Religion and Mental Health Care in the 19th Century United States

Throughout the history of the United States of America, mental health and the corresponding treatment have remained a prevalent, yet shockingly taboo topic. In some of the earliest civilizations, it was extensively believed that mental illness had to do with a lack of spirituality or possession by Satan and other demonic figures. The rise of insane asylums became prevalent nineteenth century in particular, and the treatment that the majority of patients of the era faced has since been recognized as ineffective and inhumane. Religion was heavily influential in this, and well ingrained in the functionality of society through the nineteenth century. Greatly more prevalent and expected than in today’s modern society, it naturally had a significant influence on the quality and accessibility of mental health care offered.

At the rise of the century, moral treatment for psychiatric patients was introduced, consisting of implementing routine environments and exercising reasonable discipline on patients. The first healthcare providers to offer this more humane treatment were religiously affiliated, in particular, the Friends Asylum, which was run and operated by the Quaker community in Philadelphia. As the society of the era developed, the United States became one of the first countries to begin exploring the idea that care in asylums could be therapeutic. Before this, in places such as the Pennsylvania Hospital; the first of its kind to admit both the physically and mentally ill; it was common to intentionally deplete patient’s bodily functions by causing them to vomit, bleed, or blister. It opened in 1752, and eighteenth-century medicine accounted for little humane treatment. Solitary confinement and involuntary restraints were a regular, even daily occurrence. Even as the 1800s began, it was still believed that the purpose of asylums was to keep the mentally ill off the streets for the convenience of others, rather than therapeutically treat and attempt to cure these patients. This idea was largely fueled by the religious pervasiveness and paranoia of the time.

As the installation of asylums across the country remained on the rise, it became obvious to care providers at the time that they could associate unorthodox religious beliefs and insanity. In various studies of asylum admissions, it was found that anywhere from 1-15% of were distinctly religious diagnoses, or “cause of insanity” as it was referred to. These causes included symptoms such as religious excitement, spirituality, religious mania, religious fantasy, and religious enthusiasm. Within a study of 2,258 cases from seventeen asylums in the mid nineteenth century, approximately 6.1%, or 138 cases were attributed to distinctly religious causes. This could be viewed as a poor outcome of the religious popularity at this time, as these causes are no longer reasonable grounds for admission to any kind of psychiatric treatment. Upon researching it becomes clear that many of these are symptoms of disorders that at their core do not have much at all to do with religion, such as schizophrenia. It is not uncommon, even now, for those suffering from schizophrenia to experience hallucinations or paranoia surrounding religious themes. Those suffering from Bipolar Disorder experience mania, and it can be assumed based on the prevalence at the time that it might include religious components or fixations. The current understanding of this disorder now is that those types of symptoms are simply the nature of the disorder, not religion itself.

With the modern knowledge of psychiatry and medicine that exists, it has become clear that many of the supposed “causes of insanity” that were not distinctly accredited to religion were still greatly influenced by the ubiquity of religious beliefs, particularly those aligned with Christianity and Catholicism. For example, masturbation was not an uncommon reason for admission to asylums, though the stigma surrounding this was heavily cultured by beliefs that this was an act of disrespect to God. Moral Insanity was one of the most common reason, though this term was so broad and subjective it could include anything from kleptomania to homosexuality. Even though centuries have passed, people continue to argue about the morality of homosexuality as it relates to religion, many hailing it as a sin to God. In“Hints for the Young in Relation to the Health of Body and Mind”, published in 1870 by Dr. Samuel B. Woodward, the first superintendent of Worcester Asylum. It states that 'From the hand of God himself we receive the nobel attributes which distinguish us from the animals around us. This vice reduces us below their level.” These were some of the commonly held ideas of the time.

In the mid-nineteenth century, Pliny Earle, an experienced physician and social scientist began visiting European asylums in hopes of drawing comparisons and potentially improving the state of mental health care in the United States. After visiting thirteen Insane Asylums across Europe, he concluded that the supposed “religious excitement” was a distinctly American “cause of insanity,” taking note of that none of 1,557 cases admitted to the Asylum at Charenton in what is now Saint-Maurice, Val-de-Marne, France was attributed to religious excitement. This starkly contrasted with 53 of the 678 cases treated at the Massachusetts State Hospital in 1841. He attributed this to the heated and extensive religious debates occurring in the United States, claiming they “promoted insanity.” Be that as it may, American psychiatry was an expansion of British and French teachings, and the hypothesis of religious insanity took firm root in every one of the three countries. Yet, despite the prevalence of religiously attributed mental illness, the “cure rates” for said causes were quite high. Generally, during this time it was commonly believed that close to 80% of mental illness could be entirely cured, but only if treated early.

First conceptualized and implemented by German physician Franz Joseph Gall, phrenology began spreading to North America in 1834 after he gave a speech about its supposed effectiveness here. Phrenology is a detailed study that cites certain areas of the brain having specific functions and capacities, which can be measured by the bumps on one’s skull. Upon its introduction in Germany, it offended churches and scientists alike, with churches accusing the theory and practice being “contrary to religion.” However, as it spread to North America, the perceptions of this practice by the religious greatly shifted. O.S. Fowler, an American phrenologist believed it could “enhance to number of inborn capacities and excellencies of God’s noblest work,” and that it enabled participants to engage the work of God. Fowler used the “spirituality organ” that supposedly was found at the very top of the head to validate his theory, citing that it helps form your perceptions of truth and intuition. Because all humans possess it, he believed it demonstrated mankind’s genetic and innate abilities to “become godly.” Although nearly everything about this practice has since been disproved for its flawed logic, it was the first time mental illness was considered in terms of brain matter rather than spirituality or lack thereof. Despite its religious associations and scientific inaccuracies, the concept was still a step away from spirituality-obsessed psychiatry, and this was a step in the right direction. It is often referred to as the “midwife to modern psychiatry.” and at the time most asylum superintendents were partial to phrenology.

Despite what is considered a positive shift in the treatment of patients as the 19th century arrived, much of the methods were still ineffective and inhumane towards patients. Benjamin Rush, an American physician, began implementing humane methods of treatment, such as encouraging doctors to give their patients “therapeutic gifts,” taking them on outdoor walks and enforcing routines for patients. Rush was deeply religious and strongly believed that Christianity was a necessary foundation of the United States; this consequently affected his work. Although these implementations were beneficial, methods like mercury therapy, bloodletting, purging, or extremely cold and hot baths remained in use. It’s unlikely that most of these patients were truly cured, however, it is more likely that discharges from asylums occurred when a patient’s mental stability had improved from its previous state; this of course not getting to the root cause of their symptoms.

A nurse and notable activist for patient rights, Dorothea Dix took up this cause. Having suffered from various illnesses herself, she sought treatment in Europe. It was here that she met reformers interested in a similar goal: improve the lives and treatment for patients. She lobbied state legislators, fiercely advocating for the implementation of genuinely humane treatment in asylums across the country. Many doubted Dix, especially due to her beliefs, as she was a Unitarian,which was not aligned with her family or the ideas of most people at the time. Dix had a strong faith that God is loving, and members of the church should spread that love. This concept was still unpopular and remained so for decades.

Dorothea Dix’s story argues the notion that any religious beliefs would negatively influence the state of care, Rather, the religions with main tenets about God loving individuals only if they abide by his rules were the main culprits. This cause was difficult to uphold, as these contained the most members, such as Christianity and Catholicism. The idea that sinning against God’s wishes was a psychiatric insufficiency or disorder worthy of admission to an insane asylum was extremely damaging to the advancement of psychiatric care, though it was a constant occurrence for decades preceding and following the nineteenth century. Despite making significant progress at the time and even opening an asylum in her name, Dix’s death put an end to this idea, and asylums quickly reverted to their former practices and her efforts seemed to be in vain.

The United States holds a long and complicated history with mental health, and it's taken a tremendous amount of progressive thinking and medical advancements to reach where the country is in terms of mental health care today. A fair amount of this can be attributed to a decrease in religious prevalence in the medical and political fields, as it became obvious that its presence in these areas created a space for bias and prejudice. Religion, outstandingly Christianity and Catholicism, can be largely blamed for the amount of the inhumane treatment and scientifically contradictory diagnoses of the era, but due to its disproportionate popularity before the 21st century, there was not an alternative option. As the United States became further distanced from religious ubiquity, the closer it moved towards respectable scientific practices in the medical community. This was a significantly positive shift and offered hope to many suffering from mental illness that their struggles could indeed be overcome or managed using humane, non-tortuous and effective methods.