History of Mental Health Treatment

Much has changed since then. A modern woman with a true mental illness might get treatments that are somewhat tailored due to her gender, but the underlying fundamental theories of mental illness don’t shift from man to woman, and a practitioner is required to respect the rights of the patient at all times. A woman in a modern facility might also have the opportunity to weigh in on the therapies she does, or does not, accept, and she might be allowed to leave as soon as she feels at least somewhat recovered. It’s a huge shift, and it’s been made via a series of small, difficult-to-measure steps.

In the early part of America’s history, people who had mental illnesses were placed in institutions that were quite similar to jails. Once inside these facilities, people simply weren’t given the opportunity to leave, no matter how much they might want to do so. In addition, some of these facilities had terrible procedural rules that allowed people with illnesses to be treated in ways that were unspeakably cruel.

In the 1840s, a woman in Boston, Dorothea Dix, began to research conditions in traditional mental health institutions. It’s been suggested[2] that Dix had a mental illness of her own, and she was more receptive to the plight of the ill as a result, but no matter the underlying motivation, Dix spent years conducting interviews with experts and patients, and her results were startling.

In a piece she wrote to the General Assembly of North Carolina, she outlines cases in which the mentally ill were chained to their beds, kept in filthy conditions and even abused. She begins her report with this series of sentences:

“I admit that public peace and security are seriously endangered by the non-restraint of the maniacal insane. I consider it in the highest degree improper that they should be allowed to range the towns and country without care or guidance; but this does not justify the public in any state or community, under any circumstances or conditions, in committing the insane to prisons…”[3]

Rather than committing the mentally ill to prisons, Dix hoped to open a series of institutions devoted to mental health, and she hoped these facilities would provide work, recreation and understanding to the ill. It’s one of the first documents to outline compassionate care, although it wasn’t widely implemented due to the work that Dix did.

Placing the mentally ill in facilities allowed members of the general public to ignore the problem. They didn’t see anyone who had a mental illness roaming the streets, and if they placed a person in an institution like this, they may not have come back to visit or shared stories of any visits they did make. The people just seemed to disappear.

Much of that changed in the late 1880s, due to the work of a writer named Nelly Bly. She agreed to pose as a mentally ill woman on an assignment for a local newspaper, and she documented everything that happened to her in a series of articles, which were later turned into a book. Bly was a wonderful writer, and her descriptions were hard to ignore.

“… I could not sleep, so I lay in bed picturing to myself the horrors in case a fire should break out in the asylum. Every door is locked separately and the windows are heavily barred, so that escape is impossible. In the one building alone there are, I think Dr. Ingram told me, some three hundred women. They are locked, one to ten in a room. It is impossible to get out unless these doors are unlocked.”[4]

In addition to describing the physical building, Bly describes the harsh treatments she obtained, including solitary confinement, hair pulling and more. Bly’s book was a sensation, and according to news reports,[5] the institution in which she lived was reformed as a result of her work. But she also managed to outline what living in a facility like this was actually like and how it didn’t seem to help anyone to get better, and that may have deepened the discussion people in this country had about mental illness, and it may have spurred experts to come up with radical treatments that could actually effectively treat mental illnesses. If housing them and isolating them didn’t work, they needed to find something else that would.

This work continued in some institutions well into the 1940s and 1950s, and in some cases, it did help some people who had serious illnesses. But many of these techniques fell out of favor, and in the years to come, an entirely different method of treatment began to take prominence in people with mental illnesses.

It was a global problem, and experts began to wonder if they could take people out of the institutions and provide them with medications they could use at home.

They were left there until 2009, when inspectors from the federal Department of Labor, as well as officials from nearby communities, reported conditions that they felt were abusive.

Those who weren’t shipped to programs like this sometimes slipped between the cracks altogether, and they made a life on the streets, sleeping in cardboard boxes, begging for food and railing at the sky when the days were bad. In one study of the issue,[11] conducted in 1988, researchers found that 28 percent of the homeless people they studied had a diagnosable mental illness. That’s a remarkably high number.

In the 1990s, experts discovered that many people with mental illness entered the criminal justice system, due to a combination of drug use and mandatory sentencing rules.[12] Administrators of these facilities scrambled to keep up with the demand for services from people who were profoundly ill and unable to get the help they needed on the outside.

Community agencies have worked for years to provide people with the help they need to manage their conditions without entering a facility for life. Social workers, mental health counselors and more have all been involved in this movement, and while it’s safe to say that some communities provide help that’s superior to the level of assistance seen in other communities, it’s clear that people have options for treatment today through community resources that just didn’t exist a decade or so ago.

Laws have also changed, and they now allow concerned family members and community members to place people with mental illnesses inside therapeutic facilities for a short period of time, until they gain control. Some state laws even force people with mental illnesses to take medications, even if they don’t wish to do so.[13]

It’s easy to view these legislative changes as a method that can allow people in the community to live with people who have mental illnesses, without worrying about their health and harm. But people who have mental illnesses have rights, and some don’t wish to accept this kind of treatment. Some patients want to manage their own conditions, using online resources as well as their doctors, and they’d like to have much more autonomy.[14]

It’s unclear what role this might play in the future. But it is clear that practitioners now respect people with mental illnesses to an unprecedented degree, compared with previous years. Rather than silencing them with restraints and drugs, experts now want to partner with patients and help them. This could bring about a form of mental health treatment everyone could support.

If you’d like to know more about how mental health issues are treated in Foundations Recovery Network facilities, we urge you to give us a call. Our admissions coordinators are here 24/7 to answer your questions.