History of Mental Health in America

An era of "moral treatment" was introduced from Europe at the turn of the nineteenth century, representing the first of the reform movements in mental health services in the United States (U of T Library). The first reformers, including Dorothea Dix and Horace Mann imported the idea that mental illness could be treated by moving the individual to an asylum to receive a mix of somatic and psychosocial treatments in a controlled environment characterized by "moral" sensibilities (Smith). The term "moral" had a connotation different from that of today. It meant the return of the individual to reason by the application of psychologically oriented therapy. The moral treatment period was characterized by the building of private and public asylums. Almost every state had an asylum dedicated to the early treatment of mental illness to restore mental health and to keep patients from becoming chronically ill. Moral treatment accomplished the former objective, but it could not prevent chronicity (Mandell).

Issues in Mental Health Nursing

Mental Health Month Poster

English: Institute of Mental Health building in Be...

Moral treatment was influenced by social norms, religious beliefs, medical expertise, scientific theory, and demographic characteristics. Key components of moral treatment included: the belief that insanity is a curable disease of the brain, total isolation in order to avoid stress from society, a gentle yet firm routine of work develops discipline, a gentle yet firm routine of work, recreation, and rest will develop self-discipline, as well as the belief that causes of and solutions to insanity rest with society (Jones). Shortly after the Civil War, the failures of the promise of early treatments were recognized and asylums were built for untreatable, chronic patients. The quality of care deteriorated in public institutions, where overcrowding and underfunding ran rampant.

Progressive Era reformers believed that mental illness was the product of environmental factors, as well as the fact that it was both preventable and progressively...