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The History of the Institutions for Intramural Psychiatric Involvement and Treatment

Throughout the centuries, care and treatment of the mad and the psychiatrically disordered resemble a nightmare, save a few humanitarian exceptions. Cruelty, torture, humiliation, and banning are but a few of the abominations inflicted on these people. In addition, they were regularly exposed to starvation, thirst, cold, and exhaustion. Conditions in institutions in the United States at the beginning of the twentieth century were deplorable. Ridenour states that conditions were reminiscent of the worst abominations of the past: iron cages on stone floors, without heating, light, or furniture, and patients who were not let out of the cages even when they died. Improvement in these conditions was but very gradual. At the time of World War II they still occurred. In the fifties, State Mental Hospitals in the United States were overcrowded. There was a great lack of trained therapists, and no more than one physician for every 200 patients. Only about one tenth of the patients were treated, “while the other nine-tenths vegetate, waiting to die.” Some advancement was being made, mainly owing to psychoactive drugs, in changing direction from custodial care to environment therapy, and more intensive treatment of some patients. In 1956 the population of the State Mental Hospitals began to decline due to shorter periods of hospitalization. In these years, mental illness was increasingly becoming the most important health problem in the United States. Half of all hospital beds were occupied by psychiatric patients. One of every ten or twelve Americans spent some time in a Mental Hospital. In some states, more than a third of the total budget went to caring for the mentally ill. The American Psychiatric Association stated that in the United States more than 75% of the hospitalizations were involuntary, compared to for instance England, where this percentage was less than 30.

At the beginning of the twentieth century, besides “insane asylums,” institutions were erected that would later be called “psychopathic hospitals.” There, in addition to clinical observation and short-term treatment, also were out-patient clinics. Private clinics existed, and still do, in which conditions were and are generally much better. Institutions erected by the Veterans Administration after World War II enjoyed high quality as well, according to Ridenour, although she does not explain that any further.
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