The history of mental health treatment in the United States dates to even before the revolutionary war, with the first Psychiatric Hospital being built in 1773 in Williamsburg, Virginia. The Eastern State Hospital can trace its history to a given by Francis Fauquier, Royal Governor of the colony of Virginia, on November 6, 1766. Here is an excerpt from his speech, “It is expedient I should also recommend to your Consideration and Humanity a poor unhappy set of People who are deprived of their senses and wander about the Country, terrifying the Rest of their fellow creatures. A legal Confinement, and proper Provision, ought to be appointed for these miserable Objects, who cannot help themselves. Every civilized Country has an Hospital for these People, where they are confined, maintained and attended by able Physicians, to endeavor to restore to them their lost reason.”

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In 1885 the original 1773 Eastern State Hospital, in 1985 it was reconstructed on its excavated foundation.

In 1950, 232 State Psychiatric Hospitals with a total of 322 when you include county operated hospitals, with over half a million psychiatric patients. By 2005 the number of hospitals had reduced to 204, and the number of patients down to 49,000.

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1864 - 1889 Reasons for Admission from the Trans-Allegheny Lunatic Asylum in Weston, WV

Trans-Allegheny Lunatic Asylum Credit- C

Trans-Allegheny Lunatic Asylum in Weston, WV

Credit: The Culture Club

Open from 1864 to 1994, the Trans-Allegheny Lunatic Asylum, also known as the Weston State Hospital, saw the beginnings of modern psychiatry, the institutionalization of thousands of patients, and was finally forced to closed when the treatment of mental illness started changing and the facilities of the hospital were no longer considered adequate for patients.

Discontinued treatments of mental illness include; Bloodletting, the procedure of making incisions in the vein and relieving blood pressure and imbalances; Insulin Comas, the practice of deliberately putting a patient into a low blood sugar coma believing fluctuations in insulin levels could alter the function of the brain; Metrazol Therapy, which is a stimulate induced seizure usually administered several times a week and was the precursor of electroconvulsive therapy, which is still used in some cases of mania and catatonia; and the infamous Lobotomy, which was invented by Dr. Walter Freeman, took only 5 minutes to complete and in its early days only used two instruments, a small hammer and an ice pick like tool, called an orbitoclast which was inserted through the eye socket to cut the connections of the prefrontal cortex. More treatments included Ice Water Baths, Electroshock Therapy, Restraint and Isolation.

These barbaric methods of treatment were used well into the 20th Century but shifted only recently to Somatic or Psychotherapeutic. Somatic treatment includes use of drugs, electroconvulsive therapy, and other therapies that stimulate the brain. Drug treatments include antidepressants such as SSRIs and SNRIs, antianxiety medications, antipsychotics, and mood stabilizers. Electroconvulsive therapy (ECT), the modern version of Metrazol, in which electrodes are placed on the head and the patient is placed under anesthesia, the electrical currents are used to induce a brief seizure.

Psychotherapy often referred to talk therapy, consists of one or more of the following forms Behavioral, Cognitive, Interpersonal, Psychoanalysis, Psychodynamic and Supportive. By creating an empathetic and accepting atmosphere, the therapist often can help the person identify the source of the problems and consider alternatives for dealing with them. The emotional awareness and insight that the person gains through psychotherapy often results in a change in attitude and behavior that allows the person to live a fuller and more satisfying life.


This film describes and demonstrates a prefrontal lobotomy, an operative procedure employed in mental disorders resistive to other methods of treatment. The procedure consists of cutting the white matter in each frontal lobe in the plane of the coronal suture. This passes just anterior to the frontal horn of the ventricle and interrupts the anterior thalamic radiation. This film includes a written description of the procedure, review of landmarks on the skull and frontal lobe on a demonstration skull and brain, operation on a live patient, and X-rays taken after the operation. Filmed with cooperation of George Washington University.

Credit: National Library of Medicine