35 Facts About Mental Asylums

Early Beginnings and Purpose

Mental asylums have a long and complex history. They were initially created with the hope of providing care and treatment for those with mental illnesses. Let's dive into some key facts about their origins and intended purpose.

1. The earliest recorded lunatic asylum in Europe is Bethlem Royal Hospital in London, which admitted its first mental patients in 1330.
2. Mental asylums were initially envisioned as quiet, idyllic homes where those with mental illnesses could be cured. The idea of treating mental illness in these institutions became popular in the United States by the year 1860, with 28 of the 33 states having public insane asylums.
3. Reform efforts by activists like Dorothea Dix led to the founding or enlargement of over 30 mental hospitals. Dix's crusade aimed to move mentally ill individuals out of poorhouses and jails and into asylums.

Treatment Approaches and Conditions

The methods and conditions within asylums varied greatly. Some were humane and aimed at rehabilitation, while others were harsh and inhumane.

4. Moral treatment, which emphasized care of curable patients, was introduced into American asylums. This approach included a regimented daily schedule, disciplined work, and visits from family members were discouraged to promote quiet and silence.
5. Psychiatry emerged as a medical specialty in the 19th century. Psychiatrists, or "alienists," were optimistic that mental illness could be cured with appropriate asylum care. However, there was conflict among practitioners, with rehabilitative approaches declining as biological theories gained popularity.
6. By the end of the 19th century, national systems of regulated asylums for the mentally ill had been established. These institutions were designed to provide a structured environment aimed at restoring patients to more orderly thinking.
7. Conditions in asylums varied widely. Some institutions were overcrowded and underfunded, leading to minimal treatment for patients. For example, the St. Louis Insane Asylum in 1900 collected data on patients but entered little information about the nature of treatment due to the poor conditions.

Diagnoses and Treatments

The diagnoses and treatments in asylums were often broad and sometimes brutal. Here's a look at some of the methods used.

8. Diagnoses in asylums were often broad and included categories such as melancholia, mania, addiction, dementia, and diseases related to syphilis. The St. Louis Insane Asylum in 1900 had 433 patients with psychiatric diagnoses, with the mean age being 38.1 years.
9. Treatment methods in asylums were often brutal and inhumane. For example, the Trans-Allegheny Lunatic Asylum performed lobotomies with ice picks, and patients were locked in cages. Insulin shock therapy and electroconvulsive therapy were also commonly used.
10. Some asylums practiced castrations as a form of treatment. The Topeka State Hospital, for instance, was given permission to castrate patients deemed habitual criminals, idiots, epileptics, imbeciles, and insane. A total of 54 castrations took place between 1931 and the hospital's closure in 1997.

Overcrowding and Private Asylums

Overcrowding was a significant issue in many asylums, and private institutions often provided substandard care.

11. Asylums often faced overcrowding issues. The Trans-Allegheny Lunatic Asylum, originally meant to house 250 patients, grew to 2400 by 1949. This led to neglect and poor living conditions for many patients.
12. Privately run asylums began to increase in number during the 19th century. These institutions were often poorly regulated and provided substandard care. For example, Greystone Park Psychiatric Hospital in New Jersey was criticized for its overcrowding and use of insulin shock therapy and electroconvulsive therapy.

Notorious Institutions and Abuse

Some asylums became infamous for their terrible conditions and abuse of patients.

13. Willowbrook State School on Staten Island operated under terrible conditions. Patients were left to wander around covered in their own urine and feces, and some were sexually assaulted by staff. The institution was also linked to the infamous criminal Cropsey, who killed children and buried them near the grounds.
14. The Magdalene Asylum, also known as the Magdalene Laundries, were Catholic-Church run institutions established for Ireland’s "fallen women" in the 18th century. Over its 150-year history, around 30,000 women were institutionalized for reasons ranging from being prostitutes to having a child out of wedlock. The women suffered physical and emotional abuse.
15. Patients in many asylums were subjected to cruelties intended to cure them of their illnesses. The Topeka State Hospital was notorious for its abuses, with patients being confined in leather straps for extended periods, leading to severe physical damage.

Decline and Deinstitutionalization

By the mid-20th century, the decline of asylums began, leading to significant changes in mental health care.

16. By the 1950s, the death knell for psychiatric asylums had sounded. New systems of nursing homes and community mental health care began to meet the needs of vulnerable elders. The introduction of chlorpromazine, a new medication, offered hopes of curing persistent psychiatric symptoms.
17. The community mental health system aimed to return those suffering from mental illnesses to their families and communities. This shift marked a significant departure from the institutionalized care of the past.
18. To improve the quality of care in asylums, nurses' training schools were established within these institutions. These schools followed the same training standards as those in general hospitals, ensuring that nurses received comparable clinical and classroom experiences.
19. Training schools in asylums actively welcomed male students, providing them with places either in schools that also accepted women or in separate schools formed just for them. This inclusivity was a significant step forward in the profession of nursing.

Economic Challenges and Alternatives

Economic crises and new approaches to mental health care further impacted the operation of asylums.

20. The economic crisis of the 1930s drastically cut state appropriations for asylums, exacerbating their financial struggles. World War II created acute shortages of personnel, further challenging the operations of these institutions.
21. In response to the decline of asylums, some psychiatrists established separate programs within general hospitals to treat patients suffering from acute mental illnesses. These "psychopathic hospitals" offered alternative forms of care.
22. The Mental Hygiene Movement focused on preventing mental disorders through outpatient clinics and private practice. This approach aimed to reduce the need for institutional care by addressing mental health issues early on.
23. Therapies like insulin and electric shock therapies, psychosurgery, and various medications were experimented with in asylums. These treatments posited brain pathology as the cause of mental illness, mirroring medical approaches to physical symptoms.

Deinstitutionalization and Modern Mental Health Care

The process of deinstitutionalization marked a significant shift in how mental health care was provided.

24. Deinstitutionalization, a process that began in the 1950s, aimed to move patients from asylums into community-based care. This shift was driven by the introduction of new medications and the recognition that institutional care was often ineffective.
25. Today, psychiatric care and treatment are delivered through a web of services including crisis services, short-term and general-hospital-based acute psychiatric care units, and outpatient services ranging from twenty-four-hour assisted living environments to clinics and clinicians’ offices offering psychopharmacological and psychotherapeutic treatments.
26. The quality and availability of outpatient services vary widely. Some historians and policy experts wonder if "asylums," in the true sense of the word, might still be needed for the most vulnerable individuals who require supportive living environments.

Legacy and Impact

The legacy of mental asylums is complex and multifaceted, influencing contemporary mental health care.

27. Only a small number of historic public and private psychiatric hospitals remain. These institutions have largely been replaced by modern facilities and community-based care systems.
28. Some asylums are said to be haunted, with paranormal activity reported in places like the Trans-Allegheny Lunatic Asylum. These institutions have become popular among paranormal seekers, who often stay overnight in the facilities.
29. Countries that have deinstitutionalized may be experiencing re-institutionalization or relocation to different institutions. This trend is evident in the rise of supported housing facilities and forensic psychiatric beds.
30. New Zealand established a reconciliation initiative in 2005 for ex-patients of state-run mental institutions. The initiative addressed poor admissions reasons, unsanitary conditions, lack of communication, physical violence, and inadequate complaints mechanisms.
31. In several South American countries, the total number of beds in asylum-type institutions has decreased, replaced by psychiatric inpatient units in general hospitals and other local settings.
32. By the beginning of the 20th century, the number of "lunatics" housed in disparate institutions had grown to about 100,000. This growth coincided with the development of psychiatry as a medical specialty.
33. The United States experienced two waves of deinstitutionalization. The first wave began in the 1950s and targeted people with mental illness. The second wave focused on individuals diagnosed with developmental disabilities.
34. Jails have become society's primary mental institutions, though few have the funding or expertise to carry out that role properly. In New York City's Rikers Island, 28% of inmates require mental health services, a number that rises each year.
35. The legacy of mental asylums is complex and multifaceted. While they were often sites of abuse and neglect, they also represented a significant attempt to provide care and treatment for those with mental illnesses. The evolution of mental health care continues to shape our understanding and approach to treating mental health disorders.

The Legacy of Mental Asylums

Mental asylums have a complicated history. Initially, they aimed to provide care for those with mental illnesses, but many fell short, leading to overcrowding, abuse, and neglect. Reformers like Dorothea Dix pushed for better conditions, but challenges persisted. Over time, treatments evolved from brutal methods to more humane approaches, thanks to advances in psychiatry and medication.

By the 1950s, the shift towards community-based care began, marking the decline of traditional asylums. Today, mental health care focuses on outpatient services and supportive living environments. While historic asylums are mostly gone, their legacy remains a reminder of the importance of compassionate and effective mental health care. The journey from asylums to modern mental health care highlights the ongoing need for improvement and understanding in treating mental illnesses.