What Happened To Asylums?
A Brief History of Mental Health Treatment
Me: Hey Siri, find a therapist near me.
Siri: Okay Michael. Here’s a list of therapists in San Diego.
Finding high-quality, evidence-based mental health services hasn’t always been as straightforward as pulling out our phones and searching for a clinic.
For centuries, mental illness wasn’t discussed openly, empirically researched, or effectively treated.
I’m going to bring you on a brief tour of the evolution of mental health treatment: the techniques and procedures that are designed to transform abnormal or maladaptive thoughts and behaviors into normal or adaptive ones.
Ancient Views
People thousands of years ago viewed mental illness as a struggle between good and evil that manifested in the human body.
To release evil spirits, some ancient groups performed trephination — removing a section of the skull to release the demons that were causing abnormal behavior.
Ancient Greek and Roman views on mental health can be traced back to Hippocrates, who believed that the four humors (yellow bile, black bile, blood, and phlegm) were the causes of mental illness.
For example, according to Hippocrates, excessive black bile would lead to “Melancholy”.
In ancient China, mental health conditions were treated with herbs, acupuncture, massage, and exercise.
The Middle Ages
Living during a time of wars, plagues, and uprisings, the people of the Middle Ages were all too familiar with mental illness.
Like the ancients, they attributed mental illness to the battle between good and evil, or more specifically, between God and Satan. Alternatively, mental illness was understood as the result of witchcraft.
Mental health treatments during the Middle Ages were designed to rid the body of the devil, demons, or evil spells. For example, exorcisms were performed to rid the body of evil.
Asylums Make Their Entrance
As we make our way into the Renaissance, we begin to see the emergence of institutions designed to provide treatment for people with mental illnesses — asylums.
Although they were originally designed to provide ethical care for patients, asylums were notorious for inhumane conditions and immoral treatments.
For instance, in the Bedlam Asylum in London, patients were displayed as a tourist attraction during the day, and were confined to cages and chains at night.
Harriet Martineau (1802–1876), a British writer, described asylum conditions:
In pauper asylums we see chains and strait-waistcoats, — three or four half-naked creatures thrust into a chamber filled with straw, to exasperate each other with their clamour and attempts at violence; or else gibbering in idleness, or moping in solitude.
The 19th and 20th Centuries
Around 1800, the treatment and stigma surrounding people with mental disorders began to improve.
The most commonly cited innovators are Philippe Pinel and William Tuke, who developed treatments that emphasized humane, moral, and respectful techniques.
Dubbed “Moral Treatment”, Pinel and Tuke believed that patients should be given the opportunity to discuss their problems in a safe environment in which they could self-reflect, work, seek companionship, rest, and pray.
Moral Treatment declined in the late 1800s due to understaffed hospitals, crowded institutions, and underfunded programs. In addition, it wasn’t clear that treating all clients with kindness and patience was the most effective paradigm.
After the decline of Moral Treatment, two perspectives emerged:
- The Somatogenic Perspective: Psychological or behavioral problems have physical causes.
- The Psychogenic Perspective: Abnormal functioning has psychological roots.
Modern Times
Today, psychological treatments are rigorously evaluated through comprehensive research. You can read an overview of several paradigms that guide treatment here.
Rather than discuss specific therapeutic techniques or psychological paradigms (there are too many to count), I’m going to comment on general trends that we’ve seen in mental health treatment.
For one, there has been an emphasis on deinstitutionalization — the transition from large, state-run asylums and institutions to smaller community-based centers and outpatient services.
Rather than lumping all clients together, as was done with asylums, we now have a diverse number of centers and resources that are designed for specific populations, including family service centers, crisis centers, LGBTQ+ mental health centers, private practices, psychiatric hospitals, support groups, school psychologists, case management services, and social services.
Furthermore, some mental health professionals focus on how multicultural factors, including race, gender, culture, and religion, impact the efficacy of psychological services.
In addition to increased diversity in the types of services that are available, there’s been a growing interest in prevention techniques, stopping the development of mental illness; and positive psychology, the promotion happiness and optimism.
Most recently, we’ve seen an emergence of virtual therapy, which has made psychological treatments more widely available and accessible than ever before.
In Sum
We’ve seen a transition from immoral, superstitious treatments to our modern, empirically-derived, and ethical mental health practices.
As we move forward, there’s no doubt that mental health treatments will become more specialized, accessible, ethical, and effective, which inspires hope after centuries of the horror.
