The treatment of the mentally ill in the United States has traveled Essay
Policies regarding the treatment of those deemed mentally ill have been formed, reformed, and then changed back. New break throughs in medicine, new ideas in care, and new ideas on the origins of the illnesses have all played their part in shaping how these people are treated. In the United States, the mentally ill have come almost a full circle in how they are treated. Starting at the beginning of United States history and ending in the new 21st century, the treatment and policies regarding the mentally ill have run the gambit. In the beginning, the US followed the European methods of treating the mentally ill.
The methods followed the Elizabethan Poor Law of 1601, wherein the town was responsible for taking care of the mentally ill (Bell, 3). Those found to be suffering from mental illness were confined or taken care of by family. These methods often meant that the person was locked up, usually in barely livable conditions. Those considered dangerous were confined in jails or log cages, while those who were more mild mannered were just neglected or abused. (Gardner, 3). Also, those who were found to be mentally ill, but physically able, were auctioned off as workers (Bell, 3).
Whatever the treatment, however, caring for these people was seen as a local, not state, concern. Examples of this relegation to the community level can be seen in some of the laws passed by the Massachusetts’s legislature in the late 1600’s. For example, these laws 1) made local officials responsible for the mentally ill in their township should private care fail, 2) determined legal means of determining sanity, and 3) provided a framework for dealing with the property of a mentally ill person or how to deal with the danger said person presented (Grob, 4).
As population in cities in the United States increased, and people began living in closer quarters, this care system began to break down. Almshouses, where the insane were thrown in with the poor, aged, orphaned, etc. , were used as one way of dealing with the break down. Also, private donors and charities gave money to help out those in acute distress. However, the money was usually insufficient in dealing with the numbers of people in need. However, with the enlightenment of the 1700’s, new ideas brought new treatment for the insane.
During the next century, the mentally ill would get hospitals and treatment for the first time. In 1752, the Pennsylvania Hospital in Philadelphia opened its doors. This was the first hospital in the American colonies that admitted the mentally ill. This was a private, general hospital, and it housed these patients in a separate ward. Later, in 1773, Eastern Lunatic Asylum opened in Williamsburg, Va. This was the first public institution in American fully devoted to the care of the mentally ill, and it was founded on the notion that the public was responsible for caring for those in need.
Therefore, unlike the other hospitals founded before it, this hospital accepted both those who could pay (these patients were charged fifteen pounds of tobacco a year) and those who could not pay (Gardner, 4). However, the treatment of the mentally ill in all of these institutions was still harsh, though it was assumed to be humane and therapeutic. Patients were whipped, put in physical restraints, placed in the “madd shirt,” given cold showers, underwent bloodletting and blistering, and much more (Bell, 5). Fortunately for these patients, help was on the way in the form of the Quakers and other reformers.
In the late 1700’s and early 1800’s, new ideas were being brought forth both in Europe and America on the treatment for mentally ill. In the England, William Tuke, a Quaker, founded the York Retreat in 1792. At this Retreat, he urged the creation of a trusting and warm environment for the patients, and more “normal” treatment of these people (Grob, 11). Tuke’s ideas provided an influence for the treatment of the mentally ill in private, US institutions. American Friends, the Quaker group in the United States, used Tuke’s guidelines, and established four institutes based on his teachings.
These institutions provided differently for care, with different ideas on how to best facilitate treatment, but all of them included the “homey” environment that Tuke talked about. Another doctor looking at the treatment of the insane was Benjamin Rush. In the 1780’s, Rush began working with ideas on proper treatment of the insane at the Pennsylvania Hospital. Though he used some of the methods mentioned before for “treating” the mentally ill, such as bloodletting and blistering, he made several advances in the favor of the mentally ill.
He arranged for proper heating for the cells as, prior to this, popular sentiment had it that the insane could not feel the heat or cold. Also, Rush separated the violent patients from the rest of the group. Also, he established programs of recreation, work, and exercise for the patients. These ideas were very beneficial for these people, and were used in many other institutions for the mentally ill. Many of the Quaker-established hospitals used programs like Rush’s. Throughout the early 1800’s, and up until the 1850’s, the ideas of asylums for the insane took root in the United States.
As populations grew, communities found it difficult to care for their mentally ill. Also, religious groups and private citizens formed groups that explored the conditions of the jails and almshouses used by most areas to confine the mentally ill. They found the conditions, listed before, horrible. Building asylums for them, in the manner used by the Quakers, seemed like a good solution. The moral treatment and high “cure” rates of these institutions, along with the humanitarian efforts of many individuals, convinced many that the asylums should receive government money to help them continue their good works.
Legislatures were approached by citizens, mainly religious leaders and doctors, who wanted the state to help fund and manage these new institutions. These groups provided data that they had collected in fact-finding missions to jails and almshouses, showing the horrible conditions the insane were kept in. States, following the tide of public sentiment, began allotting money to these causes. Beginning in 1824, many private and public hospitals opened throughout the United States. During this time, too, new groups and break throughs were also helping the treatment of the insane.
Studies of the mentally ill began to show the true causes of these disorders. While before, causes of mental illness had been attributed to demons, and then later to overstimulation that required only withdrawal from external stimuli to correct, new ideas were emerging. Because of observations made in the asylums, doctors began to realize that the problems were diseases of the brain. Though it would be many decades before these ideas would be refined enough to even begin to explain the true origin of mental illness, it was a start in the right direction.
These new ideas helped achieve in better treatment for the mentally insane, as it meant that environmental factors were strictly controlled because of the perceived impact on the brain. Also during this time, groups were being formed to help spread information and ideas on mental illness. In 1844, the Association of Medical Superintendents of American Institutions for the Insane (later the American Psychiatric Association) was formed. Groups such as these were committed to helping and distributing information about the insane. Law creates charity boards. In the latter part of the 19th century, more work was done to help the mentally ill.
Reformers like Dorothea Dix and many others worked to both create more asylums and to better the ones that already existed. Many of the asylums that had been created early in the 1800’s were no longer serving their purposes. Overpopulation of the wards, deterioration of the care and facilities of the hospital, and more were common afflictions of the asylums. Also, during the Civil War time period, public hospitals were neglected. These hospitals had to both be repaired, because of wartime damage, and prepared for new patients in the form of soldiers whose minds had been damaged by the war.
The influx of patients made up for low number of patients admitted during the war, a trend that was seen across the country. Still, the work of reformers helped create over 32 new state mental institutions to provide care for all the new patients. However, most asylums were still overpopulated. And the functioning of the asylums was not nearly as beneficial as it had once been. The treatment of the mentally ill, without the backing of the reformers that is had once had, began to worsen.
Institutionalization was usually reserved for those exhibiting extreme symptoms, leaving those who were ill but exhibiting only marginal behavior without any kind of treatment. These people were often left at the mercies of their family or in the almshouses. Moves to commit a person were usually started by an immediate family member, and this was done only as a last resort to preserve the family structure. However, in the 1890’s, some states began empowering courts to commit individuals. It was a complex process, usually involving a medical exam.
In most cases of judicial commitment, it was the doctor’s findings that were binding, and the court just acted as a recording agent. The asylum, once a place designed to help cure an individual became little more than a warehouse for the mentally ill. Doctors and attendants relied on drugs, sedatives and hypnotics, to calm patients and keep the peace. Acting out was deemed detrimental to recovery, even though the asylum during this time was usually seen as a last resort. Many critics of the institutions at this time faulted the superindentends of the asylums. (discuss shortcomings- Grob)