Doctors in all ages have made fortunes by killing their patients by means of their cures. The difference in psychiatry is that it is the death of the soul.
—R.D. Laing
Medical Before Medicine
For most of history, madness wasn’t a medical issue—it was a nuisance to be contained. The earliest solution? Drill a hole in the skull. Trepanation, practiced over 7,000 years ago, was meant to release demons or bad energy. If the patient survived, they were “cured.” If not, at least their suffering ended.
Hippocratic medicine reframed madness as a bodily imbalance—too much bile, blood, or phlegm. The treatment? Drain it. Bloodletting, purging, and forced vomiting aimed to beat insanity out of the body. Meanwhile, religious authorities had their own methods: fasting, flogging, and exorcism. If prayer failed, torture might succeed.
For centuries, priests, magistrates, and families handled the insane with brute force. No science. No real treatment. Then everything changed—not because madness was understood, but because it became a logistical problem.
From Lepers to Lunatics: How Asylums Were Born
By the 16th century, Europe’s leprosaria—once built to isolate the diseased and unwanted—stood largely abandoned. As leprosy declined, the structures remained: walled compounds designed for lifelong confinement. But while lepers faded from view, another group of social outcasts was drawing increased attention—the mad. They carried no visible illness, but their behavior disturbed the public just as much. Historically, they had been confined, exorcised, or cast out. However, as cities grew, their presence became harder to ignore. In the densely packed streets of early modern Europe, the mad became a civic problem, not just a personal one.
Urbanization made madness harder to ignore, and growing moral anxiety demanded social order. Religious reformers and rising state powers pushed for discipline and control. Though the Church’s dominance was waning, its instinct to label deviance as dangerous persisted—now reframed in legal and administrative terms. The mad, once cast out or punished, were increasingly classified, managed, and confined. Fortunately for the state, a ready-made solution was at hand: by the 17th century, many former leprosy hospitals had quietly transformed into asylums. In 1656, Louis XIV formalized this shift by establishing the Hôpital Général de Paris, where society’s unwanted—beggars, criminals, and the insane—were swept into centralized confinement.
What became of the leprosarium caretakers? Many stayed. Institutions endure, and so do those who staff them. As leprosy waned, monks, nuns, and lay attendants simply inherited a different kind of patient. To them, the mad were no different from lepers: incurable, long-term residents who needed containment, not cure. The buildings stayed. The routine continued. The caregivers adapted. Only the sign on the door changed.
From Confinement to Control
The transformation of leprosaria into asylums marked more than a population shift—it marked the early roots of psychiatric custody. Religious attendants who once tended to diseased flesh now managed troubled minds. They lacked medical training, but that wasn’t the point. Asylums, like the leper houses before them, existed to remove the unsettling from public view—not to heal them.
By the 18th and 19th centuries, a new figure entered the asylum: the medical doctor. Known then as alienists, these early psychiatrists represented a turning point—the first time physicians officially took over the care of the mad. But their role wasn’t to cure. It was to control. Their tools—purging, bloodletting, ice baths, restraints—were harsh and speculative, yet effectiveness wasn’t judged by recovery. Success meant silence. Order. Compliance. The goal wasn’t healing—it was submission.
As asylums grew, they needed more than high walls—they needed legitimacy. Madness had to appear medical, not moral or social. So diagnoses were invented, vague terms like “melancholia” and “monomania” carried the weight of science without its substance. Theories were crafted to explain behavior without understanding it. Former leprosy doctors became gatekeepers of the mind, cloaked in new authority. With titles, terminology, and invented categories, they gave birth to a profession built not on cure, but on classification.
And so, the patients remained, just as the lepers once had—confined, controlled, and forgotten. Only now, their isolation came with a medical label. Suffering was reframed as treatment, and lifelong confinement was recast as care. What had once been exile became therapy. Chains were no longer needed; a diagnosis was enough. The buildings filled. The system held. The solution worked.
When Treatment Became Trauma
For centuries, madness had been managed through brute confinement—chains, straitjackets, and isolation cells kept the insane from disturbing the outside world. But by the 19th century, psychiatry sought a more active role. Madness, doctors reasoned, must originate in the body—perhaps tangled in the intestines, lurking in the uterus, or festering in the skull.
So they cut.
In the early 20th century, some of the most respected doctors believed madness stemmed from hidden infections. Teeth were pulled, ovaries excised, colons resected—all in the name of cure. When symptoms persisted, the solution was simple: cut more. Surgical mutilation became medicine’s answer to the mind’s mysteries—and the body paid the price.
But medicine wasn’t done yet. The brain was next.
Brain Under Siege
By the early 20th century, psychiatry had run out of body parts to remove. But one organ remained untapped: the brain.
Early psychiatric treatments were crude and punishing. Insulin comas, Metrazol-induced seizures, and electroshock therapy didn’t heal brains—they scrambled them. Patients often emerged confused, weakened, or catatonic, though some appeared calmer or more compliant. That was enough. Forgetting their delusions counted as progress. These methods didn’t cure madness; they suppressed it just enough to maintain and preserve the illusion of medical success.
Then came the lobotomy.
António Egas Moniz, a Portuguese neurologist, theorized severing the frontal lobe’s connections could “reset” an unruly brain. Walter Freeman, an American psychiatrist, took it a step further. He replaced the surgical suite with his infamous “icepick” technique, using a slender orbitoclast and a hammer to sever brain connections through the skull. A few taps above the eyeball, and the patient’s problematic emotions were gone.
Lobotomies were hailed as success. Tens of thousands underwent the procedure. Formerly resistant patients became docile, compliant, and easy to manage. They stared blankly, drooled, and forgot their own names. This wasn’t healing; it was erasure. Psychiatry called it progress, but it was medicine stripped to its most mechanical and ruthless form.
However, lobotomy had one unfortunate flaw—it was hard to miss. Families balked at the sight of vacant-eyed relatives reduced to empty husks. Psychiatry needed the same effect, just with better optics. Erasure was still the goal, but now it required polish—something powerful enough to subdue, yet subtle enough to pass for care.
The Chemical Straitjacket
Then came Thorazine—psychiatry’s holy grail. Described as a “chemical lobotomy,” it delivered the same effect as Freeman’s icepick, but without the blood, bruises, or backlash. Patients could walk, talk, even return to daily life—just dulled enough to function. Just dulled enough to obey. Submission, once carved with a scalpel, now came by prescription. They called it a miracle—if you didn’t mind the vacant eyes.
Thorazine opened the gates, and the flood began. Tranquilizers, stimulants, painkillers—rebranded as treatment, sold as solutions. The shackles were gone, the seizures replaced. No more straps or shocks—just neurotransmitters, and a story convincing enough to sell.
Depression became a serotonin imbalance. Anxiety was blamed on faulty GABA. Schizophrenia? A dopamine problem. Proof wasn’t necessary. The words sounded scientific. The drugs were powerful. The sales pitches were flawless.
Freud once saw madness as part of life’s emotional depth—something to explore, not erase. But understanding took time, and medication worked quickly. Psychiatry no longer needed insight or theory. Just needed dosage charts.
The asylums emptied, but the system didn’t die—it adapted. Chains were traded for chemicals, and walls for words. Diagnosis became the new restraint. Patients walked free, but under control.
The architecture of confinement simply moved inside the patient.
Rebranded, Reinvented, Still in Power
Psychiatry began as a bureaucratic fix, a convenient way to fill empty leprosy hospitals and legitimize the confinement of society’s unwanted. Once the mad were placed inside, medics inherited authority over them. That authority didn’t come from knowledge—it came from structure. Psychiatry simply defined the problem and claimed the power to solve it.
Over time, the definitions changed, but the purpose did not. What began as religious judgment eventually became medical classification. Madness was renamed, reorganized, and explained with ever-shifting theories. Psychiatry didn’t need to cure—it needed to survive. And by constantly reframing its targets, it did just that. From asylums to SSRIs, the system adapted.
Today, lobotomies are called deep brain stimulations. Ice baths became magnetic pulses. Leather restraints became mood stabilizers. Hundreds of thousands of people still receive electroshock every year. The tools may look different, but the function remains the same: control.
Every generation believes it has found the answer. Every generation is wrong.
Reclaiming the Human Condition
The human experience was never meant to be medicine’s domain. The more psychiatry has meddled, the less it has understood. It has cut, burned, shocked, drugged, and subdued its way through history—leaving behind compliance, not cures. There is no meaningful success, only rebranded failure.
And yet, psychiatry persists—not because it heals, but because it has made itself essential. By turning pain and struggle into pathology, it seized authority and declared itself the cure.
Human distress is not a disorder, an imbalance to correct, or a disease to eradicate. It is life.
And it is time for those who respect it to reclaim the conversation.
Because medicine was never meant to be in this business in the first place.
Great post overall! I agree with a lot of what you’re saying and can really see the historical roots there. However, I do think it is a very eurocentric view. I don’t think all cultures have universally treated madness in the same way throughout history, or even today. There’s only so much you can generalize.
Also you referenced Freud, perhaps a contentious choice. Although psychotherapy may be seen as a better alternative to medication, because it “gets to the root” and whatnot, let’s not forget that therapy is not beyond debate either. It is often just as much about control & punishment as psychiatry is, and can be just as traumatizing sometimes.
Thanks for writing!
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Dr. Cima has presented a fine, brief overview of the history of psychiatry. Foucault’s “History of Madness” documents how the asylums were originally invented in Europe to contain lepers. As leprosy receded, the idea of containing people was transferred to “les miserables’ of all types.
The French Revolution set out to get rid of the King’s method of involuntary commitment: the infamous “lettres de cachet” that had been used on many of its leaders. But the asylums were maintained, yet became administered by doctors, who had to justify their positions, as Robert Castel documents in “The Regulation of Madness.”
Szasz cites the private “trade in lunacy” that began in England with private houses taking in unwanted family members — for a price.
We need to keep this history of involuntary commitment and treatment in mind because it still exists, both in the U.S. and around the world. Psychiatrists keep finding new ways and new language to try and convince us they are really doing medicine. It appears their latest catchphrase is the oxymoron “behavioral health.”
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“Human distress is not a disorder, an imbalance to correct, or a disease to eradicate. It is life. And it is time for those who respect it to reclaim the conversation. Because medicine was never meant to be in this business in the first place.”
Exactly, I agree. There is a need for serious changes in the mental health system in this direction.
Frontal Lobotomy… This method does not exist today, or it does exist but may be done secretly. Today, it seems that ECT has taken the place of frontal lobotomy. It is a fact known by everyone that psychiatric drugs are ‘chemical lobotomy’.
One of the genius ideas of modern psychiatry is the “ECT lobotomy”. So.. Actually.. ECT is a method of damaging (/harvesting, boiling) and cooking the human brain with ‘electric heat’. With ECT, ‘brain damage’ is inevitable. But psychiatry continues to deny even this. Psychiatry hides behind the excuse that ‘too little electricity is given to the brain’. And psychiatry must be very proud of the way it ‘cooks’ people’s brains.
In fact.. What psychiatry fails to understand is that it cannot consider that ‘the human brain can be so easily disrupted by electrical currents’, no matter how low.
The human brain has a very sensitive structure. It works with an unidentifiable type of energy, much, much below 1 volt. However, this energy has a a very different ‘type of energy’ than the ‘electrical’ energy that the world currently uses. The brains of all living things, including humans and animals, do not work with the ‘electrical energy current’ that everyone knows.
What does it work with? It works with spiritual energy. Spiritual energy is a very different type of energy than electrical energy. It is not possible to imitate spiritual energy with the electrical energy currently used.
But unfortunately this is being done.. Under the name of ‘mental health treatment’… Healthy brains are being attacked with the electrical energy currently used. Results… It results in damage to healthy brains (brain damage). Although, Psychiatry denies this fact, the facts are in this direction. Giving electricity to healthy brains means destroying those healthy brains.
There is an ‘eclipse of reason’ in the world of science and medicine. Psychiatry is trying to find mental illnesses in the brain (with ECT and psychiatric drugs) even though ‘mind and mental illnesses’ are not in the brain. This is a ”eclipse of reason (mind-numbing)’ for psychiatry. This is an ‘eclipse of reason’ not only for psychiatry, but also for the real world of science and medicine.
Imagine a world of science and medicine… trying to look for something that is not in the brain as if it were in the brain, but cannot find anything. Not only does it not find ‘mental illnesses’ in the brain, it acts as if it has and attacks the brain (with psychiatric drugs and harmful psychiatric treatments such as ECT). It does this under the name of so-called ‘mental health treatment’.
Psychiatric drugs are chemical lobotomies. It is the chemical version of frontal lobotomy. Both damage the brain; (causes chemical brain damage.) In psychiatric drugs like ECT do not treat mental illness. And they haven’t for decades. (You can’t treat something that isn’t in the brain. Point.)
So, what did psychiatric drugs do? They damaged healthy brains, that is, they damaged them. (chemically induced brain damage) So.. Healthy brains also created a ‘chemical imbalance’. The ‘chemical imbalance’ caused by psychiatric medications made existing psychological problems worse. It caused psychological problems that did not exist to emerge. As a result of this chemical imbalance, natural psychological problems became ‘permanent’; (usually long term; after months and/or years of psychiatric medication use)
However, despite all these negative developments.. Psychiatry denied these negative developments and continued to spread the word that ‘psychiatric drugs work’. Psychiatric drug companies tried to sell their useless psychiatric drugs under different brand names with new updates, saying ‘these psychiatric drugs work!’ The mainstream media jumped headfirst on this and tried to spread misleading information like, “These psychiatric drugs work!” And unfortunately, they do this ‘drug propaganda’ for every current psychiatric drug. Whenever a psychiatric drug doesn’t work, they put a new psychiatric drug on the market under another name/brand name instead. And they are playing the above game. Even though they know they don’t work… they are putting new psychiatric drugs on the market ‘as if they work’ and are carrying out a perception operation in this regard.
As a final word… Yes, mental health systems need serious reorganizations, changes, etc. etc. Best regards.
With my sincerest wishes. 🙂 Y.E. (Researcher blog writer (Blogger))
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Psychiatry is a monstrous profession that uses people’s suffering against them for profit and ego gratification
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Many thanks for your comment! Could not agree more. It certainly is the case.
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Thank you for the brief history of psychiatry, Randy. It helps explain why the DSM “bible” is actually being taught in the seminaries today, and part of why the younger generations are not going to the churches.
For goodness sakes, one cannot believe in a DSM “bible” of scientifically “invalid” stigmatizations, while also believing in the Holy Bible, which is a book of wisdom, that’s message is largely about the need for love and mutual respect.
But I will point out that all this is unethical and unwise, on the part of the seminaries that actually believe in God, and want to bring the young people into their churches.
For goodness sakes, now I understand why none of the young “mental health professionals” – who are “partnered” with my ex-religion – ever bother to show up for church services. And now I understand why my mom’s former church is a dying, greying, church.
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But we must question ourselves and the inefficacy of polemicizing the issue to society at large, because it is patently proving ineffective and you all must accept that otherwise you continue your talking shop as psychiatry continues to profit out of the destruction of hundreds of millions of children and nearly a billion human beings all included across the Earth. And there is nothing further to say on this point. If you really recognize and accept your impotence, you have already broken through it into a clearer vision and through that vision can go beyond impotent social action. Otherwise you just become an absurdity typing into a laptop like me. But at least I’m only absurd because I’m an inside out hello kitty punch bag ready to telephone her letter box sisters and call them for a meeting about how to turn profitable infanticide into the conviction of psychiatrists.
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Just a reminder, in the US, separation of church and state is supposed to be the rule of law … but the psych industries (I’m pretty certain, illegally – in addition to many of the 501c3 organizations they’ve “partnered with”) bridged that gap.
Not to defame the truth tellers of MiA, which is a 501c-3 organization, that I do donate to. But the unrepentant Holy Spirit blasphemers of my ex-religion, are not innocent.
https://www.youtube.com/watch?v=RcsGp9wzN48
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Thomas Szasz called BS on human suffering as a disease decades ago, but I believe that suffering can be so painful that people deserve the right to try to control it by whatever means they choose.
My problem is with psychiatry claiming medical legitimacy with its socially constructed pseudoscience and using it to control people under duress.
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“Human distress is not a disorder, an imbalance to correct, or a disease to eradicate. It is life.”
THANK YOU!!!
It’s relief to finally have someone echo what I’d always suspected: that psychiatry—and psychology—are actually in the business of pretending to be something they’re not—while (curiously?) tricking people into believing they’re something they’re not!
P.S. This is the best historical indictment of psychiatry I’ve ever read as it doesn’t shy away from confronting the hard truths about psychiatry or try to make excuses for psychiatry’s dirty deeds—past or present.
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Hi Randy
You have omitted two important features in this re-write of Foucault’s European history. The first is the judgement of dangerousness. The doctors entered the asylums as the courts needed (??) an authority to assess dangerousness. This is a very real need, and I would like to see some of the anti-psychiatry folk or a Szaszian argument argument to the contrary. Doctors seemed a simple but the correct (for the time) choice – although what has followed has not followed the Hippocratic oath to do no harm as we all know.
The second is the York retreat under William Tuke – a close reading of his grandson Samuel Tuke’s book “Description of the Retreat” – especially the treatment of the grazier (p. 100) – who was described as “one of the worst patients” who recovered after he gave “very sensible directions for the treatment of a sick cow” – and his esteem went up. Although Foucault is equally harsh on Tuke as well as Pinel in his earlier work (Madness & Civilisation), he is more reserved in his later work (Psychiatric Power).
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This a a very good critique of psychiatry. Good but partial. Cima did not state how the Christian church’s systematic and violent attack on mostly women healers, birthers and spiritual leaders resulted in the torturing and killing of hundreds of thousands (maybe more than an million) over centuries. “Science” came to the rescue claiming “they are not witches, they are crazy” (Thomas Szazs). By then centuries of torture and terrorizing had created so much suffering and trauma that there were many “uncontrollable” people suffering from unknown afflictions in Europe. In recent decades, it is beginning to be recognized as trauma and problems of living. Even so, this misogyny is exploding in the US presently, along with other terrible prejudices, that will have long lasting impacts on people who suffer through problems of living.
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Thank you so much for packing so much history in your beautiful, flowing prose. I will be able to share your essay with those who have never given such a second thought, and I imagine it will at the very least, cause them to ponder.
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Yes, this is a refreshing perspective that only recently broke through, in my personal understanding of psychiatry, that drugs are restraints; drugs replace the shackles and the chains; drugs keep the patient coming back for more, checking in, supervised and overseen by the authorities.
There is even a famous image of the French Psychiatrist releasing poor people from their shackles as they fawn gratefully over his mighty intellect
But shackles and chains can bite into the skin. They can rust; they’re nickel-plated and they turn green; they leave sores and broken skin; they weigh us down immensely; they’re obviously noticeable if we were seen by the public.
Today the asylums are “virtual” with invisible shackles and restraints. Everyone on the street may be a mental patient; they may be an escapee; they may be a renegade who takes no medication. No way to tell; their status may change, day-to-day. But the ones who do, the ones who receive treatment, they’re in a virtual incarceration. Their bonds consist of a prescription pad, office visits, and pharmacy orders. It’s a cycle that can totally snowball and become onerous.
When they began introducing me to drugs, my head spun from all the “Rubrics” for usage. Each one had a unique set of admonitions. “Take with food!” “Take without food!” “Take with a full glass of milk!” “Don’t drink milk or grapefruit juice!” “Avoid Fava Beans and Nice Chianti!”
The rituals around pill-taking can be overwhelming. A person like me has no regular schedule, can’t adhere to discipline. Every day for me is a different day, with unique challenges, and everything is done in a unique order, and I cling to any structure applied from a job or church.
But taking pills is a scheduled ritual. It’s another layer on top of eating, sleeping, exercising. Taking pills when their efficacy relies on a solid foundation of a sated stomach, a roof over your head, good hygiene. That’s the challenge. There’s the rub.
So I am a slave of the Blessed Virgin Mary. She is my true mother in Heaven. The Catholic Church is our True Mother on Earth. My pastor is my father in spirit and in truth. I confess to the priest. I may be a zealot or I may overindulge in religion, at the expense of spirituality. But it imparts discipline. My faith is based on Truth Himself, Christ Jesus. The Cross is the Tree of Life; the Resurrection is something we all hope to share.
May God bless you, MadInAmerica, for whatever good comes of your activities! Happy Holy Week! #MAGA #MAHA
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Very hopeful comment, currently striving for Jesus myself, and being in the know now of the harms of psychoactive drugs, which dulls my emotions totally. If you can, pleasenprsy for me and my wellbeing as well as for getting off of these drugs. Thanks. And bravo on the article.
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