Advances and New Directions

By Silvano Arieti; H. Keith H. Brodie | Go to book overview

CHAPTER 19

THE CHRONIC MENTALLY ILL

John A. Talbott


¶ Historical Background

THE CARE and treatment of the chronic mentally ill date back to the founding of America. From the early Colonial period, there are reports of families who were distressed by the conduct and behavior of their kin and requested the court's permission to build outhouse-like cells in which to house their mentally ill relatives. 13 Later, jails, workhouses, and almshouses housed the chronic mentally ill. 49 An early precursor of "dumping" occurred in some Massachusetts communities when mentally ill persons were transported over county or town lines in order to shift the responsibility for their care to another community.13

In the mid 1800s, Dorothea Dix, appalled by the shabby treatment and dismal surroundings which localities provided for the severely and chronically mentally ill, successfully crusaded to have the states assume the burden for their care and treatment. These institutions were intended to provide the best available treatment and care of the mentally ill, known at that time as "moral treatment." Moral treatment followed Pinel's example in Paris of "striking off the chains" and was also modeled on Tuke's establishment, the York Retreat in England, which emphasized a humane, familial-like atmosphere and pleasant, open settings, with a minimum of physical restraint and a maximum of structured activity.13,49

The numbers of the chronic mentally ill in America soon grew larger than the institutions' capacity to provide humane housing. This situation was due to increasing immigration from Europe, the impersonality of the industrial era, and the "aging-into" chronicity of the seriously mentally ill. 11 Ultimately, state hospitals provoked scandals similar to those that motivated Dorothea Dix to agitate for elimination of local community responsibility for care of the mentally ill. 16

As America entered the twentieth century, society was ripe for experimentation with new methods in the care and treatment of the mentally ill. The combined efforts of dedicated individuals, such as Clifford Beers, 6 accompanied by the establishment of alternative treatment settings (psychopathic hospitals, child guidance clinics, outpatient

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