Mental Health Monday–Psychiatry, A History

Writer Colleen Rowan Kosinski asks:

What mental health treatments were there in the 19th century?

Great question! I had to pull out the history books for this one. (Which I happen to enjoy, BTW.)

The history of mental health treatment is not a pretty one. Prior to the mid 1800’s, people with mental illness were either imprisoned (in horrible conditions, you know, like being chained naked to a wall in a dungeon) or kept isolated in the family home…or barn. The idea was to keep them away from Society as a whole because they could be harmful to Society.

From the middle ages on, those with mental illness were also kept in institutions known as Asylums. Conditions were…deplorable at best.

A mental asylum as depicted by Francisco Goya

The first Insane Asylum in the US was in Virginia. Called the Eastern State Hospital, it opened in 1773.  At the time, it was believed no cure for mental illness existed, and so no one was discharged from the institutions, but more and more people were admitted. The end result was overcrowding.

The patients were subjected to the same routine, day in and day out…not too bad, except when treatments such as blood letting, purging, cold water baths, the Tranquilizer Chair, restraints, etc, were used. (Remember, these treatments were considered humane at the time. Oy.)

Bloodletting, Tranquilizer Chair, Restraint

In the early 1800’s, French psychiatrist Phillippe Pinel developed the “Moral Movement” for the treatment of the mentally ill. Moral treatment purported that mental illness was the result of psychosocial stressors such as abuse and trauma, not necessarily from demon possession or some other fantastical reason. As a result, mentally ill individuals were seen as needing protection from Society rather than the other way around.

Phillippe Pinel

Benjamin Rush (the American “father” of psychiatry) and Dorothea Dix (an “advocate” of the mentally ill) made a ton of headway in the treatment of individuals with mental illness by trying to identify what caused it.

Benjamin Rush and Dorothea Dix

In 1841, a new facility called The Pennsylvania Hospital for the Insane (later named the Institute of Pennsylvania Hospital) was opened. This facility actually had occupational therapy suites, libraries, and swimming pools that allowed patients to engage in recreational activities and educational endeavors. (Nice, right?)

Pennsylvania Hospital for the Insane

By the end of the 1800’s, Emil Kraepelin (a German scientist) really defined the idea that mental illness is a biologic and genetic illness. He coined the terms “manic depression” (now called major depression and bipolar disorder) and “dementia praecox” (later called Schizophrenia by Eugene Bleuler). By this time, society began softening toward those with mental illness and a movement toward more humane treatment started. Key word: STARTED.


It wasn’t until the mid-1900’s that psychotropic medications were developed (Thorazine being the first…well, except for Lithium, which was popular in tonics starting in the late 1800’s) and more laws supporting the rights of those with mentally ill were passed. Deinstitutionalization (discharging patients to the community with outpatient care) followed and now we have today’s system of inpatient, outpatient, support services, etc…which is another post entirely. 😉

Remember, these posts are for writing purposes only and are NOT to be construed as medical advice or treatment.

Check out Lydia’s Medical Monday and Sarah’s The Strangest Situation.


11 comments on “Mental Health Monday–Psychiatry, A History

  1. Sarah Fine says:

    Very nice summary, Laura! We certainly have come a long way, with plenty of road in front of us still.

  2. Kendall Grey says:

    What an interesting history. So glad we’ve moved away from cruel “treatments” to safer, more humane practices. Thanks for sharing all this awesome info!

  3. What horrible ways to treat anyone with mental illness. I’m so glad treatment has improved!

  4. LydiaK says:

    OMG, wouldn’t it be a killer novel to put a MC in one of these institutions? Wow. I love medical history. Thanks Laura!

  5. lexcade says:

    What a great post! Thanks for the info, Laura 🙂

  6. Fascinating post!!! 🙂 So, I suppose, in a way, the practice of locking your crazy wife in an attic was actually more humane than how she’d be treated at the asylum. ;-} Bring on the gothic novels!

  7. Karen Lange says:

    Interesting stuff. You really do learn something new every day. 🙂

  8. I think that if we were to grab the founders of religions who claimed to be prophets back in their day (hundreds of years ago) and subject them to a psychiatric examination, we would discover that they are in fact, mentally ill. Boy would that sure change the face of America.

  9. roguemutt says:

    It’s no wonder Tom Cruise thinks he’s smarter than psychiatrists.

  10. J E Fritz says:

    If you want to read horror, just read the history of mental illness.

  11. Linda Gray says:

    Wow, so scary to think we’re not far removed from that. So glad we have a new approach, and I do hope understanding and effective treatments continue to evolve, as there doesn’t seem to be a happy solution to many truly serious problems (even though we’re leaps and bounds beyond Goya’s depiction of a mental asylum!). Just saw A Dangerous Method a week ago. Interesting.

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