Before the Scientific Era
Although the concept of mental illness is relatively new, all societies throughout history have had individuals whose behavior set them apart as unacceptably and incomprehensibly different. However, premodern societies more often could find informal ways of coping with such individuals. First, premodern societies could offer acceptable, low-level roles to those whose thought patterns and behaviors differed from the norm. Second, because work roles rarely required individuals to function in highly structured and regimented ways, many troubled individuals could perform at marginally acceptable levels. Third, in premodern societies, work occurred within the context of the family, whether at home or in fields or forests. As a result, families could watch over those whose emotional or cognitive problems interfered with their abilities to care for themselves. These three factors enabled families to normalize mental illness—that is, to dismiss problematic behavior as mere eccentricity. As a result, unless individuals behaved violently or caused problems for civil authorities, their families and communities could deal with them informally.
In some cases, however, individuals behaved too unacceptably or incompre- hensibly for their communities to normalize. In these cases—and as with all ill- nesses (as described in Chapter 5)—communities needed to find explanations to help them understand why such problems struck some people and not others. Such explanations helped to make the world seem more predictable and safe by convincing the community that such bad things would never happen to “good people” like themselves.
Until the modern scientific age, people typically viewed disturbing behavior as a punishment for sin or for violating a taboo, as a sign that the afflicted individ- ual was a witch, or as a result of evildoing by devils, spirits, or witches. Therefore, the public assigned treatment to religious authorities—whether shamans, witch doctors, or priests—who relied on prayer, exorcism, spells, and treatments such as bloodletting or trepanning (drilling a hole in the skull to let “bad spirits” out). Re- ligious control of socially disturbing behavior reached a spectacular climax with the witchcraft trials of the 15th to 17th centuries, during which religious author- ities brutally killed at least 100,000 people, including some we would now label as mentally ill.
As a capitalist economy began to develop, both religious control and in- formal social control began to decline. Under capitalism, work moved from home and farm to workshops and factories, mak- ing it more difficult for families to care informally for problematic relatives. In addition, a capitalist economy could less readily absorb those whose produc- tivity could not be scheduled and regimented. At the same time, widespread migration from the countryside to cities weakened families and other social support systems, as did migration from Europe to the United States in subse- quent centuries. Meanwhile, other changes in society weakened religious sys- tems of social control.
These changes fostered a need for new, formal institutions to address mental illness. By the end of the 18th century, however, only a few hospitals devoted to treating people with mental illnesses existed along with a few private “madhouses” run by doctors for profit. Instead, most of those we would now label mentally ill were housed with poor people, people with disabilities, and criminals in the newly opened network of public almshouses, or poorhouses.
Conditions in both almshouses and madhouses were generally miserable, but they were especially bad for those considered mentally ill. Doctors and the public typically believed that persons with mental illness were incur- able and were essentially animals. As a result, institutions treated people with mental illnesses like animals—chaining them for years to basement walls or cells, often without clothing or proper food, and beating them if they caused problems.
