Mental Illnesses / Disabilities
Illness in the 1840s
In the early part of America’s history,
people who had mental illnesses were
placed in institutions that were quite
similar to jails. Once inside these
facilities, people simply weren’t given
the opportunity to leave, no matter how
much they might want to do so. In
addition, some of these facilities had
terrible procedural rules that allowed
people with illnesses to be treated in
ways that were unspeakably cruel.
In the 1840s, a woman in Boston,
Dorothea Dix, began to research
conditions in traditional mental health institutions. It’s been suggested[2] that Dix had a mental illness of her
own, and she was more receptive to the plight of the ill as a result, but no matter the underlying motivation, Dix
spent years conducting interviews with experts and patients, and her results were startling.
In a piece she wrote to the General Assembly of North Carolina, she outlines cases in which the mentally ill
were chained to their beds, kept in filthy conditions and even abused. She begins her report with this series of
sentences:
“I admit that public peace and security are seriously endangered by the non-restraint of the maniacal insane. I
consider it in the highest degree improper that they should be allowed to range the towns and country without
care or guidance; but this does not justify the public in any state or community, under any circumstances or
conditions, in committing the insane to prisons…”[3]
Rather than committing the mentally ill to prisons, Dix hoped to open a series of institutions devoted to mental
health, and she hoped these facilities would provide work, recreation and understanding to the ill. It’s one of
the first documents to outline compassionate care, although it wasn’t widely implemented due to the work that
Dix did.
History Timeline
After the 1920s, the United States saw yet again another shift in society’s view on mental health. A Mind That
Found Itself, a book by Clifford Beers, prompts discussion on how mentally ill people are treated in institutions.
His ideas begin the roots of the National Mental Health Association. Countless other books like Ken Kesey’s One
Flew Over the Cuckoo’s Nest in 1962 also offered an interesting perspective on how people are treated in
psychiatric hospitals. This early period of the 20th century marked a big movement in advocacy and care
standards for mental health care.
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1946: President Harry Truman signs a law that aims to reduce mental illness in the United States, the
National Mental Health Act. This law paved the way for the foundation of the National Institute on
Mental Health (NIMH) in 1949.
1950s to 1960s: A wave of deinstitutionalization begins, moving patients from psychiatric hospitals to
outpatient or less restrictive residential settings. Institutionalization was often thought of as the best
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method of treatment but overstaffing and poor living conditions prompted a push to outpatient care.
This movement also sparks the development of antipsychotic drugs, so as to make a person’s life outside
an institution more manageable. In fact, over a 30-year period the number of institutionalized patients
dropped from 560,000 in the 1950s to 130,000 in 1980.
1990s: A new generation of prescription antipsychotic drugs emerge, as well as new technology in the
medical field.
2008 to 2010: The Wellstone and Domenici Mental Health Parity and Addiction Equity Act passes into
law. This made it so insurers who did provide mental health coverage could not put limitations on
benefits that are not equal to limits on other medical care coverage.
Innovative Therapies in the 1930s
In the early part of the 1900s, experts began to try to understand what might make a person behave in an
erratic way, and what kinds of thoughts and opinions might be attached to what outsiders would deem
“madness.” Sigmund Freud was a major influence here, obviously, as he developed a number of theories that
attempted to explain unusual behavior, and he devised therapies that aimed to help people who might once
have been placed in a prison with no help at all.[6]But work advocated by Freud could take months or even
years to complete, and some people didn’t seem to get better when they were under the guidance of the socalled “talking cure.” As a result, practitioners began dabbling in radical cures in the 1930s,[7] hoping to
eliminate mental illnesses altogether with one big gesture.
By Cesar Blanco from Mexico (Sigmund Freud Uploaded by Viejo sabio) [CC-BY-2.0
(http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
By Photography Harris A Ewing (Saturday Evening Post, 24
May 1941, pages 18-19) [Public domain], via Wikimedia
Commons
Techniques that were used on the mentally ill included:
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Insulin-induced comas
Lobotomies
Malarial infections
Electroshock therapy
By Otis Historical Archives National Museum of Health and
Medicine (originally posted to Flickr as Reeve041476) [CC-BY2.0 (http://creativecommons.org/licenses/by/2.0)], via
Wikimedia Commons
This work continued in some institutions well into the 1940s
and 1950s, and in some cases, it did help some people who had
serious illnesses. But many of these techniques fell out of favor,
and in the years to come, an entirely different method of
treatment began to take prominence in people with mental
illnesses.
Chemical Interventions
In the 1940s and 1950s, chemists began to
experiment with different powders and pills that
could calm imbalances inside the brain and deliver
real relief to people who had mental illnesses. Rather
than strapping people down to their beds, or asking
people to simply talk about their problems, these
chemists hoped to use a form of chemical restraint.
People would feel better, and they might behave
better, and no institutionalization would be needed at
all.To a large extent, this was a successful project.
Medications like lithium seemed capable of soothing
people with very severe cases of bipolar disorder,
while antipsychotic medications seemed capable of
helping people with schizophrenia.
At the same time, the number of people hospitalized due to mental illness had reached staggering proportions.
[8] It was a global problem, and experts began to wonder if they could take people out of the institutions and
provide them with medications they could use at home.
QUESTIONS FOR PRESENTATION:
1. Explain how people with mental illnesses were treated between 1840 to 1920s.
2. Explain how innovative therapies changed from the 1930s to the 1960s.
3. How are people with mental illnesses treated today (both socially and physically?). How does this
compare to the early 1900s?