A Step In Time

Following on from my last post, I thought it would be a good idea to do some research into the treatment of mentally ill patients in the past. Why? Well history teaches us many things and a lesson or two from the past never did anyone any wrong!

The famous Greek physician Hippocrates first began treating mental health disorders as diseases with a physiological basis in 400 B.C. Up until this point, mental illness was thought to be an affliction resulting from displeasure of the gods or even evidence of demonic possession. Hipprocates' new perspective on mental illness led the way for later Greek medical writers who would begin prescribing treatments such as quiet time, occupation and even the use of drugs such as the purgative hellebore. In Ancient times such as these, family members were responsible for taking care of the mentally disturbed.

The fall of the Roman Empire led to the displacement of the rational view of mental illness with that of religous demonology. During the Middle Ages the abnormal behaviour of mentally ill people was attributed to supernatural forces and as such, exorcism was used as a treatment to drive out the evil inside. This pattern of thinking prevailed into the 15th and 16th centuries where madness, and any other unusual behaviour such as delusions and hallucinations, were considered evidence of demonic possession and witchcraft. In the 1600s the isolation of mentally ill patients in Europe began to increase, as did their mistreatment, with the insane often being chained to walls and left in dungeons. ​

At the end of the 18th century reforms advocating the more humane treatment of mentally ill patients began taking place. Phillipe Pinel was one such reformer who forbade the use of shackles and chains as restraints and ordered a change in the environment for patients. He made efforts to ensure patients were not confined within the dreary walls of the hospital. Instead the introduction of more pleasant surroundings such as sunny rooms and the freedom to have time outside would provide some solace to the mentally ill. In the 1840s the American Dorothea Dix continued to advocate for improved living conditions for patients. After thirty years of lobbying, the United State Congress finally agreed to fund the construction of thirty-two state psychiatric facilities. Unfortunately this was not to end the mistreatment of the insane, as State mental hospitals became increasingly over-crowded and custodial care began to supersede humane treatment.

In an undercover report from the inside, Elizabeth Cochrane, better known by her pen name as 'Nellie Bly', brought to light the harrowing conditions of mental institutions in America. It was 1887 and after feigning insanity and being admitted to the Women's Lunatic Asylum on Blackwell's Island, Bly was able to experience first-hand the mistreatment, brutality and negligence faced by patients. According to Bly they were given spoiled beef, bread that was no more than dried dough and dirty undrinkable water to drink and eat. Waste was left all around the eating places, dangerous patients were tied together with ropes and rats crawled everywhere. Worse still, Bly, having talked to her fellow patients became convinced that some were just as sane as she was. Her subsequent report in The World newspaper, later published in book form as 'Ten Days in a Mad-House', resulted in a grand jury launching an investigation into the mistreatment of patients and the terrible conditions of the asylum. This eventuated in a substantial increase in the budget of the Department of Public Charities and Corrections, and more rigorous examinations in the future to ensure only the seriously ill were admitted to asylums. ​

In the early 1900s the primary treatment of neurotic mental disorders was that of psychoanalytical therapies. These 'talking cures' were developed by people such as Sigmund Freud and Carl Jung. Drugs, electro-convulsive therapy, surgery, insulin-induced comas and even malarial infections were also used to treat those with schizophrenia and other persistent mental illnesses during the 1930s. The removal of certain parts of the brain surgically, in an operation known as lobotomy, was common place and would be performed widely over the next two decades.

In 1948 the Australian psychiatrist John Cade discovered the effects of lithium carbonate as a mood stabiliser in the treatment of bipolar disorder. This was the first effective medication available to treat mental illness. Fast forward to the 1990s and a new generation of anti-psychotics were introduced. A new era had begun.

The history of mental illness is mostly a dark one. For centuries the mentally ill have fallen prey to those in positions of authority and power and the seemingly enlightened. Yet it is also filled with stories of compassion and courage. Those who dared to advocate for the rights of the mentally ill in the past are the reason we have improved our understanding and treatment of the mentally ill today. For that, we should be grateful.

References

Petersen CA. A historical look at psychology and the scientist-practitioner model. Am Behav Sci [Internet]. 2007 [cited 2016 Jan 28];50(6):758-65. Available from: ProQuest

Ward C. Spirit possession and mental health: a psycho-anthropological perspective. Human Relations [Internet]. 1980 [cited 2016 Jan 28];33(3):149-63. Available from: SagePub

Roberts AR, Kurtz L. Historical perspectives on the care and treatment of the mentally ill. J Soc & Soc Welf [Internet]. 1987 [cited 2016 Jan 28];14(4):75. Available from: PubMed

Lutes JM. Into the Madhouse with Nellie Bly: Girl Stunt Reporting in Late Nineteenth-Century America. American Quarterly [Internet]. 2002 [cited 2016 Jan 28];54(2):217-53. Available from PubMed

Shorter E, Healy D. Shock therapy: a history of electroconvulsive treatment in mental illness. Rutgers University Press; 2013

Kucharski A. History of frontal lobotomy in the United States, 1935-1955. Neurosurgery [Internet]. 1984 [cited 2016 Jan 28];14(6):765-72. Available from: PubMed

Baraban JM. Toward a crystal-clear view of lithium's site of action. Proc Nat Acad Sci U S A [Internet]. 1994 [cited 2016 Jan 28];91(13):5738. Available from: PubMed

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