Mental health services, and psychiatry in particular, have always lived at the intersection of medicine, human dignity, and the pressures of society. Throughout history, people living with severe mental illness, such as schizophrenia or bipolar disorder, have been treated with fear, stigma, and repression.
For centuries, they were chained, hidden away, or viewed as cursed. A common belief persisted: they were dangerous and best removed from sight. At times, even political dissent was pathologized. In the USSR, for instance, “sluggish schizophrenia” became a diagnosis used against political opponents.
From Asylums to Reform
After the French Revolution and into the 19th century, asylums emerged as a supposedly more humane response. Yet these institutions were often large, remote, and isolating, places where people spent entire lives cut off from society.
The mid-20th century brought a turning point. With the arrival of the first antipsychotic medications, such as chlorpromazine in the 1950s, countries like the USA, UK, and Italy began closing psychiatric hospitals. In Italy, Franco and Franca Basaglia led a movement that culminated in the landmark “Law 180,” reshaping mental health care by emphasizing dignity, community, and reintegration.
Today’s Evidence-Based Model
The World Health Organization now recommends a model that combines acute psychiatric care in general hospitals with community-based services. This approach is considered the most effective way to support people with mental illness while respecting their rights. It is the standard in much of Western Europe, as well as in New Zealand and Australia.
Yet in many places, psychiatric care still relies heavily on hospital beds and institutional models. The result is often the “revolving door” phenomenon, patients cycling in and out of hospitals because community supports remain inadequate. In some ways, this repeats the mistakes of the asylum era in a modern form.
The Road Ahead
Looking forward, psychiatry faces new pressures. Aging populations, climate change, migration and displacement from wars, and the risk of global crises will all shape the demand for mental health care. At the same time, technology is transforming how we diagnose, monitor, and support patients.
These forces will challenge policymakers, researchers, and practitioners to design systems that build resilience, not only for individuals but for communities and societies as a whole.
Conclusion: Avoiding Old Mistakes
The history of psychiatry reminds us of a simple truth: when mental illness is treated with fear, neglect, or exclusion, human dignity suffers. As we move into an uncertain future, the task is not just to build more efficient systems, but to ensure they are humane, responsive, and just.
If we listen to the lessons of the past, we can avoid repeating them. If we don’t, the “elephant in the room” of institutionalization may quietly return.
