What really happened inside mental asylums: the history no one ever tells you
6 min read
Originally written by Leo🙏🏼 in 2021. Updated 2026
For centuries, psychiatric asylums were places where society hid what it could neither understand nor heal.
They were built with the promise of care, yet often became institutions of confinement, isolation, and experimentation. Long before psychiatry developed effective treatments, mental illness inspired fear more than compassion. Doctors worked in the dark, families had few alternatives, and patients frequently became subjects of methods that today seem unimaginable.
Perhaps nothing illustrates this better than the history of London’s Bethlem Royal Hospital, better known simply as “Bedlam.” The very word has entered the English language as a synonym for chaos, but its origins are far more disturbing. And in fact, during the eighteenth century, it had become one of London’s most popular tourist attractions.
For the price of two pennies, visitors could walk through the wards and stare at the patients as though they were exhibits in a zoo. Contemporary accounts describe crowds laughing, mocking, and provoking the inmates, while the hospital itself benefited financially from this horrific spectacle. Some historians estimate that tens of thousands of people visited every year, making mental illness a form of public entertainment.
Around Bedlam, myths naturally flourished.
Londoners whispered that the screams heard at night came from people possessed by demons rather than patients suffering from psychiatric disorders.
Also ghost stories spread through the city, describing restless spirits wandering the hospital’s corridors long after death. While many of these tales belong to folklore rather than documented history, they reflect a time when madness was often explained through superstition, religion, or fear instead of medicine.
The treatments inside these institutions were no less unsettling. One of the most common remedies was water therapy. Physicians believed that cold water could calm an agitated mind or shock the body back into balance. Some patients were strapped into large tubs filled with water for hours or even days, unable to move. Others were tightly wrapped in wet sheets, creating a form of restraint that was thought to reduce excitement, while particularly violent patients were subjected to powerful streams of freezing water directed onto their heads and bodies. Although these methods were presented as medical treatments, they often functioned as punishment or control rather than genuine therapy.
As medicine advanced into the nineteenth and twentieth centuries, treatments became more scientific—but not necessarily more humane.
One extraordinary example emerged from the fight against neurosyphilis, a devastating condition caused by untreated syphilis spreading to the brain.
Austrian psychiatrist Julius Wagner-Jauregg noticed that some patients improved after experiencing very high fevers, and his solution was astonishing: deliberately infect patients with malaria. The resulting fever could become hot enough to kill the syphilis bacteria, after which the malaria itself could be treated with quinine. It was an extraordinary gamble, but one that saved some lives in an era with no antibiotics. In recognition of this breakthrough, Wagner-Jauregg even received the Nobel Prize in Medicine in 1927.
Today the treatment sounds shocking, yet at the time it represented one of the few genuine medical successes against an otherwise fatal disease.
The 1930s brought another radical idea: insulin coma therapy. Massive doses of insulin pushed patients into prolonged unconsciousness, sometimes for hours at a time.
Doctors hoped that repeatedly forcing the brain into a coma would somehow “reset” severe mental illnesses such as schizophrenia, with hospitals around Europe and North America embraced the procedure despite its considerable risks. Mortality rates were significant, and many survivors experienced lasting complications. Nevertheless, in an age before antipsychotic medications, desperate physicians clung to the hope that even dangerous interventions might succeed where nothing else had.
One of psychiatry’s most controversial chapters began not in a laboratory, but in a slaughterhouse. In Rome in 1938, Italian neurologist Ugo Cerletti observed pigs being briefly stunned with electric current before slaughter.
The animals lost consciousness without immediately dying, and Cerletti wondered whether controlled electricity might have therapeutic effects on humans experiencing severe psychiatric illness. Together with his colleague Lucio Bini, he applied the first electroconvulsive treatment to a patient suffering from acute psychosis. The man survived—and reportedly improved. And electroconvulsive therapy, later known simply as electroshock, rapidly spread around the world.
Few medical treatments have accumulated as many myths as electroshock. Popular culture often portrays it as little more than torture, thanks largely to films such as One Flew Over the Cuckoo’s Nest. Early versions were indeed performed without anesthesia or muscle relaxants, making them frightening and physically traumatic. Modern electroconvulsive therapy, however, is dramatically different. It is administered under general anesthesia with carefully controlled electrical stimulation and remains one of the most effective treatments for severe depression, catatonia, and certain treatment-resistant psychiatric disorders.
The history of electroshock is therefore both a warning about past abuses and an example of how medicine can evolve beyond its origins.
Yet no treatment became more infamous than lobotomy.
Portuguese neurologist António Egas Moniz believed that severing connections in the brain’s frontal lobes could relieve severe mental illness by interrupting destructive thought patterns. The operation often left patients calmer and easier to manage, which many hospitals interpreted as success. In reality, countless patients lost their personalities, emotions, initiative, or ability to live independently. Despite these devastating consequences, he was awarded the Nobel Prize in Physiology or Medicine in 1949, reflecting how revolutionary the procedure appeared at the time.
If Moniz invented lobotomy, American physician Walter Freeman transformed it into a mass phenomenon. Rejecting the need for neurosurgeons or operating theaters, Freeman developed the transorbital lobotomy, a procedure that became notorious as the “ice-pick lobotomy.” A slender metal instrument resembling an ice pick was inserted through the thin bone above the eye socket and driven into the brain with a small hammer before being swept side to side to sever nerve connections. The entire operation could take less than ten minutes.
In any case, Freeman performed more than three thousand lobotomies, often traveling across the United States in his specially equipped van, nicknamed the “Lobotomobile.” He demonstrated the procedure before audiences almost like a traveling showman, convinced he was revolutionizing psychiatry. Some patients undoubtedly became less violent or distressed, but many more emerged permanently disabled, emotionally blunted, or unable to function independently.
Today the ice-pick lobotomy stands as one of the starkest examples of medical certainty outpacing scientific evidence.
Asylums themselves inspired countless legends beyond their medical history. Abandoned psychiatric hospitals around the world have become fertile ground for ghost stories, paranormal investigations, and urban legends. Former institutions such as the Trans-Allegheny Lunatic Asylum in the United States, the Beelitz-Heilstätten complex in Germany, and the abandoned wings of old European hospitals are frequently described as haunted. Visitors report mysterious voices, shadowy figures, and unexplained footsteps echoing through empty corridors.
Whether one believes such stories or not, these legends reveal something deeper: places where so much suffering occurred naturally become repositories of collective memory, grief, and imagination.
Even if, looking back, it is tempting to dismiss these practices as simple barbarism, the reality is more complicated, as most emerged from genuine desperation. Physicians faced illnesses they could neither explain nor cure, while families watched loved ones descend into psychosis, depression, dementia, or neurological disease with almost no hope of recovery. In the absence of effective drugs, every new idea—even terrifying ones—could appear worth trying.
The history of psychiatric hospitals is therefore neither a story of monsters nor heroes. It is a reminder of how easily medicine can lose its way when patients become diagnoses rather than people.
Luckily, scientific progress has transformed mental healthcare beyond recognition, replacing many of these brutal interventions with evidence-based therapies, medication, and a far greater respect for patients’ rights. Yet the abandoned corridors of the old asylums still remind us of a timeless lesson: compassion must advance alongside science, because when medicine forgets the human being at its center, even its greatest ambitions can become its darkest mistakes.
