A psychiatric hospital is a hospital specialising in the treatment
of persons with mental illness. Psychiatric wards differ
only in that they are a unit of a larger hospital.Psychiatric
hospitals have a number of differences from other hospitals.
First, they often have elaborate procedures to prevent
patient suicide (for example, appliances with power
cords are not allowed, and access to stairways and high,
open windows is restricted. Second, they attempt to
reduce the amount of sensory stimulation patients receive.
Contrary to popular belief, psychiatric hospitals are
generally quiet, even boring places. Third, psychiatric
hospitals often try to as normal an environment as possible.
For example, unlike most other hospitals many or most
patients in psychiatric hospitals wear everyday clothes
rather than patient examination garments.
In the United States, psychiatric hospitals in the past were often
set up as separate institutions with funding and administrations
separate from those of general health care. Since the development
effective therapies in the there has been an increasing move towards
integration of psychiatric treatment within the general health sector.
Psychiatric wards in general hospitals and various based treatments
are replacing the old asylums worldwide.
In the United Kingdom during the late county authorities
were expected to provide their own asylums, for the care or incarceration
of lunatics. Private institutions had existed before this, and provided
the only care available. Throughout this period, private institutions
continued to exist and be founded for so called idiots and imbeciles,
who were usually those who today would be said to have mental retardation
or learning disabilities. The county asylum structure was nationalised
in when the institutions were absorbed into to the and worldwide,
most psychiatric hospitals have been replaced by Care in the Community
and psychiatric wards in general hospitals. It was only until relatively
recently that incarceration was mandatory for all with considerable
mental health problems. Today, secure and medium-secure units care
for those who require more support or supervision.
Today, in both countries, if a patient had been admitted
to the hospital on a voluntary basis, the patient is often allowed
to check him or herself out of the hospital against medical advice.
In most jurisdictions, requires at least a day's notice. This is
so in the event a doctor decides the patient would still present
a danger to self or others, there is time to commence involuntary
commitment procedures.Since the efforts have been made to improve
mental health care. Nevertheless, many problems remain in those
countries where free health not available or where funding is limited.
This especially affects those with little money to pay for expensive
facilities. Limited funding of hospitals can lead to a lack of adequate
staff and resources which can lead to the use of restraints and
medication for punishment rather than treatment. Procedural deficiencies
such as a lack of documentation for involuntary treatment and other
serious deficiencies remain all too common in some countries.
The history of psychiatric hospitals is linked heavily
with social and scientific attitudes towards mental health, and
the attitudes towards those afflicted with mental illness, both
of which have changed greatly over the past centuries.Scene of Bethlem
Hospital from the final plate of William Hogarth's A Rake's Progress.As
the number of people living in cities increased, there became an
increasingly large population of urban mentally ill. Generally speaking,
in rural areas the mentally ill had been able to rely on local charity
and support, managed to simply "blend in" with the rest
of the population. However, under the demands of larger cities they
faced a higher degree of difficulty and had a much greater chance
of causing disruption or simply being noticed. This led to the building
early asylums which were little more than repositories for the mentally
ill – removing them from mainstream society in the same manner
as a jail would for criminals. Conditions were often extremely poor
and serious treatment was not yet an option. The first known psychiatric
hospital, Bethlem Royal Hospital was founded in London in had begun
accepting "lunatics". It soon became famous for its harsh
treatment of the insane and in the 18th century would allow visitors
to pay a penny to observe their patients as a form of "freak
show". In it is recorded that the "lunatics" were
called "patients" for the first time, and within twenty
years separate wards for the "curable" and "incurable"
patients had been established, representing the beginning of a clear
shift in the attitude towards mental illness towards a disease of
some form.
In 1793 Phillipe Pinel is credited as being the first
to introduce humane methods into the treatment of the mentally ill
as the superintendent of the Asylum de Bicêtre in Paris. He
removed patient restraints and introduced categorising and separation
as well as observation and talking to patients as methods of cure.
At much the same time William Tuke was pioneering a more enlightened
approach to the treatment of the mentally ill in England. These
ideas gradually took hold in different countries, and in the United
States attitudes towards the treatment of the mentally ill began
to drastically improve during the mid-Dix in the United States,
began to advocate a more humane and progressive attitude towards
the mentally ill. In the United States, for example, numerous states
established state mental health systems paid for by taxpayer money
d often money from the relatives of those institutionalised These
centralised institutions were often linked with loose governmental
bodies, though in general oversight was not high and quality consequently
varied. They were generally geographically isolated as well, located
away from urban areas because the land was cheap and there was less
political opposition. Many state hospitals in the United States
were built in the on the Kirkbride Plan, an architectural style
meant to have curative effect.
While many of those in state hospitals were voluntarily
admitted, many more were involuntarily committed by courts. For
this reason, state hospital patients were usually from the lower
class, as the mentally ill from families with money often had enough
private care to avoid being labelled a public menace.In the , state
hospitals in some places began to overflow by the beginning of the
. As state populations increased, so did the number of mentally
ill and so did the cost of housing them in centralised institutions.
During wartime, state mental hospitals became even more overburdened,
often serving as hospitals for returning servicemen as well as for
their regular clientele. The incentive to discharge patients was
high, yet there were still no adequate treatments or therapies for
the mentally ill.
Stockton State Hospital, in Stockton, California,
was California's first state psychiatric hospital (picture ca. 1910).This
provided a fruitful environment for the popularity of quick-fix
solutions, like the eugenic compulsory sterilisation programs undertaken
in over 30 U.S. states (and, later, in Nazi Germany), which allowed
institutions to discharge patients while still claiming to be serving
the public interest. These new treatments of mental illness –
which was now seen as a "defect", and likely a hereditary
one – were seen less as therapeutic for the individual patient
than as preventative for the society as a whole.By th treatment
of the mentally ill became effective for the first time with the
advent of electroconvulsive therapy (ECT) and insulin shock therapy,
and the use of the lobotomy technique. In modern times, insulin
shock therapy and lobotomies are viewed as being almost as barbaric
as the Bedlam "treatments", though in their own copt to
aid those suffering from early signs of mental illness before they
got to the stage where they would be institutionalised in a mental
hospital. At the time, mental hospitals were viewed as the least
desirable solution to the problem of mental illness, both from a
humane point of view and an economic one. The point of view continued
to promulgate and went even further in the backlash against social
welfare policies in the 1980s, which lead to massive deinstitutionalisation
and funding cuts. These changes lead to the closing of many mental
hospitals and the further reliance on local community care.
In some nations, mental hospitals were used as sites
for the stifling of political dissidence or even genocide. Under
Nazi Germany, a euthanasia program began which resulted in the killings
of tens of thousands of the mentally ill housed in state institutions,
and the killing techniques perfected at these sites became later
implemented in the Holocaust (see T-4 Euthanasia Program). In the
Soviet Union, dissidents were often put into asylums and kept on
a variety of destabilising medications, with the hope of not simply
removing them from society, but making them unreliable in the eyes
of others (see Psikhushka). Both of the attitudes in these cases
– that the mentally ill were a scourge and needed to be eliminated,
and that the line between 'patient' and 'prisoner' is incredibly
blurry – have their precedents in the history of mental hospitals,
though were taken to extremes by totalitarian regimes.
Mental hospitals in the media
Mental hospitals are often depicted as frightening places in fiction,
where treatments are forced upon inmates by uncaring staff, or inmates
themselves are either violently deranged or sinister. Although there
have been cases of abuse of patients in real life, and some conditions
do occasionally result in violent behaviour, this stereotype of
mental hospitals is grossly misleading.Some recent depictions of
mental hospitals in the media include:
K-Pax, a film starring Kevin Spacey as an instituti
who claims to be a space alien.
AAsylum, in the Batman mythos. In the films, the asylum
was seen briefly in Batman Forever and then in Batman
and Robin, but had a more vital role in Batman Begins.
Girl, Interrupted, a film based on a book written by
a former patient of McLean Hospital a film in which
Halle Berry plays a psychiatrist who ends up institutionalised
in the very hospital she used to work at.
In Halloween, after having murdered his sister, a young
Michael Myers is placed in Smith's Grove Sanitarium
until he escapes 15 years later.
House on Haunted Hill set in The Vannacutt Psychiatric
Institute for the Criminally Insane, a fictional institute
reknown for its mass-murdererings of patients in Los
Angeles, CA.
One Flew Over the Cuckoo's Nest, a film based on a book
by Ken Kesey about power and identity, set in a brutally-run
mental institution.
Patch Adams, a film starring Robin Williams as "Patch"
Adams, a man who checks himself into a mental hospital
but eventually leaves when he discovers what he needs
isn't there.
Session 9, a film shot in Danvers State Hospital in
which a cleaning crew wins a bidding contract to clean
up an abandoned large mental hospital within a week.
One of the cleaners discovers old tapes of disturbing
therapy sessions and develops schizophrenia under the
stress of the tight schedule. Sharon's Secret, a film
about an institutional psychiatrist investigating a
16-year-old girl suspected of murdering her parents.
Terminator 2: Judgment Day, an action film in which
Linda Hamilton plays a heroine committed for her (apparently)
delusory belief that the end of the world is about to
be brought about by a killer artificial intelligence.
In The Silence of the Lambs, Dr Hannibal Lecter is held
at the Baltimore State Hospital for the Criminally Insane.
Twelve Monkeys, a science fiction film in which a man
claiming to be from a post-apocalyptic future (played
by Bruce Willis) understandably ends up being committed.
Ginger Snaps 2: Unleashed, a horror flick in which Emily
Perkins plays a young werewolf who is committed to mental
institution after overdosing on an anti-lycantropic
serum intended to cue German army. The town's insane
asylum is accidentally unlocked as the Germans are leaving
and the inmates take over the town.
The Simpsons television series features Calmwood Mental
Hospital is several episodes, most notably "Hurricane
Neddy", in which Ned Flanders—whose home
had been destroyed in a hurricane—checks in after
thinking he's lost his mind.
Psychonauts Pointy Towers Home for the Disturbed is the laboratory
of the evil Dr. Loboto. Raz infiltrates the decrepit mental hospital
(at night, mind you) to rescue his girlfriend Lilli from the Doctor's
clutches.
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