Changing Perceptions.

In the seventeenth and early eighteenth centuries most Americans viewed mental illness as a spiritual problem, resulting from sin, guilt, or, at its worst, demonic possession. Throughout the eighteenth century a gradual shift occurred in which people began to emphasize the physical causes of mental maladies, in accordance with the practice of Enlightenment thinkers who were beginning to combine new scientific methods with the traditional approach to understanding the human body through humoral theory.

Control.

Throughout most of this period people who showed signs of madness were confined in institutions only if they became violent. For the most part the only available institutions were jails and almshouses. In America only the Pennsylvania Hospital, established in 1751, accepted mentally ill patients. Those patients received harsh treatment, generally being kept in chains in basement cells. The first hospital devoted exclusively to housing the mentally...