One of the most significant medical and social initiatives of the twentieth century was the demolition of the traditional state hospitals that housed most of the mentally ill, and the placement of the patients out into the community. The causes of this deinstitutionalization included both idealism and legal pressures, newly effective medications, the establishment of nursing and group homes, the woeful inadequacy of the aging giant hospitals, and an attitudinal change that emphasized environmental and social factors, not organic ones, as primarily responsible for mental illness. Though closing the asylums promised more freedom for many, encouraged community acceptance and enhanced outpatient opportunities, there were unintended consequences: increased homelessness, significant prison incarcerations of the mentally ill, inadequate community support or governmental funding. This book is written from the point of view of an academic neurologist who has served 60 years as an employee or consultant in typical state mental institutions in North Carolina and Ohio.

A total institution is defined by Goffman as a place of residence and work where a large number of like-situated, individuals, cut off from the wider society for an appreciable period of time, together lead an enclosed, formally administered round of life. Prisons serve as a clear example, providing we appreciate that what is prison-like about prisons is found in institutions whose members have broken no laws. This volume deals with total institutions in general and, mental hospitals, in particular. The main focus is, on the world of the inmate, not the world of the staff. A chief concern is to develop a sociological version of the structure of the self. Each of the essays in this book were intended to focus on the same issue--the inmate's situation in an institutional context. Each chapter approaches the central issue from a different vantage point, each introduction drawing upon a different source in sociology and having little direct relation to the other chapters. This method of presenting material may be irksome, but it allows the reader to pursue the main theme of each paper analytically and comparatively past the point that would be allowable in chapters of an integrated book. If sociological concepts are to be treated with affection, each must be traced back to where it best applies, followed from there wherever it seems to lead, and pressed to disclose the rest of its family.

Closing The Asylum: The Mental Patient in Modern Society. The Covid-19 pandemic has affected the mental health of almost everyone, but it has impacted most severely on disadvantaged groups such as people with severe mental health problems, throwing pre-existing inequalities into sharper and starker relief. Though they had mostly all been closed by the turn of the century, the passing of the old Victorian asylums is still a matter of enduring controversy. In this acclaimed book, first published almost thirty years ago, Peter Barham examines the changing fortunes of mental patients in the era of the asylum and after. He demonstrates powerfully that the closure of mental hospitals cannot meet the real needs of people with severe mental health problems without a profound rethinking of the role, rights and status of the former mental patient in society. In a prologue to this new edition, he highlights the ironies of a post-asylum present afflicted by welfare minimalism, widespread deprivation and impoverishment, and a dramatic increase in the use of coercion and constraint in the delivery of mental health care. Closing the Asylum sets the scene for understanding how the experience of being treated as second class citizens has come about, and the author's forceful warnings of the dangers in the current mental health scene are highly germane to any consideration of what must change in our society after Covid. Veteran mental health survivor and campaigner Peter Campbell also contributes a preface in which he examines the passing of the asylums, and their after-life, in the light of his own experience.

In the late 1970s, Barbara Taylor, then an acclaimed young historian, began to suffer from severe anxiety. In the years that followed, Taylor's world contracted around her illness. Eventually, she was admitted to what had once been England's largest psychiatric institutions, the infamous Friern Mental Hospital in London

The last 40 years has seen a significant shift from state commitment to asylum-based mental health care to a mixed economy of care in a variety of locations. In the wake of this deinstitutionalisation, attention to date has focussed on users and providers of care. The consequences for the idea and fabric of the psychiatric asylum have remained 'stones unturned'. This book address an enduring yet under-examined question: what has become of the asylum? Focussing on the 'recycling' of both the idea of the psychiatric asylum and its sites, buildings and landscapes, this book makes theoretical connections to current trends in mental health care and to ideas in cultural/urban geography. The process of closing asylums and how asylums have survived in specific contexts and markets is assessed and consideration given to the enduring attraction of asylum and its repackaging as well as to retained mental health uses on former asylum sites, new uses on former sites, and interpretations of the derelict psychiatric asylum. The key questions examined are the challenges posed in seeking new uses for former asylums, the extent to which re-use can transcend stigma yet sustain memory and how location is critical in shaping the future of asylum and asylum sites.

Though the origins of asylums can be traced to Europe, the systematic segregation of the mentally ill into specialized institutions occurred in the United States only after 1800, just as the struggle to end slavery took hold. In this book, Wendy Gonaver examines the relationship between these two historical developments, showing how slavery and ideas about race shaped early mental health treatment in the United States, especially in the South. She reveals these connections through the histories of two asylums in Virginia: the Eastern Lunatic Asylum in Williamsburg, the first in the nation; and the Central Lunatic Asylum in Petersburg, the first created specifically for African Americans. Eastern Lunatic Asylum was the only institution to accept both slaves and free blacks as patients and to employ slaves as attendants. Drawing from these institutions' untapped archives, Gonaver reveals how slavery influenced ideas about patient liberty, about the proper relationship between caregiver and patient, about what constituted healthy religious belief and unhealthy fanaticism, and about gender. This early form of psychiatric care acted as a precursor to public health policy for generations, and Gonaver's book fills an important gap in the historiography of mental health and race in the nineteenth century.

• Examines the success of homeopathic psychiatric asylums in the United States from the 1870s until 1920 • Focuses on New York’s Middletown State Homeopathic Hospital for the Insane, which had a treatment regime with thousands of successful outcomes • Details a homeopathic blueprint for treating mental disorders based on Talcott’s methods, including nutrition and side-effect-free homeopathic prescriptions In the late 1800s and early 1900s, homeopathy was popular across all classes of society. In the United States, there were more than 100 homeopathic hospitals, more than 1,000 homeopathic pharmacies, and 22 homeopathic medical schools. In particular, homeopathic psychiatry flourished from the 1870s to the 1930s, with thousands of documented successful outcomes in treating mental illness. Revealing the astonishing but suppressed history of homeopathic psychiatry, Jerry M. Kantor examines the success of homeopathic psychiatric asylums in America from the post–Civil War era until 1920, including how the madness of Mary Todd Lincoln was effectively treated with homeopathy at a “sane” asylum in Illinois. He focuses in particular on New York’s Middletown State Homeopathic Hospital, where superintendent Selden Talcott oversaw a compassionate and holistic treatment regime that married Thomas Kirkbride’s moral treatment principles to homeopathy. Kantor reveals how homeopathy was pushed aside by pharmaceuticals, which often caused more harm than good, as well as how the current critical attitude toward homeopathy has distorted the historical record. Offering a vision of mental health care for the future predicated on a model that flourished for half a century, Kantor shows how we can improve the care and treatment of the mentally ill and stop the exponential growth of terminal mental disorder diagnoses that are rampant today.