Until the end of the nineteenth century, psychiatry was chiefly concerned with the custodial care of the insane in asylums. Insanity was believed to be caused by disease of the brain, although it was recognized that the brain displayed no obvious signs of abnormality at post-mortem in some common forms of insanity. Mental illness was considered to be a sign of degeneration, perhaps caused by factors like alcoholism in one or other parent.
Kraepelin's important differentiation of manic-depressive illness from dementia praecox (schizophrenia) did not begin to be defined until 1896. Asylums contained patients suffering from many varieties of psychiatric illness who had nothing in common with one another except their inability to comply with the standards of behaviour demanded by society.
Patients suffering from mental illness were subjected to a variety of medical treatments ranging from the application of electricity and the wet pack to the prescription of purges and emetics, bromides, chloral hydrate, paraldehyde, and even injections of morphine. Since none of these treatments were effective, asylums became depressing institutions in which chronic cases accumulated and from which very few inmates were or could be discharged as cured. The consequence was that no doctor aiming at professional distinction chose to work in an asylum, and the doctors who did so were despised by their medical colleagues.
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