The Curious Case of Empty Asylums and the Birth of Psychiatry

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.