As was typical of all health care in the United States in the early colonial days, family members with mental illnesses were generally cared for at home, possibly locked in a barn, attic, or cellar if dangerous. Some were housed in prisons or almshouses, the precursors to asylums. The main treatments were bloodletting and purgatives. There was little understanding of the causes of mental illness.

By the mid-1800s the causes of mental illness were believed to be due to moral issues. People were incarcerated in “insane asylums” as punishment for their aberrant behavior. Treatments were very limited and included discussions of moral discipline, lobotomy, and/or isolation.

Lobotomy

Another intervention that drew considerable attention was brain surgery. Initially introduced in the late 1880s in Switzerland, in 1936 American neurologists Walter J. Freeman II and James W. Watts developed a specific protocol for prefrontal lobotomy. Though strongly resisted by other professionals, the public was intrigued and demanded access to the procedure. (It is noted that few of the negative side effects were reported to the public.) Upstaged by the success of antipsychotics, antidepressants, and other medications, this treatment was discontinued by the mid-1950s, though it is occasionally used for extreme cases.

(https://www.britannica.com/science/lobotomy)

Hydrotherapy

A more common treatment was hypothermia therapy. A Catholic monk, Father Sebastian Kneipp (1821-1897), developed tuberculosis as a young adult. He read On the Healing Virtues of Cold Water (1738), a book on “cold water cure” by Dr. Johann Siegmund Hahn. Kneipp tried hydrotherapy with some success and subsequently became a vocal advocate for its use for all kinds of health problems. His practice involved not only curing the patients’ physical woes, but emotional and mental as well. It became a very popular treatment in Europe. Eventually, it was popularized in America and became a common treatment for mental illnesses in asylums. (https://en.wikipedia.org/wiki/Hydrotherapy )

Sigmund Freud and Psychoanalysis

At the beginning of the 20^th century, Sigmund Freud (1856-1939), an Austrian neurologist, launched a new approach to understanding and treating mental illness, now known as psychoanalysis. After studying physiology and zoology, including research projects on the brain and nervous system, at the University of Vienna, he graduated with an M.D. in 1881. He then began his medical practice at the Vienna General Hospital where he specialized in neurological disorders. His work at an affiliated psychiatric clinic led him to resign his hospital post and enter private practice specializing in “nervous disorders” in 1886.

Over the ensuing years, Freud developed his theory of the unconscious and the mind’s psychological structure of id, ego, and superego. His revolutionary approach to the diagnosis and treatment of mental illness became known as psychoanalysis. He gave many presentations as a docent at the University of Vienna and elsewhere in Europe. He also lectured in America in 1909 (Gay 2006, 212). Early on, Freud added the dual importance of sexuality and aggression (death drives in conflict with sex drives) to his theories of psychopathology. His clear detailing of patients’ histories, the organization of his interviews, and his documentation of outcomes became a favorite method of investigating and treating various mental illnesses. Some of Freud’s colleagues in the International Psychoanalytic Association he founded in 1911 developed theories that diverged from his in significant ways. Alfred Adler and Carl Jung, for instance, “de-emphasized sexuality in favor of other unconscious forces” (“Sigmund Freud: Conflict & Culture,” Library of Congress, https://www.loc.gov/exhibits/freud/freud03.html).

Electric Shock Therapy (EST)

In the 1930s and ’40s Electric Shock Therapy (EST) was introduced and gained traction throughout the U.S. as a strategy for treating mental illness. Though most commonly in use through the early 1960s, it is still employed to treat intractable depression.