Mental Illness in the US: Before the happy pills

History of mental illness

Every year, an estimated 42.5 million Americans suffer from some condition linked to mental illness. One could surmise the growth of mental illness reports have risen due to the radical transformation of the relationship between mental illness and its acceptance in society over time.

So how far back can we track mental illness and how was it treated?

Early History

  • Prehistoric times: Mental illness was believed to stem from magical beings and rituals were used to treat these sick people. One of the most primitive ways of dealing with the mentally sick was a procedure called trepanation where a hole in the skull was created using a sharp object, usually a bone. It was believed to release the evil spirits trapped inside curing the afflicted person.
  • Ancient Egypt: The Egyptians believed mental illness was caused by the loss of power or status. They believed the cause of the illness lie within the subconscious and would use opium to stimulate visual dreaming.
  • 400 B.C: There were differing explanations of mental illness during this time from philosophers. Many believed it was a gift or curse from the gods and with no treatment. Hippocrates, however, believed mental illness was caused by physiology. He suggested simple changes to a person’s diet, and physical surroundings would cure them.
  • Middle Ages: Displeasure of the gods and sin were the root causes for mental illness during this time. Causes of illness ranged from witchcraft to demonic possession. For demonic possessions, the patient would be immersed in scalding hot water in an effort to draw the demon out of the body. Women accused of witchery were burned at the stake.
  • Victorian times: Gender bias was experienced fairly often in Victorian times. Menstruation, pregnancy, post-partum depression, disobedience, chronic fatigue, or anxiety could cause women to be seen as unbalanced and labeled as hysteria. These women were then placed in institutions, sometimes for the remainder of their life.

Treatment or Torture?

From the middles ages to the 1800s, the mentally ill were hidden away from society in institutions. Most patients taken to institutions were there to be forgotten and not cured. Behind the walls of the institution, patients were not treated as humans in need of help but prisoners. The rooms that housed patients were jail cells with patients chained to walls, sometimes overcrowded and covered with feces. Bedlam Institute, London’s first asylum for the mentally ill, over the centuries has made a name for itself as a leading example of how the mentally ill were mistreated. For one penny, onlookers could visit the asylum and poke patients through their cells with long wooden sticks.

Gawking at patients as if they were animals was just one form of mistreatment. Their treatment methods are considered inhumane today.

  • Red hot pokers: Patients were branded or poked with a red hot iron to bring them to their senses.
  • Hydro-therapy: Patients stood in a narrow shower while being sprayed by cold water from a hose to stimulate them.
  • Insulin therapy: Used on patients with schizophrenia. The insulin would drop the patient’s blood sugar placing them into a coma and brought on convulsions and brain seizures. Glucose shots either injected or given through nasal passages were used to bring the patients out of their coma.
  • Lobotomy: A brain operation where the cortex of the brain’s frontal lobe was disconnected from the lower centers of the brain. This was normally down by sticking a long needle through the eye of the patient. If the procedure was done incorrectly, the result could be death.

Some of these treatments continued on through the 1970s.

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Advancements in mental illness

During a time when mental illness was not prioritized in medicine, two women fought for a change. In the 1840s, Dorothy Dix observed the mentally ill in a Massachusetts institute where she conducted interviews with patients. She documented the treatment of the patients she saw in a piece she wrote to the General Assembly of North Carolina. Her argument was the mentally ill should not be thrown away but committed to institutions devoted to mental health and understanding it’s causes. Over 40 years, she helped to establish 32 state institutes.

Another woman who brought to light the mistreatment of the mentally ill was reporter, Nellie Bly. In an assignment for the local paper in the 1880s, she committed herself to one of the largest institutions in New York as a mentally ill woman where she stayed for ten days. When her story was published, she exposed the mistreatment she experienced and the filthy conditions of the institute. Her story brought attention to the public and politicians bringing in reform for institutions.

It wasn’t until the 1900s that experts began to try and understand the peril of mental illness. During this time, Sigmund Freud proposed the idea of the unconscious. He believed some people had thoughts so upsetting they were buried deep in a person’s subconscious. His practice, known as the “talking cure,” was widely debated then and still to this day.

In the 1940s-50s, the use of medication to solve mental illness emerged. Chemists began experimenting with pills that may “calm imbalances inside the brain and deliver relief.”

Modern Day

While there is still stigma around mental illness, there are many options for help. The mentally ill are not hidden away, but institutions exist to treat and understand their plight. Psychologists offer “talk therapy” while psychiatrists offer talking as well as prescriptive medication if needed. Organizations like the National Alliance on Mental Illness dedicate their cause to bettering lives for those affected by mental illness as well as educating others about illnesses.

As a physician, do you believe there is still a large negative stigma toward mental illness? What do you think are the biggest issues facing mental illness today? If you work in this field, we would love to hear from you.

We will be discussing this and more inside Sermo, our physician community. If you’re an M.D. or D.O., please join us.


  1. Treatment of the Mentally Ill
  2. The 10 Worst Mental health Treatments in History
  3. A Short History of Mental Health
  4. History of Mental Health Treatment
  5. Timeline: Treatments for Mental Illness
  6. Early Treatment of Mental Disorders