Asylums : the historical perspective before, during, and after

Abstract

Extensive institutionalisation of people with mental disorders has a brief history lasting just 150 years. Yet asylums feature prominently in modern perceptions of psychiatry's development, on a mental map drawn in sharp contrasts between humanity and barbarity, knowledge and ignorance, and good and bad practice. This Review seeks to nuance the standard narrative of asylums by considering the voices and views of those who were in them at different historical timepoints. The arguments are to caution against dismissing inpatient care outright as simply fundamentally misconceived, and to show the ideological background to many structures and changes, which might superficially seem merely clinical and instrumental. The aim of this Review is to bring out what current mental health systems can learn from an evidence-based analysis of asylums' actual successes and failures in the past.