Caring for the Mentally Ill: A Historical Overview

1. The Care of America’s Mentally Ill: A History of Good Intentions Gone Bad Ludy T. Benjamin, Jr. Texas A&M University

2. Bibliography in Your Notebook

3. 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

4. Clinical Psychologist as Prototype

5. The New Psychology Was there an interest in the abnormal mind?

6. Interest in Abnormality • George Johnson’s work at Massachusetts School for the Feebleminded, 1894 • Lightner Witmer’s clinic in 1896 • A. R. T. Wylie’s work at Minnesota School for Idiots and Imbeciles, 1896 • Boris Sidis’ lab at the New York Pathological Institute, 1896 • William Krohn’s 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

7. Titchener on “the scope of psychology” “…the scope of psychology extends, still further, from the normal to the abnormal mind…The living organism may show defect…So it is with mind….All these various fields of psychology may be cultivated for their own sake…they 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)

8. 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

9. But Abnormality Was the Domain of American Psychiatry

10. Care of the Mentally Ill in the 1600s and 1700s

11. 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

12. Invention of the Mental Asylums

13. 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)

14. 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

15. 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)

16. The Private Asylums: 1800-1825 McLean Asylum (Boston)

17. The Private Asylums: 1800-1825 Bloomingdale Asylum (New York)

18. 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 others…Yet 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)

19. Eastern Kentucky Lunatic Asylum: 1824

20. Worcester State Lunatic Asylum: 1833

21. Georgia Lunatic Asylum: 1837

22. Utica Insane Asylum: 1843

23. The Utica Crib

24. Government Hospital for the Insane: 1855

25. 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 persons…teachers and business men who have experienced reverses.’” Grob (1994)

26. Bloomingdale Asylum: Female Day Room

27. Bloodletting Spinning therapies Cold baths Sensory deprivation Laxatives Opium and morphine Early Asylum Treatments

28. Treatments: Rush Chair

29. Treatments:Spinning Chair & Surprise Bath

30. 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)

31. Dances: Exercise and Music

32. Theater

33. Butler Insane Asylum Farm Summary 1885

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

35. Association of Medical Superintendents of American Institutions for the Insane (AMSAII) Psychiatry as an Asylum Profession: 1844

36. The Reality of Chronic Illness Willard Asylum for the Chronic Insane, 1869

37. Segregated Asylums Longview (Ohio) Colored Asylum, 1866

38. And Another Goldsboro (NC) Colored Asylum, 1880

39. And Another Canton (SD) Asylum for Insane Indians, SD, 1902

40. The Late 19th Century • Moral therapy wasn’t working • Aftermath of the Civil War • Chronic cases were overwhelming (especially schizophrenia and dementia) • State funding was declining • Superintendent psychiatrists lost respect

41. Warehousing Patients

42. 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)

43. Malaria fever therapy Insulin shock therapy Metrazol shock therapy Electroshock therapy The Shock Therapies: 1920-1960s 75,000 patients between 1935 and 1941

45. Lobotomy Walter Freeman demonstrating his transorbital lobotomy technique Egas Moniz -- Nobel Prize, 1949

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

48. In Summary:Good Intentions Gone Bad • Moral therapy • Compassion of the early superintendents • Never sufficient funding • Never adequate staffing • Somatic treatments • Community Mental Health Center Movement

49. Student Projects: The Annual Asylum Reports