Evolution of Mental Illness

Ideas about Mental Illness

Ancient Mesopotamians believed that mental illnesses masked demonic possession

2000 BCE - 1600 BCE

First Ancient Egyptian description of Mental illness

1600 BCE - 1500 BCE

The first Egyptian recognition of depression and dementia was found in the Book of Hearts, written on the Ebers papyrus. Mentions of mental illness are also found in the Edwin Smith papyrus. Although the papyri covered medical treatments that were advanced for the time, diseases of unknown origin (like many mental illnesses) were generally attributed to supernatural forces.

First Ancient Indian description of mental illness

1400 BCE - 1300 BCE

Ancient Hindu texts describe illnesses brought on by devils, characterized by bizarre behavior and lack of self-control.

First Ancient Persian description of mental illness

700 BCE - 650 BCE

Ancient Persians also believed that mental illness was caused by demons.

First Ancient Hebrew description of Mental Illness

600 BCE - 550 BCE

Ancient Hebrews believed that any and all illnesses were punishments from God for committing sin, mental illnesses included.

Early "bodily fluid imbalance" thinking in India

600 BCE - 400 BCE

Early strains of “bodily fluid imbalance” thinking in Ancient India- ill health is thought to arise from an imbalance of three bodily fluids or forces.

Hippocrates introduces "four bodily fluids" ideas

470 BCE - 360 BCE

Hippocrates and later Roman physician Galen (129AD-ca. 200) introduced the concept of the four essential fluids of the human body - blood, phlegm, bile, and black bile - in Ancient Greece and Rome.

First Ancient Chinese description of mental Illness

400 BCE - 300 BCE

An early Chinese text, titled "The Yellow Emperor's Classic of Internal Medicine" described insanity, dementia, and seizures as being caused by demonic possession and other supernatural forces.

Bodily fluid imbalance thinking continues through Middle Ages

500 CE - 1400 CE

In Middle Ages, mental illness was thought to be the result of an imbalance of the four essential fluids.

Mental illness viewed poorly

500 CE - 1400 CE

Mentally ill were often treated no better than animals, and were generally viewed as a burden to the family.

European beliefs hold that mental illness is a choice

1406 - 1800

After asylums were created, pervading belief was that patients needed to choose rationality over insanity (leading to many inhumane “shocking” and threatening treatments)

First European Asylum opened

1406 CE

The first European asylum is thought to be the Valencia Mental Hospital. Although not much is known about this asylum, care for the mentally ill was horrific and severely lacking. Instead of helping patients, asylums of the time were nothing more than prisons.

Franz Mesmer introduces "Mesmerism"

1774 - 1779

Franz Mesmer believed that human bodies contained a magnetic fluid and health was affected based on the distribution of the fluid throughout the body.

Phillipe Pinel improves asylum in Paris

1792

Pinel took charge of the La Bicetre asylum in Paris to test his hypothesis that mentally ill patients would improve if they were treated with kindness and consideration. Asylum reform spread through Europe and even into the Americas (albeit rather slowly).

Mass Asylum movement

1800 - 1950

Mentally ill were placed in asylums, with or without consent, to rid the public of their "burden". Asylums were often overpopulated and understaffed, with too few resources to handle the influx.

Moral management-style treatments fell

1800 - 1900

During the 19th century, moral management treatments (helping patients with their mental needs and managing the soul) fell as the Mental Hygiene movement rose. Mental Hygiene was focused solely on the patient's physical needs, and otherwise ignored mental outbursts.

Biomedical advances

1864 - 1940

Biomedical advances led to unnecessary faith placed solely in medicine as the wonder cure (not that meds didn’t do their job, just that they couldn’t be the only treatment)

Freud publishes volumes on psychoanalysis

1888 - 1939

Freud published various volumes on personality and psychopathology called Psychoanalytic Theory.
Freud believed that the mind was structured into three parts- the id, the ego, and the superego. Both the ego and super ego functioned consciously and unconsciously, but the id functioned only unconsciously. He also believed that anxiety arose as the three parts of the mind battled each other, resulting in mental illnesses

Mental Illness believed to be a biochemical imbalance

1933 - 1949

Mental illness was thought to be the result of a biochemical imbalance, comparable to a physical injury

Creation of Psychiatric Manual

1939 - 1945

WWII saw the creation of a US psychiatric manual used for categorizing mental disorders.

Mandatory sterilization of mentally ill

1939 - 1945

During this time, compulsory sterilization movements were started in many countries around the world. Nazi Germany was responsible for the sterilization and eventual death of an estimated 200,000 patients due to covert “euthanasia” programs. Sterilization of mentally ill continues today in certain countries.

Anti-asylum movement leads to discharge of patients

1960 - 1980

Anti-psychiatric hospital movements led to discharge of many patients. However, most were not equipped to deal with the outside world (with or without medication) and thus became homeless or imprisoned.

Current Ideas about Mental illness

1990 - 2013

Understanding of most mental illnesses has progressed in Western and more developed countries. Some countries still view it as shameful to have a mental illness. In many countries today, mentally ill are still treated with apprehension (by the general public) and those deemed dangerous to society are locked away in prisons or put in long-term psychiatric facilities.

Less Developed Ideas

1990 - 2013

In other countries, supernatural ideas about mental illnesses persist. Most of these countries are in the developing world. This lack of understanding has led to mental illnesses being ignored and when they are recognized, the underdevelopment of mental health facilities.

Current Chinese ideas

1990 - 2013

Chinese Confucian ideals are very strict and do not allow space for mental illnesses, which leads to individuals seeking out traditional medicine, prescriptions, and as a last resort, family care.

Care for Mental Illness

Early attempts to treat Mental illness

5000 BCE - 2000 BCE

Attempts to treat mental illnesses are visible, evidenced by trephined skulls. Crude efforts to drill or break a hole in the skull were carried out using stone instruments. Most probably died, but some lived (healed skulls) and pressure on brain was released

Ancient Mesopotamian treatment

2000 BCE - 1600 BCE

Ancient Mesopotamia- mentally ill treated with “magico-religious” rituals such as exorcisms, prayer, incantations, atonement, and other mythic rituals as well as more human approaches like threats, bribery, and punishment.

Ancient Egyptian Treatment

1600 BCE - 1500 BCE

Ancient Egyptians recommended that mentally ill were to engage in recreational activities such as concerts, dances, and painting.

Ancient Persian Treatment

700 BCE - 600 BCE

Ancient Persians believed good health would be easier to achieve if the proper precautions were taken to protect from disease. These methods included good hygiene and purity of mind and body achieved through good thoughts and deeds.

Ancient Hebrew treatment

600 BCE - 500 BCE

Hebrews “cured” by appealing to God- most healers/physicians were also high-level priests with special ways of appealing to God.

European Middle Ages Treatment

500 - 1300

Patients were given laxatives, emetics, and were bled using leeches in an effort to bring the four fluids back to balance. Laxatives were created using specific ingredients from Europe and the Middle East. Tobacco from the Americas was commonly used to induce vomiting. Other treatments included bloodletting from the forehead, cephalic, saphenous, and/or hemorrhoidal veins to draw corrupted humors away from the brain. Custom diets were recommended. Treatment and care were generally left up to the family of the afflicted- due to shame and stigma, many families hid their mentally ill, kept them in pigpens, put them under the control of servants, or deserted them to the streets for a lifetime of begging. Stigma attached to mental illness was (and still is) very strong in countries that put an emphasis on family honor. Mentally ill were left to wander the streets if they were peaceful; if not, they were thrown in jail (sometimes for life). Particularly in Europe, beatings were administered as punishment for their behavior and as a means of “teaching” individuals out of their illness; others were flogged out of town.

Mentally ill given to Clergy

900 - 1400

Options instead of family care included lodging mentally ill into workhouses or checking them into general hospitals, where they were then abandoned. The clergy played a significant role, and often delivered better quality, more humane care. However, the mentally ill population soon grew too large for the clergy to handle.

Asylums open in Europe

1406 - 1550

Mentally ill population grew too large for clergy to treat, so asylums were born! The first asylum is thought to be the Valencia mental hospital in Spain, established around 1406 CE. St. Mary of Bethlehem (later nicknamed Bedlam) opened doors in 1547. Treatment was notoriously horrible, though much treatment for asylums were famous for terrible living conditions and cruel abuse at the hands of undertrained, underequipped staff.
Asylums of the time were more like prison than an institute aimed at recovery. The main goal of such institutes was to take the burden of mentally ill off of the family’s hands.

Early Asylum Treatment

1406 - 1750

When staff did try to cure patients, methods typical of the time were used; purging, bloodletting, dousing the patient in hot or ice-cold water, blistering, physical restraints, threats, and other forms of intimidation were used as well as the “gyrating chair” which mainly resulted in unconsciousness. Powerful drugs were administered for sedation- this was usually for the ease of the staff, rather than the comfort of the patient.

Religious treatment

1500 - 1650

o Treatments were offered by physicians, and commonly included large religious influence and little actual medicine. Exorcisms, prayers, charms, and amulets were available.
Astral talismans were easily made using brass or tin emblems with astrological signs etched into them and cast at astrologically significant times. These were worn around the neck of the afflicted while they recited; also used were scraps of Latin liturgy wrapped in paper, bundled with a leaf of mugwort or St. John’s Wort and tied with taffeta. Amulets were also used, supplemented by prayers and charms, to soothe troubled minds, prevent mystical infection, and protect against witches and evil spirits.

Mesmerism emerges

1774 - 1779

Mesmerism was an early form of psychoanalysis. Created in late 1700s, Mesmerism included gathering mentally ill around a tub of various chemicals. Mesmer believed in “animal magnetism” and that by affixing iron rods to different parts of the body, magnetic forces would move fluids around the body and cure the afflicted.

Asylum Improvements

1792 - 1825

Mental patients were given better facilities, with access to sanitation, fresh air, sunny rooms, and were treated with kindness and consideration in France and England. In the early 1800s, the same ideas spread to America. Patients were treated with kindness and consideration, and were encouraged to go outside and engage in manual labor and spiritual discussion. Treatment was focused on moral management, specifically on the patient’s social, individual, and occupational needs.

Mental Hygiene Movement

1839 - 1900

Dix's efforts also created the Mental Hygiene movement. Patients were treated based on physical needs only- mental disturbances ignored. Later, patients treated using only medicine. Either way, the Moral Management movement had ended.

Dorothea Dix improves asylums

1839 - 1881

Dorothea Dix fundraised for better asylums in US and in Europe. New asylums were built and more money was given to existing ones. However, this was still not enough to dramatically improve the lives of the mentally ill.

Cut Funding to Asylums

1913 - 1945

During wars, funding to asylums was cut and more care and attention were dedicated to soldiers. During wartime, many patients starved to death

Somatic Treatments

1933 - 1950

EPtients were treated using somatic treatments such as electroconvulsive shock therapy, psychosurgery (such as lobotomies), and psychopharmacology.

Mandatory sterilization of mentally ill

1939 - 1945

Several countries started sterilization and euthanasia programs (though euthanasia was mainly in Nazi Germany).

Psychoactive Drugs introduced

1949 - 1959

Psychopharmacology really took off in the 1950s after the discovery of Chlorpromazine in France.

Anti-Asylum Movement

1960 - 1980

Accounts of asylum abuse and the discovery of psychoactive drugs led to massive deinstitutionalization movement, especially in US. It was believed that drugs would be the cure-all, end-all, which led to immense numbers of mentally ill being discharged from mental hospitals, often without support systems.

Cognitive Behavioral Therapy Begins

1960 - 1970

Cognitive behavioral therapy begins in the US during the 60s. It was believed that discharged mental patients could seek care within their community, as well as taking medication. Cognitive behavioral therapy has been shown to be highly effective for treating several different kinds of mental illness, but after the antipsychiatry movement, the infrastructure was not equipped to handle all patients needing care.

SSRI antidepressants introduced

1990 - 2000

SSRI antidepressants are introduced in the 90s and quickly become some of the most prescribed drugs globally.

Current Care for Mental illnesses

1990 - 2013

Current care for mental illnesses in most developed countries often includes a combination of therapy and medication. In countries where having a mental illness is shameful, affected are mostly treated using medication, sometimes self-administered, because it is easier to hide it from family and friends. In countries where supernatural beliefs about mental illnesses persist, individuals seek out traditional healers before finding professional medical help.