The History of the Treatment of Mental Illness

Credit to flickr.com user Digital Collections, UIC Library. Used with permission under a Creative Commons license.

Skull drills. Exorcisms. Isolation. Lobotomies. “Happy pills.” These are all treatments which have been applied–often forcibly–to people who suffer from mental illness.

 

The first apparent “cure” for mental illness was trephining (also referred to as trepanning). People in Neolithic times would chip holes–or trephines–in each others’ skulls with stone pieces, which was thought to release evil spirits from the head. This also happened to release pressure from brain inflammation. Some people actually survived this practice, as there have been skulls found with holes in them that showed signs of healing. This practice lasted for centuries, with more sophisticated equipment being invented, such as skull saws and drills.

To ancient peoples such as the Hebrews and the Persians, mental illnesses were attributed to supernatural forces, like demons and upset deities. Practices such as exorcisms and prayer were common in the ancient world. Egyptians appeared to be the most advanced civilization when it came to treatment of mental illnesses, recommending activities such as painting and attending concerts.

The Greek physician Hippocrates introduced the four humors–blood, bile, phlegm, and black bile–theory, which said that the combination of these fluids made up personalities. In the Middle Ages, mental illness was said to stem from an imbalance of the four humors. To bring the body back into balance, vomiting was induced, people were given laxatives, and leeches were applied. Sufferers of mental illness were also told to avoid red meat and wines. Beatings were also routinely applied to the mentally ill.

The first mental hospital was established in 792 AD, in Baghdad, followed by those in Aleppo and Damascus. However, at this time, the mentally ill were left to be cared by their families, and were often subject to abuse, concealment, or abandonment. Clergy-run facilities were soon established, which promised humane care. However, these could not handle the treatment of the entire population of the mentally ill.

Asylums were the next step, set up worldwide around the 1500s. The first in Europe is thought to be the Valencia mental hospital in Spain, 1406 AD, and though not much is known about this particular asylum, many treated their patients deplorably. Asylums, up until the mid-1800s, were places where the mentally ill slept shackled to the walls in their own waste. “Cures” ranged from bloodletting to dousing in hot and cold water to shock the system back to rationality. Physical restraints, threats, and straightjackets were common, implemented to get the sufferer to “choose” sanity. In Saint Mary of Bethlehem asylum in London, visitors could pay a penny to see violent patients in a freak show.

This all changed, starting in 1792 with a man named Philippe Pinel, in Paris. He took over La Bicentre asylum to test his hypothesis that compassion would cure the mentally ill. Patients were unchained and given clean, sunny rooms, and were no longer treated like animals. This humanitarian approach spread, kicking off a brief period of “moral management,” where patients were encouraged to perform manual labor and make moral choices.

Medical advances ended moral management. By 1939, Sigmund Freud had published twenty-four volumes of work in psychoanalysis, changing the world forever.  Freud tried hypnosis, free association, and dream interpretation. Although Freud’s work provoked criticism, psychoanalysis was popular until the mid-1900s.

During this time, psychopharmacology, surgeries, and electro-convulsive shock therapy (ECT) were common. The latter treatment was used to abuse patients in some mental hospitals, however. Because ECT is scary, patients were frequently intimidated and threatened with the practice. Some people were shocked over a hundred times. However, with reforms, this practice is still used today.

Egas Moniz performed the first lobotomy in 1935, first shocking the patient into a coma, and then hammering an instrument similar to an icepick through the top of each eye socket. This practice severs the emotional centers of the brain from the frontal lobes, producing a calm and immature patient that is unable to control their impulses or feel anything. Lobotomies were cheap, easy, and popular around the world for twenty years–until doctors started noticing the undesirable side effects.

With the introduction of the psychotropic drug Lithium in 1949, Australian psychiatrist J.F.J. Cade kicked off a wave of successful anti-psychotic medicines which effectively managed symptoms. Unfortunately, this also kicked off a wave of deinstitutionalization in the 1960s, as mental illnesses were thought to be managed entirely by medication. Thousands of the mentally ill discharged from mental wards ended up homeless. In the 1980s, over a third of all homeless individuals were severely mentally ill in America. Over 100,000 individuals who suffered from severe mental illness were imprisoned, and over a fourth of that population were held without charges as they waited for beds at one of the nation’s sole remaining mental hospitals.

Despite advancements made in therapies, many mentally ill people rely solely on psychotropic medications to avoid the shame of stigma. Mental health care is grossly underfunded in many countries around the world even today, and is widely stigmatized. The treatment of mental illness has come a long way, but we still have so much further to g

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