Throughout history people with severe mental illness have been characterized as bizarre, belligerent, disorganized, destructive, out of control, combative, delusional, and irritable. Caregivers, in response, have sought to confront, control, restrain, and neutralize their patients to care for them and improve their health. They did so with a wide range of physical measures, including chains, twirling chairs, hollow wheels, needle cabinets, hydrotherapy techniques, and straitjackets. Taken together, these “treatments” demonstrate how extreme aberrant behavior was met by equally extreme “therapeutic” measures.
Below we discuss some early interventions (arranged alphabetically) that demonstrate the wide range of “treatments” used between 1700 and 1950, between the time of the dawn of American psychiatry to the introduction of antipsychotics. Although many of these “treatments” are recognized now as cruel and ineffective, they were considered state-of-the-art for their times and were developed and promoted in a sincere effort to help people struggling with serious mental illness.
Bloodletting. Bloodletting, either by leeches or by incision, was a common 18th-century practice for a variety of ailments. Benjamin Rush (1745-1813), recognized as the father of American psychiatry, used bloodletting in treating people with mental illness.1 Bloodletting involved taking copious amounts of blood from the patient, leaving him depleted, exhausted, and obviously anemic. It was indicated for patients with an agitated psychosis in which such treatments caused a drop in blood pressure with resultant sedation.2 In 1854, Pliny Earle published An Examination of the Practice of Bloodletting in Mental Disorders.3 Blood transfusion also was attempted as a treatment, sometimes using animal blood.4
Chains. Restrictive chains, shackles, and fetters were popular interventions in the 18th and 19th centuries, although their use dates back much earlier. Chains were a primitive method of containing aggressive individuals. Aulus Cornelius Celsus (25 BC-50 AD), who chronicled treatments for mental illness available in his day, reported on the use of chains. Jacques-Rene Tenon (1724-1816), a reformer who surveyed 18th-century hospitals and advocated for their improvement, recommended chains as part of his therapeutic vision.4 Rush, on the other hand, advocated for the removal of chains from most patients with mental illness in the Pine Building of the Pennsylvania Hospital, as well as advising the removal of patients from the building's unheated basement.1
Hollow wheels. In the late 18th century, German psychiatrist Johann Reil (1758-1813) invented a therapeutic hollow wheel (figure 1). The patient was placed inside and could either remain stationary or run forward or backward. Theoretically, this activity would engender goal-directed behavior, with the hope that such forced activity on the patient's part would take him out of his hallucination-filled world and into reality:
Freed at times to satisfy his physical needs, the patient could spend generally 36-48 hours in the wheel and would then be ‘either tractable and obedient as a result of the wheel’ or so fatigued by the constant pace that he presented little if any management problem.5
Figure 1. This image depicts a reproduction of a hollow wheel. Exhibit at the Glore Psychiatric Museum, Member Museum of The St. Joseph Museums, Inc., St. Joseph, Missouri.
Sadly, staff occasionally found it entertaining to watch a patient wear himself down during a 36-hour period in the wheel.
Needle cabinets. Needle cabinets were steel boxes designed to hold a patient in a standing position. High-pressure water then was pumped directly onto the skin.6 (Since needle cabinets could be viewed as a form of hydrotherapy, they are discussed below.)
Purging. Many, including Rush, employed purging as a treatment. Rush believed that purging could cure mental illness by expelling noxious elements from the body. The patient was given an emetic in the hope that the ensuing vomiting would expel any offending substances from the body.1
Straitjackets/waist restraints. The straitjacket has a long history, and all too frequently its use has been depicted in movies dealing with psychiatric hospitals. The straitjacket was used to contain and control violent patients. As Rush wrote in 1812, “These [straitjackets] will sometimes be necessary in order to prevent their destroying clothes and the furniture of their cells, as well as to punish outrages on their keepers and each other.”7 A waist restraint was a different form of a straitjacket; Rush used the term “strait waistcoat.” Again, the rationale was to prevent injury and to curb destructive actions.6