THE MENTALLY ILL IN AMERICA A HISTORY OF THEIR CARE AND TREATMENT FROM COLONIAL TIMES By ALBERT DEUTSCH WITH AN INTRODUCTION BY WILLIAM A. WHITE, M. D., D. Sc., LL. D. Late Superintendent, St. Elizabeths Hospital, Washington, D. C. Professor of Psychiatry, George Washington University 1946 COLUMBIA UNIVERSITY PRESS NEW YORK Third Printing, 194, Columbia University Press, Ne w York FOREIGN AGENT OXFORD UNIVERSITY PRESS, Humphrey Milford, Amen House, London, E. G. 4, England, AND B. I. Building, Nicol Road, Bombay, India First and second printings, 1937, 1938 Double day, Do ran Company, Inc. COPYRIGHT, 1937 BY THE AMERICAN FOUNDATION FOR MENTAL HYGIENE, INC. ALL RIGHTS RESERVED CONTENTS PAGE INTRODUCTION by William A. White, M. D. ix AUTHORS FOREWORD xv CHAPTER I. PROPHETS, DEMONS AND WITCHES . . II. COLONIAL AMERICA THE OLD WORLD HERITAGE 24 III. COLONIAL PROVISIONS FOR THE MENTALLY ILL PUNISHMENT, REPRESSION AND INDIFFERENCE . ., . 39 IV. RATIONAL HUMANITARIANISM THE BEGIN NINGS OF REFORM .... - 55 V. BENJAMIN RUSH THE FATHER OF AMERI CAN PSYCHIATRY 72 VI. THE RISE OF MORAL TREATMENT . 88 VII. RETROGRESSION OVER THE HILL TO THE POORHOUSE 114 VIII. THE CULT OF CURABILITY AND THE RISE OF STATE INSTITUTIONS . . . 132 IX. DOROTHEA LYNDE Dix MILITANT CRU SADER . 158 X. MID-CENTURY PSYCHIATRISTS .... 186 XL CONFLICT OF THEORIES RESTRAINT OR NON-RESTRAINT 213 XII. THE TREND TOWARD STATE CARE . . . 229 XIII. STATE CARE EXODUS FROM THE POORHOUSE 246 XIV. PSYCHIATRY EMERGES FROM ISOLATION . 272 XV. THE MENTAL HYGIENE MOVEMENT AND ITS FOUNDER 300 vi CONTENTS CHAPTER PAGE XVI. HISTORICAL BACKGROUNDS OF MENTAL DEFECT . . . . . 331 XVII. CHANGING CONCEPTS IN MENTAL DEFECT 353 XVIII. INSANITY AND THECRIMINAL LAW . . 386 XIX. OUR COMMITMENT LAWS 417 XX. MODERN TRENDS IN INSTITUTIONAL CARE AND TREATMENT 440 XXI. TOWARDS MENTAL HYGIENE .... 463 BIBLIOGRAPHY 497 INDEX . 5 5 ILLUSTRATIONS PlNEL AT THE SALPETRIERE Frontispiece FACING PAGE EIGHTEENTH-CENTURY HOSPITALS FOR THE MENTALLY ILL IN AMERICA . 68 BENJAMIN RUSH 76 DOROTHEA LYNDE Dix 160 THE ORIGINAL THIRTEEN ... 192 OLD METHODS OF RESTRAINT AND A MOD ERN SUBSTITUTE . . 224 CLIFFORD W. BEERS 304 HYDROTIIKRAPY, OLD AND NEW 448 INTRODUCTION TT IS with deep satisfaction that I introduce this important book to the reading public. If the lessons it teaches are understood and taken to heart by its readers, society will be the authors debtor. Mr. Deutschs book, the preparation of which has been made possible by the American Foundation for Mental Hygiene, might be described in a very few words by saying that it traces the evolution of a cultural pattern as repre sented by the way in which people through the years have thought and felt about the so-called insane. It is an exceed ingly illuminating presentation and because of the dramatic material with which it deals, it may well prove to be a spear head for the penetration of important social facts and the understanding of social processes which, presented with less appealing or less startling illustration, might fail to attract attention. It is altogether fitting that in the presentation of this extraordinary and important story of mans struggles with himself, the illustrations should be taken more particularly from their American setting. In this way the whole matter is brought home to us who live in this country and we see what has actually been taking place, more especially since earlycolonial days, and we can feel that we ourselves are a part of the whole story and that the victories that have been won and the ground that has been gained are assets of which we can avail ourselves. It is always an illuminating pro cedure to trace the path along which we have come, to be come acquainted with the historical forces that are driving us, and their directions, because after all we have to conquer, not by opposing these forces, but by conforming to them. Mr...

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work.This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work.As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant.

In the first comprehensive one-volume history of the treatment of the mentally ill, the foremost historian in the field compellingly recounts our various attempts to solve this ever-present dilemma from colonial times to the present. Gerald Grob charts the growth of mental hospitals in response to the escalating numbers of the severely and persistently mentally ill and the deterioration of these hospitals under the pressure of too many patients and too few resources. Mounting criticism of psychiatric techniques such as shock therapies, drugs, and lobotomies and of mental institutions as inhumane places led to a new emphasis on community care and treatment. While some patients benefited from the new community policies, they were ineffective for many mentally ill substance abusers. Grob’s definitive history points the way to new solutions. It is at once an indispensable reference and a call for a humane and balanced policy in the future.

"In this book, Lynn Gamwell and Nancy Tomes explore the historical roots of Americans' understanding of madness today. Drawing on a rich array of sources, the authors interweave the perceptions of medical practitioners, the mentally ill and their families, and journalists, poets, novelists, and artists. As they trace successive ways of explaining madness and treating those judged insane, Gamwell and Tomes vividly depict the political and cultural dimensions of American attitudes toward mental illness." "Gamwell and Tomes observe telling differences in the ways in which patients of different genders, races, and classes have been diagnosed and treated. The authors demonstrate how definitions of madness figured in national debates over abolitionism, women's rights, and alternative medicine. Madness in America also considers how the boundaries between sanity and insanity have been repeatedly redrawn in such areas as sexual behavior and criminality."--BOOK JACKET.Title Summary field provided by Blackwell North America, Inc. All Rights Reserved

Mental Institutions in America: Social Policy to 1875 examines how American society responded to complex problems arising out of mental illness in the nineteenth century. All societies have had to confront sickness, disease, and dependency, and have developed their own ways of dealing with these phenomena. The mental hospital became the characteristic institution charged with the responsibility of providing care and treatment for individuals seemingly incapable of caring for themselves during protracted periods of incapacitation. The services rendered by the hospital were of benefit not merely to the afflicted individual but to the community. Such an institution embodied a series of moral imperatives by providing humane and scientific treatment of disabled individuals, many of whose families were unable to care for them at home or to pay the high costs of private institutional care. Yet the mental hospital has always been more than simply an institution that offered care and treatment for the sick and disabled. Its structure and functions have usually been linked with a variety of external economic, political, social, and intellectual forces, if only because the way in which a society handled problems of disease and dependency was partly governed by its social structure and values. The definition of disease, the criteria for institutionalization, the financial and administrative structures governing hospitals, the nature of the decision-making process, differential care and treatment of various socio-economic groups were issues that transcended strictly medical and scientific considerations. Mental Institutions in America attempts to interpret the mental hospital as a social as well as a medical institution and to illuminate the evolution of policy toward dependent groups such as the mentally ill. This classic text brilliantly studies the past in depth and on its own terms.