Psychology Treatment
For most of U.S. history up to the time of the Community Mental Health Act of 1963, the mentally ill were generally warehoused in state and local mental institutions on a long-term basis. Most had been involuntarily committed by orders from courts or physicians, and the discharge rate was very low. Before the 1950s and 1960s, there were few effective treatments for mental illnesses like depression, anxiety disorders and schizophrenia, which were commonly considered incurable. Only with the psycho-pharmacological revolution in recent decades and new anti-depressant and anti-psychotic medications has it been possible for the severely mentally ill to be treated on an outpatient basis through community mental health centers. Of course, as the old state hospitals have emptied many of the mentally ill have ended up homeless, since they are unable to hold maintain regular employment or continue on a medication regimen without supervision. According to present-day state laws, involuntary commitment to mental institutions can only apply to those judged to be a danger to themselves and others, and therapeutic practice no prefers short-term stays whenever possible. This has led to a problem of psychiatric wards being filled with patents repeatedly sent to these facilities for short stays instead of long-term commitment to state hospitals. Even worse, jails and other punitive facilities are increasingly being used as warehousing facilities in the same way as they state hospitals back during the 'snake pit' days before 1960.
In the early modern era, with the growth of commercial towns in North America and Western Europe, the authorities gradually become aware of the problem of large numbers of paupers, vagrants and mentally ill persons who could not be cared for by their families and local communities. Of course, society had always been aware of mental illness, even if the causes was thought to be demon possession, although for the most part deranged individuals who were not a danger to others were not confined. From the 17th Century until well into the 20th Century, governments set up almshouses, poorhouses and workhouses that confined the elderly poor, the disabled, orphans and the mentally ill in the same institution, although in social welfare policy there was always a distinction between those who were physically and mentally capable of working and those who were not. In 1752, the Pennsylvania Hospital opened up a ward for the mentally ill in the basement, although the treatments were either nonexistent or ineffective -- if not positively harmful. From the very start, most mental institutions in America were basically places of long-term confinement and warehousing for individuals who could not be treated or cured, and were unable to care for themselves (Levine, 1981, p. 15).
In 1833, Horace Mann recommended that Massachusetts establish the first hospital decided to care for the mentally ill, which opened at Worcester. At that time, physicians were still optimistic that the majority of the mentally ill could be cured, thus "removing them from the welfare rolls and saving the state money in the long run" (Levine, p. 17). In reality, of course, the new state hospitals continued the role of custodial care, with commitments often lasting for life, due to the lack of effective diagnosis and treatment of mental illness. America in the 1830s was undergoing a capitalist revolution, with the decline of the old aristocracy and its paternalist culture in many parts of the country, at least outside the slaveholding Southern states. This new society was more urban, industrialized and competitive, with a new capitalist class coming to power. At the same time, abolitionism, women's rights and prison reform also became important for the first time in American history: indeed, they all had their origins in the same era. Many people at the time believed that mental illness was increasing as the old agrarian society was overturned and "communities badly rent by social and economic change" (Levine, p. 19). Not for the last time would many social observers associate the rise of mental illness with the pressures and strains of urban, industrial civilization.
Dr. Samuel Woodward, the first superintendent of the Worcester State Hospital, was a religious and humanitarian man who generally shared the liberal ideology of progress that was common during this period. He truly believed that the majority of the mentally ill could be cured with kind and humane treatment, and also in the "perfectibility of people" in general (Levine, p. 20). Yet long experience was to prove that the early optimism was not justified and that...
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