Movement History of the Consumer/ Client/ Survivor/ Ex-patient/ Ex-Inmate/ User Community (Timeline)

1. Did you know that prior to 1960 it was common for physicians and psychologists at state hospitals to be assigned help-patients who acted as personal servants in charge of house cleaning, gardening, laundry, and cooking?

2. Did you know that in 1995-97 at least four major books on the history of mental health care in America were written and not one contains first hand accounts from ex-patients?

3. Did you know that the federal government established the fully segregated Canton Indian Insane Asylum in South Dakota in 1902 and that the town of Canton has since built the Hiawatha Municipal Golf Course around the graves of 121 former inmates?

4. Did you know that only one type of mental illness was thought to exist in American slaves? It was called Drapetomania and was defined as the inexplicable urge of a slave to run away!

5. Did you know that there are people who still remember what it was like to be a patient at a state hospital in the 1930's? They remember working on the hospital farms, the experience of malarial treatments, wet packs, metrazol shock, insulin coma therapy and how (or if) things changed with the introduction of Thorazine in the 1950's.

6. Did you know that Central State Hospital in Virginia was established in 1869 exclusively for ���colored insane���?

History of Mental Illness and Early Treatment in a Nutshell (Timeline follows)

Early man widely believed that mental illness was the result of supernatural phenomena such as spiritual or demonic possession, sorcery, the evil eye, or an angry deity and so responded with equally mystical, and sometimes brutal, treatments. Trephining (also referred to as trepanning) first occurred in Neolithic times. During this procedure, a hole, or trephine, was chipped into the skull using crude stone instruments. It was believed that through this opening the evil spirit(s)--thought to be inhabiting one���s head and causing their psychopathology--would be released and the individual would be cured. Some who underwent this procedure survived and may have lived for many years afterward as trephined skulls of primitive humans show signs of healing. Pressure on the brain may have also incidentally been relieved. This procedure endured through the centuries to treat various ailments such as skull fractures and migraines as well as mental illness, albeit with more sophisticated tools such as skull saws and drills developed solely for this purpose.

In ancient Mesopotamia, priest-doctors treated the mentally ill with magico-religious rituals as mental pathology was believed to mask demonic possession. Exorcisms, incantations, prayer, atonement, and other various mystical rituals were used to drive out the evil spirit. Other means attempted to appeal to the spirit with more human devices-- threats, bribery, punishment, and sometimes submission, were hoped to be an effective cure.

Hebrews believed that all illness was inflicted upon humans by God as punishment for committing sin, and even demons that were thought to cause some illnesses were attributed to God���s wrath. Yet, God was also seen as the ultimate healer and, generally, Hebrew physicians were priests who had special ways of appealing to the higher power in order to cure sickness. Along the same spiritual lines, ancient Persians attributed illness to demons and believed that good health could be achieved through proper precautions to prevent and protect one from diseases. These included adequate hygiene and purity of the mind and body achieved through good deeds and thoughts.

Ancient Egyptians seem to be the most forward-thinking in their treatment of mental illness as they recommended that those afflicted with mental pathology engage in recreational activities such as concerts, dances, and painting in order to relieve symptoms and achieve some sense of normalcy. The Egyptians were also very advanced in terms of medicine, surgery, and knowledge of the human body. Two papyri dating back to the sixteenth century BCE, the Edwin Smith papyrus and the Ebers papyrus, document early treatment of wounds, surgical operations, and identifies, very likely for the first time, the brain as the site of mental functions. These papyri also show that, despite innovative thinking about disease, magic and incantations were used to treat illnesses that were of unknown origin, often thought to be caused by supernatural forces such as demons or disgruntled divine beings. Ancient Egyptians also shared the early Greek belief that hysteria in women, now known as Conversion Disorder, was caused by a ���wandering uterus,��� and so used fumigation of the vagina to lure the organ back into proper position.

In all of these ancient civilizations, mental illness was attributed to some supernatural force, generally a displeased deity. Most illness, particularly mental illness, was thought to be afflicted upon an individual or group of peoples as punishment for their trespasses. In addition to the widespread use of exorcism and prayer, music was used a therapy to affect emotion, and the singing of charms and spells was performed in Babylonia, Assyria, the Mediterranean-Near East, and Egypt in hopes of achieving a cure.

Beliefs about mental illness and proper treatments were altered, and in some cases advanced, by early European thinkers. Between the 5th and 3rd centuries BCE, Greek physician Hippocrates denied the long-held belief that mental illness was caused by supernatural forces and instead proposed that it stemmed from natural occurrences in the human body, particularly pathology in the brain. Hippocrates, and later the Roman physician Galen, introduced the concept of the four essential fluids of the human body���blood, phlegm, bile, and black bile���the combinations of which produced the unique personalities of individuals. Through the Middles Ages, mental illness was believed to result from an imbalance of these humors. In order to bring the body back into equilibrium, patients were given emetics, laxatives, and were bled using leeches or cupping. Specific purges included a concoction developed by Ptolemy called Hiera Logadii, which combined aloes, black hellebore, and colocynth and was believed to cleanse one of melancholy. Confectio Hamech was another laxative developed by the Arabs that contained myrobalans, rhubarb, and senna. Later, tobacco imported from America was popularly used to induce vomiting. Other treatments to affect the humors consisted of extracting blood from the forehead or tapping the cephalic, saphenous, and/or hemorroidal veins to draw corrupted humors away from the brain. In addition to purging and bloodletting (also known as phlebotomy), customized diets were recommended. For example, ���raving madmen��� were told to follow diets that were ���cooling and diluting,��� consisting of salad greens, barley water, and milk, and avoid wine and red meat.

Custody and care of the mentally ill were generally left to the individual���s family, although some outside intervention occurred. The first mental hospital was established in 792 CE Baghdad and was soon followed by others in Aleppo and Damascus���mass establishment of asylums and institutionalization took place much later, though. The mentally ill in the custody of family were widely abused and restrained, particularly in Christian Europe. Due to the shame and stigma attached to mental illness, many hid their mentally ill family members in cellars, caged them in pigpens, or put them under the control of servants. Others were abandoned by their families and left to a life of begging and vagrancy.

The social stigma attached to mental illness was, and to some extent still is, pronounced in countries that have strong ties to family honor and a reliance on marriages to create alliances and relieve families of burdensome daughters. In China, the mentally ill were concealed by their families for fear that the community would believe that the affliction was the result of immoral behavior by the individual and/or their relatives. The mentally ill were also thought to have ���bad fate��� that would negatively influence anyone who associated with the disturbed individual, scaring away potential suitors and leading to the idea that mental illness was contagious. Historically in Greece, ���a mentally ill [family] member implies a hereditary, disabling condition in the bloodline and threatens [the family���s] identity as an honorable unit,��� therefore treatment of the mentally ill in these cultures meant a life of hidden confinement or abandonment by one���s family. Mentally ill vagrants were left alone to wander the streets so long as they did not cause any social disorder. Those who were deemed dangerous or unmanageable, both in family homes or on the streets, were given over to police and thrown in jails or dungeons, sometimes for life. Particularly in Europe during the Middle Ages, beatings were administered to the mentally ill who acted out as punishment for the disturbances their behavior caused and as a means of ���teaching��� individuals out of their illnesses. Others who were considered nuisances were flogged out of town.

Through the Middle Ages and until the mass establishment of asylums, treatments for mental illness were offered by humanistic physicians, medical astrologers, apothecaries, and folk or traditional healers. Aside from secular exorcisms, prayers, charms, amulets, and other mystical treatments were available. In the 17th century, astral talismans were popular and were easily made using brass or tin emblems with astrological signs etched into them and cast at astrologically significant times. These were worn around the neck of the afflicted while they recited prayers. Also worn around the neck were scraps of Latin liturgy wrapped in paper, bundled with a leaf of mugwort or St. John���s Wort and tied with taffeta. Amulets were also used, supplemented by prayers and charms, to soothe troubled minds, prevent mystical infection, and protect against witches and evil spirits. Sedatives during the 17th century consisted of opium grains, unguents, and laudanum to ���ease the torment��� of mental illness.

Some treatment options existed beyond family custody and care, such as lodging the mentally ill in workhouses or checking them into general hospitals where they were frequently abandoned. The clergy also played a significant role in treating the mentally ill as ���medical practice was a natural extension of ministers��� duty to relieve the afflictions of their flocks.��� Private madhouses were established and run by members of the clergy to treat the mentally afflicted who could afford such care. Catholic nations regularly staffed mental health facilities with clergy, and most mentally ill individuals in Russia were housed in monasteries until asylums spread to this region of the world in the mid-1800s. To relieve mental illness, regular attendance in church had been recommended for years as well as pilgrimages to religious shrines. Priests often solaced mentally disturbed individuals by encouraging them to repent their sins and seek refuge in God���s mercy. Treatment in clergy-run facilities was a desirable alternative as the care was generally very humane, although these establishments could not treat the whole of the mentally ill population, especially as it seemed to grow in number.

In order to accommodate the burgeoning amount of mentally ill individuals, asylums were established around the world starting, most notably, from the sixteenth century onward. The first institution to open its doors in Europe is thought to be the Valencia mental hospital in Spain, in 1406. Although not much is known about the treatment patients received at this particular site, asylums were notorious for the deplorable living conditions and cruel abuse endured by those admitted. For many years, asylums were not facilities aimed at helping the mentally ill achieve any sense of normalcy or otherwise overcome their illnesses. Instead, asylums were merely reformed penal institutions where the mentally ill were abandoned by relatives or sentenced by the law and faced a life of inhumane treatment, all for the sake of lifting the burden off of ashamed families and preventing any possible disturbance in the community.

The majority of asylums were staffed by gravely untrained, unqualified individuals who treated mentally ill patients like animals. A case study describes a typical scene at La Bicetre, a hospital in Paris, starting with patients shackled to the wall in dark, cramped cells. Iron cuffs and collars permitted just enough movement to allow patients to feed themselves but not enough to lie down at night, so they were forced to sleep upright. Little attention was paid to the quality of the food or whether patients were adequately fed. There were no visitors to the cell except to deliver food, and the rooms were never cleaned. Patients had to make do with a little amount of straw to cover the cold floor and were forced to sit amongst their own waste that was also never cleaned up. These conditions were not all unique to La Bicetre, and this case study paints a fairly accurate picture of a typical scene in asylums around the world from approximately the 1500s to the mid-1800s, and in some places, the early 1900s.

The most infamous asylum was located in London, England���Saint Mary of Bethlehem. This monastery-turned-asylum began admitting the mentally ill in 1547 after Henry VIII announced its transformation. The institution soon earned the nickname ���Bedlam��� as its horrific conditions and practices were revealed. Violent patients were put on display like sideshow freaks for the public to peek at for the price of one penny; gentler patients were put out on the streets to beg for charity.

Soon after the establishment of ���Bedlam,��� other countries began to follow suit and founded their own mental health facilities. San Hipolito was built in Mexico 1566 and claims the title of the first asylum in the Americas. La Maison de Chareton was the first mental facility in France, founded in 1641 in a suburb of Paris. Constructed in 1784, the Lunatics��� Tower in Vienna became a showplace. The elaborately decorated round tower contained square rooms in which the staff lived. The patients were housed in the spaces between the walls of the rooms and the wall of the tower and, like at Bedlam, were put on display for public amusement.

When staff did attempt to cure the patients, they followed the practices typical of the time period���purging and bloodletting, the most common. Other treatments included dousing the patient in either hot or ice-cold water to shock their minds back into a normal state. The belief that patients needed to choose rationality over insanity led to techniques aiming to intimidate. Blistering, physical restraints, threats, and straitjackets were employed to achieve this end. Powerful drugs were also administered, for example, to a hysterical patient in order to exhaust them. Around the mid-1700s, the Dutch Dr. Boerhaave invented the ���gyrating chair��� that became a popular tool in Europe and the United States. This instrument was intended to shake up the blood and tissues of the body to restore equilibrium, but instead resulted in rendering the patient unconscious without any recorded successes.

Although cruel treatment in asylums surely felt to the patients as if it had been going on for ages, conditions began to improve in the mid-to- late 1800s as reforms were called for, and this shameful and unenlightened period was somewhat brief in relation to the span of world history. One of the earliest reforms occurred at an asylum in Devon, England. This facility had employed opium, leeches, and purges as cures for mental illness, but in the mid-1800s emphasized non-restraint methods to affect patients��� health.

One of the most significant asylum reforms was introduced by Philippe Pinel in Paris. During the year of 1792, Pinel took charge of La Bicetre to test his hypothesis that mentally ill patients would improve if they were treated with kindness and consideration. Filth, noise, and abuse were eliminated quickly after patients were unchained, provided with sunny rooms, allowed to exercise freely on the asylum grounds, and were no longer treated like animals.

The same reforms were undertaken around this time by an English Quaker, William Tuke. Founded in 1796, the York Retreat in York, England was run by Tuke and other Quakers who stressed the importance of treating all people with respect and compassion, even the mentally ill. In keeping faithful to this ideal, the York Retreat was a pleasant country house, modeled on a domestic lifestyle, that allowed patients to live, work, and rest in a warm and religious environment that emphasized mildness, reason, and humanity.

This humanitarian movement spread across the Atlantic to the United States in the early 1800s. Stemming largely from the work of Pinel and Tuke, moral management emerged in America as ���a wide-ranging method of treatment that focused on a patient���s social, individual, and occupational needs.��� Applied to asylum care, moral management focused on the mentally ill individual���s spiritual and moral development as well as the rehabilitation of their personal character to lessen their mental ailments. These goals were sought through encouraging the patient to engage in manual labor and spiritual discussion, always accompanied by humane treatment.

Although moral management was highly effective, it largely failed to continue through the late 1800s for several reasons. First, ethnic prejudice created tension between staff and patients as immigration increased. The leaders of the moral management movement also failed to pass along their teachings, so there was a lack of replacements. Third, supporters of this movement did not realize that bigger hospitals differed from smaller ones in more ways than just size, leading to an overextension of hospital facilities. Biomedical advances also led to the demise of moral management as most believed that medicine would soon be the cure-all for physical as well as mental afflictions and, therefore, psychological and social help was not necessary. Lastly, the rise of a new movement called Mental Hygiene focused solely on the patient���s physical health and ignored their psychological disturbances. Although this new movement ended the effective reign of moral management and resulted in many patients becoming helpless and dependent, there were several humanitarian positives to Mental Hygiene.

Dorothea Dix was a schoolteacher forced to retire early due to her bouts of tuberculosis. Soon after she began teaching in a women���s prison and learned of the horrific conditions of jails, almshouses, and particularly mental health facilities, Dix commenced a forty-year long campaign to reform asylums called the Mental Hygiene movement. Although this movement did not directly affect patients��� mental illnesses, it raised millions of dollars to build hospitals that were suitable for proper care and influenced twenty American states to respond to her pleas for change, resulting in greater physical comfort of the patients. Dix also managed to oversee the opening of two institutions in Canada and completely revamp the systems of mental health care in Scotland and several other countries.

Improvements in asylum care continued in America and Europe, although sub-par conditions persisted in numerous American and European institutions. Many countries around the world were also slow, or failed completely, to implement sufficient reforms. For example, asylums in Nigeria, Africa were not even established until 1906 after citizens started complaining about the disruptive behavior of mentally ill individuals that were left to roam the streets and wander from village to village. Until that year, the mentally ill were either sent to asylums in Sierra Leone or locked in the lunatic ward of local prisons. When asylums were finally established in Lagos and Abeokuta, the conditions were less than pleasant. Common complaints included dark, overcrowded cells, a lack of basic supplies, poor bathing facilities, and the use of chains to restrain patients. Very little treatment was offered to help the patients with their mental illnesses with the exception of minimal occupational therapy and agricultural work as well as the administration of sedatives to keep patients calm and under control���a practice that was likely more beneficial to the staff than the afflicted.

Significant advances in psychological concepts after the mass establishment of asylums did not arise until the development of psychoanalysis by Sigmund Freud in the late 1800s to early 1900s. Examination of an earlier practice, Mesmerism, must be mentioned first though as it is commonly posited to have provided a foundation for later psychoanalytic techniques. Austrian physician Franz Mesmer believed that human bodies contained a magnetic fluid that was affected by the planets and determined one���s health depending on its distribution. Mesmer concluded that all persons were capable of using their own magnetic forces to affect the magnetic fluid in others and considered himself to be powerful enough to cure illnesses with his ���animal magnetism.��� Mesmer gained a large following when he opened a clinic in Paris 1778 and started practicing his ���mesmerism.��� In order to affect cures, several patients at a time were seated around a tub containing various chemicals. Iron rods attached to the tub were applied to the afflicted parts of their body (as patients were generally hysterical and experiencing numbness or paralysis), after which Mesmer would emerge in light purple robe and circle around the room touching the patients either with his hand or with a wand. Although Mesmer���s techniques reportedly were effective, he was branded a fraud by his medical colleagues, and his ���cures��� were later believed to be the result of hypnotism, a psychoanalytic practice.

Between the years of 1888 and 1939, Sigmund Freud, an Austrian neurologist and psychiatrist, published twenty-four volumes explaining his thoughts about personality and psychopathology called Psychoanalytic Theory. Freud believed that the human mind was structured in three divisions���the id, the ego, and the superego. The id functioned unconsciously, driven by the two main primal desires for sex and aggression. The superego functioned both consciously and unconsciously, demanding that the individual deny the id���s impulses and instead live a virtuous life, striving to meet society���s ideals. The ego also functioned both consciously and unconsciously and was deemed the mediator between an individual���s id and superego, always working to find a balance between what one desired and what society considered acceptable. The unconscious was thought to be the seat of psychopathology as it contained unacceptable desires and painful memories that had been repressed by the two higher functions as they would have been too unsettling to acknowledge. Freud believed that anxiety arose as these three parts of the human mind battled each other, resulting in mental illness and that if the individual could only reveal and address the content of their unconscious, then their mental ailments would be cured.

The resulting treatments created by Freud are known as psychoanalysis, or ���talking cures��� and began with hypnosis, a revised form of mesmerism. When this specific method did not prove to be effective, Freud turned to free association in which the patient was instructed to relax and share whatever thoughts came to mind, no matter how trivial or embarrassing they might have been. Freud believed that these thoughts would create a path that he could follow into the patient���s unconscious, where he could then retrieve years of repressed thoughts and feelings. The unconscious was also thought to be revealed through an individual���s beliefs, habits, and even slips of the tongue and pen, which came to be known as ���Freudian slips.��� Dream analysis was another popular method of treatment promoted by Freud. Patients were asked to record their dreams, sometimes every morning in a journal kept bedside. The psychoanalyst would then study the manifest content of the dream, or what was remembered by the patient, and search for latent content, or the unconscious materials that were thought to be censored by the conscious mind and instead encoded as symbols. Although Freud provoked many critics who considered his ideas pseudo-science, psychoanalysis was a very popular method of treating mental illness from the early to mid 1900s.

Also in development and widespread use during this time were somatic treatments for mental illness such as electroconvulsive therapy, psychosurgery, and psychopharmacology. These treatments were based on the biological model of mental pathology that assumes mental illness is the result of a biochemical imbalance in the body and can be compared to physical diseases. Therefore, somatic treatments were designed to correct an individual���s chemical imbalance in order to restore their mental health.

Electroconvulsive therapy has roots in methods designed to shock the body but without the aid of electricity. In 1933, Manfred Sakel reported his first experimental findings, testing the efficacy of insulin-shock treatment on schizophrenic patients in Berlin, Germany. Insulin was administered to the patient in a dose high enough to induce coma, and although the treatment seemed to be beneficial to individuals in the early stages of schizophrenia, it was not proven to be useful in advanced cases of schizophrenia. Sakel���s vague theoretical rationale for this specific method and the difficult regimen of care this treatment required also led to the abandonment of insulin-shock therapy.

Ladislaus Joseph von Meduna experimented with shock therapy and schizophrenia in Budapest, Hungary, also during the year 1933. Instead of insulin, Meduna injected patients with Metrazol, a less toxic synthetic preparation of camphor. This treatment was soon abandoned as it possessed a period of unpredictable length between injection and convulsions, giving the patient just enough time to become fearful and uncooperative. It also often produced convulsions that were so severe as to cause fractures.

Finally in 1938, Italian physicians Ugo Cerletti and Lucio Bini administered the first shock therapy using electricity to a schizophrenic patient and received successful results. This treatment soon became widespread and was used most often in America and Europe. There is some history of abuse associated with electroconvulsive therapy (ECT) though, that took place in mental institutions. Because the idea of an electrical current being passed through one���s head is undoubtedly frightening, ECT was used to intimidate, control, and punish patients, some of whom were subjected to this treatment over a hundred times. Despite previous instances of abuse, this treatment is still used today, albeit with significant reforms. It is generally reserved only for the mentally ill who suffer from severe depression, especially of the variety accompanied by psychotic symptoms, and only as a last resort after the patient has not responded to any other treatments, including medication. Patients are also administered a general anesthetic and muscle relaxant prior to the treatment so that they do not suffer any discomfort and there is no danger of fractured bones. Electroconvulsive therapy is commonly performed on a patient three times a week until a dozen sessions are reached, although some patients may require more or less sessions to benefit. The only negative side effects reported are amnesia limited to the few hours before the session and disorientation; both disappear soon after ECT is stopped.

When electroconvulsive therapy was not effective, patients were sometimes forced to undergo psychosurgery, a practice that developed and was widely practiced in the 1930s to 1950s. It was in Portugal, 1935, that Egas Moniz performed the first lobotomy with the aid of a neurosurgeon, Almeida Lima; Walter Freeman was responsible for popularizing lobotomies in America. To execute this procedure, the patient was first shocked into a coma. The surgeon then hammered an instrument similar to an icepick through the top of each eye socket and severed the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain. The intended purpose of the lobotomy was to calm uncontrollably violent or emotional patients, and it did--at first--prove to be successful. Because of the preliminary positive results and the facts that it was easy, inexpensive, and the average time it took to complete the procedure was only about ten minutes, lobotomies quickly spread around the world as a popular practice for severely mentally ill patients who were resistant to other treatments. It was only after tens of thousands of patients worldwide had undergone this procedure during the following twenty years that people started to take notice of its undesirable side effects. Lobotomies generally produced personalities that were lethargic and immature. Aside from a twenty-five percent death rate, lobotomies also resulted in patients that were unable to control their impulses, were unnaturally calm and shallow, and/or exhibited a total absence of feeling. Not surprisingly, this practice was quickly abandoned with the introduction of psychoactive drugs.

Since the late 1800s, substances such as chloryl hydrate, bromides, and barbiturates were administered to the mentally ill in order to sedate them, yet they were ineffective in treating the basic symptoms of psychosis. It was not until Australian psychiatrist J.F.J Cade introduced the psychotropic drug Lithium in 1949 that psychopharmacology really took off. A series of successful anti-psychotic drugs were introduced in the 1950s that did not cure psychosis but were able to control its symptoms. Chlorpromazine (commonly known as Thorazine) was the first of the anti-psychotic medications, discovered in France, 1952. Valium became the world���s most prescribed tranquilizer in the 1960s, and Prozac, introduced in 1987, became the most prescribed antidepressant.

The introduction of psychopharmacology is arguably one of the most significant and successful contributions to mental illness treatment, although it did lead to a movement that has been devastating to mental health care systems around the world, especially in the United States. The advent of psychoactive drugs convinced many that all illnesses would soon be effectively managed with medication, leading to the deinstitutionalization movement that rapidly occurred starting in the 1960s. It was believed that numerous community-based facilities would be conveniently available to the mentally ill should they choose to seek it out, although this plan was never sufficiently realized. Instead, thousands of the mentally ill discharged from institutions were incapable of living independently, medicated or not, and became homeless as a result of inadequate housing and follow-up care. In the 1980s, it was estimated that one-third of all homeless individuals in America were considered severely mentally ill. Lack of support and guidance led to the incarceration of over 100,000 mentally ill individuals in America as well. A 1992 survey reported that 7.2 percent of the inmate population was ���overtly and seriously mentally ill;��� over one-fourth of that population was being detained without charges until beds became available in one of the country���s few remaining mental hospitals.

Psychotropic medication has additionally allowed individuals to avoid directly confronting their mental health issues, for example through counseling. Despite successful advances in therapy, such as Roger���s Client-Centered Counseling and Cognitive-Behavioral Therapy, among many others, mentally ill individuals have found it easier to avoid the shame associated with mental illness in countries where psychopathology is profoundly stigmatized. For instance, since deinstitutionalization, community health centers, day-care facilities, short- and long-term residencies, vocational training programs, and mobile units have all been established in Greece, yet the majority of the mentally ill, aside from those suffering from severe psychosis, still treat themselves only with psychotropic medication as they find it easier to hide their mental ailments from their friends, family, and communities. Supernatural beliefs about mental illness persist in other countries around the world, motivating most individuals to consult traditional healers first to help restore their mental health before they seek out professional, medical assistance. Workers in Nigerian asylums claimed that individuals were often only admitted after traditional healers has exhausted all treatment possibilities, and even today this country is known for its ethnopsychiatry as its mental health facilities employ traditional healers and frequently incorporate their practices into more modern treatments. It is also common in several countries that mental health is a grossly misunderstood and ignored problem, leading to serious underdevelopment of mental health facilities. Some countries in the Arab world have the highest income per capita, yet all have mental health systems that are severely lacking, including Morocco, Lebanon, the United Arab Emirates, and more. Individuals in these countries also continue to hold supernatural beliefs about mental illness and feel ashamed due to stigma, so they often consult traditional healers first with physical complaints, which are more likely psychosomatic symptoms. China is another country whose mental health services are limited due to stigma and misunderstanding. Confucian ideals about social order allow no wiggle-room for mental illness. Those afflicted with psychopathology rush to traditional healers, seek out prescriptions for psychoactive medication, or are begrudgingly taken care of by family members; the mentally ill who become disruptive to society are likely to be incarcerated.

This article has examined the major developments in mental health care as well as some interesting details about mental illness treatments throughout world history. Perceptions of mental health have changed greatly since the earliest civilizations and will continue to change as more is learned about the minds of humankind. Although significant advances have been made in this field of study that greatly benefit many individuals suffering from psychopathology, there remains much room for improvement. It will likely be ages before the workings of the human mind will be fully understood, if this is indeed an attainable goal.

From: http://www.studentpulse.com/print?id=283

Some four thousand years ago, the ancient Egyptians did not differentiate between mental and physical illnesses; they believed that despite their manifestations, all diseases had physical causes. They thought the heart was responsible for mental symptoms. Hippocrates and the early Greeks believed as well that all illness resulted from a biological malfunction; in the case of depression, from an excess of ���black bile���.

The ancients may have been off the mark as to specific causes, but their nonperjorative view of mental suffering and their search for medical causes were right on track. Some of the earliest views of mental illness follow:

Early Egypt: During this time period mental illness was believed to be caused by loss of status or money. The recommended treatment was to ���talk it out���, and to turn to religion and faith. Suicide was accepted at this time.

Job/Old Testament: Despair and cognition was the accepted cause of mental illness; faith the cure.

Homer: Homer believed that mental illness was caused by God's taking a mind away. He offered no treatment.

Aeschylus: Demon possession was the theory of Aeschylus to explain Mental illness ; exorcism the cure.

Socrates: Socrates believed that mental illness was heaven-sent and not shameful in the least. He believed it to be a blessing, and therefore no treatment was required.

Aristotle: Melancholia was the cause of mental illness according to Aristotle, and music was the cure.

Hippocrates: It was the belief of Hippocrates that both melancholia and natural medical causes contributed to mental illness. He advised abstinence of various types, a natural vegetable diet and exercise as treatment.

Celsius: Celsus believed mental illness to be a form of madness to be treated with entertaining stories, diversion and persuasion therapy.

Galen: Psychic functions of the brain were considered by Galen to be the foremost cause of mental illness. Treatment consisted of confrontation, humor and exercise.

As history progressed, however, the ���mind��� view of mental illness came to predominate, and with it the conviction that the victim was to blame. Possession by evil spirits, moral weakness, and other such ���explanations��� made a stigma of mental illness and placed the responsibility for a cure on the resulting outcasts themselves. The most apparently ill were chained to walls in institutions such as the infamous Bedlam, where the rest of society could forget they existed.

Conditions in these institutions were horrible. ���Inmates��� as they were called were crowded into dark cells, sometimes sleeping five to a mattress on dank damp floors, chained in place. There was no fresh air, no light, very little nutrition and they were whipped and beaten for misbehavior much like wild animals. No differentiation was made between mentally ill and criminally insane; all were packed together. Some women were committed at this time simply for the ���crime��� of attempting to leave their husband, or at their husband's insistence in order to gain control of her assets.

They were not recognized as sick people and were accused of having abandoned themselves to shameful and forbidden practices with the devil, sorcerers and other demons (unbelievably there are people who still believe this today). The mentally ill were accused of having succumbed to spells, incantations and of having committed many sinful offences and crimes. They were persecuted without mercy and many of them were burned at the stake.

The few doctors who tried to convince the authorities and general public that the ���insane��� were mentally ill, and sick people who needed attention and care were ridiculed. Often they faced danger to their professional reputations and to their person as well.

During the 1700's many people were simply locked away by their families, perhaps for a lifetime. Poorer individuals were jailed or placed in publicly funded almshouses. They received basic car, but conditions were undeniably bad.

Institutional Care

During the 18th and 19th centuries, hospitals and asylums assumed the care of the mentally ill. The first hospital to accept and treat mentally ill patients was the Pennsylvania Hospital founded by the Quakers in 1752. Treatment there was the same as for other patients�Ķclean surroundings, good care and nutrition, fresh air and light�Ķin short the mentally ill were treated as human beings.

Asylums for the Mentally Ill

The word ���asylum��� means shelter or refuge. One definition found in the 10th edition of Webster's Dictionary is ���an institution for the care of the destitute or sick and especially the insane���.

The first actual mental asylum in America opened in 1769 under the guidance of Benjamin Rush, who became known as ���America's first psychiatrist.���

Benjamin Rush, who became known as America's first psychiatrist was a professor at America's first psychiatric hospital in 1769. This hospital, located in Williamsburg, Virginia was to be the only such institution in the country for fifty years.

Rush graduated from Princeton University at the age of fifteen, and studied medicine at the University of Edinburgh in his twenties. Soon after he began to practice medicine he realized that his primary interest was in the treatment of the mentally ill. He divided the mentally ill roughly into two groups; those who suffered general intellectual derangement and whose problems seemed only partial.

Rush disapproved completely of restraint of any kind, for long periods of time. He outlawed the use of whips, chains and straitjackets and developed his own methods for keeping control. Looking at some of his methods, we may feel he was quite harsh, but in his day his methods were considered exceedingly humane.

The tranquilizing chair seen above (National Library of Medicine, Bethesda, MD drawing) was a device intended to heal by lowering the pulse and relaxing the muscles. It was designed to hold the head, body, arms and legs immobile for long periods of time and enable the patient to settle.

The gyrator, as its name suggests was a contraption similar to a spoke on a wheel. The patient was strapped to the board head outward and the wheel was rotated at a high rate of speed, sending the blood racing to his head and supposedly relieving his congested brain.

The circulating swing worked similar to the gyrator with the patient bound in place in a sitting position.

Looking back it is obvious the treatments were still primitive, but a change had been made.

Nearly fifty years later America's second asylum was built near Philadelphia by the Quakers and was called ���The American Friends' Asylum���. This asylum, and others that followed embraced the teaching of Englishman William Tuke in providing ���moral treatment��� for its patients. No chains were used and violent patients were separated from the others.

In 1841 Dorothy Dix, an American woman, appalled at the conditions in jails and mental institutions where the mentally ill were housed began a forty-year quest to champion the mentally ill. Through her efforts more than thirty hospitals for indigent patients with mental illnesses were built.

By the mid 1800's many institutions were making the effort to truly help their residents, yet by today's standards their efforts were crude.

Real changes began to occur with the arrival of the twentieth century. During World War 1 it was discovered that large numbers of soldiers were incapacitated by emotional problems and it was plain to see that not just a few, but many suffered from abnormal behavior. It was reasoned that if trauma such as the war could cause such widespread symptoms, then it was reasonable to assume lesser trauma, perhaps occurring frequently could produce the same effect.

Mental illnesses began to be recognized as medical in origin and the classification as to type and symptoms proceeded.

In the 1940's and 50's medication was discovered that helped the severely mentally ill. Great hope was placed in these drugs, but it was soon discovered they did not cure the illness, although they were quite successful at ameliorating some of the symptoms. These medicines, the anti psychotics, are still in use today. ECT and insulin therapy was also discovered, and went a long way to helping especially those in depression. ECT, in a refined and safer mode is also practiced today.

Several serendipitous discoveries in the next several years nearly revolutionized the treatment of the mentally. New medications were discovered to help in most cases of severe mental conditions, and more new ones are being found.

Lifelong institutionalization is rare as patients recover enough to be cared for in their own homes and communities. Community help for the mentally ill has progressed enormously in the past even twenty years.

No, we still do not know the cause of the major mental illnesses, schizophrenia, bipolar affective disorder (manic depression) or clinical depression but treatment is available. Researchers continue to look at the genetics in an attempt to identify the cause. Though it may not come in our time, it will for our children and their children.

The stigma of mental illness has not been eradicated, though the move to equate mental illness with physical illness has resulted in greater understanding on some fronts. We still have a long way to go in this area.

TIMELINE

10,000 BC

In prehistoric times there was, as far as historians can tell, no division between medicine, magic and religion. In the Stone Age there is evidence of trepanning the skull, and also that parts of the cut skull were used as amulets. Study of cave drawings indicates that mesolithic people utilized a magical law relating to all human activities of the time, by which they made sense of the world. A cave painting in Ariege, France, shows a strange being with human feet and hands and antlers who has been identified as a 'psychiatrist (witch doctor)', but it is not clear how this identification has been made.

5,000 BC

Attempts to treat mental illness date back as early as 5000 BCE as evidenced by the discovery of trephined skulls in regions that were home to ancient world cultures

2,850 BC

At Memphis, the temple of Imhotep, a great Egyptian healer who was deified, became a medical school where patients received sleep therapy, occupational therapy, excursions on the Nile, concerts, dances and painting. There were carefully worded malpractice laws and detailed clinical treatises; however psychiatric theory was largely magical, and successful treatments were attributed to amulets worn or to the patron god.

2,000 BC

In Mesopotamia, according to the code of Hammurabi preserved in Cuneiform clay tablets, priest-physicians dealt especially with mental disturbance which was attributed to demonic possession, whilst 'lay' physicians dealt solely with physical injury. This was the first known division between mental and physical symptoms. These priest-physicians, the Asu, used psychotherapy, and studied dreams that were regarded as showing the will of the gods. Every physician had his own god and every disease its own demon. Diseases and drugs were codified, and the doctor was responsible for his patient, whose life story was studied in a holistic approach.

The Talmud is full of psychological commentary. Rabbi Hunah stated that good men have bad dreams, implying that dreams are a safety valve for wishes repressed by moral principles. Judaism also suggested that sickness and madness were punishments for sins. In the Old Testament, Saul suffered from suicidal depression, Nebuchadnezzar had a psychotic fear of being a wolf, and Ezekial was coprophagic (eating of feces or dung), while David feigned madness to escape from the King of Gath. One effect of Hebrew psychiatry was that the religion of one God caused a lot of magical ideas to be discarded. However, despite the caring of the Hebrews, and the building of a special hospital for mentally ill people, statements like, 'a wizard shall surely be put to death; they shall stone them with stones' were to be used in an inhumane way for centuries. Deuteronomy names insanity as one of the many curses that God will inflict on those who do not obey Him: 'the Lord shall smite thee with madness, and blindness, and astonishment of heart'. Saul's psychotic episodes were attributed to an evil spirit sent by the Lord, and treated with music therapy: 'And it came to pass, when the evil spirit was upon Saul, that David took an harp, and played with his hand: so Saul was refreshed, and was well, and the evil spirit departed from him.' Rabbi Asi in ancient Judea recommended that disturbed patients should talk freely about their worries.

800BC

According to Homer, an eminent specialist, Melampus, pioneered the use of white hellebore for treating delusions, and Greek comedies frequently satirized the taking of the drug, which was considered a panacea. An eminent physician, Aesculapius, developed a form of sleep-therapy in luxurious surroundings, taking great care with patients' diet and exercise. Aesculapian temples, named after him, were built in places of particular beauty or near springs with medicinal waters, and there patients with psychological problems could be cared for and encouraged to sleep, with the suggestion that Aeculapius would appear in their dreams to cure them.

600 BC

In India, Buddha attributed human thoughts to our sensations and perceptions, which, he said, gradually and automatically combine into ideas. In China, Confucius said, 'A man can command his principles; principles do not master the man', and 'learning undigested by thought is labor lost; thought unassisted by learning is perilous'. In Greece, either Solon or Thales (sources differ) gave the famous advice, 'Know thyself'.

Witch doctors in Africa could only qualify for their profession by first having undergone convulsions and sickness themselves and a thorough exposure of their dreams.

430BC

Hippocrates who was born in 460BC at Kos wrote 76 treatises which are still considered to be the foundations of modern medicine and psychiatry. He treats mental disorders as diseases to be understood in terms of disturbed physiology, rather than reflections of the displeasure of the gods or evidence of demonic possession, as they were often treated in Egyptian, Indian, Greek, and Roman writings. Later, Greek medical writers set out treatments for mentally ill people that include quiet, occupation, and the use of drugs such as the purgative hellebore. Family members care for most people with mental illness in ancient times. He described melancholia, postpartum psychosis, mania, phobias and paranoia, and was called as a psychiatric witness in trials. Hippocrates also believed that thoughts and feelings occur in the brain, rather than the heart as was often thought, and classified personality in terms of the four humors ��� fluids which in health were naturally equal in proportion (pepsis). When the four humors, blood, black bile, yellow bile and phlegm, were not in balance (dyscrasia, meaning ���bad mixture���), a person would become sick and remain that way until the balance was somehow restored. Hippocratic therapy was directed towards restoring this balance. For instance, using citrus was thought to be beneficial when phlegm was overabundant. Hippocrates is credited with being the first physician to reject superstitions, legends and beliefs that credited supernatural or divine forces with causing illness. Hippocrates was credited by the disciples of Pythagoras of allying philosophy and medicine. He separated the discipline of medicine from religion, believing and arguing that disease was not a punishment inflicted by the gods but rather the product of environmental factors, diet, and living habits. Indeed there is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. Hippocratic medicine was humble and passive. The therapeutic approach was based on ���the healing power of nature��� (���vis medicatrix naturae��� in Latin). According to this doctrine, the body contains within itself the power to re-balance the four humors and heal itself (physis). Hippocratic therapy focused on simply easing this natural process. To this end, Hippocrates believed ���rest and immobilization [were] of capital importance���. In general, the Hippocratic medicine was very kind to the patient; treatment was gentle, and emphasized keeping the patient clean and sterile. For example, only clean water or wine were ever used on wounds, though ���dry��� treatment was preferable. Soothing balms were sometimes employed. Hippocrates was reluctant to administer drugs and engage in specialized treatment that might prove to be wrongly chosen; generalized therapy followed a generalized diagnosis. However, potent drugs were used on certain occasions. This passive approach was very successful in treating relatively simple ailments such as broken bones which required traction to stretch the skeletal system and relieve pressure on the injured area.

400BC

Plato, Greek student of Socrates, proposed a view of the soul (psyche) as a charioteer driving two horses, one noble, the other driven by base desires. The charioteer struggles to balance their conflicting impulses. This is similar to Freud's theory of the superego, ego and id. Plato also discussed the origin of dreams, as well as the nature of sexual sublimation. In ���The Laws��� Plato also describes the place where those who did not measure up to the Greek ideal should be set aside. This was the earliest known description of what were to later become German Concentration Camps.

384BC

Aristotle showed an awareness of the importance of genetic inheritance, and saw mental growth as a sequence of cause and effect: aspirations influence behavior and thus become causes. Aristotle saw actions, feelings and thoughts as a single unit. His awareness of the potential for change and his image of a self-actualized person accords with Erich Fromm's description. Aristotle, like Meyer, also believed in the concept of total reactions, rather than separating man's faculties. Arateus antedated modern concepts of mental disease as extensions of normal personality traits. The concept of personal will and ego and of emotional and rational behavior was defined by Pythagorus. Aristophanes' plays include classic Freudian free-association sessions, beginning 'come onto the couch'.

110BC

To elicit the state of mind of the mentally disturbed person, Cicero designed an interview format that contained the following items:

1. Nomen (clan/tribe, region, connections)

2. Natura (sex, nationality, family status age, physique)

3. Victus (education, association, habits/life-style)

4. Fortuna (rich/poor, free/slave, social class)

5. Habitus (appearance)

6. Affectio (passions, emotions, temperament)

7. Studium (interests)

8. Consilium (motivation)

9. Factum (working history)

10. Casus (significant life events)

11. Orationes (form and content of discourse)

This assessment tool was used throughout the Roman Empire, was still used by the Celtic monasteries in the following centuries and continued in use until the Dissolution of the Monasteries in the 16th century (i.e for about 1600 years). Cicero rejected the concept of the four humors, saying that melancholia was caused, not by black bile, as Hippocrates had suggested, but by violent rage, fear and grief.

40BC

Asclepiades was a Greek doctor who practiced in Rome, using a form of physiotherapy designed to move the oppositely charged 'atoms' of which the human body was formed. He invented a swinging bed which had a relaxing effect on emotionally disturbed patients, found music helpful, and spoke out strongly against incarceration of mentally ill people. He disliked the term 'insanity', referring to 'passions of sensations', and differentiated between hallucinations and delusions. Asclepiades waged a strong campaign against bleeding, which in fact went on for another 1500 years.

0

In the last years before Christ the influence of enlightened views of the Roman doctors began to decline, and Cornelius Celsus (25BC-50AD) recommended starvation, fetters and flogging and anything 'which thoroughly agitates the spirit'. He reinstated the idea that some illnesses were caused by the anger of the gods, and his words were used in the Middle Ages to justify the burning of witches.

100

The Roman, Aretaeus, an eclectic medical philosopher, established the fact that manic and depressive states occur in the same individual and that lucid intervals exist between manic and depressive episodes. He also understood that not everyone with mental illness is destined to suffer intellectual deterioration, a fact not adequately emphasized until the twentieth century, if then, and he was very concerned about the welfare of his patients, understanding the undesirability of treatments that patients find unacceptable. He abandoned terms relating to the four humors and gave clear descriptions of emotional states. The Romans tended to concentrate on pleasant physical therapies: warm baths, massage, diet, well-lighted and pleasant rooms, and music. They also used shocks by electric eels.

131

Galen (131-200) was an anatomist rather than a physician, and borrowed ideas from many sources. He dedicated many of his writings to a Creator, a fact that led to his having a far greater influence over the Christian world in later centuries than his work perhaps merited, and helped to retard the development of medicine.

200

Follower of Asclepiades, Soranus of Ephesus, said that patients should be kept in light, airy conditions, should not be beaten, kept in the dark or given poppy to make them drowsy, and he stressed the importance of convalescence and aftercare. He also took social background and culture into account and insisted on the importance of the doctor-patient relationship. Although he described mental distress in terms of an organic disturbance he treated it by psychological methods, minimizing the use of drugs and other physical treatments. But he also suggested that mania should be treated with the alkaline waters of the town. These waters contained high levels of lithium salts. Lithium treatment was rediscovered for manic depression by John Cade, an Australian psychiatrist, in 1948.

865

Rhazes (865-925), called 'the Persian Galen' (but 700 years later), was chief physician at Baghdad hospital where there was a psychiatric ward, and, because the Arabs had no fear of demons, patients were kindly treated. They used the writings of Galen and Aristotle to guide them, and appear to have made use of forms of behavior therapy.

1020

In Salerno University, Constantinus Africanus (1020-1087) a Jew who became a Christian, translated Hippocrates from Arabic into Latin. Once again the nervous system was examined and the brain seen as the seat of mental illness. Hydrotherapy was used.

1100���s

Medieval laymen had more enlightened attitudes toward mental health problems than did professionals, for poetry and other literature present very realistic views of the subject. The poems Amadas (late 12th century), and also Tristan both indicate an understanding of the idea that emotional crises may result in severe emotional disorders and that they may be corrected by a realistic psychological approach.

1247

Bethlem Royal Hospital of London is a psychiatric hospital at Beckenham in the London Borough of Bromley. Although no longer in its original location and buildings, it is recognised as the world's first and oldest institution to specialize in the mentally ill. It has been variously known as St. Mary Bethlehem, Bethlem Hospital, Bethlehem Hospital and Bedlam. Bethlem has been a part of London since 1247, first as a priory for the sisters and brethren of the Order of the Star of Bethlehem, from where the building took its name. Its first site was in Bishopsgate (where Liverpool Street station now stands). In 1337 it became a hospital, and it admitted some mentally ill patients from 1357, but did not become a dedicated psychiatric hospital until later. Early sixteenth century maps show Bedlam, next to Bishopsgate, as a courtyard with a few stone buildings, a church and a garden. Conditions were consistently dreadful, and the care amounted to little more than restraint. There were 31 patients and the noise was ���so hideous, so great; that they are more able to drive a man that hath his wits rather out of them.��� Violent or dangerous patients were manacled and chained to the floor or wall. Some were allowed to leave, and licensed to beg. It was a Royal hospital, but controlled by the City of London after 1557, and managed by the Governors of Bridewell. Day to day management was in the hands of a Keeper, who received payment for each patient from their parish, livery company, or relatives. In 1598 an inspection showed neglect; the ���Great Vault��� (cesspit) badly needed emptying, and the kitchen drains needed replacing. There were 20 patients there, one of whom had been there over 25 years.

1250

Pietro Albano (1250-1316) was burned to death by the Inquisition for minimizing spiritual principles in his attempt to unite Aristotle's thinking with the medical facts.

1300���s

Medieval laymen had more enlightened attitudes toward mental health problems than did professionals, for poetry and other literature present very realistic views of the subject.

It was not until the 14th century that people with mental health problems were considered witches and again became victims of persecution. The physical care of the insane was better in the early middle ages than it was during the 17th and 18th centuries. In the early days of the Bethlehem hospital (Bedlam), which began to care for people with mental health problems in the 12th century, patients were treated with concern, and were issued with arm badges to wear so that they could be returned to hospital if their symptoms should recur. Apparently vagrants sometimes counterfeited the badges so that they could be taken for former patients of Bethlem.

Ironically, witchhunts began at the dawn of the Renaissance (1300-1700), provoked at least in part by anxiety about the sexual activities of some monks and nuns. The Church needed to take action against this and the blame fell upon women who stirred men's passions and were therefore seen as agents of the devil. At the same time severe plague killed 50 per cent of the population in Europe, leading to a conviction among some groups that it was sent as punishment for sin. These groups therefore practiced self-flagellation and humiliation to relieve their guilt. In the 15th century the ideology of the mass movement of witch hunting was codified in the Malleus Maleficorum, a gruesome and pornographic book. It consisted of three main parts, the first a collection of arguments in support of the existence of witches and witchcraft, concluding that to doubt their existence was to be a heretic; the second describing witches and how they may be identified; the third concerned with their treatment. A lot of the information was about deviant behavior, much of it overtly sexual. This was at least partly due to the belief that insanity was caused by possession by the devil, and a devil possessed a witch by copulating with her. As the ultimate salvation of the immortal soul was more important than the comforts of the possessed body, physical punishments such as drowning and burning were used to make the body an intolerable refuge for the devil. The wide dissemination of this book was greatly facilitated by the development of printing, and it ran into 10 editions. Another obvious and kinder treatment for the supposed possession was exorcism which often succeeded.

Some enlightened care was offered in monasteries. The Sisters of the Society of Hospitalers created hospitals offering good food, rest and calm, and a Franciscan monk, Bartholemew Anglicus in his book De Proprietatibis Rerum, prescribed music and occupation for depressed patients and sleep and gentle binding for frenzied patients. There was no hint of demonology.

1406-1407

The first institution to open its doors in Europe is thought to be the Valencia mental hospital in Spain. Although not much is known about the treatment patients received at this particular site, asylums were notorious for the deplorable living conditions and cruel abuse endured by those admitted. For many years, asylums were not facilities aimed at helping the mentally ill achieve any sense of normalcy or otherwise overcome their illnesses. Instead, asylums were merely reformed penal institutions where the mentally ill were abandoned by relatives or sentenced by the law and faced a life of inhumane treatment, all for the sake of lifting the burden off of ashamed families and preventing any possible disturbance in the community.

1484

Malleus Maleficorum (The Witches��� Hammer) by two Dominican German monks, Johann Sprenger and Heinrich Kraemer backed by a Papal Bull became the witch-hunter���s bible.

1492

Juan Luis Vives, born in Valencia in 1492, died in Bruges at the age of 48, respected by Erasmus, Henry VIII and St Thomas More. He put forward a concept of treatment for mental distress which we might do well to bear in mind today: ���Since there is nothing in the world more excellent than man, nor in man than his mind, particular attention should be given to the welfare of the mind; and it should be considered a highest service if we either restore the minds of others to sanity or keep them sane and rational ... One ought to feel great compassion for so great a disaster to the health of the human mind, and it is of utmost importance that the treatment be such that insanity be not nourished and increased, as may result from mocking, exciting or irritating madmen�Ķ��� Since he was also deeply committed to education for women, presumably he included everyone in this view.

1500���s

In the 16th century, while demonology and witch-hunts continued, there were again those who put forward more enlightened beliefs.

1520

Paracelsus, a contemporary of Vives, totally rejected demonology in dealing with mental distress. He saw it as a natural disease, writing, ���We must not forget to explain the origin of the diseases which deprive man of his reason, as we know from experience that they develop out of man's disposition. The present-day clergy of Europe attribute such diseases to ghostly beings and threefold spirits: we are not inclined to believe them.���

Paracelsus (1493-1541) and another contemporary, Agrippa (1486-1535), disliked dangerous dispensing methods and complained of physicians recommended for their esoteric religions, splendid clothes and amulets. 'Simple and native medicines are quite neglected. Costly foreign remedies are preferred which latter are mixed in such enormous numbers that the action of one is counteracted by that of another'. But such ideas were treated with great suspicion by the religious community. Paracelsus claimed he learned all he knew from wise women ��� women skilled in the use of herbal remedies who acted as community midwives and laid out the dead.

Agrippa's pupil Johann Weyer (b.1515) managed to bring a profound influence on the treatment of mental distress. Weyer emphasized that illnesses attributed to witches came from natural causes, and made the revolutionary demand that witches should themselves be sent to physicians for treatment. Weyer also considered the effects of drug-induced hallucinations, and provided clinical descriptions of auditory hallucinations and persecution mania. However his book, De Praestigiis Daemonum was proscribed by the Catholic church, and he himself was accused of being a sorcerer.

1547

The most infamous asylum was located in London, England���Saint Mary of Bethlehem. This monastery-turned-asylum began admitting the mentally ill in 1547 after Henry VIII announced its transformation. The institution soon earned the nickname ���Bedlam��� as its horrific conditions and practices were revealed. Violent patients were put on display like sideshow freaks for the public to peek at for the price of one penny; gentler patients were put out on the streets to beg for charity

1566

San Hipolito was built in Mexico 1566 and claims the title of the first asylum in the Americas.

1600���s

In the 17th century there was a widespread belief that if mad people behaved like animals, they should be treated like animals. People with mental health problems were often cared for privately.

Thomas Willis, a neuroanatomist and doctor, speaking of treatment of the mentally ill said, ���The primary object is naturally curative discipline, threats, fetters and blows are needed as much as medical treatment...Truly nothing is more necessary and more effective for the recovery of these people than forcing them to respect and fear intimidation. By this method, the mind, held back by restraint, is induced to give up its arrogance and wild ideas and it soon becomes meek and orderly. This is why maniacs often recover much sooner if they are treated with torture and torments in a hovel instead of with medicaments.���

Native American shamans, or medicine men, summoned supernatural powers to treat the mentally ill, incorporatin g rituals of atonement and purification.

1620

Patients of the notoriously harsh Bethlem Hospital banded together and sent a ���Petition of the Poor Distracted People in the House of Bedlam (concerned with conditions for inmates)��� to the House of Lords.

1621

Robert Burton's Anatomy of Melancholy (1621) written from his own experience, noted the aggression that lies behind depression, and proposed a therapeutic program of exercise, music, drugs and diet, with a stress on the importance of discussing problems with a close friend, or, if one is not available, with a doctor.

1641

La Maison de Chareton was the first mental facility in France, founded in 1641 in a suburb of Paris.

1661

Rev. John Ashbourne was stabbed by a patient who had been cared for in his house. Ashbourne was renowned in Suffolk as a 'clerical mad-doctor', and after his death Ashbourne's wife and son, who unlike Ashbourne had received the Cambridge license to practice medicine from Trinity College, continued to run the 'mad-business' until at least 1686. This system of private treatment began with Helkiah Crooke, physician to James I and Bethlem Hospital who took patients into his own home for treatment. From boarding a single lunatic it was a short step to providing accommodation for numbers of patients, and thus setting up a private madhouse.

1670

Two doctors set up madhouses in London in the 1670s. John Archer, one of Charles II's 'Physicians in Ordinary', and Thomas Allen, a physician at Bethlem Hospital who also ran a private asylum. Allen seems to have been a humanitarian scientist who prevented his colleagues from transfusing sheep's blood into a man, and also ordered the first postmortem recorded at the Bethlem Hospital. One of his patients was James Carkesse, a clerk in Samuel Pepys's office at the Admiralty. Treatment varied according to ability to pay. Elsewhere in the country a Mistress Miller 'mad for two years' was treated by diet, glysters (large syringes used for purging), leeches, fresh cyder drinks, warm herb baths, and applying animal organs such as 'warm lungs of lambs' to her shaven head.

1692

Witchcraft and demonic possession were common explanations for mental illness. The Salem witchcraft trials sentenced nineteen people to hanging.

1700���s

The 18th century saw the development of new asylums built to house people with mental health problems separately from houses of correction and poor houses. One of these was the New Bethlem, seen to be so magnificent it was thought 'everyone might become half mad in order to lodge there'. (Palatial as it looked, it was built on a land-fill site and deteriorated rapidly.) Whilst mental hospitals that followed New Bethlem were reasonably managed in London, the provincial institutions were often very poor. At Newcastle there were 'chains, iron bars, dungeon-like cells, many close, cold, dark holes, less comfortable than cow houses. There was no separation of the sexes, no classification, and for medical treatment the old exploded system of restraint and coercion.'

1724

Puritan clergyman, Cotton Mather (1663-1728), broke with superstition by advancing physical explanations for mental illnesses.

1739

The London-Citizen Exceedingly Injured; or, a British Inquisition Display���d, in an Account of the Unparallel���d Case of a Citizen of London, Bookseller to the Late Queen, Who Was in a Most Unjust and Arbitrary Manner Sent on the 23rd of March Last, 1738, by One Robert Wightman, a Mere Stranger, to a Private Madhouse. London: T. Cooper by Cruden, Alexander.

1740

Mr. Cruden Greatly Injured: An Account of a Trial between Mr. Alexander Cruden, Bookseller to the Late Queen, Plaintif, and Dr. Monro, Matthew Wright, John Oswald, and John Davis, Defendants; in the Court of the Common-Pleas in Westminster Hall July 17, 1739, on an Action of Trespass, Assault and Imprisonment: the Said Mr. Cruden, Tho��� in His Right Senses, Having Been Unjustly Confined and Barbarously Used in the Said Matthew Wright���s Private Madhouse at Bethnal-Green for Nine Weeks and Six Days, till He Made His Wonderful Escape May 31, 1738. To Which is Added a Surprising Account of Several Other Persons, Who Have Been Mostly Unjustly Confined in Private Madhouses. London: A. Injured by Alexander Cruden

1750

Around the mid-1700s, the Dutch Dr. Boerhaave invented the ���gyrating chair��� that became a popular tool in Europe and the United States. This instrument was intended to shake up the blood and tissues of the body to restore equilibrium, but instead resulted in rendering the patient unconscious without any recorded successes

1751

First mental hospital in the United States, Pennsylvania University Hospital where a basement was reserved for people identified as mentally ill.

1754

The Adventures of Alexander the Corrector, Wherein Is Given an Account of His Being Unjustly Sent to Chelsea, and of His Bad Usage during the Time of his Chelsea Campaign . . . with an Account of the Chelsea-Academies, or the Private Places for the Confinement of Such As Are Supposed to Be Deprived of the Exercise of Their Reason by Alexander Cruden.

1757

Benjamin Franklin introduced a form of ECT, for which the rich were expected to make a donation of sixpence, but the poor 'to be electrified gratis'.

1758

William Battie (1703-1776) was a pioneer in the care of mental patients (from whose name the term 'batty' is derived), who helped raise the 'mad business' to a respectable medical specialty. He wrote Treatise on Madness in 1758, and was founding medical officer of St Luke's Hospital in London. He was part of a new school of thought, that institutionalizing patients in asylums was in itself therapeutic: their purpose in confining individuals was not just to protect them and society, but was in itself curative. He recognized that mental nurses needed special training, and wrote that madness is 'as manageable as many other distempers' and that its victims 'ought by no means to be abandoned, much less shut up in loathsome prisons as criminals or nuisances to the society'

1770's

The earliest recorded mutual self-help societies of individuals with alcohol abuse problems are created by Native Americans.

New therapies at this time included water immersion: ���the greatest remedy is to throw the patient unwarily into the sea, and to keep him under water as long as he can possibly bear without being stifled.��� Another method was a special spinning stool which spun the patient round until he was dizzy. The spinning was supposed to rearrange the brain contents into the right positions. Another specialist created a novel form of drama therapy involving lion's dens and executions which was part of a concept of 'non-injurious torture'. Other doctors believed in horse-riding, and George Cheyne, who saw melancholia as a particularly English condition, advocated a milk, seed and vegetable diet. Even King George III was subjected to hot irons, enemas and emetics and was chained to his bed in a straitjacket.

1773

Three years before the Declaration of Independence was written, the first mental health hospital in U.S., named Eastern State Hospital, opens in Williamsburg, Virginia in 1773.

Tranquilizer Chair - Benjamin Rush, the ���father of American psychiatry,��� theorized that insanity was caused by ���morbid��� qualities in the blood, leading him to conclude that as much as ���four-fifths of the blood in the body��� should be drawn away; Rush bled one patient 47 times, removing four gallons of blood over time. He also strapped patients horizontally to a board and spun them around at great speeds. He confined others in his ���Tranquilizer Chair' that completely immobilized every part of their body for long periods and blocked their sight with a bizarre wooden shroud, while they were doused in ice-cold water.

Dr. Benjamin Rush, of the Pennsylvania Hospital in Philadelphia, begins pioneering efforts to improve mental health treatment leading him to be known as the ���Father of American Psychiatry.��� Dr. Rush also articulates the concept of alcoholism as a disease and is among the first individuals to prescribe abstinence from alcohol as the sole remedy. As part of his program to improve the care given mental patients admitted to the Pennsylvania Hospital in Philadelphia, Dr. Rush struck at the hearsay, superstition, and ignorance surrounding mental illness. He introduced occupational therapy, amusements, and exercise for patients and saw to it that they had decent, clean quarters. The person most responsible for the early spread of moral treatment in the United States was Benjamin Rush (1745���1813), an eminent physician at Pennsylvania Hospital. He limited his practice to mental illness and developed innovative, humane approaches to treatment. He required that the hospital hire intelligent and sensitive attendants to work closely with patients, reading and talking to them and taking them on regular walks. He also suggested that it would be therapeutic for doctors to give small gifts to their patients every so often. However, Rush's treatment methods included bloodletting (bleeding), purging, hot and cold baths, mercury, and strapping patients to spinning boards and ���tranquilizer��� chairs.

In England a Bill passed the Commons on The Regulation of Private Madhouses, but it was thrown out by the Lords.

1774

One More Proof of the Iniquitous Abuse of Private Madhouses by Samuel Bruckshaw.

In England it became essential to produce a medical certificate confirming insanity before non-pauper lunatics could be confined, but the rights of paupers were totally disregarded. For the wealthy there was still the far more human alternative of being the individual private patient of a doctor or clergyman.

The Case, Petition, and Address of Samuel Bruckshaw, who Suffered a Most Severe Imprisonment, for Very Near the Whole Year, Loaded with Irons, without Being Heard in his Defense, Nay Even without Being Accused, and at Last Denied an Appeal to a Jury. Humbly Offered to the Perusal and Consideration of the Public by Samuel Bruckshaw.

On July 28, 1774, Franz Otto Mesmer, a Viennese doctor stumbled on what may have been a clue to mental illness. He was treating a twenty nine year old woman who suffered from severe episodes of convulsions (beginning with headache, and followed by delerium, vomiting, paroxysms of rage, then a partial paralysis). On this day he tried something new, and brought to her bed three magnets, placing one over each leg and a third heart-shaped one on her stomach. She convulsed�Ķthen was amazingly free of pain! Following a few more treatments her attacks disappeared completely�Ķthough they later returned and further treatment was required. For the most part Mesmer was judged a ���quack��� by his colleagues and accused of fraud. Mesmer's discovery that one man may possess enough power over another to relieve psychic illness led to the knowledge that, with help, man possesses the power within himself to heal himself. In effect, Mesmer mesmerized his patients and helped open the door to psychoanalysis.

1778

Austrian physician Franz Mesmer believed that human bodies contained a magnetic fluid that was affected by the planets and determined one���s health depending on its distribution. Mesmer concluded that all persons were capable of using their own magnetic forces to affect the magnetic fluid in others and considered himself to be powerful enough to cure illnesses with his ���animal magnetism.��� Mesmer gained a large following when he opened a clinic in Paris 1778 and started practicing his ���mesmerism.��� In order to affect cures, several patients at a time were seated around a tub containing various chemicals. Iron rods attached to the tub were applied to the afflicted parts of their body (as patients were generally hysterical and experiencing numbness or paralysis), after which Mesmer would emerge in light purple robe and circle around the room touching the patients either with his hand or with a wand. Although Mesmer���s techniques reportedly were effective, he was branded a fraud by his medical colleagues, and his ���cures��� were later believed to be the result of hypnotism, a psychoanalytic practice

1784

Constructed in 1784, the Lunatics��� Tower in Vienna became a showplace. The elaborately decorated round tower contained square rooms in which the staff lived. The patients were housed in the spaces between the walls of the rooms and the wall of the tower and, like at Bedlam, were put on display for public amusement. When staff did attempt to cure the patients, they followed the practices typical of the time period���purging and bloodletting, the most common. Other treatments included dousing the patient in either hot or ice-cold water to shock their minds back into a normal state. The belief that patients needed to choose rationality over insanity led to techniques aiming to intimidate: blistering, physical restraints, threats, and straitjackets were employed to achieve this end. Powerful drugs (chloryl hydrate, bromides, and barbiturates) were also administered, for example, to a hysterical patient in order to exhaust them.

1785

Under the Enlightened concern of Grand Duke Pietro Leopoldo in Florence, Italian physician Vincenzo Chiarugi instituted humanitarian reforms. Between 1785 and 1788 he managed to outlaw chains as a means of restraint at the Santa Dorotea hospital, building on prior attempts made there since the 1750s. From 1788 at the newly renovated St. Bonifacio Hospital he did the same, and led the development of new rules establishing a more humane regime.

1792

William Tuke (1732-1822), a Quaker tea merchant, founded the Retreat at York. Tuke was the patriarch of a notable Quaker family from York, England. Tuke admired Pinel greatly and followed his ideas, providing an atmosphere of benevolence, comfort and sympathy for his patients. William Tuke's son Henry (1755-1814) and grandson Samuel (1784-1857) continued at York in the same humanitarian spirit.

1793

According to psychiatric legend, French psychologist Phillip Pinel strikes the chains from mental patients held in the Bastille in France. Paris had two madhouses, the Bicetre and the Salpetriere. Conditions were horrific! Crying, screaming depressed men and women lived in damp dungeons without light or air in chains, guarded by convicts who treated them like wild beasts.

Philip Pinel (1745-1826), the leading French psychiatrist of his day, was the first to say that the ���mentally deranged��� were diseased rather than sinful or immoral. In 1793, he removed the chains and restraints from the inmates at the Bicetre asylum, and later from those at Salpetriere. Along with the English reformer William Tuke, he originated the method of ���moral management,��� using gentle treatment and patience rather than physical abuse and chains on hospital patients. Pinel is credited with revolutionizing the Hospitals in France but in fact the humanitarian reforms were begun by Jean-Baptiste Pussin and his wife. Pussin had himself been a patient at the Bicetre, and it became the policy there to choose staff from among recovered or convalescing patients. Pinel described these people as best placed to understand the needs of the inmates as a result of what they themselves had experienced (Peer Support!). Pinel went on to Salpetriere where he carried out similar reforms, establishing a regime of study and medical care to replace the bloodletting, purging and ducking that had previously been used. Chiarugi in Italy as well as Tuke in England independently arrived at the same conclusions at the same time or earlier. The ex-patient Jean-Baptiste Pussin and his wife Margueritte, and the physician Philippe Pinel (1745���1826), are also recognized as the first instigators of more humane conditions in asylums. From the early 1780s, Pussin had been in charge of the mental hospital division of the La Bic��tre, an asylum in Paris for male patients. From the mid 1780s, Pinel was publishing articles on links between emotions, social conditions and insanity. In 1792 (formally recorded in 1793), Pinel became the chief physician at the Bicetre. Pussin showed Pinel how really knowing the patients meant they could be managed with sympathy and kindness as well as authority and control. In 1797, Pussin first freed patients of their chains and banned physical punishment, although straitjackets could be used instead. Patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well-ventilated rooms. Pussin and Pinel's approach was seen as remarkably successful and they later brought similar reforms to a mental hospital in Paris for female patients, La Salpetri��re. Pinel's student and successor, Jean Esquirol (1772���1840), went on to help establish 10 new mental hospitals that operated on the same principles. There was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to refrain from inhumane treatment while being able to stand up to pleading, menaces, or complaining. Pinel used the term ���traitement moral��� for the new approach. ���Moral��� in French had a mixed meaning of both psychological/emotional and moral.

1796

���Address to Humanity, Containing a Letter to Dr. Thomas Monro; a Receipt to Make a Lunatic, and Seize his Estate and a Sketch of a True Smiling Hyena��� by William Belcher.

Founded in 1796, the York Retreat in York, England was run by William Tuke and other Quakers who stressed the importance of treating all people with respect and compassion, even the mentally ill. In keeping faithful to this ideal, the York Retreat was a pleasant country house, modeled on a domestic lifestyle, that allowed patients to live, work, and rest in a warm and religious environment that emphasized mildness, reason, and humanity.

1800���s

At the beginning of the nineteenth century a public outcry about conditions in asylums led to the setting up of a select committee 'to consider of provision being made for the better regulation of madhouses in England'. The report describes appalling conditions of inadequate clothing, cramped and crowded accommodation filthy with excrement on straw, with patients chained to the walls, and in one case, a surgeon who was known to be drunk and insane. As David Stafford-Clark wrote in Psychiatry Today, ���It may seem beyond belief that physicians could contemplate other human beings naked, cold, crusted with their own excrement, chained and starving in the dark on stone floors, without pity and without remorse. But they could, and they did, and it is only by the exertions and the example of exceptional men that our own standards have been raised above this appalling state.��� Asylum staff spent much of their working life locked away with their patients. Husband and wife teams were a feature of asylum organization in the early 19th century, many sharing their home life with their patients. In Britain, one such couple was George and Catherine Jepson at the Retreat in York, and Dr. and Mrs. Ellis at the Hanwell Asylum. Patients who came under these humanitarian regimes were lucky; many more were kept in conditions where fear and cruelty prevailed.

In the first part of the 19th century, a lot of doctors, such as Conolly, Kirkbride, Bucknill, and Daniel Hack Tuke were proud to work in the new asylums. There was also a new endeavor to study insanity. Esquirol in France followed the lead given by Pinel in attempting a classification of mental disorder. A line of successors in France and later in Germany culminated in Emil Kraepelin (1855-1927), a student of Wundt's, who produced a systematic classification of mental disease which forms the basis of modern systems. This is an attempt at grouping by causes as well as by symptoms, and in Kraepelin's work can be seen the merging of two psychological traditions: the experimental and the medical. At the same time growth in populations of asylums mirrored growth in unemployment and poverty following social upheaval caused by industrial revolution. An English Quaker named William Tuke (1732���1819) independently led the development of a radical new type of institution in northern England, following the death of a fellow Quaker in a local asylum in 1790. In 1796, with the help of fellow Quakers and others, he founded the York Retreat, where eventually about 30 patients lived as part of a small community in a quiet country house and engaged in a combination of rest, talk, and manual work. Rejecting medical theories and techniques, the efforts of the York Retreat centered around minimizing restraints and cultivating rationality and moral strength. The entire Tuke family became known as some of the founders of moral treatment. They created a family-style ethos and patients performed chores to give them a sense of contribution. There was a daily routine of both work and leisure time. If patients behaved well, they were rewarded; if they behaved poorly, there was some minimal use of restraints or instilling of fear. The patients were told that treatment depended on their conduct. In this sense, the patient's moral autonomy was recognized. William Tuke's grandson, Samuel Tuke, published an influential work in the early 19th century on the methods of the retreat; Pinel's Treatise On Insanity had by then been published, and Samuel Tuke translated his term as ���moral treatment���.

The 18th century saw the beginning of modern psychology as a separate discipline. The word psychology was used in the first half of the century to mean the secular philosophical analysis and interpretation of mental phenomena. In the latter half of the 19th century its reference shifted from a predominantly philosophic to a predominantly scientific study of mental phenomena. Wilhelm Wundt (1832-1920) is commonly regarded as the founder of scientific psychology. Although other people began experimental psychology earlier, Wundt had the first laboratory for teaching and research in the subject. Alexander Bain (1818-1903) was not an experimenter but wrote two very influential books, The Senses and the Intellect (1855) and The Emotions and the Will (1859). At the same time there were considerable influences from the growing understanding of the physiology of the nervous system.

One development of the late 18th century which had a significant influence on the development of psychological practice was Mesmerism. Franz Mesmer began by using magnets in the belief that they exercised some influence on the human body. He later abandoned this notion, but induced a number of phenomena which are now recognized as suggestion and hypnosis. Others in the 19th century took up mesmerism as an aid to medicine, and it was James Braid who attributed the phenomena to processes within the person, expectations arising from suggestion coupled with a narrowing of attention. An active school of hypnosis developed in Paris under the leadership of Charcot who established a notable neurological clinic at La Salpetriere. His work influenced Ribot who established a psychological laboratory under Beaunis and Binet.

In the closing years of the 19th century several medical psychologists were developing psychogenic theories of the neuroses. Outstanding among them were Pierre Janet (1859-1949) and Sigmund Freud (1856-1939), a pupil and prot��g�� of Charcot. Janet's view was that the neurotic lacked sufficient mental energy to hold his psyche together in a state of integration; as a result parts of it functioned in disassociation from the rest. Freud's view by contrast was that there were diverse mental energies in conflict with one another. Early in the development of his theory he spoke of the sex instincts versus the moral instincts; later of libido versus ego, and finally of eros (life instincts) versus thanatos (death instincts). Freud also proposed three major components to the psyche (strangely translated from German into Latin rather than English by his translators): das Es (the It, or Id) symbolizing instinct or unconscious desire, das Ich (the I, or Ego) and das UberIch (the Upper-I, conscience or Superego). Freud's ideas are the basis for psychoanalytic theory. Although this began as a contribution to psychopathology, it quickly expanded into a more general theory. The interpretation of dreams, the explanation of slips of the tongue and of the pen, and an account of the psychic origins of art, religion and society began with Freud and have become part of everyday currency. Literature and literary criticism, art, morality and religion have all felt this influence.

1801

���The Strange Effects of Faith with Remarkable Prophecies��� by Joanna Southcott

1802

Dorothea Dix, born April 4th in Hampden, Maine, whose devotion to the mentally ill led to widespread reforms in the U.S. and abroad. She left home at 10, was teaching school by 14, and founded a Boston home for girls while still in her teens. She was one of the first Americans to argue that mentally ill people should not be treated as criminals and imprisoned, and she established the first hospitals dedicated to humane treatment of the insane. A Boston schoolteacher, Dorothea Dix (1802���1887), made humane care a public and a political concern in the US. In 1841 Dix visited a local prison to teach Sunday school and was shocked at the conditions for the inmates. She subsequently became very interested in prison conditions and later expanded her crusade to include the poor and mentally ill people all over the country. She spoke to many state legislatures about the horrible sights she had witnessed at the prisons and called for reform. Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment. Many asylums were built on the so-called Kirkbride Plan.

1810

���Madness: Exhibiting a Singular Case of Insanity, and a No Less Remarkable Difference in Medical Opinion: Developing the Nature of Assailment, and the Manner of Working Events; with a Description of the Torture Experienced by Bomb-Bursting, Lobster-Cracking, and Lengthening the Brain��� by John Halsam (ed.)

1811

���A Letter to Dr. R. D. Willis: to Which are Added, Copies of Three Other Letters: Published in the Hope of Rousing a Humane Nation to the Consideration of the Miseries Arising from Private Madhouses: with a Preliminary Address to Lord Erskine��� by Anne Mary Crowe.

1812

Benjamin Rush (1745-1813) became one of the earliest advocates of humane treatment for the mentally ill with the publication of Medical Inquiries and Observations Upon Diseases of the Mind, the first American textbook of psychiatry.

1813

���The Second Book of Wonders��� by Joanna Southcott.

1816

���Early Life of William Cowper��� by Wiliam Cowper.

1817

The American School for the Deaf is founded in Hartford, Connecticut. This is the first school for disabled children anywhere in the Western Hemisphere.

1818

���Bethlehem Hospital��� by Urbane Metcalf.

1823

���Fiction or the Memories of Francis Barnett��� 2 vols. by Francis Barnett.

1825

���A Description of the Crimes and Horrors in the Interior of Warburton's Private Mad-House at Hoxton, Commonly Called Whibmore House��� by John Mitford.

1825

���Part Second of the Crimes and Horrors of the Interior of Warburton's Private Mad-Houses at Hoxton and Bethnal Green and of These Establishments in General with Reasons for Their Total Abolition��� by John Mitford.

1827

���Observations on the Causes, Symptoms, and Treatment of Derangement. Founded on an Extensive Moral and Medical Practice in the Treatment of Lunatics. Together With the Particulars of the Sensations and Ideas of a Gentleman During Mental Alternation, Written by Himself During His Confinement.��� by Paul Slade Knight.

1830

���Narrative of the Treatment Experienced by John Tempest, Esq., of Lincoln's Inn, Barrister at Law during Fourteen Months Solitary Confinement under a False Imputation of Lunacy��� by John Tempest

1832

The Perkins School for the Blind in Boston admits its first two students, the sisters Sophia and Abbey Carter.

1833

���An Account of the Imprisonment and Sufferings of Robert Fuller, of Cambridge, Boston��� by Robert Fuller.

1834

Vermont Asylum for the Insane also known as Battleboro Retreat, founded. Anna Hunt Marsh (birth year unknown, died 1834) established the Vermont Asylum of the Insane in 1834. Marsh was born and raised in Hinsdale, New Hampshire. She was the widow of physician Perley Marsh. She is responsible for the creation of the Brattleboro Retreat, originally known as the Vermont Asylum for the Insane. She was the first woman credited with starting a hospital for the mentally ill. She was responsible for selecting the trustees before her death. A bad healing experience leading to the death of a member of her family has been suggested as an impetus to her idea of creating a humane care option. Her vision was a facility patterned on a Quaker concept called moral treatment. She didn't have much to do with Brattleboro until she died, but her influence is enormous. Upon her death, her will instructed heirs to build a mental hospital in Brattleboro. This was founded in 1834 with her $10,000 bequest. The Brattleboro Retreat grew in popularity and had success treating people with a combination of fresh air, exercise, good food, and other treatments for the ���insane���. Large porches on the buildings allowed patients to sit and read, relax, and recover. As of 2006, the Brattleboro Retreat, now named Retreat Healthcare, is still in operation serving a wide variety of mental conditions. It is a 1000-acre (4 km��) campus of many large buildings, a working farm, and lots of land to explore.

1838

���Scenes in a Mad House��� Boston: Samuel N. Dickinson authored by John Barton Derby who spent time as an inmate of McLean Asylum for a brief period.

���A Narrative of the Treatment Experienced by a Gentleman, During a State of Mental Derangement; Designed to Explain the Causes and the Nature of Insanity, and to Expose the Injudicious Conduct Pursued Towards Many Unfortunate Sufferers Under That Calamity.��� 2 vols. by John Percavel 1838 and 1840 (republished, with an introduction by Gregory Bateson, Stanford, CA: Stanford University Press, 1961).

1840's

The Washingtonians, an organization with the central tenant that 'social camaraderie was sufficient to sustain sobriety,' enlist recovering alcoholics as missionaries to individuals with drinking disorders, thus pioneering the notion of service as a tool of self-help.

Dorothea Dix crusades for asylum reform.

1840

In 1840 there were only eight asylums for the insane in the U.S. Dorothea Dix���s crusading led to establishment or enlargement of 32 mental hospitals, and transfer of the mentally ill from poorhouses and jails.

The first attempt to measure the extent of mental illness and mental retardation in the United States occurred with the U.S. Census of 1840. The census included the category ���insane and idiotic.���

1841

Dorothea Dix, a schoolteacher forced to retire due to her bouts of tuberculousis, begins her work on behalf of people with disabilities incarcerated in jails and poorhouses. A Boston schoolteacher, Dorothea Dix (1802-1887), made humane care a public and a political concern in the United States. In 1841 Dix visited a local prison to teach Sunday school and was shocked at the conditions for the inmates. She subsequently became very interested in prison conditions and later expanded her crusade to include the poor and mentally ill people all over the country. She spoke to many state legislatures about the horrible sights (people were being housed in county jails, private homes and the basements of public buildings) she had witnessed at the prisons and called for reform. Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment. In the mid-nineteenth century Dorothea Lynde Dix was influential in changing conditions in institutions in New England, and in 1881 at 40th anniversary of the Medico-Psychological Association at University College, Daniel Tuke, the president, paid respect to her 'who has a claim to the gratitude of mankind for having consecrated the best years of her life to the fearless advocacy of the cause of the insane'. 

���The Madhouse System��� by Richard Paternoster.

The American Annals of the Deaf begins publication at the American School for the Deaf in Hartford, Connecticut.

1842

���A Sketch of the Life of Elizabeth T. Stone, and of Her Persecution, with an Appendix of Her Treatment and Sufferings While in the Charleston McLean Asylum Where She was Confined Under the Pretence of Insanity.��� Boston: Author; Elizabeth Stone.

���Scene in a Private Mad-House.��� Asylum Journal. 1(1): 1 by Anonymous

1843

���Remarks by Elizabeth T. Stone, upon the Statements Made by H.B. Skinner, in the Pulpit of the Hamilton Chapel, on Sunday Afternoon, 18th of June 1843, in Reference to What She Had Stated Concerning His Being Chaplain in the Charlestown McLean Asylum: and Also a Further Relation on Her Suffering While Confined in That Place for 16 months and 20 days.��� Boston: Author; Elizabeth Stone.

There were approximately 24 hospitals���totaling only 2,561 beds���available for treating mental illness in the United States.

1844

Founding of the American Psychiatric Association (APA). At a meeting in 1844 in Philadelphia, 13 superintendents and organizers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which later became the American Psychiatric Association in 1921. The Association of Medical Superintendents of American Institutions for the Insane included among its tenets:

�Ģ Insanity is a disease to which everyone is liable.

�Ģ Properly and promptly treated, it is about as curable as most other serious diseases.

�Ģ In the majority of cases it is better and more successfully treated in well-organized institutions than at home.

�Ģ Overcrowding is an evil of serious magnitude.

�Ģ The insane should never be kept in penal institutions.

1845

Alleged Lunatics' Friends Society organized by former mental patients in England. This organization is seen as the forerunner of present day advocacy groups. The group lasted until 1863.

The ���Lunacy Act��� is passed concerning running good hospitals.

1846

���The Lily of the West: On Human Nature, Education, the Mind, Insanity, with Ten Letters as a Sequel to the Alphabet; the Conquest of Man, Early Days; a Farewell to My Native Home, the Song of the Chieftain's Daughter, Tree of Liberty, and the Beauties of Nature and Art,��� by G. Grimes, an Inmate of the Lunatic Asylum of Tennessee. Nashville. Grimes, Green.

���A Secret Worth Knowing: A Treatise on the Most Important Secret in the World: Simply to say, Insanity, by G. Grimes, an Inmate of the Lunatic Asylum of Tennessee.��� Nashville: Nashville Union, Grimes, Green.

1847

���Thirty-Two Years of the Life of an Adventurer��� New York: by Drake, John H.

���A Secret Worth Knowing: A Treatise on Insanity, the Only Work of the Kind in the United States or, Perhaps in the Known World: Founded on General Observation and Truth,��� by G. Grimes, an Inmate of the Lunatic Asylum of Tennessee. New York: W. H. Graham. Grimes, Green.

1848

The first residential institution for people with mental retardation is founded by Samuel Gridley Howe at the Perkins Institution in Boston. During the next century, hundreds of thousands of developmentally disabled children and adults will be institutionalized, many for their entire lives. Samuel Gridley Howe told the Massachusetts legislature, ���There are at least a thousand persons of this class who not only contribute nothing to the common stock, but who are ravenous consumers, who are idle and often mischievous, and who are dead weight upon the prosperity of the state.���

���Illustrations of Insanity Furnished by the Letters and Writings of the Insane.��� American Journal of Insanity. 4: 290-308 by Anonymous.

1849

���Five Months in the New York State Lunatic Asylum, by an Inmate.��� Buffalo: L. Danforth by Anonymous

���Mr. Dyce Sombre's Refutation of the Charge of Lunacy Brought Against Him in the Court of Chancer.��� Paris by Dvee Sombre.

1850

���The Ohio Lunatic Asylum.��� The Journal of Psychological Medicine and Mental Pathology. 3: 456-90, by Anonymous.

In the 1850s, Superintendent of Eastern State Lunatic Asylum in Virginia, John Minson Galt, II suggested a day-patient approach similar to the town of Geel (present-day Germany), where patients went into town and interacted with the community during the day and returned to the hospital at night to sleep. The Court of Directors rejected this proposal. The idea was a century ahead of its time and re-emerged as deinstitutionalization in the 1900s. However, Dr. Galt did carry out an experiment with deinstitutionalization in Williamsburg that lasted for a decade. Convalescing patients who behaved well and had good self-control (approximately half of the 280 patients at the time), had the freedom of the town at all times during the day. The townspeople were also encouraged to visit and socialize with patients still confined to the hospital grounds. Many of these changes were a part of a new era called "moral management," brought about due to a change in social perception of mental illness.

1851

In his article, ���Diseases and Peculiarities of the Negro Race,��� Dr. Samuel Cartwright, a highly respected and widely published doctor from the University of Louisiana, discusses two diseases which he claims are unique to African Americans. One is his newly-discovered ���Drapetomania,��� a disease which causes slaves to run away; the other, ���Dysaethesia Aethiopica,��� a disease causing ���rascality��� in black people free and enslaved. Dysaethesia Aethiopica was a mental illness described by Dr. Cartwright that proposed a theory for the cause of laziness among slaves. Today, Dysaethesia Aethiopica is considered an example of scientific racism.

���Autobiography of the Rev. William Walford.��� London by William Walford.

���Astounding Disclosures! Three Years in a Mad House, by a Victim. A True Account of the Barbarous, Inhuman and Cruel Treatment of Isaac H. Hunt, in the Maine Insane Hospital, in the Years 1844, '45, '46 and '47, by Drs. Isaac Ray, James Bates, and Their Assistants and Attendants.��� Skowhegan: The Author. Hunt, Isaac H.

���The Opal Volume 1.��� New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1852

���Startling Facts from the Census,��� was published in the American Journal of Insanity. It argued that slavery kept blacks well, because there was a higher incidence of insanity in Blacks in the North than the South.

���Insanity Among the Colored Population of the Free States��� by Dr. Jarvis. Jarvis writes to ���disabuse any readers mind��� of the information released in ���startling facts from the census���. Jarvis' investigation into the Census actually created what is now called the ���modern census��� as he found the statistics were largely unreliable.

���A Letter from a Patient.��� The Opal ��� A monthly Periodical of the State Lunatic Asylum, Devoted to Usefulness. 2: 245-246. Anonymous. ���The Opal Volume 2.��� New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

���Astounding Disclosures! Three Years in a Mad House, by a Victim. Contains Also: A Short Account of Miss Elizabeth T. Stone in the McLean Asylum at Somerville, Mass. and a Short Account of the Burning of the Maine Asylum, Dec. 4th, 1850.��� Skowhegan: The Author: Hunt, Isaac H.

1853

Invention of the hypodermic syringe, its use to inject morphine to reduce pain rapidly became widespread during the Civil War.

Dorothea Dix is credited for the creation of the first public mental hospital in Harrisburg Pennsylvania.

���Passages from the History of a Wasted Life.��� Boston: Benj. B. Mussey. Middle-Aged Man [pseud.].

���The Opal Volume 3.��� New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1854

Dorthea Dix's diligent work in the 1840's for the humane treatment of people identified as ���mentally ill,��� convinces many states to construct special institutions for the ���mentally ill.��� Legislation was passed at the federal level to provide aid to the states for these mental institutions. President Franklin Pierce felt that it was the states responsibility to ensure the social welfare, not the federal government. He vetoed the Indigent Insane Bill. This was one example of the controversy of who has responsibility, state or federal government. This bill would have provided a grant of land for ���the relief and support of indigent, curable and incurable insane.��� Its passage by Congress was the culmination of more than six years of intense work by Dix and her allies in trying to provide asylums that would emphasize ���moral treatment��� approaches to mental illness. President Pierce, in his veto message, said, ���If Congress has the power to make provisions for the indigent insane, the whole field of public beneficence is thrown open to the care and culture of the federal government. I readily acknowledge the duty incumbent on us all to provide for those who, in the mysterious order of providence, are subject to want and to disease of body or mind, but I cannot find any authority in the Constitution that makes the federal government the great almoner of public charity throughout the United States.���

���A Chapter from Real Life. By a Recovered Patient.��� The Opal ��� A monthly Periodical of the State Lunatic Asylum, Devoted to Usefulness. 4: 48-50. Anonymous. ���The Opal Volume 4.��� New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

���Letters of a Lunatic: A Brief Exposition of My University Life During the Years 1853-1854.��� New York: The Author. Adler, George J.

The New England Gallaudet Association of the Deaf is founded in Montpelier, Vermont.

1855

The first Federal facility, Government Hospital for the Insane opened in Washington, D.C. It was renamed St. Elizabeth���s Hospital in 1916.

���Life in the Asylum.��� The Opal ��� A monthly Periodical of the State Lunatic Asylum, Devoted to Usefulness. 5: 4-6. Anonymous, New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

���Letters to the People on Health and Happiness.��� New York: Harper and Brothers. Beecher, Catherine.

���Two Years and Three Months in the New York Lunatic Asylum at Utica.��� Syracuse: Published by the Author. Davis, Phebe B.

���Scenes from the Life of a Sufferer: Being the Narrative of a Residence in Morningside Asylum.��� Edinburgh. by Anonymous

1856

The Opal Volume 6 New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1857

The Opal Volume 7 New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1858

Henry Knight cut the ribbon on the first institution for Undesirables in Connecticut stating, ���Being consumers and not producers, they are a great pecuniary burden in the state.���

The Opal Volume 8 New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1859

Charles Darwin���s ���Origin of Species��� led to a pessimistic feeling that insanity, instead of being concerned with the will and moral management was a hereditary incapacity, leading to reduced concern for the unfortunate, and a feeling that the mad ought to be locked up.

The Opal Volume 9 New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1860

���The travels and experiences of Miss Phebe B. Davis, of Barnard, Windsor County, VT, being a sequel to her two years and three months in the N.Y. state lunatic asylum at Utica, N.Y.��� by Davis, Phebe. B.

Simon Pollak demonstrates the use of braille at the Missouri School for the Blind.

The Gaffaudet Guide and Deaf Mutes' Companion becomes the first publication in the United States aimed at a disabled readership.

���Seven Months in the Kingston Lunatic Asylum, and What I Saw There,��� by Ann Pratt.

1861

Susan B. Anthony & Elizabeth Cady Stanton ��� ���Could the dark secrets of those insane asylums be brought to light...we would be shocked to know the countless number of rebellious wives, sisters and daughters that are thus annually sacrificed to false customs and conventionalisms and barbarous laws made by men for women.���

Helen Adams Keller is born In Tuscumbia, Alabama.

���The American Godhead: or, the Constitution of the United States Cast Down by Northern Slavery, or by the Power of Insane Hospitals.��� Boston: The Author: Stone, Elizabeth.

���The Opal Volume 10,��� New York: Utica State Lunatic Asylum. Edited by the ���Patients.���

1862

���Statement of Mrs. Lydia B. Denny, Wife of Reuben S. Denny, of Boston, in Regard to Her Alleged Insanity.��� n.p. Denny, Lydia B.

The Veterans Reserve Corps is formed by the U.S. Army. After the war, many of its members join the Freedman's Bureau to work with recently emancipated slaves.

1864

���The Monomaniac, or Shirley Hall Asylum.��� New York: James G. Gregory. Gilbert, William.

The enabling act giving the Columbia Institution for the Deaf and Dumb and Blind the authority to confer college degrees is signed by President Abraham Lincoln, making it the first college in the world expressly established for people with disabilities. A year later, the institution's blind students are transferred to the Maryland Institution at Baltimore, leaving the Columbia Institution with a student body made up entirely of deaf students. The institution would eventually be renamed Gallaudet College, and then Gallaudet University.

���The Exposure on Board the Atlantic and Pacific Car of the Emancipation for the Slaves of Old Columbia�Ķor, Christianity and Calvinism Compared, with an Appeal to the Government to Emancipate the Slaves of the Marriage of the Union.��� Chicago: Author Packard, Elizabeth Parsons Ware.

1865

���Great Disclosure of Spiritual Wickedness!! In High Places with an Appeal to the Government to Protect the Inalienable Rights of Married Women.��� Boston: Author. Packard, Elizabeth Parsons Ware.

1866

Alfred Meyer (1866-1950) believed in living medicine, seeing the patient in his own world. His wife became what was later called a social worker, visiting Meyer's patients to learn more about their home backgrounds. Rather than seeing disturbance as a result of brain pathology he saw it as a reaction or maladjustment involving the total person. He helped to change the hospital's approach from custody to active therapy, and stressed the importance of unhurried conversations with patients.

���Marital Power Exemplified in Mrs. Packard's Trial and Self- Defense from the Charge of Insanity; or, Three Years Imprisonment for Religious Belief, by the Arbitrary Will of a Husband, with an Appeal to the Government to so Change the Laws as to Afford Legal Protection to Married Women.��� Hartford, CT: Case, Lockwood, Packard, Elizabeth Parsons Ware

1867

���Life in a Lunatic Asylum: An Autobiographical Sketch.��� London by Anonymous.

1868

Mrs. Elizabeth Packard, (1816-1897) one of North America's first ex-insane asylum inmate activists, confined from 1860-63 in Illinois State Hospital for the Insane in Jacksonville, Illinois, published the first of several books and pamphlets in which she detailed her forced commitment by her husband in the Jacksonville (Illinois) insane Asylum. Elizabeth Packard was locked up in a state insane asylum in Illinois from 1860 - 1863 because she disagreed with some of her husband's religious views, had different ideas than he did about how to raise their children, and also because she opposed slavery while he was in favor of it. For daring to have such opinions, she spent three years confined as a madwoman.

In a series of publications and numerous public speeches, she recounted what happened to her and why laws and conditions in asylums needed to be changed. Some reports credit her years of work to getting 21-34 laws changed across the United States around these and related matters dealing with inmates' rights. She also visited asylum inmates in various states to offer her personal support. The American Bar Association, in a 1968 report, said that Elizabeth Packard was responsible for changes to commitment laws in Illinois, Iowa and Massachusetts and other states as well. She was crucial to raising public consciousness in North America about the treatment of asylum inmates during the second half of the nineteenth century.

Some publications by Elizabeth Parsons Ware Packard:

* Barbara Sapinsley, ���The Private War of Mrs. Packard���. New York: Paragon House, 1991.

* 'Elizabeth Parsons Ware Packard' in ���Women of the Asylum: Voices from behind the Walls, 1840-1945���, edited by J. Geller and M. Harris. New York: Anchor Books, 1994: pages 58-68.

���Before I entered an insane asylum and learned its hidden life from the standpoint of the patient, I had not supposed that the inmates were outlaws, in the sense that the law did not protect them in any of their inalienable rights.��� ��� Elizabeth Packard

She also founded the Anti-Insane Asylum Society in Illinois in 1868 (which apparently never became a viable organization) based on her experience of commitment in an Illinois Asylum. Her husband committed her because her religious beliefs were different than her,

From: Psychiatric News December 7, 2001

http://pn.psychiatryonline.org/cgi/content/full/36/23/40

Volume 36 Number 23

�� 2001 American Psychiatric Association

p. 40

History Notes

Pioneer for Patients��� Rights

By Lucy Ozarin, M.D.

While Dorothea Dix was pleading with state legislators in the mid-19th century to establish asylums for the mentally ill, Elizabeth Packard was engaged in a nationwide campaign to protect to the inmates of those asylums.

Mrs. Packard, the wife of a Presbyterian clergyman in Monteno, Ill., and mother of six children, was summarily committed in 1860 to the asylum in Jacksonville, Ill. At that time, Illinois law stated that ���married women with infants who in judgment of the medical superintendents of the state asylums are evidently insane or distracted may be detained at the request of the husband or guardian without the evidence of insanity required in other cases.���

Mrs. Packard remained in the asylum for three years. She claimed her husband put her there because her liberal theological views differed from his Calvinist theology. She finally obtained a hearing before the asylum trustees, who ordered the asylum superintendent to return her to her husband. He subsequently locked her up in their home.

Learning that her husband was planning to have her committed to the Northhampton asylum in her native Massachusetts, Mrs. Packard smuggled a note to a friend who obtained a writ of habeus corpus from a local judge, and a jury trial over the issue followed. She was declared sane and then moved to her father���s house in Massachusetts, where she began a campaign against what she termed excesses of the asylums.

She published three books, which had extensive circulation and sales. (Copies of the books are in the APA Library Rare Books Room.)

The title page of the first book, published in 1866, reads: ���Marital Power Exemplified in Mrs. Packard���s Trial and Self Deferral from the Charge of Insanity or Three Years Imprisonment for Religious Belief by the Arbitrary Will of a Husband with an Appeal to the Government to Change the Laws as to Afford Protection to Married Women.���

The second book, which was published in 1868, was titled The Prisoner���s Hidden Life or Insane Asylums Unveiled as Demonstrated by the Investigating Committee of the Legislature of Illinois Together with Mrs. Packard Coadjutor���s Testimony.

The third book, which came out in 1869, Modern Persecution or Insane Asylums Unveiled, recounted the experiences of patients whom Mrs. Packard met while she was in the asylum.

Having succeeded in arousing considerable public interest, Mrs. Packard fought for laws that would protect women���s rights regarding commitment, and she also championed a personal liberty bill, which the Illinois legislature passed in 1869. That law required a jury trial for before a person could be committed to an asylum, and it remained in effect for 25 years. Iowa enacted a similar law in 1872, and the Massachusetts legislature also took similar steps to safeguard the rights of patients.

Mrs. Packard���s campaign helped to mobilize sufficient public interest and support so that in 1880, a group of influential citizens and social reformers organized the National Society for the Protection of the Insane and the Prevention of Insanity. The society disbanded in 1886. Albert Deutsch, in his book The Mentally Ill in America, cites the unremitting antagonism of the National Association of Medical Superintendents of American Institutions for the Insane (forerunner of the American Psychiatric Association) as helping bring about the demise of the organization.

A long, unsigned editorial in the October 1869 issue of the American Journal of Insanity (now the American Journal of Psychiatry), presumably written by the editor, Dr. John Gray, superintendent of the Utica (N.Y.) State Hospital, begins, ���For the last two or three years, the state of Illinois has been singularly under the influence of a handsome and talkative crazy woman and of a Legislature prompted by her to be crazy on at least one point,��� and ���an attractive person and a double-springed tongue gave force and persuasion to the direful romance of this fascinating woman, and she was successful enough, by her feminine arts, to bewitch a whole legislature.���

Dr. Gray portrayed Mrs. Packard as a crazy but fascinating (sexy?) woman, but perhaps she was an early feminist seeking the rights of women in a male-dominated society. Whichever was the case, she was quite successful.

On June 18, 1860, Mrs. Elizabeth Parsons Ware Packard was abducted on her husband���s orders and taken to the insane asylum in Jacksonville, Illinois, where she spent the next three years. After she was released, she wrote profusely. In one volume, Modern Persecution or Insane Asylums Unveiled, she detailed her experiences during that time. For the first four months of my prison life, Dr. McFarland treated me himself, and caused me to be treated with all the respect of a hotel boarder, so far as lay in his power. As to medical treatment, I received none at all, either from himself, or his subordinates. And the same may be said with equal truth, of all the inmates. This is the general rule; those few cases where they receive any kind of medical treatment, are the exceptions. 0A little ale occasionally is the principal part of the medical treatment which these patients receive, unless his medical treatment consists in the ���laying on of hands,��� for this treatment is almost universally bestowed. But the manner in which this was practiced, varied very much in different cases. For the first four months the Doctor ���laid his hands��� very gently upon me, except that the pressure of my hand in his was sometimes quite perceptible, and sometimes, as I thought, longer continued than this healing process demanded! �ĶBut after these four months he laid his hands upon me in a different manner, and as I then thought and still do think, far too violently. There was no mistaking the character of these grips���no duplicity after this period, rendered this modern mode of treatment of doubtful interpretation to me. [The eighth] ward was then considered the worst in the house, inasmuch as it then contained some of the most dangerous class of patients, even worse than the fifth in this respect, and in respect to filth and pollution it surpassed the fifth at that time. It is not possible for me to conceive of a more fetid smell, than the atmosphere of this hall exhaled. An occupant of this hall would inevitably become so completely saturated with this most offensive effluvia that the odor of the eighth ward patients could be distinctly recognized at a great distance, even in the open air. I could, in a few moments after the Doctor put me in among them, even taste this most fetid scent at the pit of my stomach. Even our food and drink were so contaminated with it, we could taste nothing else sometimes. It at first seemed to me, I must soon become nothing less than a heap of putrefaction. But I have found out that I can live, move, breathe, and have a being, where I once thought I could not! The patients were never washed all over, although they were the lowest, filthiest class of prisoners. They could not wait upon themselves any more than an infant, in many instances, and none took the trouble to wait upon them. The accumulation of this defilement about their persons, their beds, their rooms, and the unfragrant puddles of water through which they would delight to wade and wallow, rendered the exhalations in every part of the hall almost intolerable. One night I was aroused from my slumbers by the screams of a new patient who was entered in my hall. The welcome she received from her keepers, Miss Smith and Miss Bailey, so frightened her that she supposed they were going to kill her. Therefore, for screaming under these circumstances, they forced her into a screen-room and locked her up. Still fearing the worst, she continued to call for ���Help!��� Instead of attempting to soothe and quiet her fears, they simply commanded her to stop screaming. But failing to obey their order, they then seized her violently and dragged her to the bathroom, where they plunged her into the bathtub of cold water. This shock so convulsed her in agony that she now screamed louder than before. They then drowned her voice by strangulation, by holding her under the water until nearly dead. When she could speak, she plead in the most piteous tones for ���Help! Help!��� But all in vain. The only response was ���Will you scream any more?��� She promised she would not, but to make it a thorough ���subduing,��� they plunged her several times after she had made them this promise! My room was directly opposite with open ventilators over both doors, I could distinctly hear all. This is what they call giving the patient a ���good bath!��� But the bewildered, frightened stranger finds it hard to see the ���good��� part of it. The patient was then led, wet and shivering, to her room, and ordered to bed with the threat, ���If you halloo again, we shall give you another bath.���

Similarly, in Massachusetts at about the same time, Elizabeth Stone, also committed by her husband, tried to rally public opinion to the cause of stopping the unjust incarceration of the ���insane.���

���Two years and four months in a lunatic asylum: From August 20th, 1863 to December 20th, 1865.��� Saratoga Springs, NY: Van Benthuysen and Sons. Chase, Harim

���Mrs. Olsen���s Narrative of her One Year���s Imprisonment at Jacksonville Insane Asylum.��� Appended to ���The Prisoner���s Hidden Life or Insane Asylums Unveiled.��� Elizabeth Packard. Chicago: Author. Olsen, Sophie.

���The Prisoner���s Hidden Life; or, Insane Asylums Unveiled.��� Chicago: Author. Packard, Elizabeth Parsons Ware.

1869

Central State Hospital in Virginia was established in 1869 exclusively for ���colored insane.���

The first wheelchair patent is registered with the U.S. Patent Office.

���The Life and Travels of Benjamin S. Snider: His Persecution, Fifteen Times a Prisoner.��� Washington: The Author, Snider, Benjamin S.

1870

���Lunatic Asylums: Their Use and Abuse.��� New York. Titus, Mrs. Ann H.

���Narrative of a Pilgrim and Sojourner on Earth, from 1791 to the Present Year, 1870,��� by Louisa Perina Courtauld Clemens.

1871

���Behind Bars.��� Boston: Lee & Shepard. Lunt, Adeline T.P.

1872

Clitoridectomies are performed in association with women���s mental disorders.

���My Outlawry, A Tale of Madhouse Life.��� London, by Louisa Lowe

���Report of a Case Heard in Queen's Bench, November 22nd, 1872, Charging the Commissioners in Lunacy with Concurring in the Improper Detention of a Falsely-Alleged Lunatic and Wrongfully Tampering with her Correspondence.��� London by Louisa Lowe.

���How an Old Woman Obtained Passive Writing and the Outcome Thereof.��� London, by Louisa Lowe

���A Nineteenth Century Adaptation of Old Inventions to the Repression of New Thoughts and Personal Liberty.��� London, by Louisa Lowe

���Gagging in Madhouses as Practised by Government Servants in a Letter to the People, by one of the Gagged.��� London, by Louisa Lowe

���The Lunacy Laws and Trade in Lunacy in a Correspondence with the Earl of Shaftesbury.��� London, by Louisa Lowe

1873

���Modern Persecution; or Insane Asylums Unveiled.��� Hartford: Author: Packard, Elizabeth Parsons Ware.

1874

The Woman���s Christian Temperance Union (WCTU) ��� the first national organization composed of community-based groups ��� was founded and focused on the problems that alcohol caused families and society.

Opening its doors, the Athens Lunatic Asylum welcomed its first patient in 1874. This state-of-the-art mental hospital was based on the design of renowned architect Thomas Kirkbride and embraced the current societal trends toward institutionalizing the insane. The hospital began as a type of long- term care for those not easily accepted or able to function in society. The typical meaning of ���asylum��� at the time was a safe haven with little likelihood of departure.

���Ten Years and Ten Months in Lunatic Asylums in Different States.��� Hoosick Falls: The Author, Swan, Moses

1875

North Carolina General Assembly appropriated $10,000 to build a ���colored insane asylum���

1876

���A Mad World and Its Inhabitants.��� New York: Appleton by Chambers, Julius

���Lunatic Asylums: and How I Became an Inmate of One.��� Chicago: Ottaway and Colbert, Metcalf, Ada.

1877

���Am I a Lunatic? Or, Dr. Henry T. Helmbold's Exposure of his Personal Experience in the Lunatic Asylums of Europe and America.��� New York: Helmbold, Henry

1878

���The History of My Orphanage, or the Outpourings of an Alleged Lunatic.��� London by Georgina Weldon.

Joel W. Smith presents his Modified Braille to the American Association of Instructors of the Blind. The association rejects his system, continuing to endorse instead New York Point, which blind readers complain is more difficult to read and write. What follows is a ���War of the Dots��� in which blind advocates for the most part prefer Modified Braille, while sighted teachers and administrators, who control funds for transcribing, prefer New York Point.

���The Mystic Key; or The Asylum Secret Unlocked.��� Hartford: Author, Packard, Elizabeth Parsons Ware.

1879

Wilhelm Wundt established the first formal psychological laboratory at the University of Leipzig in Germany where he introduced a scientific approach to psychology and performed many experiments to measure peoples' reaction time. This event is considered the birth of psychology.

���A Sketch of Psychiatry in Southern States.��� Presidential Address, American Medico-Psychological Association.Baltimore. Powell,T.O.

���Behind the Scenes; Or, Life in an Insane Asylum.��� Chicago: Culver. Smith, Lydia Adeline Jackson Button; Hoyne and Co.

���My Experience in a Lunatic Asylum, by a Sane Patient.��� London by Charles Herman Merivale

1880

The Eastern Asylum for the Colored Insane was opened with accommodations for four hundred and twenty patients.

The International Congress of Educators of the Deaf, at a conference in Milan, Italy, calls for the suppression of sign languages and the firing of all deaf teachers at schools for the deaf. This triumph of oralism, is seen by deaf advocates as a direct attack upon their culture.

The National Convention of Deaf Mutes meets in Cincinnati, Ohio, the nucleus of what will become the National Association of the Deaf (NAD). The first major issue taken on by the NAD is oralism and the suppression of American Sign Language.

���A Blighted Life: A True Story.��� (orig. pub. 1880; reprinted, Bristol: Thoemmes Press, 1996) by Bulwer Rosina Lytton.

1881

At the 40th anniversary of the Medico-Psychological Association at University College, Daniel Hake Tuke, the president, paid respect to Dorthea Dix, 'who has a claim to the gratitude of mankind for having consecrated the best years of her life to the fearless advocacy of the cause of the insane.���

1882

���An Insight into an Insane Asylum.��� Louisville, KY: The Author, Camp, Joseph.

���How I Escaped the Mad Doctors.��� London by Georgina Weldon.

1883

Sir Francis Galton in England coins the term eugenics, in his book ���Essays in Eugenics,��� to describe his pseudo-science of ���improving the stock��� of humanity. The eugenics movement, taken up by Americans, leads to passage in the United States of laws to prevent people with various disabilities from moving to this country, marrying, or having children. In many instances, it leads to the institutionalization and forced sterilization of people with disabilities or poor people, including children. Eugenics campaigns against people of color and immigrants led to passage of ���Jim Crow��� laws in the South and legislation restricting immigration by southern and eastern Europeans, Asians, Africans, and Jews. The U.S. eugenics movement was a key inspiration for Nazi Germany's similar programs to segregate and sterilize mentally disabled people, and German scientists even traveled to California to study our program of forced sterilization.

Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and schizophrenia holds to this day.

Phenothiazines developed as synthetic dyes.

���A Checkered Life.��� Chicago: S. P. Rounds by Joyce, John A.

���The Bastilles of England; or The Lunacy Laws at Work.��� London by Louisa Lowe.

���The Memorial Scrapbook; A Combination of Precedents.��� Boston: Pennell, Lemira Clarissa.

1884

���A Palace Prison; or, The Past and the Present.��� New York: Fords, Howard & Hulbert Anonymous.

���Another Section of the ���M.S.B.������ by L.C.P.

���A Boomerang for a Swarm of B.B.B.���s.��� Boston: Pennell, Lemira Clarissa

1885

Virginia established an asylum for the ���colored insane��� in Petersburg.

���The Right Spirit.��� Buffalo, NY: Courier by Cottier, Lizzie D.

���Prospectus of Hospital Revelations; How Opinions Vary.��� Pennell, Lemira Clarissa

���Twenty-Five Years with the Insane.��� Detroit: John MacFarlane. Putnam, Daniel.

���The Autobiography of Mark Rutherford.��� New York: Dodd, Mead. Rutherford, Mark.

1886

���Psychopathia Sexualis��� by German psychiatrist Richard von Krafft-Ebing creates the terms ���sadism��� and ���masochism��� and thereby claims for psychiatry the right to determine the socially acceptable bounds of sexuality. Krafft-Ebing and other psychiatrists spelled out what they considered to be normal, healthy sexuality and correspondingly postulated that practitioners of sadism or masochism were abnormal psychopaths or sexual deviants. Despite any scientific evidence to support them, these claims became part of popular western culture.

���From Under the Cloud or, Personal Reminiscences of Insanity.��� Cincinnati: Printed by Robert Clarke for the Author. Agnew, Anna. This Red Book is Partly a Reprint of What Was Published in 1883, and Later.

���And Earlier Letters from Prominent Men. Instructions to Dr. Harlow from Springfield, His Letters from the Hospitals, and Much Else.��� Boston: n.p.. Pennell, Lemira Clarissa

1887

Dorothea Dix dies. She was an activist and reformist for improving the environments and conditions of lunatic asylums. She is credited with the establishment of dozens of institutions.

���Ten Days in a Madhouse; or, Nellie Bly���s Experience on Blackwell���s Island. Feigning Insanity in Order to Reveal Asylum Horrors.��� New York: Norman L. Munro by Bly, Nellie. (Elizabeth Cochrane). It was rare for a woman to hold a job in the 19th century. It was even rarer for one to work at as a newspaper reporter ��� and rarer still to have that paper send her undercover, to expose the brutality and neglect within a New York mental institution. But in 1887, that's exactly what Nellie Bly did. Bly had herself involuntarily committed to the Blackwell's Island Insane Asylum for ten days. (She checked into a women's boarding facility, acted erratically, and then allowed the all-too-eager boarding house employees to call the loony bin). After gaining entrance to the facility, the 23-year-old reverted back to a normal, sane pattern of behavior and tried to get them to release her. ���Yet strange to say, the more sanely I talked and acted the crazier I was thought to be,��� she wrote in her series of articles for the New York World. Bly recounted stories of spoiled food, nurses who kept patients awake all night, ice cold baths, beatings and forced feedings. The articles aroused public outcry, brought on much needed political reform, and were so popular that Bly turned them into a book, called Ten Days in a Mad-House (which is still in print).

���Life Among the Insane.��� North American Review. 144: 190-199 by Brinkle, Andrianna P.

���The Life Story of Sarah Victor.��� Cleveland: Williams Victor, Sarah M.

1888

���Hospital Revelations.��� Pennell, Lemira Clarissa

Anne Sullivan meets Helen Keller for the first time in Tuscumbia, Alabama.

���Hospitals for the Insane. Viewed from the Standpoint of Personal Experience, by a Recovered Patient.��� Alienist and Neurologist. 9: 51-57. Rutz-Rees, Janet E.

1889

���An Explanation to the Public as to Why Mrs. Lemira Clarissa Pennell Was Confined in the Insane Hospital and the Portland Poor House.��� Augusta, Maine: n.p.. Pennell, Lemira Clarissa

1890

Dr. Gottlieb performed partial lobotomies on six patients of a psychiatric hospital in Switzerland. He drilled holes into their heads and extracted sections of their frontal lobes. One died after the operation, and another was found dead in a river 10 days after release.

New York passes ���The State Care Act��� that fosters state responsibility for mental health services.

The 1890 Lunacy Act was very different from the 1845 Lunacy Act, which was about running good hospitals; the 1890 Act was about locking people up. At the same time advances in general medical knowledge from strict attention to pathology and bacteriology led to a search for organic causes of mental distress, and the doctors in the asylums, instead of going out and playing cricket with patients, began to spend their time on research instead in the hope of finding the causes of the conditions they were treating, by for example dissecting the brains of deceased patients.

���A Secret Institution.��� New York: Bryant Publishing Co. Lathrop, Clarissa Caldwell.

���New Horrors��� by Pennell, Lemira Clarissa

1891

In Robert Burton���s synopsis of the causes of melancholy he lists god, devil, witches and magicians.

���Madhouses of America.��� Cohoes: New York. Trull, William L.

1892

American Psychological Association (APA) founded.

���The Yellow Wallpaper.��� New England Magazine. 5(5) 647-56. Gilman, Charlotte Perkins.

���The Great Drama; or, the Millennial Harbinger.��� Hartford: Author; Packard, Elizabeth Parsons Ware.

1893

���Three Years in a Mad House.��� Chicago: Donohue, Henneberry Fleming, E. G.

1896

Dementia praecox is first diagnosed.

���The Confessions of a Nervous Woman.��� Post Graduate Monthly. Journal of Medicine and Surgery. 11: 364-368. Anonymous.

1897

Dr. T.O. Powell reported that the Alabama facility had about three hundred and Ԩ�fty African-American patients. The facility maintained a ���colony��� of one hundred African-American men about two miles from the main facility.

1898

���Transactions of the Antiseptic Club.��� New York: E.B. Treat. Abrams, Albert.

���A Madman's Musings: Being a Collection of Essays Written by a Patient During His Detention in a Private Madhouse.��� London by Anonymous.

1899

���Professor Hieronymous��� (trans. from 1895 Norwegian ed.), London by Bertha Amalia Skram.

���Experience of a Criminal��� by A. Telso.

1900's

Progressive activists push for the creation of state Workers' Compensation programs. By 1913, some 21 states have established some form of Worker's Compensation; the figure rises to 43 by 1919.

First institutions to treat addiction as a medical problem ��� i.e. early treatment centers ��� are created. There will be two major developments in psychology: Gestalt theory or a holistic approach, and behaviorism or stimulus-response theory. These two approaches begin to merge in the techniques of cognitive behavioral therapy which is increasingly practiced in the 21^st Century. In the 20th century the search for organic causes and treatments for mental health problems, continued, spurred on by the successful identification and treatment of conditions such as phenylketonuria and thyroid conditions. The observation of changes in emotional state in people treated for other conditions ��� for example the anti-depressant effect of iproniazid for tuberculosis ��� began the continuing search for biochemical treatments for every kind of mental state.

The end of the 19th century and beginning of the twentieth, patients suffering from neurosyphilis were found to improve after infections, supposedly because the heat of the fever killed the infective agent that caused syphilis. So fever treatment was given, using first tuberculin injections and, later, infected blood from malaria patients. The malaria was treated with quinine. Later on, syphilis was treated with arsenic compounds, and then, from the 1940s, with penicillin, before this stage was reached, and neurosyphilis was no longer seen.

Early in the 20th century, the ���mental hygiene��� movement came into being, due largely to the efforts of Clifford Beers in New England. A former mental patient, Beers shocked readers with a graphic account of hospital conditions depicted in his famous book, ���A Mind that Found Itself.���

The inspection of immigrants at Ellis Island included screening to detect the mentally disturbed and retarded among the thousands of men, women, and children arriving daily. The high incidence of mental disorders found among the immigrants prompted public recognition of mental illness as a national health problem.

Other psychotic illnesses were, and of course still are, less easy to treat because their cause is not known. Sedatives, in the form of alkaloids such as morphine (an opium derivative), hyoscyamus (derived from the plant henbane, and from which hyoscine was derived), and chloral hydrate, which is still available as a sleeping drug today. Intravenous and intramuscular injections of morphine began in the mid-nineteenth century. Some cases of mania were treated with apomorphine mixed with hyoscine to make them vomit, which wore them out and hence had a calming effect. For a while bromide was fashionable, and this led to the development of deep sleep treatment. This involved inducing prolonged sleep, for days at a time, disturbing the patient every few hours just enough to give them some nourishment and toilet them. After the long period of sleep, patients would apparently wake with their psychotic symptoms resolved. Later it was also used for mood disorders, and people were thought to wake up in a state more amenable to psychotherapy. When bromide was deemed too toxic, it was replaced with barbiturates, the most popular of which was Veronal. Deep sleep treatment continued to be used until the 1960s by which time it was discredited, although it has been suggested more recently as a way of getting heroin addicts through cold turkey.

Other physical treatments used in the 20th century include insulin coma therapy in which patients were given insulin to induce a coma and convulsions, and then brought round with glucose injections. Camphor injections were also used to induce fits in the 1930s, and had been used to treat psychosis during the eighteenth century. Fits were also induced with drugs including metrazol.

Psychosurgery (lobotomy) was used in the mid-20th century with an enthusiasm verging on abandon, and an appalling level of technical crudeness. A refined version is still practiced on a small number of patients.

In the 1st World War the treatment of shell shock with talking therapies by psychiatrists such as William Rivers led eventually to treatment for what is now called post traumatic stress disorder, with debriefing for victims of traumatic incidents such as hostages, and eventually to the regular provision of counseling for survivors of traumatic incidents. But some soldiers were treated by people such as Lewis Yealland at the National Hospital for Nervous Diseases, who used electric shock treatment - techniques that were nothing short of torture, but as effective in achieving their immediate goal as torture often is.

The approach to traumatic stress in the 2nd World War was a spur to the evolution of group therapy by people such as Wilfred Bion and Foulkes.

1900

Sigmund Freud presented his concepts of psychoanalysis in a publication entitled ���The Interpretation of Dreams.��� The Interpretation of Dreams revolutionizes psychiatric theory and practice. He is the first to use the unconscious to treat psychiatric illness in patients by using 'psychoanalysis' - free association and interpretation of dreams.

Inspection of immigrants at Ellis Island included screening to detect the ���mentally disturbed and retarded���. The high incidence of mental disorders among immigrants prompted public recognition of mental illness as a national health problem.

1901

Charles Woodruff explained intellectual superiority of northern European Christians with essay on civilization & brain development. July, American Journal of Insanity.

The National Fraternal Society of the Deaf is founded by alumni at the Michigan School for the Deaf in Flint. It becomes the world's only fraternal life insurance company managed by deaf people. Through the first half of the century, it advocates for the rights of deaf people to purchase insurance and to obtain drivers' licenses.

1902

Helen Keller, the first deaf-blind person to matriculate at college, publishes her autobiography, The Story of My Life, in a serial 1903 form in Ladies' Home journal in the latter part of 1902, as a book in 1903.

���Inferno��� (trans. M. Sandbach), London by August Strindberg.

1904

Clitoridectomies performed in association with women���s mental disorders.

1905

Sigmund Freud's Three Essays on the Theory of Sexuality describes the stages of sexual development and explains the effects of infantile sexuality on sexual dysfunction.

Bernard Sachs, author of ���A Treatise on the Nervous Diseases of Children��� recommends that masturbation in children be treated by cautery to the spine and to the genitals. Cauterize is to burn, sear or destroy tissue.

���Spiritual Adventures,��� London by Arthur Symons.

1906

Preventive legislation was needed to curb the increasing dependence on the drugs in patient medicines; the Federal Food and Drug Act of 1906 removed narcotics from those products.

���The Lunacy Law of the World: Being that of Each of the Forty-Eight States and Territories of the United States, with an Examination Thereof and Leading Cases Thereon; Together with that of the Six Great Powers of Europe���Great Britain, France, Italy, Germany, Austria-Hungary, and Russia.��� Roanoke Rapids, NC. by John Armstrong Chaloner.

1907

The first issue of the Matilda Ziegler Magazine for the Blind is published.

���The House of Quiet,��� by Arthur Christopher Benson.

1908

The word schizophrenia���which translates roughly as ���splitting of the mind��� and comes from the Greek roots schizein (�ɦ�ؑ�������, ���to split���) and phr��n, phren- (�ܦőƑ�, �ܦő���-, ���mind���)���was coined by Eugen Bleuler in 1908 and was intended to describe the separation of function between personality, thinking, memory, and perception. Bleuler described the main symptoms as 4 A's: flattened Affect, Autism, impaired Association of ideas and Ambivalence. Bleuler realized that the illness was not a dementia as some of his patients improved rather than deteriorated and hence proposed the term schizophrenia instead.

Clifford Beers (1876-1943) publishes ���A Mind That Found Itself,��� an account of physical, emotional and sexual abuse he witnessed as a patient inside state and private mental institutions. The Mind That Found Itself, an account of his experience as a mental patient in a Connecticut mental institution which vividly describes the cruelty that was the norm of institutional care. This work promotes the founding of the mental hygiene movement in the United States. He had spent some time in a psychiatric hospital as a patient after throwing himself out of a fourth floor window believing he may have a brain tumor like his brother. He started the Clifford Beers Clinic in New Haven in 1913. It was the first outpatient mental health clinic in the United States. Beers was one of the biggest supporters of the eugenics movement in America, which also flourished in Germany during the early part of the Twentieth Century. Since the postwar period, both the public and the scientific community has generally associated eugenics with Nazi abuses, which included enforced racial hygiene, human experimentation, and the extermination of undesired population groups. Developments in genetic, genomic, and reproductive technologies at the end of the 20th century however, have raised many new questions and concerns about what exactly constitutes the meaning of eugenics and what its ethical and moral status is in the modern era.

1909

The New York Public School System adopts Modified, or American Braille for use in its classes for blind children, after public hearings in which blind advocates call for abandoning New York Point.

The first folding wheelchairs are introduced for people with mobility disabilities.

The National Committee for Mental Hygiene is founded by Clifford Beers in New York City. This was the forerunner of the National Mental Health Association (NMHA) (now named Mental Health America (MHA)).

Sigmund Freud visited America and lectured on psychoanalysis at Clark University in Worcester, Massachusetts.

���A Man Remade: Or, Out of Delirium's Wonderland,��� by Charles Roman.

���My Life as a Dissociated Personality,��� by B.C.A. (with an introduction by Morton Prince, MD).

���The Maniac: A Realistic Study of Madness from the Maniac's Point of View,��� by E. Thelmer.

1910

Emil Kraepelin first describes Alzheimer's Disease.

���Autopsychology of the Manic-Depressive,��� Journal of Nervous and Mental Diseases. 37: 606-20. by Eva Charlotte Reid.

���The Autobiography of a Neurasthenic,��� by M. A. Cleaves.

���Legally Dead: Experiences During Seventeen Weeks' Detention in a Private Asylum.��� London, By Marcia Hamilcar

1911

The state of Maryland opened its hospital for the colored insane near Crownsville, MD.

Eugen Bleuler, a Swiss psychiatrist, popularizes the term 'schizophrenia' in his book, ���Dementia Praecox or the Group of Schizophrenias.��� He writes that dementia praecox patients do not always develop dementia but instead, 'schizophrenia.' The cure for dementia praecox is said to be found in the restoration to consciousness of certain memories, and the illness is renamed schizophrenia.

Congress passes a joint resolution (P.R. 45) authorizing the appointment of a federal commission to investigate the subject of workers' compensation and the liability of employers for financial compensation to disabled workers.

1912

���The Kadikak Family��� by Henry H. Goddard was a best selling book. It proposed that disability was linked to immorality and alleged that both were tied to genetics. It advanced the agenda of the eugenics movement. ���The Threat of the Feeble Minded��� (pamphlet) created a climate of hysteria allowing for massive human rights abuses of people with disabilities, including institutionalization and forced sterilization.

���Eight and One-Half Years in Hell,��� by Cyrus S. Turner.

���Autobiography of Roosevelt's Adversary,��� by James Fullerton

���Remembrances of a Religio-Maniac,��� Stratford-on-Avon, UK. by D. Davidson.

���Thy Rod and Thy Staff,��� London by Arthor Christopher Benson.

1914

The Harrison Act of was the first effort toward making it impossible for people with addictions to legally obtain drugs.

���Psychoanalytic Review��� published 3 articles on blacks about their inability to work a job connected to mental disorders.

���Who's Looney Now?��� by John Armstrong Chaloner.

1915

���My Last Drink,��� by Joseph H. Francis.

1917

The Smith-Hughes Vocational Education Act became law.

Physiologic Shock Treatments using Malaria-Induced Fever began. The Austrian psychiatrist Julius von Wagner-Jauregg uses malaria-induced fever to cause remission in patients with slight or incomplete paralysis (also called dementia paralytica).

Alfred Adler establishes the school of individual psychology and becomes the first psychoanalyst to challenge Freud. He coins the terms 'lifestyle' and 'inferiority complex' in his book, Study of Organ Inferiority and Its Psychical Compensations.

���A Diary of Human Days,��� by Mary MacLane

1918

The Smith-Sears Veterans Rehabilitation Act provided for the promotion of vocational rehabilitation and return to civil employment of disabled persons discharged from U.S. military. The Smith-Sears Veterans Vocational Rehabilitation Act establishes a federal vocational rehabilitation for disabled soldiers.

There are now 22 recognized categories of mental illness.

The American Psychoanalytic Association ruled that only individuals who have completed medical school and a psychiatric residency can become candidates for psychoanalytic training.

1919

Rusk State Penitentiary in Texas was turned into a hospital for the ���Negro insane.���

���Confessions of an Agoraphobic Victim.��� American Journal of Psychology. 30: 295-299, by Vincent.

���An Autobiography,��� by George Fox

1920

The 18th Amendment, ratified in 1920, prohibits the manufacture, sale, or transportation of intoxicating liquors.

The Smith-Fess Vocational Rehabilitation Act provided for the promotion of vocational rehabilitation of persons disabled in industry. The Fess-Smith Civilian Vocational Rehabilitation Act is passed, creating a vocational rehabilitation program for disabled civilians. The United States Office of Vocational Rehabilitation was established. National Vocational Rehabilitation Act of 1920 - Established state/federal system of rehabilitation services.

Harry Stack Sullivan's ward for schizophrenic patients at Sheppard-Pratt Hospital demonstrates the impact of a therapeutic milieu when patients are able to be returned to the community.

���A Thousand Faces,��� by Florence S. Thompson and George W. Galvin.

���The story of Opal ��� the journal of an understanding heart.��� The Atlantic Monthly Press by Opal Whitley.

1921

The U.S. Veterans Bureau was established (later known as the Department of Veterans Affairs).

The American Foundation for the Blind is founded. Helen Keller becomes its principal fund raiser, (Robert Irwin becomes director of research, 1922 executive director in 1929.)

The Association of Medical Superintendents of American Institutions for the Insane (AMSAII) becomes the American Psychiatric Association.

1922

Narcotic Drug Import and Export Act also called the Jones-Miller Act. Increased penalties and further restricted the import and export of opium and coca.

���The Experiences of an Asylum Patient,��� London, by Rachel Grant-Smith.

1923

���Daughters of Fire: Sylvia���Emilie���Octavie��� (trans. from 1862 French ed.). London, by Gerard Labrunie [Gerard De Nerval].

���From Harrow School to Herrison House Asylum,��� London, by Harald Hewitt.

1924

The Commonwealth of Virginia passed a state law that allowed for sterilization (without consent) of individuals found to be, ���feebleminded, insane, depressed, mentally handicapped, epileptic and other.��� Alcoholics, criminals and drug addicts were also sterilized.

Heroin Act made the manufacture and possession of heroin illegal

1925

Harry Stack Sullivan (February 21, 1892, Norwich, New York ��� January 14, 1949, Paris, France) was a U.S. psychiatrist whose work in psychoanalysis was based on direct and verifiable observation (versus the more abstract conceptions of the unconscious mind favored by Sigmund Freud and his disciples). Sullivan was the first to coin the term ���problems in living��� to describe the difficulties with self and others experienced by those with so-called mental illnesses. This phrase was later picked up and popularized by Thomas Szasz, whose work was a foundational resource for the antipsychiatry movement. ���Problems in living��� went on to become the movement's preferred way to refer to the manifestations of mental disturbances. Sullivan made his reputation based on his experimental treatment ward for schizophrenics at the Sheppard Pratt Hospital, between 1925-29. He employed specially trained ward attendants to work with the patients to provide them with the peer relationships (peer support!) he believed they'd missed out on during the latency period of development. Doctors, nurses and other authority figures were banned from the ward. He believed there was a homosexual element to latency age peer relationships and that a failure to go through this stage led to self-loathing, a withdrawal from the world in fantasy and psychosis, and a failure to move on to heterosexual adjustment. Thus the patients, who were all young male homosexuals as well as schizophrenics, in their positive interactions with the attendants, also young male homosexuals, would heal the wounds from missing male intimacy as pre-people. One patient, Jimmie, came to the ward at fifteen and later moved in with Sullivan and became his lover for many years. Jimmie was known to Sullivan's associates as his adopted son, a fiction whereby he could keep his sexual identity in the closet.

Clitoridectomies performed in association with women���s mental disorders.

���Cruelties in an Edinburgh Asylum,��� Edinburgh by William Simpson.

���The Confession of a Fool��� (trans. Ellie Scheussner), by August Strindberg.

1926

Emil Kraepelin (1856���1926) dies. He is seen as being the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

���The Traitor���Being the Untampered with, Unrevised Account of the Trial and All that Led to it,��� by Harry K. Thaw

1927

On May 2, 1927 the U.S. Supreme Court, in Buck v. Bell (Carrie Buck, AKA Carrie Buck Detamore), rules that the forced sterilization of people with disabilities is not a violation of their constitutional rights. Justice Oliver Wendell Holmes wrote, ���It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind�Ķ.Three generations of imbeciles are enough.��� Justice Holmes equated sterilization to vaccination. Nationally, twenty-seven states began wholesale sterilization of ���undesirables.��� The decision removes the last restraints for eugenicists; advocating that people with disabilities be prohibited from having children. By the 1970s, some 60,000 disabled people are sterilized without consent. This included people identified as having ���mental illness.���

Franklin Roosevelt co-founds the Warm Springs Foundation at Warm Springs, Georgia. The Warm Springs facility for polio survivors becomes a model rehabilitation and peer counseling program.

Physiological Shock Treatments using Insulin Coma and Convulsions began.

Julius von Wagner-Jauregg using malaria-induced fever (see Physiologic Shock Treatments 1917) becomes the first psychiatrist to win the Nobel prize.

Bureau of Prohibition Created by an act of the same name. Replaced the Bureau of Internal Revenue with a new bureau under the Dept. of Treasury. This is the first organization responsible solely for the enforcement of drug and alcohol laws.

���Reluctantly Told,��� by Jane Hillyer.

���The Locomotive God,��� by W. E. Leonard.

1928

���Exposure of the Asylum System,��� by M. J. Nolan

���Sanity for Sale: The Story of the Rise and Fall of William B. Ellis, by Himself,��� by William B. Ellis.

���Sanity for Sale: The Story of American Life Since the Civil War,��� by William B. Ellis.

1929

The establishment of two Federal Narcotics farms was authorized within the PHS (Public Health Service). The Lexington Hospital opened in 1935 and the Fort Worth Hospital in 1938. Both facilities participated in pioneering research on drug abuse, carried forward by the Addiction Research Center at Lexington, which later moved to Baltimore.

Seeing Eye establishes the first dog guide school for blind people in the United States.

���Pick Up the Pieces,��� by Emerson D. Owens. [North 3-1].

���Reminiscences of a Stay in a Mental Hospital.��� London, by Mary Riggall.

���The Layman Looks at Doctors,��� by S.W. Pierce and J. T. (pseudonym).

���When���A Record of Transition,��� by J. L. Pole.

1930���s

Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed surgically, an operation called a lobotomy, which is performed widely over the next two decades to treat schizophrenia, intractable depression, severe anxiety, and obsessions.

1930

The Mental Treatment Act of 1930 introduced the category of voluntary patients and the notion of rehabilitation.

The U.S. Public Health Service established the Narcotics Division, later named Division of Mental Hygiene. The division brought together for the first time the threads of the mental health movement���from research and treatment programs to combat drug addiction to the study of the causes, prevalence, and means of preventing and treating nervous and mental disease. Dr. Walter Treadway headed the division. He was succeeded by Dr. Lawrence Kolb who retained the post until his retirement in 1944 when Dr. Robert H. Felix took over.

Federal Bureau of Narcotics replaced the Bureau of Prohibition and moved the enforcement of drug laws from the Dept. of Treasury to the Dept. of Justice. Its first commissioner, the infamous Harry Anslinger, began actions to control cannabis in addition to opium and coca.

���Wondering. The Impressions of an Inmate.��� Atlantic Monthly. 145: 669. by Anonymous.

���The Shutter of Snow,��� by E. H. Coleman.

���Confessions: A Study in Pathology,��� by Arthur Symons.

1931

The International Foundation for Mental Health Hygiene is founded by Clifford Beers.

���Guilty but Insane: A Broadmoor Autobiography.��� London, by Wannack (pseudonym).

���The Recovery of Myself: A Patient���s Experience in a Hospital for Mental Illness,��� by Marian King.

���Sketches in the Life of John Clare��� (written by himself, first published with an introduction, notes and additions, by Edmund Blunden). London, by John Clare.

���Sane in Asylum Walls.��� London, by James Scott.

1932

The Treaty of London standardizes American and English braille.

The Disabled American Veterans was chartered by Congress to represent disabled veterans in their dealings with the federal government.

Uniform State Narcotic Act encouraged states to pass uniform state laws matching the federal Narcotic Drug Import and Export Act. Suggested prohibiting cannabis use at the state level. By 1937 every state had passed laws prohibiting cannabis use.

���Behind the Door of Delusion,��� by Inmate Ward Eight [Marion Woodson].

���I Lost My Memory--The Case as the Patient Saw It.��� London, by Anonymous.

1933

The 21st Amendment repealed the 18th Amendment, which meant that states once again had the right to enact laws regulating the sale and use of alcoholic beverages.

Franklin Delano Roosevelt, the first seriously physically disabled person ever to be elected as a head of government, is sworn into office as president of the United States. He continues his ���splendid deception,��� choosing to minimize his disability in response to the ableism of the electorate.

Manfred Sakel reported his first experimental findings, testing the efficacy of insulin-shock treatment on schizophrenic patients in Berlin, Germany. Insulin was administered to the patient in a dose high enough to induce coma, and although the treatment seemed to be beneficial to individuals in the early stages of schizophrenia, it was not proven to be useful in advanced cases of schizophrenia. Sakel���s vague theoretical rationale for this specific method and the difficult regimen of care this treatment required also led to the abandonment of insulin-shock therapy.

Ladislaus Joseph von Meduna experimented with shock therapy and schizophrenia in Budapest, Hungary, also during the year 1933. Instead of insulin, Meduna injected patients with Metrazol, a less toxic synthetic preparation of camphor. This treatment was soon abandoned as it possessed a period of unpredictable length between injection and convulsions, giving the patient just enough time to become fearful and uncooperative. It also often produced convulsions that were so severe as to cause fractures

���Mania,��� by Lawrence M. Jayson.

���Dreams and Life (trans. from 1855 French ed.).��� London, by Gerard Labrunie [Gerard De Nerval].

���Two Lives,��� by W. E. Leonard.

1934

Physiologic Shock Treatments with Metrazol Convulsions began. Psychiatrists began to inject insulin to induce shock and temporary coma as a treatment for schizophrenia.

USDA develops phenothiazines as insecticide.

���Magpie: The Autobiography of a Nymph Errant,��� by Lois Vidal.

1935

Bill W. and Dr. Bob found the self-help society known as Alcoholics Anonymous on June 10, 1935.

Sigmund Freud states in his ���Letter to an American Mother��� that, ���Homosexuality is assuredly no advantage, but it is nothing to be ashamed of, no vice, no degradation; it cannot be classified as an illness.���

It was in Portugal, 1935, that Egas Moniz performed the first lobotomy with the aid of a neurosurgeon, Almeida Lima.

The League of the Physically Handicapped is formed in New York City to protest discrimination against people with disabilities by federal relief programs. The group organizes sit-ins, picket lines, and demonstrations, and it travels to Washington, D.C., to protest and meet with officials of the Roosevelt administration.

The Committee for the Study of Sex Variants is formed.

Social Security of Act of 1935 - Established federal/state system of health services for ���crippled��� children; permanently authorized civilian rehabilitation program. Congress passes and President Roosevelt signs the Social Security Act. This established federally funded old-age benefits and funds grants to the states for assistance to blind individuals and disabled children. The Act also extended existing vocational rehabilitation programs established by earlier legislation. The federal government first provided child welfare services with the passage of the Social Security Act of 1935 (49 Stat. 620). Under Title IV-B (Child Welfare Services Program) of the act, the Children's Bureau received funding for grants to states for ���the protection and care of homeless, dependent, and neglected children and children in danger of becoming delinquent.���

���Man the Unknown,��� written by Nobel Prize winning Dr. Alexis Carrel, suggested the removal of criminals and the mentally ill by euthanasia, using institutions equipped with suitable gases. American eugenics may have reached its apotheosis in 1935 when Alexis Carrel, a physician at Rockefeller Institute for Medical Research in New York, wrote that the mentally ill ���should be humanely and economically disposed of in small euthanistic institutions supplied with proper gases.��� The U.S. psychiatrists who embraced the program of compulsory sterilization directly influenced the doctors of the Third Reich, who would soon begin the ���mercy killings��� of mental patients.

���The Living of Charlotte Perkins Gilman,��� by Charlotte Perkins Gilman.

���My First Life; a Biography, by Brenda Dean Paul, Written By Herself.��� London, by Brenda Dean Paul.

���Asylum,��� by William Seabrook.

���New Armor for Old,��� by William O'Sullivan Molony.

1936

Prefrontal Lobotomy was performed by the Portuguese physician and neurologist Antonio Egas Moniz. His method involved drilling holes in patients' heads and destroying the tissue connecting the frontal lobes by injecting alcohol into them. Egas Moniz published an account of the first human frontal lobotomy. Between 1936 and the mid-1950s, an estimated twenty thousand of these surgical procedures were performed on American mental patients.

Passage of the Randolph Sheppard Act establishes a federal program for employing blind vendors at stands in the lobbies of federal office buildings.

Psychosurgery Brutality

American psychiatrist Walter Freeman (center) developed the frontal lobotomy, a barbarous act which plunged an icepick-like instrument beneath the eyelid and, using a surgical mallet, drove it through the eye socket bone and into the brain. Movement of the instrument severed the fibers of the frontal brain lobes, causing irreversible brain damage. James Watts and Walter Freeman became the first American doctors to perform prefrontal lobotomy (by craniotomy in an operating room). Freeman was president of the American Association of Neuropathologists from 1944 to 1945 and president of the American Board of Psychiatry and Neurology from 1946 to 1947. Freeman performed nearly 2,500 lobotomies in 23 states, mostly based on scanty and flimsy evidence for its scientific basis, but more significantly he popularized the lobotomy. A neurologist without surgical training, he initially worked with several surgeons. Seeking a faster and less invasive way to perform the procedure, Freeman adopted Amarro Fiamberti's transorbital lobotomy and began to perfect it, initially by using ice picks hammered into each frontal lobe through the back of each eye socket (���ice pick lobotomy���). Freeman was able to perform these very quickly, outside of an operating room, and without a surgeon. For his first transorbital lobotomies, Freeman used an actual icepick from his kitchen. Later, he utilized an instrument created specifically for the operation called a leucotome. In 1948 Freeman developed a new technique which involved wrenching the leucotome in an upstroke after the initial insertion. This procedure placed great strain on the instrument and in one case resulted in the leucotome breaking off in the patient's skull. As a result, Freeman designed a new, stronger instrument, the orbitoclast. Freeman embarked on a national campaign in his van which he called his ���lobotomobile��� to demonstrate the procedure to doctors working at state-run institutions; Freeman would show off by icepicking both of a patient's eyesockets at one time - one with each hand. According to some, institutional care was hampered by lack of effective treatments and extreme overcrowding, and Freeman saw the transorbital lobotomy as an expedient tool to get large populations out of treatment and back into private life. The ���ice pick lobotomy��� was, according to Ole Enersen, performed by Freeman ���with a recklessness bordering on lunacy, touring the country like a travelling evangelist. In most cases,��� Enersen continued, ���this procedure was nothing more than a gross and unwarranted mutilation carried out by a self righteous zealot.��� Freeman's most notorious operation was on the ill-fated Rosemary Kennedy, who was permanently incapacitated by a lobotomy at age 23. Another of his patients, Howard Dully, has now written a book called My Lobotomy about his experiences with Freeman and his long recovery after the surgery he underwent at 12 years old. To execute this procedure, the patient was first shocked into a coma. The surgeon then hammered an instrument similar to an icepick through the top of each eye socket and severed the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain. The intended purpose of the lobotomy was to calm uncontrollably violent or emotional patients, and it did--at first--prove to be successful. Because of the preliminary positive results and the facts that it was easy, inexpensive, and the average time it took to complete the procedure was only about ten minutes, lobotomies quickly spread around the world as a popular practice for severely mentally ill patients who were resistant to other treatments. It was only after tens of thousands of patients worldwide had undergone this procedure during the following twenty years that people started to take notice of its undesirable side effects. Lobotomies generally produced personalities that were lethargic and immature. Aside from a twenty-five percent death rate, lobotomies also resulted in patients that were unable to control their impulses, were unnaturally calm and shallow, and/or exhibited a total absence of feeling (Butcher 620). Not surprisingly, this practice was quickly abandoned with the introduction of psychoactive drugs.

���Diary of Vaslav Nijinsky��� (ed. Joan Accocella). New York: Farrar, Straus and Giroux, (orig. pub. 1936). Nijinsky, Vaslav.

���The Exploration of the Inner World,��� by Anton T. Boisen.

1937

Karen Horney, a German-born psychiatrist challenges Freud's theory of the castration complex in women and his theory that Oedipal complex and female sexuality influences neurosis. In ���The Neurotic Personality of Our Time,��� she argues that neurosis largely is determined by the society in which one lives.

Herbert A. Everest and Harry C. Jennings patent a design for a folding wheelchair with an X-frame that can be packed into a car trunk. They found Everest & Jennings (E & J), which eventually becomes the largest manufacturer of wheelchairs in the United States.

J. Edgar Hoover declares ���War on the Sex Criminal!���

Marijuana Tax Act made it federally illegal to buy, sell, barter, or give away cannabis without paying a transfer tax. This is the first federal law regulating the possession and sale of cannabis. Declared unconstitutional in 1969 in U.S. vs Timothy Leary.

Recovery, Inc. is a self-help mental health program based on the ground breaking work of founder and neuropsychiatrist, Abraham A. Low, M.D.

���Chronicles of Interdict No. 7807,��� by Anne Kirk.

���Searchlight, an Autobiography,��� by Augusta Catherine Fischer.

���Dear Theo: The Autobiography of Vincent Van Gogh��� (ed. Irving Stone), by Vincent Van Gogh.

���A Patient's Memoirs; The Rocket Buster,��� by G. C. Wegefarth.

���A Mind Restored: The Story of Jim Curran,��� by Elsa Krauch.

���A Mind Mislaid,��� by Henry Collins Brown.

���1935 -1936,��� by William Cary Sanger.

1938

Physiological Shock Treatments by electric shock therapy (EST), currently known as electroconvulsive treatment (ECT) is first used by Ugo Cerletti. Electrotherapy (applying electric current to the brain) was first used in American hospitals to treat mental illnesses in the 1940���s. Italian physicians Ugo Cerletti and Lucio Bini administered the first shock therapy using electricity to a schizophrenic patient and received successful results. This treatment soon became widespread and was used most often in America and Europe. There is some history of abuse associated with electroconvulsive therapy (ECT) though, that took place in mental institutions. Because the idea of an electrical current being passed through one���s head is undoubtedly frightening, ECT was used to intimidate, control, and punish patients, some of whom were subjected to this treatment over a hundred times. Despite previous instances of abuse, this treatment is still used today, albeit with significant reforms. It is generally reserved only for the mentally ill who suffer from severe depression, especially of the variety accompanied by psychotic symptoms, and only as a last resort after the patient has not responded to any other treatments, including medication. Patients are also administered a general anesthetic and muscle relaxant prior to the treatment so that they do not suffer any discomfort and there is no danger of fractured bones. Electroconvulsive therapy is commonly performed on a patient three times a week until a dozen sessions are reached, although some patients may require more or less sessions to benefit. The only negative side effects reported are amnesia limited to the few hours before the session and disorientation; both disappear soon after ECT is stopped.

Food, Drug, and Cosmetic Act revised and expanded the Pure Food and Drug Act to require more extensive labeling and safety testing of food products. Introduced safety standards and required that new drugs be shown to be safe before marketing.

Wagner-O'Day Act of 1938 - Authorized federal purchases from workshops for people who are blind.

Randolph-Sheppard Act of 1938 - Authorized federal program to employ people who are blind as vendors on federal property.

Passage of the Fair Labor Standards Act leads to an enormous increase in the number of sheltered workshop programs for blind workers. Although intended to provide training and job opportunities for blind and visually disabled workers, it often leads to exploitation of workers at sub-minimum wages in poor conditions.

���They Said I was Mad.��� The Forum and Century. 100: 231-237, by Anonymous.

���The Witnesses,��� London, by Thomas Barcley Hennell.

1939

Amid the outbreak of World War II and a societal acceptance of eugenics, Germany���s Adolph Hitler orders widespread ���mercy killing��� of the sick and disabled decreeing ���that patients with incurable medical illnesses be killed because they are 'biologically unfit.' Approximately 270,000 patients with mental illness are killed by physicians and medical personnel complying with the Nazi doctrine of racial purity. The Nazi euthanasia program was code-named Aktion T4 and was instituted to eliminate ���life unworthy of life.���

���The Insanity Racket: A Story of One of the Worst Hell Holes in This Country,��� by Luther Osborne.

���The Capital's Siberia,��� by James Duffy.

1940

908 patients were transferred from an institution for retarded and chronically ill patients in Schoenbrunn, Germany to the euthanasia installation at Eglfing-Haar to be gassed. A monument to the victims stands in the courtyard at Schoenbrunn.

The National Federation of the Blind is formed in Wilkes-Barre, Pennsylvania, by Jacobus Broek and other blind advocates. It advocates for ���white cane laws��� and input by blind people into programs for blind clients, among other reforms.

The American Federation of the Physically Handicapped is founded by Paul Strachan as the nation's first cross-disability, national political organization. It pushes for an end to job discrimination and lobbies for passage of legislation calling for a ���National Employ the Physically Handicapped Week,��� among other initiatives.

The concept of a ���National Psychiatric Institute��� was born, but World War II intervened and the plan was not introduced before the Congress. The war demonstrated the tremendous toll taken by mental illness. More men received medical discharges from the Armed Forces for neuropsychiatric disorders than for any other reason more than 1 million Americans were rejected for military service for that reason.

Newdigate Owensby promotes pharmacological shock treatment for the treatment of homosexuality

Selective Service Medical Circular No. 1 recommends that doctors screen out homosexuals from military draftees

Sandor Rado���s ���A Critical Examination of the Concept of Bisexuality.���

���Borderland Minds,��� by Margaret Isabel Wilson

���They Call Them Camisoles,��� by W. Wilson.

���Criminal Complaints with Probable Causes (A True Account).��� Bound, circular letter by Percy L. King

���Insulin and I,��� American Journal of Orthopsychiatry, 10: 810-814, by Anonymous.

���The Book of Margery Kempe��� (edited and introduced by Sanford Brown Meech and Hope Emily Allen). Oxford, by Margery Kempe.

���Asylum Piece,��� by Helen Woods Edmonds.

���The Bridge of Eternity,��� by Looney Lee Gary (pseudonym).

���Postscript on a Benign Psychosis,��� Psychiatry, 3: 527-34, by Elaine F. Kinder.

1941

Hitler suspended the Aktion T4 program that killed nearly one hundred thousand people. Euthanasia continued through the use of drugs and starvation instead of gassings.

���Spinner's Lake.��� London, by Maude Harrison.

���The Triumph of Personal Thought and How I Became a Mason,��� by Jacob Alexson.

���California Justice: Is This Supposed to Be a Democracy?��� by Arthur Penn.

���Minds in the Mending.��� Atlantic Monthly: 168: 330-34 by Olivia Harlan.

1942

���467 Poisoned at Oregon State Hospital November 18, 1942���

One of the most tragic incidents in Salem���s history was the poisoning of nearly 500 patients and staff at the Oregon State Hospital, on the evening of November 18, 1942. Many who ate the scrambled eggs served for dinner that evening would later claim that they had tasted funny, some saying they���d been salty, others saying they tasted soapy. Within five minutes of consuming them, the diners began to sicken, experiencing violent stomach cramps, vomiting, leg cramps, and respiratory paralysis. Witnesses described patients crawling on the floor, unable to sit or stand. The lips of the stricken turned blue, and some vomited blood. The first death came within an hour; by midnight, there were 32; by 4 a.m., 40. Local doctors rushed to the hospital to help out staff doctors. The hospital morgue, outfitted for two to three bodies, was overwhelmed. Eventually 47 people would die; in all, 467 were sickened. Though five wards had been served the suspect eggs, all the deaths occurred in four; in the fifth, an attendant had tried the eggs, found them odd tasting, and ordered her charges not to eat them.

Officials were baffled, and immediately focused on the frozen egg yolks which all the victims had been served, and which had come from federal surplus commodities. It was thought that the eggs might have spoiled due to improper storage, or even that they might have been deliberately poisoned by a patient who could have gotten a hold of a poison while on furlough. The biggest fear, however, was the fear of sabotage: with the country engaged in World War II, this possibility loomed large. Oregon Governor Charles Sprague ordered all state institutions to stop using the eggs. The federal government issued a similar order, and the Agriculture Department ordered an investigation into the handling of its frozen eggs.

But the eggs were part of a 36,000-pound shipment which had been divided between schools, NYA projects and state institutions in Oregon and Washington, 30,000 pounds of which had already been consumed with no ill effects. State officials confirmed that the eggs had been properly stored, and the president of National Egg Products Inc. pointed out that eggs bad enough to kill would be so obviously spoiled that no one would eat them.

The day after the poisoning, with dozens still ill, pathologists determined that the sickness and death had been caused by sodium flouride, an ingredient in cockroach poison; pathology reports showed large amounts of the compound in the stomachs of the dead victims. Five grams--the size of an aspirin--would have been fatal; some of the dead had eaten more sodium flouride than eggs. Cockroach poison was known to be available at the hospital, kept in a locked cellar room to which only regular kitchen employees had keys. State Police launched an investigation, and began interviewing staff and patients at the hospital.

Finally, several days after the poisonings, two cooks at the hospital, A.B. McKillop and Mary O���Hare, admitted that they knew what had happened, that they had realized soon after the symptoms had struck, but had not come forward for fear of being charged. McKillop took responsibility, saying he had been the one to send a patient trusty, George Nosen, to the cellar to get dry milk powder for the scrambled eggs he was preparing. He had given Nosen his keys to the cellar, and Nosen returned with a tin half-full of powder, an estimated six pounds of which were mixed into the scrambled eggs at McKillop���s direction. When people had begun getting ill, he had questioned Nosen about where he���d found the powder, and discovered he had brought roach poison.

Despite McKillop���s insistence that O���Hare bore no responsibility for the poisoning, and over the objections of the State Police, who had determined that the poisoning was accidental, District Attorney M.B. Hayden ordered both cooks arrested. A grand jury declined to indict them; the patient George Nosen was never charged. Considered by many of his fellow patients to be a mass murderer, he became something of a pariah at the hospital where he spent the rest of his life. Two brief attempts at life outside the institution failed, and he died at the State Hospital 41 years later, after suffering a heart attack during a fight with another patient.

Compiled and written by Kathleen Carlson Clements

Bibliography: Capital Journal, November 19-December 1, 1942

Henry Viscardi begins his work as an American Red Cross volunteer, training 1944 disabled soldiers to use their prosthetic limbs. His work at Walter Reed Army Medical Center in Washington, D.C., draws the attention of Howard Rusk and Eleanor Roosevelt, who protest when Viscardi's program is terminated by the Red Cross and the military.

���The Eclipse of a Mind,��� by Alonzo Graves.

���No Hiding Place: An Autobiography,��� by William Seabrook.

1943

Clifford Beers dies

���Prelude to Sanity,��� by S. Greiner.

���Autobiography and A Ray of Darkness,��� Oxford, by Margiad Evans.

This memo shows the letterhead of the We Are Not Alone Society (1947), one of the first patients groups in the modern era. It has a green ink note indicating how this patients support and rights group was started in 1943. It says, ���This is invaluable for the letterhead. It has 8 names. Mike Obolensky was a former Russian prince. Slava Orleans was his cousin. Mike and I were patients in Rockland State at the same time. In the Spring or early summer of 1943 there was a meeting in the hospital of the group that formed WANA. Bill Wilson, founder & head of AA, was there and said a few words.��� We Are Not Alone (WANA), a mental patients' self-help group, is organized at the Rockland State Hospital in New York City. Their goal was to help others make the difficult transition from hospital to community. Their efforts led to the establishment of Fountain House, a psychosocial rehabilitation service for people leaving state mental institutions.

Congress passes the Vocational Rehabilitation Amendments, known as the LaFollette-Barden Act, adding physical rehabilitation to the goals of federally funded vocational rehabilitation programs and providing funding for certain health care services.

1944

Howard Rusk is assigned to the U.S. Army Air Force Convalescent Center in Pawling, New York, where he begins a rehabilitation program for disabled airmen. First dubbed ���Rusk's folly��� by the medical establishment rehabilitation medicine becomes a new medical specialty.

During World War II, it became evident that there were severe shortages of professional mental health personnel and that understanding of the causes, treatment, and prevention of mental illness lagged far behind other fields of medical science and public health. Dr. William Menninger, chief of Army neuropsychiatry and an outstanding leader of the profession, called for Federal action. A national mental health program was proposed, forming the foundation of the National Mental Health Act of 1946.

The new director of the Public Health Service Division of Mental Hygiene, Dr. Robert H. Felix, presented a proposal for a national mental health program to the Surgeon General of the U.S. This proposal was to form the basis of the National Mental Health Act of 1946.

���Brainstorm,��� by Carlton Brown.

���The Book of Margery Kempe,��� rendered into modern English by W. Butler-Bowdon, by Margery Kempe.

���The Lost Weekend,��� by C. Jackson.

1945

The Blinded Veterans Association (BVA) is formed in Avon, Connecticut.

President Harry Truman signs Public Law 176, a joint congressional resolution calling for the creation of an annual National Employ the Handicapped Week.

Boyce R. Williams is hired by the federal Office of Vocational Rehabilitation as Consultant for the Deaf, the Hard of Hearing, and the Speech Impaired. He begins close to four decades of work at OVR, designing and implementing educational and vocational programs for deaf Americans.

���A Man Against Time: An Heroic Dream,��� by W. E. Leonard.

1946

President Harry S. Truman signs the National Mental Health Act of 1946 on July 3rd, creating for the first time in US history a significant amount of funding for psychiatric education and research and calling for the establishment of a National Institute of Mental Health (NIMH). National Institute of Mental Health was to conduct research into mind, brain, and behavior and thereby reduce mental illness. As a result of this law, NIMH will be formally established on April 15, 1949.

The first meeting of the National Advisory Mental Health Council was held on August 15. Since no Federal funds were available, the Greentree Foundation awarded a grant of $15,000 to finance the meeting.

The National Mental Health Foundation is founded by conscientious objectors who served as attendants at state mental institutions during World War II. It works to expose the abusive conditions at these facilities and becomes an early impetus in the push for deinstitutionalization.

Walter Freeman first performs a transorbital lobotomy on a live patient. This new form of psychosurgery was intended for use in State mental hospitals that often did not have the facilities for anesthesia, so Freeman suggested using electroconvulsive therapy to render the patient unconscious. (Jack, 2005)

Congress enacts the Hospital Survey and Construction Act, also known as the Hill-Burton Act, authorizing federal grants to the states for the construction of hospitals, public health centers, and health facilities for rehabilitation of people with disabilities.

The Cerebral Palsy Society of New York City is established by parents of children with cerebral palsy. This is the first chapter of what will be come the United Cerebral Palsy Associations, Inc.

���First They Came���
First they came for the Communists, and I didn't speak up, because I wasn't a Communist.
Then they came for the sick, the so-called incurables, and I didn't speak up, because I wasn't mentally ill.
Then they came for the Jews, and I didn't speak up, because I wasn't a Jew.
Then they came for me, and by that time there was no one left to speak up for me.
Modern translation of poem by Martin Niemoeller, 1946

Anna Freud, the youngest daughter of Sigmund Freud, publishes, ���The Psychoanalytic Treatment of Children,��� which introduces basic concepts in the theory and practice of child psychoanalysis

���The Snake Pit,��� by Mary Jane Ward.

���Out of the Dark Ages.��� Woman���s Home Companion; 34-35, 91-92; August, by Mary Jane Ward.

���The Abrupt Self,��� by David Martens.

���My Way Back to Sanity,��� Ladies Home Journal. 63(10): 54-55, 242-250, by Jane Elliot.

���Autobiography of David��� (ed. Ernest Raymond). London, by David (pseudonym).

1947

On July 1 the first mental health research grant (MH-1) was awarded to Dr. Winthrop N. Kellogg of Indiana University by the Division of Mental Hygiene. It was titled ���Basic Nature of the Learning Process.���

The National Reporting Program on Patients in Mental Institutions was transferred from the U.S. Census Bureau to the Division of Mental Hygiene.

From 1947-51 Governor Luther Youngdahl (Republican; Minnesota) started development of community-based mental health services and humane treatment for people in state institutions.

The Nuremberg Trials convicted a number of psychiatrists who held key positions in Nazi regimes.

Paralyzed Veterans of America (PVA) is founded at the Birmingham Hospital in Van Nuys, California, by Fred Smead, Randall Updyke, and other delegates from Veterans Administration hospitals across the country.

The first meeting of the Presidents Committee on National Employ the Physically Handicapped Week is held in Washington, D.C. Its publicity campaigns, coordinated by state and local committees, emphasize the competence of people with disabilities and use movie trailers, billboards, and radio and television ads to convince the public that its ���good business to hire the handicapped.���

Harold Russell wins two Academy Awards for his role in The Best Year of Our Lives. Harold John Russell (January 14, 1914 - January 29, 2002) was a Canadian-American World War II veteran who became one of only two non-professional actors to win an Academy Award for acting (the other being Haing S. Ngor). Russell also holds the unique honor of being the only person to receive two Academy Awards for the same role. While an Army instructor, and training with the U.S. 13th Airborne Division stateside in 1944, a defective fuse detonated an explosive he was handling while making a training film. As a result, he lost both hands and was given two hooks to serve as hands. After his recovery, and while attending Boston University as a full-time student, Russell was featured in an Army film called Diary of a Sergeant about rehabilitating war veterans. When film director William Wyler saw the film on Russell, he cast him in The Best Years of Our Lives with Fredric March and Dana Andrews. Russell played the role of Homer Parrish, a sailor who lost both hands during the war. For his role as Parrish, Russell won the Academy Award for Best Supporting Actor in 1947. Earlier in the ceremony, he was awarded an honorary Oscar for ���bringing hope and courage to his fellow veterans.��� The special award had been created because the Board of Governors very much wanted to salute Russell, a non-professional actor, but assumed he had little chance for a competitive win. It was the only time in Oscar history that the Academy has awarded two Oscars for the same performance. Russell authored two autobiographies, Victory in My Hands (1949) and The Best Years of My Life (1981).

Fountain House in NYC begins psychiatric rehabilitation for mentally ill persons.

���These are my Sisters: An ���Insandectomy,��� by Lara Jefferson.

���The Kingdom of the Lost.��� London, by John Andrerw Howard Ogdon.

���Between Us and the Dark,��� by Lenore McCall.

���If a Man Be Mad,��� by H. Maine.

1948

The National Paraplegia Foundation is founded by members of the Paralyzed Veterans of America, as the civilian arm of their growing movement. Foundation chapters in many cities and states take a leading role in advocating for disability rights.

The disabled students' program at the University of Illinois at Galesburg is officially established. Founded and directed by Timothy Nugent, the program moves to the campus at Urbana-Champaign, where it becomes a prototype for disabled student programs and then independent living centers across the country.

We Are Not Alone (WANA), a mental patients' self-help group, is organized at the Rockland State Hospital in New York City.

Fountain House opens in New York City. This is the first of the clubhouse model, influenced by WANA. (We are not alone). Members of Fountain House supported one another by creating a community among people struggling with serious mental illness. This initiative laid the groundwork for the ���clubhouse��� model, which promotes the importance of meaningful work in people's lives, and which would serve as a model for psychiatric rehabilitation programs developed in the 1960s and 1970s.

Congress did not appropriate funds to implement the National Mental Health Act until fiscal year 1948.

The combined specialty of 'neuropsychiatry' was divided into 'neurology,' dealing with organic or physical diseases of the brain, and 'psychiatry' dealing with emotional and behavioral problems.

���Inside the Asylum.��� London, by John Vincent.

���The Stubborn Wood,��� by Emily Harvin (pseudonym).

���Views of a Nearsighted Cannoneer,��� by Seymour Krim.

1949

On April 15 the NIMH (National Institute of Mental Health) was established with the abolishment of the Division of Mental Hygiene. NIMH was one of the first four NIH (National Institute of Health) institutes.

Antonio Egas Muniz wins the Nobel Prize for Medicine for his work on the lobotomy.

Phenothiazines shown to hinder rope-climbing abilities in rats.

The Australian psychiatrist John F. J. Cade introduces the use of lithium to treat psychosis. He shows that lithium quieted ���manic patients���. Prior to this, drugs such as bromides and barbiturates had been used to quiet or sedate patients, but they were ineffective in treating the basic symptoms of those suffering from psychosis. Lithium will gain wide use in the mid-1960s to treat those with manic depression, now known as bipolar disorder. The FDA approved the drug in 1970.

The first Annual Wheelchair Basketball Tournament is held in Galesburg, Illinois. Wheelchair basketball, and other sports, become an important part of disability lifestyle and culture over the next several decades.

Timothy Nugent founds the National Wheelchair Basketball Association.

The National Foundation for Cerebral Palsy is chartered by representatives of various groups of parents of children with cerebral palsy. Renamed the United Cerebral Palsy Associations, Inc., in 1950, it becomes, together with the Association for Retarded Children, a major force in the parents' movement of the 1950s and thereafter.

D. O. Cauldwell first describes ���psychopathic transsexualism���

���The World Next Door,��� by Fritz Peters.

���A Doctor Regrets, Being the First Part of A Publisher Presents Himself,��� London, by Donald McIntosh Johnson.

���The Third Strike,��� by Jerry Gray.

1950's

First psychotropic drugs discovered contributing to the beginning of deinstitutionalization. By the mid-1950s, America had reached the peak of public-asylum psychiatry in the United States with more than 500,000 Americans residing in state-supported institutions. The average length of stay was measured in years; many patients expected to spend their entire lifetime in such institutional communities. Many factors led to the movement called deinstitutionalization: journalistic expos��s; the introduction of chlorpromazine (Thorazine) into the United States, which initiated the psychopharmacologic revolution; Blue Cross-Blue Shield's decision to cover inpatient psychiatry in general hospitals; and President Eisenhower's major study of the care of the mentally ill population.

In England during the 1950s the tradition of caring for mentally ill people within large institutions came under intense criticism from both inside and outside the system. There was a growing realization that the structure and organization of mental hospitals was essentially pathogenic; innovators in care demonstrated that new therapeutic ideas could be introduced into the system with beneficial effects. Thomas Main at the Cassel Hospital, David Martin at Claybury and David Clark at Fulbourn were among the first to demonstrate that changing the organization of mental hospitals and adopting open-door policies could result in significant improvement in even the most institutionalized patients. David Clark in five years turned Fulbourn from a closed hospital to a completely open-door hospital. ���We got workshops going, halfway houses, we had Open Days, brought the public in, took patients out. We changed the place completely and much of what we did was a return to the principles of sound asylum management, known for a century. Fulbourn was much better in 1865 than in 1910.��� However these moves only allowed people out into the grounds; doctors still believed that their duty was to keep their patients in custody.

The second half of the 20th century saw the development of 'anti-psychiatry', whose main proponents were Ronald Laing and Thomas Szasz. Laing's professional aim had been to 'complain against the denigration of experience and the dehumanization of the patient, but in doing so I wanted to bring them back into the ordinary human fold.' Laing believed that psychiatric medication could be helpful, and was among those practitioners who used LSD themselves in experiments to explore their own psyches, and also gave it to their patients with the aim of facilitating the psychotherapeutic process. Laing and his followers set up the Philadelphia Association, and also Kingsley Hall, an experimental therapeutic community whose most famous patient was Mary Barnes who was encouraged to regress into babyhood as a means of achieving her recovery from psychosis.

Szasz has described mental illness as a metaphorical illness because, ���the mind (whatever that is) is not an organ or part of the body. Hence it cannot be diseased in the same sense as the body can.��� He takes the view that any psychiatric diagnosis is a license for coercion and the exercise of psychiatric power. 'If mental illness is not a disease why then treatment or indeed admission?' He also accepts that the corollary of this is that if patients have rights, they also have responsibilities, and should, for example accept responsibility for all their actions whatever their state of mind when they committed them. He has concluded that the only help that can be given to patients is through psychotherapy.

Psychotherapeutic treatment declined in the latter part of this century, partly because of a case brought in 1979 against a private psychiatric clinic in the US by a physician with a psychotic depression. The patient sued successfully on the grounds that he should have been treated with proven effective medication rather than spending seven months undergoing in-depth psychoanalysis, and the case left a strong impression that treating psychiatric illness with psychoanalysis constituted malpractice.

New perceptions of mental illness are beginning to develop, informed partly by people like Szasz and Laing, and partly by the growing perception of a need for sensitivity in dealing with people from other cultures whose mental distress may be expressed as a spiritual crisis in a way that has become almost unknown in Western culture.

At the end of the 20th century, rather than adopting either 'the medical model' or 'the social model' of mental illness, people working in the field of mental ill health are beginning to recognize that mental distress has many different causes, and many different disciplines and approaches have a part to play in treatment. Distress may be explained in terms of responses to circumstances, of brain chemistry, of genetics, and all are increasingly seen not to be mutually exclusive but to interact and play a part in mental health: life events almost certainly change brain chemistry for good as well as for ill, and many different treatments may be successful in different circumstances. But treatments that are experienced by the patient as torturous or punitive, however well-intentioned, are unlikely to be so successful in the long-term as those which are experienced as therapeutic. Current practitioners would do well to bear in mind the precepts of such people as Imhotep, Vives, Pussin, and Laing, alongside the latest neuropharmacological theories.

In the mid-1950���s, the numbers of hospitalized mentally ill people in Europe and America peaks. In England and Wales, there were 7,000 patients in 1850, 120,000 in 1930, and nearly 150,000 in 1954. In the United States, the number peaks at 560,000 in 1955.

A new type of therapy, called behavior therapy, is developed, which holds that people with phobias can be trained to overcome them.

1950

Mary Switzer was appointed the Director of the U.S. Office of Vocational Rehabilitation where she emphasized independent living as a quality of life issue.

Rhone Poulenc synthesizes chlorpromazine, a phenothiazine, for use as an anesthetic.

Beginning of Senator Joseph Macarthy���s hearings on communists in the government; purges of homosexuals from government.

In ���Childhood and Society,��� Erik Erikson restates Freud's concepts of infantile sexuality and develops the concepts of 'adult identity,' and 'identity crisis.'

The Social Security Amendments of 1950 establish a federal-state program to aid the permanently and totally disabled (APTD). This is a limited prototype for later federal disability assistance programs such as Social Security Disability Insurance.

The Association for Retarded Children of the United States (later renamed the Association for Retarded Citizens and then The Arc) is founded in Minneapolis by representatives of various state associations of parents of mentally retarded children.

���The Other Side of the Bottle,��� by Dwight Anderson (with Page Cooper).

1951

The Boggs Act imposed mandatory minimum sentences for those convicted of violating the Narcotic Drug Import and Export Act or the Marihuana Tax Act. These minimums were mostly repealed in 1970.

Howard Rusk opens the Institute of Rehabilitation Medicine at New York University Medical Center. Staff at the Institute, including people with disabilities, begin work on such innovations as electric typewriters, mouthsticks, and improved prosthetics, as adaptive aids for people with severe disabilities.

Mattachine Society, the earliest homophile organization in the United States, founded in Los Angeles.

���The Homosexual in America,��� by Edward Sagarin under the pseudonym Donald Webster Cory.

���Fight against Fears,��� by Lucy Freeman.

���Autobiography of a Schizophrenic Girl��� (trans. from 1950 French ed.), edited by Marguerite Sechehaye.

1952

The American Psychiatric Association (APA) publishes the first edition of the Diagnostic and Statistical Manual (DSM) of Mental Disorders. There are 112 mental disorders in its initial, 1952 edition. The first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) groups the ���sexual deviations��� (including homosexuality) under the category of Sexual Deviation Personality Disorder (sociopathic personality disorders).

The first conventional antipsychotic drug, Chlorpromazine, discovered in France, was introduced to treat patients with schizophrenia and other major mental disorders. Used to treat psychosis and delusion, in many cases, Thorazine alleviated symptoms of hallucinations, delusions, agitation and thought disorders. The French psychiatrists Jean Delay and Pierre Deniker report that chlorpromazine (Thorazine ��) calms hospitalized chronic schizophrenic patients without causing clinically significant depression. The drug is called 'hibernotherapie' because patients became quiet, like animals in hibernation.

George Jorgensen undergoes sex reassignment surgery in Denmark to become Christine Jorgensen

The President's Committee on National Employ the Physically Handicapped Week becomes the Presidents' Committee on Employment of the Physically Handicapped, a permanent organization reporting to the President and Congress.

Henry Vicardi takes out a personal loan to found Abilities, Inc., a jobs training and placement program for people with disabilities.

���The Cardboard Giants,��� by Paul Hackett.

���Recovery from a Long Neurosis,��� Psychiatry 15: 161-177, by Anonymous (Mrs. F. H.).

���Bars and Barricades, Being the Second Part of A Publisher Presents Himself.��� London, by Donald McIntosh Johnson.

���Wisdom, Madness and Folly: The Philosophy of a Lunatic,��� by John Custance (pseudonym).

���How Thin the Veil: A Newspaperman's Story of His Own Mental Crackup and Recovery,��� by Jack Kerkoff.

1953

BF Skinner publishes ���Science and Human Behavior,��� describing his theory of operant conditioning, an important concept in the development of behavior therapy.

���Hell's Cauldron,��� by Gerald Erasmus Wilcox [Thomas G. E. Wilkes].

���And Lo, the Star,��� by Margaret Atkins McGarr.

���To Hell and Back; The Story of an Alcoholic,��� by James E. Hummal [James H. Ellis].

1954

First psychiatric drugs are created contributing to the beginning of deinstitutionalization.

Chlorpromazine, marketed in the US as Thorazine, found to induce symptoms of Parkinson���s disease. Chlorpomazine (Thorazine) receives FDA approval.

Vocational Rehabilitation Act of 1954 - Authorized innovation and expansion grants, and grants to colleges and universities for professional training.

Wagner-Peyser Act Amendments of 1954 - Required federal/state employment security offices to designate staff members to assist people with severe disabilities. Congress passes the Vocational Rehabilitation Amendments, authorizing federal grants to expand programs available to people with physical disabilities. Mary Switzer, Director of the Office of Vocational Rehabilitation, uses this authority to fund more than 100 university based rehabilitation related programs.

The U.S. Supreme Court in Brown v. Board of Education of Topeka, rules that separate schools for black and white children are inherently unequal and unconstitutional. This pivotal decision becomes a catalyst for the African-American civil rights movement, which in turn becomes a major inspiration to the disability rights movement.

Social Security Act of 1935 was amended by PL 83-761 to include a ���freeze��� provision for workers who were forced by disability to leave the workforce. This protects their benefits when they retire by not counting the years between the time they cease working and their retirement, thus freezing their retirement benefits at their pre-disability level. Congress passed Title II of the Social Security Act, the Disability Income Program, and it was signed by President Eisenhower. The federal government began to become ���the great almoner of public charity,��� as Title II of the Social Security Act anticipated the important future titles, Title XVIII, Medicare; Title XIX, Medicaid; and Title XVI, the Supplemental Security Income Program. These three acts were passed in the 1960s and 1970s

���I���ll Cry Tomorrow,��� by Lillian Roth with Mike Connolly and Gerald Frank.

���This is Norman Brokenshire���An Unvarnished Self-Portrait,��� by Norman Brokenshire.

���Long Journey; a Verbatim Report of a Case of Severe Psychosexual Infantilism,��� by Harold Kenneth Fink.

���Justice and Justices,��� by Basil Hubbard Pollitt.

���Episode���A Record of Five Hundred Lost Days,��� by Peter W. Denzer.

���Adventure into the Unconscious.��� London, by John Custance (pseudonym).

1955

Congress authorizes the Mental Health Study Act. The Mental Health Study Act of 1955 called for ���an objective, thorough, nationwide analysis and reevaluation of the human and economic problems of mental health.��� The act furnished the basis for the historic study conducted by the Joint Commission on Mental Illness and Health. The commission's final report, Action for Mental Health, provided the background for President John F. Kennedy���s special message to Congress on mental health.

Chlorpromazine said to induce symptoms similar to encephalitis lethargica.

Deinstitutionalization began with the US inpatient census peaking with 550,000 people institutionalized. The number of patients in mental hospitals began to decline reflecting the introduction of psychopharmacology in the treatment of mental illness.

The Texas hospital for the ���Negro insane��� achieved notoriety when on April16, 1955, a group of African-American prisoners in the maximum-security unit rebelled and took over the hospital for five hours. The rebellion was led by nineteen-year-old Ben Riley, who articulated inmate demands for better counseling, organized exercise periods, an end to prisoner beatings, and that all inmates have the same rights enjoyed by the white inmates regarding meals, bathing and freedom of movement.

Harold Wilke becomes the founder and first executive director of the Commission on Religion and Health within the United Church of Christ General Synod in New York. In this capacity he works to open religious life and the ministry to women and people with disabilities.

Daughters of Bilitis, the first lesbian rights organization in the United States, founded in San Francisco.

���Voices Calling,��� by Lisa Wiley.

���Fear Strikes Out: The Jim Piersall Story,��� by James Piersall and Albert Hirshberg.

���The Mind in Chains (Autobiography of a Schizophrenic),��� by William L. Moore.

���Ward N-1,��� by John White.

1956

Social Security Amendments of 1956 - Established Social Security Disability Insurance Trust Fund and provided for payments to eligible workers who became disabled. Congress passes the Social Security Amendments of 1956, which creates a Social Security Disability Insurance (SSDI) program for disabled workers aged 50 to 64.

Congress appropriated $12 million for research in the clinical and basic aspects of psychopharmacology and the Psychopharmacology Service Center was established.

The number of consumers in mental hospitals began to decline reflecting the introduction of psychopharmacology in the treatment of mental illness.

The Health Amendments Act authorized the support of community services for the mentally ill, such as halfway houses, daycare, and aftercare under Title V.

Evelyn Hooker begins publishing research on the psychology of non-clinical homosexuals, based on work begun in the 1940's.

The American Medical Association formally recognizes alcoholism as a disease and the insurance industry begins to underwrite addiction treatment.

Narcotics Control Act also known as the Daniels Act. Further increased penalties and mandatory minimums for violations of existing drug laws.

���Schizophrenia, 1677: A Psychiatric Study of an Illustrated Autobiographical Record of Demoniacal Possession,��� by Christoph Haizmann (eds. Ida Macalpine and Richard Hunter).

���Accent on Living��� begins publication.

���A Tale Told by a Lunatic.��� Dumfries, by Isabella Millar Norrison.

1957

The first pharmacologic treatment for depression is reported with the work of Kuhn on the tricyclic antidepressant imipramine and of Loomer, Saunders and Kline on the monoamine oxidase (MAO) inhibitor iproniazid.

The first National wheelchair Games in the United States are held at Adelphi College in Garden City, New York.

Little People of American is founded in Reno, Nevada, to advocate on behalf of dwarfs or little people.

Gunnar Dybwad is named executive of the Association for Retarded Children.

British Wolfenden Commission recommends decriminalization of homosexuality.

���No Hiding Place,��� by Beth Day.

���Too Much, Too Soon,��� by Dianna Barrymore.

���The God Within,��� by Christina M. Valentine.

���The Plague of Psychiatry,��� by D. G. Simpson.

���Selected Writings,��� by Gerard de. Nerval. (trans. Geoffrey Wagner).

1958

National Defense Education Act of 1958 - Authorized federal assistance for preparation of teachers of children with disabilities.

C. Henry Kempe (Denver, Colorado) created one of the first Child Protection Teams to identify and treat child abuse.

Congress passes the Social security Amendments of 1958, extending Social Security Disability Insurance benefits to the dependents of disabled workers.

Gini Laurie becomes editor of the Toomeyville Gazette at the Toomey Pavilion Polio Rehabilitation Center. Eventually renamed the Rehabilitation Gazette, this grassroots publication becomes an early voice for disability rights, independent living and cross-disability organizing, and it features articles by disabled writers on all aspects of the disability experience.

The American Federation of the Physically Handicapped is dissolved at a convention in Grand Rapids, Michigan. Participants organize the National Association of the Physically Handicapped, Inc. to take its place.

���The Inside of the Cup.��� London, by A. Wingfield.

���Mine Enemy Grows Older,��� by Alexander King.

���A Lawyer's Story In and Out of the World of Insanity,��� by Basil Hubbard Pollitt.

���Like a Lamb.��� London, by Ella Hales (pseudonym).

���Operators and Things: The Inner Life of a Schizophrenic.��� London, by Barbara O'Brien (pseudonym).

���The Lost Days of My life. London,��� by Jane Simpson.

1959

First reports of permanent motor dysfunction linked to neuroleptics, later named tardive dyskinesia.

���Breakdown,��� by Robert G. Dahl.

���Beyond Shadows: A Minister and Mental Health,��� by Robert Frederick West.

���My Fight for Sanity.��� London, by Judith Kruger.

���The Taste of Ashes���An Autobiography,��� by Bill Stern and Oscar Fraley.

���Cynicism and Realism of a Psychotic,��� by John L. Schmacher.

���Prodigal Shepherd,��� by Father Ralph Pfau.

1960's

Federal agencies devoted to addiction research are founded. The American Medical Association formally recognizes alcoholism as a disease and the insurance industry begins to underwrite addiction treatment.

Conventional antipsychotic drugs, such as haloperidol, were first used to control outward (���positive���) symptoms of psychosis, bringing a significant measure of calm and order to previously noisy and chaotic psychiatric wards.

Lithium revolutionized the treatment of manic depression.

In the mid-1960���s, many seriously mentally ill people are removed from institutions. In the United States they are directed toward local mental health homes and facilities. The number of institutionalized mentally ill people in the United States will drop from a peak of 560,000 to just over 130,000 in 1980. Some of this deinstitutionalization is possible because of anti-psychotic drugs, which allow many psychotic patients to live more successfully and independently. However, many people suffering from mental illness become homeless because of inadequate housing and follow-up care.

1960

Congress passes the Social Security Amendments of 1960, eliminating the restriction that disabled workers receiving Social Security Disability Insurance benefits must be aged 50 or older.

French physicians describe a potentially fatal toxic reaction to neuroleptics, later named neuroleptic malignant syndrome.

A study by E. Morton Jellinek proposed the earliest version of the modern disease theory of alcoholism.

Scientists at the American pharmaceutical company Hoffmann-LaRoche develop the benzodiazepines chlordiazepoxide (Librium ��)

Kurt Freund uses pharmacological aversion therapy to 'cure' homosexuality.

The first Paralympic Games, under the auspices of the International Paralympic Committee (IPC) are held in Rome, Italy.

���Out of the Depths,��� by Anton T. Boisen.

���I Can't Forget,��� by Eloise Davenport.

���Living with Schizophrenia.��� Canadian Medical Association Journal, 82, 218-222, by Norma McDonald.

���To Bedlam & Part Way Back,��� by Anne Sexton.

���In a Forest Dark,��� by Harry Feldman.

���The Harvard Psylocibin Project,��� conducted by Leary, T. and Alpert, R. concludes in 1962.

1961

The American Council of the Blind is formally organized.

President Kennedy appoints a special President's Panel on Mental Retardation, to investigate the status of people with mental issues and develop programs and reforms for its improvement.

The American National Standards Institute, Inc. (ANSI) publishes American Standard Specifications for Making Buildings Accessible to, and Usable by, the Physically Handicapped. This landmark document becomes the basis for all subsequent architectural access codes.

A result of the Mental Health Study Act (1955), Action for Mental Health, the final report of the Joint Commission on Mental Health and Illness, was transmitted to Congress. A 10-volume series, it assessed mental health conditions and resources throughout the U.S. ���to arrive at a national program that would approach adequacy in meeting the individual needs of the mentally ill people of America.���

In England, in 1961 Enoch Powell made his 'water tower' speech at a meeting of the National Association for Mental Health (not yet called Mind), announcing the proposed closure of the large psychiatric institutions with the development of care in the community. Edith Morgan (then a member of the Association's staff) commented, 'We all sat up, looked at each other and wondered what had happened. Because we'd been struggling for years to get the idea of community care and the eventual closure of mental hospitals on the map and here it was offered to us on a plate'.

���Asylums: Essays on the social situation of mental patients and other inmates.��� New York: Anchor Books. Goffman, E. Another critic of the mental health establishment's approach, Goffman claims that most people in mental hospitals exhibit their psychotic symptoms and behavior as a direct result of being hospitalized.

���The Myth of Mental Illness,��� by Thomas Szasz. Psychiatrist Thomas Szasz's book, The Myth of Mental Illness, argues that there is no such disease as schizophrenia.

���Madness and Civilization,��� by Michel Foucault

���Self and Others,��� Pelican Books. Laing, R.D.

���Sweetheart, I Have Been to School,��� by Mary Noone (pseudonym).

���The Ha-Ha,��� by Jennifer Dawson.

���Shock Treatment,��� by Winfred Van Atta.

���Faces in the Water,��� by Janet Frame.

���In the Forests of the Night.��� London. by S. Martel.

���Pencil Shavings���Memoirs.��� Cambridge, by Olive Higgins Prouty.

1962

422,000 individuals were hospitalized for psychiatric care in the United States.

The President's Committee on Employment of the Physically Handicapped is renamed the President's Committee on Employment of the Handicapped, reflecting its increased interest in employment issues affecting people with cognitive disabilities and mental illness.

The 1962 Social Security Amendments (Public Law 87-543) required each state to make child welfare services available to all children. It further required states to provide coordination between child welfare services (under Title IV-B) and social services (under Title IV-A, or the Social Services program), which served families on welfare. The law also revised the definition of ���child welfare services��� to include the prevention and remedy of child abuse.

Ed Roberts sued to gain admission to the University of California. Edward V. Roberts becomes the first severely disabled student at the University of California at Berkeley. In 1970, he formed a group on campus called the Rolling Quads and one year after that, Ed and his associates established the nation���s first Center for Independent Living (CIL). 15 years after being told he was ���too disabled to work���, Ed was appointed as the head of Vocational Rehabilitation for California, and established 9 CILs in the state in 1975. Today there are over 300 CILs nationwide. Ed is known as the father of the independent living movement.

California Mental Hygiene Department determines that chlorpromazine and other neuroleptics prolong hospitalization.

James Meredith sued to become the first black person to attend the University of Mississippi.

Battered Child Syndrome not recognized by middle class, but recognized in lower class so poor children were rescued from bad, incompetent parents. ���There is no indication that the ancient ritual of child beating has been mitigated by modern theories of child raising. Parents continue to kick and punch their children, twist their arms, beat them with hammers or the buckle end of belts, burn them with cigarettes or electric irons, and scald them with whatever happens to be on the stove.��� Gathering documentation from 71 hospitals, a University of Colorado team headed by Pediatrician C. Henry Kempe found 302 battered-child cases in a single year; 33 of the children died, 85 suffered permanent brain damage. An accompanying Journal editorial predicts that when statistics on the battered-child syndrome are complete, ���It is likely that it will be found to be a more frequent cause of death than such well-recognized and thoroughly studied diseases as leukemia, cystic fibrosis and muscular dystrophy.��� In 1961 Dr. C. Henry Kempe, a pediatric radiologist, and his associates proposed the term ���battered child syndrome��� at a symposium on the problem of child abuse held under the auspices of the American Academy of Pediatrics. The term refers to the collection of injuries sustained by a child as a result of repeated mistreatment or beatings. The following year The Journal of the American Medical Association published the landmark article ���The Battered Child Syndrome��� (C. Henry Kempe et al., vol. 181, no. 17, July 7, 1962). The term ���battered child syndrome��� developed into ���maltreatment,��� encompassing not only physical assault but other forms of abuse, such as malnourishment, failure to thrive, medical neglect, and sexual and emotional abuse. Dr. Kempe had also proposed that physicians be required to report child abuse. According to the National Association of Counsel for Children, by 1967, after Dr. Kempe's findings had gained general acceptance among health and welfare workers and the public, forty-four states had passed legislation that required the reporting of child abuse to official agencies, and the remaining six states had voluntary reporting laws. This was one of the most rapidly accepted pieces of legislation in American history. Initially only doctors were required to report and then only in cases of ���serious physical injury��� or ���non-accidental injury.��� Today all the states have laws that require most professionals who serve children to report all forms of suspected abuse and either require or permit any citizen to report child abuse. One of the reasons for the lack of prosecution of early child abuse cases was the difficulty in determining whether a physical injury was a case of deliberate assault or an accident. In recent years, however, doctors of pediatric radiology have been able to determine the incidence of repeated child abuse through sophisticated developments in X-ray technology. These advances have allowed radiologists to see more clearly such things as subdural hematomas (blood clots around the brain resulting from blows to the head) and abnormal fractures. This brought about more recognition in the medical community of the widespread incidence of child abuse, along with growing public condemnation of abuse.

Counterculture author Ken Kesey's best-selling novel, One Flew Over the Cuckoo's Nest is based on his experiences working in the psychiatric ward of a Veterans' Administration hospital. Kesey is motivated by the premise that the patients he sees don't really have mental illnesses; they simply behave in ways a rigid society is unwilling to accept. In 1975, Kesey's book will be made into an influential movie starring Jack Nicholson as anti-authoritarian anti-hero Randle McMurphy.

���Mental Hospital,��� by Morton M. Hunt.

���The World is a Wedding,��� by Bernard Kops.

���Nothing to Lose.��� London, by Clare Marc Wallace.

1963

President John Kennedy, in a special address to Congress, calls for a reduction, ���over a number of years and by hundreds of thousands, (in the number) of persons confined��� to residential institutions, and he asks that methods be found ���to retain in and return to the community the mentally ill and mentally retarded, and there to restore and revitalize their lives through better health programs and strengthened educational and rehabilitation services.��� Passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act, an outgrowth of President Kennedy���s message, began a new era in Federal support for mental health services. Though not labeled such at the time, this is a call for deinstitutionalization and increased community services to substitute for custodial institutional care.

South Carolina passes the first statewide architectural access code.

John Hessler joins Ed Roberts at the University of California at Berkeley, other disabled students follow. Together they form the Rolling Quads to advocate for greater access on campus and in the surrounding community.

Congress passes the Mental Retardation Facilities and Community Health Centers Construction Act, authorizing federal grants for the construction of public and private nonprofit community mental health centers. Mental Retardation Facilities and Community Mental Health Centers Construction Act Amendments of 1965 - Established grant program to cover initial staffing costs for community mental health centers. Passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act provides the first federal money for developing a network of community-based mental health services. Advocates for deinstitutionalization believe that people with mental illness will voluntarily seek out treatment at these facilities if they need it, although in practice this will not always be the case.

President Kennedy signs Public Law 88-164, the Community Mental Health Centers Act to substitute comprehensive community care for custodial institutional care. Though not labeled such at the time, this is a call for deinstitutionalization and increased community services. The federal CMHC program was based on a seed-money concept. Local communities applied for federal funds that declined over several years (initially five years and then eight). Alternative funds, especially third-party payments, were expected to replace the declining federal grant. These programs were intended to serve catchment areas of between 75,000 and 200,000 individuals and provide five essential services: inpatient services, outpatient services, day treatment, emergency services, and consultation and education services. The country was divided into 3,000 catchment areas, and the hope in the 1960s was that the entire country would be covered by the mid-1970s. That did not come to pass. The Community Mental Health Centers Act (PL 88-164) passed by the U.S. Congress, creating a federally funded community mental health system nationwide. Services are facilities based and paid on a fee-for-service basis.

The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) has grown to 168 mental disorders in the DSM-II from the 112 mental disorders in its initial, 1952 edition.

Six-week NIMH collaborative study concludes that neuroleptics are safe and effective ���antischizophrenic��� drugs.

Scientists at the American pharmaceutical company Hoffmann-LaRoche develop the benzodiazepines diazepam (Valium ��)

In January, Ola Mae Quarterman-Clemons, an African-American woman, at the age of eighteen refused to sit on the back of the bus and spent the next thirty days in jail. She sat in the front seat of an Albany, Georgia bus, refused to move on the command of the driver, was arrested by a policeman and convicted in city court for using ���obscene��� language. The driver testified that she had told him: ���I paid my damn twenty cents, and I can sit where I want.��� Subsequently Miss Quarterman told a federal court, to which her case had gone on appeal, that she had used the word ���damn��� in relation to her twenty cents, not in relation to the driver. (Anywhere but in the Deep South a judge might have thought it incredible that she should be forced to defend her words by making such a distinction.) The city's counsel insisted her race had nothing to do with her arrest, and in cross-examination asked if it were not true that the cause of her arrest was her ���vulgar language.��� She replied softly, ���That's what they said.���

���No Man Stands Alone���The True Story of Barney Ross,��� by Barney Ross.

���And Always Tomorrow,��� by Sarah E. Lorenz.

���I Was a Mental Statistic,��� by Edward X. Lane

���The Bell Jar,��� by Sylvia Plath.

1964

Congress passes and President Johnson signs the Civil Rights Act that prohibits discrimination on the basis of race, religion, ethnicity, national origin, and creed -- later, gender was added as a protected class. The Civil Rights Act outlaws discrimination on the basis of race in public accommodations and employment, as well as in federally assisted programs. It will become a model for subsequent disability rights legislation.

Neuroleptics found to impair learning in animals and humans.

M. P. Feldman and M. K. MacCulloch report on the use of electric shock aversion therapy in the treatment of homosexuality.

The Surgeon General's Report on Smoking and Health was issued and it documented that smoking cigarettes caused cancer and other serious diseases.

23 unmarried mothers per 1000 in mental hospitals. reason: pregnant.

���I never promised you a rose garden.��� New York: Signet. Greenberg, J.

���Sanity, Madness and the Family,��� by R.D. Laing & Aaron Esterson

Robert H. Weitbrecht invents the ���acoustic coupler,��� forerunner of the telephone modem, enabling teletypewriter messages to be sent via standard telephone lines. This invention makes possible the widespread use of teletypewriters for the deaf (TDD's, now called TTY's), offering deaf and hard-of-hearing people access to the telephone system.

���Chastise Me with Scorpions,��� by Laura Rhodes and Lucy Freeman.

���Diary of a Paranoiac,��� by Edwin Mumford.

���The Divided Self: The Healing of a Nervous Disorder.��� London, by Walter Steward Spencer [W. S. Stewart].

���God Gets in the Way of a Sailor,��� by H. G. Thach.

���Truth Forever on the Scaffold: I Tried to Help My Country,��� by James Ross.

���Episode: Report on the Accident Inside My Skull,��� by E. Hodgins.

���Beyond All Reason.��� London, by Morag Coate.

���The White Shirts,��� by E. Field.

1965

Elementary and Secondary Education Act of 1965 - Authorized federal aid to states and localities for educating deprived children, including children with disabilities.

Social Security Act Amendments of 1965 - Established Medicaid program for elderly people and for blind persons and other persons with disabilities. Medicare and Medicaid were established through passage of the Social Security Amendments of 1965, providing federally subsidized health care to disabled and elderly Americans covered by the Social Security program. These amendments changed the definition of disability under Social Security Disability Insurance program from ���of long continued and indefinite duration��� to ���expected to last for not less than 12 months.���

During the mid-1960���s NIMH launched an extensive attack on special mental health problems. Established were centers for child and family mental health, crime and delinquency, minority group mental health problems, schizophrenia, urban problems, and later, rape, aging, and technical assistance to victims of natural disasters.

The CMHC (Community Mental Health Center) Act Amendments of 1965, (P.L. 91-211), were enacted and included the following major provisions: Construction and staffing grants to centers were extended and facilities that served those with alcohol and substance abuse disorders were made eligible to receive these grants. Grants were provided to support the initiation and development of mental health services in poverty-stricken areas. A new program of grants was established to support further development of children���s services. The mental health centers staffing amendments authorized grants to help pay the salaries of professional and technical personnel in Community Mental Health Centers.

The Joint Commission on Mental Health of Children was established by Congress to recommend national action for child mental health.

One-year follow-up of NIMH collaborative study finds drug-treated patients more likely than placebo patients to be rehospitalized.

Vocational Rehabilitation Amendments of 1965 are passed, authorizing federal governments for the construction of rehabilitation centers, expanding existing vocational rehabilitation programs, and creating the National Commission on Architectural Barriers to Rehabilitation of the Handicapped.

William C. Stokoe, Carl Croneberg, and Dorothy Casterline publish A Dictionary of American Sign Language on Linguistic Principles, establishing the legitimacy of American Sign Language and beginning the move away from oralism.

The Autism Society of America is founded by parents of children with autism in response to the lack of services, discrimination against children with autism, and the prevailing view of medical ���experts��� that autism is a result of poor parenting, as opposed to neurological disability.

Congress establishes the National Technical Institute for the Deaf at the Rochester Institute of Technology in Rochester, New York.

Washington Mattachine Society adopts a resolution declaring that, ���homosexuality is not a sickness.���

Bureau of Drug Abuse Control formed under the Department of Health, Education, and Welfare. Responsible for enforcing the Drug Abuse Control Amendment. Drug Abuse Control Amendment regulated, for the first time, the sale and possession of stimulants, depressants, and hallucinogens. It restricted research into psychoactives such as LSD by requiring FDA approval.

���Madness and civilization: A history of insanity in the age of reason.��� New York, NY: Vintage Books, by Foucault, M.

���Portrait of a Schizophrenic Nurse.��� London, by Clare Marc Wallace.

���Memoirs of an Amnesiac,��� by Oscar Levant.

���In Search of Sanity: The Journal of a Schizophrenic,��� by Gregory Stefan.

���All the Hairs on My Head Hurt,��� by Dressler La Marr [Jinxy R. Howell].

���Spy Wife,��� by B. W. Powers and W. Diehl.

���Ward Seven: An Autobiographical Novel,��� by Valeriy Tarsis. (trans. from 1965 Russian ed.).

1966

Dr. Robert Morgan: ���In summary, even one or two ECT treatments risk limbic damage in the brain leading to retarded speed, coordination, handwriting, concentration, attention span, memory, response flexibility, retention, and re-education. On the psychological side, fear of ECT has produced stress ulcers, renal disease, confusion, amnesic withdrawal, and resistance to re-educative or psychological therapy. The research thus indicated that ECT was a slower-acting lobotomy with the added complications of shock-induced terror.���

Elementary and Secondary Education Act Amendments of 1966 - Created National Advisory Committee on Handicapped Children; created Bureau of Education for the Handicapped in U.S. Office of Education.

Fair Labor Standards Amendments of 1966 - Established standards for employment of workers with disabilities, allowing for sub-minimum wages.

Despite the large population directly affected, alcohol abuse and alcoholism did not receive full recognition as a major public health problem until the mid-1960���s. The National Center for Prevention and Control of Alcoholism was established as part of NIMH. Four years later it became a division on its way to institute status.

Frederick C. Schreiber becomes the executive secretary of the National Association of the Deaf.

President Johnson establishes the President's Committee on Mental Retardation.

Christmas in Purgatory by Burton Blatt and Fred Kaplan, is published, documenting the appalling conditions at state institutions for people with developmental disabilities.

A research program on drug abuse was inaugurated with the establishment of the Center for Studies of Narcotic and Drug Abuse within NIMH. Division status followed in 1968, with institute status in 1972.

���Mishaps, Perhaps,��� by C. Solomon.

���Woman in Two Worlds; a Personal Story of Psychological Experience,��� by Wanda Martin.

���Crazy,��� by Jane Doe (pseudonym).

1967

NIMH was separated from NIH and raised to bureau status in Public Health Services by a reorganization that became effective January 1. NIMH���s Division of Clinical, Behavioral and Biological Research, within the Mental Health Intramural Research Program, comprising activities conducted in the Clinical Center and other NIH facilities, continued at NIH under an agreement for joint administration between NIH and NIMH.

On August 13, DHEW Secretary John W. Gardner transferred St. Elizabeths Hospital, the Federal Government���s only civilian psychiatric hospital, to NIMH.

Elementary and Secondary Education Amendments of 1967 - Authorized regional resource centers; authorized centers and services for deaf-blind children.

The National Theatre of the Deaf is founded with a grant from the federal Office of Vocational Rehabilitation.

���The Politics of Experience & The Bird of Paradise.��� Penguin Books, by Laing, R.D.

���The American Woman and Alcohol,��� by P. Kent.

���Five Years in Mental Hospitals: An Autobiographical Essay,��� by Arthur Wellon.

���By Reason of Insanity,��� by John Balt.

1968

Homophile activists protest against Dr. Charles Socarides at the American Medical Association meeting in San Francisco. Much of Socarides' career was devoted to studying how homosexuality develops and how it might be altered. He postulated that homosexuality was a neurotic adaptation, and that it could be 'treated.'

NIMH became a component of Public Health Service���s Health Services and Mental Health Administration (HSMHA).

In a drug withdrawal study, the NIMH finds that relapse rates rise in direct relation to dosage. The higher the dosage that patients are on before withdrawal, the higher the relapse rate.

Handicapped Children's Early Education Assistance Act of 1968 - Established grant program for preschool and early education of children with disabilities.

Vocational Education Act Amendments of 1968 - Required participating states to earmark 10 percent of basic vocational education allotment for youth with disabilities.

Architectural Barriers Act of 1968 - Required most buildings and facilities built, constructed, or altered with federal funds after 1969 to be accessible. The Architectural Barriers Act is passed, mandating that federally constructed buildings and facilities be accessible to people with physical disabilities. This act is generally considered to be the first ever federal disability rights legislation. Architectural Barriers Act: prohibits architectural barriers in all federally owned or leased buildings.

DSM-II reclassifies the sexual deviations as a separate category of personality disorders.

Bureau of Narcotics & Dangerous Drugs is created by executive order, under the Department of Justice, by merging the Federal Bureau of Narcotics and the Bureau of Drug Abuse Control.

���Born To Trouble: Portrait of a Psychopath,��� by R. Lloyd.

���Tornado: My Experience with Mental Illness,��� by Hellen Moeller.

���Half a Lifetime,��� by Alton Brea.

���The Unimportance of Being Oscar,��� by Oscar Levant,

���Never Come Early,��� by Joseph J. Partyka

���More Mishaps,��� by C. Solomon.

1969

The Stonewall Inn riots in New York���s Greenwich Village ignites a radical gay rights movement.

National Institute of Mental Health Task Force on Homosexuality, headed by Evelyn Hooker, completes its Final Report; publication delayed until 1972.

Niels Erk Bank-Mikkelsen from Denmark and Bengt Nirje from Sweden introduce the concept of normalization to an American audience at a conference sponsored by the President's Committee on Mental Retardation, helping to provide the conceptual framework for deinstitutionalization. Their remarks, and those of others, are published in Changing Patterns in Services for the Mentally Retarded.

���Silent News��� is founded by Julius and Harriet Wiggins as a newspaper for deaf people.

Crisis in Child Mental Health, the report of the Joint Commission on Mental Health of Children, was made public.

Journal of Nervous and Mental Diseases describes how they attempted to reduce the aggressive behavior of a thirty-one year old schizophrenic woman by shocking her with a cattle prod whenever she made accusation of being persecuted and abused; made verbal threats, or committed aggressive acts.

Dr. Herbert Modlin, ���managed��� a group of paranoid women back to feminine health; he helped them re-establish their relationships with their husbands. He decided that his paranoid ���patients needed strong male control, both within their marriages and within the hospital.

���Aftershock,��� by Ellen Wolfe.

���My Testimony,��� by Anatoly Marchenko

���Fear No Evil,��� by John E. Leach.

���The Prison of My Mind,��� by Barbara Fields Benziger.

1970's

The final report of President Carter���s Commission on Mental Health calls for attention to basic community supports for mental health consumers. The Comprehensive Drug Abuse Prevention and Control Act consolidated drug laws and strengthened law enforcement; it also authorized the Controlled Substances Act classifying drugs based on medical value, harmfulness, and potential for abuse or addiction. President Nixon identified drug abuse as ���public enemy number one in the United States��� and launched the war on drugs and crime. The initial National Household Survey on Drug Abuse is completed in 1971. By 1970 the woman���s movement, gay rights movement and the disabilities rights movement emerged. Throughout the 1970s, the CMHC program competed with many urgent domestic programs, both health-related and non-health-related. Richard Nixon tried to discontinue the program but was rebuffed by the Democratic Congress. Congress passed amendments that added more requirements for the mental health centers but did not appropriate the funds necessary either to pay for the newly required services or to cover even half of the country in the time frame initially envisioned. Required services included those for children, the elderly population, and chemically dependent persons as well as rehabilitation, housing, and preventive services.

1970

Insane Liberation Front (ILF) is organized by Howie The Harp (homeless advocate), Dorothy Weiner (union organizer) and Tom Wittick (political activist/organizer) in Portland, Oregon. It is the first known, modern, organized, self-help, advocacy, ex-patient group that was dedicated to liberation from psychiatry. This marks the birth of the modern mental patients��� movement.

Developmental Disabilities Services and Facilities Construction Amendments of 1970 - Expanded services to individuals with epilepsy and cerebral palsy; authorized new state formula grant program; defined ���developmental disability��� in categorical terms; established state-level planning council. The Developmental Disabilities Services and Facilities Construction Amendments are passed. They contain the first legal definition of developmental disabilities and authorize grants for services and facilities for the rehabilitation of people with developmental disabilities and state ���DD Councils.���

Mass deinstitutionalization began. Patients and their families were left to their own resources due to lack of outpatient programs for rehabilitation and reintegration back into society.

Nursing home resident Max Starkloff founds Paraquad in St Louis.

Disabled in Action is founded in New York City by Judith Heumann, after her successful employment discrimination suit against the city's public school system. With chapters in several other cities, it organizes demonstrations and files litigation on behalf of disability rights.

The Physically Disabled Students Program (PDSP) is founded by Ed Roberts, John Hessler, Hale Zukas, and others at the University of California at Berkeley. With its provisions for community living, political advocacy, and personal assistance services, it becomes the nucleus for the first Center for Independent Living, founded two years later.

Urban Mass Transportation Act Amendment of 1970 - Authorized grants to states and localities for accessible mass transportation. Congress passes the Urban Mass Transportation Assistance Act, declaring it a ���national policy that elderly and handicapped persons have the same right as other persons to utilize mass transportation facilities and services.��� Passage of the act has little impact, however, as the law contains no provision for enforcement.

Comprehensive Drug Abuse Prevention and Control Act consolidated drug laws and strengthened law enforcement it also authorized the Controlled Substance Act classifying drugs based on medical value, harmfulness, and potential for abuse and addiction. The Controlled Substance Act replaced the Drug Abuse Control Amendment and organized federally regulated drugs (including opiates, coca, cannabis, stimulants, depressants, and hallucinogens) into five schedules with varying restrictions and penalties.

The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act established the National Institute of Alcohol Abuse and Alcoholism within NIMH.

Dr. Julius Axelrod, an NIMH researcher, won the Nobel Prize in Physiology or Medicine for research into the chemistry of nerve transmission for ���discoveries concerning the humoral transmitters in the nerve terminals and the mechanisms for their storage, release and inactivation.��� He found an enzyme that terminates the action of the nerve transmitter, noradrenaline.

The Food and Drug Administration (FDA) approves lithium to treat people diagnosed with manic-depression based upon NIMH research. The Australian psychiatrist John Cade had shown 20 years earlier (1949) that lithium quieted ���manic patients���. This allegedly led to a savings of approximately $40 billion over the next couple of decades and a sharp drop of inpatient days and suicides.

Gay rights activists storm panels on homosexuality at the American Psychiatric Association (APA) annual convention in San Francisco.

First Christopher Street Liberation Day March in New York City commemorating the Stonewall riots.

Ed Roberts formed a group on campus called the Rolling Quads and one year after that, Ed and his associates established the nation���s first Center for Independent Living (CIL). 15 years after being told he was ���too disabled to work���, Ed was appointed as the head of Vocational Rehabilitation for California in, and established 9 CILs in the state in 1975. Today there are over 300 CILs nationwide. Ed is known as the father of the independent living movement.

Urban Mass Transit Act: requires that all new mass transit vehicles be equipped with wheelchair lifts. As mentioned earlier, it was twenty years, primarily because of machinations of the American Public Transit Association (APTA), before the part of the law requiring wheelchair lifts was implemented.

Beginning in the 1970s, The Mental Patients Union (MPU) and Community Organization for Psychiatric Emergencies (COPE) established, evolving eventually into the Campaign Against Psychiatric Oppression (CAPO) in England.

���Power/knowledge: Selected interviews and other writings 1972-1977.��� Ed. C. Gordon. New York: Pantheon Books. Foucault, M.

���Pedagogy of the Oppressed,��� by Paulo Friere

���Psychiatry and Anti-Psychiatry,��� David Cooper

���Sojourn in a Palace for Peculiars,��� by Marty Roberts.

���The Other Caroline,��� by Mary Jane Ward.

���Mental.��� UK, by Robert Quentin Nelson.

1971

The National Center for Law and the Handicapped is founded at the University of Notre Dame in South Bend, Indiana, becoming the first legal advocacy center for people with disabilities in the United States.

The Caption Center is founded at WGBH Public Television in Boston, and it begins providing captioned programming for deaf viewers.

Javits-Wagner-O'Day Act of 1971 - Extended purchase authority to workshops for people with severe disabilities in addition to blindness; retained through 1976 preference for workshops for people who are blind. The Fair Labor Standards Act of 1938 is amended to bring people with disabilities other than blindness into the sheltered workshop system. This measure leads to the establishment, in coming years, of an enormous sheltered workshop system for people with cognitive and developmental disabilities.

A group of 17 national health and mental health organizations sponsored a 2-day conference honoring the 25th anniversary of the enactment of the National Mental Health Act.

Mental Patients Liberation Project (MPLP) founded by Howie The Harp in New York City

Mental Patients Liberation Front (MPLF) founded by two ex-patients in Boston (still in existence and sponsors the Ruby Rogers Advocacy and Drop-In Center). Printed at the New England Free Press, a 56-page document entitled ���Your Rights as a Mental Patient in Massachusetts.���

Mental Patients' Association in Vancouver, Canada begins operating drop-in centers and residences within months of it's founding

Center for the Study of Legal Authority and Mental Patient Status (also known as LAMP) begun in Berkeley by David Richman

Founding of Bonita House a halfway house in Berkeley, CA for persons who have been in psychiatric hospitals with c/s/x activist Sherry Hirsch as Executive Director

The U.S. District Court for the Middle District of Alabama hands down its first decision in Wyatt v. Stickney, ruling that people in residential state schools and institutions have a constitutional right ���to receive such individual treatment as (would) give them a realistic opportunity to be cured or to improve his or her mental condition.��� Disabled people can no longer simply be locked away in ���custodial institutions��� without treatment or education. This decision is a crucial victory in the struggle for deinstitutionalization.

The original Soteria House opened in 1971. A replication facility opened in 1974 in another suburban San Francisco Bay Area City. Despite the publication of consistently positive results the Soteria Project ended in 1983.

Annual APA meeting in Washington DC features first-ever panel of gay people speaking about ���Lifestyles of Non-Patient Homosexuals.���

President Nixon identified drug abuse as ���public enemy number one in the United States��� and launched the war on drugs and crime.

Emotions Anonymous (Self-help, peer support organization), founded in St. Paul, Minnesota.

The initial National Household Survey on Drug Abuse is completed.

���The Radical Therapist,��� a journal begun in 1971 in North Dakota by Michael Glenn, David Bryan, Linda Bryan, Michael Galan and Sara Glenn, challenged the psychotherapy establishment in a number of ways, raising the slogan ���Therapy means change, not adjustment.���

���The Manufacture of Madness.��� New York: Dell Publishing Co./Delta, Szasz, Thomas S.

���Bird's Nest Soup,��� by Hanna Greally.

���Beneath the Underdog, His World as Composed by Mingus,��� by C. Mingus (editor N. King).

���A Question of Madness��� (trans. from 1971 Russian ed.), by Zhores Medvedev.

���Bellevue Is a State of Mind,��� by Anne Barry.

���A Time and a Time.��� London. by S. Davys.

���Life on a Psychiatric Ward.��� Mind, by Anonympous.

���Secrets of the Trade: Notes on Madness, Creativity and Ideology,��� by J. K. Adams.

���Confessions from the Malaga Madhouse: A Christmas Diary,��� by Charlotte Painter.

���A Leaf of Spring,��� by A. Yesenin-Volpin.

���Out of the Depths,��� by William J. Collins.

1972

The U.S. District Court for the District of Columbia, in Mills v. Board of Education, rules that the District of Columbia cannot exclude disabled children from the public schools. Similarly, the U.S. District Court for the Eastern District of Pennsylvania, in PARC v. Pennsylvania, strikes down various state law used to exclude disabled children from the public schools. These decisions will be cited by advocates during the public hearings leading to passage of the Education for All Handicapped Children Act of 1975. PARC in particular sparks numerous other right-to-education lawsuits and inspires advocates to look to the courts for the expansion of disability rights.

The Houston Cooperative Living Residential Project is established in Houston, Texas, becoming a model, along with the Center for Independent Living in Berkeley, for subsequent independent living programs.

Paralyzed Veterans of America, the National Paraplegia Foundation, and Richard Heddinger file suit to force the Washington Metropolitan Area Transit Authority to incorporate access into their design for a new, multibillion dollar subway system in Washington, D.C. Their eventual victory becomes a landmark in the struggle for accessible public mass transit.

Wolf Wolfensberger et al. publish ���The Principle of Normalization in Human Services,��� expanding the theory of normalization and bringing it to a wider American audience.

The parents of residents at the Willowbrook State School in Staten Island, New York, file suit (New York ARC v. Rockefeller) to end the appalling conditions at that institution. A television broadcast from the facility outrages the general public, which sees the inhumane treatment endured by people with developmental disabilities. This press exposure, together with the lawsuit and other advocacy, eventually moves thousands of people from the institution into community-based living arrangements.

Social Security Amendments of 1972 - Extended Medicare coverage to individuals with disabilities; established Supplemental Security Income program for elderly people and for blind persons and other persons with disabilities.

Small Business Investment Act Amendments of 1972 - Established the ���Handicapped Assistance Loan Program��� to provide loans to nonprofit sheltered workshops and individuals with disabilities.

The Rehabilitation Act was passed by Congress and vetoed by President Richard Nixon.

Demonstrations are held by disabled activists in Washington, D.C., to protest the veto of what will become the Rehabilitation Act of 1973 by President Richard M. Nixon. Among those organizing demonstrations in Washington and elsewhere are Disabled in Action, Paralyzed Veterans of America, the National Paraplegia Foundation, and other groups.

The Drug Abuse Office and Treatment Act established a National Institute on Drug Abuse within NIMH.

Passage of the Social Security Amendments of 1972 creates the Supplemental Security Income (SSI) program. The law relieves families of the financial responsibility of caring for their adult disabled children. It consolidates existing federal programs for people who are disabled but not eligible for Social Security Disability Insurance.

Madness Network News begins publication in San Francisco.

First Center for Independent Living (CIL) founded in Berkeley, California by Ed Roberts. The particulars were hammered out for more than a year. The group was officially formed in 1972. A roach-infested two- bedroom apartment was found. Dollars were dug out of personal pockets, some benefit poker games were arranged, but not until July 1972 was the financial squeeze settled. The Rehabilitation Administration produced a grant for $50,000, enough to tide them over while other funds were secured. Generally recognized as the world's first independent living center, the CIL sparks the worldwide independent living movement.

Tardive dyskinesia is said to resemble Huntington���s disease, or ���postencephalitic brain damage���.

The Judge David L. Bazelon Center for Mental Health Law is founded in Washington, D.C, to provide legal representation and to advocate for the rights of people with mental illness.

APA annual meeting sponsors panel--���Psychiatry: Friend or Foe to Homosexuals: A Dialogue������that includes gay activists, gay sympathetic psychiatrists, and a disguised gay psychiatrist, Dr. H Anonymous (John Fryer, MD).

The Legal Action Center, with offices in Washington, D.C., and New York City, is founded to advocate for the interests of people who are alcohol or drug dependent. Today, it also works on behalf of people with HIV/AIDS.

The Network Against Psychiatric Assault (NAPA) is organized in San Francisco.

Mental Patients Alliance of Central New York is established. Carol Hayes-Collier is instrumental to the effort.

The Commonwealth of Virginia ceased its sterilization program (begun in 1924). 8,300 individuals never received justice regarding their sterilizations.

First Conference on Human Rights and Psychiatric Oppression. Thomas Hertzberg, Ph.D. of Northville State Hospital in Detroit, Michigan went to a radical caucus of the American Psychological Association, where psychologists were talking about why it was that psychologists could hold national conferences to talk about consumers yet consumers were not going to conferences to talk about psychologists. That radical caucus knew that there were many abuses in the mental health system to be talked about. They also had heard that there were a few consumer groups organizing on a local level. So, Tom set about to find these groups and to invite them to a planning meeting to be held in Detroit, Michigan to develop a national consumer conference. Tom located Su and Dennis Budd, Howie The Harp, Louis Frydman, Ph.D. of Lawrence, Kansas and others. They met in a very nice hotel to plan what was to become known as the first Conference on Human Rights and Psychiatric Oppression held in 1973.

���Will There Really Be a Morning?��� by Frances Farmer.

���A Mingled Yarn,��� by Beulah Parker.

���Red Square at Noon.��� London, by N. Gorbanevskaya.

���Saints and Strait Jackets: An Intimate View of Life in an Australian Psychiatric Hospital, By an Ex-Patient,��� by Barbara Heaslip.

���Women and Madness,��� by Phyllis Chesler.

���Twice Through the Lines: The Autobiography of Otto John,��� by John Otto.

���Memoirs of a Mental Case,��� by Howard J. Etten.

���Bound for Broadmoor.��� London, by Peter Thompson.

���Fragments from the Diary of a Madman.��� London, by Pawel Cienin.

1973

NIMH temporarily rejoined NIH on July 1 with the abolishment of HSMHA.

On September 25 the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA)--composed of the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and NIMH--was established administratively by the DHEW secretary as the successor organization to HSMHA.

A task force consisting of over 300 consultants, was established to review and analyze the 25-year history of federally sponsored research programs in mental health. Their report, Research in the Service of Mental Health, was issued in 1975.

The first Conference on Human Rights and Psychiatric Oppression is held at the University of Detroit. (held annually until 1985). This conference became an annual event and was held yearly for 13 years between 1973 and 1985. During that time, the Conference on Human Rights and Psychiatric Oppression went through several name changes as the movement grew in scope, ending as the International Conference for Human Rights and Against Psychiatric Oppression. This conference attracted people from Canada, the Netherlands, and Britain. Throughout its history, this conference held yearly demonstrations at hospitals. Some of these demonstrations held vigils friends and neighbors who died in such places. During the life of the Conference on Human Rights and Psychiatric Oppression, ex-patients and psychiatric inmates had no money to organize nationally, yet the drive for companionship and the support of peers drove people to hitchhike and otherwise to beg, borrow, and pool resources to get to the national conferences. The conferences were held in campgrounds and in university dormitories. They drew from 50 to 100 people a year. The expense of the conference itself was often funded by donations from those few ex-patients and psychiatric inmates who had a little money to spare. Many of the early conferences ran in the red. Professionals who supported ex-patients and psychiatric inmates' efforts to organize reported that they experienced negative consequences. Many of the professionals that debated the ethics of assisting ex-patients and psychiatric inmates to organize and were punished severely for aiding the conference. For instance, it was reported that Dr. Tom Hertzberg was fired for bringing people together. Dr. Louis Frydman experienced negative consequences (he was sued for interfering with the doctor-patient relationship and threatened with loss of his tenure at the university where he worked), and later, many brave professionals who helped ex-patients and psychiatric inmates make contact with supportive persons or to independently manage ex-patient organizations simply disappeared from provider agencies. The ex-patient and psychiatric inmate movement was considered dangerous for mental health clients because of perceived misinformation in the movement publications and perceived unskilled techniques used in self-help and mutual support ex-patient and psychiatric inmate-run organizations. Professionals believed they knew what was best and that mental patients should not question their authority.

The American Psychiatric Association (APA) votes to remove homosexuality from the DSM, its list of mental illnesses in part due to the efforts of protests from the movements. Due to new clinical information and political pressure from the National Gay Task Force, the American Psychiatric Association changes the diagnosis of homosexuality from a disease to a condition that can be considered a disease only when subjectively disturbing to the individual. The Board of Trustees (BOT) of the APA approves the deletion of homosexuality from the DSM-II and substitutes a diagnosis of ���Sexual Orientation Disturbance��� In 1980, however, when the APA published a new Diagnostic and Statistics Manual (DSM III), in place of homosexuality was a new diagnosis, ���Gender Identity Disorder in Childhood,��� also known as ���Sissy Boy Syndrome.���

Rehabilitation Act of 1973 - Prohibited disability discrimination in federally assisted programs and activities and federal agencies; required affirmative action programs for people with disabilities by federal agencies and some federal contractors; established the Architectural and Transportation Barriers Compliance Board to enforce the Architectural Barriers Act of 1968. Passage of the Rehabilitation Act of 1973 marks the greatest achievement of the disability rights movement. Of particular interest, Title V, Sections 501, 503 and 504 prohibited discrimination in federal programs and services and all other programs or services receiving federal funds. Key language in the Rehabilitation Act, found in Section 504, states ���No otherwise qualified handicapped individual in the United States, shall, solely by reason of his handicap, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance.��� The act -- particularly Title V and, especially, Section 504 for the first time, confronts discrimination against people with disabilities. Section 504 prohibits programs receiving federal funds from discriminating against ���otherwise qualified handicapped��� individuals and sparks the formation of ���504 workshops��� and numerous grassroots organizations. Disability rights activism seize on the act as a powerful tool and make the signing of regulations to implement Section 504 a top priority. Litigation arising out of Section 504 will generate such central disability rights concepts as ���reasonable modification,��� ���reasonable accommodation,��� and ���undue burden,��� which will form the framework for subsequent federal law, especially the Americans with Disabilities Act of 1990.

The Drug Enforcement Administration is created by executive order under the Dept. of Justice. Combined the Bureau of Narcotics and Dangerous Drugs and several other law enforcement organizations.

Peter Breggin, M.D. founds the Center for the Study of Psychiatry

The first handicap parking stickers are introduced in Washington, D.C.

Passage of the Federal-Aid Highway Act authorizes federal funds to provide for construction of curbcuts.

The Consortium for Citizens with Disabilities is organized to advocate for passage of what will become the Developmentally Disabled Assistance and Bill of Rights Act of 1975 and the Education for All Handicapped Children Act of 1975.

���New Threat to Blacks: Brain Surgery to Control Behavior���Controversial Operations Are Coming Back As Violence Curbs.��� Ebony 1973, February, p.63���72. Mason,B.J.

���Journey Out of Nowhere,��� by Nancy Covert Smith.

���I Couldn't Catch the Bus Today: The True Story of a Nervous Breakdown That Became a Pilgrimage,��� by David Lazell.

���Back to Earth,��� by Edwin E. ���Buzz��� Aldrin Jr. (with Wayne Warga).

���Recovery,��� by John Berryman.

���The Journal of Judith Beck Stein,��� by Judith Beck Stein.

���A Guard Within.��� London, by Sarah Ferguson.

���Madhouse,��� by Robert Goulet.

���Someone With Me: The Autobiography of William Kurelek,��� by William Kurelek (editor J. Maas).

���Lesbian Nation,��� by Jill Johnston.

���I Came to My Island: A Journey Through the Experience of Change,��� by Hanna Bauer.

1974

ADAMHA was officially established on May 4 when President Nixon signed P.L. 93-282.

Boston researchers report that relapse rates were lower in pre-neuroleptic era, and that drug treated patients are more likely to be socially dependent.

In 1974 Congress passed the Child Abuse Prevention and Treatment Act (CAPTA; Public Law 93-247). The law stated: [Child abuse and neglect refer to] the physical or mental injury, sexual abuse, negligent treatment or maltreatment of a child under age eighteen, or the age specified by the child protection law of the state in question, by a person who is responsible for the child's welfare under circumstances which indicate the child's health or welfare is harmed or threatened thereby, as determined in accordance with regulations prescribed by the Secretary of Health, Education, and Welfare. This law created the National Center on Child Abuse and Neglect (NCCAN), which developed standards for handling reports of child maltreatment. NCCAN also established a nationwide network of child protective services and served as a clearinghouse for information and research on child abuse and neglect. Since 1974 CAPTA has been amended a number of times.

Education Amendments of 1974 - Required states to establish plans and timetables for providing full educational opportunities for all children with disabilities as condition of receiving federal funds.

Headstart, Economic Opportunity, and Community Partnership Act of 1974 - Required that at least 10 percent of children enrolled in Head Start be children with disabilities. Congress enacts the Community Services Act, creating the Head Start program, with the stipulation that at least 10 percent of program openings be reserved for disabled children.

Housing and Community Development Act of 1974 - Established Section 8 housing program for low-income families, including individuals with disabilities and/or their families.

Referendum organized by antigay psychoanalysts to overturn APA BOT (Board of Trustees) decision is defeated. APA members support BOT decision to remove homosexuality by significant majority.

Wade Blank founded the Atlantis Community in Denver, Colorado, a model for community-based, consumer-controlled, independent living. The Atlantis Community provided personal assistance services primarily under the control of the consumer within a community setting.

Second Conference on Human Rights and Psychiatric Oppression held in Topeka, Kansas. It was the first time it was run by psychiatric survivors.

���Madness Network News Reader.��� San Francisco, CA: Glide Publications.

The first U.S. National Wheelchair Basketball Tournament is held, as well as the first National Wheelchair Marathon.

The Boston Center for Independent Living is founded.

Halderman v. Pennhurst is filed in Pennsylvania on behalf of the residents of the Pennhurst State School & Hospital. The case, highlighting the horrific conditions at state ���schools��� for people with mental retardation, becomes an important precedent in the battle for deinstitutionalization, establishing a right to community services for people with developmental disabilities.

The first convention of ���People First��� is held in Salem, Oregon. People First becomes the largest U.S. organization composed of and led by people with cognitive disabilities.

The first Client Assistant Projects (CAPs) are established to act as advocates for clients of state vocational rehabilitation agencies.

North Carolina passes a statewide building code with stringent access requirement drafted by access advocate Ronald Mace. This code becomes a model for effective architectural access legislation on other states. Mace founds Barrier Free Environments to advocate for accessibility in buildings and products.

���Every Day Gets a Little Closer: A Twice-Told Therapy,��� by I. Yalon and Ginny Elkin.

���W-3,��� by Bette Howland.

���Retreat From Sanity,��� by M. B. Bowers.

���Visions of a Madman,��� Madness Network News Reader. by P.G. Harrison. (eds. S. Hirsh, J. K. Adams, & L.R. Frank).

���These Are My Sisters: An Insandectomy.��� Tulsa, OK: Vickers, 1947 (reprint) by Lara Jefferson (pseudonym).

���Hurry Tomorrow��� a documentary on involuntary treatment at metropolitan state hospital filmed by Richard Cohen and Kevin Rafferty premiered as a benefit for NAPA, Network Against Psychiatric Assault to overflow audiences at the Clay Theatre in San Francisco. Additional screenings continue at other theaters.

���What It���s Like���From the Receiving End.��� Special Issue of Mind Out, by Anonymous.

���Sketchbook From Hell,��� by Edward Dixon Garner.

���A Quest for Justice: My Confinement in Two Institutions,��� by Bertrand Wilson.

���Being Different: The Autobiography of Jane Fry,��� by Jane Fry.

���Ordeal in a Mental Hospital: The Radical Therapist,��� by Anonymous.

1975

Coverage of Ambulatory mental health services (outpatient) by private health plans ��� The CMCH Act Amendments of 1975 (P.L. 94-63) mandated a more detailed community mental health center definition emphasizing comprehensiveness and accessibility to all persons regardless of ability to pay, through the creation of a community governing board and quality assurance. Required core services expanded from the 1963 levels from 5 to 12, which included the following: Children Services Elderly Services Screening Services Follow-up Care Transitional Services Alcohol abuse Services Drug abuse Services.

The U.S. Supreme Court, in O'Connor v. Donaldson, rules that people cannot be institutionalized against their will in a psychiatric hospital unless they are determined to be a threat to themselves or to others. It is a violation of civil rights to medicate, treat, or hospitalize a person against their will. Also, Rogers v. Macht (Rogers v. Okin or Rogers v. Commissioner of Mental Health) filed and finally adjudicated in 1982 establishing a limited right to refuse treatment (psychiatric drugs) in Massachusetts.

Developmentally Disabled Assistance and Bill of Rights Act of 1975 - described congressional findings regarding rights of persons with developmental disabilities; established funding for protection and advocacy systems; added requirement that state plan include deinstitutuionalization plan; required states to develop and annually review rehabilitation plans for all clients. Congress passes the Developmentally Disabled Assistance and Bill of Rights Act, providing federal funds to programs serving people with developmental disabilities and outlining a series of rights for those who are institutionalized. The lack of an enforcement mechanism within the bill and subsequent court decisions, will, however, render this portion of the act virtually useless to disability rights advocates. Among other things, it establishes the National Protection and Advocacy (P&A) system.

The community mental health centers program was given added impetus with the passage of the CMHC amendments of 1975.

Education for All Handicapped Children Act of 1975 - Required states to establish policy assuring free appropriate public education for children with disabilities as condition for receiving Part B funds; established procedural safeguards, procedures for mainstreaming children with disabilities to the maximum extent possible, and procedures for nondiscriminatory testing and evaluation practices. Education of All Handicapped Children Act (PL 94-142): requires free, appropriate public education in the least restrictive environment possible for children with disabilities. This law is now called the Individuals with Disabilities Education Act (IDEA). The Education for All Handicapped Children Act (Pub. Law 94-142) established the right of children with disabilities to a public school education in an integrated environment. The act is a cornerstone of federal disability rights legislation. In the next two decades, millions of disabled children will be educated under its provisions, radically changing the lives of people in the disability community.

NAPA (Network Against Psychiatric Assault) in Los Angeles is formed after theatrical screenings of ���Hurry Tomorrow.��� The film is reviewed in the Los Angeles Times, ���...a crucifying indictment of ward conditions, drug companies and the violations of present laws. The film is an act of courage and a warning about mind control told with compassion and rage.���

���Hurry Tomorrow��� is screened at international film festivals including Edinburgh, London, Rotterdam, Los Angeles Filmex and wins the Grand Prize at Ann Arbor Film Festival.

Hospital staff and state employees union asks the governor to ban ���Hurry Tomorrow��� as reported in the Los Angeles Times.

The first convention of American Association of the Deaf-Blind is held in Cleveland.

The American Coalition of Citizens with Disabilities is founded. It becomes the preeminent national cross-disability rights organization of the 1970s, pulling together disability rights groups representing blind, deaf, physically disabled, and developmentally disabled people. It hires Frank Bowe as its first executive director, begins a major study of the current status of Americans with disabilities.

The Association of Persons with Severe Handicaps (TASH) is founded by special education professionals responding to PARC v. Pennsylvania (1972) and subsequent right-to-education cases. The organization will eventually call for the end of aversive behavior modification and the closing of all residential institution for people with disabilities.

The Atlantis Community is founded in Denver as a group housing program for severely disabled adults who, until that time, had been forced to live in nursing homes.

���Mainstream: Magazine of the Able-Disabled��� begins publication in San Diego.

The first Parent and Training Information Centers are founded to help parents of disabled children to exercise their rights under the Education for All Handicapped Children Act of 1975.

Fifteen years after being told he was ���too disabled to work,��� Edward Roberts becomes the Director of the California Department of Rehabilitation. He moves to establish nine independent living centers across that state, based on the model of the original Center for Independent Living in Berkeley. The success of these centers demonstrates that independent living can be replicated and eventually results in the founding of hundreds of independent living centers all over the world.

The Western Center on Law and the Handicapped is founded in Los Angeles.

���Too Much Anger, Too Many Tears: A Personal Triumph Over Psychiatry.��� New York: Quadrangle/ The New York Times Book Co. Gotkin, J. & Gotkin, P.

���Reality Police: The Experience of Insanity in America,��� by Anthony Brandt.

���Time and the Human Robot,��� by Hope Rogers.

���Road to Love: An Autobiography,��� by John Harrison Farmer.

���The Far Side of Despair���A Personal Account of Depression,��� by Russell K. Hampton.

���The Eden Express��� (reprinted in 2002), by Mark Vonnegut.

���Living with Depression���and Winning,��� by Sarah Fraser.

���How I Conquered Claustrophobia.��� Mind Out, by Brigit Barlow.

���Addicted to Suicide���A Woman Struggling to Live,��� by Mary Savage.

���Whom the Gods Destroy,��� by John Neary.

���One Flew Over the Cuckoo���s Nest,��� by Ken Kesey made into an award winning movie starring Jack Nicholson.

1976

First ECT (Electro-Convulsive Therapy) informed consent lawsuit

NAPA (Network Against Psychiatric Assault) conducts a one-day protest against involuntary treatment and slave wages paid to people locked up in state hospitals. The demonstrators spontaneously decide to occupy the outer office of then Governor Jerry Brown -- they remain there for a month. There is extensive media coverage and stories throughout California about this extraordinary protest. On July 4th, some NAPA members and the filmmaker attend a midnight screening of ���Hurry Tomorrow��� for Governor Brown, future Governor Gray Davis and Director of Health Jerome Lachner, in Lackner's home -- a few miles from the protest. After screening the film Governor Brown commits to investigate conditions in California state hospitals -- once the demonstrators depart his office. Protesters continue an educational campaign for legislative analysts and lawmakers during their month long stay. The Governor talks to the press about the protest, involuntary treatment and the film.

Governor Brown of California follows through on his word to NAPA by launching an investigation into the state hospitals that results in uncovering more than a thousand patient deaths in a three-year period. The story makes headlines both in Los Angeles and California, and nationally. ���Hurry Tomorrow��� is credited with triggering the biggest and most continuous news story of that year and is featured on CBS and ABC Evening News.

���Hurry Tomorrow��� is screened at international film festivals including Edinburgh, London, Rotterdam, Los Angeles Filmex and wins the Grand Prize at Ann Arbor Film Festival.

���That Nigger���s Crazy.��� Madness Network News, Vol 3:5, March 1976. Highlights scientiԨ�c racism from Samuel Cartwright to Shockley and Jenson, by Teish Luisah, an African-American activist, priestess, psychiatric survivor and author. She co-edited the 1976 Third World Issue of Madness Network News.

���Schizophrenia: The Sacred Symbol of Psychiatry.��� New York: Basic Books, Szasz, Thomas S.

���Insanity Inside Out,��� by Kenneth Donaldson.

Passage of an amendment to Higher Education Act of 1972 provides services to physically disabled students entering college.

The Transbus group, made up of Disabled in Action of Pennsylvania, the American Coalition of Cerebral Palsy Associations, and others, and represented by the Public Interest Law Center of Philadelphia, files suit (Disabled in Action of Pennsylvania, Inc. v. Coleman) to require that all buses purchased by public transit authorities receiving federal funds meet Transbus specifications, making them wheelchair accessible.

Disabled in Action pickets the United Cerebral Palsy telethon in New York City, calling telethons ���demeaning and paternalistic shows which celebrate and encourage pity.���

The Coalition of Provincial Organizations of the Handicapped is founded in Winnipeg, Canada, later becoming the Council in Canadians with Disabilities.

The Disability Rights Center is founded in Washington, D.C. Sponsored by Ralph Nader's Center for the Study of Responsive Law, it specializes in consumer protection for people with disabilities, joining the Justice department in anti-trust action against the Everest & Jennings Company.

The Westside Center for Independent Living founded in Los Angeles as one of the first nine independent living centers established by Ed Roberts and the California Department of Rehabilitation.

���Anna.��� London, by David Reed.

���Josh: My Up and Down, In and Out Life,��� by Joshua Logan.

���Breakdown,��� by Stuart Sutherland.

���The Grigorenko Papers,��� by P. G. Grigorenko.

���Schizophrenia: The Sacred Symbol of Psychiatry.��� New York: Basic Books, Szasz, Thomas S.

���Midnight Baby-Autobiography,��� by Basil Hubbard Pollitt.

���The Case of Leonid Plyushch��� (trans. Marie Sapiets), by Leonid Plyushch.

���Horrors of the Half-Known Life.��� Barker-Benfield, G.J. New York, NY: Harper & Row.

1977

NIMH (National Institute of Mental Health) initiates a unique but modestly funded demonstration program, the Community Support Program (CSP) to stimulate and assist states and localities in improving opportunities and services in the community for people with a serious mental illness.

President Jimmy Carter established the President���s Commission on Mental Health on February 17 by Executive Order No. 11973. The commission was to review the mental health needs of the Nation and to make recommendations to the President as to how the Nation might best meet these needs.

An NIMH study that randomizes schizophrenia patients into drug and non-drug arms reports that only 35% of the non-medicated patients relapsed within a year after discharge, compared to 45% of those treated with medication.

U.S. Congress created a National Committee for the Protection of Human Subjects of Biomedical and Behavioral Research to investigate allegations that psychosurgery ��� including lobotomy techniques ��� was used to control minorities and restrain individual rights.

A study demonstrates that the male model of mental health involves a man���s ability to ���own��� or be ���serviced by��� a woman. Men who will not or cannot do this (male homosexuals, ���schizophrenics���, alcoholics or drug addicts) will be labeled neurotic or psychotic and often hospitalized. The absence of a woman to take care of them despite their lack of masculinity will be associated with longer psychiatric hospital stays.

President Jimmy Carter appoints Max Cleland to head the U.S. Veterans Administration, making Cleland the first severely disabled (as well as the youngest) person to fill that position.

Disability rights activists in ten cities stage demonstrations and occupations of the offices of the federal department of Health Education and Welfare (HEW) to force the Carter Administration to issue regulations implementation Section 504 of the Rehabilitation Act of 1973. The demonstrations galvanize the disability community nationwide, particularly the San Francisco action, which lasts nearly a month. One 28 April, HEW Secretary Joseph Califano signs the regulations.

The White House Conference on Handicapped Individuals brings together 3,000 disabled people to discuss federal policy toward people with disabilities. This first ever gathering of its kind results in numerous recommendations and acts as a catalyst for grassroots disability rights organizing.

Passage of the Legal Services Corporation Act Amendments adds financially needy people with disabilities to the list of those eligible for publicly funded legal services.

The U.S. Court of appeals for the Seventh Circuit, in Lloyd V. Regional Transportation authority, rules that individuals have a right to sue under Section 504 of the Rehabilitation Act of 1973 and that public transit authorities must provide accessible service. The U.S. Court of Appeals for the Fifth Circuit, in Snowden v. Birmingham Jefferson County Transit Authority, undermines this decision by ruling that authorities need provide access only to ���handicapped persons other than those confined to wheelchairs.���

MHCC (Mental Health Consumer Concerns, Inc.) Jay Mahler, Contra Costa County, California

Mental Patients Rights Association (MPRA), (Sally Zinman, West Palm Beach, Florida)

Project Acceptance (Su Budd, Kansas)

Mental Patients Liberation Alliance (MPLA) of Central New York is incorporated. (George Ebert, Syracuse, NY)

Vermont Liberation Organization (Paul Dorfner)

���Clouds of Fear.��� London, by Roger Hall.

���Wander, Wander: A Woman's Journey into Herself,��� by Dix Never.

���Midnight Express,��� by B. Hayes (with W. Hoffer).

���My Ambition is to be Dead,��� Journal of Child Psychotherapy, 4(3), 66-83, by A. Hurry.

���The Cracker Factory,��� by Joyce Rebeta-Burditt.

���A Case Between Mentally Sound and Mentally Unsound,��� by Lai Quek Seng.

���I���m Eve,��� by Chris Costner Sizemore and Elen Sain Pittillo.

���No Longer Lonely,��� by Pat Ansite.

���The Joy of Gay Sex,��� by Charles Silverstein and Edmund White

���Maniac: Anatomy of a Mental Illness,��� by Charles F. Hellmuth.

1978

���On Our Own: Patient Controlled Alternatives to the Mental Health System��� a seminal work and is published by McGraw-Hill. Written by Judi Chamberlin, it becomes a standard text of the psychiatric survivor movement.

California investigator Maurice Rappaport reports markedly superior three-year outcomes for patients treated without neuroleptics. Only 27% of the drug-free patients relapsed in the three years following discharge, compared to 62% of the medicated patients.

Canadian researchers describe drug-induced changes in the brain that make a patient more vulnerable to relapse, which they dub ���neuroleptic induced supersensitive psychosis���.

Neuroleptics found to cause 10% cellular loss in brains of rats.

���History of Shock Treatment��� by Leonard Roy Frank

The final report submitted to the President of President Carter's Commission on Mental Health chaired by First Lady Rosalyn Carter calls for attention to basic community supports for mental health consumers. The report reassessed the CMHC program concept. The decision was made to reinvigorate the program with additional dollars and redirect the program toward the tens of thousands of individuals who had been dehospitalized during the 1970s. The Mental Health Systems Act of 1980 (Public Law 96���398) was an effort to find new meaning in the original Kennedy legislation, and it was signed just one month before the election of 1980. Medical Assistance (MA) added for community MH services (outpatient and day treatment).

Amendments to the Rehabilitation Act: provides for consumer-controlled centers for independent living.

Dr. Solomon H. Snyder, an NIMH grantee, was awarded the Albert Lasker Award in Basic Medical Research for his pioneering work in identifying the opiate receptors, and the demonstration of their relation to the enkephalins, natural chemicals released by the brain which have the effect of relieving pain and influencing emotional behavior.

On July 5-6, 1978, Wade Blank, founder of ADAPT (1983) and nineteen disabled activists held a public transit bus ���hostage��� on the corner of Broadway and Colfax in Denver, Colorado. Disability rights activism in Denver stage a sit-in demonstration, blocking several Denver Regional Transit Authority buses, to protest the complete inaccessibility of that city's mass transit system. The demonstration is organized by the Atlantis Community and is the first action in what will be a year-long civil disobedience campaign to force the Denver Transit Authority to purchase wheelchair lift-equipped buses. AD