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distinction was not made between the “insane” and the “feeble- minded” (people with mental retardation). Both were placed under the category of “mentally defective” and were treated the same (Deutsch 1949, 332). General hospitals were founded in the late eighteenth cen- tury, and Pennsylvania Hospital, in the mid-eighteenth century, became the first hospital in the United States to admit mental pa- tients. Their low status can be seen as reflected in the fact that they were treated in the basement of the hospital. The first hospi- tal established only for persons with mental illness opened in Williamsburg, Virginia, in 1776. The establishment of a psychi- atric hospital in Pennsylvania and other states soon followed. The establishment of these hospitals was also the beginning of a two- tier public health policy, which in many instances continues today, in which mental health care is frequently segregated from physical health care and is often treated as the poor stepchild, with less funding. By the late eighteenth century, some physicians began to con- sider the relationship between “insanity” and natural causes such as disease and stress. Slowly some people also began to recognize mental disability as an economic and social problem (Rochefort 1997), but it was the former attitude that had an immediate effect. One important pioneer who influenced developments in the young United States was Dr. Philippe Pinel, who after the French Revolution took charge of two psychiatric hospitals in Paris and began an approach, called moral treatment, that was based on providing a sympathetic and supportive environment to assist healing. This approach of permissiveness and kindness was fol- lowed in the small early mental hospitals in the United States. Many people, however, were still placed in urban almshouses and jails. In response to those conditions, Dorothea Dix began in the mid-nineteenth century a reform movement by advocating the building and expansion of state psychiatric hospitals, so as to allow persons with mental illness to be moved from the poor- houses and jails into an environment in which they could receive care. For financial reasons, the almshouses and jails quickly re- leased the mentally ill to the new state hospitals. Social reformers after the Civil War supported the asylum movement along with their other causes. The trend of viewing mental illness in natural terms that had begun among physicians in the eighteenth century continued in America through the Nineteenth Century 3