History of psychiatric institutions
Encyclopedia
The story of the rise of the lunatic asylum and its gradual transformation into, and eventual replacement by, the modern psychiatric hospital
, is also the story of the rise of organized, institutional psychiatry
. While there were earlier institutions that housed the 'insane' the arrival at the answer of institutionalisation as the correct solution to the problem of madness was very much an event of the nineteenth century. To illustrate this with one regional example, in England at the beginning of the nineteenth century there were, perhaps, a few thousand 'lunatics' housed in a variety of disparate institutions but by 1900 that figure had grown to about 100,000. That this growth should coincide with the growth of alienism
, later known as psychiatry, as a medical specialism is not coincidental.
In the Islamic world, the Bimaristan
s were described by European travelers, who wrote on their wonder at the care and kindness shown to lunatics. In 872, Ahmad ibn Tulun
built a hospital in Cairo
that provided care to the insane. Nonetheless, Roy Porter
cautions against idealising the role of hospitals generally in medieval Islam stating that "They were a drop in the ocean for the vast population that they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession."
In Europe during the medieval era, a variety of settings were employed to house the small subsection of the population of the mad who were housed in institutional settings. Porter
gives examples of such locales where some of the insane were cared for, such as in monasteries. A few towns had towers where madmen were kept (called Narrentürme or fools' tower). The ancient Parisian hospital Hôtel-Dieu
also had a small number of cells set aside for lunatics, whilst the town of Elbing boasted a madhouse, Tollhaus, attached to the Teutonic Knights' hospital. Other such institutions for the insane were established after the Christian Reconquista
, including hospitals in Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481), and Toledo (1483). The Priory of Saint Mary of Bethlehem
, which later became known more notoriously as Bedlam
, was founded in 1247. At the start of the fifteenth century it housed just six insane men. The former lunatic asylum Het Dolhuys
from the 16th century in Haarlem
, the Netherlands is now a museum of psychiatry with an overview of treatments from the origins of the building up to the 1990s.
In the United States, Virginia
is recognized as the first state to establish an institution for the mentally ill. Eastern State Hospital, located in Williamsburg
, was founded in 1773. Along with the first institution in America, Virginia also founded the first Colored Asylum in 1870. Their land was given to them by the House of Burgesses
in 1769.
Phillipe Pinel (1793) is often credited as being the first in Europe to introduce more humane methods into the treatment of the mentally ill (which came to be known as moral treatment
) as the superintendent of the Asylum de Bicêtre in Paris
. A hospital employee of Asylum de Bicêtre, Jean-Baptiste Pussin
, was actually the first one to remove patient restraints. Pussin influenced Pinel and they both served to spread reforms such as categorising the disorders, as well as observing and talking to patients as methods of cure. Vincenzo Chiarugi
in Italy
may have banned chains before this time. Johann Jakob Guggenbühl in 1840 started in Interlaken
the first retreat for mentally disabled children.
Around the same time as Pussin and Pinel, the Quakers, particularly William Tuke
, pioneered an enlightened approach (moral treatment
) in England at the York Retreat
which opened in 1796. The Retreat was not a psychiatric hospital, and in fact the medical approaches of the day were abandoned in favor of understanding, hope, moral responsibility and occupational therapy. The Brattleboro Retreat and the former Hartford Retreat were named after it.
After 13 years, as a result of their highly regarded reputation, they were invited to oversee the newly built first pauper asylum in Middlesex called the Hanwell Asylum
. Accepting the posts, the asylum opened in May 1831. Here the Ellises introduced their own brand of humane treatment and 'moral therapy' combined with 'therapeutic employment.' As its initial capacity was 450 patients, it was already the largest asylum in the country and subject to even more building soon after. Therefore, the immediate and continuing success of humane therapy working on such a large scale encouraged its adoption at other asylums. In recognition of all this work he received a knighthood. He continued to develop therapeutic treatments for mental disorders, always with moral treatment as the guiding principle.
In Lincoln
(Lincolnshire
, England
) Robert Gardiner Hill
, with the support of Edward Parker Charlesworth, developed a mode of treatment that suited 'all types' of patients, whereby the reliance on mechanical restraints and coercion could be made obsolete altogether - a situation he finally achieved in 1838.
By the following year of 1839 Sergeant John Adams and Dr. John Conolly
were so impressed by the work of Hill, that they immediately introduced the method into their Hanwell Asylum
, which was by then the largest in the kingdom. The greater size required Hill's system to be developed and refined. This was necessary as it was beyond Conolly to be able to supervise each attendant as closely as Hill had done. Even so, he bid a pair of extra soft slippers made so that he could walk around the building at night without his foot falls warning the attendants of his imminent approach. By September 1839, mechanical restraint was no longer required for any patient. For years, this day was remembered at the Hanwell asylum by a celebration on its anniversary.
Conolly also was a very accomplished communicator who wrote and lectured widely about his work in mental health.
Reformers, such as American Dorothea Dix
began to advocate a more humane and progressive attitude towards the mentally ill. Some were motivated by a Christian duty to mentally ill citizens. 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 institutionalized inside them). These centralized institutions were often linked with loose governmental bodies, though oversight 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. States made large outlays on architecture that often resembled the palaces of Europe, although operating funding for ongoing programs was more scarce. Many patients objected to transfers from private hospitals to state facilities. Some Brattleboro Retreat patients tried to hide when state officials arrived to transfer them to the new Waterbury State Hospital. This decline in patient census led to the collapse of many private institutions, which still accepted indigent patients even when state reimbursement for private hospitals dropped in the face of rising state hospital costs.
in the British Isles
was established at Monaghan Lunatic Asylum, in Monaghan
, Ireland
. This led to the claim by Joseph Devlin
in the House of Commons that "that the only successfully conducted institutions in Ireland are the lunatic asylums"
's groundbreaking malarial therapy for general paresis of the insane
(or neurosyphilis
) first used in 1917, and for which he won a Nobel Prize
in 1927. This treatment heralded the beginning of a radical and experimental era in psychiatric medicine that increasingly broke with an asylum based culture of therapeutic nihilism in the treatment of chronic psychiatric disorders, most particularly dementia praecox
(increasingly known as schizophrenia
from the 1910s, although the two terms were used more or less interchangeably until at least the end of the 1930s), which were typically regarded as hereditary degenerative disorders and therefore unamenable to any therapeutic intervention. Malarial therapy was followed in 1920 by barbiturate
induced deep sleep therapy
to treat dementia praecox
, which was popularized by the Swiss psychiatrist Jakob Klaesi
. In 1933 the Viennese based psychiatrist Manfred Sakel
introduced insulin shock therapy
and in August 1934 Ladislas J. Meduna
, a Hungarian neuropathologist and psychiatrist working in Budapest
, introduced cardiazol shock therapy (cardiazol is the tradename of the chemical compound pentylenetetrazol
, known by the tradename metrazol in the United States
), which was the first convulsive or seizure therapy for a psychiatric disorder. Again, both of these therapies were initially targeted at curing dementia praecox
. Cardiazol shock therapy, founded on the theoretical notion that there existed a biological antagonism between schizophrenia
and epilepsy
and that therefore inducing epiletiform fits in schizophrenic patients might effect a cure, was superseded by electroconvulsive therapy
, invented by the Italian neurologist Ugo Cerletti
in 1938. In 1935 the Portuguese neurologist Egas Moniz
devised
the leucotomy, a surgical procedure targeting the brain's frontal lobes. This was shortly thereafter adapted by Walter Freeman and James W. Watts in what is known as Freeman-Watts procedure or the standard prefrontal lobotomy
. From 1946, Freeman developed the transorbital lobotomy, using a device akin to an ice-pick. This was an "office" procedure which did not have to be performed in a surgical theatre and took as little as fifteen minutes to complete. Freeman is credited with the popularisation of the technique in the United States. In 1949, 5074 lobotomies were carried out in the United States and by 1951 18,608 people had undergone the controversial procedure in that country.
In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the first options which produced any noticeable effect on their patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past. Elsewhere, particularly in India
, use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment. The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalization. Lobotomies were performed in the hundreds from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs.
movement of the early 20th century led to a number of countries enacting laws for the compulsory sterilization of the "feeble minded", which resulted in the forced sterilization of numerous psychiatric inmates. As late as the 1950s, laws in Japan
allowed the forcible sterilization of patients with psychiatric illnesses.
, a euthanasia
program began which resulted in the killings of thousands of the mentally ill housed in state institutions. In 1939 the Nazis secretly began to exterminate the mentally ill in a euthanasia campaign. Around 6,000 disabled babies, children and teenagers were murdered by starvation or lethal injection.
The first antipsychotic drug, chlorpromazine
(known under the trade name Largactil in Europe and Thorazine in the United States), was first synthesised in France in 1950. Pierre Deniker
, a psychiatrist of the Saint-Anne Psychiatric Centre in Paris, is credited with first recognising the specificity of action of the drug in psychosis in 1952. Deniker travelled with a colleague to the United States and Canada promoting the drug at medical conferences in 1954. The first publication regarding its use in North America was made in the same year by the Canadian psychiatrist Heinz Lehmann
, who was based in Montreal. Also in 1954 another antipsychotic, reserpine
, was first used by an American psychiatrist based in New York, Nathan S. Kline. At a Paris based colloquium on neuroleptics (antipsychotics) in 1955 a series of psychiatric studies were presented by, among others, Hans Hoff
(Vienna), Aksel (Istanbul), Felix Labarth (Basle), Linford Rees (London), Sarro (Barcelona), Manfred Bleuler (Zurich), William Mayer-Gross (Birmingham), Winford (Washington) and Denber (New York) attesting to the effective and concordant action of the new drugs in the treatment of psychosis.
The new antipsychotics had an immense impact on the lives of psychiatrists and patients. For instance, Henry Ey, a French psychiatrist at Bonneval, related that between 1921 and 1937 only 6 per cent of patients suffering from schizophrenia and chronic delirium were discharged from his institution. The comparable figure for the period from 1955 to 1967, after the introduction of chlorpromazine, was 67 per cent. Between 1955 and 1968 the residential psychiatric population in the United States dropped by 30 per cent. Newly developed antidepressants were used to treat 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.
The discovery of the mood stabilizing effect of lithium carbonate
by John Cade
in 1948 would eventually revolutionize the treatment of bipolar disorder
, although its use was banned in the United States until the 1970s.
The use of psychosurgery
was narrowed to a very small number of people for specific indications. New treatments led to reductions in the number of patients in mental hospitals.
exposed abuses throughout the psychiatric care system and were instrumental in reforms of the 1940s and 1950s. The CPS reformers were especially active at the Philadelphia State Hospital where four Quakers initiated The Attendant magazine as a way to communicate ideas and promote reform. This periodical later became The Psychiatric Aide, a professional journal for mental health workers. On May 6, 1946, Life magazine printed an exposé of the psychiatric system by Albert Q. Maisel based on the reports of COs. Another effort of CPS, namely the Mental Hygiene Project, became the National Mental Health Foundation. Initially skeptical about the value of Civilian Public Service, Eleanor Roosevelt
, impressed by the changes introduced by COs in the mental health system, became a sponsor of the National Mental Health Foundation and actively inspired other prominent citizens including Owen J. Roberts, Pearl Buck and Harry Emerson Fosdick
to join her in advancing the organization's objectives of reform and humane treatment of patients.
, the former Soviet Union
, East Germany, and Romania
during Communist rule, mental hospitals were, and in some cases still are, used as sites for the stifling of political dissent.
The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. The movement for deinstitutionalization came to the fore in various countries in the 1950s and 1960s.
The prevailing public arguments, time of onset, and pace of reforms varied by country. Class action lawsuits in the United States, and the scrutiny of institutions through disability activism and antipsychiatry, helped expose the poor conditions and treatment. Sociologists and others argued that such institutions maintained or created dependency, passivity, exclusion and disability, causing people to be institutionalized
.
There was an argument that community services would be cheaper. It was suggested that new psychiatric medications made it more feasible to release people into the community.
There were differing views on deinstitutionalization, however, in groups such as mental health professionals, public officials, families, advocacy groups, public citizens, and unions.
In Hong Kong
, a number of residential care services such as half-way houses, long-stay care homes, supported hostels are provided for the discharged patients. In addition, a number of community support services such as Community Rehabilitation Day Services, Community Mental Health Link, Community Mental Health Care, etc. have been launched to facilitate the patients to re-integrate into the community.
established a reconciliation
initiative in 2005 in the context of ongoing compensation
payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. The forum heard of poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate complaints mechanisms; pressures and difficulties for staff, within an authoritarian psychiatric hierarchy based on containment; fear and humiliation in the misuse of seclusion
; over-use and abuse of ECT
, psychiatric medication
and other treatments/punishments, including group therapy
, with continued adverse effects; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice and emotional distress and trauma.
There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counseling to help them deal with their experiences, and advice on their rights, including access to records and legal redress.
beds and rising numbers in the prison population.
Some developing European countries still rely on asylums.
(e.g. mentally impaired). Although these waves began over fifty years ago, deinstitutionalization continues today; however, these waves are growing smaller as fewer people are sent to institutions.
A process of indirect cost-shifting
may have led to a form of "re-institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant. In Summer 2009, author and columnist Heather Mac Donald
stated in City Journal, "jails have become society’s primary mental institutions, though few have the funding or expertise to carry out that role properly... at Rikers, 28 percent of the inmates require mental health services, a number that rises each year."
Psychiatric hospital
Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
, is also the story of the rise of organized, institutional psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
. While there were earlier institutions that housed the 'insane' the arrival at the answer of institutionalisation as the correct solution to the problem of madness was very much an event of the nineteenth century. To illustrate this with one regional example, in England at the beginning of the nineteenth century there were, perhaps, a few thousand 'lunatics' housed in a variety of disparate institutions but by 1900 that figure had grown to about 100,000. That this growth should coincide with the growth of alienism
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, later known as psychiatry, as a medical specialism is not coincidental.
Medieval era
As early as 490 in Jerusalem, there was a hospital devoted to the treatment of mentally ill patients.In the Islamic world, the Bimaristan
Bimaristan
Bimaristan is a Persian word meaning hospital, with Bimar- from Middle Persian of vīmār or vemār, meaning "sick" plus -stan as location and place suffix...
s were described by European travelers, who wrote on their wonder at the care and kindness shown to lunatics. In 872, Ahmad ibn Tulun
Ahmad ibn Tulun
Ahmad ibn Ṭūlūn was the founder of the Tulunid dynasty that ruled Egypt briefly between 868 and 905 AD. Originally sent by the Abbasid caliph as governor to Egypt, ibn Ṭūlūn established himself as an independent ruler.-Biography:...
built a hospital in Cairo
Cairo
Cairo , is the capital of Egypt and the largest city in the Arab world and Africa, and the 16th largest metropolitan area in the world. Nicknamed "The City of a Thousand Minarets" for its preponderance of Islamic architecture, Cairo has long been a centre of the region's political and cultural life...
that provided care to the insane. Nonetheless, Roy Porter
Roy Porter
Roy Sydney Porter was a British historian noted for his prolific work on the history of medicine.-Life:...
cautions against idealising the role of hospitals generally in medieval Islam stating that "They were a drop in the ocean for the vast population that they had to serve, and their true function lay in highlighting ideals of compassion and bringing together the activities of the medical profession."
In Europe during the medieval era, a variety of settings were employed to house the small subsection of the population of the mad who were housed in institutional settings. Porter
Roy Porter
Roy Sydney Porter was a British historian noted for his prolific work on the history of medicine.-Life:...
gives examples of such locales where some of the insane were cared for, such as in monasteries. A few towns had towers where madmen were kept (called Narrentürme or fools' tower). The ancient Parisian hospital Hôtel-Dieu
Hôtel-Dieu de Paris
The Hôtel-Dieu de Paris is regarded as the oldest hospital in the city of Paris, France, and is the most central of the Assistance publique - hôpitaux de Paris hospitals. The hospital is linked to the Faculté de Médecine Paris-Descartes...
also had a small number of cells set aside for lunatics, whilst the town of Elbing boasted a madhouse, Tollhaus, attached to the Teutonic Knights' hospital. Other such institutions for the insane were established after the Christian Reconquista
Reconquista
The Reconquista was a period of almost 800 years in the Middle Ages during which several Christian kingdoms succeeded in retaking the Muslim-controlled areas of the Iberian Peninsula broadly known as Al-Andalus...
, including hospitals in Valencia (1407), Zaragoza (1425), Seville (1436), Barcelona (1481), and Toledo (1483). The Priory of Saint Mary of Bethlehem
Bethlem Royal Hospital
The Bethlem Royal Hospital is a psychiatric hospital located in London, United Kingdom and part of the South London and Maudsley NHS Foundation Trust. Although no longer based at its original location, it is recognised as the world's first and oldest institution to specialise in mental illnesses....
, which later became known more notoriously as Bedlam
Bethlem Royal Hospital
The Bethlem Royal Hospital is a psychiatric hospital located in London, United Kingdom and part of the South London and Maudsley NHS Foundation Trust. Although no longer based at its original location, it is recognised as the world's first and oldest institution to specialise in mental illnesses....
, was founded in 1247. At the start of the fifteenth century it housed just six insane men. The former lunatic asylum Het Dolhuys
Het Dolhuys
Het Dolhuys is a national museum for psychiatry in Haarlem, the Netherlands. The museum was founded in 2005 in the newly renovated former old age home known as Schoterburcht, located just across the Schotersingel from the Staten Bolwerk park. The whole complex is much older than that however,...
from the 16th century in Haarlem
Haarlem
Haarlem is a municipality and a city in the Netherlands. It is the capital of the province of North Holland, the northern half of Holland, which at one time was the most powerful of the seven provinces of the Dutch Republic...
, the Netherlands is now a museum of psychiatry with an overview of treatments from the origins of the building up to the 1990s.
18th century
Virginia
The Commonwealth of Virginia , is a U.S. state on the Atlantic Coast of the Southern United States. Virginia is nicknamed the "Old Dominion" and sometimes the "Mother of Presidents" after the eight U.S. presidents born there...
is recognized as the first state to establish an institution for the mentally ill. Eastern State Hospital, located in Williamsburg
Williamsburg, Virginia
Williamsburg is an independent city located on the Virginia Peninsula in the Hampton Roads metropolitan area of Virginia, USA. As of the 2010 Census, the city had an estimated population of 14,068. It is bordered by James City County and York County, and is an independent city...
, was founded in 1773. Along with the first institution in America, Virginia also founded the first Colored Asylum in 1870. Their land was given to them by the House of Burgesses
House of Burgesses
The House of Burgesses was the first assembly of elected representatives of English colonists in North America. The House was established by the Virginia Company, who created the body as part of an effort to encourage English craftsmen to settle in North America...
in 1769.
Phillipe Pinel (1793) is often credited as being the first in Europe to introduce more humane methods into the treatment of the mentally ill (which came to be known as moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
) as the superintendent of the Asylum de Bicêtre in Paris
Paris
Paris is the capital and largest city in France, situated on the river Seine, in northern France, at the heart of the Île-de-France region...
. A hospital employee of Asylum de Bicêtre, Jean-Baptiste Pussin
Jean-Baptiste Pussin
Jean-Baptiste Pussin was a hospital superintendent who, along with his wife and colleague Marguerite, is recognized as having established more humane treatment of patients with mental disorders...
, was actually the first one to remove patient restraints. Pussin influenced Pinel and they both served to spread reforms such as categorising the disorders, as well as observing and talking to patients as methods of cure. Vincenzo Chiarugi
Vincenzo Chiarugi
Vincenzo Chiarugi was an Italian physician who introduced humanitarian reforms to the psychiatric hospital care of people with mental disorders. His early part in a movement towards moral treatment was relatively overlooked until a gradual reassessment through the 20th century left his work...
in Italy
Italy
Italy , officially the Italian Republic languages]] under the European Charter for Regional or Minority Languages. In each of these, Italy's official name is as follows:;;;;;;;;), is a unitary parliamentary republic in South-Central Europe. To the north it borders France, Switzerland, Austria and...
may have banned chains before this time. Johann Jakob Guggenbühl in 1840 started in Interlaken
Interlaken
Interlaken is a municipality in the Interlaken-Oberhasli administrative district in the Canton of Bern in Switzerland, a well-known tourist destination in the Bernese Oberland.-History:...
the first retreat for mentally disabled children.
Around the same time as Pussin and Pinel, the Quakers, particularly William Tuke
William Tuke
William Tuke was an English businessman, philanthropist and Quaker. He was instrumental in the development of more humane methods in the custody and care of people with mental disorders, an approach that came to be known as moral treatment.-Career:Tuke was born in York to a leading Quaker family...
, pioneered an enlightened approach (moral treatment
Moral treatment
Moral treatment was an approach to mental disorder based on humane psychosocial care or moral discipline that emerged in the 18th century and came to the fore for much of the 19th century, deriving partly from psychiatry or psychology and partly from religious or moral concerns...
) in England at the York Retreat
The Retreat
The Retreat, commonly known as the York Retreat, is a place in England for the treatment of people with mental health needs. Located in Lamel Hill in York, it operates as a not for profit charitable organisation....
which opened in 1796. The Retreat was not a psychiatric hospital, and in fact the medical approaches of the day were abandoned in favor of understanding, hope, moral responsibility and occupational therapy. The Brattleboro Retreat and the former Hartford Retreat were named after it.
19th century
In 1817, William Ellis was appointed as superintendent to the newly built West Riding Pauper Asylum at Wakefield. As a Methodist, he had strong religious convictions. With his wife as matron, they put into action those things they had learned from the Sculcoates Refuge in Hull which operated on a similar model as the York.After 13 years, as a result of their highly regarded reputation, they were invited to oversee the newly built first pauper asylum in Middlesex called the Hanwell Asylum
Hanwell Asylum
The County Asylum at Hanwell, also known as Hanwell Insane Asylum, and Hanwell Pauper and Lunatic Asylum, was built for the pauper insane and is now the West London Mental Health Trust ...
. Accepting the posts, the asylum opened in May 1831. Here the Ellises introduced their own brand of humane treatment and 'moral therapy' combined with 'therapeutic employment.' As its initial capacity was 450 patients, it was already the largest asylum in the country and subject to even more building soon after. Therefore, the immediate and continuing success of humane therapy working on such a large scale encouraged its adoption at other asylums. In recognition of all this work he received a knighthood. He continued to develop therapeutic treatments for mental disorders, always with moral treatment as the guiding principle.
In Lincoln
Lincoln, Lincolnshire
Lincoln is a cathedral city and county town of Lincolnshire, England.The non-metropolitan district of Lincoln has a population of 85,595; the 2001 census gave the entire area of Lincoln a population of 120,779....
(Lincolnshire
Lincolnshire
Lincolnshire is a county in the east of England. It borders Norfolk to the south east, Cambridgeshire to the south, Rutland to the south west, Leicestershire and Nottinghamshire to the west, South Yorkshire to the north west, and the East Riding of Yorkshire to the north. It also borders...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
) Robert Gardiner Hill
Robert Gardiner Hill
Robert Gardiner Hill MD was born in Louth, Lincoln, of parents engaged in trade. He is normally credited with being the first superintendent of a small asylum to develop a mode of treatment where by the reliance on mechanical restraint and coercion could be made obsolete altogether, a situation...
, with the support of Edward Parker Charlesworth, developed a mode of treatment that suited 'all types' of patients, whereby the reliance on mechanical restraints and coercion could be made obsolete altogether - a situation he finally achieved in 1838.
By the following year of 1839 Sergeant John Adams and Dr. John Conolly
John Conolly
John Conolly , English psychiatrist, was born at Market Rasen, Lincolnshire, of an Irish family. He spent four years as a lieutenant in the Cambridgeshire Militia and lived for a year in France before embarking on a medical career.He graduated with an MD degree at University of Edinburgh in 1821...
were so impressed by the work of Hill, that they immediately introduced the method into their Hanwell Asylum
Hanwell Asylum
The County Asylum at Hanwell, also known as Hanwell Insane Asylum, and Hanwell Pauper and Lunatic Asylum, was built for the pauper insane and is now the West London Mental Health Trust ...
, which was by then the largest in the kingdom. The greater size required Hill's system to be developed and refined. This was necessary as it was beyond Conolly to be able to supervise each attendant as closely as Hill had done. Even so, he bid a pair of extra soft slippers made so that he could walk around the building at night without his foot falls warning the attendants of his imminent approach. By September 1839, mechanical restraint was no longer required for any patient. For years, this day was remembered at the Hanwell asylum by a celebration on its anniversary.
Conolly also was a very accomplished communicator who wrote and lectured widely about his work in mental health.
Reformers, such as American Dorothea Dix
Dorothea Dix
Dorothea Lynde Dix was an American activist on behalf of the indigent insane who, through a vigorous program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums...
began to advocate a more humane and progressive attitude towards the mentally ill. Some were motivated by a Christian duty to mentally ill citizens. 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 institutionalized inside them). These centralized institutions were often linked with loose governmental bodies, though oversight 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
Kirkbride Plan
The Kirkbride Plan refers to a system of mental asylum design advocated by Philadelphia psychiatrist Thomas Story Kirkbride in the mid-19th century.-History:The establishment of state mental hospitals in the U.S...
, an architectural style meant to have curative effect. States made large outlays on architecture that often resembled the palaces of Europe, although operating funding for ongoing programs was more scarce. Many patients objected to transfers from private hospitals to state facilities. Some Brattleboro Retreat patients tried to hide when state officials arrived to transfer them to the new Waterbury State Hospital. This decline in patient census led to the collapse of many private institutions, which still accepted indigent patients even when state reimbursement for private hospitals dropped in the face of rising state hospital costs.
Radical politics
In February 1919, the first sovietSoviet (council)
Soviet was a name used for several Russian political organizations. Examples include the Czar's Council of Ministers, which was called the “Soviet of Ministers”; a workers' local council in late Imperial Russia; and the Supreme Soviet of the Soviet Union....
in the British Isles
British Isles
The British Isles are a group of islands off the northwest coast of continental Europe that include the islands of Great Britain and Ireland and over six thousand smaller isles. There are two sovereign states located on the islands: the United Kingdom of Great Britain and Northern Ireland and...
was established at Monaghan Lunatic Asylum, in Monaghan
Monaghan
Monaghan is the county town of County Monaghan in Ireland. Its population at the 2006 census stood at 7,811 . The town is located on the main road, the N2 road, from Dublin north to both Derry and Letterkenny.-Toponym:...
, Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...
. This led to the claim by Joseph Devlin
Joseph Devlin
Joseph Devlin, also known as Joe Devlin, was an Irish journalist and influential nationalist politician...
in the House of Commons that "that the only successfully conducted institutions in Ireland are the lunatic asylums"
Physical therapies
A series of radical physical therapies were developed in central and continental Europe in the late 1910s, the 1920s and, most particularly, the 1930s. Among these we may note the Austrian psychiatrist Julius Wagner-JaureggJulius Wagner-Jauregg
Julius Wagner-Jauregg was an Austrian physician, Nobel Laureate, and Nazi supporter.-Early life:...
's groundbreaking malarial therapy for general paresis of the insane
General paresis of the insane
General paresis, also known as general paralysis of the insane or paralytic dementia, is a neuropsychiatric disorder affecting the brain and central nervous system, caused by syphilis infection...
(or neurosyphilis
Neurosyphilis
Neurosyphilis is an infection of the brain or spinal cord caused by the bacterium Treponema pallidum. It usually occurs in people who have had untreated syphilis for many years, usually about 10 - 20 years after first infection.-Symptoms and signs:...
) first used in 1917, and for which he won a Nobel Prize
Nobel Prize
The Nobel Prizes are annual international awards bestowed by Scandinavian committees in recognition of cultural and scientific advances. The will of the Swedish chemist Alfred Nobel, the inventor of dynamite, established the prizes in 1895...
in 1927. This treatment heralded the beginning of a radical and experimental era in psychiatric medicine that increasingly broke with an asylum based culture of therapeutic nihilism in the treatment of chronic psychiatric disorders, most particularly dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
(increasingly known as schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
from the 1910s, although the two terms were used more or less interchangeably until at least the end of the 1930s), which were typically regarded as hereditary degenerative disorders and therefore unamenable to any therapeutic intervention. Malarial therapy was followed in 1920 by barbiturate
Barbiturate
Barbiturates are drugs that act as central nervous system depressants, and can therefore produce a wide spectrum of effects, from mild sedation to total anesthesia. They are also effective as anxiolytics, as hypnotics, and as anticonvulsants...
induced deep sleep therapy
Deep Sleep Therapy
Deep sleep therapy , also called prolonged sleep treatment or continuous narcosis, is a psychiatric treatment based on the use of psychiatric drugs to render patients unconscious for a period of days or weeks.-History:...
to treat dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
, which was popularized by the Swiss psychiatrist Jakob Klaesi
Jakob Klaesi
Jakob Klaesi-Blumer was a Swiss psychiatrist most notable for his contributions to the sleep therapy and his phenomenological analysis of expression.-Life:...
. In 1933 the Viennese based psychiatrist Manfred Sakel
Manfred Sakel
*Fink, M , "Meduna and the Origins of Convulsive Therapy", American Journal of Psychiatry, 141: 1034-1041 *Fink, M (1984), "Meduna and the Origins of Convulsive Therapy", American Journal of Psychiatry, 141(9): 1034-1041 *Fink, M (1984), "Meduna and the Origins of Convulsive Therapy", American...
introduced insulin shock therapy
Insulin shock therapy
Insulin shock therapy or insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks...
and in August 1934 Ladislas J. Meduna
Ladislas J. Meduna
Ladislas J. Meduna was a Hungarian neurologist and neuropathologist noted for his development of shock treatment for persons suffering from schizophrenia.Meduna was born to a well-to-do family in Budapest, Hungary, in 1896...
, a Hungarian neuropathologist and psychiatrist working in Budapest
Budapest
Budapest is the capital of Hungary. As the largest city of Hungary, it is the country's principal political, cultural, commercial, industrial, and transportation centre. In 2011, Budapest had 1,733,685 inhabitants, down from its 1989 peak of 2,113,645 due to suburbanization. The Budapest Commuter...
, introduced cardiazol shock therapy (cardiazol is the tradename of the chemical compound pentylenetetrazol
Pentylenetetrazol
Pentylenetetrazol , also known as metrazol, pentetrazol, pentamethylenetetrazol, Cardiazol or PTZ, is a drug used as a circulatory and respiratory stimulant. High doses cause convulsions, as discovered by the Hungarian-American neurologist and psychiatrist Ladislas J. Meduna in 1934...
, known by the tradename metrazol in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
), which was the first convulsive or seizure therapy for a psychiatric disorder. Again, both of these therapies were initially targeted at curing dementia praecox
Dementia praecox
Dementia praecox refers to a chronic, deteriorating psychotic disorder characterized by rapid cognitive disintegration, usually beginning in the late teens or early adulthood. It is a term first used in 1891 in this Latin form by Arnold Pick , a professor of psychiatry at the German branch of...
. Cardiazol shock therapy, founded on the theoretical notion that there existed a biological antagonism between schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
and that therefore inducing epiletiform fits in schizophrenic patients might effect a cure, was superseded by electroconvulsive therapy
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
, invented by the Italian neurologist Ugo Cerletti
Ugo Cerletti
Ugo Cerletti was an Italian neurologist who discovered the method of electroconvulsive therapy in psychiatry. Electroconvulsive therapy is a procedure in which electric currents are passed through the brain, deliberately triggering a brief seizure...
in 1938. In 1935 the Portuguese neurologist Egas Moniz
Egas Moniz
António Caetano de Abreu Freire Egas Moniz , known as Egas Moniz , was a Portuguese neurologist and the developer of cerebral angiography...
devised
the leucotomy, a surgical procedure targeting the brain's frontal lobes. This was shortly thereafter adapted by Walter Freeman and James W. Watts in what is known as Freeman-Watts procedure or the standard prefrontal lobotomy
Lobotomy
Lobotomy "; τομή – tomē: "cut/slice") is a neurosurgical procedure, a form of psychosurgery, also known as a leukotomy or leucotomy . It consists of cutting the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain...
. From 1946, Freeman developed the transorbital lobotomy, using a device akin to an ice-pick. This was an "office" procedure which did not have to be performed in a surgical theatre and took as little as fifteen minutes to complete. Freeman is credited with the popularisation of the technique in the United States. In 1949, 5074 lobotomies were carried out in the United States and by 1951 18,608 people had undergone the controversial procedure in that country.
In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the first options which produced any noticeable effect on their patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past. Elsewhere, particularly in India
India
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment. The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalization. Lobotomies were performed in the hundreds from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs.
Compulsory sterilization of the "feeble-minded"
The eugenicsEugenics
Eugenics is the "applied science or the bio-social movement which advocates the use of practices aimed at improving the genetic composition of a population", usually referring to human populations. The origins of the concept of eugenics began with certain interpretations of Mendelian inheritance,...
movement of the early 20th century led to a number of countries enacting laws for the compulsory sterilization of the "feeble minded", which resulted in the forced sterilization of numerous psychiatric inmates. As late as the 1950s, laws in Japan
Japan
Japan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
allowed the forcible sterilization of patients with psychiatric illnesses.
Germany and occupied Europe: Nazi Euthanasia Program Aktion T4
Under Nazi GermanyNazi Germany
Nazi Germany , also known as the Third Reich , but officially called German Reich from 1933 to 1943 and Greater German Reich from 26 June 1943 onward, is the name commonly used to refer to the state of Germany from 1933 to 1945, when it was a totalitarian dictatorship ruled by...
, a euthanasia
Euthanasia
Euthanasia refers to the practice of intentionally ending a life in order to relieve pain and suffering....
program began which resulted in the killings of thousands of the mentally ill housed in state institutions. In 1939 the Nazis secretly began to exterminate the mentally ill in a euthanasia campaign. Around 6,000 disabled babies, children and teenagers were murdered by starvation or lethal injection.
Drugs
The twentieth century saw the development of the first effective psychiatric drugs.The first antipsychotic drug, chlorpromazine
Chlorpromazine
Chlorpromazine is a typical antipsychotic...
(known under the trade name Largactil in Europe and Thorazine in the United States), was first synthesised in France in 1950. Pierre Deniker
Pierre Deniker
Pierre Deniker was involved, jointly with Jean Delay and J. M. Harl, in the introduction of chlorpromazine , the first antipsychotic used in the treatment of schizophrenia, in the 1950's. Thorazine had been used in surgical procedures peri-operatively as an anti-nausea medication in France....
, a psychiatrist of the Saint-Anne Psychiatric Centre in Paris, is credited with first recognising the specificity of action of the drug in psychosis in 1952. Deniker travelled with a colleague to the United States and Canada promoting the drug at medical conferences in 1954. The first publication regarding its use in North America was made in the same year by the Canadian psychiatrist Heinz Lehmann
Heinz Lehmann
Heinz Edgar Lehmann, OC, FRSC was a German born Canadian psychiatrist best known for his use of chlorpromazine for the treatment of schizophrenia in 1950s....
, who was based in Montreal. Also in 1954 another antipsychotic, reserpine
Reserpine
Reserpine is an indole alkaloid antipsychotic and antihypertensive drug that has been used for the control of high blood pressure and for the relief of psychotic symptoms, although because of the development of better drugs for these purposes and because of its numerous side-effects, it is rarely...
, was first used by an American psychiatrist based in New York, Nathan S. Kline. At a Paris based colloquium on neuroleptics (antipsychotics) in 1955 a series of psychiatric studies were presented by, among others, Hans Hoff
Hans Hoff
Hans Hoff, born 1963, is a Swedish social democratic politician who has been a member of the Riksdag since 1999.-References:*...
(Vienna), Aksel (Istanbul), Felix Labarth (Basle), Linford Rees (London), Sarro (Barcelona), Manfred Bleuler (Zurich), William Mayer-Gross (Birmingham), Winford (Washington) and Denber (New York) attesting to the effective and concordant action of the new drugs in the treatment of psychosis.
The new antipsychotics had an immense impact on the lives of psychiatrists and patients. For instance, Henry Ey, a French psychiatrist at Bonneval, related that between 1921 and 1937 only 6 per cent of patients suffering from schizophrenia and chronic delirium were discharged from his institution. The comparable figure for the period from 1955 to 1967, after the introduction of chlorpromazine, was 67 per cent. Between 1955 and 1968 the residential psychiatric population in the United States dropped by 30 per cent. Newly developed antidepressants were used to treat cases of depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
, and the introduction of muscle relaxants allowed ECT
Electroconvulsive therapy
Electroconvulsive therapy , formerly known as electroshock, is a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect. Its mode of action is unknown...
to be used in a modified form for the treatment of severe depression and a few other disorders.
The discovery of the mood stabilizing effect of lithium carbonate
Lithium carbonate
Lithium carbonate is a chemical compound of lithium, carbon, and oxygen with the formula Li2CO3. This colorless salt is widely used in the processing of metal oxides and has received attention for its use in psychiatry. It is found in nature as the rare mineral zabuyelite.-Properties:Like almost...
by John Cade
John Cade
For the former Maryland State Senator, see John A. CadeFor the Louisiana Republican state chairman, see John H. Cade, Jr.Dr John Frederick Joseph Cade AO was an Australian psychiatrist credited with discovering the effects of lithium carbonate as a mood stabilizer in the treatment of bipolar...
in 1948 would eventually revolutionize the treatment of bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
, although its use was banned in the United States until the 1970s.
The use of psychosurgery
Psychosurgery
Psychosurgery, also called neurosurgery for mental disorder , is the neurosurgical treatment of mental disorder. Psychosurgery has always been a controversial medical field. The modern history of psychosurgery begins in the 1880s under the Swiss psychiatrist Gottlieb Burckhardt...
was narrowed to a very small number of people for specific indications. New treatments led to reductions in the number of patients in mental hospitals.
United States: Reform in the 1940s
From 1942 to 1947, conscientious objectors in the US assigned to psychiatric hospitals under Civilian Public ServiceCivilian Public Service
The Civilian Public Service provided conscientious objectors in the United States an alternative to military service during World War II...
exposed abuses throughout the psychiatric care system and were instrumental in reforms of the 1940s and 1950s. The CPS reformers were especially active at the Philadelphia State Hospital where four Quakers initiated The Attendant magazine as a way to communicate ideas and promote reform. This periodical later became The Psychiatric Aide, a professional journal for mental health workers. On May 6, 1946, Life magazine printed an exposé of the psychiatric system by Albert Q. Maisel based on the reports of COs. Another effort of CPS, namely the Mental Hygiene Project, became the National Mental Health Foundation. Initially skeptical about the value of Civilian Public Service, Eleanor Roosevelt
Eleanor Roosevelt
Anna Eleanor Roosevelt was the First Lady of the United States from 1933 to 1945. She supported the New Deal policies of her husband, distant cousin Franklin Delano Roosevelt, and became an advocate for civil rights. After her husband's death in 1945, Roosevelt continued to be an international...
, impressed by the changes introduced by COs in the mental health system, became a sponsor of the National Mental Health Foundation and actively inspired other prominent citizens including Owen J. Roberts, Pearl Buck and Harry Emerson Fosdick
Harry Emerson Fosdick
Harry Emerson Fosdick was an American clergyman. He was born in Buffalo, New York. He graduated from Colgate University in 1900, and Union Theological Seminary in 1904. While attending Colgate University he joined the Delta Upsilon Fraternity. He was ordained a Baptist minister in 1903 at the...
to join her in advancing the organization's objectives of reform and humane treatment of patients.
Communist world: Psychiatric internment as a political device
In some nations, such as North KoreaNorth Korea
The Democratic People’s Republic of Korea , , is a country in East Asia, occupying the northern half of the Korean Peninsula. Its capital and largest city is Pyongyang. The Korean Demilitarized Zone serves as the buffer zone between North Korea and South Korea...
, the former Soviet Union
Soviet Union
The Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
, East Germany, and Romania
Romania
Romania is a country located at the crossroads of Central and Southeastern Europe, on the Lower Danube, within and outside the Carpathian arch, bordering on the Black Sea...
during Communist rule, mental hospitals were, and in some cases still are, used as sites for the stifling of political dissent.
Deinstitutionalization
By the beginning of the 20th century, ever-increasing admissions had resulted in serious overcrowding. Funding was often cut, especially during periods of economic decline, and during wartime in particular many patients starved to death. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, and ill-treatment and abuse of patients.The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. The movement for deinstitutionalization came to the fore in various countries in the 1950s and 1960s.
The prevailing public arguments, time of onset, and pace of reforms varied by country. Class action lawsuits in the United States, and the scrutiny of institutions through disability activism and antipsychiatry, helped expose the poor conditions and treatment. Sociologists and others argued that such institutions maintained or created dependency, passivity, exclusion and disability, causing people to be institutionalized
Institutionalized
Institutionalized may refer to:* The act of being placed in a psychiatric hospital* "Institutionalized" , a song on Suicidal Tendencies 1983 titular album* Institutionalized , a 2005 rap album by American rapper Ras Kass...
.
There was an argument that community services would be cheaper. It was suggested that new psychiatric medications made it more feasible to release people into the community.
There were differing views on deinstitutionalization, however, in groups such as mental health professionals, public officials, families, advocacy groups, public citizens, and unions.
Asia
In Japan, the number of hospital beds has risen steadily over the last few decades.In Hong Kong
Hong Kong
Hong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
, a number of residential care services such as half-way houses, long-stay care homes, supported hostels are provided for the discharged patients. In addition, a number of community support services such as Community Rehabilitation Day Services, Community Mental Health Link, Community Mental Health Care, etc. have been launched to facilitate the patients to re-integrate into the community.
New Zealand
New ZealandNew Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...
established a reconciliation
Truth and Reconciliation Commission
The Truth and Reconciliation Commission was a court-like restorative justice body assembled in South Africa after the abolition of apartheid. Witnesses who were identified as victims of gross human rights violations were invited to give statements about their experiences, and some were selected...
initiative in 2005 in the context of ongoing compensation
Damages
In law, damages is an award, typically of money, to be paid to a person as compensation for loss or injury; grammatically, it is a singular noun, not plural.- Compensatory damages :...
payouts to ex-patients of state-run mental institutions in the 1970s to 1990s. The forum heard of poor reasons for admissions; unsanitary and overcrowded conditions; lack of communication to patients and family members; physical violence and sexual misconduct and abuse; inadequate complaints mechanisms; pressures and difficulties for staff, within an authoritarian psychiatric hierarchy based on containment; fear and humiliation in the misuse of seclusion
Seclusion
The act of secluding, i.e. shutting out or keeping apart from society, or the state of being secluded, or a place that facilitates it . A person, a couple, or a larger group may go to a secluded place for privacy, or because the place is quiet...
; over-use and abuse of ECT
ECT
-Automotive:* Electronically controlled transmission, found in premium automobiles* Engine coolant temperature-Industry & Technology:* Eddy-current testing, a nondestructive testing technique for metal objects...
, psychiatric medication
Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at...
and other treatments/punishments, including group therapy
Group therapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
, with continued adverse effects; lack of support on discharge; interrupted lives and lost potential; and continued stigma, prejudice and emotional distress and trauma.
There were some references to instances of helpful aspects or kindnesses despite the system. Participants were offered counseling to help them deal with their experiences, and advice on their rights, including access to records and legal redress.
Africa
- UgandaUgandaUganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...
has one psychiatric hospital. - South AfricaSouth AfricaThe Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
has several psychiatric hospitals. These hospitals are spread throughout the country. The most well known institutions include: Weskoppies Psychiatric HospitalWeskoppies Psychiatric HospitalWeskoppies is a public psychiatric hospital in Pretoria, Gauteng. It is situated to the west of the city centre and was built on the site of the old botanical gardens....
, Denmar Psychiatric HospitalDenmar Psychiatric Hospital-History:Denmar was established in 1951 and was the first private psychiatric hospital in Pretoria. It started as an 18 bed facility.-Facilities:* 150 Beds* Theater and day clinic* 24h admissions* 22 Psychiatrists* Occupational Therapy...
and Groendakkies.
Europe
Countries where deinstitutionalization has happened may be experiencing a process of "re-institutionalization" or relocation to different institutions, as evidenced by increases in the number of supported housing facilities, forensic psychiatricForensic psychiatry
Forensic psychiatry is a sub-speciality of psychiatry and an auxiliar science of criminology. It encompasses the interface between law and psychiatry...
beds and rising numbers in the prison population.
Some developing European countries still rely on asylums.
United States
The United States has experienced two waves of deinstitutionalization. Wave one began in the 1950s and targeted people with mental illness. The second wave began roughly fifteen years after and focused on individuals who had been diagnosed with a developmental disabilityDevelopmental disability
Developmental disability is a term used in the United States and Canada to describe lifelong disabilities attributable to mental or physical impairments, manifested prior to age 18. It is not synonymous with "developmental delay" which is often a consequence of a temporary illness or trauma during...
(e.g. mentally impaired). Although these waves began over fifty years ago, deinstitutionalization continues today; however, these waves are growing smaller as fewer people are sent to institutions.
A process of indirect cost-shifting
Cost-shifting
Cost-shifting is either an economic situation where one group underpays for a service resulting another group overpaying for a service or where one group pays a smaller share of costs than before resulting in another group paying a larger share of costs than before...
may have led to a form of "re-institutionalization" through the increased use of jail detention for those with mental disorders deemed unmanageable and noncompliant. In Summer 2009, author and columnist Heather Mac Donald
Heather Mac Donald
Heather Lynn Mac Donald is an American political commentator and thinker notable for her advocacy of secular conservatism. She has advocated her positions on numerous subjects including crime prevention, immigration reform, academia, the art world, and politics. She is a prolific essayist...
stated in City Journal, "jails have become society’s primary mental institutions, though few have the funding or expertise to carry out that role properly... at Rikers, 28 percent of the inmates require mental health services, a number that rises each year."
South America
In several South American countries, the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.See also
- History of mental disorders
- Deinstitutionalization
- Psychiatric hospitalPsychiatric hospitalPsychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...
- Asylum Whistles & More at the Whistle Museum
- Kirkbride PlanKirkbride PlanThe Kirkbride Plan refers to a system of mental asylum design advocated by Philadelphia psychiatrist Thomas Story Kirkbride in the mid-19th century.-History:The establishment of state mental hospitals in the U.S...
- Timeline of psychiatryTimeline of psychiatryThis is a timeline of the modern development of psychiatry.-Early History of Psychiatry:1550 BCThe Ebers papyrus, one of the most important medical papyri ofancient Egypt, briefly mentioned clinical depression.4th century BC...