Today we understand that mental illnesses are medical conditions that need to be treated through medication, psychotherapy, etc, but during the 18th and 19th centuries, they were seen as "a spiritual problems resulting from sin, guilt, or, at its worst, demonic possession." People who were found to be mentally ill were often cruelly punished and exorcised to relieve them of their suffering. Some early treatment practices included drilling a hole into the ill person's skull and bloodletting. Over time, this perception changed and the mentally ill became seen as criminals. As their numbers increased, institutions such as asylums were created to accommodate them. However, the sufferers still did not receive better treatment than they did earlier, but rather were tortured and "kept chained to walls and in social isolation." For a long time, this was the fate of the mentally insane, and it remained this way until an advocate by the name of Dorothea Dix came along.