History of Mental Health

I chose this image because it shows the steps for someone to be involuntarily committed. It shows how much it has changed compared to Pete Earley’s Crazy.

The movie I chose to discuss is Shutter Island. This movie was directed by Martin Scorsese and was released in 2010. This movie stars Leonardo DiCaprio as “Teddy Daniels”, a US marshal and former World War Two veteran. Teddy is sent to Shutter Island to find a patient that has gone missing. The story takes place in 1954 and was pretty historically accurate as far as the care and conditions of the mental asylum. 

https://www.youtube.com/watch?v=du5V3hyGXNA

Something that stood out was when Teddy asked Dr. John Cawley about the type of treatment conducted on Shutter Island. John Cawley replies that there are two schools of thought in psychiatry: the “old school” and the new school”. The doctor then goes on to explain how the old school is focused more on caretaking explaining the use of unethical surgeries like lobotomies. This was true of American asylums in the decades prior to the 1950s. As the lobotomy had been used during the 1930s. The doctor also tells Teddy that the new school focused on humane treatment, medicine, and curing. Which translates as the 1950s saw an increase in the search for medicinally based treatment. Most significant was the creation of Thorazine or Chlorpromazine, the first antipsychotic. Which is mentioned countless times throughout the movie and was seen as the best drug at the time. 

The asylum itself is accurate. First is that the asylum was placed on an island away from the city. This was common for asylums as they had developed an “out of sight out of mind” idea. Another scene shows patients sleeping quarters which were just a giant room filled with beds. This is subtle yet shows the issues of overcrowding that overtook asylums in the early 1900s. At the beginning of the movie Teddy sees a lobotomized patient. The appearances are over exaggerated however, it shows the effects that asylums had on the physical body. Another example of this is when we meet George Noyce who is extremely skinny and beat up. 

The effect of past trauma is something that is touched upon. It is mentioned to Teddy when he discusses his past. Linking current behaviors to those experiences which is something the Freud’s Psychoanalysis touched upon. The focus is mostly PTSD  is discussed in Shutter Island. Teddy having liberated Dachau is plagued by nightmares and flashes of the horrors that he had seen there. The doctor’s reactions to it made sense during the time. John Cawley referred to one of these flashes as a migraine and urged Teddy to take an aspirin. This lines up with knowledge at the time as after World War Two as the term PTSD did not exist and there was little understanding of it.  

While the story is fictional, many of the small details are not. Whether it be the philosophy of American psychologists or the physical building this movie fits what we have learned. As it stands the movie offers real information in an extremely entertaining way. 8.5/10.

Citations

Psycho War Clip

“Dr Cawley Psychotherapy War – Shutter Island (2010) – Movie Clip HD Scene.” YouTube, May 9, 2020. https://www.youtube.com/watch?v=du5V3hyGXNA.

Who are you clip

Image

Sarapampuriportfolio. “Movie ‘Shutter Island’ (2010) – Review – Blog of Sara Pampuri.” Sara Pampuri, January 24, 2021. https://sarapampuriportfolio.altervista.org/en/movie-shutter-island-review/.

This poster describes Thorazine also known as Chlorpromazine. This drug was created in 1955 and was the first antipsychotic. This week in class we discussed the 1950s and the focus on drugs to help the mentally ill.

During the twentieth century America had been overcome by the fight for civil rights. After many years of fighting, the 19th amendment was passed in 1920 giving women the right to vote. This was shortly followed by the passing of the Indian Citizenship Act in 1924. After that was the civil rights movement of the 1950s-1960s. Amongst all the fighting for civil liberties there was another group of individuals who fought for their rights and won. That being the patients in mental asylums. In some cases, patients had been placed in these asylums for little or no reason at all forcing them to take an involuntary “life sentence” at one of these asylums. During the second half of the twentieth century life for the “mentally ill” changed throughout America. After gaining their freedom they were thrown into a world that had all but forgotten about them. This paper will argue that while the second half of the twentieth century was “revolutionary” for Americans dealing with mental disabilities, these changes would only work to further ostracize those individuals from the rest of society.

In 1950 there were over 500,000 patients in insane asylums across the United States. The extremely high number of patients in asylums was something that the joint commission had aimed to change, in the “Action for mental health: Final report of the Joint Commission on Mental Illness and Health” it is noted as saying “The objective of Modern treatment of persons with major mental illness is to enable the patient to maintain himself in the community in a normal manner.” (Action for Mental Health).” This was published in 1961 and would spark the “revolution” that took place. The idea of these patients getting back into the community was executed in a top-down manner. The first step federally was the Community Mental Health Act signed in 1963.

This act shifted federal funding from hospitals to community mental health programs and centers. The signing of this act meant that responsibility for the mentally ill was slowly being pushed back upon society. This was in stark contrast to the idea of care taking that had been developed amongst American mental asylums. While the 1963 act and others during the 1960s-1970s were seen as wins for civil rights, these individuals were put into an unforgiving society. Now one of the major issues facing society was the number of individuals that were released in such a short time span.  In “‘Community Care’: Historical Perspective on Deinstitutionalization” author Andrew Scull states that “the dramatic decrease took place between 1965 and 1980, when numbers fell from 475,202 to 132,164.” (71, Community care).

On the surface it appears as though treatment had taken a substantial leap. However, that was not the case rather individuals were being thrown out of asylums and into the community. When these former patients were reintroduced, they were met with a society that treated them as outcasts and figuratively continued the mistreatment that they had faced in the asylums. With over 300,000 of the “mentally ill” being released into society it appeared to overwhelm America. During the time it is noted that “Their plight triggered popular fears of dangerous “maniacs” running the streets and invading neighborhoods” (folklore).  This clearly shows that these individuals would not be immediately “adapted” into society the way that they were intended to. As a result of this many former patients found themselves with no one to turn to in a society which was content ignoring them. Leaving them to seek shelter in welfare hotels, halfway houses, and homeless shelters. For these patients they went from a place of stability, directly to the “lowest rank” of American society.

Another thing that fueled negative feelings towards former patients’ is that their actions “went against societal norms.”  While there is a discussion to be had about what norms are, who sets them, and how one should conduct themselves to fit these norms. We should turn the focus on how going against these norms impacted societies view of the mentally ill. Similar, to the days before asylums community care took over as the chief way to care for those with mental disabilities. During the twentieth century America had become a progressive nation so, it was reasonable to believe that these individuals could seamlessly integrate into society. The major issue was that society had retained the same negative stigmas about mental illness that led to the overcrowding and hiding away of these individuals. These beliefs are perfectly exemplified in the “Action for Mental Health Report” written by the Joint commission in 1961. It states that “They do not feel as sorry as they do relief to have out of the way persons whose behavior disturbs or offends” (Action for mental Health, 58). The significance of this quote is that it shows the overall lack of empathy towards mentally ill Americans during this time. It speaks to the fact that most Americans would rather these individuals be locked away than “deal with” their behaviors. For many these asylums had become places to “drop off’ unwanted or troublesome individuals. In a turn of events the states were the ones dumping off patients. America answered with a lack of empathy for these individuals, which is a problem considering that is a major part of community care.

Aside from convenience there was another driving factor in the ostracization of the mentally ill in America. Since they had been “hidden away” for so long, many Americans didn’t know what to make of these “newly” added individuals. So, from societies perspective the “strangeness” of their actions helped to further solidify their ideas of the mentally ill.  Along with strange behaviors there was a general lack of understanding of what mental illness is especially in the broad society’s knowledge. With a lack of empathy, a more damaging societal view emerged. It is noted that “It has been observed countless times that sight or thought of major mental illness, as our culture has come to understand it, stimulates fear” (Action for mental Health Report, 59). This sort of fear of the unknown that Americans had developed created a new set of problems more significant than “fitting in” to society. Not only did patients have to face the transition into society they had to do it in a world that actively feared them for factors that were out of their control. It is important to note that this quote is from 1961 but this sentiment carried throughout the rest of the century.

More concrete proof of Americans fear of the mentally ill can be seen in the way that popular media took off with its portrayal of mental illness and mental health facilities. The most prevalent of which can be seen in popular American movies during the back half of the twentieth century. In “The Folklore of Deinstitutionalization: Popular Film and the Death of the Asylum, 1973–1979” author Troy Rondinone discusses the connection between horror movies produced during this time and “fears” Americans had. Rondinone specifically mentioned “The Exorcist”, “One Flew Over the Cuckoo’s nest”, and “Halloween.” These films were met with immense popularity and are still considered classics to this day. However, Rondinone notes that “The movies folklorically confirmed popular horrors of mental hospitals, and the people trapped inside them.” (folklore). The negative portrayal of mental health and mental institutions in these movies further differentiated the former patients from the rest of society.

The ostracizing of former patients is not only seen in popular media, but it can also be seen in the “transferring” of these patients. After these individuals had gained their freedom, they were essentially just sent off to other institutions. In the 1960s and into the early 1970s most of the patients being moved out of asylums were individuals over the age of 65. Many Americans saw these individuals as burdens and lacked either the means or want to care for them. This can be seen when Andrew Scull states that “Between 1963 and 1969 alone, the numbers of elderly patients with mental disorders living in nursing homes increased by nearly 200,000, from 187,675 to 367,586. By 1972, … the mentally disturbed population housed in nursing and board and care homes had risen to 640,000.” (75, community care). With the run of the American asylum ending families looked for a new place to “dump off” these unwanted individuals. Reinforcing the the idea of hiding away these individuals had persisted through societal changes.

For younger patients they were not lucky enough to be put back into “care” facilities. Previously, “odd” behaviors got people sent to an asylum now they were sent to jail instead. The Book “From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945” looks at Philadelphia and the polices reaction to the recently released patients. The book notes that Philadelphia police commissioner “published a directive that encouraged police to take people exhibiting antisocial behavior to jail, since they could no longer take them to hospitals involuntarily.” (Community Care, 98). This was seemingly a quick fix to the problem of unwanted people. It is important to note that this attempt to hide away these members of society was not exclusively a Philadelphia thing. It is also noted that “the number of people diagnosed with mental illnesses entering the prison system sharply increased, a trend that occurred in countless cities across the United States” (Community Care, 98-100). This sort of “institutional transfer” that occurred showed how American society had wished to rid themselves of these individuals as soon as they got their rights. Americans’ willingness to hide these individuals speaks the truth that many of the former patients never had a real chance of making it in American society.

While the twentieth century was one where many people gained their rights that does not mean that all citizens were in favor of it these changes. In the case of the mentally ill deinstitutionalization was met with negativity from the majority of American citizens. As far as public perception many Americans feared these individuals. This fear would be further exemplified by movies that painted mental illness as scary, increasing the spread of this fear. As a result of this fear Americans worked to “re-institutionalize” former patients. Whether that be dropping a grandparent off at a nursing home or sending individuals to jail instead of asylums, America worked to hide away these people. Overall, the deinstitutionalization of the mentally ill was met by an America that wanted to push them out of society.

Citations

Parsons, Anne E. From Asylum to Prison: Deinstitutionalization and the Rise of Mass Incarceration after 1945. The University of North Carolina Press, 2018.

RONDINONE, TROY. “The Folklore of Deinstitutionalization: Popular Film and the Death of the Asylum, 1973–1979.” Journal of American Studies 54, no. 5 (2020): 900–925. https://doi.org/10.1017/S0021875819000094.

Scull, Andrew. “‘Community Care’: Historical Perspective on Deinstitutionalization.” Perspectives in Biology and Medicine 64, no. 1 (2021): 70–81. https://doi.org/10.1353/pbm.2021.0006.

Bennett, Douglas. “Deinstitutionalization in Two Cultures.” The Milbank Memorial Fund Quarterly. Health and Society 57, no. 4 (1979): 516–32. https://doi.org/10.2307/3349726.

Action for mental health: Final report of the Joint Commission on Mental Illness and health, 1961. New York: John Wiley and Sons, 1961.

Images

“Kennedy’s Vision for Mental Health Never Realized.” USA Today, October 20, 2013. https://www.usatoday.com/story/news/nation/2013/10/20/kennedys-vision-mental-health/3100001/.

Raphael, Steven, and Michael A. Stoll. “Assessing the Contribution of the Deinstitutionalization of the Mentally Ill to Growth in the U.S. Incarceration Rate.” The Journal of Legal Studies 42, no. 1 (2013): 187–222. https://doi.org/10.1086/667773.

“Social Norm Examples.” YourDictionary. Accessed November 9, 2023. https://www.yourdictionary.com/articles/examples-social-norms.

“Deinstitutionalization – Special Reports | The New Asylums | Frontline.” PBS. Accessed November 9, 2023. https://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.

Video

YouTube. YouTube, 2008. https://www.youtube.com/watch?v=2WSyJgydTsA.

I believe this picture perfectly exemplifies what we have discussed this week. This is because while there were mental disorders that African America males were struggling with, the doctors would just diagnose them with schizophrenia. They chose to ignore other mental disorders even when these patients would show the exact same symptoms as a white patients. They chose to ignore that evidence not specifically Ionia but the psychiatric field as a whole. Although this could be attributed to American society and its racist views. Regardless, misdiagnosing patients with schizophrenia. was extremely detrimental to the individuals,  as well as for the world of psychology. 

This week we discussed cognitive behavioral therapy. I chose this image because it shows the key ideas CBT. In a simple easily digestible way.

The reason I chose this picture is because we have been discussing mental asylums from women’s perspective. As we have discussed many women were put into these hospitals for less than solid reasons. I believe this picture perfectly shows the struggle and the feelings of hopelessness that patients felt.

My working thesis is “this paper will argue American society forced mental health facilities to become long term care facilities.” The first place to look for that is how “insane” people were viewed by the majority of Americans during the nineteenth and twentieth centuries. As cities became more populated throughout America citizens became less likely to take care of mentally ill family members. These people were seen as burdens not only to the families but by the community. This led to mental health facilities becoming somewhat of a “dumping ground” for unwanted individuals. This can be seen in the broad spectrum of things that got people sent to these facilities as well as the seemingly instant increase in the elderly population. Once communities filled mental asylums they then put little or no money into any facet of the hospitals. Leading to serious problems of overpopulation and abuse. This is in serious contrast to the original purpose of these facilities. The goal for all of these facilities was to cure individuals to a point where they could return to society. But since society viewed the individuals so poorly the hospitals  never had a true chance.  The idea of moral treatment was what every hospital in America was built on. The issue of overcrowding is the main reason these hospitals became care facilities. Simply put the hospitals never had the knowledge and resources to individually work with patients. Funding also plays a huge role in this. It is mentioned multiple times that Kirkbride and other operators had to beg for money to keep running their hospitals. Which really harkens back to how society viewed “insane” individuals. As they were willing to send them there but not willing to ensure their safety.

Sources

Grob, Gerald N. 2011. Mad among Us : A History of the Care of America’s Mentally Ill. Editora: New York: Free Press.

Grob argues that American hospitals were made with good intentions but societal factors led to its eventual downfall. Grobs discusses how the development of these hospitals coincided with growing societal beliefs. For my project it discusses the growing displeasure that Americans had about the mentally Ill.

Tomes, Nancy. 1994. The Art of Asylum-Keeping.

The main argument that Tomes is making is that Kirkbrides asylum philosophy lost appeal because of “new social realities.” It follows Thomas Kirkbride and his ideal facility which was never able to come to fruition. This source is useful because it talks about moral treatment in theory and in action and gives a unique perspective that most head physicians shared.

Tone, Andrea. 2009. The Age of Anxiety : A History of America’s Turbulent Affair with 

Tranquilizers. New York: Basic Books.

The author discusses the issues with feeding humans pills to help deal with mental illness. She points to the use of tranquilizers to remedy anxiety. This shows the willingness of modern doctors to prescribe heavy medication, showing how treatment has never really changed overtime.

Shorter, Edward. 1998. A History of Psychiatry: From the Era of the Asylum to the Age 

of Prozac. New York ; Chichester: Wiley.

Shorter argues against the “revisionist” history of psychiatric care that took place in the 1960s. Shorter mentions how the work done in the sixties discredited mental illness and their true effects. This touches on the evolution of Psychiatric hospitals be that physically or in the public eye up until the modern day. 

Magennis, A.L. “Lives Forgotten; Morbidity and Mortality in the Late 19th Century 

Colorado Insane Asylum.” American Journal of Physical Anthropology, 2003, 144–.

The article emphasizes the poor treatment that the patients faced. Magennis discusses the examinations of patients’ skeletal remains, noting that many of them suffered violent deaths. This is a good piece to help expand on the idea that Americans used hospitals as a dumping ground.

Jimenez, Mary Ann. Changing Faces of Madness : Early American Attitudes and 

Treatment of the Insane. Hanover, NH: Published for Brandeis University Press by University 

Press of New England, 1987.

Mary Ann Jimenez makes the case that as society developed there became a need to care for these individuals. Mainly she points at the growing need running along side Americas industrialization This adds context to show societies changing views as their life styles began to change.

 Sutton, John R. “The Political Economy of Madness: The Expansion of the Asylum in 

Progressive America.” American Sociological Review 56, no. 5 (1991): 665–78. 

https://doi.org/10.2307/2096087.

This article argues that in the late 1890s-1940s it was the governments responsibility to take care of these individuals. Sutton points to a political split which ultimately only hurt the people who needed help. The government showed little support to these facilities yet everyone reaped in the benefits.

 Riddle, Bryan Justin. “Treatment, Warehousing, and Dispersion: Mt. Pleasant Insane 

Asylum, 1844-1980.” ProQuest Dissertations Publishing, 2010.

This author argues that Iowas government was ultimately the downfall of Mount Pleasant Insane Asylum. He notes how Iowa did not give the proper resources to the asylum so it ultimately spiraled into a disaster. This article is a perfect example of how society let down these individuals and never gave the hospitals a real opportunity to work.

 Holt, Anna Kate. “Seeking Voices in Dark Places: The History of the Tennessee 

Asylum for the Insane.” ProQuest Dissertations Publishing, 2023.

Holt argues that other authors do not cover the racism that was regularly apart of hospitals. She points to the Tennesse Asylum to show the how racism effected not only this asylum but similar ones across the nation.The fact that racism was so prevalent amongst these facilities speaks volumes to societal problems. 

 Lanzoni, Susan. “The Asylum in Context: An Essay Review.” Journal of the History of 

Medicine and Allied Sciences 60, no. 4 (2005): 499–505. https://doi.org/10.1093/jhmas/jri070.

This review argues that the issue of overcrowding was a variety of factors. Early in the article the author discusses the role that families play however in the end, Lanzoni mentions that “lax procedures” on commiting individuals is what did the most damages. This article shows a couple of different views that add perspectives on the family side, political side, and the institution side.

Kemp, Donna R. Mental Health in America : a Reference Handbook. Santa Barbara, 

Calif: ABC-CLIO, 2007.

Kemp argues that the ever changing definition of mental illness makes it difficult for individuals to find adequate treatment. It covers the changing definitions and treatments of a varies of different illnesses. Speaks to the terrible treatment that patients recieved and the fields sort of Guinea pig approach to mental illness.

FEE, Elizabeth, and Theodore M BROWN. “Freeing the Insane.” American Journal of 

Public Health (1971) 96, no. 10 (2006): 1743–1743. https://doi.org/10.2105/AJPH.2006.095448.

This article argues that the treatment in the 1800s was a major step in the right direction for the world of mental health. Points to use of “moral treatment” that occurred in America and other countries compared to treatment during the 1700s. As my paper will focus on the negative it is important to understand that leaps were made during this time period. 

 Geloso, Vincent, and Raymond J. March. “Rent Seeking for Madness: The Political 

Economy of Mental Asylums in the United States, 1870 to 1910.” Public Choice 189, no. 3-4 

(2021): 375–404. https://doi.org/10.1007/s11127-021-00890-1.

This piece argues that “stronger political influence from mental healthcare providers contributed to the rise in institutionalization.” They point to the rising level of rates from 1870-1910. A perfect example of policies that allowed for the neglect of patients and hospitals alike.

Yanni, Carla. 2007. The Architecture of Madness : Insane Asylums in the United States. 

Minneapolis: University Of Minnesota Press.

This author argues that the architecture of insane asylums has evolved overtime. They had to change from the kirkbride model in order to better suit patients. It is also mentioned that hospitals now prefer open spaces with art which shows the evolution of American hospitals. 

 Ryan, Madeline Kearin. “The Smell of the Insane: Disciplining the Olfactory Domain in 

the Nineteenth-Century Asylum.” Historical Archaeology 56, no. 4 (2022): 722–39. 

https://doi.org/10.1007/s41636-022-00378-9.

This article focuses on the failure of the facilities to keep patients properly taken care of. TH articles paints this a top down problem.For my paper it talks about the failures of asylum operators to successfully implement proper regiments for patients.

 Deitz, Charles. “‘A Tomb for the Living’: An Analysis of Late 19th-Century United States 

Newspaper Reporting on the Insane Asylum.” ProQuest Dissertations Publishing, 2018.

Deitz’ argues that newspapers helped to push negative narratives about mental illness. While also promoting false narratives about asylums. This works perfectly with my other sources to display growing societal views.

 Braslow, Joel. Mental Ills and Bodily Cures : Psychiatric Treatment in the First Half of 

the Twentieth Century. Reprint 2019. Berkeley, CA: University of California Press, 1997. 

https://doi.org/10.1525/9780520917934.

This piece argues that doctors went to extreme lengths for these tests. Which violated the rights of individuals and went unknown to families.  This article speaks to the poor treatment that patients had to undergo in these facilities and further strengths the idea that patients were test subjects. 

Grob, Gerald N. Mental Institutions in America : Social Policy to 1875. London:Routledge Publisher, 2017

In this piece Grob argues that mental institutions are unable to produce results. This drastically impacts the amount of support they receive from the public. For my paper it shows where societies expectations and reality just didn’t line up.

  Grob, Gerald N. “Review: John C. Burnham, ‘Mental Institutions in America: Social Policy to 1875’ (Book Review).” Journal of Social History. Berkeley, Calif: University of California Press Books Division, 1975.

This source agrees that Grob is right, and that it was social policy that was the largest factor in hospitals failures. For my paper it solidifies some of what I had found and my overall thesis. 

  Lambe, Jennifer. “Memory Politics: Psychiatric Critique, Cultural Protest, and One Flew Over the Cuckoo’s Nest.” Literature and Medicine 37, no. 2 (2019): 298–324. https://doi.org/10.1353/lm.2019.0014.

This article covers a form of popular media but flips it in a way to reflect upon current America’s treatment of those with mental illness. It really works to show how patients are often ignored by society. For my paper this shows some of the more general preconceived notions that  American society held.

The media piece I decided to include this week comes from one of my favorite shows of all time, Ghost Adventures. In the short clip they discuss the reasons that people were admitted to the hospital; mostly they focus on people that were committed for “no reason.” They focus on how living in Kirkbrides asylum negatively affected the mental health of all people but specifically the ones who should not have been there. What stands out the most is when they describe the various methods of restraint. While we have talked about it in class, being able to see the rooms and the restraining “set ups” truly brings to light what kind of life these people had.

https://www.travelchannel.com/videos/the-asylums-horrid-conditions-0143384

This photo shows the “bedroom” of an American psychiatric hospital in 1861. It perfectly displays the poor conditions we have discussed this week. Specifically issues of overcrowding as we can see the room is completely full of beds with narrow walkways. The overall lack of privacy speaks to how patients were continually dehumanized throughout hospitals.