People of ancient times
believed that any sickness indicated displeasure of the gods and, in fact, was
a pun-ishment for sins and wrongdoing. Those with mental disorders were viewed
as being either divine or demonic, depending on their behavior. Individuals
seen as divine were worshipped and adored; those seen as demonic were
ostracized, punished, and sometimes burned at the stake. Later, Aristotle
(382–322 BC) attempted to relate mental disorders to physical disorders and
developed his theory that the amounts of blood, water, and yellow and black
bile in the body controlled the emotions. These four sub-stances, or humors,
corresponded with happiness, calm-ness, anger, and sadness. Imbalances of the
four humors were believed to cause mental disorders, so treatment was aimed at
restoring balance through bloodletting, starving, and purging. Such
“treatments” persisted well into the 19th century (Baly, 1982).
In early Christian times
(1–1000 AD), primitive beliefs and superstitions were strong. All diseases were
again blamed on demons, and the mentally ill were viewed as possessed. Priests
performed exorcisms to rid evil spirits. When that failed, they used more
severe and brutal mea-sures, such as incarceration in dungeons, flogging, and
In England during the
Renaissance (1300–1600), people with mental illness were distinguished from
criminals. Those considered harmless were allowed to wander the countryside or
live in rural communities, but the more “dangerous lunatics” were thrown in
prison, chained, and starved (Rosenblatt, 1984). In 1547, the Hospital of St.
Mary of Bethlehem was officially declared a hospital for the insane, the first
of its kind. By 1775, visitors at the institution were charged a fee for the
privilege of viewing and ridiculing the inmates, who were seen as animals, less
than human (McMillan, 1997). During this same period in the colonies (later the
United States), the mentally ill were considered evil or possessed and were
punished. Witch hunts were conducted, and offenders were burned at the stake.
In the 1790s, a period of enlightenment concerning persons with
mental illness began. Phillippe Pinel in France and William Tukes in England
formulated the concept of asylum as
a safe refuge or haven offering protection at institutions where people were
whipped, beaten, and starved just because they were mentally ill (Gollaher,
1995). With this movement began the moral treatment of the mentally ill. In the
United States, Dorothea Dix (1802–1887) began a cru-sade to reform the
treatment of mental illness after a visit to Tukes’s institution in England.
She was instrumental in opening 32 state hospitals that offered asylum to the
suffer-ing. Dix believed that society was obligated to those who were mentally
ill; she advocated adequate shelter, nutritious food, and warm clothing
The period of enlightenment was short-lived. Within 100 years after
establishment of the first asylum, state hos-pitals were in trouble. Attendants
were accused of abusing the residents, the rural locations of hospitals were
viewed as isolating patients from their families and homes, and the phrase insane asylum took on a negative connotation.
The period of scientific
study and treatment of mental dis-orders began with Sigmund Freud (1856–1939)
and others, such as Emil Kraepelin (1856–1926) and Eugene Bleuler (1857–1939).
With these men, the study of psychiatry and the diagnosis and treatment of
mental illness started in earnest. Freud challenged society to view human
beings objectively. He studied the mind, its disorders, and their treatment as
no one had done before. Many other theorists built on Freud’s pioneering work.
Kraepelin began classifying mental disorders according to their symp-toms, and
Bleuler coined the term schizophrenia.
A great leap in the treatment
of mental illness began in about 1950 with the development of psychotropic drugs, or drugs used to
treat mental illness. Chlorpromazine (Thorazine), an antipsychotic drug, and
lithium, an anti-manic agent, were the first drugs to be developed. Over the
following 10 years, monoamine oxidase inhibitor antidepressants; haloperidol
(Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents,
called benzodiazepines, were introduced. For the first time, drugs actually
reduced agitation, psychotic thinking, and depression. Hospital stays were
shortened, and many peo-ple were well enough to go home. The level of noise,
chaos, and violence greatly diminished in the hospital setting.
The movement toward treating
those with mental illness in less restrictive environments gained momentum in
1963 with the enactment of the Community Mental Health Cen-ters Construction
Act. Deinstitutionalization, a
deliberate shift from institutional care in state hospitals to community
facilities, began. Community mental health centers served smaller geographic
catchment, or service, areas that pro-vided less restrictive treatment located
closer to individu-als’ homes, families, and friends. These centers provided
emergency care, inpatient care, outpatient services, partial hospitalization,
screening services, and education. Thus, deinstitutionalization accomplished
the release of individuals from long-term stays in state institutions, the
decrease in admissions to hospitals, and the development of community-based
services as an alternative to hospital care.
In addition to
deinstitutionalization, federal legislation was passed to provide an income for
disabled persons: Supplemental Security Income (SSI) and Social Security
Disability Income (SSDI). This allowed people with severe and persistent mental
illness to be more independent financially and to not rely on family for money.
States were able to spend less money on care of the mentally ill than they had
spent when these individuals were in state hospi-tals because this program was
federally funded. Also, com-mitment laws changed in the early 1970s, making it
more difficult to commit people for mental health treatment against their will.
This further decreased the state hospital populations and, consequently, the
money that states spent on them.