Treatments
"Dark Side of Serbian Mental Institutions." YouTube. YouTube, n.d. Web. 17 May 2014. <https://www.youtube.com/watch?v=q1kbayAdlgg>.
Bloodletting
Benjamin Rush, a physician who has been referred to as “the father of modern psychiatry” largely due to his book, Medical Inquiries and Observations on the Diseases of the Mind, worked at a mental hospital. He believed in treating mentally ill patients with bloodletting, a treatment that was used by Ancient civilizations. He dismissed demonic theories behind mental illness, and instead thought that psychiatric disorders originated from “hypertension in the brain’s blood vessels” (Goodwin, 1999).
It was thought that removing blood from the body would help to ease the tension. Patients would indeed typically calm down after a bloodletting, but that was mainly because they were just too weak.
Today, such treatments seem incredibly cruel. But during earlier times, professionals genuinely believed that they were helping patients.
Blue, Amy V. "Greek Psychiatry's Transition from the Hospital to the Community." Medical Anthropology Quarterly 7.3 (Sept. 1993): 301-318.
It was thought that removing blood from the body would help to ease the tension. Patients would indeed typically calm down after a bloodletting, but that was mainly because they were just too weak.
Today, such treatments seem incredibly cruel. But during earlier times, professionals genuinely believed that they were helping patients.
Blue, Amy V. "Greek Psychiatry's Transition from the Hospital to the Community." Medical Anthropology Quarterly 7.3 (Sept. 1993): 301-318.
Hypnotism
Hypnotism was another popular early form of psychiatric diagnosis and treatment.
It was employed as a diagnostic and treatment tool by some of the earliest pioneers of the field of psychology, including Sigmund Freud, who eventually fell out of favor with the practice. Even today, hypnotism is promoted with the promise of helping patients with sleep disorders, nicotine addiction, depression, and a whole range of diseases and conditions.
"Measuring the Unmeasurable: An Introduction to Psychology." Making the Modern World. 2004. ISB fund of the Treasury and the Cabinet Office. 6 Nov. 2007 .
It was employed as a diagnostic and treatment tool by some of the earliest pioneers of the field of psychology, including Sigmund Freud, who eventually fell out of favor with the practice. Even today, hypnotism is promoted with the promise of helping patients with sleep disorders, nicotine addiction, depression, and a whole range of diseases and conditions.
"Measuring the Unmeasurable: An Introduction to Psychology." Making the Modern World. 2004. ISB fund of the Treasury and the Cabinet Office. 6 Nov. 2007 .
Lobotomies
The lobotomy is among one of the most brutal and infamous treatments for mental health conditions. The process involves a surgeon intentionally causing trauma to the prefrontal cortex, the part of the brain that deals with behavior and personality among other functions.
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:
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:
To induce sedation, inflict two quick shocks to the head.
Roll back one of the patients’ eyelids.
Insert a device, 2/3 the size of a pencil, through the upper eyelid into the patients’ head.
Guided by the markings indicating depth, tap the device with a hammer into the patients’ head/ frontal lobe.
After the appropriate depth is achieved, manipulate the device back and forth in a swiping motion within the patient’s head.
Houston, R.A. “Clergy and the Care of the Insane in Eighteenth-Century Britain.”Church History 73.1 (March 2004): 114-138. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.
Hydrotherapy
Hydrotherapy was a popular method of treatment for mental illness at the beginning of the twentieth century, and was used at many institutions. Water was thought to be an effective treatment because it could be heated or cooled to different temperatures, which, when applied to the skin, could produce various reactions throughout the rest of the body. One of the main benefits of hydrotherapy treatment was its ability to take effect quickly. Hydrotherapy could be accomplished with baths, packs, or sprays. Warm continuous baths were used to treat patients suffering from insomnia, those considered to be suicidal and assaultive, and calmed excited and agitated behavior. A patient could expect a continuous bath treatment to last from several hours to several days, or sometimes even over night. Continuous baths were the most effective when held in a quiet room with little light and audio stimulation, thus allowing the patient to relax and possibly even fall asleep. Bath temperatures typically ranged from 92°F to 97°F, so as not to cause injury to the patients. Packs consisted of sheets dipped in varying temperatures of water, which were then wrapped around the patient for several hours depending on the case. Sprays functioned like showers, and used either warm or cold water. Cold water was used to treat patients diagnosed with manic-depressive psychoses, and those showing signs of "excitement and increased motor activity." Application of cold water slowed down blood flow to the brain, decreasing mental and physical activity. The temperature for a cold pack ranged between 48°F and 70°F. Hydrotherapy was used throughout the early twentieth century.
MacDonald, Michael. Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England. New York City: Cambridge University Press, 1981.
MacDonald, Michael. Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England. New York City: Cambridge University Press, 1981.
Restraints
Straightjackets, leather mitts, muffs, and wristlets were restraints used on violent patients who tore their own clothing, were liable to strike others, or destroyed property. These restraints were also used to prevent patients from scratching at sores, tearing off dressings, or interfering with attendants who were trying to wash wounds. Patients who refused to eat were restrained in order to insert feeding tubes, as proper nutrition was seen as a key component of moral therapy. There were, however, more restrictive restraint treatments, such as crib beds. These barred cribs confined patients to the bed, and were often used in conjunction with other forms of restraint.
During the 1870s, only 10% of patients, admitted to the London Asylum for the Insane, were subjected to the use of mechanical restraints. According to the annual asylum reports from 1877-1880, the use of restraints was reduced by 75%. During 6.7 million patient hours at this institution, only 24,463 were spent restrained in 1880. Dr. Bucke abolished the use of mechanical restraints in 1883, although their last reported use was in 1885. This reduction was symbolized by Asylum staff cutting up hand restraints in order to make slippers for patients.
Although annual reports no longer reported restraint use after 1885, further research has identified patient files at other institutions which noted that their use persisted subsequent to their alleged cessation.
Rosen, George. Madness in Society: Chapters in the Historical Sociology of Mental Illness. Chicago: The University of Chicago Press, 1968.
During the 1870s, only 10% of patients, admitted to the London Asylum for the Insane, were subjected to the use of mechanical restraints. According to the annual asylum reports from 1877-1880, the use of restraints was reduced by 75%. During 6.7 million patient hours at this institution, only 24,463 were spent restrained in 1880. Dr. Bucke abolished the use of mechanical restraints in 1883, although their last reported use was in 1885. This reduction was symbolized by Asylum staff cutting up hand restraints in order to make slippers for patients.
Although annual reports no longer reported restraint use after 1885, further research has identified patient files at other institutions which noted that their use persisted subsequent to their alleged cessation.
Rosen, George. Madness in Society: Chapters in the Historical Sociology of Mental Illness. Chicago: The University of Chicago Press, 1968.
Electric Shock Therapy
Shock therapy has been in use in asylums since the early 1930s. The earliest form shock therapy, insulin therapy was invented by Manfred Sakel in 1933 as one of the first treatments that involved inducing comas or seizures. Sakel first tested his treatment on "addicts" and "neurotics," and seeing some improvement in their condition reasoned that it might be a viable treatment option for patients with schizophrenia. Sakel recorded that "the convulsions and comas of the deep shock brought about dramatic psychological changes in the patient. . .the indications were rather that the physiological shock restored the homeostasis in the nerve cell by forcing it to mobilizing its defence reactions, thus causing a restoration of the balance in the automatic nervous system. . .In this, [he] thought, lay the curative efficacy of the Insulin Shock Treatment."
In 1939, the former London Asylum opened its Metrazol clinic. Metrazol replaced insulin therapy in most of the Ontario asylums as it was easier to administer than insulin shock. Metrazol was first used in clinical experiments by Hungarian physician, Ladislaus von Meduna in 1933. Meduna reasoned that artificially induced epileptic convulsions might "cure" schizophrenia due to his observations of patients who had both epilepsy and schizophrenia. Meduna noticed that those patients who had epileptic seizures would experience a remission of their symptoms of schizophrenia. Metrazol was one of many convulsant drugs used to induce seizures. The Asylum began to phase out its use in 1943, turning instead to electroconvulsive therapy.
Scientists began to experiment with electricity to shock patients in the late 1930s. Italian doctors Ugo Cerletti and Lucio Bini were the first to successfully use electroconvulsive treatment on a human subject in April 1938. This new form of shock treatment began to be used by institutions throughout the world in the early 1940s. The 1942 report from the Asylum shows London's interest in acquiring an ECT machine, in order to initiate plans to replace Metrazol treatments with electroconvulsive therapy. It was not until 1944 that ECT was used exclusively at the London Asylum.
Shock treatments were administered up to three times a week, and could take place over several weeks. Many dangers are associated with shock therapy, including fractured bones from the convulsions, and brain damage. Electroconvulsive therapy, although still controversial, is used on patients suffering from depression, catatonic or manic excitement, paranoid reactions, hebephrenics, and schizophrenia.
Sadowsky, Jonathan Hal. Imperial Bedlam : Institutions of Madness in Colonial Southwest Nigeria. Berkeley: Berkeley University of California Press, 1999. 24 Nov. 2007 . Path: Library Home; Research Tools; Online Catalog. Stigma and Mental Illness. Ed. Paul Jay Fink and Allan Tasman. Washington DC: American Psychiatric Press, Inc. , 1992.
In 1939, the former London Asylum opened its Metrazol clinic. Metrazol replaced insulin therapy in most of the Ontario asylums as it was easier to administer than insulin shock. Metrazol was first used in clinical experiments by Hungarian physician, Ladislaus von Meduna in 1933. Meduna reasoned that artificially induced epileptic convulsions might "cure" schizophrenia due to his observations of patients who had both epilepsy and schizophrenia. Meduna noticed that those patients who had epileptic seizures would experience a remission of their symptoms of schizophrenia. Metrazol was one of many convulsant drugs used to induce seizures. The Asylum began to phase out its use in 1943, turning instead to electroconvulsive therapy.
Scientists began to experiment with electricity to shock patients in the late 1930s. Italian doctors Ugo Cerletti and Lucio Bini were the first to successfully use electroconvulsive treatment on a human subject in April 1938. This new form of shock treatment began to be used by institutions throughout the world in the early 1940s. The 1942 report from the Asylum shows London's interest in acquiring an ECT machine, in order to initiate plans to replace Metrazol treatments with electroconvulsive therapy. It was not until 1944 that ECT was used exclusively at the London Asylum.
Shock treatments were administered up to three times a week, and could take place over several weeks. Many dangers are associated with shock therapy, including fractured bones from the convulsions, and brain damage. Electroconvulsive therapy, although still controversial, is used on patients suffering from depression, catatonic or manic excitement, paranoid reactions, hebephrenics, and schizophrenia.
Sadowsky, Jonathan Hal. Imperial Bedlam : Institutions of Madness in Colonial Southwest Nigeria. Berkeley: Berkeley University of California Press, 1999. 24 Nov. 2007 . Path: Library Home; Research Tools; Online Catalog. Stigma and Mental Illness. Ed. Paul Jay Fink and Allan Tasman. Washington DC: American Psychiatric Press, Inc. , 1992.
Utica Crib
Use of the “Utica Crib” began in the 1840's at Utica, but spread throughout the United States to other mental institutions. It was widely used in the 19th century to confine patients.
Prior to the development of psychoanalysis and psychiatric medications, doctors had a limited understand or know how to treat mental disorders. Doctors attempted a variety of treatments and would subdue a patient and restrain them for their own protection, the protection of other patients and themselves.
Some Utica cribs were made out of wood, some iron. Literally shaped like a crib, the sides and lid were made of spindles, which allowed airflow. The difference was the Utica Crib was adult-sized and had a lid, which could be fastened over the patient. The person restrained could not sit up nor get out. The bottom was cushioned with layers of straw. Additionally, the crib could be suspended with chains and rocked to calm the patients. The idea behind it was to give the patient a place to rest in a secure, protected space.
Dr. Amariah Brigham, the first superintendent of Utica Hospital, believed the "insane" needed moral and medical treatment and he used rest, quiet, seclusion, diet and care as cures. He promoted non-restraint, there were no dungeons or chains at Utica, and he found existing types of restraints for highly disturbed patients unacceptable. He invented the Utica Crib for use as what he considered a more humane restraint. The Utica Crib design was based on a similar device that was being used in asylums in France during the 1840s.
"1880 The Utica Crib." The Inmates of Willard 1870 to 1900 A Genealogy Resource. N.p., n.d. Web. 12 May 2014.
Prior to the development of psychoanalysis and psychiatric medications, doctors had a limited understand or know how to treat mental disorders. Doctors attempted a variety of treatments and would subdue a patient and restrain them for their own protection, the protection of other patients and themselves.
Some Utica cribs were made out of wood, some iron. Literally shaped like a crib, the sides and lid were made of spindles, which allowed airflow. The difference was the Utica Crib was adult-sized and had a lid, which could be fastened over the patient. The person restrained could not sit up nor get out. The bottom was cushioned with layers of straw. Additionally, the crib could be suspended with chains and rocked to calm the patients. The idea behind it was to give the patient a place to rest in a secure, protected space.
Dr. Amariah Brigham, the first superintendent of Utica Hospital, believed the "insane" needed moral and medical treatment and he used rest, quiet, seclusion, diet and care as cures. He promoted non-restraint, there were no dungeons or chains at Utica, and he found existing types of restraints for highly disturbed patients unacceptable. He invented the Utica Crib for use as what he considered a more humane restraint. The Utica Crib design was based on a similar device that was being used in asylums in France during the 1840s.
"1880 The Utica Crib." The Inmates of Willard 1870 to 1900 A Genealogy Resource. N.p., n.d. Web. 12 May 2014.
Tranquilizer Chair
"Confinement by means of a strait waistcoat, or of a chair which I have called a tranquilizer.... The tranquilizer has several advantages over the strait waistcoat or mad shirt. (Phillips) It opposes the impetus of blood towards the brain, it lessens muscular action everywhere, it reduces the force and frequency of the pulse, and favors" the patient being able to be doused in cold water. (Okasha)
Okasha, A. “Mental Health Services in the Arab World.” Arab Studies Quarterly 25.4 (Fall 2003): 39-52. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.
Phillips, Michael R. “The Transformation of China’s Mental Health Services.” The China Journal 39 (Jan. 1998): 1-36.
Okasha, A. “Mental Health Services in the Arab World.” Arab Studies Quarterly 25.4 (Fall 2003): 39-52. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.
Phillips, Michael R. “The Transformation of China’s Mental Health Services.” The China Journal 39 (Jan. 1998): 1-36.
Anti-Psychotic Drugs
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.
"Timeline: Treatments for Mental Illness." American Experience - A Brilliant Madness: Timeline. 1992-2002. PBS. 6 Nov. 2007 .
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.
"Timeline: Treatments for Mental Illness." American Experience - A Brilliant Madness: Timeline. 1992-2002. PBS. 6 Nov. 2007 .