How was anxiety treated in the 1800s?

In the 1800s, the treatment of anxiety, often not recognized as a distinct psychological condition but rather as a "nervous disorder" or part of general "insanity," was largely rudimentary, often punitive, and lacked the scientific understanding prevalent today. Approaches ranged from institutionalization with severe conditions to various physical and chemical interventions, most of which were ineffective or even harmful.

A Harsh Reality in Asylums

For individuals exhibiting severe symptoms of mental distress, including what we now identify as anxiety disorders, institutionalization in asylums was a common, albeit often brutal, approach. In the early part of the 19th century, the treatment of those deemed mentally ill was extremely problematic.

• Physical Restraints and Confinement: Patients could spend days in physical restraints, with some even chained to walls. This was a common method to manage perceived agitation or dangerous behavior, rather than a therapeutic intervention.
• Public Spectacle: Disturbingly, facilities would often conduct public tours, allowing visitors to observe patients as a form of entertainment. This highlights the lack of dignity and therapeutic intent in many institutions.
• Overcrowding and Poor Conditions: Asylums were frequently overcrowded, unsanitary, and lacked proper medical care, often exacerbating patients' conditions rather than alleviating them.

Common "Treatments" and Interventions

Beyond the harsh conditions within institutions, various methods were employed in an attempt to "treat" mental afflictions, including anxiety. These methods were based on prevailing, often misguided, theories about the body and mind.

Physical and Chemical Approaches

Many treatments focused on presumed physical imbalances or relied on sedatives.

• Bloodletting and Purging: Based on ancient theories of humors, practices like bloodletting (removing blood) or purging (inducing vomiting or diarrhea) were common, believed to rebalance the body's fluids. These methods often weakened patients further.
• Hydrotherapy: This involved the use of water, often in extreme temperatures. Patients might be subjected to prolonged cold baths or showers, believed to shock the system into recovery.
• Opium and Alcohol: Opium (often in the form of laudanum) and alcohol were widely used as sedatives to calm agitated patients or induce sleep. While offering temporary relief, they led to addiction and obscured underlying issues.
• Bromides: Towards the latter half of the century, compounds like potassium bromide gained popularity as sedatives for nervous conditions, though their long-term effects and efficacy were poorly understood.

The Concept of Moral Treatment

While often idealized, the "Moral Treatment" movement, emerging in the late 18th and early 19th centuries, advocated for a more humane approach.

• Focus on Environment: This approach emphasized a calm, structured, and respectful environment, engaging patients in productive activities, regular routines, and gentle persuasion rather than harsh discipline.
• Limited Implementation: Unfortunately, true moral treatment was rarely sustained, particularly as asylum populations grew and funding became scarce. Many institutions claiming to practice moral treatment often reverted to custodial care.

Lack of Specialized Understanding

A key factor in 19th-century anxiety treatment was the absence of a clear diagnostic framework for psychological conditions as we understand them today. Anxiety symptoms were often lumped under broader categories like:

• Nervous Disorders: A catch-all term for various unexplained physical and mental complaints.
• Melancholia: Often used to describe states of depression or profound sadness, which could include anxiety symptoms.
• Hysteria: Primarily applied to women, this diagnosis covered a wide array of symptoms, including anxiety, fainting, and emotional outbursts, often attributed to a "wandering womb."

Summary of 19th-Century Anxiety Treatment

The table below summarizes the typical approaches to anxiety in the 1800s:

In essence, treatment for anxiety in the 1800s was a blend of rudimentary medical practices, often punitive custodial care, and early, frequently failed, attempts at more humane approaches, all without a clear understanding of the psychological nature of anxiety itself.