Private institutions in the US had already proven successful, and now state governments were sinking large sums into palatial stone edifices overlooking vast acreages in rural settings.
These institutions were not set up as the chamber of horrors they would later become. Rather, they had farms attached to them. Inmates worked the farms, performed other chores, and engaged in recreational and educational activities.
Time out. You mean way-way back, people recognized that if you treated the mentally ill with compassion, took them away from stressful environments, and gave them opportunities to take pride in their work then their conditions might actually improve?
Well, yes. Not only that, this approach became the model of care.
But did it work? In the very same 1844 Journal issue is a report describing an institution in Utica, then in operation for 18 months. According to the report, of 433 patients admitted, 123 had recovered.
We can’t be sure what the report meant by the term, recovery. But it is fair to assume that in an age of no psychiatric meds or other treatments (or “treatments” that made patients worse), more than one-quarter of those admitted were deemed to be in good enough condition to return to their homes and communities.
How impressive is this? A successful drug trial is when 50 percent of patients get 50 percent better. Very few trials even measure for remission (considered full symptom reduction), and none measure for recovery (as in being able to return to previous function, such as in work and relationships).
So what happened? How did institutions go from offering hope to doling out despair?
About a month ago, I had a chance to hear Robert Liberman, MD of UCLA give a talk to some undergrads at USC. As Dr Liberman explained, not long after the institutions were established, new waves of immigrants began flooding into the US. The system became overwhelmed. Instead of rising to meet the challenge, state governments simply gave up.
It was considered more expedient to simply warehouse the mentally ill for the rest of their lives in hellish conditions in these very same institutions.
