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"Caring , and seeing with the heart.", answered the soul.
The History of Mental Illness
by Kimberly Leupo
Treating public illness has long been a process of trial and error guided by public attitudes and medical theory.
The Colonial American society referred to those suffering from mental illnesses as ‘lunatics” which interestingly enough was derived from the root word lunar meaning, “moon.” Through astrological reasoning it was believed that insanity was caused by a full moon at the time of a baby’s birth or a baby sleeping under the light of a full moon. Colonists declared these lunatics possessed by the devil, and usually they were removed from society and locked away.
Those considered lunatics were grouped into two all-encompassing categories: mania and melancholy. The only medical procedures centered around the idea of catharsis. Colonists believed to cure an individual it was necessary to undergo cathartic medical treatment, and to either catalyze crisis or expel crisis from the individual. Such medical procedures involved submerging patients in ice baths until they lost consciousness or executing a massive shock to the brain. Means to expel crisis from the patient included inducing vomiting and the notorious “bleeding” practice. The bleeding practice entailed draining the bad blood from the individual, unfortunately this inhumane practice normally resulted in death or the need for lifelong care; at best the odds were one in three that this procedure would actually lead to an improvement in the patient’s health. Although the colonial era’s methods of handling the mentally ill and medical procedures could be considered barbaric by present- day standards, the vast majority of people were content because the lunatics were no longer visible in society.
Around the turn of the 19th century, Europeans introduced a new approach to the treatment of the mentally ill known as “Moral Management.” This approach was based on the belief that the environment played a vital role in the treatment of the mentally ill. Creating a more domestic feel, beds, pictures and decorations replaced shackles, chains and cement cells. It was thought that recovery would more likely occur if conditions and surroundings resembled the comfort of home. Treatment also took a benign approach. Phrenology was introduced, studying the shape of the brain to explain illnesses and render diagnosis. Animal magnetism was another popular practice, concentrating on the benefits of hypnosis and relaxation. Problems surfaced, however, with patients becoming unruly due to lack of restraints, and concern arose with how patients were to occupy their time. To combat these concerns, work programs and recreational activities were devised for patients in asylums, significantly moving to bridge the gap between society and the hospital.
A pivotal point in the history of the mental illness was the Civil War. After the Civil War in America a great number of servicemen suffered from postwar trauma; war wounds that were emotionally and mentally ingrained as opposed to physical injuries. These inflicted persons were passed on to state mental hospitals and asylums, where the public displayed much interest in their care and treatment. Although, the public eye watched very closely how their ‘war boys’ were treated, institutions had no choice but to reinstate old procedures due to the serious issue of overcrowding. Restraints and shock therapy were reintroduced, along with new drug treatments such as opium.
Along with the rising need to find placement for those suffering from mental illnesses, asylums began opening all over the country. Thomas Story Kirkbride was a designer of asylums at the time, and became well- known for his popular architectural ideas.
With aid from the state and federal money, the community of Athens adopted the Kirkbride Plan and constructed their own mental asylum. Doors opened in January of 1874 with the institution dawning the name “Athens Asylum for the Insane.” The asylum was an attractive, ornate structure built to please the public’s eye but also to withstand the harshest conditions from within. The original 544- room construction consisted of two staggered wings branching out from a central building. The architecture was such that allowed exit and entrance only from the center building and the design was ideal for cross- ventilation and patient control. The design called for the least disturbed patients to be placed closer to the center building to encourage interaction with the staff, and as the patients’ conditions worsened their placement would extend respectively throughout each wing toward the back of the structure.
The institution grew into a very efficient community housing farms, a dairy barn, greenhouses, a transportation system, graveyards, etc. The patients took part in tasks both indoors and out to benefit their living situation, much like that of a family. In accordance with European ideals at the time, patients at the Athens Asylum also engaged in recreational activities such as dancing, picnics, boating and church. All up and coming communities housed large and attractive asylums; it wasn’t uncommon to see postcards circulating featuring picturesque asylums with beautiful landscaping. The reputation of these institutions was significantly impressive leading parents and friends of patients to have increasing confidence in their patient’s care. Thus helping in small part to lessen the stigmatism associated with the mentally ill.
With the increasing credibility of these institutions, the populations skyrocketed. It was common for homeless people, tramps and hobos to become ‘patients’ of the asylums seasonally for shelter and food, and then "elope," or slip away when the good weather returned. Families would often submit their elderly relatives to asylums because they lacked the resources or time to deal with them appropriately. The problem with overcrowding developed because the institutions had no established criteria for accepting or rejecting patients into their care. Rapid growth in populations caused patient care to suffer. In the Athens Asylum the patient population jumped from 200 to nearly 1800, with an insignificant alteration in staffing. The community found that these institutions were an easy means to remove unwanted people from society. There was no effort to provide any other programs or support, because the state was paying for the asylum.
The severe overcrowding led to a sharp decline in patient care and once again, the revival of old procedures and medical treatments. Restraints returned. Instead of sleeping in single rooms as the Kirkbride Plan had designed, patients were sleeping in wooden cribs stacked three patients high. Ice water baths were once again used, along with shock machines and electro- convulsive therapy. And in the early 1930s the notorious lobotomy was introduced into American medical culture.
The original lobotomy was a medical procedure where the neural passages from the front of the brain are surgically separated from those in the back of the brain. The common result of this procedure was the patient forgetting their depressing or discouraging feelings or tendencies. This was a very delicate, time-consuming procedure that required great skill and training from the practicing surgeons. Because the lobotomy appeared to effectively alter the mental health of patients, great effort was invested into developing a more practical procedure with similar desired results.
To the satisfaction of his peers and the mental health community, Walter J. Freeman developed the trans- orbital lobotomy. This new medical procedure could be performed quickly and required limited after- care for the patient. The procedure was performed as follows:
Because this new form of lobotomy could be performed so quickly and easily, the trans- orbital craze swept the nation’s asylums. Freeman himself performed over 3,000 lobotomies and was labeled the traveling lobotomist. Trans- orbital lobotomies were performed on hundreds of Athens Asylum patients in the early 1950s. In a local newspaper, on November 20, 1953, the headline read “Lobotomies are Performed on 31 Athens State Hospital Patients,” and the article boasted that nearly 25 of those who received surgery would be able to go home with their relatives Sunday. Freeman and the trans-orbital lobotomy stirred up harsh criticism from those who learned of his flamboyant methodology. Due to the number of complications and deaths that resulted from the procedure, it was referred to as “psychic mercy killing” and “euthanasia of the mind.” This was by far mental health care’s darkest hour.
Along with the common use of lobotomy procedures in asylums, electro-convulsiveshock treatment continued to be a dominant practice. Thenumbers continued to rise in the institutions, and caregivers and attendants remained scarce. Rumors of abuse and neglect flooded communities who once were proud of their community asylums. In the 1950s, the Athens Asylum reached its peak population of nearly two thousand patients.
Shortly after the asylum population explosion in the mid 1900s, when mental health treatment was arguably at its worst, an apparent salvation emerged. Psychotropic medication was pioneered. In 1954 the medical community introduced an anti-psychotic drug called Thorazine for the treatment of the mentally ill. In rapid succession, other psychotropic medications became available, making it possible to cut substantially the length of time patients stayed in mental institutions. This breakthrough led to a significant decline in asylum populations, and the gradual discontinuation of less humane treatments and procedures.
Reflecting the changes in the treatment of the mentally ill brought about by drug therapy, and state and federal public policies in the 1960s’ state institutions changed their procedures resembling the previous moral management revolution. There was an emphasis on protecting the human rights of the mental patients that had historically been overlooked. New employees were hired to be less hierarchical and environmentally controlling as their predecessors. Treatments were geared at the individual and proved to be more effective then group cure-alls. There also was a notable move to de-institutionalize mental patients. In 1960 there were over 500,000 patients in mental institutions in America. It had become increasingly clear that there were many inmates in asylums in custodial care who were able to function in society with adequate out-patient care. Institutions continued to provide 24-hour, long term in-patient care, but now introduced outpatient services, day and night hospitalization, diagnostic services, pre-care and after-care, and more extensive training and research.
Simultaneous with the breakthrough in medical treatment, the community mental health movement became a centerpiece of President John F. Kennedy’s congressional program. There were concurrent shifts in insurance coverage for the mentally ill provided by the Comprehensive Mental Health bill in 1964, and the Medicare and Medicaid Acts in 1966. All of these national movements led to a reduction of the use of existing mental health hospitals and an explosive growth in private hospitals, general hospitals with psychiatric wings, and community mental health centers. As a result states greatly restricted long-term, full care services in state mental institutions in the late 1960s and early 1970s.
In 1972, a federal court ruled that patients in mental health facilities could no longer work at these institutions without pay. The impact of this ruling further changed the nature of the Mental Health Center, for now the remainder of the agricultural pursuits and dairy farming had to go, as well as the upkeep of much of the grounds. The institutions didn’t have enough money to pay the patients for their contributions and also didn’t have adequate money or staffing to occupy patients with abundant much free time. The costs of housing patients increased dramatically, patients became bored and felt they lacked the purpose they once clung to, thus the need to de-institutionalize was more prevalent then ever.
As more patients were de-institutionalized, cottages and buildings were gradually closed at the Athens mental institution. Budgets because increasingly restricted and utilities to unused buildings had to be cut off. Farming and dairy activities gradually ceased, leaving large tracts of land fallow.
During the de-institutionalization process, three out of every four patients were released from the Athens Asylum. The relocating trauma was great; patients were released to their families, nursing homes, and half- way houses. The homeless population soared, the mentally ill population representing nearly a third. The state pushed this process along by offering monetary rewards for decreasing the number of in-patients in asylums.
The number of patients in mental institutions in the United States was reduced to 100,000 by 1986. The Athens Mental Health Center has emphasized short-term inpatient care since 1976, and refers patients to the Tri- County Mental Health and Counseling Service for out- patient care. By the mid-1970s the long and short-term inpatient population was reduced to 300-400 patients, and by 1987 to around 200.