Design a site like this with
Get started

The Dark Side of Psychiatry in the 20th Century

Photo by Jon Butterworth on Unsplash

The medical field of psychiatry in its current state, while far from perfect, does a great deal of good for a great many people, myself included.  Things weren’t always that way, though, and luckily we’ve come a very long way from some of the downright barbaric practices of the previous century.  As both a mental health clinician and someone living with a mental illness, I certainly appreciate the progress that’s been made.

Here’s a look at some of the lowlights from the 20th century.

Body parts?  Not necessary

Dr. Henry Cotton was a psychiatrist who headed up a New Jersey psychiatric institution in the early 1900s.  He firmly believed that mental illness was due to infection, and to cure the mental illness the source of the infection must be removed from the body.  This led to the removal of teeth, tonsils, spleens, ovaries, testicles, colons, and other bits and pieces.

Because there were no antibiotics at the time, anyone who didn’t have an infection before surgery would most certainly develop one afterwards.  And who needs a colon anyway?


Who wants “mental defectives” procreating and making more crazy people?  As repulsive as this may sound, it was part of eugenics, the concept of producing s higher quality gene pool by keeping undesirables from reproducing.  In the early 1900s this was a popular idea, and people with mental illness were a prime target.

In the United States, Indiana was the first state to pass a mandatory sterilization law in 1907.  Twenty other states soon followed, with California being the most active in applying the law.  Overall there were 65,000 people in 33 states who were targeted for compulsory sterilization.  Mostly women were affected.  Women who got pregnant while unmarried were considered “feeble-minded” for not adhering to societal (aka male?) standards, and so they were thrown into the pot as well.

The practices in the U.S. pale in comparison to Nazi Germany, not surprisingly.  It’s estimated that somewhere between 73-100% of people with schizophrenia in Germany, or around 250,000 individuals altogether, were sterilized or killed.  This began in 1934 and continued to the end of World War II in 1945.  The doctors who led the sterilization program believed that schizophrenia was due to a recessive gene, and could be eradicated entirely through a sterilization/extermination program.

When a program to kill chronically mentally individuals was first proposed to Adolf Hitler, his response was:

“It is right that the worthless lives of such creatures should be ended, and that this would result in certain savings in terms of hospitals, doctors and nursing staff.”

How delightful.

The strategy of killing people with gas in a “shower” room was first implemented in asylums, and was “effective” enough that usage spread to concentration camps.


A Portuguese neurologist was the first to perform lobotomies to “treat” mental illness, and was later awarded a Nobel prize for his work.  This involved drilling holes in the skull and disrupting neuronal fibres in the prefrontal cortex of the brain.  Lobotomies tended to dull people both emotionally and cognitively and blunt their personality.  Some people died during the procedure, and others were left with serious brain damage.

American neurologist Dr. Walter Freeman wanted to come up with a method of doing lobotomies that wouldn’t require an operating room and general anaesthesia, as this wasn’t available at most psychiatric hospitals.  He came up with the transorbital (through the eye socket) ice pick lobotomy, which involved jabbing the ice pick tool into the prefrontal cortex.  The year 1949 was prime time for lobotomies in the U.S., with 5074 procedures performed.  Approximately 40,000 total were completed in the U.S.  Lobotomies were carried out in a number of other countries as well.

In other medical insanity, we have insulin shock therapy, which was used for schizophrenia in the 1940s and 1950s.  Enough insulin was administered to get the patient’s blood sugar so low they went into a coma.  Coma was the goal, and convulsions were a nice little side benefit.  These weren’t quiet, peaceful comas; they included assorted moaning and thrashing about.  After about an hour, glucose was administered to bring the patient out of the coma.  John Nash, who was depicted in the movie A Beautiful Mind, was treated with insulin shock therapy at one point.

All in the family

Why blame someone’s genes when you could just blame their mother?  From the 1940s to the 1970s, the notion of the “schizophrenogenic mother” was popular, based on the idea that the way a mother raised a child could result in schizophrenia.  This idea was driven by a psychoanalytic perspective and even made it into psychiatry textbooks at the time.

Alas, this idea was not based in reality whatsoever, so it ended up going the way of the dodo bird.


The process of deinstitutionalization, moving people from psychiatric hospitals into the community, began in the 1960’s with legislation introduced by President John F. Kennedy.  Community mental health centres were created, but the most severely ill fell through the very wide cracks, and many ended up homeless or incarcerated.

Deinstitutionalization sounds great in theory, but depending on the severity of someone’s illness, a huge amount of support may be needed to allow them to function well in the community.  This requires dollars, which are seldom forthcoming.  The negative effects of deinstitutionalization continue to be seen today.


It’s fascinating (not in a good way) that practices can be viewed as acceptable at the time but in retrospect are profoundly disturbing.  In spite of all the challenges that those of us living with mental illness face now, we are much better off compared to 100 years ago.


About the guest author:

Ashleyleia is a talented blogger and author from Canada. Her entertaining and informative blog is called: Mental Health @ Home.


Published by Ashley L. Peterson

I'm the author of four books: Psych Meds Made Simple, Making Sense of Psychiatric Diagnosis, Managing the Depression Puzzle, and A Brief History of Stigma. These are informed by my professional experience as a former pharmacist and mental health nurse, as well as my lived experience of major depressive disorder. My goal with Mental Health @ Home is to challenge mental illness stigma and provide a safe space for open dialogue to empower others to share their voices.

28 thoughts on “The Dark Side of Psychiatry in the 20th Century

  1. The 20th century was only 18 years ago. Sadly, there has been little change. Here in California and other states with extremely liberal policies we have a massive problem with violent, mentally ill homeless people. Deinstitutionalization is right at the heart of it too. Even the normal homeless people feel threatened by the situation here,

    Liked by 1 person

    1. Much more needs to be done to prevent homelessness. I would caution, though, against associating violence with mental illness, as people with mental illness are not an increased risk to commit violence compared to people without mental illness, and in fact are more likely to be targets of violence.

      Liked by 1 person

      1. That depends on if you talk to ivory tower academics or to law enforcement. I’ve been assaulted 3 times in my life by mentally ill people. Even with that being the case, I will agree with what I believe your true premise is; that most “mentally ill” people are NOT violent. They fall into the category of struggling with mild to moderate depression or similar conditions, are still functional members of society usually, etc… Calling such people mentally ill in the first place is unfair in my opinion as it lumps them into a VERY broad category with people like violent psychotics. People struggling like that deserve empathy and support.


        1. I’m sorry you were assaulted and I can see how that could contribute to negative judgments regarding mental illness. However, that does not mean that those judgment reflect the reality of mental illness. Talking about “violent psychotics” and saying that empathy and suport are only merited for certain illnesses that allow people to be “still functional members of society usually”
          is reflective of stigma rather than actual knowledge of mental illnesses that involve psychosis.


  2. Ashleyliea interesting read. the beginnings of ECT were pretty horrific . I was a RN and have post grad in Mental Health Nursing. When I first saw ECT as a student nurse it was still a frightening experience, 30 years ago, So much better now with the use of muscle relaxants less time taken and less applications. When it works it is wonderful to see the difference in the person. I worked in some large psychiatric facilities in NSW Australia. When the Government here disbanded them under Richmond Report. In the wisdom of relocating long term residents who were like brothers spread huge distances apart, very bad and traumatising. Two of the guys both in their 50s at the time, would vandalise things wait about until the police came and it was due to them having mental illnesses, and the damage (say a broken bit of glass in a phone booth) not worth arresting them but they would be sent back to the mental health in patient support. They would usually arrive within hours of each other. Our psychiatrists understood that they were pinning for each other and would keep them as in patients for as long as possible and our community teams fought tirelessly to have them moved into the same block of units. No more vandalism!

    Liked by 1 person

    1. It’s so important to let people maintain the connections that are meaningful to them!

      I’m glad ECT has evolved into the safe and effective treatment it is today. It’s certainly made a huge difference for me when I’ve been in hospital.

      Liked by 1 person

  3. Having been a patient for many years, i have been subjected to years of abuse by doctors who just wanted to see how certain medicines worked.
    Also, hospitals are teaming with employees that have criminal records and no concern for the well being of any of the patients.
    I WILL NOT go to an ER or hospital regardless of how i feel because I know precisely what happens. You have no rights. You are less than human.
    Psychiatry has a very long way to go indeed.

    Liked by 1 person

Comments are closed.

%d bloggers like this: