Mental Health Care & the History of the Institution

Colonial Period & the Early Republic

Family & the Almshouse/Prison were the two main institutions society had for accommodating mental illness. Those without families or means ended up in almshouses or prisons often in horrid conditions.

Enlightened Reform & The Moral Treatment

Dorothea Dix (1843)

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Thomas Kirkbride [Moral Treatment] “On the Construction, Organization, and General Arrangements of Hospitals for the Insane” (1854) 

Kirkbride Plan:

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Hudson River State Hospital:

Hudson River State Hospital-Kirkbride.jpg


Good Intentions Gone Awry? Overcrowding and Eugenic Solutions

Nellie Bly “Ten Days in a Madhouse” (1887)

nellie bly



Eugenics and Biological Determinism 

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Sterilization employed to prevent continuation of “hereditary” mental defects and notion of mental issues as a result of one’s deterministic genes rather than social factors

1927 Buck v. Bell Supreme Court decision upholds legality of compulsory sterilization

WWII and the Beginnings of National Reform

“Strangers to Reason: Life Inside a Psychiatric Hospital” (1938)

Not published in LIFE. Pilgrim State Hospital, Brentwood, NY, 1938.


“Bedlam 1946” Life

bedlam 1946

More on the role of conscientious objectors during WWII in reforming mental health care:


1946 National Mental Health Act signed into law

1949 National Institute of Mental Health established

The Rise of Psychosurgical “Cures” in the 1940’s & 1950’s

Walter Freeman and the Transorbital Lobotomy (1945)

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The Rise of Psychopharmocology in the 1950’s

Discovery of chlorpromazine (thorazine)




Beyond the Asylum, Into the Community

1963 Community Mental Health Act signed into Law by Kennedy

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1965 Social Security Amendments of 1965 creates Medicaid and Medicare

1967 Reagan (as California Governor) signs Lanterman-Petris-Short (LPS) Act makes it much harder to involuntarily commit folks [strengthens patients legal rights]

1973 Souder v. Brennan mandates the application of Fair Labor Standards Act protections (minimum wage, overtime) to patient labor in mental institutions

1980 Jimmy Carter signs Mental Health Systems Act to support community-based mental healthcare options

1981 Reagan repeals Carter’s MHSA essentially defunding community-care options


2015 Helping Families in Mental Health Crisis Act under debate in Congress