When asylums were first built, alienists had high hopes that their patients would be quickly cured. Most felt that if families could bring patients in soon after the onset of symptoms, therapy and a changed environment would be helpful. Superintendents tried to get patients, then, during the “acute” phase or within a year of their becoming insane.
Families didn’t usually act this quickly. They often tried to keep family members at home until their symptoms became too difficult to manage. Asylums began to get patients who had been insane for a long time, and there was not as much hope for a cure. At that point, asylums began to differentiate between acute and chronic care. They spent most of their energy with patients they thought stood a good chance of returning to society. Asylums provided little more than custodial care to the chronic insane, and institutionalization became a lifelong fate for these unfortunate patients.