The hospitals were primarily in the business of confinement rather than treatment. As “insane asylums” there institutions were rarely expected to send rehabilitated people home. The “unfortunate” residents of the asylums were expected to remain there for life. Thus, there was little reason for diagnosis. Why determine cause or assign a category to someone who is not going to receive any specific treatment.
Why provide a prognosis when a resident of the asylum is expected to remain in the institution until they die (which is likely to be much sooner than would be the case if they were not confined in these often unhealthy environments). At most, there was the first gathering of statistics about how many people were admitted to the hospital—and there was the first tentative use of the term “mental illness” (after all these people were being admitted to a “hospital” and there were usually one or more physicians affiliated with the hospital).
This condition tended to exist throughout most of the first half of the 20th Century, though the returning soldiers from World War I with “battle fatigue” were often sent to a hospital or “soldier’s home” (begun after the Civil War) and World War II produced many victims of “shell shock” that lead to a significant increase in the number of men (and some women) admitted to hospitals that specialized in the confinement (and limited treatment) of emotional and mental disturbance.
Early DSM
The significant increase in “mental health” patience in the late 1940s, created a crisis in the field of psychiatry and, more broadly, the newly emerging field of “mental health.” Movies and books were produced that portrayed the horrible conditions in many hospitals—the movie, Snake Pit, being the most popular of these portrays. It now became clear that something more had to be done in the use of numbers and classifications.
