The early terms and definitions of mental deficiency were very wide, idiot, imbecile or lunatic and covered many symptoms which today we describe as an illness such as nervous breakdown, dementia, or Alzheimer's decease.
Until the beginning of the 19th century those displaying signs of mental illness were viewed with considerable suspicion and often abused. Mental hospitals, known as madhouses, lunatic asylums and later as psychiatric hospitals were often places of cruelty and neglect where patients whose families were often deeply ashamed of them, were locked away.
The earliest mental hospital was originally founded as a priory in Lambeth in1247, becoming the infamous lunatic asylum known as Bethlem in 1377. The Relief of the Poor Act of 1601 required each parish to provide work for the poor and take responsibility for the aged, sick and infirm which included any idiots and lunatics, thus the mentally sick were usually housed in the workhouse. It was not until 1770 that Bethlem ceased to be a tourist attraction where sightseers paid to view the shackled and manacled inmates. The idea that the mentally ill should be locked away encouraged the establishment of a number of private madhouses in which conditions varied greatly, many were primitive institutions with mad doctors who pursued their own theories about the treatment of insanity, inmates were often half-starved as they were then easier to restrain. In 1774 an attempt was made to regulate madhouses but this was limited to the care of private patients and did not cover pauper lunatics whose treatment in an asylum would have been paid for by the parish overseers.
The Lunatics Act of 1845 required every county to provide an asylum for its pauper lunatics, resulted in a rapid building program and growth of mental hospitals, pauper lunatics were transferred from parish funded workhouses to asylums paid for by county councils, this resulted in improvements in the conditions of lunatics with public asylums having annual inspections. By the middle of the 19th century the physical restraint of patients gave way to the psychological treatment of seclusion as well as the padded cell which remained with us until the introduction of tranquillising drugs in the 20th century.