Madness and Mental Asylums: A Brief History

A lot of people tend to think of abuse, neglect, and filth when they consider what an asylum was back in the day. Of course, there are instances where this interpretation stands completely accurate, but, for many patients, asylums were also seen as safe havens where they were cared for and understood. This post will briefly go through the history of these places and we will look at the rise and fall of state-ran asylums, treatments, and the growing reliance on prescription drugs.


(Photo of patient toothbrushes in Hudson River State Hospital. Photo taken by Christopher Payne. Sourced from: Asylum: Inside The Closed World Of State Mental Hospitals, pg 93.)

Early asylums, in terms of compassionate care, were first centered around nunneries and churches. Before the 20th century, it was most common for mentally ill individuals to be cared for by their families (D’Antonio). Institutional, live-in care was only afforded by the wealthy. For centuries, mental illness was not understood and people’s afflictions were oftentimes interpreted as possessions or as an otherworldly punishment for some sort of misdeed. As a result, people were stigmatized and became social pariahs. Many mentally ill patients ended up being grouped together with criminals and were placed in jail-like settings where they were oftentimes physically restrained (“An Illustrated History of the Mental Asylum”). Patients were simply put in places to confine them and it would take a lot of reform before institutions began actually treating patients for their disorders and providing a model of care centered around compassion instead of isolation from society (“An Illustrated History of the Mental Asylum”).

It was not until the 19th century that reformers began advocating for a system that focused on care, not custody (“Mental Health”). These patients were not prisoners but they lacked the ability to defend themselves. One person that managed to improve the field of mental health care was Dorothea Dix who challenged the idea that people with mental health issues could not be cured or helped (Parry). She spent years of her life inspecting hospitals and asylums in order to see if she found evidence of abuse. Dorothea began advocating for state-supported care around the time that prison reforms were taking place in the United States (“26d. Prison and Asylum Reform”).

By the late 18th to early 19th century, rapid urbanization provided families with greater access to mental health facilities (“An Illustrated History of the Mental Asylum”). Between 1890 and 1918, state-run asylums were at the height of popularity and unique programs were developed that enabled patients to learn life skills, enjoy social and creative recreational activities, and undergo personalized treatments (Holtzman). Before mental illness was understood in as complete detail as today, many treatments were physical (“A History of Mental Illness: Obsolete Practices”).

One of the most damaging, yet fascinating, treatments was the lobotomy. First developed by a Portuguese neurologist, Egas Moniz, in 1935, it became one of the most popular treatments for a variety of mental illnesses (Levinson). The procedure severed the connection between the prefrontal cortex and the frontal lobes, a place in the brain that helps control a person’s personality, social behavior, and general decision-making (“A History of Mental Illness: Obsolete Practices”). In 1936 the procedure was first performed in the United States by Walter Freeman and it was believed to treat schizophrenia, depression, obsessive compulsive disorders, and hyper activity; to name a few (Levinson).

Lobotomies were seen as cures because it was a common belief that people who underwent the procedure would be fit to rejoin society (Levinson). This idea was popular during a time where under-funding, under-staffing, and overcrowding plagued mental institutions. The practice fell out of favor around the 1950s because the results were unreliable. As you can imagine, some patients suffered rather extreme consequences from their brains essentially being stirred up by medical professionals. Another reason for the rapid decline was the development of psychiatric drugs (Levinson).

Even though many of these institutions began as well-intended safe-havens, the execution of providing proper care for America’s mentally ill proved to be a difficult task. Institutions were flooded with patients, many living at these facilities just about their entire lives (Sacks 2). The development of psychiatric drugs were supposed to alleviate an individual’s symptoms, making it theoretically possible for them to rejoin society, thus lessening the need for live-in facilities (Sacks 3). State funding was cut and places struggled to maintain a high quality of care. Starting in the 1960s and moving into the 1990s, most mental health institutions were shut down, leaving individuals suffering from mental health disorders with fewer opportunities for care. It has now become commonplace for cities in the Unites States, and prisons for that matter, to be painted with the bodies of individuals that have mental health disorders. Sadly, asylums were closed in an attempt to improve the treatment of these people before another solution was put into place. As you consider what it was like to live in such facilities it is important to look at both perspectives. Surely some of these places were fueled by mistreatment and agony, but others offered protection, love, and social opportunities otherwise unheard of outside of the iron fences.


(Photo I took of a bed while on a tour of Pennhurst Asylum in Spring City, Pennsylvania in 2016.)

“If my heart could speak, I’m sure it would say, I wish I were someplace else Today. Among These books, a great amount of Knowledge There musT be, buT whaT good is Knowledge where oThers carry The keys. Through The LasT Ten years many improvemeanTs have been made, BuT The final words seem To say, don’t forget, my good man you’re still a paTienT here Today. Intelligence, ability, and knowledge surely will never lasT, Why all we wanT To look aT, my good man, is your pasT. I wish ThaT some of These people, who write the books and make The rules, could spend jusT a few years walking in our shoes.”  -poem found painted on the wall at Augusta State Hospital in Augusta Maine. (Sourced from Christopher Payne’s Asylum: Inside The Closed World Of State Mental Hospitals, pg 201)

Interested in seeing more posts about mental health? Drop a like or post a comment and let me know!

Until Next Time



  • “A Breif History of Mental Illness and the U.S. Mental Health Care System.” Unite for Sight. Accessed 17 June, 2020.
  • “A History of Mental Illness: Obsolete Practices.” Concordia. 14 October, 2016. Accessed 16 June, 2020.
  • “An Illistrated History of the Mental Asylum.” Seeker. 12 December, 2012. Accessed 16 June, 2020.
  • D’Antonio, Patricia. “History of Psychiatric Hospitals.” Penn Nursing. Accessed 16 June, 2020.
  • Holtzman, Ellen. “A Home Away from Home.” American Psychological Association, March 2012, Vol. 43, No 3, pg 24. Accessed 16 June, 2020.
  • Levinson, Hugh. “The Strange and Curious  History of Lobotomy.” BBC News. 8 November, 2011. Accessed 17 June, 2020.
  • “Mental Health.” Science Museum. Accessed 16 June, 2020.
  • Parry, Manson S. “Dorothea Doc (1802-1887).” Am J Public Health, April 2006 96 (4): 624-625: U.S. National Library of Medicine. Accessed 16 June, 2020.
  • Payne, Christopher. Asylum: Inside The Closed World Of State Mental Hospitals. The Mit Press: Massachusetts, 2009.
  • Sacks, Oliver. “Asylum.” Forword found in Asylum: Inside The Closed World Of State Mental Hospitals. The Mit Press: Massachusetts, 2009. Pages 1-5.
  • “26d. Prison and Asylum Reform.” U.S. History. Accessed 16 June, 2020.

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