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  • Writer's pictureKimberly Taylor

How did mental asylums evolve over time and get to where they are today??

Updated: Apr 18, 2022

The Middle Ages: In the Middle Ages, mental illness was regarded as demonic possession. For centuries, the mentally ill were often shackled and shunned and hidden away like a shameful secret.

18th Century: First Mental Asylum opens its doors On October 12, 1773, Eastern State Hospital was established, the first insane asylum in what is now the United States. Eastern State Hospital was built in colonial Williamsburg, Virginia. This was a time in history when mentally ill (aka, “insane, lunatics”) people were seen as something to make fun of and were used as entertainment.

Though not in the U.S., the famous English insane asylum, Bethlehem Royal Hospital (more commonly known as “Bedlam,” and yes, that is the source of that word) was a popular tourist attraction! Eastern State Hospital did a thriving business as it seems there was no shortage of patients. The poor state of mental health treatment back then meant people with “issues” were locked away instead of being given proper mental health care. Of course, psychotropic medicines did not exist then, either. As the hospital became more crowded, individual care declined even more to the point where patients were mere inmates to be housed. In 1885 an electrical fire in a new wing burned the place down.

1848 - 1890 Between 1848 and 1890, dozens of grand mental asylums were built around the United States under the Kirkbride Plan, designed by Thomas Story Kirkbride. An architecture of fresh air and sunlight offered a very different curative approach from the crowded facilities that characterized earlier mental health treatment facilities. Now, after overcrowding and funding cuts brought horrid conditions to these spaces during the 20th century, the Victorian structures are disappearing, and many believe they’re taking a voiceless history with them. According to a report from Preservationworks, which last month focused on Kirkbride preservation at its conference, there were once over 70 of these asylums, but now only 15 remain.

Late 18th Century to the 1950’s: The establishment of mental institutions (previously known as Lunatic Asylums or Insane Asylums) grew from the late 18th Century through the 1950’s, until in the United States nearly 600,000 people were residents in mental hospitals! This trend reversed with improved treatment and the use of drugs, and by 1977 the mental patient population had shrunk in the United States to 160,000. Unfortunately, the Reagan years saw shrinking mental health budgets from government sources and many people went untreated, becoming homeless and straining society. Today only around 35,000 mental patients are in hospitals, while a tremendous amount of our world’s largest prison population is actually mentally ill people that did not get treatment. Something like 100,000+ prison inmates (at least 16% of prison populations) are believed to be mentally ill persons.

1990’s During the 1990’s, most American asylums were shut down. The mass closure of state mental hospitals in the United States coincided with the advent and popularity of neuroleptic medications, the patient rights movement, and the well-intentioned, but poorly delivered, national transition towards community-based mental health care. At one point in the 1950s, more than half a million Americans were confined to state psychiatric institutions, many of them for life. Today, the total number of state psychiatric beds in the U.S. sits around 37,000, with most beds on short-term, acute inpatient units in general medical hospitals.

Today: Today, most Kirkbride hospitals sit abandoned, neglected, and vandalized, though several are still in operation (at greatly reduced capacity) or have been renovated for uses other than mental health care. Perhaps the best example of mixed-use renovation is the former Traverse City State Hospital in Traverse City, Michigan. Closed in 1989, the hospital has been converted into residential condos, offices, and retail space.





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