A Short History of Mental Illness Treatment
The Virtual Psychology Classroom notes that, as late as the 17th century, treatment for those "under the devil’s control" was worse than the ailment: “… many individuals suffering from mental illness were tortured in an attempt to drive out the demon.” When this didn’t work, and of course it usually didn’t, the victim was thought to be eternally possessed and in need of execution. Death provided a permanent release from mental torment.
First Asylums Opened
By the 18th century, a slightly more enlightened attitude began to take hold. The idea that someone’s mind was under the control of a fiendish spirit faded.
Sufferers were put into lunatic asylums, as they were called. They could be grim places, and those inside were treated more as prisoners than patients.
Although it was now recognized that diseases of the mind could not be driven out with a sound whipping there wasn’t much that medicine could do to lessen the suffering. Inmates were mostly just warehoused to keep them away from the general population.
Bethlem Royal Hospital
One famous (although infamous is a more accurate description) insane asylum was the Bethlem Royal Hospital in London, England.
(It became known as Bedlam, and the word “bedlam” passed into the English language to describe any out-of-control situation).
Bethlem was Europe’s first mental hospital. It opened in 1247 as a shelter for the homeless. Over the centuries, it moved location several times and started to take in mental patients. Many of these poor wretches simply lay shackled in their own filth.
Various potions were tried as treatments along with blood letting and forced vomiting. Hot and cold baths were also administered, which did little in the way of curing insanity but at least gave inmates a chance to clean up a bit.
Meanwhile, members of the general public were charged admission to visit the mad house, as though the patients were exhibits in a zoo, which, of course, they were.
Word spread about conditions inside Bethlem and a committee, under Member of Parliament Edward Wakefield, visited the place and exposed the horrors going on behind its walls. His 1815 report caused a public outrage.
Mr. Wakefield and his colleagues wrote: “One of the side rooms contained about ten [female] patients, each chained by one arm to the wall; the chain allowing them merely to stand up by the bench or form fixed to the wall, or sit down on it. The nakedness of each patient was covered by a blanket only ... Many other unfortunate women were locked up in their cells, naked and chained on straw ... In the men’s wing, in the side room, six patients were chained close to the wall by the right arm as well as by the right leg ... Their nakedness and their mode of confinement gave the room the complete appearance of a dog kennel.”
But, it was plight of one James Norris that caused the biggest ruckus. Thrown into Bethlem for some unnamed insanity he had endured ten years of solitary confinement, his upper body held in a metal cage that was chained to a post.
Parliament enacted laws that attempted to provide more humane treatment for asylum inmates.
Reform of Insane Asylums
Elsewhere, activists were trying to improve conditions in mental hospitals. An early reformer was the French physician Phillippe Pinel, who some have described as the father of modern psychiatry.
At the start of the 19th century, Dr. Pinel took over the Bicêtre insane asylum. A Public Broadcasting Service (PBS) timeline notes that he ended the use of chains and shackles and brought patients out of dungeons and gave them fresh air and sunny rooms.
Reform in the United States
In 1841, Dorothea Dix accepted a teaching job at a correctional institute in Massachusetts. What she found there horrified her. No matter their age or sex, the mentally ill were locked up with criminals. The Encyclopedia Britannica adds “They were left unclothed, in darkness, without heat or sanitary facilities; some were chained to the walls and flogged.”
Over the next 40 years, she pushed for humane treatment of people with mental disorders within properly operated hospitals. She established 32 mental hospitals in the United States and Canada and took her campaign for reform to Europe.
Treatment of Psychiatric Disorders
In the late 19th and early 20th centuries three men of German extraction started the scientific research into psychiatric disorders. German Emil Kraepelin (1856-1926), Austrian Sigmund Freud (1856-1939), and Switzerland’s Carl Jung (1875-1961) classified mental disorders and identified their biological and genetic origins.
They also developed treatments involving talk therapy in which patients explore their mental health with the guidance of a psychoanalyst; they are then given strategies for coping with the negative aspects of their condition.
But, in the early days of psychiatry, treatment options were limited. In an effort to help the afflicted, therapists tried approaches that today might seem a little barbaric.
Deep sleep therapy involved knocking the patient out with narcotics and keeping them in a drug-induced coma for weeks or months. Another approach was to inject patients on a daily basis with doses of insulin to put them to sleep for long periods.
While unconscious, patients were subjected to electric-shock therapy and were injected with a variety of drugs that were believed to cure mental illness.
Deep sleep therapy came into use in 1920 and continued for four or five decades. But the treatment involved a high death rate among patients and has been abandoned. It also became associated with Central Intelligence Agency efforts at mind control and brainwashing.
By the mid-1930s, other experiments in treating mental distress were being tried. The prefrontal lobotomy came into use in 1935.
The theory was that a lot of mental illnesses could be traced to the prefrontal cortex of the brain. This is at the front of the skull and is where personality and behaviour are controlled. The idea was to sever the connection from this area to the rest of the brain.
The first method was to drill into the skull and inject alcohol to destroy the connecting nerves. Later, a simplified but even more gruesome procedure was developed in which the nerves were cut.
Lobotomies were performed widely over the next couple of decades; 40,000 of them in the U.S. alone. Claims were made that the mental health of some patients improved after the operation. However, others experienced a dulling down of their emotions and descended into an almost vegetative state. Some died as a result of the surgery.
The procedure went into decline and disappeared. However, with the vastly improved medical techniques now available some researchers believe that surgery on brain tissue can improve psychiatric disorders.
Electro-convulsive shock therapy (ECT) was first developed in 1938 and it remains in use today as a treatment for people with severe depression. The Mayo Clinic describes how “electric currents are passed through the brain, intentionally triggering a brief seizure” while the patient is under a general anaesthetic.
In the early days, ECT developed a bad reputation because of the high doses of electricity that were delivered without anaesthetic. Patients suffered broken bones because of the convulsions and many had memory loss along with other serious side effects.
Now used sparingly, the Mayo Clinic says that by changing brain chemistry “It often works when other treatments are unsuccessful.”
Following the Second World War, drugs started to appear that were able to help many people with psychological disorders.
In 1948, lithium was introduced to treat psychosis in which people lose touch with reality. The drug has a calming effect and has since been used to treat many conditions including bipolar disorder.
A few years later, another class of drugs, chlorpromazine (Thorazine), was developed in France. PBS notes that “Studies show that 70 percent of patients with schizophrenia clearly improve …” on these types of medications.
In the mid-1950s, behaviour therapy was developed to help people with phobias. Sufferers can be slowly guided into facing and conquering their fears. They are gradually introduced to whatever causes their panic attacks in a carefully controlled setting.
They are taught relaxation exercises at the same time. Patients become desensitized to whatever they feared – flying, water, thunderstorms – and are able to face them without anxiety.
A better understanding of brain chemistry led to the development of pharmaceuticals that could correct malfunctions. A large class of anti-depressants, called selective serotonin reuptake inhibitors has brought relief to millions of people.
Anti-anxiety drugs and mood stabilizers have joined the list of pharmaceuticals that are now used widely to improve mental health.
However, as with all medications, there are side effects that can range from mild to severe. But even powerful side effects are preferable to torture and execution.
The publicity surrounding the pitiful case of James Norris brought about his release from restraints in 1814, although he was still confined inside Bethlem. However, he was so weakened by his years of mistreatment that he died within a few weeks.
All over the Western world, mental institutions have been closed in favour of “treatment in the community” or some other euphemism for cost-cutting that governments can dream up. The experience in the United States is typical. Many mentally ill people are still institutionalized, but now they are in prisons not hospitals. As Mother Jones reports “Studies suggest approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people.”
- “Introduction and History of Mental Illness.” The Virtual Psychology Classroom, undated.
- “Timeline: Treatments for Mental Illness.” PBS, American Experience, undated.
- “Dorothea Lynde Dix.” Encyclopedia Britannica, undated.
- “Electroconvulsive Therapy.” Mayo Clinic Staff, undated
- “TIMELINE: Deinstitutionalization And Its Consequences” Deanna Pan, Mother Jones, April 29, 2013.