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The History of Mental Health Diagnosis and Treatment in the United States
Bayley Mabryn Askin
Department of Psychology, William Carey University
PSY-410 Abnormal Psychology
Dr. Richard Sheridan
May 28, 2025
Introduction
Mental health diagnosis and treatments in the United States have evolved significantly from the 1800s to now. They have led to shifts in scientific perspectives and societal views while also increasing attention to mental health as a crucial aspect of public well-being. Each century has introduced new diagnoses, methods of treatment, as well as explanatory models for mental disorder, filtered through the complex interaction of cultural norms, medical technology, as well as politics. This paper provides an in-depth analysis of the primary mental health diagnosis and treatment in the 1800s, the 1900s, as well as the 21st century. It also explains the way in which mental health practice reflects wider society values as well as scientific advancement, and evaluates the advancement as well as the limits of the current mental health treatment system.
Mental Illness in the 1800s
In the 19th century, mental illness was stigmatized and not understood. The prevailing model explained mental illness as a deviation from moral or religious beliefs, as opposed to an actual medical issue. Diagnoses relied less on reality than on behavioral observation and subject interpretation. The “diagnoses” of “melancholia,” “mania,” “hysteria,” “dementia praecox,” and “moral insanity” were often said. These diagnoses included symptoms ranging from depression, anxiety, hallucinations, and violent acts. Diagnosis varied without standardization, using gender, race, and class biases in the interpretations.
Treatment during the time was inadequate, unsystematized, and inhumane. In the past, when it came to handling individuals struggling with health issues, they were often placed into asylums or almshouses for care and treatment. However, these asylums, initially intended as places of sanctuary, ended up overcrowded and lacking in resources, leading to uncaring conditions. The personnel frequently had little or no training, and patients were often physically restrained, isolated, and punished. Despite these horrible surroundings, the “moral treatment” movement started to emerge and brought attention to kindness, routine regimes, work therapy, and religious instruction. Reformers like Dorothea Dix fought for the cause of improved treatment as well as the establishment of state-owned asylums. She was the force behind the establishment of many institutions all over the nation.
Medical interventions were primitive and frequently harmful. Often, clinicians would use ancient ideas like bloodletting, purging, and blistering on patients. To tranquilize them, they also used electroconvulsion, restraints, and ice baths. The overall understanding of mental sickness had an absolute basis in spiritual failure or in character weakness, which further ingrained stigma and largely resulted in prolonged institutionalization.
Mental Health in the 1900s
The 20th century was a defining period for the history of mental health treatment. As psychology, psychiatry, and neuroscience developed, the explanations for mental illness became more scientific and medical. Diagnoses became standardized, particularly with the release of diagnostic manuals like the DSM-I in 1952. Schizophrenia, manic-depressive illness (bipolar disorder today), neuroses, and personality disorders received clinical characterization. While institutionalization remained widespread in the early decades of the century, the nature of diagnosis and treatment started to shift.
Psychoanalysis was a prevailing theoretical framework in the early 1900s. Sigmund Freud focused his concepts with respect to unconscious conflict, early experience, and verbal therapy as a means of cure. Despite the controversy that has long surrounded it, the therapeutic ideal fashioned by psychoanalysis had an impact well into the mid-20th century in diagnosis and treatment. The new psychotropic drugs in the 1950s, like chlorpromazine (Thorazine), revolutionized treatment since they brought relief from symptoms in diseases like schizophrenia. Advances in pharmacology allowed numerous patients to move from institutional to community living.
The deinstitutionalization process, spurred by human as well as financial considerations, sped up in the 1970s as well as the 1960s. Legislation such as the Community Mental Health Act in 1963 targeted the replacement of state hospitals with community mental health center services. Even as the shift in the delivery mode of care was profound, the process was underfinanced as well as inadequately planned. The consequence was the inability to render adequate care to many people suffering from severe mental illness. This made homelessness, as well as incarceration, increase in this population group.
New therapies appeared in the latter half of the century. Cognitive, humanistic, and behavioral therapies expanded the base of therapies. Advances in the areas of the genetic basis, brain imaging, and functions of neurotransmitters provided the biological underpinnings of many mental illnesses. Therapies for mental illness remained fragmented, but inequality in the quality as well as quantity of care extended beyond racial, socioeconomic, and geographic boundaries.
Mental Health in the 2000s
Mental healthcare in the 21st century has seen unprecedented developments in mental illness understanding, diagnosis, and treatment. The DSM-5 was published in 2013 with new criteria and an inclusive framework for categories like autism spectrum disorder and expanded definitions under PTSD and depressive disorders. There started awareness, activism, and media coverage, which has reduced stigmatization, although it continues to exist in some of the population.
Treatment is now characterized by involvement of biological, psychological, as well as social aspects with biopsychosocial treatment. Medicinal treatment is characterized by the emergence of newer-generation medications with higher efficacy with less burden of side effects, like newer antidepressants, antipsychotics, and anxiolytics. Evidence-based therapies such as cognitive-behavioral therapy (CBT) or CBT with modifications, dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), as well as eye movement desensitization and reprocessing (EMDR), are utilized en masse in the treatment of all forms of mental disorders.
Technology has also played a role in transforming the mental healthcare field. Telehealth services expanded the reach of care even amidst the COVID-19 pandemic as patients received therapy and medication management from their homes. Web-based support groups and mobile mental health apps provide additional self-management tools and support from similar individuals. Bad digital privacy, low-quality care, and disparities in digital access are often-seen challenges.
There has also been growing emphasis placed on trauma-informed care, cultural competency, and integration of mental and physical health care. Providers are recently realizing the impact of adverse childhood experiences (ACEs), systemic racism, and the social determinants of health on mental health. Despite these developments, the mental health care system is still fighting against insurance limitations, waits, and shortages of staff, particularly in rural areas.
Public policy initiatives such as the Affordable Care Act and the Mental Health Parity and Addiction Equity Act have attempted to expand coverage and access to treatment. The problem is, implementation is based on the state, and many are still choosing not to provide adequate care. Efforts are still ongoing to train different cultural providers, integrate the health systems, and expand programs.
Conclusion
The history of diagnosis and treatment of mental illness in America is one of multidimensional, shifting dynamics with science, culture, and public policy. From asylums and aversive therapies in the early-to-mid-1800s to biomedical technologies to cyber interventions in the early-21st century, mental health care has come to be more humane and research-based. Each century has had its achievements but also its setbacks, illustrating the continuing need for advocacy, research, and policy reform. Despite the important advances in care and understanding of mental illness, system barriers persist in the way in which people access and experience equity in mental health care. Corrections to these disparities require an integrated strategy to education, facilities in healthcare, legal reform, and community involvement. As we grow more sensitive to the nuances of mental health, we need to build the system so it honors early intervention, coordinated care, and the human dignity of all individuals.
