Evolution of Mental Illness

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

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.

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

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.

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.

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.

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.

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 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.

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.

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.

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.

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

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

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

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

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 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.

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.

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