To understand modern American mental-health systems, it is necessary to realize how relatively young the very concept of organized and humane mental-health treatment is in Western civilization. Dr. Benjamin Rush, one of the signers of the Declaration of Independence, is credited with being the father of American psychiatry, partly on account of his advocacy of humane and systematic treatment of the mentally ill. Rush's Medical Inquiries and Observations upon the Diseases of the Mind was published in 1812, the first American work on psychiatry ("Rush," Funk & Wagnalls, 1975). Rush appears to have taken a practical, clinical approach to treatment, as evident in his encouraging patients to keep a journal of their symptoms (Riordan, 1996); in the modern period, so-called scriptotherapy is suggested as an adjunct to counseling. The specifics of some of Rush's views have been interrogated by subsequent research. For example, Rush viewed alcoholism in moral and physical terms and published anti-bingeing tracts as head of Philadelphia's Pennsylvania Hospital (Burke & Clapp, 1997; Katchner, 1993). However, on the whole Rush's work, which specialized in the treatment of mental disorders, can be associated with a tendency in the earliest decades of the U.S. republic toward social and personal improvement for which public and private institutions were well suited. As Wiltse comments:
There were few social evils that were not challenged by some inspired St. George or well-meaning Don Quixote. The evils of drinking, pauperism, ignorance; the abuses of the penal system and the inhumanity meted out to the handicapped and mentally ill were exposed and remedies were vigorously advocated (Wiltse, 1961, p. 125).
Efforts to improve the lot of the mentally ill by means of transformed social policy persisted throughout the nineteenth century, not least for the reason that the mentally ill were often confined to jails, prisons, and poorhouses, where the...