Psychiatric hospital

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A psychiatric hospital (also called at various places and times, mental hospital, mental ward, asylum or sanitarium) is a hospital specializing in the treatment of persons with mental illness. Psychiatric wards differ only in that they are a unit of a larger hospital.

1 Types of psychiatric hospitals
- 1.1 Crisis stabilization
2 Anti-psychiatry objections to mental hospitals
3 History
4 See also
5 External links

[edit] Types of psychiatric hospitals

There are a number of different types of modern psychiatric hospitals.

[edit] Crisis stabilization

One type is the crisis stabilization unit, which is in effect an emergency room for mental disorders. Because involuntary commitment laws in many states can be unclear, many of these stabilization units have conference rooms which are used as courtrooms for emergency commitment procedures.

See also: Psychiatric emergency services

[edit] Anti-psychiatry objections to mental hospitals

Some observers, notably psychiatrist Dr. Thomas Szasz, have objected to calling mental hospitals "hospitals" (see anti-psychiatry). Lawrence Stevens has described mental hospitals as "jails" [1].

In particular, anti-psychiatry activists have advocated for the abolition of long-term hospitals for the criminally insane on the grounds that the insanity defence should not be permitted, and those confined to such institutions should be incarcerated in a regular prison instead, others on the grounds that the inmates' confinement to these "hospitals" punishes them for crimes of which they have been judged not guilty, and others on various other grounds.

[edit] History

Image:The Rake's Progress 8.jpg

The history of psychiatric hospitals is linked heavily with social and scientific attitudes towards mental health, and the attitudes towards those suffering with mental illness, both of which have changed greatly over the past centuries.

[edit] Cities

As the number of people living in cities increased, there became an increasingly large population of urban mentally ill. Generally speaking, in rural areas the mentally ill had been able to rely on local charity and support, or managed to simply "blend in" with the rest of the population. However, under the demands of larger cities they faced a higher degree of difficulty and had a much greater chance of causing disruption or simply being noticed. This led to the building of the early asylums which were little more than repositories for the mentally ill – removing them from mainstream society in the same manner as a jail would for criminals. Conditions were often extremely poor and serious treatment was not yet an option.

[edit] Bethlem Royal Hospital

Main article: Bethlem Royal Hospital

The first known psychiatric hospital, Bethlem Royal Hospital (Bedlam), was founded in London in 1247 and by 1403, had begun accepting "lunatics". It soon became infamous for its harsh treatment of the insane, and in the 18th century would allow visitors to pay a penny to observe their patients as a form of "freak show". In 1700 it is recorded that the "lunatics" were called "patients" for the first time, and within twenty years separate wards for the "curable" and "incurable" patients had been established. Mental illness was now no longer an affliction, but a disease, to be diagnosed and potentially cured.

[edit] Humane treatment

Phillipe Pinel (1793) is often credited as being the first to introduce humane methods into the treatment of the mentally ill as the superintendent of the Asylum de Bicêtre in Paris. A hospital employee of Asylum de Bicêtre, Jean-Baptiste Pussin, was actually the first one to remove patient restraints. Pussin influenced Pinel and they both served to spread reforms such as categorising the disorders, as well as observing and talking to patients as methods of cure. At much the same time William Tuke was pioneering a more enlightened approach to the treatment of the mentally ill in England at the Retreat in York. This spread to other charitable institutions such as St Andrew's Hospital in Northampton [2]. These ideas gradually took hold in different countries, and in the United States attitudes towards the treatment of the mentally ill began to drastically improve during the mid-19th century.

Reformers, such as Dorothea Dix in the U.S., began to advocate a more humane and progressive attitude towards the mentally ill. In the United States, for example, numerous states established state mental health systems paid for by taxpayer money (and often money from the relatives of those institutionalised inside them). These centralised institutions were often linked with loose governmental bodies, though in general oversight was not high and quality consequently varied. They were generally geographically isolated as well, located away from urban areas because the land was cheap and there was less political opposition. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.

While many of those in state hospitals were voluntarily admitted, many more were involuntarily committed by courts. For this reason, state hospital patients were usually from the lower class, as the mentally ill from families with money often had enough private care to avoid being labelled a public menace.

In the United States, state hospitals in some places began to overflow by the beginning of the 20th century. As state populations increased, so did the number of mentally ill and so did the cost of housing them in centralised institutions. During wartime, state mental hospitals became even more overburdened, often serving as hospitals for returning servicemen as well as for their regular clientele. The incentive to discharge patients was high, yet there were still no adequate treatments or therapies for the mentally ill.

[edit] Ineffective treatments

This provided a fruitful environment for the popularity of quick-fix solutions, like the eugenic compulsory sterilisation programs undertaken in over 30 institutions interest. These new treatments of mental illness – which was now seen as a Service exposed abuses ere especially active at the Byberry Hospital in Philadelphia workers. On 1946-05-06 healthcare system based on the reports of COs. Another effort of CPS, Mental Hygiene Project became the National Mental Health Foundation. Initially sceptical about the value of Civilian Public Service, Eleanor Roosevelt, impressed by the changes citizens such as Harry Emerson Fosdick joined her in advancing the organization's objectives of reforof patients.

[edit] Radical medicine

By the mid-1940s, treatment of the mentally ill took a new turn, with the advent of electroconvulsive therapy (ECT) and insulin shock therapy, and the use of frontal lobotomy. In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", though in their own context they were seen as the first options which produced any noticeable effect on their patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past. Elsewhere, particularly in India, reports have surfaced that ECT is enjoying increased use, as a cost-effective alternative to drug treatment. The effect of a lobotomy on an overly excitable patient often allowed them to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution than institutionalisation. Lobotomies were performed in great numbers from the 1930s to the 1950s.

[edit] Drugs

By the mid-1950s, the first psychiatric drugs became available for the treatment of mental illness, such as thorazine, which revolutionised psychiatric care and provided new ways for many of the severely mentally ill to return to normal society. Newly developed antidepressants were used to treat cases of depression, and the introduction of muscle relaxants allowed ECT to be used in a modified form for the treatment of severe depression and a few other disorders. The use of Psychosurgery was narrowed to a very small number of people for specific indications. New treatments led to reductions in the number of patients in mental hospitals.

[edit] Deinstitutionalisation

In the early 1960s in U.S., amid public images of mental hospitals as sites for horror movies, a deinstitutionalisation movement caught hold in many states. At the time, mental hospitals were viewed as the least desirable solution to the problem of mental illness, both from a humane point of view and an economic one. California, for example, began to scale back its large mental health system in favour of community-based care, whereby smaller clinics would provide care. Although many facilities were emptied, outpatient services proved severely inadequate, a disaster according to some, which has only recently been addressed with the enactment of the California Mental Health Services Act. Popular books and movies such as One Flew Over the Cuckoo's Nest and Zen and the Art of Motorcycle Maintenance painted very unflattering portraits of mental hospitals as torture chambers run by sadistic staff, contributing to the deinstitutionalization movement.

The negative stereotypes (and an undercurrent belief that patients were "entitled to think what they wanted", rather than accept societal norms) continued to promulgate, however, and went even further in the backlash against social welfare policies in the 1980s, which lead to massive deinstitutionalisation and funding cuts. These changes led to the closing of many mental hospitals and the further reliance on local community care. Many former patients, instead of reintegrating successfully into society or receiving community treatment, simply wound up as homeless persons.

A similar movement took place in the UK, in which "Care in the Community" came to take the place of most mental hospitals.

[edit] Political device

In some nations, mental hospitals were used as sites for the stifling of political dissidence or even genocide. Under Nazi Germany, a euthanasia program began which resulted in the killings of tens of thousands of the mentally ill housed in state institutions, and the killing techniques perfected at these sites became later implemented in the Holocaust (see T-4 Euthanasia Program). In the Soviet Union, dissidents were often put into asylums and kept on a variety of destabilising medications, with the hope of not simply removing them from society, but making them unreliable in the eyes of others (see Psikhushka). In the case of Zhores Medvedev, the ire of officials was aroused by manuscripts that had been published (without his permission) in the West and a book, Biology and the Cult of Personality, which was an attack on Lysenkoism.

The attitudes in these cases – that the mentally ill were a scourge and needed to be eliminated, and that the line between 'patient' and 'prisoner' is incredibly blurry – have their precedents in the history of mental hospitals, though were taken to extremes by totalitarian regimes.