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Introduction
For a long time, mental illness was viewed not as a disease, but as a manifestation of evil spirits.1 Confusion and apprehension have been the legacy view of mental illness, even as far back as ancient Greece. In 380 BC, Socrates wrote in The Republic that “The offspring of the inferior…. will be put away in some mysterious, unknown place, as they should be.” During the middle ages, an obsession with evil in the form of witches became prominent. The official practice guidelines for detecting evil and witches, the Malleus Maleficarum (1486), assisted inquisitors in finding evil lurking amidst women, the socially disenfranchised, and those suffering from mental illness.2 In 1494, theologian Sebastian Brant wrote The Ship of Fools, which detailed the phenomenon of sending away persons with mental illness aboard cargo ships through the canals of Europe and overseas. During the Renaissance (14th to 17th centuries) families were expected to care for relatives with mental illness, which often involved confinement in the home.3 Lay concepts of evil often fuse with professional ethics of mental illness, and threaten to confound each other’s ideologies.4 Even today, there remains a deeply ingrained societal prejudice that persons with mental illness are “ticking time bombs, ready to explode into violence.”5 Thus, the primitive association between mental disorder and moral depravity has yet to be completely dissolved. The age-old concept that depravity is somehow involved in the origin of mental disease lingers in the shadows and waits to be resurrected.6,7
In 1656, the first Hôpital-Général was opened in Paris. These institutions were for the “insane” (sic), as well as those deemed to pose a threat to normality and progress. Within 3 years, the Hôpital-Général in Paris became home to more than 6000 people—approximately 1% of the French population. In London, the famous Bethlem Hospital began showing its patients off for a price in 1815. The hospital earned an annual revenue from this weekly event of almost 400 British pounds from 96 000 visitors who came (the equivalent today of a little more than 44 000 U.S. dollars).
Early in the 19th century, the idea of “moral treatment” came to the United States. According to Patricia D’Antonio of the University of...