Breaking the Cycle: Pt. 2 – Relics of a Dark Past

Exploring the dark history of asylums and the rise of Deinstitutionalization in the United States and what that means to you as a modern mental health patient.

Let’s go Back, Shall we?

The year is 1930. The place is a medium sized city in America. The person is you – aged 15.

You’ve struggled with your mental health from an early age and your family loves you but just doesn’t understand what’s happening.

They’ve taken you to several medical doctors who diagnose you with a variety of ailments – some writing you off as histrionic and attention seeking while others believe you to have schizophrenia or some kind of mania.

Yet one consensus comes from them all: you need to be committed to a State Institution for the Insane as there’s no appropriate mental health resources in the town you live in.

Your family reluctantly agrees with the doctors, after all they’re professionals and they know what’s best for people, right? Besides, there’s no way they can keep taking care of you since there’s no local resources – at least in the asylum they have the tools to help you.

So at 15, you’re sent upstate against your will to a dreary place that looks like it was built a million years ago. The place is more horrible than you’d even imagined.

Turns out, the doctors there have about as little of a clue as the ones in your hometown, but they try anyway (yikes). You’re subjected to electroshock, ice and heat baths, insulin therapy, and a variety of psychotropic drugs and heavy sedatives. You even undergo a lobotomy, or the destruction of your frontal lobe, to make you more compliant.

When you don’t react very well to any of these “treatments” you’re isolated and drugged more. Physical, emotional and sexual abuse also occurs on a daily basis because the perpetrators know no one will believe an insane person if they spoke up. You’re an easy target for predators.

Eventually, as it becomes clear that none of the current treatments are improving your condition, the doctors mostly stop trying. You remain institutionalized and drugged, a permanent fixture of the system for the rest of your days.

Horrifying isn’t it?

I related that scenario to highlight an important fact: as bad as we may have it now – mental health care (as well as the care of those with intellectual disabilities) was an absolute nightmare for patients before the middle of the 20th century in the US.

What do I mean? Well, follow me kids, on a fascinating journey into the history of mental health care to find out how the concept of Deinstitutionalization has shaped the current status of our modern MH care system.

Here we go:

Before the 1950’s and 1960’s, knowledge on mental health (and health in general) was really pretty limited. People considered “madness” or intellectual disability an internal failing rather than a systemic problem that could be cured.

This was a point in time where so called treatments were more likely to be informed by colloquial knowledge and short lived sensationalist “discoveries” versus actual science. Ah!

For instance – treatments such as electroshock therapy and lobotomies were brutal, barbaric, had no medical basis and frequently made mental health conditions worse. Lobotomies, billed as a quick and easy “solution” to aggression due to mental illness, were often performed needlessly and carelessly on patients against their will leading to lifelong intellectual disabilities and even death.

And even as science began to shape new treatments, the improvements weren’t done ethically. People with intellectual disabilities, people with mental health issues and people of color were often experimented on without their consent or without consideration of their long term well being.

As for facilities and resources – there were really were none. Just state run and private asylums, hospitals that catered only to the mentally ill. And by cater I mean they housed and (sometimes) fed patients, that’s about it for the positives.

As with any large, underfunded and grossly understaffed government organization – the asylums of the turn of the century were stuffed with patients who weren’t getting better not because they didn’t want to, but because with so many heads and not enough staff, money or knowledge the best most places could do was just maintain patients indefinitely, leading to more and more bloat of the system with each coming year.

This, of course, led to rampant abuse, mistreatment, and apathy as providers struggled to care for the growing number of patients.

Enter Deinstitutionalization

So obviously the system wasn’t working out so great. Enter Deinstitutionalization and the Community Care movement in the US and UK which was kicked off, oddly enough, by the effects of WWII.

You see, as more and more soldiers came home from the Great War, it turned out they were pretty traumatized and were having a hard time assimilating back into society.

It soon became apparent to policy makers that these veterans, who made up a huge part of the then current US population, needed vastly better mental health care lest the country lose an entire generation, especially one that had had just fought so hard to basically save the world.

So lawmakers, reformers and President Harry Truman (a war vet himself) moved together to create the National Institute of Mental Health in 1949. This was huge because it made mental health a national priority and provided tons of funding for sorely needed psychiatric studies as well as created a raft of new positions in the mental health field.

In effect this rocketed the knowledge of mental health care so far forward that in less than ten year’s time, the NIMH had completely changed the nation’s view on psychological health and become a powerhouse in the research and development of effective and safe treatments for psychological disorders.

NIMH and The Advent of Community Based Mental Health Care

Another thing the NIMH and successive governments did throughout the 1950s and 60s was advance the idea of Community Mental Health Care, which was a push to get people out of institutions and into a network of government funded local community mental health centers. The greatest tool at their disposal was Deinstitutionalization, a concept made popular in England around the same time.

Along with abolishing the large state run asylums, proponents of Deinstitutionalization wanted to provide cheaper and more effective mental health care, create local centers where people could receive outpatient care, a make families and communities more responsible for a patient’s long term care instead of the state. In effect, Deinstitutionalization was to provide a “mixed economy of care” that could be accessed whether you lived in a small town or a big city, whether you were poor or rich.

This meant people with intellectual disabilities and chronic mental health conditions could manage their conditions from the comfort of their home leading to a vastly improved quality of life.

What Does this Mean for Us Today?

Basically we enjoy a lot of the freedoms we often take for granted today thanks to this movement.

Deinstitutionalization is the reason we can treat our disorders safely and effectively today. It’s the reason why we have access to outpatient care, therapists, peer reviewed research, short term hospitalizations, support groups, psychiatrists, and medications we can take ourselves.

Thanks to the Community Care movement and Deinstitutionalization, laws such as the Baker Act, provide strict treatment criteria, affirm patient’s rights and clearly establish standards of care that weren’t in place less than 100 years ago. The movement also provided us with a lot of the modern laws that protect our privacy and prevent us from being permanently institutionalized.

At it’s core, the movement provided autonomy to people who had previously been deemed indigent. Today we can make our own decisions on healthcare, go about our daily lives, and have families just everyone else without fear that well be permanently separated from society.

In short – it’s provided an incredible hope to those the world had found hopeless not so long ago.

We’ve Come a Long Way but There’s More to be Done!

As we know today, asylums are relics of a dark past- thank goodness!

We’ve certainly come a long way as a country in regards to mental health thanks to the work of reformers and the Community Care Movement. But, as always there’s more to be done.

As great as Deinstitutionalization has been for the Mental Health Community at large it’s also created some the worst modern problems affecting us today. Stay tuned for Part 3 where we explore the mixed success of Community Mental Health Care and what that means to us.

Thanks for reading and have a great day <3

MB