Psychiatric hospital

From Wikipedia, the free encyclopedia

This article or section has multiple issues. Please help improve the article or discuss these issues on the talk page. It needs additional references or sources for verification. Tagged since August 2007. It may need a complete rewrite to meet Wikipedia's quality standards. Tagged since November 2008.

A psychiatric hospital, also known as an asylum, is a hospital specializing in the treatment of serious mental illness, usually for relatively long-term inpatients.

Psychiatric institutions vary widely in their goals and methods. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who as a result of a psychological disorder, require routine assistance, treatment or a specialized and controlled environment. Patients are often admitted on a voluntary basis, but involuntary commitment is practiced when an individual may pose a significant danger to themselves or others.

Contents 1 History 1.1 By region 1.1.1 Europe 1.1.2 Middle East 1.1.3 United States 2 Ineffective treatments 2.1 Radical medicine 2.2 Drugs 3 Political Device 4 Types 4.1 Crisis stabilization 4.2 Open units 4.3 Medium-term 4.4 Juvenile wards 4.5 Long term care facilities 4.6 Halfway houses 4.7 Form of prison 5 Anti-psychiatry objections 6 In popular culture 7 See also 8 References 9 External links

[edit] History

Society has long recognized that during the time that someone is without their sanity they can be a dangerous to themselves and other people.^{[citation needed]} Very often they cannot care for themselves properly. Also, in an age when naked flame was used both for lighting, cooking and other processes, the dangers of a fire getting out of control were maximized.^{[citation needed]} Many unscrupulous people were and still are always ready to take advantage of those with weak minds.^{[citation needed]}

In poor or nomadic societies, the victim was often tied up until either the madness passed from them or the underlining malady, which brought with it a loss of reason, succeeded in killing the sufferer.^{[citation needed]}

Bethlem Royal Hospital (Bedlam) was the first known psychiatric hospital in Europe,^[1] founded in London in 1547. It soon became infamous for its treatment of the insane. In the eighteenth century, outsiders would pay a penny to come and watch their patients as a form of entertainment. In 1700, the "lunatics" were called "patients" for the first time. Within twenty years separate wards for the "curable" and "incurable" patients had been established. The institution was still a coercive and brutal regime when William Battie criticized its practices in his treatise in 1785. By 1815 thousands of visitors were still being permitted in to view the "unfortunates" as they were by then called.^[2] At this time there was minimal understanding of mental health issues and treatment methods were in the early stages of development. Patients were often given, what today would be considered ridiculous treatments, which often resulted in fatality or outstanding injury.^{[citation needed]}

For wealthy families, the practice was often to employ a keeper to watch over the family member that was in crisis. An example from fiction gets has an important part in Charlotte Brontë Jane Eyre when Mr Rochester's places the care of ill wife Bertha under the watchful eye of Grace Poole. Alternatively, they may place their relative in the care of someone who makes a living by providing accommodation and care for the insane in private houses. These were simply known as "private asylums." The word "asylum" comes from the Greek for "refuge," because the place served as a refuge or sanctuary from the dangers that existed outside.

Phillipe Pinel and William Tuke were the pioneers of the psychiatric asylums where the patients were analyzed, and new treatments tested.

[edit] By region

[edit] Europe

By the 1790s in the Age of Enlightenment there began a more rational and early scientific approach aimed at understanding the workings of the mind and brain (which were still considered to be two completely separate phenomena ).^{[citation needed]}This work naturally lead to studying those individuals who brains, appeared over a relative short time to start malfunctioning.^{[citation needed]}

Phillipe Pinel (1793) is often credited as being the first in Europe to introduce more humane methods into the treatment of the mentally ill (which came to be known as moral treatment) as the superintendent of the Asylum de Bicêtre in Paris.^[3] A hospital employee of Asylum de Bicêtre, Jean-Baptiste Pussin, was actually the first one to remove patient restraints. Pussin influenced Pinel and they both served to spread reforms such as categorising the disorders, as well as observing and talking to patients as methods of cure. Vincenzo Chiarugi in Italy may have banned chains before this time. Johann Jakob Guggenbühl in 1840 started in Interlaken the first retreat for mentally disabled children.

Around the same time as Pussin and Pinel, the Quakers, particularly William Tuke, pioneered an enlightened approach (moral treatment) in England at the York Retreat which opened in 1796. The Retreat was not a psychiatric hospital, and in fact the medical approaches of the day were abandoned in favor of understanding, hope, moral responsibility and occupational therapy.^{[citation needed]}The Brattleboro Retreat and the former Hartford Retreat were named after it.

Other professions such as mathematicians had already begun to publish their work to claim their discoveries as their own in the expectation that this would lead to well paid employment. Gradually physicians across Europe began to copy this habit of sharing new knowlage. Physician who where inspired by reading about the successes of Phillipe Pinel and William Tuke copied aspects of their work and made their own discoveries.^{[citation needed]}

Societal changes going on during this time exasperate the problems that had always existed. With increased agricultural efficiency and the dawn of the industrial revolution in Europe, society became evermore unequal. Common land which had provided subsistence during times of low employment were lost to Enclosure and turned over to private ownership and control. Workhouses and prisons were built in an effort to force people to find non-existent work. In England, there was some recognition that these changes since the 1600s meant work opportunities would longer stay in balance with the population, so the solution of penal transportation to over- seas colonies was tried, where the prisoners had to serve their sentence working on plantations.^{[citation needed]}

However, magistrates and judges of the local courts could not but notice that formally respected, upright and hard-working citizens were coming before them for sentencing to prison due to acts caused by their loss of sanity and witnessing that their families were also condemned to the work-house due to the resulting lack of any means of support. If the sufferer was the breadwinner, then his whole families began a spiral of descent that few could ever escape from.^{[citation needed]}

The judges also saw that central government (that was causing these problems to increase by the laws they passed) was getting evermore powerful against judiciaries official employer, the very unpopular King William IV.^{[citation needed]} This made it harder for local government and the judiciary to maintain law, order and respect in the eyes of the people. The French peasants had already revolted and they would have personally met many French refugees. Together with this, was the increasing financial drain on local taxation.^{[citation needed]}

By the early 1800s the judiciary and the representatives local government of the counties around London resolved to do something about this situation. As they were all people who put great value in good organization, they set about looking at the best way to deal with the problems of insanity in their local area by looking at the effectiveness of methods practised else where. It is interesting to note: what is so often missed in accounts of medical history, is that improvements came about largely through people acting out of self-interest, rather a desire follow a noble cause.^{[citation needed]}

In 1817, William Ellis was appointed as superintendent to the newly built West Riding Pauper Asylum at Wakefield. As a Methodist, he had strong religious convictions. With his wife as matron, they put into action those things they had learned from the Sculcoates Refuge in Hull which operated on a similar model as the York. After 13 years, as a result of their highly regarded reputation, they were invited to oversee the newly built first pauper asylum in Middlesex called the Hanwell Asylum. Accepting the posts, the asylum opened in May 1831. Here the Ellis's introduced their own brand of humane treatment and 'moral therapy' combined with 'therapeutic employment.' As its initial capacity was for 450 patients, it was already the largest asylum in the country and subject to even more building soon after. Therefore, the immediate and continuing success of humane therapy working on such a large scale, encouraged its adoption at other asylums. In recognition of all this work he received a knighthood. He continued to develop therapeutic treatments for mental disorders and always with moral treatment as the guiding principle.^[4]

In Lincoln, Lincolnshire, England, Robert Gardiner Hill with the support of Edward Parker Charlesworth, developed a mode of treatment that suited 'all types' of patients, where by the reliance on mechanical restraints and coercion could be made obsolete altogether, a situation he finally achieved in 1838.^{[citation needed]}

By the following year of 1839 Sergeant John Adams and Dr. John Conolly was so impressed by the work of Hill, that they immediately introduced the method into their Hanwell Asylum, which was by then the largest in the kingdom. The greater size required Hill's system to be developed and refined. This was necessary as it was beyond Conolly to be able to supervise each attendant as closely as Hill had done. Even so, he bid a pair of extra soft slippers made so that he could walk around the building at night without his foot falls warning the attendance of his imminent approach. By September 1839, mechanical restraint was no longer required for any patient. For years, this day was remembered at the Hanwell asylum by a celebration on its anniversary.^{[citation needed]} Hanwell also was a very accomplished communicator who wrote and lectured widely about his work in mental health.^{[citation needed]}

By compiling written records of such things as what the patients were given to eat, what exercise they where give, daily activities undergone and recreational opportunities; together with observations detailing what effect any changes to these practices had, different research doctors could compare each others results and by copying parts of another hospital’s regime they could by a process of elimination, ascertain what interventions made real improvements in recovery.^{[citation needed]} Using such means these and others, more effective treatment methods gradually took hold in different countries,^{[citation needed]} and attitudes toward the treatment of the mentally ill began to drastically improve during the mid-19th century. Courts began to administer involuntary commitments with a greater eye towards medical justification.^{[citation needed]}

[edit] Middle East

Unlike medieval Christian physicians who relied largely on demonological explanations for mental illness and treatment, medieval Muslim physicians and psychologists relied mostly on clinical observations. Such scholars made significant advances to psychiatry and were the first to provide psychotherapy and moral treatment for mentally ill patients, in addition to other forms of treatment such as baths, drug medication, music therapy and occupational therapy.^{[citation needed]}

In the 10th century, the Persian physician Muhammad ibn Zakarīya Rāzi (Rhazes) combined psychological methods and physiological explanations to provide treatment to mentally ill patients. His contemporary, the Arab physician Najab ud-din Muhammad, first described a number of mental illnesses such as agitated depression, neurosis, and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and mania (Dual-Kulb).^[5]

In the 11th century, another Persian physician Avicenna recognized 'physiological psychology' in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with inner feelings, which is seen as a precursor to the word association test developed by Carl Jung in the 19th century.^[6] Avicenna was also an early pioneer of neuropsychiatry, and first described a number of neuropsychiatric conditions such as hallucination, insomnia, mania, nightmare, melancholia, dementia, epilepsy, paralysis, stroke, vertigo and tremor.^[7]

[edit] United States

Virginia is recognized as the first state to establish an institution for the mentally ill.^[8] Eastern State Hospital, located in Williamsburg, was founded in 1773.^[9] Their land was given to them by the House of Burgesses in 1769.^[8]

Reformers, such as American Dorothea Dix began to advocate a more humane and progressive attitude towards the mentally ill. Some were motivated by a Christian Duty to mentally ill citizens. In the United States, for example, numerous states established state mental health systems paid for by taxpayer money (and often money from the relatives of those institutionalized inside them). These centralized institutions were often linked with loose governmental bodies, though oversight and quality consequently varied. They were generally geographically isolated as well, located away from urban areas because the land was cheap and there was less political opposition. Many state hospitals in the United States were built in the 1850s and 1860s on the Kirkbride Plan, an architectural style meant to have curative effect.^[10] States made large outlays on architecture that often resembled the palaces of Europe, although operating funding for ongoing programs was more scarce. Many patients objected to transfers from private hospitals to state facilities. Some Brattleboro Retreat patients tried to hide when state officials arrived to transfer them to the new Waterbury State Hospital. This decline in patient census led to the collapse of many private institutions, which still accepted indigent patients even when state reimbursement for private hospitals dropped in the face of rising state hospital costs.^{[citation needed]}

[edit] Ineffective treatments

These treatments provided a fruitful environment for the popularity of quick-fix solutions,^[11] like the eugenic compulsory sterilization programs undertaken in over 30 U.S. states (and, later, in Germany), which allowed institutions to discharge patients while still claiming to be serving the public interest. These new treatments of mental illness – which is now seen as a "defect", and likely a hereditary one – were seen less as therapeutic for the individual patient than as preventative for the society as a whole.^{[citation needed]}

From 1942 to 1947, conscientious objectors in the US assigned to psychiatric hospitals under Civilian Public Service exposed abuses throughout the psychiatric care system and were instrumental in reforms of the 1940s and 1950s. The CPS reformers were especially active at the Philadelphia State Hospital where four Quakers initiated The Attendant magazine as a way to communicate ideas and promote reform. This periodical later became the The Psychiatric Aide, a professional journal for mental health workers. On May 6, 1946, Life Magazine printed an exposé of the psychiatric system based on the reports of COs. Another effort of CPS, namely the Mental Hygiene Project, became the National Mental Health Foundation. Initially skeptical about the value of Civilian Public Service, Eleanor Roosevelt, impressed by the changes introduced by COs in the mental health system, became a sponsor of the National Mental Health Foundation and actively inspired other prominent citizens including Owen J. Roberts, Pearl Buck and Harry Emerson Fosdick to join her in advancing the organization's objectives of reform and humane treatment of patients.^{[citation needed]}

[edit] Radical medicine

By the mid-1940s,^{[citation needed]} treatment of the mentally ill took a new turn, with the advent of electroconvulsive therapy (ECT) and insulin shock therapy, and the use of frontal lobotomy. In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the first options which produced any noticeable effect on their patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past.^[12] Elsewhere, particularly in India, use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment. The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalization. Lobotomies were performed in the hundreds from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs.

[edit] Drugs

By the mid-1950s, the first psychiatric medications became available, such as chlorpromazine, which revolutionized psychiatric care and provided new ways for many of the severely mentally ill to return to normal society.^{[citation needed]} Newly developed antidepressants were used to treat cases of depression, and the introduction of muscle relaxants allowed ECT to be used in a modified form for the treatment of severe depression and a few other disorders.^{[citation needed]} The use of psychosurgery was narrowed to a very small number of people for specific indications.^{[citation needed]} New treatments led to reductions in the number of patients in mental hospitals.^{[citation needed]} When the mentally ill began having sex with eacher, the goverment decided on eugenics^{[citation needed]}

[edit] Political Device

In some nations, such as North Korea, the former Soviet Union, East Germany, and Romania during Communist rule, mental hospitals were, and in some cases still are, used as sites for the stifling of political dissent or even genocide. Under Nazi Germany, a euthanasia program began which resulted in the killings of tens of thousands of the mentally ill housed in state institutions, and the killing techniques perfected at these sites became later implemented in the Holocaust (see T4 euthanasia program).^{[citation needed]}

[edit] Types

There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity.

[edit] Crisis stabilization

The crisis stabilization unit is in effect an emergency room for psychiatry, frequently dealing with suicidal, violent, or otherwise critical individuals. Laws in many jurisdictions providing for involuntary commitment require a commitment order issued by a judge within a short time (often 72 hours) of the patient's entry to the unit, if the patient does not or is unable to consent themselves.

[edit] Open units

Open units are psychiatric units that are less secure than crisis stabilization units. They are not used for acutely suicidal persons; the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms, because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits depending on the type of patients admitted.

[edit] Medium-term

Another type of psychiatric hospital is a medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective.

[edit] Juvenile wards

Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children and/or adolescents with mental illness. However, there are a number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self mutilation, or eating disorders.

These usually consist of anyone aged under 10.

[edit] Long term care facilities

In the UK long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security and being locally sited to help with reintegration into society once medication has stabilized the condition^[13][14] are often features of such units. An example of this is the Three Bridges Unit, in the grounds of Hanwell Asylum in West London and the John Munroe Hospital in Staffordshire. However these modern units have the goal of treatment and rehabilitation back into society within a short time-frame (two or three years) and not all forensic patients' treatment can meet this criterion, so the large hospitals mentioned above often retain this role.

[edit] Halfway houses

One type of institution for the mentally ill is a community-based halfway house. These facilities provide assisted living^[15] for patients with mental illnesses for an extended period of time, and often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists, although some localities lack sufficient funding.

[edit] Form of prison

In some countries the mental institution may be used for the incarceration of political prisoners, as a form of punishment (see Psikhushka).

[edit] Anti-psychiatry objections

This article's Criticism or Controversy section(s) may mean the article does not present a neutral point of view of the subject. It may be better to integrate the material in those sections into the article as a whole. (November 2009)

Some critics, notably psychiatrist Dr. Thomas Szasz, have objected to calling mental hospitals "hospitals" (see anti-psychiatry).

The French historian Michel Foucault is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilization. He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a bourgeois family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family-Children (paternal authority), Fault-Punishment (immediate justice), Madness-Disorder (social and moral order).^[16][17]

Erving Goffman coined the term 'Total Institution' for places which took over and confined a person's whole life. The anti-psychiatry movement coming to the fore in the 1960s oppose many of the practices, conditions, or existence of mental hospitals. The Consumer/Survivor Movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily.

Some anti-psychiatry activists have advocated for the abolition of long-term hospitals for the criminally insane, including on the grounds that those judged not guilty by reason of insanity should not then be indefinitely confined with potentially less legal rights, or on the converse grounds that insanity is not a coherent concept and so should not be a basis for different treatment.

[edit] In popular culture

• One Flew Over the Cuckoo's Nest
• A Beautiful Mind
• the fictional Arkham Asylum
• Changeling
• The Snake Pit (1948)
• Girl, Interrupted (film) (1999)

[edit] See also

• History of mental illness
• Deinstitutionalisation
• Institutionalization (psychology)
• Kirkbride Plan
• Mental health law
• MindFreedom International
• New Freedom Commission on Mental Health
• Punitive psychiatry in the Soviet Union
• Psychiatric survivors movement
• Treatment Advocacy Center, involuntary treatment proponent group

To see lists of individual establishments: view the categorical index for Psychiatric hospitals; which appears at the very bottom of this article.

[edit] References

[edit] External links

Wikimedia Commons has media related to: Psychiatric institutions

• BBC.co.uk - 'Mental hospital wards "dire"', BBC (July 7, 2000)
• Historical Asylums website
• Asylum Projects - Asylum wiki database
• Example of Patient Rights policy in U.S.
• "AlterNet: Movie Mix: Must-See Indy Film Exposes Cruel Teen Correction Programs". http://www.alternet.org/movies/56241/. Retrieved 2007-07-08. 
• National Resource Center on Psychiatric Advance Directives
• Kirkbride Buildings History and photographs of early psychiatric hospitals

v • d • e Psychiatry Subspecialties Behavioral medicine • Biological psychiatry • Child and adolescent psychiatry • Cross-cultural psychiatry • Emergency psychiatry • Forensic psychiatry • Geriatric psychiatry • Liaison psychiatry • Military psychiatry • Neuropsychiatry • Social psychiatry Societies American Board of Psychiatry and Neurology • American Psychiatric Association • Royal College of Psychiatrists Related topics Neuroimaging • Neurophysiology • Psychiatrist • Psychopharmacology • Psychosurgery • Psychotherapy Lists List of psychiatrists • List of figures in psychiatry • List of physicians • List of psychiatric medications • List of psychiatric medications by condition treated • List of neurological disorders • List of psychotherapies • List of counseling topics