For much of history, the treatment of mental illness has varied widely depending on cultural and geographical context. In medieval Europe, for instance, it was commonly believed that mental illnesses were the result of demonic possession or witchcraft. Treatments often involved exorcism conducted by priests or trephining—a procedure where a hole was drilled into the skull to release spirits. These methods were often ineffective and led to high mortality rates.

However, other parts of the world had different approaches to mental health. In ancient China, mental illness was often attributed to an imbalance of Yin and Yang, and treatments included acupuncture and herbal remedies. Similarly, in Islamic Golden Age societies, mental health was considered a medical condition requiring diagnosis and treatment. Hospitals known as “Bimaristans” had special wards dedicated to the mentally ill, and treatments were more humane, involving medication, counseling, and even music therapy.

In African traditional societies, mental illness was often understood within the context of ancestral spirits and community well-being. Treatments could involve herbal medicine, ritualistic dances, or consultations with a spiritual leader to determine the cause of the illness.

In the Americas, Indigenous cultures had their own unique understanding of mental health, often linked to spiritual or communal harmony. Treatments could involve rituals, herbal medicines, or consultation with a shaman.

By the late 1400s to the late 1600s, particularly in Europe, the witch trials led to the execution of tens of thousands of people, many of whom were likely mentally ill. This was a dark period in the history of mental health treatment and was not reflective of attitudes worldwide.

By the 18th century, the concept of asylums began to take hold, especially in Europe. These were institutions where people considered “odd” or mentally ill were isolated from society. While this was a step away from the brutal treatments of earlier times, asylums were often overcrowded and poorly managed, leading to inhumane conditions.

Mental Health Care Reform

In the late 1700s, a French physician, Philippe Pinel, argued for more humane treatment of the mentally ill. He suggested that they be unchained and talked to, and that’s just what he did for patients at La Salpêtrière in Paris in 1795. Patients benefited from this more humane treatment, and many were able to leave the hospital.

In the 19th century, Dorothea Dix led reform efforts for mental health care in the United States. She investigated how those who are mentally ill and poor were cared for, and she discovered an underfunded and unregulated system that perpetuated abuse of this population (Tiffany, 1891). Horrified by her findings, Dix began lobbying various state legislatures and the U.S. Congress for change (Tiffany, 1891). Her efforts led to the creation of the first mental asylums in the United States.

Despite reformers’ efforts, however, a typical asylum was filthy, offered very little treatment, and often kept people for decades. At Willard Psychiatric Center in upstate New York, for example, one treatment was to submerge patients in cold baths for long periods of time. Electroshock treatment was also used, and the way the treatment was administered often broke patients’ backs; in 1943, doctors at Willard administered 1,443 shock treatments (Willard Psychiatric Center, 2009). (Electroshock is now called electroconvulsive treatment, and the therapy is still used, but with safeguards and under anesthesia. A brief application of electric stimulus is used to produce a generalized seizure. Controversy continues over its effectiveness versus the side effects.) Many of the wards and rooms were so cold that a glass of water would be frozen by morning (Willard Psychiatric Center, 2009). Willard’s doors were not closed until 1995. Conditions like these remained commonplace until well into the 20th century.

Starting in 1954 and gaining popularity in the 1960s, antipsychotic medications were introduced. These proved a tremendous help in controlling the symptoms of certain psychological disorders, such as psychosis. Psychosis was a common diagnosis of individuals in mental hospitals, and it was often evidenced by symptoms like hallucinations and delusions, indicating a loss of contact with reality. Then in 1963, Congress passed and John F. Kennedy signed the Mental Retardation Facilities and Community Mental Health Centers Construction Act, which provided federal support and funding for community mental health centers (National Institutes of Health, 2013). (Note the terminology of this bill was accepted at the time, but the language “Mental Retardation” is not appropriate usage today). This legislation changed how mental health services were delivered in the United States and started the process of deinstitutionalization.

In 1955, there were 558,239 severely mentally ill patients institutionalized at public hospitals (Torrey, 1997). By 1994, the percentage of the population who were hospitalized individuals had decreased by 92% compared to previous years (Torrey, 1997). 

Marginalized communities have been the ones most affected by the uneven treatment of individuals with mental illness. People with disabilities, people of color, and LGBTQ+ persons were the most institutionalized and mistreated. As such, there is a need to acknowledge this historical mistreatment and its ongoing effects so as to work towards achieving fairness in mental health care (Chakraborty & McKenzie, 2018).^[1]