ABSTRACT
At one time, as stated in the overview portion of this section, mental health management was almost exclusively dominated by psychiatry. Indeed, the founders of what has become the American Psychiatrie Association were all superintendents of state insane asylums. Interestingly enough, early papers emanating from this group could more clearly be classed as papers on administration/management rather than on treatment. Understanding of the nature of mental disease, or more exactly, ignorance of the nature of mental disease, shaped the organization of care in the 19th century. The serious mental disorders, such as schizophrenia and major affective disorders, tended to be treated in large state hospitals if at all. There was a prevalent belief that mental disorders were dementias, that is, brain diseases, and were incurable. Illnesses, less debilitating, received little attention. Sigmund Freud's synthesis of mental disorders as intelligible and treatable led in the 1930s to the development of a modest amount of office practice, at least for the affluent. Also in the 1930s there appeared what were perceived to be effective somatic therapies, electroconvulsive therapy (ECT) and insulin coma.
