Happy 250th Birthday, United States! 

It is truly amazing to reflect on being part of this unique moment in our nation’s history! Think of all the advances in technology, the sciences, health care, and mental health care. We’ve got some of the best inventions of all time – air conditioning, refrigeration, all sorts of vehicles, vaccines, super-duper computers in our pockets, and so much more. 

One area of immense growth has been in mental health, and here’s some history for you. 

The 18th Century 

Did you know that in 1773, the first inpatient mental health facility, the Public Hospital in Williamsburg, Virginia (now known as Eastern State Hospital), opened its doors? This was the first time a government body recognized mental illness as a medical condition requiring state-sponsored care. 

Mental health transitioned from being viewed as demonic possession or moral failure to a recognized medical condition, however, treatments were often barbaric. “Treatments” favored isolation, physical restraints like cages and straitjackets, bloodletting, and shock tactics such as ice-cold water submersions. Literally, those were “care” options employed by the Romans 2,000 years ago. In today’s world, that’s torture – Eek! 

The 19th Century 

Asylums were a new approach to mental healthcare which influenced many of the reforms of the 1800s. The system aimed to treat people with mental illness like rational beings – what a concept! Poorhouses continued to treat residents with mental illnesses. Issues of moral treatment and race went unresolved throughout the era. 

The 20th Century 

In the late 1800s through the mid 1900s, Sigmund Freud’s theories popularized talking and psychoanalysis – the psychological and environmental roots of disorders were explored. This formed the core of outpatient therapies and heavily influenced public perception of mental health. 

Public mental hospitals were frequently overcrowded and underfunded. In an era before effective medicines, physicians relied on aggressive physical interventions, often referred to as “heroic therapies.” Examples include bloodletting, lobotomies, and electroconvulsion. 

Mental healthcare changed permanently with the introduction of psychotropic medications in the 1950s. Antipsychotics, anti-depressants, and mood stabilizers were all born. 

Coupled with use of medications and emerging advocacy against institutional abuses, deinstitutionalization was introduced to shift care from psychiatric hospitals to outpatient settings in the mid to late 1900s. By the end of the century, mental health care began treating disorders as the complex intersection of genetic predispositions, psychological coping mechanisms, and sociocultural stressors. 

The 21st Century 

Just a quarter through this period, the landscape of mental health care is drastically different than anything before. We have carry-overs, like various forms of talk therapy which dominate the field, but many of those have become specialized and refined for specific issues such as

trauma, substance use, personality disorders, and more. Holistic and alternative therapies such as those with animals, music, art, and dance are experiencing a revival. 

One of the most important and transformational changes of all has been the incorporation of technology. 250 years ago, people were locked up. Today, high-quality therapy can be obtained from the comfort of your home. The accessibility of therapy has been huge for those with limited means, lives with full schedules, and in areas that have limited mental health care options. 

We still have lots of work to do to improve mental health care, but I’m so grateful to see how far our nation has come and wonder where we’ll be 250 years from now!