America in the 17th and 18th Centuries

Rural living provided easy care for the mentally ill because they were spread throughout a large area of land.

Insanity was not a substantial problem in America in the 17th and 18th centuries because rural and agricultural societies kept people at farther distances from each other than in Industrialized England.  A few mentally ill people scattered over hundreds of miles in agricultural societies is much different in terms of care than when colonization begins and there is more than one mentally ill person within the same few miles.  Legally, if there was a mentally ill case that was too much for one family to support financially, the community was required to intercede and assist (Grob, 1985; Grob, 1991).

Because mental illness was so few and far between in rural America, having a family member confined in an institution was a rare occurrence.  Only when the person threatened harm to the family or to the community at large, or the family did not have the financial resources to care for their mentally ill family member, were they placed into almshouses or were given room and board with another family (Grob, 1991).

However, as soon as colonization began and land demographics changed, mental illness became a problem because there was no place to care for the mentally ill.  This simultaneously transformed mental illness from an insignificant rural problem into a larger social problem.  An increase in immigration, religiosity, awareness of medical problems, and news of Philippe Pinel‘s treatise on insanity had a large impact on changes in how the mentally ill were treated.  Treatment and the cost of treatment of the mentally ill changed hands from families and local communities to the state.  Within a forty year time span, free public institutions increased exponentially: from only one to at least one in every state by the beginning of the Civil War (Grob, 1985; Grob, 1991).


Grob, G. N. (1985). The transformation of the mental hospital in the United States. American Behavioral Scientist, 28, 639-654.

Grob, G. N. (1991). The chronic mentally ill in America: The historical context. In V. Fransen (Ed.) Mental health services in the United States and England: Struggling for Change, (pp. 3-17). Princeton, N.J., US: Robert Wood Johnson Foundation.

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