Psychiatric hospital

A psychiatric hospital (also called a mental hospital, mental ward, asylum, and occasionally insane asylum , funny farm) is a hospital specialising in the treatment of persons with mental illness. Psychiatric wards differ only in that they are a unit of a larger hospital.

History of psychiatric hospitals

The history of psychiatric hospitals is linked heavily with social and scientific attitudes towards mental health, and the attitudes towards those afflicted with mental illness, both of which have changed greatly over the past centuries.

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As the number of people living in cities increased, there became an increasingly large population of urban mentally ill. Generally speaking, in rural areas the mentally ill had been able to rely on local charity and support, or managed to simply "blend in" with the rest of the population. However, under the demands of larger cities they faced a higher degree of difficulty and had a much greater chance of causing disruption or simply being noticed. This led to the building of the early asylums which were little more than repositories for the mentally ill – removing them from mainstream society in the same manner as a jail would for criminals. Conditions were often extremely poor and serious treatment was not yet an option. The first known psychiatric hospital, Bethlem Royal Hospital (Bedlam), was founded in London in 1247 and by 1403 had begun accepting "lunatics". It soon became (in)famous for its harsh treatment of the insane and in the 18th century would allow visitors to pay a penny to observe their patients as a form of "freak show". In 1700 it is recorded that the "lunatics" were called "patients" for the first time, and within twenty years separate wards for the "curable" and "incurable" patients had been established, representing the beginning of a clear shift in the attitude towards mental illness towards a disease of some form.

Related Topics:
Bethlem Royal Hospital - London - 1247 - 1403 - Lunatic - Freak show - 1700

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In 1793 Phillipe Pinel is credited as being the first to introduce humane methods into the treatment of the mentally ill as the superintendent of the Asylum de Bicêtre in Paris. He removed patient restraints and introduced categorising and separation as well as observation and talking to patients as methods of cure. At much the same time William Tuke was pioneering a more enlightened approach to the treatment of the mentally ill in England. These ideas gradually took hold in different countries, and in the United States attitudes towards the treatment of the mentally ill began to drastically improve during the mid-19th century.

Related Topics:
1793 - Phillipe Pinel - William Tuke

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Reformers, such as Dorothea Dix in the United States, began to advocate a more humane and progressive attitude towards the mentally ill. In the United States, for example, numerous states established state mental health systems paid for by taxpayer money (and often money from the relatives of those institutionalised inside them). These centralised institutions were often linked with loose governmental bodies, though in general oversight was not high and quality consequently varied. They were generally geographically isolated as well, located away from urban areas because the land was cheap and there was less political opposition. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.

Related Topics:
Dorothea Dix - Kirkbride Plan

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While many of those in state hospitals were voluntarily admitted, many more were involuntarily committed by courts. For this reason, state hospital patients were usually from the lower class, as the mentally ill from families with money often had enough private care to avoid being labelled a public menace.

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In the United States, state hospitals in some places began to overflow by the beginning of the 20th century. As state populations increased, so did the number of mentally ill and so did the cost of housing them in centralised institutions. During wartime, state mental hospitals became even more overburdened, often serving as hospitals for returning servicemen as well as for their regular clientele. The incentive to discharge patients was high, yet there were still no adequate treatments or therapies for the mentally ill.

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This provided a fruitful environment for the popularity of quick-fix solutions, like the eugenic compulsory sterilisation programs undertaken in over 30 U.S. states (and, later, in Nazi Germany), which allowed institutions to discharge patients while still claiming to be serving the public interest. These new treatments of mental illness – which was now seen as a "defect", and likely a hereditary one – were seen less as therapeutic for the individual patient than as preventative for the society as a whole.

Related Topics:
Eugenic - Compulsory sterilisation - Nazi Germany - Hereditary

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By the mid-1940s, treatment of the mentally ill became effective for the first time with the advent of electroconvulsive therapy (ECT) and insulin shock therapy, and the use of the lobotomy technique. In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", though in their own context they were seen as the first options which produced any noticeable effect on their patients. ECT is still used, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past. The effect of a lobotomy on an overly excitable patient often allowed them to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution than institutionalisation. Lobotomies were performed in great numbers from the 1930s to the 1950s. At the time, these new therapies became a horrific part of popular understanding of the mental hospital, helping their popularity very little, to say the least.

Related Topics:
Electroconvulsive therapy - Insulin - Shock therapy - Lobotomy - 1930s - 1950s

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By the mid-1950s, the first psychiatric drugs became available for the treatment of mental illness, such as thorazine, which revolutionised psychiatric care and provided for the first time ways for many of the severely mentally ill to return to normal society. The newly discovered antidepressants helped with most cases of depression, and the introduction of muscle relaxants allowed ECT to be used in a modified form for the treatment of severe depression and a few other disorders. Psychosurgery was refined and its use was narrowed to a very small number of people for specific indications. More effective treatments led to reductions in the number of patients in mental hospitals.

Related Topics:
Thorazine - Antidepressants - Depression - Psychosurgery

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In the early 1960s in U.S., amid public images of mental hospitals as sites for horror movies, a deinstitutionalisation movement caught hold in many states. California, for example, began to scale back its large mental health system in favour of community-based care, whereby smaller clinics would attempt to aid those suffering from early signs of mental illness before they got to the stage where they would be institutionalised in a mental hospital. At the time, mental hospitals were viewed as the least desirable solution to the problem of mental illness, both from a humane point of view and an economic one. The point of view continued to promulgate and went even further in the backlash against social welfare policies in the 1980s, which lead to massive deinstitutionalisation and funding cuts. These changes lead to the closing of many mental hospitals and the further reliance on local community care.

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A similar movement took place in the UK, in which "Care in the Community" came to take the place of most mental hospitals.

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In some nations, mental hospitals were used as sites for the stifling of political dissidence or even genocide. Under Nazi Germany, a euthanasia program began which resulted in the killings of tens of thousands of the mentally ill housed in state institutions, and the killing techniques perfected at these sites became later implemented in the Holocaust (see T-4 Euthanasia Program). In the Soviet Union, dissidents were often put into asylums and kept on a variety of destabilising medications, with the hope of not simply removing them from society, but making them unreliable in the eyes of others (see Psikhushka). Both of the attitudes in these cases – that the mentally ill were a scourge and needed to be eliminated, and that the line between 'patient' and 'prisoner' is incredibly blurry – have their precedents in the history of mental hospitals, though were taken to extremes by totalitarian regimes.

Related Topics:
Genocide - Nazi Germany - Euthanasia - The Holocaust - T-4 Euthanasia Program - Soviet Union - Psikhushka - Totalitarian

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