The first hospital in the U.S. opened its doors in 1753 in Philadelphia. While it treated a variety of patients, six of its first patients suffered from mental illness. In fact, Pennsylvania Hospital would have a pivotal impact on psychiatry.
Benjamin Rush, a physician who has been referred to as “the father of modern psychiatry” largely due to his book, Medical Inquiries and Observations on the Diseases of the Mind, worked at the hospital. He believed in treating mentally ill patients with bloodletting, a treatment that was used by Ancient civilizations. He dismissed demonic theories behind mental illness, and instead thought that psychiatric disorders originated from “hypertension in the brain’s blood vessels” (as cited in Goodwin, 1999).
It was thought that removing blood from the body would help to ease the tension. Patients would indeed typically calm down after a bloodletting, but that was mainly because they were just too weak.
Today, such treatments seem incredibly cruel. But during earlier times, professionals genuinely believed that they were helping patients.
About two decades after the opening of Pennsylvania Hospital, a second hospital opened in Williamsburg, Virginia. This one was exclusively for the mentally ill. Next came a hospital in New York City.
No doubt many readers are familiar with the horrific treatment of patients in mental asylums. However, the first group of institutions was different. Not only did they have good intentions to help individuals with mental illness, they were also smaller and offered individualized care. They followed in the footsteps of Philippe Pinel, a psychiatrist in charge of the first Parisian asylums.
Unlike the prevailing attitudes of the time, Pinel believed that mental illness was curable and he created a program called “moral treatment,” which included improvements in the patients’ living conditions. He even instituted a basic form of behavior modification to encourage order (Goodwin, 1999).
In the early U.S. institutions, superintendents were familiar with all their patients and their backgrounds and would have a treatment plan for them. Moral therapy included everything from exercise and religion training to lessons on good hygiene and activities that were tailored to each person’s interests, such as writing or music.
As stated above, asylums also used medical treatments like bloodletting, cold baths and morphine.
The problems for asylums sprouted with the growing population. As the general population increased so did the number of mentally ill, which prompted the need for big, state-funded facilities.
Asylums changed from treating patients to just housing them. Administering moral treatment wasn’t feasible anymore, considering that asylums went from having a couple hundred patients to thousands. According to Benjamin and Baker (2004), in the 1820s, on average, 57 patients were admitted to each asylum. In the 1870s, that number rose to 473!
Also, fewer and fewer people were released from the asylums. Chronic cases were common.
Institutions became filthy and had deplorable conditions. Patients were regularly abused and neglected. In 1841, Dorothea Dix, who was a pivotal figure in mental health reform, began touring hospitals and other institutions where poor individuals with mental illness were housed.
She was appalled by the devastating conditions (people were put in closets, chained to the walls; they were poorly fed and beaten). She wrote about these deplorable conditions in great detail.
When she brought her case to the Massachusetts legislature, it provoked a range of reforms. For instance, the state approved an increase in funds to the Worcester asylum.
Dix would travel to almost all the states, and her writings led to reforms and improvements in the living conditions of poor people with mental illness.
What have you heard about the earlier mental asylums? Anything surprise you about the birth of mental institutions?
Benjamin, L.T., & Baker, D.B. (2004). Clinical psychology: Mental Asylum. From Séance to Science: A History of the Profession of Psychology in America (pp.32-38). California: Wadsworth/Thomson Learning.
Goodwin, C.J. (1999). Psychoanalysis and clinical psychology: Early treatment of the mentally ill. A History of Modern Psychology (pp. 359-363). New York York: John Wiley & Sons, Inc.
Photo by Baltimore Heritage, available under a Creative Commons attribution license.