The mental hospital originated in the 19th century as the most plausible method of removing mentally aberrant persons from a society then in process of rapid industrialization and urbanization. At the time of its development the mental hospital was considered a humane substitute for methods previously in vogue—banishment, social pariah status, and death. Massive institutions were subsequently built by local governments at locations considerably distant from urban centers. At their worst, these hospitals were bedlams in which patients lived in almost indescribable filth and degradation. Even at their best, they were only humane custodial institutions from which relatively few patients emerged. So little was known about the etiology of the mental disorders that concern with custody inevitably exceeded concern with therapy.
The mental hospital failed to fulfill the expectations of its early proponents as a therapeutic institution. This failure is traceable to a combination of