ellenmcampbell

[ellenmcampbell]

The earliest facilities that could be considered mental asylums were established in the Middle East as early as the 8th century. Institutions that were similar in intention but wildly different in practice would later emerge in Europe during the Middle Ages.

After the Enlightenment era, interest in science and reason brought about a more scientific view of mental health and mental illness. This would lead to what was later known as “the great medicalization”. This shift brought about a greater understanding of mental health and mental illness, but these areas of study were still in their infancy.

Cruel treatments with poor results, such as the lobotomy, gained popularity during this time. Additionally, while mental asylums during this period were far better than they were in the middle ages, they were often overcrowded and understaffed, leading to poor conditions for patients.

In his work “Care and treatment of the mentally ill in the United States: Historical developments and reforms”, Joseph Morrissey outlines three major shifts in mental healthcare throughout history. “Three major cycles of reform in public mental health care in the United States--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems”

Today, mental health treatment is moving away from the institutionalization model, and there is a greater focus on community-based care. Mental health services have become more available, and it is much easier to live a fulfilling life with a diagnosable mental illness than it was in the past thanks to developments in both medicine and psychotherapy.

However, it is important to analyze how the mental asylum, as well as the concept of mental illness itself, has been used by those in power to produce ideal subjects for centuries.

[ellenmcampbell]

The First Mental Asylums:

The earliest known institutions that we can consider mental asylums were created in Baghdad in the early 8th century. Islamic scholars were ahead of the rest of the world in understanding mental health. They recognized mental illness as a legitimate medical condition, and believed that it could be caused by a variety of factors. The primary attitude towards the mentally ill in the Islamic world was that they were deserving of humane treatment and assistance.

Similar institutions began appearing in Europe during the 13th century. During this time, Europe was heavily dominated by the Catholic church, which saw those who suffered from mental illness as morally corrupt or possessed. Mental asylums in 13th century Europe were called “foolhouses” or “madhouses”, and were in effect nothing more than prisons.

Patients were subjected to inhumane conditions, chained to beds, and often tortured to correct their behavior. The Catholic church was inflexible and authoritarian, and little change could come about in this environment. Tragically, this model continued for centuries, with an unknown number of people suffering unimaginable cruelty for something they could not control.

[ellenmcampbell]

The Great Medicalization Period

The late 18th century saw a significant shift in the way mental illness was viewed and treated in Western societies. With the influence of the church waning and the Enlightenment era bringing about more interest in science and reason, mental health was finally reevaluated and examined under a different lens.

During this period, medical practitioners began to view mental illness as a legitimate medical condition that required specialized treatment. As a result, institutions dedicated to the care of the mentally ill were established, and medical professionals began to develop new treatments and therapies for psychiatric disorders. This led to a significant improvement in the quality of care for individuals suffering from mental illness, as well as increased public awareness and understanding of psychiatric disorders.

This was undeniably preferable to the horrors of the European asylums of the middle ages, but the heavy stigma surrounding mental illness would not disappear so easily. Additionally, the definition of mental illness was beginning to expand to include more people than ever before, and a diagnosis often meant some sort of loss of autonomy. As medical authority increased, it became a dangerous tool of oppression for those in power.

[ellenmcampbell]

Asylums after medicalization

During the medicalization period, a new kind of mental asylum was developed. With the understanding that mental illness was a disease, asylums shifted away from the punishment model of the middle ages and towards research-based treatments.

However, the research behind mental health was still in its infancy, and patients were still subjected to horrifying treatments. Some of these treatments included the lobotomy, electroconvulsive therapy, and solitary confinement. Asylums were often overcrowded and understaffed. This not only led to unsanitary conditions, but also to the asylum functioning more as a strictly regulated institution than a place where one could receive effective treatment.

Additionally, while attitudes toward the mentally ill had become more sympathetic, they were still far from compassionate. Two of the primary functions of the asylum had not changed since the middle ages: to separate the mentally ill from society, and to control them so they make as little trouble as possible. With the rise of the industrial revolution, human worth became increasingly dependent upon how productive one could be, and what constituted a mental illness was becoming more and more based on if one’s mental condition allowed one to be a good worker.

[ellenmcampbell]

“To understand the history and evolution of institutional care and treatment of the mentally ill in America is by no means a simple task. Mental hospitals were complex rather than simple institutions; they served a variety of purposes, some of which were inadvertently thrust upon them by a society seeking solutions to novel problems which grew in part out of rapid social and economic change.”

Grob, G. N. (1977)

[ellenmcampbell]

The asylum as a mechanism for controlling women

As the process of medicalization continued and the mental asylum continued to gain popularity, this social shift intersected with attitudes about women. The role of the woman post-industrial revolution was to manage the home so that her husband would have a peaceful place to rest until he returned to work again, and to produce and bring up children who would one day replenish the workforce. Because of these expectations, ideas around women’s mental health were largely concerned with their reproductive abilities and agreeableness.

The popular belief among physicians was that women's mental health was negatively impacted by menstruation, pregnancy, and childbirth. Women who exhibited symptoms of conditions like post-partum depression or premenstrual syndrome risked the possibility of being forced into a mental hospital. Women had very little agency in this time, and they could be institutionalized simply for being too troublesome for their husbands, fathers, or doctors.

This led to another unintended function of the mental asylum. With the threat of the asylum looming over their heads, women were greatly deterred from challenging the men in their life. Through this, the mental asylum perpetuated the oppression of women.

In her work “Is Insanity a Female Malady?”, Debjani Das writes about the predispositions the medical community held towards women during this period, and their effect on how women were treated within the field of mental health: “Therefore, to conclude it may be stated that insanity is a mental disease which can be medically treated. Women were prone to insanity as much as men were. The gendered definition of madness was the result of both biological differences, and also the outcome of imagined psycho-social factors, which viewed women as unsettled and prone to emotional exuberances.”

Strangely though, the asylum also offered an escape to some women at this time. In her work “THE COMMUNITY, THE HOSPITAL, AND THE WORKING-CLASS PATIENT: THE MULTIPLE USES OF ASYLUM IN NINETEENTH-CENTURY AMERICA”, Constance Mcgovern states “For single women facing a life of drudgery as domestic servants, for those without family support systems, or for those exhausted by the caretaking of an elderly parent or relative, the asylum could be benign, protective, and even more tolerant than the outside world, and patients often went to great lengths to stay.”

[ellenmcampbell]

The shift to community-based mental healthcare

There was a significant shift away from the mental asylum model of care towards community-based care for individuals with mental illness in the 20th century. Community-based care is a model of care that focuses on providing support and services to individuals with mental illness within their own communities, rather than outsourcing this support to the medical sphere. This model moves away from treating those with mental illnesses as a problem to be shoved away, and attempts to help them integrate into society with access to services and support systems.

This shift came about due to a number of factors, one of the most important of which being an increase in the public’s awareness of the conditions patients were subjected to in mental asylums. Journalist Nellie Bly helped spread this awareness by admitting herself into a New York mental asylum for 10 days. She detailed the inhumane conditions she witnessed during her stay, leading to public pressure for a reform of the mental health system.

This sparked quite a bit of debate among the medical community. In her work “Changes in the Asylum: The Case of York”, Anne Digby writes “The nature of the asylum continues to stimulate discussion because of inherent tension between these two roles. From one perspective the asylum has been seen as fundamentally curative, the objectives of protection, therapy, and socialization for the mentally ill, regarded as having outweighed custodialism. From a contrasting perspective the asylum appears intrinsically repressive; a "total institution" where custody defeated therapy.”

This conflict within the medical community is understandable. While many are able to manage their mental illness and live fulfilling lives, there are some who need regular care that only a specialized institution can provide. However, the conditions patients were subjected to during the medicalization period were inhumane and unacceptable. These institutions need major reform, and it is doubtful that they can be trusted to properly govern themselves.

In his article “REHABILITATION OF LONG-TERM MENTAL PATIENTS- WHERE IS THE ASYLUM?”, Bertram J. Black argues against the idea that the community-based care model and the existence of the mental asylum are completely incompatible. He states “The polarization of opinion between insistence that the mental hospitals must go and that mental hospitals must be retained has given way to recognition of realities. As Bachrach (1976) puts it in her discerning analysis from a sociological perspective, ‘Now, statements that acknowledge frankly that the world of mental health services has a place for both institutional and community-based facilities are becoming popular, and there is a strong call for co-existence.’”

[ellenmcampbell]

While the mental asylum has changed dramatically throughout history, certain things about it have remained consistent. The mental asylum reflects the ideas that the society it exists within hold toward the mentally ill, and it is used to control and isolate groups deemed “abnormal” in one way or another. The mental asylum can also serve as a threat to those who would otherwise challenge the status quo.

The conceptually perfect mental asylum would benefit all of society, not just those who struggle with their mental health. The reason it has caused so much harm to the population it is meant to serve is a direct result of how the mentally ill have been perceived by society throughout history.

In order to make sure that our mental healthcare system will not be used against us, we need to closely examine how the idea of mental illness has shifted to suit various needs throughout history. Once we understand how those in power once weaponized the mental asylum and mental illness, we will be able to see the warning signs and avoid making past mistakes. Mental healthcare should not be about creating ideal subjects, suppressing traits deemed undesirable, or perpetuating systems of oppression, it should be about maximizing someone's quality of life.

[ellenmcampbell]

Works Cited

Anon. n.d. “Bedlam: The Horrors of London.” Retrieved April 17, 2023 (https://www.huffpost.com/entry/bedlam-the-horrors-of-lon_b_9499118).

Anon. n.d. “Female Hysteria - Wikipedia.” Retrieved April 17, 2023 (https://en.wikipedia.org/wiki/Female_hysteria).

Anon. n.d. “Homosexuality in the DSM - Wikipedia.” Retrieved April 17, 2023 (https://en.wikipedia.org/wiki/Homosexuality_in_the_DSM).

Anon. n.d. “How Bedlam Became London.” Retrieved April 17, 2023 (https://www.bbc.com/culture/article/20161213-how-bedlam-became-a-palace-for-lunatics).

Anon. n.d. “United Kingdom - Encyclopedia Britannica.” Retrieved April 17, 2023 (https://www.britannica.com/place/United-Kingdom).

Berdzenishvili, Irina. 2022. “History of Mental Health 101: The First Asylums.” Retrieved April 17, 2023 (https://www.byarcadia.org/post/history-of-mental-health-101-the-first-asylums).

BLACK, B. J. (1977). REHABILITATION OF LONG-TERM MENTAL PATIENTS- WHERE IS THE ASYLUM? International Journal of Mental Health, 6(4), 27–39. http://www.jstor.org/stable/41344132

D’Antonio, Patricia. n.d. “History of Psychiatric Hospitals • Nursing, History, and Health Care ....” Retrieved April 17, 2023 (https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/).

Das, D. (2011). Is Insanity a “Female Malady”? Lunatic Women in the Asylums of Bengal in the Nineteenth Century. Social Scientist, 39(5/6), 23–47. http://www.jstor.org/stable/41289406

Digby A. (1983). Changes in the asylum: the case of York, 1777-1815. The Economic history review, 36, 218–239. https://doi.org/10.1111/j.1468-0289.1983.tb01230.x

Fuller, Doris. n.d. “RESEARCH WEEKLY: The Role of Asylum in Treatment - Treatment ....” Retrieved April 17, 2023 (https://www.treatmentadvocacycenter.org/fixing-the-system/features-and-news/3034-research-weekly-the-role-of-asylum-in-treatment).

Grob G. N. (1977). Rediscovering asylums: the unhistorical history of the mental hospital. The Hastings Center report, 7(4), 33–41.

Lymberis, Maria. n.d. “8th Century Baghdad - History of Psychiatry :: Dr. Maria T. Lymberis ....” Retrieved April 17, 2023 (https://www.lymberis.com/baghdad.html).

McGovern, C. M. (1987). THE COMMUNITY, THE HOSPITAL, AND THE WORKING-CLASS PATIENT: THE MULTIPLE USES OF ASYLUM IN NINETEENTH-CENTURY AMERICA. Pennsylvania History: A Journal of Mid-Atlantic Studies, 54(1), 17–33. http://www.jstor.org/stable/27773158

MORRISSEY, J. P., & GOLDMAN, H. H. Care and Treatment of the Mentally Ill in the United States: Historical Developments and Reforms. The ANNALS of the American Academy of Political and Social Science, 484(1), 12–27. https://doi.org/10.1177/0002716286484001002

Paranick, Amber. n.d. “‘Behind Asylum Bars:’ Nellie Bly Reporting from Blackwell.” Retrieved April 17, 2023 (https://blogs.loc.gov/headlinesandheroes/2022/11/nellie-bly-blackwells-island/).

[ellenmcampbell]

While the mental asylum has changed dramatically throughout history, certain things about it have remained consistent. The mental asylum reflects the ideas that the society it exists within hold toward the mentally ill, and it is used to control and isolate groups deemed “abnormal” in one way or another. The mental asylum can also serve as a threat to those who would otherwise challenge the status quo.

The conceptually perfect mental asylum would benefit all of society, not just those who struggle with their mental health. The reason it has caused so much harm to the population it is meant to serve is a direct result of how the mentally ill have been perceived by society throughout history.

In order to make sure that our mental healthcare system will not be used against us, we need to closely examine how the idea of mental illness has shifted to suit various needs throughout history. Once we understand how those in power once weaponized the mental asylum and mental illness, we will be able to see the warning signs and avoid making past mistakes. Mental healthcare should not be about creating ideal subjects, suppressing traits deemed undesirable, or perpetuating systems of oppression, it should be about maximizing someone's quality of life.

[ellenmcampbell]

The shift to community-based mental healthcare

There was a significant shift away from the mental asylum model of care towards community-based care for individuals with mental illness in the 20th century. Community-based care is a model of care that focuses on providing support and services to individuals with mental illness within their own communities, rather than outsourcing this support to the medical sphere. This model moves away from treating those with mental illnesses as a problem to be shoved away, and attempts to help them integrate into society with access to services and support systems.

This shift came about due to a number of factors, one of the most important of which being an increase in the public’s awareness of the conditions patients were subjected to in mental asylums. Journalist Nellie Bly helped spread this awareness by admitting herself into a New York mental asylum for 10 days. She detailed the inhumane conditions she witnessed during her stay, leading to public pressure for a reform of the mental health system.

This sparked quite a bit of debate among the medical community. In her work “Changes in the Asylum: The Case of York”, Anne Digby writes “The nature of the asylum continues to stimulate discussion because of inherent tension between these two roles. From one perspective the asylum has been seen as fundamentally curative, the objectives of protection, therapy, and socialization for the mentally ill, regarded as having outweighed custodialism. From a contrasting perspective the asylum appears intrinsically repressive; a "total institution" where custody defeated therapy.”

This conflict within the medical community is understandable. While many are able to manage their mental illness and live fulfilling lives, there are some who need regular care that only a specialized institution can provide. However, the conditions patients were subjected to during the medicalization period were inhumane and unacceptable. These institutions need major reform, and it is doubtful that they can be trusted to properly govern themselves.

In his article “REHABILITATION OF LONG-TERM MENTAL PATIENTS- WHERE IS THE ASYLUM?”, Bertram J. Black argues against the idea that the community-based care model and the existence of the mental asylum are completely incompatible. He states “The polarization of opinion between insistence that the mental hospitals must go and that mental hospitals must be retained has given way to recognition of realities. As Bachrach (1976) puts it in her discerning analysis from a sociological perspective, ‘Now, statements that acknowledge frankly that the world of mental health services has a place for both institutional and community-based facilities are becoming popular, and there is a strong call for co-existence.’”

[ellenmcampbell]

The asylum as a mechanism for controlling women

As the process of medicalization continued and the mental asylum continued to gain popularity, this social shift intersected with attitudes about women. The role of the woman post-industrial revolution was to manage the home so that her husband would have a peaceful place to rest until he returned to work again, and to produce and bring up children who would one day replenish the workforce. Because of these expectations, ideas around women’s mental health were largely concerned with their reproductive abilities and agreeableness.

The popular belief among physicians was that women's mental health was negatively impacted by menstruation, pregnancy, and childbirth. Women who exhibited symptoms of conditions like post-partum depression or premenstrual syndrome risked the possibility of being forced into a mental hospital. Women had very little agency in this time, and they could be institutionalized simply for being too troublesome for their husbands, fathers, or doctors.

This led to another unintended function of the mental asylum. With the threat of the asylum looming over their heads, women were greatly deterred from challenging the men in their life. Through this, the mental asylum perpetuated the oppression of women.

In her work “Is Insanity a Female Malady?”, Debjani Das writes about the predispositions the medical community held towards women during this period, and their effect on how women were treated within the field of mental health: “Therefore, to conclude it may be stated that insanity is a mental disease which can be medically treated. Women were prone to insanity as much as men were. The gendered definition of madness was the result of both biological differences, and also the outcome of imagined psycho-social factors, which viewed women as unsettled and prone to emotional exuberances.”

Strangely though, the asylum also offered an escape to some women at this time. In her work “THE COMMUNITY, THE HOSPITAL, AND THE WORKING-CLASS PATIENT: THE MULTIPLE USES OF ASYLUM IN NINETEENTH-CENTURY AMERICA”, Constance Mcgovern states “For single women facing a life of drudgery as domestic servants, for those without family support systems, or for those exhausted by the caretaking of an elderly parent or relative, the asylum could be benign, protective, and even more tolerant than the outside world, and patients often went to great lengths to stay.”

[ellenmcampbell]

“To understand the history and evolution of institutional care and treatment of the mentally ill in America is by no means a simple task. Mental hospitals were complex rather than simple institutions; they served a variety of purposes, some of which were inadvertently thrust upon them by a society seeking solutions to novel problems which grew in part out of rapid social and economic change.”

Grob, G. N. (1977)

[ellenmcampbell]

Asylums after medicalization

During the medicalization period, a new kind of mental asylum was developed. With the understanding that mental illness was a disease, asylums shifted away from the punishment model of the middle ages and towards research-based treatments.

However, the research behind mental health was still in its infancy, and patients were still subjected to horrifying treatments. Some of these treatments included the lobotomy, electroconvulsive therapy, and solitary confinement. Asylums were often overcrowded and understaffed. This not only led to unsanitary conditions, but also to the asylum functioning more as a strictly regulated institution than a place where one could receive effective treatment.

Additionally, while attitudes toward the mentally ill had become more sympathetic, they were still far from compassionate. Two of the primary functions of the asylum had not changed since the middle ages: to separate the mentally ill from society, and to control them so they make as little trouble as possible. With the rise of the industrial revolution, human worth became increasingly dependent upon how productive one could be, and what constituted a mental illness was becoming more and more based on if one’s mental condition allowed one to be a good worker.

[ellenmcampbell]

The Great Medicalization Period

The late 18th century saw a significant shift in the way mental illness was viewed and treated in Western societies. With the influence of the church waning and the Enlightenment era bringing about more interest in science and reason, mental health was finally reevaluated and examined under a different lens.

During this period, medical practitioners began to view mental illness as a legitimate medical condition that required specialized treatment. As a result, institutions dedicated to the care of the mentally ill were established, and medical professionals began to develop new treatments and therapies for psychiatric disorders. This led to a significant improvement in the quality of care for individuals suffering from mental illness, as well as increased public awareness and understanding of psychiatric disorders.

This was undeniably preferable to the horrors of the European asylums of the middle ages, but the heavy stigma surrounding mental illness would not disappear so easily. Additionally, the definition of mental illness was beginning to expand to include more people than ever before, and a diagnosis often meant some sort of loss of autonomy. As medical authority increased, it became a dangerous tool of oppression for those in power.

[ellenmcampbell]

The First Mental Asylums:

The earliest known institutions that we can consider mental asylums were created in Baghdad in the early 8th century. Islamic scholars were ahead of the rest of the world in understanding mental health. They recognized mental illness as a legitimate medical condition, and believed that it could be caused by a variety of factors. The primary attitude towards the mentally ill in the Islamic world was that they were deserving of humane treatment and assistance.

Similar institutions began appearing in Europe during the 13th century. During this time, Europe was heavily dominated by the Catholic church, which saw those who suffered from mental illness as morally corrupt or possessed. Mental asylums in 13th century Europe were called “foolhouses” or “madhouses”, and were in effect nothing more than prisons.

Patients were subjected to inhumane conditions, chained to beds, and often tortured to correct their behavior. The Catholic church was inflexible and authoritarian, and little change could come about in this environment. Tragically, this model continued for centuries, with an unknown number of people suffering unimaginable cruelty for something they could not control.