In the twentieth century the search for mental health took people down both old and new avenues. As nation after nation mobilized to fight mental illness in the nineteenth century, the asylum grabbed most of the headlines as society's first line of defense. But while asylum populations may have been growing by leaps and bounds in the nineteenth century, the family and local community continued to serve on the front lines of care into the twentieth century. In most regions, by World War I more people with mental disabilities still lived outside the asylum than inside.

In the meantime, amid the overall cultural ferment of the early twentieth century, interest in both normal and abnormal psychology spread briskly throughout society. A burgeoning popular press fanned renewed scientific interest in old ailments like hysteria, as well as new psychological disorders such as neurasthenia. At the same time, an increasingly affluent and literate public, intent on unlocking the mysteries of the mind, dabbled in self-help approaches to mental wellness, including Christian Science, New Thought, and the Emmanuel movement. The idea of preventing mental illness also caught on widely, notably in the eugenics and mental hygiene movements, enabling medical specialists to investigate other opportunities beyond the walls of the asylum. By the outbreak of World War II, the asylum had tenaciously survived as an all-purpose site for treating people with mental disabilities, but the stage was set for both its swift demise and a major expansion in the egalitarian quest for mental well-being.