Treating the Mentally Ill: A History of Psychiatric Care
This paper traces the history of psychiatric treatment in the United States, using St. Elizabeths Hospital in Washington, D.C., as a central case study. It examines Dr. Walter Freeman's pioneering and controversial use of lobotomy, including his operation on Rosemary Kennedy, and explores how public perception of such procedures shifted over time. The paper also addresses the historical misclassification of epilepsy as a mental disorder and the coercive institutionalization of epileptics from 1890 to 1940. Drawing on Thomas Szasz's critique of psychiatric power, it concludes by noting how pharmacological advances reduced physician authority to institutionalize patients and moved care toward an outpatient model.
- Introduction: A Century of Change in Psychiatric Care: Overview of St. Elizabeths and evolving mental health attitudes
- Dr. Walter Freeman and the Era of Lobotomy: Freeman's lobotomy practice and famous patients
- Pharmacology, Public Perception, and the End of Lobotomy: How drugs and scandal ended the lobotomy era
- Epilepsy and the Misuse of Psychiatric Power: Epilepsy misclassified and institutionalized as mental illness
- Conclusion: Pharmacology and the Shift to Outpatient Care: Drugs reduced coercive psychiatry; outpatient care emerged
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What makes this paper effective
- Uses a single institution — St. Elizabeths Hospital — as a concrete historical anchor that grounds an otherwise broad topic in a specific, traceable case study.
- Incorporates a well-chosen direct quotation from Thomas Szasz that concisely captures the paper's central argument about the relationship between medical power and psychiatric coercion.
- Moves logically from surgical intervention (lobotomy) to pharmacological intervention, showing a cause-and-effect arc across psychiatric history.
Key academic technique demonstrated
The paper demonstrates effective use of historical narrative as argumentative structure. Rather than stating a thesis abstractly, the author builds the argument chronologically — from 19th-century institutionalization through psychosurgery to pharmacology — allowing the historical sequence itself to support the claim that psychiatric power has diminished as treatment options improved. The Szasz quotation is deployed precisely at the moment the argument pivots toward its conclusion, making it analytically functional rather than decorative.
Structure breakdown
The paper opens with a broad historical claim about changing attitudes toward mental illness, then narrows to St. Elizabeths and Dr. Freeman's lobotomy practice. A transitional paragraph links lobotomy's decline to pharmaceutical advances. The paper then pivots to epilepsy as a secondary case study illustrating Szasz's thesis about coercive psychiatry. A closing paragraph synthesizes the argument and confirms the shift to outpatient treatment as the modern outcome of these historical forces.
Introduction: A Century of Change in Psychiatric Care
Over the past century, treating the mentally ill has evolved dramatically — from viewing them as social pariahs who do not belong in society, to recognizing them as full members of society with patient rights. Consider St. Elizabeths Hospital in Washington, D.C. St. Elizabeths dates back to the 1850s and has treated mentally ill patients ranging from the poet Ezra Pound to its most notorious modern resident, John Hinckley, who attempted to assassinate President Ronald Reagan.
Dr. Walter Freeman and the Era of Lobotomy
St. Elizabeths is also the psychiatric hospital where one of the most famous neurologists in the history of mental health medicine, Dr. Walter Freeman, worked, heading the Blackburn Pathological Laboratory. Beginning in 1924, when Freeman started his tenure at St. Elizabeths, he performed thousands of autopsies on patients who had died there (Lawrence and Weisz 168) — many of whom had been homeless and indigent prior to their arrival (Pressman 74). Freeman later pursued what he considered a perfected modification of the lobotomy procedure and performed his first lobotomy on a patient — referred to at the time as an inmate (Pressman 74; Lawrence and Weisz 168).
The modification Freeman developed involved entering the brain behind the eye using a golden ice pick (Pressman 316). While Freeman performed thousands of lobotomies at St. Elizabeths and across the United States, he is perhaps best known for one of his earliest and most famous patients: Rosemary Kennedy, sister of the late President John F. Kennedy (Szasz 152).
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