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Comment by jitl | Hacker News Reader

Horrifying description of the first such hospital constructed, https://en.m.wikipedia.org/wiki/Trenton_Psychiatric_Hospital

> In 1907, Dr. Henry Cotton became the medical director. Believing that infections were the key to mental illness, he had his staff remove teeth and various other body parts that might become infected from the hospital patients. Cotton's legacy of hundreds of fatalities and thousands of maimed and mutilated patients did not end with his leaving Trenton in 1930 or his death in 1933; in fact, removal of patients' teeth at the Trenton asylum was still the norm until 1960.

If you want to know why the state “asylum” system was dismantled in the 70s look no further.

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I mean shouldn’t we look further? What does one crazy guy removing teeth in the 1920s have to do with dismantling the asylum system? Where do insane people go now? I feel like unfortunately it’s just to the streets, which isn’t good for anyone.

https://www.theatlantic.com/health/archive/2015/01/should-th...

We should certainly look at present conditions, and do what we can to ameliorate them. That "one crazy guy" was rather emblematic of the times -- people institutionalized were subject to horrific treatment and abuses. OP said "look no further" for reasons that the system was dismantled. It wasn't this one "bad apple", the rot had spread far and wide and the system needed to be purged. Unfortunately, it also needed to be rebooted with a different culture rooted in humane care, and that has not happened on the scale that our society needs.

But there's the rub. The American way is to scale things up, and industrialize them. I've seen the inside of a few mental health wards when friends of mine have been committed. They can still be pretty awful, and I don't want to see them scaled up. I don't think that is a problem that can be solved with bigger, more industrial, institutions. I look to Geel[1] as an aspirational model, but I'm not sure such a thing is compatible with American culture. To properly address mental health problems, we need a profound cultural shift. Bit of a chicken-and-egg problem, really.

[1] https://www.npr.org/sections/health-shots/2016/07/01/4840833...

Teeth puling wasn't the worst thing that happened either. Electroshock therapy, immersion therapy, lobotomies... the list of inhumane experiments trialed on the mentally ill to "rescue" them from their subhuman status is horrifically incalculable.

1907? Compare that to Ronald Fisher going to Rothamsted Experimental Station in 1919 and spending the next 14 years pioneering Biostatistics. Notice too that he is working on plants. There are no ethical concerns about doing randomized controlled trials on plants.

Medicine is much trickier. If an eminent doctor declares a medical treatment to be successful and others doubt, can the controversy be settled by a randomized controlled trial? That requires that the control group be deprived of a treatment that has the approval of an eminent doctor. Tradition views that as unethical and forbidden.

The next big date is 1972 and the publication of Effectiveness and Efficiency: Random Reflections on Health Services. Archie Cochrane moved things along with straight talk about how few medical treatments actually worked. Trusting eminent doctors had been tried and failed. It was time for randomized controlled trials to be used, not just for proposed new treatments, but to review old treatments that some doubted.

But returning to 1907, one notes that Archie Cochrane was born in 1909. The man who persuaded the world that biostatistics was for medicine, not just plants, wasn't born yet.

Dismantling the state "asylum" system in the 1970's looks poorly timed in retrospect. The mentally ill end up missing out on the transition from eminence based medicine to evidence based medicine. Too late to go back and fix it; we've moved on to money based medicine :-(

Yikes! There sure were problems with mental health treatment in the past. However, I'm not sure the answer is letting the mentally ill slowly die on the street. Perhaps there is a way to implement asylums for the mentally ill in a way that doesn't involve involuntary disfigurement and mental anguish bordering on torture.

not just teeth removal:

Lobotomy was one of a series of radical and invasive physical therapies developed in Europe at this time that signaled a break with a psychiatric culture of therapeutic nihilism that had prevailed since the late nineteenth-century.[28] The new "heroic" physical therapies devised during this experimental era,[29] including malarial therapy for general paresis of the insane (1917),[30] deep sleep therapy (1920), insulin shock therapy (1933), cardiazol shock therapy (1934), and electroconvulsive therapy (1938)

https://en.wikipedia.org/wiki/Lobotomy#History

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