mental hygiene | Indians, Insanity, and American History Blog

Professional Nurses Would Have Looked Reassuring

Before the advent of insane asylums, most families by necessity had to simply accommodate a person’s mental health problems as best they could, and then wait to see what the future held. Once asylums became both established and accepted, medical intervention became much more the norm. Though some doctors believed strongly that many patients might not benefit at all from a stay in an asylum (one said that forcible confinement in an institution “would tend strongly to cause the disease to pass into some more intense form”), most saw institutional care as far superior to home care.

Probable Causes of Insanity, Missouri State Lunatic Asylum, 1954, courtesy Missouri State Archives

Alienists had several reasons for feeling this way. Most believed that the home environment was almost always at least partly to blame for an individual’s problem. Either something was going on that directly fed the mental problem, or associations the patient couldn’t get away from wouldn’t allow recovery. Doctors believed that simply getting a patient away from the situation and into a calm environment that didn’t make demands on him, would go a long way toward nipping the problem in the bud. They also felt that patients’ families didn’t have the knowledge or skill to handle mental illnesses, and certainly couldn’t make instant judgments concerning medicine, restraints, and the like.

Patients in Kalamazoo, Michigan Asylum, circa 1870s

Alienists, themselves, had four basic forms of treatment: mechanical, moral, hygienic, and medicinal. My next few posts will explore these types of treatment.

Dr. Isaac Ray, courtesy National Institutes of Health

The nineteenth century saw many medical breakthroughs (see last post), and the public and doctors alike began to think that science could solve all human ailments. Doctors saw that better sanitation and hygiene during the Civil War helped prevent disease,and alienists began to hope that the same strides could be achieved through mental hygiene. Dr. Isaac Ray, a very powerful and prominent insane asylum superintendent, defined mental hygiene (in part) as “preserving the mind against all incidents and influences calculated to deteriorate its qualities.”

Isaac and others involved in the mental hygiene movement believed that if people could live in a situation and atmosphere that promoted mental health, they would either not fall ill in the first place, or the symptoms might not be as severe. Stress, urbanization, poverty, and industrialization were considered major players in undermining mental health, and these mental health hygienists emphasized the importance of proper rest, diet, exercise, education, self-discipline, and proper surroundings to promote mental health. (The latter is one reason that asylums were built to be magnificent and beautiful.) Though almost everyone could see benefits to these important elements of living, not all alienists agreed that they would prevent or resolve mental problems. Some thought that all mental illness sprang from biological, rather than social, causes. Early hygienists did not institute scientific studies or use methodologies that could support their beliefs, so mental hygiene remained only on the fringes of medicine for decades.

The Principles of Mental Hygiene Had Wide Acceptance, courtesy Johns Hopkins Public Health Magazine

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Indians, Insanity, and American History Blog

Asylums And Insanity Treatments 1800 – 1935

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The Need for Treatment