Mental health treatment today is no walk in the park — from insurance companies denying coverage, to a lasting stigma, to the fact that the many of the most severely mentally ill among us to their own devices on the streets or relegated to prison. It’s an understatement to say that there is work left to be done. Yet, the inhumane history of mental health treatment reminds us how far we have already come.
While terrifying mental health remedies can be traced back to prehistoric times, it’s the dawn of the asylum era in the mid-1700s that marks a period of some of the most inhumane mental health treatments. This is when asylums themselves became notorious warehouses for the mentally ill.
“The purpose of the earliest mental institutions was neither treatment nor cure, but rather the enforced segregation of inmates from society,” writes Jeffrey A. Lieberman in Shrinks: The Untold Story of Psychiatry. “The mentally ill were considered social deviants or moral misfits suffering divine punishment for some inexcusable transgression.”
Journalist Nellie Bly captured the asylum atmosphere firsthand when she went undercover at the Blackwell Island Insane Asylum in New York in 1887. Not only was Bly committed without much of an examination to determine her sanity, but the conditions were harsh, cruel, and inhumane.
“For crying the nurses beat me with a broom-handle and jumped on me,” described one patient to Bly. “Then they tied my hands and feet, and throwing a sheet over my head, twisted it tightly around my throat, so I could not scream, and thus put me in a bathtub filled with cold water. They held me under until I gave up every hope and became senseless.”
Hydrotherapy proved to be a popular technique. Warm, or more commonly, cold water, allegedly reduced agitation, particularly for those experiencing manic episodes. People were either submerged in a bath for hours at a time, mummified in a wrapped “pack,” or sprayed with a deluge of shockingly cold water in showers.
Asylums also relied heavily on mechanical restraints, using straight jackets, manacles, waistcoats, and leather wristlets, sometimes for hours or days at a time. Doctors claimed restraints kept patients safe, but as asylums filled up, the use of physical restraint was more a means of controlling overcrowded institutions.
At the same time asylums were on the rise, so too was psychiatry, a fledgling wing of the medical profession bent on proving their ability to treat as opposed to simply manage the ill. Asylums served as the perfect lab for psychiatric treatments.
Early Psychiatric Treatments
Though Benjamin Rush, considered the father of American psychiatry, was first to abandon the theory that demon possession caused insanity, this didn’t stop him from using old “humoral treatments” on asylum patients to cure their minds. Instead of letting out demons, as the treatment was originally intended, he thought the body’s fluids were out of balance. As such, “he purged, blistered, vomited, and bled his patients,” writes Mary de Young in Madness: An American History of Mental Illness and Its Treatment.
Similarly, Henry Cotton — superintendent at New Jersey’s Trenton State Hospital from 1907 to 1930 — thought infected parts of the body led to mental illness. He focused on pulling rotting teeth, which he thought caused madness-inducing infections. When that didn’t work, presumably because contaminated saliva still made its way into the body, Cotton began removing tonsils as well.
And then he took it a step further, removing parts of stomachs, small intestines, appendixes, gallbladders, thyroid glands, and particularly parts of the colon — any place where it was thought infection could linger. Unsurprisingly, this did not prove to be a reliable cure and it carried a high mortality rate.
Inspired by the discovery that high fevers helped stop the symptoms of advanced syphilis, Julius Wagner-Jauregg experimented with inducing fevers in people with schizophrenia by injecting them with malaria-infected blood. This popular method even earned Wagner-Jauregg the 1927 Nobel Prize in Physiology or Medicine, the first ever awarded for the field of psychiatry.
Like Cotton’s body-part-removal technique before it, malaria-induced fevers had a high mortality rate: “About 15 percent of patients treated with Wagner-Juaregg’s fever cure died from the procedure,” writes Lieberman.
By then, however, the professional community was ready to move on to the next fad — insulin shock therapy.
Brought to the United States by Manfred Sakel, a German neurologist, insulin shock therapy injected high levels of insulin into patients to cause convulsions and a coma. After several hours, the living dead would be revived from the coma, and thought cured of their madness.
This process would be repeated daily for months at a time, with doctors sometimes administering as many as 50 to 60 treatments per patient, according to Lieberman. However, the procedure was obviously risky and caused amnesia. Nevertheless, the treatment proved popular based on a questionable success rate.
“By 1941, according to a U.S. Public Health survey, 72 percent of the country’s 305 reporting public and private asylums were using insulin coma therapy, not only for schizophrenia, but also for other types of madness,” writes de Young.
Another shock therapy was yet to come. Metrazol shock therapy, like insulin, worked on the mistaken premise that epilepsy and schizophrenia couldn’t exist at the same time. The key? Seizures. Laszlo von Meduna, a Hungarian physician, discovered that the drug metrazol could produce seizure-like convulsions in patients, therefore shocking their brains out of mental illness. It proved to be a shock physically as well.
“Metrazol also provoked thrashing convulsions so violent they could become, quite literally, backbreaking,” writes Lieberman. “In 1939, an X-ray study at the New York State Psychiatric Institute found that 43 percent of patients who underwent metrazol convulsive therapy experienced fractures in their vertebrae.”
“You get blown up and you go unconscious, like something boils up,” described one patient of treatment. “I felt every time I took that as if I was going to die.”
Beyond its terrifying experience, metrazol shock therapy also produced retrograde amnesia. Luckily, the Federal Drug Administration revoked metrazol’s approval in 1982, and this method of treatment for schizophrenia and depression disappeared in the 1950s, thanks to electroconvulsive shock therapy.
Electroconvulsive Shock Therapy
Buzz box, shock factory, power cocktail, stun shop, the penicillin of psychiatry. One of the most infamous treatments for mental illness includes electroconvulsive shock therapy. Types of non-convulsive electric shock therapy can be traced back as early as the 1st century A.D., when, according to de Young, “the malaise and headaches of the Roman emperor Claudius were treated by the application of a torpedo fish — better known as an electric ray — on his forehead.” But their heydey in treating mental illness began in 1938.
ECT carried less risk of fracture than metrazol shock therapy, and with the use of anesthetics and muscle relaxers in later years, the fracture rate became negligible. It wasn’t without side effects, however, including amnesia as well as increased suicidal tendencies. Ernest Hemingway, for example, died by suicide shortly after an ECT treatment.
“ECT was a welcome replacement for metrazol therapy,” writes Lieberman. “Depressed patients in particular often showed dramatic improvements in mood after just a few sessions, and while there were still some side effects to ECT, they were nothing compared to the daunting risks of coma therapy, malaria therapy, or lobotomies. It was truly a miracle treatment.”
Around the same time, doctors overseas performed the first lobotomies. The practice was brought to the United States thanks to Walter Freeman, who began experimenting with lobotomies in the mid-1940s, which required damaging neural connections in the prefrontal cortex area of the brain thought to cause mental illness.
“The behaviors [doctors] were trying to fix, they thought, were set down in neurological connections,” Barron Lerner, a medical historian and professor at NYU Langone Medical Center in New York, told Live Science. “The idea was, if you could damage those connections, you could stop the bad behaviors.”
The problem was, lobotomies didn’t just stop bad behaviors. They damaged people’s memories and personalities, which even Freeman admitted: “Every patient probably loses something by this operation, some spontaneity, some sparkle, some flavor of the personality.”
According to de Young, despite the side effects, by the time Freeman died in 1972, approximately 50,000 lobotomies had been performed on U.S. patients, mostly in asylums. However, less than 350 lobotomies were performed per year in the 1970s. By then, medication dominated mental health treatment.
Drugs had been used in treating the mentally ill as far back as the mid-1800s. Their purpose then was to sedate patients to keep overcrowded asylums more manageable, a kind of chemical restraint to replace the physical restraints of earlier years.
Doctors administered drugs such as opium and morphine, both of which carried side effects and the risk of addiction. Toxic mercury was used to control mania. Barbiturates put patients into a deep sleep thought to improve their madness. Chloral hydrate came of use in the 1950s, but like the drugs before it, it had side effects, including psychotic episodes.
And then came Thorazine, the medical breakthrough psychiatrists had seemingly been searching for all these years. While it wasn’t perfect, it proved much safer and effective at treating severe mental illness. Its use, along with other drugs that quickly followed, such as Risperdal, Zyprexa, Abilify, and Seroquel, marked the beginning of a sea change for mental health patients.
In 1955, the year the first effective antipsychotic drug was introduced, there were more than 500,000 patients in asylums. By 1994, that number decreased to just over 70,000. Starting in the 1960s, institutions were gradually closed and the care of mental illness was transferred largely to independent community centers as treatments became both more sophisticated and humane.
While these changes and modern care come with their own challenges, the treatment of mental health has come a long way in 250 years. No longer do the mentally ill need to fear living in inhumane asylums for life, being subjected to experimental shock treatments or undergoing dangerous surgeries without consent. Mental health treatment may still come with a stigma, but there’s a lot of hope for the future.