A history written in suffering — and in courage
From trepanning to the talking cure, from witch trials to care in the community. The story of how the world has treated people with mental illness is not a straight line toward enlightenment. It is a jagged path — sometimes advancing, sometimes retreating into cruelty — that is still being walked today.
From execution to understanding
Before the word schizophrenia existed, there were centuries of attempts — some well-meaning, most catastrophic — to explain and manage people whose minds worked differently. This timeline does not spare the reader, because the people who lived it were not spared either.
Trepanning
Holes drilled into skulls to release “evil spirits” — one of the oldest surgical procedures in human history. Archaeological evidence shows survival rates of 50–90%, suggesting the practice was widespread and repeated.
Hippocrates and the four humours
A rare early light: Hippocrates proposed that mental distress arose from imbalances in the body’s four humours (blood, phlegm, yellow bile, black bile) — a naturalistic explanation that briefly moved thinking away from demons and gods.
Possession, sin, and exorcism
After the fall of Rome, the Catholic Church became the primary authority on health. Aberrant behaviour was reinterpreted as demonic possession, divine punishment, or sin. “Treatments” included exorcism, flagellation, cold-water immersion, and prayer.
Bethlem (“Bedlam”) founded
London’s Bethlem Hospital — Europe’s oldest psychiatric institution — opens as a priory. By the 17th century it is synonymous with cruelty: patients chained to walls, bled, purged, and spun in rotating chairs. From the 1600s until 1770, paying visitors are admitted to taunt inmates for entertainment.
40,000–60,000 executed as “witches”
Across Europe, an estimated 100,000 people are prosecuted and 40,000–60,000 executed. Many historians believe a significant proportion suffered from undiagnosed psychotic disorders, epilepsy, or severe depression. The Malleus Maleficarum (1486) provides a handbook for identifying and torturing the accused.
Pinel and the unchaining at Bicêtre
French physician Philippe Pinel, working with hospital governor Jean-Baptiste Pussin, begins removing chains from patients at the Bicêtre Hospital in Paris. His “moral treatment” emphasises observation, fresh air, purposeful activity, and dignity — a revolutionary break from centuries of punishment.
The York Retreat opens
English Quaker William Tuke founds The Retreat in York after a fellow Quaker, Hannah Mills, dies in suspicious circumstances at the local asylum. The Retreat pioneers humane “moral treatment”: no restraints, fresh food, exercise, and respect. It becomes a model for reform worldwide.
Dorothea Dix’s crusade
American reformer Dorothea Dix travels over 10,000 miles documenting the abuse of mentally ill people in jails and poorhouses. Her lobbying leads to the creation or expansion of over 30 state-funded psychiatric hospitals. By 1880, the number of US asylums has grown from 13 to 123.
The “heroic” therapies
Well-intentioned but brutal: spinning chairs to induce vomiting; continuous baths (patients strapped into tubs for days); the Utica Crib (a cage-bed in which patients died of shock); Benjamin Rush’s “Tranquilizing Chair” that immobilised the body entirely. These were mainstream medicine.
Clifford Beers and “A Mind That Found Itself”
After three years confined in US psychiatric institutions, Clifford Beers publishes his autobiography exposing systemic abuse. It launches the mental hygiene movement and leads to the founding of what is now Mental Health America (1909) — the first large-scale patient-advocacy organisation.
Insulin coma therapy
Developed by Manfred Sakel: patients with schizophrenia are injected with massive insulin doses to induce repeated comas, 30–60 times over weeks. Mortality rate: 0.5–4.9%. Later studies show any benefit came from the intensive nursing care, not the insulin itself. Abandoned by the 1970s.
The lobotomy
Portuguese neurologist Egas Moniz develops the leucotomy (1935) and wins the 1949 Nobel Prize. American neurologist Walter Freeman adapts it into the “ice pick” transorbital lobotomy — performed through the eye socket, sometimes without anaesthesia. Freeman alone performs ~2,500; ~60,000 are performed in the US and Europe. Rosemary Kennedy (1941) is left permanently disabled. Freeman is banned from operating in 1967 after a patient dies.
Electroconvulsive therapy (ECT)
Italian neuropsychiatrist Ugo Cerletti develops ECT after observing pigs stunned with electricity in a Rome slaughterhouse. Early ECT is administered without anaesthesia or muscle relaxants, causing fractures. Modern ECT (with anaesthesia, brief-pulse current) is safe and effective for severe depression — but its brutal early use and portrayals like One Flew Over the Cuckoo’s Nest have left a lasting stigma.
Aktion T4: the Nazi “euthanasia” programme
Under Hitler’s secret authorisation, an estimated 275,000–350,000 people with mental and physical disabilities are systematically murdered in six killing centres using gas chambers disguised as showers. The programme’s infrastructure, personnel, and gassing techniques become the prototype for the Holocaust extermination camps.
Chlorpromazine: the first antipsychotic
French psychiatrists Jean Delay and Pierre Deniker demonstrate that chlorpromazine (Thorazine) can calm psychotic patients without sedating them into unconsciousness. It is the birth of modern psychopharmacology. Within a decade, US mental hospital populations begin to fall from their 1955 peak of 560,000.
UK Mental Health Act 1959
Landmark legislation replaces the Victorian Lunacy Acts. It prioritises voluntary treatment over compulsory detention, integrates mental health into the NHS, and sets the stage for care in the community.
Enoch Powell’s “Water Tower” speech
As Minister of Health, Powell calls for the closure of the great Victorian asylums — “isolated, majestic, imperious, brooded over by the gigantic water-tower” — and a 50% reduction in psychiatric beds within 15 years. It is the starting gun for deinstitutionalisation in Britain.
Soviet punitive psychiatry
The Soviet state weaponises psychiatry: political dissidents are diagnosed with “sluggish schizophrenia” — a fabricated condition — and confined to psychiatric prisons (psikhushkas). At least 20,000 people are subjected to forced drugging, insulin comas, and physical abuse. The diagnosis is never recognised outside the Eastern Bloc.
UK Mental Health Act 1983
Strengthens patient rights: formalises the right to challenge detention via tribunals, introduces independent advocacy, and tightens rules on treatment without consent. It remains the primary legal framework (amended 2007) for mental health care in England and Wales.
The unfinished revolution
Community care has replaced the asylums — but funding has not kept pace. Bed shortages, revolving-door admissions, and underfunded crisis teams leave gaps that still cost lives. The arc bends toward humanity, but it has not yet arrived.
After the Second World War, for the first time in history, the arc began to bend decisively toward humanity. Asylums emptied. Chains were replaced by medication. Laws were written to protect, not to punish. The revolution is incomplete — but it is real.
People who changed the story
Progress has never been inevitable. It has been driven by individuals — some of them patients, some politicians, some people of faith — who decided that the status quo was intolerable. Not all of them were saints. We honour what they achieved while being honest about their wider lives.
Philippe Pinel
1745–1826
French physician who pioneered “moral treatment” and began removing chains from patients at the Bicêtre and Salpêtrière hospitals in Paris. His 1801 treatise established psychiatry as a medical discipline.
The fuller picture: The famous “unchaining” was more incremental and collaborative than the heroic myth suggests — much of the practical work was done by hospital governor Jean-Baptiste Pussin. And Pinel still used straitjackets when he deemed them necessary.
William Tuke
1732–1822
English Quaker merchant who founded The Retreat in York (1796), the first institution in England to treat the mentally ill with kindness, dignity, and without restraints. His model influenced reform worldwide.
Dorothea Dix
1802–1887
American reformer who single-handedly documented the abuse of mentally ill people across the United States and lobbied state legislatures to build over 30 psychiatric hospitals. She also served as Superintendent of Army Nurses during the Civil War.
The fuller picture: The large-scale asylums she championed eventually became sites of custodial neglect themselves — the very problem the 20th-century deinstitutionalisation movement sought to fix.
Clifford Beers
1876–1943
After three years confined in US psychiatric institutions, Beers published A Mind That Found Itself (1908), launching the mental hygiene movement and founding what is now Mental Health America. He was the first prominent patient-advocate.
The fuller picture: Beers suffered recurrent breakdowns throughout his life and spent his final years institutionalised. His movement’s early embrace of “mental hygiene” rhetoric sometimes overlapped with the eugenics ideology of the era.
Enoch Powell
1912–1998
As UK Minister of Health, his 1961 “Water Tower” speech called for the closure of the Victorian asylums and launched the care-in-the-community movement. It was a genuine act of political courage that changed millions of lives for the better.
The fuller picture: Seven years later, Powell delivered the notorious “Rivers of Blood” speech (1968), opposing Commonwealth immigration in language widely condemned as racist. He was immediately sacked from the Shadow Cabinet. His mental health legacy and his racial politics remain inextricable — a reminder that progressive action in one sphere does not guarantee decency in another.
Bishop Clemens von Galen
1878–1946
Roman Catholic Bishop of Münster who publicly denounced the Nazi Aktion T4 “euthanasia” programme in a series of sermons in August 1941. His protests, shared widely via pamphlet and even RAF leaflet drops, pressured Hitler into officially halting the centralised killings.
The fuller picture: Von Galen was a conservative monarchist who initially supported aspects of the Nazi regime, including its anti-communism. He did not speak out against the persecution of Jewish people with the same force he brought to defending disabled Germans.
The arc can bend back
Everything on this page happened because powerful people decided that some human beings were worth less than others — and used the language of medicine to justify it. If you think that impulse is safely buried in the past, listen to the current President of the United States.
“We’re going to be building new institutions for people that are … seriously mentally ill, insane … We used to have mental institutions. We’re going to bring them back.”
Campaign rally rhetoric, repeatedly stated 2023–2024. No plan for funding or clinical oversight accompanied the proposal.
“… unhoused, drug addicted, and dangerously deranged …”
Language used to describe vulnerable people in the framing of the July 2025 executive order “Ending Crime and Disorder on America’s Streets.”
“Mentally impaired … disabled …”
Used as political insults against Vice President Kamala Harris during the 2024 campaign — weaponising disability as a slur.
“… bad genes …”
Used to describe immigrants in late 2024. Historians at Scientific American and STAT News identified this as language drawn directly from the eugenics playbook of the 1920s.
Historians at Scientific American and STAT News have identified this language as drawn directly from the eugenics playbook of the 1920s — the same intellectual tradition that fed Bleuler’s forced sterilisations at the Burghölzli clinic and, ultimately, the Aktion T4 gas chambers. The words are softer. The underlying logic — that some people are genetically defective and must be removed from public life — is identical.
What has already happened
- On 24 July 2025, the executive order “Ending Crime and Disorder on America’s Streets” directed federal agencies to expand involuntary civil commitment and defund evidence-based Housing First programmes.
- The order mandated the collection of personal health data from unhoused people — drawing condemnation from the ACLU, the Bazelon Center for Mental Health Law, and the National Alliance to End Homelessness.
- The US currently has roughly 18 psychiatric beds per 100,000 people — a third of what experts consider necessary. The executive order allocated no new federal funding to build or staff facilities.
- Simultaneously, the administration’s budget proposed significant cuts to Medicaid — the primary funder of public mental health services — and to the Substance Abuse and Mental Health Services Administration (SAMHSA).
- Legal experts warned the policy conflicted with the Supreme Court’s Olmstead v. L.C. ruling, which guarantees disabled people the right to live in integrated community settings rather than institutions.
The pattern is not subtle. Call people deranged. Defund the services that keep them well. Propose locking them away in institutions that do not exist, with money that has not been allocated, under laws that violate their constitutional rights. Then cut the budget of the agency responsible for their care.
A century ago, almost identical rhetoric led to forced sterilisations, the gas chambers of Aktion T4, and decades of institutional cruelty. The arc of this history does not bend toward justice on its own. It bends because people insist on bending it — and it snaps back the moment they stop paying attention.
This is why vigilance matters. This is why this page exists.
“The history of psychiatry is not a story of doctors and patients. It is a story of power and powerlessness — and of the slow, painful expansion of who counts as fully human.”
— Psycho Next Door
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