The Care of Americas Mentally Ill:

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The Care of Americas Mentally Ill A
History of Good Intentions Gone Bad
Ludy T. Benjamin, Jr. Texas AM
University
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• Bibliography in Your Notebook

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Overview of My Presentation

• Development of a psychological profession
• Development of American psychiatry
• The asylum movement
• The question of curability
• Private versus state asylums
• Early asylum treatments
• Moral therapy and its ultimate failure
• Somatic treatments of the 20th century
• The rest of the story
• Asylum reports and student projects

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Clinical Psychologist as Prototype
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The New Psychology
Was there an interest in the abnormal mind?
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Interest in Abnormality

• George Johnsons work at Massachusetts School for
  the Feebleminded, 1894
• Lightner Witmers clinic in 1896
• A. R. T. Wylies work at Minnesota School for
  Idiots and Imbeciles, 1896
• Boris Sidis lab at the New York Pathological
  Institute, 1896
• William Krohns lab at the Kankakee Hospital for
  the Insane, 1897
• Henry H. Goddard, Director of Research at the
  Vineland School for Feebleminded Boys and Girls,
  1906

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Titchener on the scope of psychology

• the scope of psychology extends, still further,
  from the normal to the abnormal mindThe living
  organism may show defectSo it is with mind.All
  these various fields of psychology may be
  cultivated for their own sakethey must, indeed,
  be so cultivated if psychology is to progress.
  At the same time, their facts and laws often
  throw light upon the problems of normal human
  psychology.
• Titchener (1910)

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Development of a Mental Health Profession

• Intelligence testing (the Binet, 1908 1916)
• Personality assessment
• Personal Data Sheet (Woodworth, 1919)
• Rorschach Ink Blots (1920s)
• MMPI (1943)
• Psychotherapy (1940s)
• Professional training (VA, APA accreditation,
  Boulder Conference
• Health insurance inclusion, independent practice
• Preeminent provider of psychotherapy by 1970s

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But Abnormality Was the Domain of American
Psychiatry
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• Care of the Mentally Ill in the 1600s and 1700s

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The United States in 1790

• US Population 3,929,214
• 94.9 rural
• 5.1 urban
• 6 cities with a population of more than 8,000
• Only NYC and Philadelphia with more than
• 25,000
• No city over 50,000

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Invention of the Mental Asylums
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The Late 1700s

• Philadelphia
• New York
• Williamsburg
• to make provision for the support and
  maintenance of ideots, lunatics, and other
  persons of unsound minds.
• (Williamsburg, 1769)

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The Second Great Awakening

• Religious revival movement (ca. 1800)
• Countered Puritan views on the inherent depravity
  of human nature
• Emphasis on free will
• Emphasis on abolition of slavery
• Individuals could be improved

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Implications for the Mentally Ill

• Within this context madness lost its aura of
  permanence appropriate therapy with a
  well-ordered asylum could in many cases lead to
  the restoration of sanity Grob (1994)

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The Private Asylums 1800-1825
McLean Asylum (Boston)
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The Private Asylums 1800-1825
Bloomingdale Asylum (New York)
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The State Asylums 1825-1850

• During the second quarter of the nineteenth
  century responsibility for the care and treatment
  of the insane slowly fell under the jurisdiction
  of asylums established and administered by the
  states. The process of asylum building was rapid
  in some areas and slow in othersYet within
  several decades a broad consensus had taken shape
  around the concept that the insane should receive
  care and treatment in public mental hospitals,
  and that ability to pay should not be a criterion
  for admission. Grob (1994)

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Eastern Kentucky Lunatic Asylum 1824
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Worcester State Lunatic Asylum 1833
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Georgia Lunatic Asylum 1837
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Utica Insane Asylum 1843
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The Utica Crib
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Government Hospital for the Insane 1855
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Transformation of the Private Asylums

• The Bloomingdale Asylum sought to serve the
  wealthy and indigent persons of superior
  respectability and personal refinement. The
  latter included families of clergymen, and other
  professional personsteachers and business men
  who have experienced reverses.
• Grob (1994)

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Bloomingdale Asylum Female Day Room
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Early Asylum Treatments

• Bloodletting
• Spinning therapies
• Cold baths
• Sensory deprivation
• Laxatives
• Opium and morphine

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Treatments Rush Chair
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TreatmentsSpinning Chair Surprise Bath
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Moral Therapy The Cure

• Religious training
• Occupational therapy
• Exercise and recreation
• Instruction in good hygiene
• Activities for specific interests (e.g. painting,
  writing, carpentry, music, gardening)

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Dances Exercise and Music
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Theater
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• Butler Insane Asylum
• Farm Summary
• 1885

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Activities

• Newspaper
• Magazine
• Furniture making
• Quilting, sewing
• Plays
• Music recitals
• Pottery, jewelry, leather crafts, etc.

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Psychiatry as an Asylum Profession 1844

• Association of Medical Superintendents of
  American Institutions for the Insane (AMSAII)

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The Reality of Chronic Illness
Willard Asylum for the Chronic Insane, 1869
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Segregated Asylums
Longview (Ohio) Colored Asylum, 1866
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And Another
Goldsboro (NC) Colored Asylum, 1880
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And Another
Canton (SD) Asylum for Insane Indians,
SD, 1902
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The Late 19th Century

• Moral therapy wasnt working
• Aftermath of the Civil War
• Chronic cases were overwhelming (especially
  schizophrenia and dementia)
• State funding was declining
• Superintendent psychiatrists lost respect

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Warehousing Patients
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The New Psychiatry

• Between 1880 and 1940 psychiatrists responded
  to their critics by altering the basic foundation
  of their specialty. They identified new careers
  outside of institutions articulated novel
  theories and therapies expanded jurisdictional
  boundaries to include not only mental disorders
  but the problems of everyday life and defined a
  preventative role. Their goal was nothing less
  than the reintegration of psychiatry into
  medicine, which would permit them to share in the
  status and prestige enjoyed by the latter.
• Grob (1994)

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The Shock Therapies 1920-1960s

• Malaria fever therapy
• Insulin shock therapy
• Metrazol shock therapy
• Electroshock therapy

75,000 patients between 1935 and 1941
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Lobotomy
Walter Freeman demonstrating his transorbital
lobotomy technique
Egas Moniz -- Nobel Prize, 1949
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The Rest of the Story

• The exposés of the 1940s and 1950s, e.g., The
  Snake Pit
• The drug therapies
• The Community Mental Health Centers Acts (1963,
  1965)
• Deinstitutionalization

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In SummaryGood Intentions Gone Bad

• Moral therapy
• Compassion of the early superintendents
• Never sufficient funding
• Never adequate staffing
• Somatic treatments
• Community Mental Health Center Movement

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Student Projects The Annual Asylum Reports
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Selected Paper Topics

• The Architectural Design of Asylums to Facilitate
  Treatment
• Conceptualizations of Mental Illness in African
  Americans
• Restraint Practices as Related to Patient
  Population and Staff Size
• Occupational Activities for Male and Female
  Patients
• Attitudes toward Immigrants in the Asylums
• Recreation and Activities for Patients

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More Asylum Paper Topics

• Factors Governing Bathing Practices
• Interpretations of Moral Treatment
• Influence of the Civil War on Asylums
• Chinese Immigrants in California and Arizona
  Asylums
• Factors Affecting Death Rates and Causes of
  Death
• Changes in Diagnostic Categories Related to
  Patient Population

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The End