![NorthernMichiganAsylumCTraverseCityMI](https://upload.wikimedia.org/wikipedia/commons/b/b0/NorthernMichiganAsylumCTraverseCityMI.JPG)
Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
s or wards specializing in the treatment of severe
mental disorders
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
, such as
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
,
bipolar disorder
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
eating disorders
An eating disorder is a mental disorder defined by abnormal eating behaviors that negatively affect a person's physical or mental health. Only one eating disorder can be diagnosed at a given time. Types of eating disorders include binge eating ...
,
dissociative identity disorder
Dissociative identity disorder (DID), better known as multiple personality disorder or multiple personality syndrome, is a mental disorder characterized by the presence of at least two distinct and relatively enduring personality states.
The di ...
,
major depressive disorder
Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...
and many others. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk
patient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...
s. Others may specialize in the temporary or permanent containment of patients who need routine assistance, treatment, or a specialized and controlled environment due to a psychiatric disorder. Patients often choose
voluntary commitment
Voluntary commitment is the act or practice of choosing to admit oneself to a psychiatric hospital, or other mental health facility. Unlike in involuntary commitment, the person is free to leave the hospital against medical advice, though there ...
, but those whom psychiatrists believe to pose significant danger to themselves or others may be subject to
involuntary commitment
Involuntary commitment, civil commitment, or involuntary hospitalization/hospitalisation is a legal process through which an individual who is deemed by a qualified agent to have symptoms of severe mental disorder is detained in a psychiatric hos ...
and
involuntary treatment
Involuntary treatment (also referred to by proponents as assisted treatment and by critics as forced drugging) refers to medical treatment undertaken without the consent of the person being treated. Involuntary treatment is permitted by law in so ...
.
Psychiatric hospitals may also be called psychiatric wards/units (or "psych" wards/units) when they are a subunit of a regular hospital.
![Niuvanniemen sairaala](https://upload.wikimedia.org/wikipedia/commons/1/11/Niuvanniemen_sairaala.jpg)
The modern psychiatric hospital evolved from and eventually replaced the older
lunatic asylum
The lunatic asylum (or insane asylum) was an early precursor of the modern psychiatric hospital.
The fall of the lunatic asylum and its eventual replacement by modern psychiatric hospitals explains the rise of organized, institutional psychiatry ...
. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint.
With successive waves of reform, and the introduction of effective
evidence-based
Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indivi ...
treatments, most modern psychiatric hospitals emphasize treatment, and attempt where possible to help patients control their lives in the outside world, with the use of a combination of
psychiatric medication
A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made o ...
s and
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
. Exceptions include Japan, where many psychiatric hospitals still use
physical restraints on patients, tying them to their beds for days or even months at a time, and India, where the use of restraint and seclusion is endemic.
History
![RetreatOriginalBuildingssm](https://upload.wikimedia.org/wikipedia/commons/0/0f/RetreatOriginalBuildingssm.jpg)
Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organized institutional
psychiatry
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
Initial psych ...
.
Hospitals known as ''
bimaristan
A bimaristan (; ), also known as ''dar al-shifa'' (also ''darüşşifa'' in Turkish) or simply maristan, is a hospital in the historic Islamic world.
Etymology
''Bimaristan'' is a Persian word ( ''bīmārestān'') meaning "hospital", with '' ...
s'' were built in the Middle East beginning around the early 9th century, with the first in
Baghdad
Baghdad (; ar, بَغْدَاد , ) is the capital of Iraq and the second-largest city in the Arab world after Cairo. It is located on the Tigris near the ruins of the ancient city of Babylon and the Sassanid Persian capital of Ctesiphon ...
under the leadership of the Abbasid Caliph
Harun al-Rashid
Abu Ja'far Harun ibn Muhammad al-Mahdi ( ar
, أبو جعفر هارون ابن محمد المهدي) or Harun ibn al-Mahdi (; or 766 – 24 March 809), famously known as Harun al-Rashid ( ar, هَارُون الرَشِيد, translit=Hārūn ...
. While not devoted solely to patients with psychiatric disorders, they often contained wards for patients exhibiting mania or other psychological distress. Because of cultural taboos against refusing to care for one's family members, mentally ill patients would be surrendered to a ''bimaristan'' only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. Psychological wards were typically enclosed by iron bars owing to the aggression of some of the patients.
Western Europe would later adopt these views with the advances of physicians like
Philippe Pinel
Philippe Pinel (; 20 April 1745 – 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist. He was instrumental in the development of a more humane psychological approach to the custody and care of ps ...
at the
Bicêtre Hospital
The Bicêtre Hospital is located in Le Kremlin-Bicêtre, a commune in the southern suburbs of Paris, France. It lies 4.5 km (2.8 miles) from the center of Paris. The Bicêtre Hospital was originally planned as a military hospital, with constru ...
in France and
William Tuke
William Tuke (24 March 1732 – 6 December 1822), an English tradesman, philanthropist and Quaker, earned fame for promoting more humane custody and care for people with mental disorders, using what he called gentler methods that came to be k ...
at the
York Retreat
The Retreat, commonly known as the York Retreat, is a place in England for the treatment of people with mental disorders, mental health needs. Located in Lamel Hill in York, it operates as a Non-profit organisation, not for profit Charitable tru ...
in England. They advocated the viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of
institutionalisation
In sociology, institutionalisation (or institutionalization) is the process of embedding some conception (for example a belief, norm, social role, particular value or mode of behavior) within an organization, social system, or society as a who ...
as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the
County Asylums Act 1808
The County Asylums Act 1808 formed mental health law in England and Wales from 1808 to 1845. Notably, the Asylums Act established public mental asylums in Britain that could be operated by the county government. It permitted, but did not compel, ...
empowered magistrates to build rate-supported asylums in every
county
A county is a geographic region of a country used for administrative or other purposesChambers Dictionary, L. Brookes (ed.), 2005, Chambers Harrap Publishers Ltd, Edinburgh in certain modern nations. The term is derived from the Old French ...
to house the many 'pauper lunatics'. Nine counties first applied, the first public asylum opening in 1812 in
Nottinghamshire
Nottinghamshire (; abbreviated Notts.) is a landlocked county in the East Midlands region of England, bordering South Yorkshire to the north-west, Lincolnshire to the east, Leicestershire to the south, and Derbyshire to the west. The traditi ...
. In 1828, the newly appointed
Commissioners in Lunacy
The Commissioners in Lunacy or Lunacy Commission were a public body established by the Lunacy Act 1845 to oversee asylums and the welfare of mentally ill people in England and Wales. It succeeded the Metropolitan Commissioners in Lunacy.
Previou ...
were empowered to license and supervise private asylums. The
Lunacy Act 1845
The Lunacy/Lunatics Act 1845 (8 & 9 Vict., c. 100) and the County Asylums Act 1845 (8 & 9 Vict., c. 126) formed mental health law in England and Wales from 1845 to 1890. The Lunacy Act's most important provision was a change in the status of mental ...
made the construction of asylums in every county compulsory with regular inspections on behalf of the
Home Secretary
The secretary of state for the Home Department, otherwise known as the home secretary, is a senior minister of the Crown in the Government of the United Kingdom. The home secretary leads the Home Office, and is responsible for all national ...
, and required asylums to have written regulations and a resident
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
.
At the beginning of the nineteenth century there were a few thousand people housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of
alienism, later known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint.
In the late 19th and early 20th centuries, terms such as "madness", "lunacy" or "insanity"—all of which assumed a unitary psychosis—were split into numerous "mental diseases", of which catatonia, melancholia and dementia praecox (modern day schizophrenia) were the most common in psychiatric institutions.
In 1961
sociologist Erving Goffman
Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociology, sociologist, Social psychology (sociology), social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth ...
described a theory
of the "
total institution
A total institution is a place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life. Privacy is limited in ...
" and the process by which it takes efforts to maintain predictable and regular behavior on the part of both "guard" and "captor", suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and
social role
A role (also rôle or social role) is a set of connected behaviors, rights, obligations, beliefs, and norms as conceptualized by people in a social situation. It is an expected or free or continuously changing behavior and may have a given indivi ...
, in other words of "
institutionalizing" them. ''Asylums'' was a key text in the development of
deinstitutionalization
Deinstitutionalisation (or deinstitutionalization) is the process of replacing long-stay psychiatric hospitals with less isolated community mental health services for those diagnosed with a mental disorder or developmental disability. In the late ...
.
With successive waves of reform and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they attempt—where possible—to help patients control their own lives in the outside world with the use of a combination of
psychiatric drug
A psychiatric or psychotropic medication is a psychoactive drug taken to exert an effect on the chemical makeup of the brain and nervous system. Thus, these medications are used to treat mental illnesses. These medications are typically made o ...
s and
psychotherapy
Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
. These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the
mental patient liberation movement. Most psychiatric hospitals now restrict internet access and any device that can take photos. In the U.S. state of
Connecticut
Connecticut () is the southernmost state in the New England region of the Northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, New York to the west, and Long Island Sound to the south. Its cap ...
, involuntary patients must be examined annually by a court-appointed psychiatrist. Patients may also apply for release at any time and receive a full hearing on the application.
Types
![Vilnius Psychiatric Hospital 1](https://upload.wikimedia.org/wikipedia/commons/3/3e/Vilnius_Psychiatric_Hospital_1.jpg)
There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity. In the
United Kingdom
The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and North ...
, both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have the goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based
halfway house
A halfway house is an institute for people with criminal backgrounds or substance use disorder problems to learn (or relearn) the necessary skills to re-integrate into society and better support and care for themselves.
As well as serving as a ...
.
Crisis stabilization
Crisis Stabilization Units (CSU) are small facilities with minimal beds used for people in crisis whose needs cannot be met safely in residential service settings.
Open units
Open psychiatric units are not as secure as crisis stabilization units. They are not used for acutely suicidal persons; instead, the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits, depending on the type of patients admitted.
Medium term
Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective.
Juvenile wards
Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children with mental illness. However, there are a number of institutions specializing only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illness.
Long-term care facilities
In the UK, long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilized the condition are often features of such units. Examples of this include the Three Bridges Unit, in the grounds of
St Bernard's Hospital
St Bernard's Hospital is the only civilian general hospital in the British overseas territory of Gibraltar.
History
Juan Mateos
In 1567, during Gibraltar's Spanish period, a retired Spanish innkeeper by the name of Juan Mateos converted his ...
in West London and the John Munroe Hospital in Staffordshire. However, these modern units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame (two or three years). However, not all patients' treatment can meet this criterion, so the large hospitals mentioned above often retain this role.
These hospitals provide stabilization and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating disorders, and so on.
Halfway houses
One type of institution for the mentally ill is a community-based
halfway house
A halfway house is an institute for people with criminal backgrounds or substance use disorder problems to learn (or relearn) the necessary skills to re-integrate into society and better support and care for themselves.
As well as serving as a ...
. These facilities provide assisted living for an extended period of time for patients with mental illnesses, and they often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many
psychiatrist
A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
s, although some localities lack sufficient funding.
Political imprisonment
In some countries, the mental institution may be used for the incarceration of political prisoners as a form of punishment. A notable historical example was the use of
punitive psychiatry in the Soviet Union
There was systematic political abuse of psychiatry in the Soviet Union, based on the interpretation of political opposition or dissent as a psychiatric problem. It was called "psychopathological mechanisms" of dissent.
During the leadership ...
and
China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
.
Secure units
In the UK, criminal courts or the
Home Secretary
The secretary of state for the Home Department, otherwise known as the home secretary, is a senior minister of the Crown in the Government of the United Kingdom. The home secretary leads the Home Office, and is responsible for all national ...
can, under various sections of the Mental Health Act, order the detention of offenders in a psychiatric hospital, but the term "criminally insane" is no longer legally or medically recognized. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although the phrase "Maximum Secure" is often used in the media, there is no such classification. "Local Secure" is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing.
Run by the
National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
, these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there is far less risk of patients harming themselves or others. The
Central Mental Hospital
The Central Mental Hospital ( ga, An Príomh-Oispidéal Meabhar-Ghalar) is a mental health facility housing forensic patients in Portrane, Dublin, Ireland. The hospital, along with a community day centre for outpatients at Usher's Island, forms ...
in Dublin performs a similar function.
Community hospital utilization
Community hospitals across the United States regularly see mental health discharges. A study of community hospital discharge data from 2003 to 2011 showed that mental health hospitalizations were increasing for both children (patients aged 0–17 years) and adults (patients aged 18–64). Compared to other hospital utilization, mental health discharges for children were the lowest while the most rapidly increasing hospitalizations were for adults under 64. Some units have been opened to provide "Therapeutically Enhanced Treatment" and so form a subcategory to the three main unit types.
The general public in the UK are familiar with the names of the High Secure Hospitals due to the frequency that they are mentioned in the news reports about the people who are sent there. Those in the UK include
Ashworth Hospital
Ashworth Hospital is a high-security psychiatric hospital in Maghull, 10 miles (16 km) northeast of Liverpool. It is a part of Mersey Care NHS Foundation Trust, catering to patients with psychiatric health needs that require treatment in c ...
in
Merseyside
Merseyside ( ) is a metropolitan county, metropolitan and ceremonial counties of England, ceremonial county in North West England, with a population of List of ceremonial counties of England, 1.38 million. It encompasses both banks of the Merse ...
,
Broadmoor Hospital
Broadmoor Hospital is a high-security psychiatric hospital in Crowthorne, Berkshire, England. It is the oldest of the three high-security psychiatric hospitals in England, the other two being Ashworth Hospital near Liverpool and Rampton Secure ...
in
Crowthorne
Crowthorne is a large village and civil parish in the Bracknell Forest district of south-eastern Berkshire, England. It had a population of 6,711 at the 2001 census, which rose to 6,902 at the 2011 census. A 2020 estimate put it at 7,808. Cr ...
, Berkshire,
Rampton Secure Hospital
Rampton Secure Hospital is a high-security psychiatric hospital near the village of Woodbeck between Retford and Rampton in Nottinghamshire, England. It is one of three high-security psychiatric hospitals in England, alongside Ashworth Hospital ...
in
Retford
Retford (), also known as East Retford, is a market town in the Bassetlaw District in Nottinghamshire, England, and one of the oldest English market towns having been granted its first charter in 1105. It lies on the River Idle and the Chesterfie ...
,
Nottinghamshire
Nottinghamshire (; abbreviated Notts.) is a landlocked county in the East Midlands region of England, bordering South Yorkshire to the north-west, Lincolnshire to the east, Leicestershire to the south, and Derbyshire to the west. The traditi ...
, and Scotland's
The State Hospital in Carstairs. Northern Ireland and the Isle of Man have their own Medium and Low Secure units but use the mainland facilities for High Secure, to which smaller Channel Islands also transfer their patients as ''Out of Area (Off-Island Placements) Referrals'' under the
Mental Health Act 1983
The Mental Health Act 1983 (c.20) is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the ment ...
. Of the three unit types, Medium Secure is most prevalent throughout the UK. As of 2009, there were 27 women-only units in England alone. Irish units include those at prisons in Portlaise, Castelrea and Cork.
Criticism
Hungarian-born psychiatrist
Thomas Szasz
Thomas Stephen Szasz ( ; hu, Szász Tamás István ; 15 April 1920 – 8 September 2012) was a Hungarian-American academic and psychiatrist. He served for most of his career as professor of psychiatry at the State University of New York Upstate M ...
argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians.
Historian
Michel Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
is widely known for his comprehensive critique of the use and abuse of the mental hospital system in ''
Madness and Civilization
''Madness and Civilization: A History of Insanity in the Age of Reason'' (French: ''Folie et Déraison: Histoire de la folie à l'âge classique'', 1961) is an examination by Michel Foucault of the evolution of the meaning of madness in the cultu ...
''. He argued that Tuke and Pinel's asylum was a symbolic recreation of the condition of a child under a
bourgeois
The bourgeoisie ( , ) is a social class, equivalent to the middle or upper middle class. They are distinguished from, and traditionally contrasted with, the proletariat by their affluence, and their great cultural and financial capital. They ...
family. It was a microcosm symbolizing the massive structures of
bourgeois society
The bourgeoisie ( , ) is a social class, equivalent to the middle or upper middle class. They are distinguished from, and traditionally contrasted with, the proletariat by their affluence, and their great cultural and financial capital. They ...
and its values: relations of Family–Children (paternal authority), Fault–Punishment (immediate justice), Madness–Disorder (social and moral order).
[Deleuze and Guattari (1972) '']Anti-Oedipus
''Anti-Oedipus: Capitalism and Schizophrenia'' (french: Capitalisme et schizophrénie. L'anti-Œdipe) is a 1972 book by French authors Gilles Deleuze and Félix Guattari, the former a philosopher and the latter a psychoanalyst. It is the first vol ...
'' p. 102Michel Foucault
Paul-Michel Foucault (, ; ; 15 October 192625 June 1984) was a French philosopher, historian of ideas, writer, political activist, and literary critic. Foucault's theories primarily address the relationship between power and knowledge, and how ...
961
Year 961 ( CMLXI) was a common year starting on Tuesday (link will display the full calendar) of the Julian calendar.
Events
By place
Byzantine Empire
* March 6 – Siege of Chandax: Byzantine forces under Nikephoros II Phokas cap ...
''The History of Madness
''Madness and Civilization: A History of Insanity in the Age of Reason'' (French: ''Folie et Déraison: Histoire de la folie à l'âge classique'', 1961) is an examination by Michel Foucault of the evolution of the meaning of madness in the cultur ...
'', Routledge 2006, pp.490–1, 507–8, 510–1
Erving Goffman
Erving Goffman (11 June 1922 – 19 November 1982) was a Canadian-born sociology, sociologist, Social psychology (sociology), social psychologist, and writer, considered by some "the most influential American sociologist of the twentieth ...
coined the term "
Total Institution
A total institution is a place of work and residence where a great number of similarly situated people, cut off from the wider community for a considerable time, together lead an enclosed, formally administered round of life. Privacy is limited in ...
" for mental hospitals and similar places which took over and confined a person's whole life.
Goffman placed psychiatric hospitals in the same category as
concentration camp
Internment is the imprisonment of people, commonly in large groups, without charges or intent to file charges. The term is especially used for the confinement "of enemy citizens in wartime or of terrorism suspects". Thus, while it can simply ...
s,
prison
A prison, also known as a jail, gaol (dated, standard English, Australian, and historically in Canada), penitentiary (American English and Canadian English), detention center (or detention centre outside the US), correction center, correc ...
s, military organizations,
orphanage
An orphanage is a Residential education, residential institution, total institution or group home, devoted to the Childcare, care of orphans and children who, for various reasons, cannot be cared for by their biological families. The parent ...
s, and monasteries.
In his book ''
Asylums'' Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone "dull, harmless and inconspicuous"; in turn, it reinforces notions of chronicity in severe mental illness.
The
Rosenhan experiment
The Rosenhan experiment or Thud experiment was an experiment conducted to determine the validity of psychiatric diagnosis. The participants feigned hallucinations to enter psychiatric hospitals but acted normally afterwards. They were diagnosed w ...
of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.
Franco Basaglia
Franco Basaglia (; 11 March 1924 29 August 1980) was an Italian psychiatrist, neurologist, professor who proposed the dismantling of psychiatric hospitals, pioneer of the modern concept of mental health, Italian psychiatry reformer, figurehead a ...
, a leading psychiatrist who inspired and planned the
psychiatric reform in Italy Psychiatric reform in Italy is the reform of psychiatry which started in Italy after the passing of Basaglia Law in 1978 and terminated with the very end of the Italian state mental hospital system in 1998. Among European countries, Italy was the fi ...
, also defined the mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism.
American psychiatrist
Loren Mosher
Loren Richard Mosher (September 3, 1933, Monterey, California – July 10, 2004, Berlin) was an American psychiatrist, clinical professor of psychiatry, expert on schizophrenia and the chief of the Center for Studies of Schizophrenia in the Nation ...
noticed that the psychiatric institution itself gave him master classes in the art of the "total institution": labeling, unnecessary dependency, the induction and perpetuation of powerlessness, the
degradation ceremony
Cashiering (or degradation ceremony), generally within military forces, is a ritual dismissal of an individual from some position of responsibility for a breach of discipline.
Etymology
From the Flemish (to dismiss from service; to discard , authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve.
The
...
, authoritarianism, and the primacy of institutional needs over the patients, whom it was ostensibly there to serve.
The anti-psychiatry movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The Psychiatric survivors movement">psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time.
, several journalists have been willingly admitted to hospitals in order to conduct
. These include:
*
.
* Frank Sutherland who received coaching from a psychiatrist in order to accurately feign symptoms, and spent 31 days in late 1973 to early 1974, leading to a series of articles in the
.
* Betty Wells who investigated in 1974, with the articles titled ''A Trip Into Darkness'' for the
.
, involuntary treatment proponent group
''For lists of establishments, see the categorical index "Psychiatric hospitals" at the bottom of the page.''