The first asylums often included people that were seen as a nuisance to society along with those that were mentally unwell. This included criminals, prostitutes, beggars and those that were unemployed (Conrad & Schneider, 1992). That created a chaotic environment where it was difficult to determine who was fit for work and who was not which later resulted in an institutional diversification where prisons, workhouses, almshouses and madhouses were created. Before the madhouse act of 1774, asylums were often run by non-licenced practitioners for profit – they often had little regard for the patients.
Separation and confinement of the ‘mad’ came with its own issues. A particular issue was the lack of a proper treatment. A scale of wellness was not established so those with severe difficulties were alongside those with milder symptoms. The treatments that were given were often cruel and ineffective. They included blood-letting, forced vomiting and the spinning chair. Before effective drugs were administered, practitioners would often restrain unruly patients. William Tuke set up the first establishment to treat patients fairly and offer therapy. Restraint was no longer used, and focus was on work and recreation. The recreational activities included sports, arts and music. Farms were the main employers for the male patients and laundry ward was the main employer for the female patients.
Due to the work of John Conolly and Lord Shaftsbury, the lunacy act of 1845 was put in to order. This built upon this foundation of moral treatment pioneered by Tuke and allowed ‘lunatics’ to live as patients instead of prisoners. Every county was legally obliged to open an asylum and treat their mentally unwell patients.
In the 1900s treatment evolved to include ECT and lobotomy. However, the evidence of its effectiveness was questionable. Years after the second world war, there was a development in psychiatry. There was an introduction of antihistamines to treat schizophrenia. From that moment onwards, there have been even greater advancements in medicine for the mentally ill. This development resulted in less of a need for mental hospitals so many mental hospitals were closed in the 1970s and 1980s. Public attitudes were also changing – people had more hope for their loved ones with mental disorders being able to live a productive life in the community.
The journey for treatments of mental illness has been a long one but today we have better treatment than ever. We have learnt that there are more effective methods than shock therapy and confinement. The use of talk therapy with medication has been proven to provide benefits for many mental health issues.