The Horrors of Historic Mental Asylums

Few subjects send such a chill shooting down the spine as historic mental asylums. They are the setting for countless horror films—places where our dark, collective nightmares reside. These were institutions of unspeakable horror, where the chaos of severe mental illness met antiquated medical thinking and, at times, shocking cruelty.

The earliest asylums were little more than holding cells for those deemed too dangerous or disruptive for society—locations of isolation where the mentally ill were kept out of sight and out of mind, often in deplorable conditions.

The idea of treatment, in any compassionate or scientific sense, was virtually non-existent. Instead, patients were subjected to a regime of confinement, often chained and left in their own filth.

As the centuries progressed, so did the evolution of mental asylums, but not always for the better. The 18th and 19th centuries saw the rise of the so-called “madhouses” or “lunatic asylums,” where overcrowding, neglect, and abuse were rampant.

It was also an era marked by a strange fascination with the macabre and the spectacle of madness, leading to the commercialization of asylums. Wealthy visitors could pay to tour these institutions, observing the patients as if they were attractions in a twisted carnival.

Despite the grim realities within, these asylums were marketed as a friendly face of benevolence and progress. Brochures and advertisements boasted of humane treatment and cures, encouraging desperate families to entrust their loved ones to these institutions.

Yet, behind closed doors, the reality was often horrendous. Treatments—if we even want to call them that—ranged from the truly bizarre to the outright cruel. Patients were subjected to ice baths, bloodletting, and the infamous “tranquilizer chair.” The line between “procedure” and torture was often blurred.

It was not until the late 19th and early 20th centuries that a movement towards reform began to take shape, driven by a growing awareness of the atrocities committed within these institutions. Pioneers in psychiatry and dedicated individuals pushed for change, advocating for the humane treatment of the mentally ill and the overhaul of the asylum system. Their efforts, initially met with resistance and plenty of skepticism, slowly began to turn the tide, ushering in a new era of mental health care.

Yet, the legacy of the historic mental asylums remains heavy on our psyche, even though many of us have never experienced anything similar, and the days of the worst cases are long gone. Like our innate fear of falling and loud sounds, there is something buried within our collective consciousness that reminds us that we must fear the asylum.

Early Days

Generally, the further back you go, the worse things become for the mentally ill. In ancient times, mental illness was strongly associated with the supernatural. Cultures around the globe interpreted the symptoms of mental disorders as manifestations of demonic possession, divine retribution, or witchcraft.

The treatments, therefore, were often rituals of exorcism, prayers, and various forms of magic aimed at expelling evil spirits or appeasing the gods. These rituals could be as benign as herbs and chants or as extreme as trepanation—the act of drilling holes into the skull to release evil spirits.

As civilizations evolved, so did their understanding of mental illness, but of course, it remained worlds away from what we would consider adequate care today. The Greeks and Romans significantly contributed to the medical understanding of mental health. Hippocrates proposed that mental disorders had natural causes and were related to imbalances of the four bodily humors. Despite this progress, treatments remained rudimentary and often savage, including bloodletting and purging—which involved giving patients concoctions that would expel liquid from the body, both upwards and down.

The Dark Ages saw a hellish regression in the understanding of mental illness, with a resurgence of superstition and the demonization of those afflicted. The mentally ill were often feared and ostracised, subjected to harsh treatments and exorcisms, or even persecuted as witches.

The Bethlem Royal Hospital in London, colloquially known as Bedlam, is perhaps the most infamous mental institution in history. Founded in 1247 AD, it became an early psychiatric hospital in the 14th Century, making it one of the oldest institutions of its kind.

Today, we use the word ‘bedlam’ to describe a chaotic or disorderly scene, and this is where it comes from—reflecting the appalling conditions that were once present within the hospital’s grand facade.

In Bedlam, patients were often shackled in chains, left in their own excrement, and subjected to public view as a form of entertainment. Treatments, based on the flawed understanding of mental illness of the time, ranged from the brutal ways of the ancients to the eccentrically grotesque forms, such as spinning chairs intended to shake the madness out of a patient. The asylum’s notoriety as a place of suffering and inhumanity highlighted the dire need for reform in the care of the mentally ill, but real change was still some way off.

The Renaissance brought about a renewed interest in the human body and mind, yet the treatment of mental illness remained primitive and often vicious. The mentally ill were increasingly removed from society, sometimes kept in monasteries or hospitals that were ill-equipped to provide any genuine care. It was during this period that many of the first institutions specifically for the mentally ill began to emerge, though they were about as far from the therapeutic environments we have today as you could imagine.

The First Asylums

By the 17th and 18th centuries, the landscape began to change with the establishment of the first asylums. While it was undoubtedly a step forward to have dedicated places to treat the mentally ill, the care afforded to them in these places was beyond anything that the vast majority of us will ever comprehend.

This was a time when the belief that mental illness could be cured by breaking the will of the patient led to barbaric treatments, such as confinement in cages, cold water shock treatments, and the use of restraints.

The founding of these early asylums was, in many cases, driven by a genuine desire to provide sanctuary to those with nowhere else to turn. The intentions behind these facilities were often rooted in compassion and a sense of moral obligation. In theory, asylums were meant to offer a place of refuge where the afflicted could be separated from the stresses of daily life and receive care.

However, despite these noble intentions, the reality of life within the walls of Europe’s first asylums was starkly different. Overcrowding became a common issue, with facilities quickly becoming inundated with patients, further compounded by a complete lack of understanding of mental illness and how to treat it.

The belief was that such harsh treatments could jolt the mind back to health, a theory that had tragic consequences for many. As in ancient times, it was thought that all mental illnesses could be cured by inducing recurring bouts of vomiting and diarrhea and by bleeding from the veins. The skin would be blistered with acidic substances and patients would have their heads shaved and be placed in cold baths. This regime would be administered repeatedly for as long as ‘the strength would bear.’

Far from being places of healing, they became warehouses for the mentally ill, where people were often forgotten by society. The lack of effective treatments, combined with the dehumanizing conditions, meant that few patients ever returned to society. Instead, many spent their entire lives within asylum walls, their conditions worsening over time. Years and years were spent being tortured, often by people who genuinely thought they were doing good.

Rising Numbers

By the 19th Century, the number of diagnosed mentally ill patients was soaring, leading to a massive increase in the number of individuals committed to asylums. This surge in population, coupled with insufficient funding and resources, resulted in severe overcrowding and hellish conditions. Patients were crammed into tiny, poorly ventilated spaces, with several individuals often sharing a single bed or being left to sleep on the hard floor.

The overcrowded conditions were exacerbated by a chronic staff shortage, leading to widespread neglect. Basic necessities such as food, water, and sanitary facilities were often completely inadequate, resulting in malnutrition, dehydration, and the spread of disease.

That horrific image we have in our minds of mental asylums really began to take shape during this period. While the exact nature of it has long been debated, most agree that the Industrial Revolution had a shattering psychological effect on many—with their effects still felt today.

Studies done in both the U.K. and the U.S. have found that people today whose ancestors lived in industrial areas during the revolution still show higher signs of neuroticism, lower conscientiousness, lower aspects of extraversion, lower life satisfaction, and lower life expectancy than people in other regions.

We’re a long way past being able to ask coal miners in the 19th Century about their work-life balance, but the correlation between the Industrial Revolution and the soaring number of those committed to mental asylums is stark.

Treatment, Torture & Medical Experimentation

What passed for treatment in these institutions often bordered on torture. Restraints such as straitjackets, manacles, and chains were commonly used not for therapeutic purposes but to control and subdue. Solitary confinement in dark, tiny cells was a frequent punishment for those deemed unmanageable or disobedient.

So-called “therapeutic” practices included shockingly inhumane procedures such as rotational therapy, where patients were spun in chairs to induce dizziness and vomiting, and hydrotherapy, which involved the use of ice-cold baths or powerful jets of water. These treatments, based on flawed theories of mental illness, did little to alleviate suffering and often exacerbated the conditions they were meant to cure.

During the 20th Century, mental institutions became hotbeds for experimental treatments. Perhaps the most infamous was lobotomy, a procedure that involves severing connections in the brain’s prefrontal cortex to alter a patient’s behavior. Initially hailed as a miracle cure for various mental illnesses, lobotomies often resulted in patients becoming emotionally blunted, vegetative, or worse. Despite the severe and frequently debilitating side effects, thousands of lobotomies were performed, sometimes even on unwilling patients.

Electroconvulsive therapy (ECT), while still used in a much more controlled and ethical manner today, was another treatment marred by abuse in its early days. High doses of electrical current were administered without proper anesthesia or muscle relaxants, leading to broken bones, severe memory loss, and even death. The use of ECT was often punitive rather than therapeutic, serving as a means to control or discipline unruly patients rather than to treat underlying psychiatric conditions.

The advent of psychopharmacology saw a new wave of experimentation within mental institutions. Patients were often used as test subjects for new drugs without their consent, exposing them to unknown risks. The discovery of drugs like chlorpromazine, while revolutionizing the treatment of schizophrenia, was preceded by trials that would definitely not meet today’s ethical standards. Patients experienced severe side effects from these early psychotropic medications, ranging from debilitating physical conditions to irreversible cognitive impairments.

The exposure of these unethical practices, often through investigative journalism and whistleblower accounts, led to public outcry and significant reform in the treatment of mental health patients. In the United States, the Belmont Report of 1979 established ethical principles and guidelines for protecting human subjects in research, emphasizing respect for persons, beneficence, and justice. This marked a turning point, leading to the establishment of institutional review boards (IRBs) to oversee research involving human subjects, ensuring that studies are ethically conducted and that the rights and welfare of participants are protected.

Hell on Earth

Nestled in the rolling hills of West Virginia, the imposing structure of the Trans-Allegheny Lunatic Asylum has a horrendous history. Constructed between 1858 and 1881, this colossal building was designed under the principles of Dr. Thomas Story Kirkbride, who advocated for the moral treatment of the mentally ill in a serene and structured environment. It sounds lovely—but it quickly became hellish.

Originally intended to house 250 patients in spacious, well-lit rooms, the Trans-Allegheny Lunatic Asylum’s population had ballooned to nearly ten times its capacity by the mid-20th Century. Patients were kept in cramped, poorly ventilated rooms, with the most violent or uncontrollable individuals often caged in basement cells with little to no light.

As the 20th Century progressed, the Trans-Allegheny Lunatic Asylum became a microcosm of the larger issues plaguing mental health institutions across the country. Reports of patient abuse, unsanitary conditions, and inadequate medical care began to surface, painting a grim picture of life inside its walls.

It was also the notorious site of an experimental lobotomy laboratory run by Walter Freeman, whose “ice pick” method involved slipping a thin pointed rod into the patient’s eye socket and using a hammer to force it to sever the connective tissue in the brain’s prefrontal cortex. Things reached a tipping point in the 1980s when investigations by health professionals and journalists brought to light the deplorable conditions within.

The Danvers State Lunatic Asylum was another location that lingered long in the American psyche and followed a similar pattern to Trans-Allegheny. The sprawling, Gothic-style building, with its beautiful design and vast, landscaped grounds, was designed to house approximately 450 patients, but by the early 20th Century, the patient population had swelled far beyond its intended capacity, reportedly as high as 2,000 at certain points.

The asylum’s therapeutic ethos gave way to more custodial and control-oriented practices as the focus shifted from treatment to containment. Restraints, isolation, and sedation became common, and the asylum began to use more controversial treatments, such as electroconvulsive therapy and lobotomies.

Danvers State Lunatic Asylum became emblematic of the horrors associated with historic mental health institutions. Tales of patient mistreatment, ghostly apparitions walking the halls, and dark, unexplained events became wound into its story. Perhaps more than any other location, the Danvers State Lunatic Asylum helped to foster deep-seated societal fears and stigmas surrounding mental illness and the institutions designed to treat it.

Danvers closed in 1992, and today, very little remains of the original building, but close by, you can still visit two separate cemeteries with the graves of 770 patients who died within those walls.

End of an Era

The mid-20th Century marked a turning point in the perception and treatment of mental illness. The publication of exposes and firsthand accounts brought the conditions of asylums to the public eye, igniting widespread outrage and a call for reform. Books like Albert Deutsch’s “The Shame of the States” and Ken Kesey’s novel “One Flew Over the Cuckoo’s Nest” raised awareness about the inhumanity going on inside.

At the same time, the evolution of psychotropic medications in the 1950s, such as chlorpromazine, revolutionized the treatment of mental disorders. For the first time, there were effective pharmaceutical treatments that could manage symptoms and offer patients a level of normalcy that was previously unattainable. This pharmacological breakthrough reduced the need for long-term institutionalization and laid the groundwork for outpatient care and community-based services.

One of the biggest shifts in mental health care was the deinstitutionalization movement, which gained momentum in the 1960s and 1970s. Driven by a growing consensus that long-term hospitalization was inhumane and counterproductive, this movement advocated for the closure of large state-run asylums and the integration of mental health services into the community.

Legislative actions, such as the Community Mental Health Act of 1963 in the United States, aimed to establish a network of community mental health centers to provide a range of services, including inpatient care, outpatient treatment, emergency services, and rehabilitation.

However, I’m afraid to say it’s been a far from easy transition. In many places, the shift to community-based care was often inadequately funded and poorly executed, leaving many individuals with mental illness without the necessary support. This shortfall has contributed to a range of social issues, including homelessness and drug addiction.

Walk down the streets of any major city, and it’s clear that our glittering metropolises of the 21st Century are badly struggling under the weight of mental illness. The horrors of historic mental asylums serve as a sobering reminder of the consequences of misunderstanding, stigmatizing, and mistreating mental illness. We didn’t get it right then, and increasingly, we’re not getting it right now.

Key Takeaways

• Historic mental asylums were notorious for deplorable conditions and cruel treatments.
• Early asylums often isolated and mistreated patients, with little focus on compassionate care.
• The Industrial Revolution correlated with a surge in mental illness and asylum populations.
• Experimental treatments in asylums often crossed into torture and unethical practices.
• Reforms in the mid-20th century aimed to improve mental health care, but challenges persist.

Frequently Asked Questions

What were the conditions like in the earliest mental asylums?

The earliest asylums were little more than holding cells for those deemed too dangerous or disruptive for society. Patients were often kept in deplorable conditions, subjected to a regime of confinement, often chained and left in their own filth.

How were mental illnesses treated in ancient times?

In ancient times, mental illness was strongly associated with the supernatural. Treatments often involved rituals of exorcism, prayers, and various forms of magic aimed at expelling evil spirits or appeasing the gods. These rituals could range from benign herbs and chants to extreme procedures like trepanation.

What was the Bethlem Royal Hospital in London known for?

The Bethlem Royal Hospital, also known as Bedlam, was infamous for its appalling conditions. Patients were often shackled in chains, left in their own excrement, and subjected to public view as a form of entertainment. Treatments ranged from brutal ancient methods to eccentric and grotesque forms.

What were some of the treatments used in the first asylums?

Treatments in the first asylums included confinement in cages, cold water shock treatments, and the use of restraints. Patients were often subjected to vomiting, diarrhea, and bleeding. The skin would be blistered with acidic substances, and patients would have their heads shaved and be placed in cold baths.

What were the conditions like in the Trans-Allegheny Lunatic Asylum?

The Trans-Allegheny Lunatic Asylum became overcrowded, with patients kept in cramped, poorly ventilated rooms. The most violent or uncontrollable individuals were often caged in basement cells with little to no light. Reports of patient abuse, unsanitary conditions, and inadequate medical care surfaced, highlighting the grim conditions within.

What role did the Community Mental Health Act of 1963 play in mental health care?

The Community Mental Health Act of 1963 aimed to establish a network of community mental health centers to provide a range of services, including inpatient care, outpatient treatment, emergency services, and rehabilitation. This was part of the deinstitutionalization movement, which advocated for the closure of large state-run asylums and the integration of mental health services into the community.

What were some of the experimental treatments used in mental institutions during the 20th century?

Experimental treatments included lobotomies, electroconvulsive therapy (ECT), and the use of new psychotropic medications. Lobotomies often resulted in severe side effects, while ECT was sometimes used punitively. Patients were often used as test subjects for new drugs without their consent, exposing them to unknown risks.

How did the Industrial Revolution impact mental health?

The Industrial Revolution had a shattering psychological effect on many people. Studies have found that descendants of those who lived in industrial areas during the revolution still show higher signs of neuroticism, lower conscientiousness, lower aspects of extraversion, lower life satisfaction, and lower life expectancy than people in other regions.

What was the impact of the deinstitutionalization movement?

The deinstitutionalization movement aimed to close large state-run asylums and integrate mental health services into the community. However, the transition was often inadequately funded and poorly executed, leaving many individuals with mental illness without the necessary support and contributing to social issues like homelessness and drug addiction.

What was the significance of the Belmont Report of 1979?

The Belmont Report of 1979 established ethical principles and guidelines for protecting human subjects in research. It emphasized respect for persons, beneficence, and justice, leading to the establishment of institutional review boards (IRBs) to oversee research involving human subjects and ensure ethical conduct.

Sources

• Original Into the Shadows video: The Horrors of Historic Mental Asylums
• Hero image source by Barney Moss from London, UK / openverse, by.

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