A Brief History of Mental Health
Historical Approach
Prior to the 1500's, what we now call mental illnesses were often considered to be the result of things such as demonic possession, evil spirits, genies, sorcery, witchcraft, an imbalance of bodily fluids, immoral behavior, a spiritual test, broken relationships with God or gods, or phases of the moon. In order to cure people of these maladies, a variety of treatments were introduced.
Some treatments included cutting holes in a person's skull to let out evil spirits, casting spells, the use of hallucinogenic substances to induce a trance-like state, the use of herbs, ointments, and potions, exorcisms, incantations, prayers, beatings, and starvation. Stoning (throwing stones at a person in an attempt to literally "knock some sense into them") and bloodletting (pulling out blood from a person either by cutting them or using leeches in an attempt to remove harmful bodily fluids) were also used.
Asylums and Deinstitutionalization
In the next three centuries, individuals with mental illness were frequently found in jail or on the streets. In the late 1600's, spiritual causes of mental illness began to take a back seat to physical causes and those with mental illness were treated like animals. They were often put in cells (or cages) within the "madhouses" or "asylums" that were now being built. Believe it or not those without mental illness would actually pay to tour the asylums, much the way that today we pay to look at animals in a zoo. Terms such as crazy, insane, and lunatic became more widely used to describe a person with a mental illness; terms that today still hold an emotional charge and are considered insensitive at best.
Asylums continued to grow and become more numerous into the 1800's. In the middle of the century, a pioneering woman by the name of Dorothea Dix began to study the treatment of people in these "insane asylums". Around 1848 after observing these harsh treatments, she began calling for reform. States began building asylums that focused more on social and physical treatment as opposed to simply locking people up and making money off of them as a form of entertainment for the community.
While in some ways things were improving, in other ways they were not. A few years later, Samuel A. Cartwright wrote a paper about what he called drapetomania. Drapetomania as he described it, was a mental illness that caused black slaves in United States to seek freedom. He considered it the fault of white landowners who were "too familiar and too friendly" with the slaves in their households. Treating slaves as near equals motivated them to desire freedom, as he put it. The US Civil War began ten years after the writing of his paper.
By the end of the Civil War the quality of care began to get worse again. Dorothea Dix moved from the United States to Europe and continued her work in England and Scotland. This followed a major defeat at the hands of then US President Franklin Pierce. The asylums became less treatment oriented and focused primarily on custodial care.
In an effort towards preventative care (to avoid further filling up the already overcrowded asylums) institutions introduced the idea of outpatient care. Now for the first time a person could see a mental health worker without actually living in an institution. This led to a movement called "deinstitutionalization" where many of the people who had been locked up and living in asylums began to be released.
Unfortunately, supportive social services did not yet exist as they do today. Those who were released were often looked down upon by society and had no help in the form of housing assistance, employment training, etc. and thus they often ended up in jails and hospitals (if family members could not or would not care for them) just as had been the case in previous generations.
As we moved into the 20th century, inmates were renamed patients and asylums were renamed hospitals. Social services and welfare services began to develop. Fields such as psychiatry and social work began to develop.
The Impact of Shell Shock
We gained a greater appreciation for the causes of some mental health disorders following World Wars I (1914-1918) and II (1939-1945), as soldiers returned home with "shell shock". Soldiers who were once healthy were coming back in droves with similar mental health issues. It was such an overwhelming and undeniable occurrence that people began to realize that the extreme conditions of war were actually the cause of these issues.
What was first called shell shock is today known as Posttraumatic Stress Disorder (or PTSD). Although this was not the first ever mental health diagnosis, the widespread occurrence of shell shock really led the way to the development of formalized and uniform diagnoses and an appreciation of the impact of an "unseen" medical condition.
As recently as the 1970's through the 1990's different psychiatric medications became available and grew tremendously popular in their usage. Professional books, manuals, and associations were also created to help explain and share information about different mental health conditions. Although they have been helpful in understanding mental health disorders, today many people question the appropriateness of mental health diagnoses and labels. Given the history over the past several hundred years, it's not difficult to see why there remains a social stigma around mental health today. Click here for more about the concerns associated with labeling.