Abnormal Psychology. William J. Ray

In the United States, Rush, who had signed the Declaration of Independence, later established a wing at the Pennsylvania Hospital in Philadelphia for the treatment of mental illness. He is often considered to be the father of American psychiatry and saw mental illness as a problem of the mind. However, he continued to practice bloodletting as the best treatment for mental illness. Rush developed a tranquilizing chair that he believed would change the flow of blood. Professionals tend to view this invention as neither helpful nor hurtful to the patient. He also wrote the first psychiatric textbook published in America.

      In France, Pinel sought to change the way the insane were treated. He engaged the idea that mental illness could be studied using the methods of the natural sciences. In 1793, Pinel became the director of the Bicêtre Asylum in Paris. As director, he reviewed the commitment papers of the inmates, toured the building, and met with each patient individually. The building was in bad shape, and the patients were chained to walls. As Pinel (1806) himself described the institution, “everything presented to me the appearance of chaos and confusion.” Pinel petitioned the government and received permission to remove the chains, and he also abandoned the practice of bloodletting.

      Rush believed the tranquilizing chair would benefit patients with mental illness by changing the flow of blood.

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      Pinel began to carefully observe patients and also talk with them. In these discussions, he attempted to create a detailed case history and to better understand the development of the disorder. This led to a classification system that he published in 1789, which sorted mental diseases into five categories: melancholia, mania without delirium, mania with delirium, dementia, and idiocy. In 1795, Pinel became the chief physician at the Hospice de la Salpêtrière, where he remained for the rest of his life. Pinel is known as the father of scientific psychiatry.

      Vincenzo Chiarugi was less well known outside of Italy until a paper published in the middle of the last century, which brought his name to the attention of Americans (Mora, 1959). Some 8 years earlier than Pinel, Chiarugi began removing chains from his patients. Early in his career, Chiarugi became the director of a large hospital in Florence, which included special facilities for the mentally ill. This was established with the passage of a law in 1774 in Italy that allowed mentally ill individuals to be hospitalized. As director of the hospital, Chiarugi created guidelines concerning how patients were to be treated. One of his rules specified that patients were to be treated with respect. He also directed that if restraints were required, they should be applied in a manner to protect the patient from sores and be made of leather rather than chains. He also used psychopharmacological agents such as opium for treatment.

      In France, Pinel sought to change the way the insane were treated. Here, he removes the chains from a patient with mental illness.

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      In addition to mental health professionals, the humane care of individuals with mental illness was moved forward by a number of other individuals. William Tuke (1732–1822) was a successful English merchant and a Quaker philanthropist. Some friends had told him of being turned away from an asylum in York, England, when they had tried to visit a fellow Quaker who had been confined there. Within a few days, the patient was reported dead. Tuke visited the asylum and found the conditions deplorable. Having retired, he decided to devote his life to creating alternative places where “the unhappy might find refuge” (Tuke, 1813).

      In 1796, near the town of York, he created the Retreat for Persons Afflicted With Disorders of the Mind. This Quaker retreat, as it was called, carried with it the idea that the individuals who were there should be given respect as well as good food and exercise. There were to be no chains or manacles. The model for the retreat was a farm, and the patients performed farm duties as part of their treatment. Others visited to learn of its operation. In 1813, the Quakers of Philadelphia founded the Friends’ Asylum for the Use of Persons Deprived of the Use of Their Reason, which was the first private psychiatric hospital in the United States. Both the retreat in York and the Friends’ Hospital of Philadelphia continue to function today as places for mental health treatment.

      Another individual who contributed to the American mental health movement was Dorothea Dix (1802–1887). While teaching women at the East Cambridge House of Correction in Massachusetts, Dix had her eyes opened to the terrible conditions these women faced. Dix also realized that a number of these women had some type of mental illness. From this experience, she devoted her life to crusading for the improved treatment of the mentally ill. As part of this crusade, she visited every state east of the Mississippi River and testified before local and national legislatures. It is estimated that her work led to the establishment of some 40 mental hospitals in the United States and Europe.

      The Friend’s Hospital of Philadelphia was the first private psychiatric hospital in the United States and still functions today.

      Friends’ Asylum for the Insane near Frankford, printed by Lehman & Duval, 1836 (litho), Lehman, George (d.1870)/Library Company of Philadelphia, PA, USA/The Bridgeman Art Library.

      By the 1950s, there were a number of hospital facilities in the United States for those with mental illness. These were administered by both state governments and private organizations. This changed in the 1950s as described in LENS: Closing Mental Hospitals in America.

      Lens

      Closing Mental Hospitals in America

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      During the first half of the twentieth century, state mental hospitals were the main source of treatment and care for those with serious mental disorders in the United States (see W. Fisher, Geller, & Pandiani, 2009; Torrey, 1997). By the 1950s, there were more than a half million individuals in these hospitals. However, during the 1950s and 1960s, a number of events occurred that changed the way individuals with mental disorders were treated in the United States.

      One significant event was the introduction of antipsychotic medication. Prior to this, individuals with serious mental disorders such as schizophrenia needed a high level of care and protection. With the introduction of medications that would help treat the disorder, it was possible for some of these individuals to live outside the hospital.

      The Community Mental Health Act of 1963, signed into law by President John F. Kennedy, reflected the growing understanding that all but a small portion of those in mental hospitals could be treated in the community. The basic idea was that community mental health centers would offer a variety of programs to help those with mental illness.

      Although the population of the United States increased by 100 million between 1955 and 1994, the number of individuals in mental hospitals decreased from 550,239 to 71,619 (Torrey, 1997). The process of moving individuals from mental hospitals to the community was known as deinstitutionalization. Figure 1.12 shows this drastic change.

      For some individuals with mental illness today who would have been placed in a hospital in the 1950s, their quality of life in the community is much better than it would have been. However, for many individuals, the ideals of the community mental health movement were never fulfilled. The community facilities for those with mental illness were never fully funded or were not even built. This left many individuals without the type of treatment they needed. Some have found themselves homeless and on the streets. Others, who were disruptive