# data[].attributes.body
Although Esther was not staying at an actual specific asylum, as she is just a character in a book, readers are able to capture an idea of what they may have been like from a patient’s point of view

“What bothered me was that everything about the house seemed normal, although I knew it must be chock-full of crazy people. There were no bars on the windows that I could see, and no wild or disquieting noises” (Plath 140).

# data[].attributes.body
Rosemary Kennedy was born during World War I with some form of mental disability.  (It is unclear what type of disability she had because the knowledge of mental illnesses wasn’t where it is today. It is believed that she has some form of learning disability.) In 1941, her father, Joseph P. Kennedy Sr. chose for his daughter to have a new psychiatric procedure, a lobotomy. “Instead of improving her life, this ill-conceived procedure dramatically worsened the brain damage she had experienced at birth, and she was never the same.”
(Patrick Kennedy’s Common Sense)
https://www.history.com/news/kennedy-family-secret-inspired-special-olympics
Eunice Kennedy (left) with her sister Rosemary Kennedy (right).

# data[].attributes.body
One patient’s experience:

“Begging, pleading, crying, and resisting, they [the patients] were herded into the gymnasium and seated around the edge of the room.

Between them and the shock treatment table was a long row of screens. The table on the other side of the screen held as much terror for most of these patients as the electric chair in the penitentiaries did for criminals... In order to save time, one or more patients were called behind the screen to sit down and take off their shoes while the patient who had just preceded them was still on the table going through the convulsions that shake the body after the electric shock has knocked them unconscious.

One attendant stands at the head of the table to put the rubber heel in their mouth so they won't chew their tongue during the convulsive stage. On either side of the table stand three other attendants to hold them down...The only comforting thing from those times was the sight of some of the quieter and more controlled patients comforting the terror-stricken ones. I can remember many a friendly hand placed on mine--many a comforting shoulder I leaned against while I waited my turn... This has changed somehow now I am glad to say, and treatments are not quite so inhumanely administered--but I hope to see the day when they will be entirely replaced by the new drugs now coming into use as tranquilizers."
https://www.sos.mo.gov/archives/exhibits/quest/treatment/1930-1950

# data[].attributes.body
Although the study of mental health was a new topic during the early 1900s, the “hospitals” for those with mental illnesses were no where near the quality of mental health facilities today. The treatment of patients in these facilitates during the 1900s was dehumanizing.
#gruesome #watchwithdiscretion #horrifying

# data[].attributes.attachment_link.title
Top 10 HORRIFYING Mental ASYLUMS in the United States

# data[].attributes.body
#inhumane #degregationofsociety #1900streatments

# data[].attributes.attachment_link.readable_text
These harrowing photos look inside mental asylums of the 19th and 20th centuries and reveal just how disturbing their conditions once were.

"The degree of civilization in a society," goes Russian novelist Fyodor Dostoyevsky's deathless phrase, "can be judged by entering its prisons." But perhaps that phrase also applies to another class of institutions meant to house those deemed unfit for society: mental asylums.

And for centuries - right up until the present day, in some places - the quality of most mental asylums, at least those in the European tradition, revealed little degree of civilization at all.

It wasn't until the very end of the 18th century that just a few doctors in France and England, including Philippe Pinel and William Tuke, first brought forth the then-revolutionary notion of doing away with chains and corporal punishment.

It wasn't until England's Lunacy Act of 1845 that a government first officially designated the mentally ill as actual patients in need of treatment.

And it wasn't until the middle of the 19th century that France, England, and the United States first established public, state-run asylums with government oversight and committees in place to investigate abuses - the full extent of which will never be truly known.

Of course, abuse, neglect, and mistreatment inside mental asylums hardly ended in the middle of the 19th century - on the contrary. While facilities for the mentally ill had now become institutionalized, the late 19th and 20th centuries brought many new problems.

For one, the growth of psychiatry as a discipline meant more diagnoses and thus patients to fit into facilities that were growing ever more overcrowded. Likewise, the growth of psychiatry meant more doctors developing more procedures that seemed increasingly radical throughout the early and mid-20th century, which gave us electroshock therapy and the lobotomy, among others.

At the same time, the rise of fascism and totalitarianism in Europe gave rise to a wave of politically-motivated abuses in mental asylums, with powerful regimes including those in Nazi Germany, the Soviet Bloc, and apartheid-era South Africa summarily institutionalizing suspected enemies of the state and/or creating eugenics programs to weed out those who truly were mentally ill.

But even in cases not nearly so extreme, even in the garden-variety mental asylums (a term itself that has now fallen out of favor) of 20th century Europe and America, the institutional conditions were often startling by today's standards: lobotomies performed with repurposed ice picks, patients chained to concrete slabs, children in straight jackets tied to radiators, and worse.

Let the harrowing photos above return you to a comparatively benighted era in psychiatric care - one that wasn't actually all that long ago.
Next, see 37 haunting portraits of life inside Victorian mental asylums. Then, step inside one of the most infamous mental asylums of all time with this look at Bethlem Royal Hospital, more commonly known as "Bedlam."

# data[].attributes.attachment_link.title
44 Haunting Photos Taken Inside Mental Asylums Of Decades Past

# data[].attributes.attachment_link.description
"The degree of civilization in a society," goes Russian novelist Fyodor Dostoyevsky's deathless phrase, "can be judged by entering its prisons." But perhaps that phrase also applies to another class of institutions meant to house those deemed unfit for society: mental asylums. And for centuries - right up until the present day, in some places - the quality of most mental asylums, at least those in the European tradition, revealed little degree of civilization at all.

# data[].attributes.body
A popular form of “treatment” in the early 1900s.
https://dualdiagnosis.org/mental-health-and-addiction/history/#_ftnref4

# data[].attributes.body
Esther received not only electroshock therapy, but also insulin shock therapy.
“Three times each day the nurses injected me, and about an hour after each injection they gave me a cup of sugary fruit juice and stood by, watching me drink it.  ‘Lucky you,’ Valerie said. ‘You’re on insulin.’” (Plath 191-192).

The reason for giving Esther these injections of insulin was to make sure she had a reaction to it (which was really causing her body to go into shock because she had low blood sugar) and supposedly that reaction was supposed to make her feel better.  In all reality, it did the opposite. The injections didn’t improve her mental health and could have been detrimental to her physical health.

# data[].attributes.body
In 1955, there were 559,000 people in asylums, and people weren’t expected to get better with treatments, yet they were given treatments anyways.

This is similar to Esther in The Bell Jar, who is put into a mental health facility, and although her case is deemed as hopeless, she is continually
being treated. There were also a lot of people being treated for mental illnesses at the time, and the book takes place in the 1950’s.

# data[].attributes.attachment_link.readable_text
Deinstitutionalization was a government policy that moved mental health patients out of state-run institutions and into federally funded community mental health centers. It began in the 1960s as a way to improve the treatment of the mentally ill while also cutting government budgets.

In 1955, the number peaked at 559,000 patients or 0.3% of the population.﻿﻿﻿﻿﻿ If the same percentage of the population were institutionalized today, that would be 1,109,148 people.﻿﻿﻿﻿﻿

Effects of Deinstitutionalization

Between 1955 and 1994, roughly 487,000 mentally ill patients were discharged from state hospitals. That lowered the number to only 72,000 patients.﻿﻿﻿﻿﻿﻿ States closed most of their hospitals. That permanently reduced the availability of long-term, in-patient care facilities. By 2010, there were 43,000 psychiatric beds available.﻿﻿﻿﻿﻿﻿ This equated to about 14 beds per 100,000 people.

As a result, 3.5 million people considered severely mentally ill do not receive any psychiatric treatment at all.﻿﻿﻿﻿﻿﻿ About 200,000 of those who suffer from schizophrenia, depression, or bipolar disorder often become homeless.﻿﻿﻿﻿﻿﻿﻿﻿﻿

More than 350,000 people are in jails and prisons.﻿﻿﻿﻿﻿﻿ Sixteen percent of all inmates are severely mentally ill. There are almost 10 times as many severely mentally ill people in jails and prisons than in hospitals.

3 Causes of Deinstitutionalization

Three societal and scientific changes occurred that caused deinstitutionalization. First, the development of psychiatric drugs treated many of the symptoms of mental illness. These included chlorpromazine and later clozapine.

Second, society accepted that the mentally ill needed to be treated instead of locked away. This change of heart began in the 1960s.

Third, federal funding such as Medicaid and Medicare went toward community mental health centers instead of mental hospitals.

History of Deinstitutionalization

Congress passed the National Mental Health Act.﻿﻿﻿﻿﻿ It created the National Institute of Mental Health in 1949. The Institute researched ways to treat mental health in the community.

The Food and Drug Administration approved Thorazine, known generically as chlorpromazine, to treat psychotic episodes. The only other treatments available at the time were electroshock therapy and lobotomies. There were only 7,000 psychiatrists, 13,500 psychologists, and 20,000 social workers in the entire country.﻿﻿﻿﻿﻿

The number of patients in public mental health hospitals reached a record of 559,000. They suffered from schizophrenia, bipolar disorder, and severe depression. Many had organic brain diseases such as dementia and brain damage from trauma. Others suffered from mental retardation combined with psychosis, autism, or brain damage from drug addiction. Most patients were not expected to get better given the treatments at the time. Congress passed the Mental Health Study Act of 1955.﻿﻿﻿﻿﻿ It established the Joint Commission on Mental Illness and Health to evaluate the nation's mental health situation.

The commission published its findings in Action for Mental Health. It recommended that community health centers be set up to treat those with less severe mental illnesses. The American Psychological Association's paper, "Recognition and Prevention of Major Mental and Substance Use Disorders," said the commission's research estimated that 20% of the population suffered from some form of mental illness and distress.﻿﻿﻿﻿﻿

Ken Kesey published "One Flew Over the Cuckoo's Nest." ﻿﻿﻿﻿﻿ It was a fictional story about abuses in a mental hospital. The author dramatized his experiences as a nurse's aide in the psychiatric wing of a California veteran's hospital. The book helped turn public opinion against electroshock therapy and lobotomies.

President John F. Kennedy signed the Community Mental Health Centers Construction Act.﻿﻿﻿﻿﻿ It provided federal funding to create community-based mental health facilities. They would provide prevention, early treatment, and ongoing care. The goal was to build between 1,500 and 2,5000 centers.﻿﻿﻿﻿﻿ That would allow patients to remain close to their families and be integrated into society. Many of those in hospitals had no families.

President Lyndon B. Johnson signed the Social Security Amendments of 1965. It created Medicaid to fund health care for low-income families. It did not pay for care in mental hospitals. As a result, states transferred those patients into nursing homes and hospitals to receive federal funding.

California's Governor Ronald Reagan signed the Lanterman-Petris-Short Act.﻿﻿﻿﻿﻿ It limited a family's right to commit a mentally ill relative without the right to due process. It also reduced the state's institutional expenses. That doubled the number of mentally ill people in California's criminal justice system the following year.﻿﻿﻿﻿﻿ It also increased the number treated by hospital emergency rooms. Medicaid covered those costs. Other states followed with similar involuntary commitment laws.

The film, "One Flew Over the Cuckoo's Nest," hit theaters.﻿﻿﻿﻿﻿ Jack Nicholson's Oscar-winning portrayal of a mistreated patient further turned public opinion against mental hospitals.

Only 650 community health centers had been built. That was less than half of what was needed. They served 1.9 million patients.﻿﻿﻿﻿﻿ They were designed to help those with less severe mental health disorders. As states closed hospitals, the centers became overwhelmed with those patients with more serious challenges.

President Jimmy Carter signed the Mental Health Systems Act to fund more community health centers. But it focused on a broad range of a community's mental health needs. That lessened the federal government's focus on meeting the needs of those with chronic mental illness.﻿﻿﻿﻿﻿

President Reagan repealed the Act through the Omnibus Budget Reconciliation Act of 1981. It shifted funding to the state through block grants. The grant process meant that community mental health centers competed with other public needs. Programs like housing, food banks, and economic development often won the federal funds instead.

The Food and Drug Administration approved clozapine to treat the symptoms of schizophrenia. That strengthened the prejudice against the hospitalization of the mentally ill.

The Great Recession forced states to cut $4.35 billion in mental health spending in three years.﻿﻿﻿﻿﻿

The Affordable Care Act mandated that insurance companies must cover mental health care as one of the ten essential benefits. That included treatment for alcohol, drug, and other substance abuse and addiction. Patient co-pays could be as high as $40 a session. The number of therapist visits could be limited.

Deinstitutionalization successfully gave more rights to the mentally challenged. Many of those in mental hospitals lived in the backwater for decades. They received varying levels of care. It also changed the culture of treatment from "send them away" to integrate them into society where possible.

Deinstitutionalization especially benefited those with Down syndrome and other high-functioning mental disorders.

Many of those released from institutions were severely mentally ill. They were not good candidates for community centers due to the nature of their illnesses. Long-term, in-patient care provides better treatment for many with severe mental illnesses.

There wasn't enough federal funding for the mental health centers. That meant there weren't enough centers to serve those with mental health needs. It also made it difficult to create any comprehensive programs. Mental health professionals underestimated how difficult it was to coordinate community resources scattered throughout a city for those with disorders.

The courts made it almost impossible to commit anyone against their will. That's true regardless of whether it was for the person's own safety and welfare or for that of others.

How It Affects You

There were 11.4 million people who experienced serious mental illness in 2018. Of those, 64% received treatment for their disease. One reason many don't is that 13.4% don't have insurance coverage.

Mental health issues affect the sufferer's family. At least 8.4 million people provide care to an adult with mental or emotional health issues. They spend around 32 hours a week providing unpaid care.

The cost to society is also large. Around 12 million emergency room visits are due to mental health issues. Mood disorders are the most common reason for hospitalization after pregnancy and birth. Serious mental illness costs $193.2 billion in lost earnings each year.

Those suffering from mental health issues comprise almost 40% of those in prison and 20% of the homeless. Another 40% of Veteran's Health Administration patients have a mental or behavioral health issue.

If you or someone you love is one of those people, then you know how the state of mental health treatment in the United States affects you.

# data[].attributes.attachment_link.description
Deinstitutionalization was a government policy that moved mental health patients out of state-run institutions and into federally funded community mental health centers. It began in the 1960s as a way to improve the treatment of the mentally ill while also cutting government budgets.

# data[].attributes.body
In this type of treatment, doctors induced seizures with a stimulant medication. Roughly a minute after the injection of metrazol was given, patients would enter into a seizure. As a result of the seizures, many patients ended up with fractured bones and torn muscles.

# data[].attributes.attachment_link.title
A History of Mental Illness Treatment | CSP Global

# data[].attributes.attachment_link.description
The history of mental illness treatment is filled with strange practices, from blood-letting to lobotomies. Learn about these obscure treatments here.

# data[].attributes.body
Exposing patients to long, hot water baths or showers was believed to have a calming effect so doctors in asylums used this method as a way to treat mental illnesses.
https://www.sos.mo.gov/archives/exhibits/quest/treatment/1930-1950

# data[].attributes.body
One of the asylums Esther ends up at is Belsize. Although Belsize is fictional, it still replicates what asylums were like in the 1950’s.

“At Belsize, even at Belsize, the doors had locks, but the patients had no keys. A shut door meant privacy, and was respected, like a locked door. One knocked, and knocked again, then went away” (Plath 218).

# data[].attributes.body
An anonymous individual who was placed into a mental health facility involuntarily stated: “I would rather die than go in again. I am not depressed, and my psychiatrist considers me normal, but I can’t live through that again. The staff was abusive, demeaning, and dismissive. I felt in fear for my life. Any lack of cooperation was met with physical and chemical punishment. Several of the staff gave me the impression that I would never be released and would spend my lifetime forcibly retained and chemically blasted into oblivion” (Miller 3).

# data[].attributes.body
This treatment started in the late 1920s and ended around the 1960s.  Doctors put their patients into a low blood sugar coma with hopes that the large fluctuations in insulin levels would alter the brain. Doctors injected insulin into their patients, sending the patients into comas. These comas were risky because some proved fatal.  The mortality rate was between 1 and 10 percent.

# data[].attributes.attachment_link.title
A History of Mental Illness Treatment | CSP Global

# data[].attributes.attachment_link.description
The history of mental illness treatment is filled with strange practices, from blood-letting to lobotomies. Learn about these obscure treatments here.

# data[].attributes.body
This treatment was “designed to disrupt the circuits of the brain”. “It consisted of surgically cutting/removing the connections between the prefrontal cortex and frontal lobes of the brain.
https://online.csp.edu/blog/psychology/history-of-mental-illness-treatment

# data[].attributes.body
Often times, the asylums were designed to hold a certain number of patients, yet the number of patients entered into the asylums were more than they could handle.  For example, some asylums were made to hold only 2,000 patients, yet doctors would take on more than 4,000 patients.
https://www.youtube.com/watch?v=s_-bg1dZb80

# data[].attributes.body
People in asylums feel invisible in society due to the ways they’re separated and treated.

“It’s like watching Paris from an express caboose heading in the opposite direction-every second the city gets smaller and smaller, only you feel it’s really you getting smaller and smaller and lonelier and lonelier” (Plath 200).

In this case, Esther views her life based on the perspective of other people.

# data[].attributes.body
“To the person in the bell jar, blank and stopped as a dead baby, the world itself is the bad dream” (Plath 175 ).

The idea of the bell jar is an idea of one being trapped and unable to escape. In Esther’s case, or anyone with a mental illness, they are trapped with the idea of a mental illness that isolates them from overall society.