would likely now be diagnosed with post-traumatic stress disorder (PTSD).  In 1946, Harry Truman signed the National Mental Health Act calling for a National Institute of Mental Health to conduct research.  Not long after, in 1949 Australian psychiatrist J.F.J. Cade introduced the use of Lithium, a drug that is still prescribed today.

In 1950, thorazine was discovered and became the first anti-psychotic drug.  Treatment became more community based, and the population in hospitals began to lessen.  In the 1960’s legal battles were fought to free patients from psychiatric hospitals, and the homeless population soared.  In 1963 the Mental Retardation Facilities and Community Mental Health Centers Construction Act was signed, which provided federal money for developing community based centers.

With less hospitals, the homeless populations continued to grow.  In the 1980’s an estimated 1/3 of all homeless in the US were believed to be mentally ill.  In 1992, 7.2% of US inmates were mentally ill.  Some of those inmates were not charged with a crime, but were awaiting a bed in a hospital.

Today, there still exists limited access to mental health care, and there is a great stigma against those with mental illness.  Organizations such as the National Alliance for Mental Illness (NAMI), founded in 1979, fight tirelessly for the fair treatment of individuals with mental illness.  The Affordable Care Act forced insurance companies to treat mental health care the same as any other medical expense.

It is my hope that the treatment of the mentally ill will continue to evolve.  Now that we have a Trump presidency on the horizon, it is possible that access to mental health care will decline.  Help for the mentally ill and homeless may all but disappear.  It is important that we all remember where we have been in the treatment of the mentally ill, and not let an abysmal man yank us backward.



The Rise and Fall of the American Asylum – Documentary

Inquiries Journal – The History of Mental Illness: From Skull Drills to Happy Pills


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