A brief history of psychiatry: millennia past and present--part II

Institutional treatment of psychiatric disorders dates back at least to the time of Hippocrates, when there were efforts to improve patients' general health in pleasant surroundings. Institutions for the mentally ill and for abusers of addicting substances have varied through the centuries from squalid conditions to surroundings meant to improve psychological and social well being. In the eighteenth-century, Pinel, Rush, and others assumed that environmental changes could affect psychological states and alter behavior. Twentieth century debate has been concerned with whether or not patients are better treated in hospitals or in the community. Currently, the focus on minimizing health care costs has emphasized often-valuable intensive and not so intensive outpatient programs, almost to the exclusion of sometimes-necessary inpatient hospitalization. Contemporary social and political trends inside and outside the mental health professions include attempts to modify this emphasis and to focus on the specific needs of individual patients.