Emily Smith

William Wells Brown

  The 18th century was known as the “Period of Enlightenment” but this term certainly did not apply to the treatment of the mentally ill. Little progress had been made from the time of the Greeks and Romans when the ill were thought to be possessed by demons and subjected to exorcisms. The mentally ill in Colonial America were considered criminals, rogues, and vagabonds. It was the common belief that they were incurable and incapable of any sense of sensation. They were most often erroneously placed in jails, poorhouses, asylums, or wandered freely about. It was not until 1742 that the mentally ill citizens first gained legal recognition. The statute mandated that responsibility must be taken for those incapable of caring for themselves. However this only succeeded in placing more ailing people in jails or similar situations where the care was excessively cruel and consistently futile. It was not until 1773 that the first public hospital opened in the United States. Gradually a small trickle of similar hospitals opened, but they were few and far between. Despite the new attempts to confine the mentally ill in these facilities, the treatment provided was heartless, and brutal (Talbott 15-18).

In the early 19th century the notion of “moral treatment” was dawning. The idea of moral treatment centered on the belief that the ill were conscious of emotions and capable of feelings, and perhaps even curable. The Quakers were the first to embrace this idea and after working for nearly a century to provide more compassionate care, they opened their own hospital in 1813. This period of moral treatment literally removed the shackles from patients and resolved to treatment in a more benevolent manner. The Quakers were not the only people to advocate change in the treatment of the ill. However it these concepts were still not universal practice. Those that could procure treatment were still subject to barbaric, and sadistic treatment from inept staff, and ill-equipped hospitals.

In 1810 Benjamin Rush who is considered the "father of American psychiatry" set forth new standards to be practiced in the Pennsylvania Hospital. The list included: provide work, exercise, and amusement for all patients, separate harmful patients from harmless ones, and have a more capable and qualified staff. The list also integrated more considerate staff conduct that would ensure the patient’s comfort. Nevertheless despite Rush’s good intentions his own and other’s understanding of the illnesses were still in their infancy (Baxter & Hathcox 13).

One of Rush’s additional widely used innovations was the "Rush Chair". This device was designed to restrain the patient and deprive them of their senses. The patient would be secured in the chair with a box placed over their head. It was believed that this would restore the patient to reason, this also was the perceived outcome of cold water dousing and pool dunking (Baxter & Hathcox 14-15)

Hospitals and institutions began opening across the nation, focusing more on curing then simply containing. Unfortunately there were still too few facilities for the growing population of the diagnosed mentally ill, and many were still inappropriately placed in jails or asylums.(Baxter & Hathcox 51-52).

Then in 1841 the most significant event in the mental health care movement took place. Doreatha Dix, an unknown prayer leader visited a Massachusetts prison and was shocked by what she witnessed. She observed the variety of petty to harmful criminals and the obviously mentally ill female prisoners housed together in sordid and cramped quarters. The visibly ill were being treated no better than the criminals were(Baxter & Hathcox 29).

Dix began a campaign in the Massachusetts legislation to improve overall conditions and to increase funding for mental health hospitals. Her first success was the enlarging of the Worcester Asylum. Dix continued tirelessly from there; she is personally responsible for the construction of thirty-two hospitals and the enlargements of many others. Equally important was Dix’s role in bringing the atrocity of the current situation to the public’s eyes. She spoke out about the cruelties being committed that she had witnessed. Few had been exposed to the harsh conditions and were unaware of what was endured by patients and permitted by staff. The public support enabled the development of hospitals funded on a state, county, municipal, private, charity, and religious levels (Baxter & Hathcox 31).

Another important innovation took place in October of 1844. Thirteen superintendents of different institutions and hospitals gathered together in order to discuss and devise new ideas for the changes and revelations to be made in their establishments. From this meeting the American Psychiatric Association was created. Their ideas became a list of twenty-six new standards that was issued in 1851. This list covered all the necessary components in the building and successful administration of a productive and well-managed institution. Another important advance to come about from this meeting was the "Kirkbride Plan”. Thomas Kirkbride completed the new architectural design for the hospitals. It also outlined the qualities to seek in locations, and the best fit grounds for an institution. This was the standard construction design in the United States for nearly sixty year (Baxter & Hathcox 31-32)

Doreatha Dix continued working with legislation and the public throughout this time, focusing on funding, and care. Due almost exclusively to Dix’s movement of reform twenty-eight states had at least one mental health hospital by 1860. There were now many more facilities available and vast improvements in treatment had taken place (Talbott 17).

Regrettably the late 1800’s marked the gradual deterioration of mental health care. Due to the increasing national population fueled by immigration the numbers in the hospitals grew at an expedient rate. The hospitals were not equipped in size or staff overcrowding became a serious problem. Countless people that needed treatment were turned away and those in the system were not provided with the individual care that was vital. Therefore there was a steady regression back to the custodial, generalized care that was provided in the past. The treatments were no longer comprised of torture and restraint, but could not ensure the compassionate, and nurturing care that had so tenaciously been campaigned for (Talbott 19).

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