History of mental health

Even in developed countries, mental health has not always been seen as such. It does have a journey, a transformation, and advocacy for its current state. Mental illnesses have a long nasty past and continue so today through stigmatization and prejudices.

Since the ancient period, there have been three main notions on the causes of mental illness: supernatural, somatic, and psychogenic. For the supernatural,  It was claimed that demonic or bad spirits are to blame for mental conditions, as well as gods’ displeasure and the gravitational pull of the Earth. An example of a supernatural explanation for mental illness is the trephination procedure.  Prehistoric people drilled holes in the skulls of people suffering from mental disorders to heal head injuries and epilepsy, as well as to let evil spirits trapped in the head be expelled from the skull. [1] As early as 2700 B.C.E., the Chinese idea of “yin and yang,” or the balance of opposing positive and negative physiological forces, was used to explain mental (and physical) sickness. Somatogenic theories classify physical dysfunctions as a result of sickness, hereditary inheritance, or brain injury or imbalance. Traumatic or stressful experiences, maladaptive learned associations, and cognitions, or distorted perceptions are the focus of psychogenic theories of mental illness.

When it came to mental health conditions, Greek doctors didn’t believe in supernatural explanations. Hippocrates (460–370 BC) endeavored to detach superstition and religion from medicine by establishing the concept that one of the four basic physiological fluids(humors) such as blood, black bile, yellow bile, and phlegm to be responsible for the causation of illness whether physical or mental.  He did not believe that mental illness was shameful or that people suffering from it should be penalized for their actions. Hippocrates divided mental illness into four categories: epilepsy, manic, melancholy, and brain fever.

According to Greek philosopher Plato (429-347 BCE), he believed that community and families should care for the mentally ill humanely using reasoned conversations because of the important role that early learning and social environment play a role in the development of mental problems. Also,  Galen (A.D. 129-199), a Greek physician, stated that mental diseases were caused by physical or mental factors such as fear, shock, intoxication, head traumas, puberty, and shifts in menstruation cycles.[2]

Instead of accepting Hippocrates’ theory of four humors, philosopher Cicero and physician Asclepiades (c. 124-40 BC) in Rome said that melancholy is not caused by excess black bile but rather by feelings of sadness, dread, and fury. Roman doctors used massages and warm baths to cure mental disorders.  When it comes to physical and mental health, they embraced the concept of “contrariis contrarius,” which means opposite by opposite, and used contrasting stimuli to achieve a state of equilibrium.

Economic and political turbulence endangered the Roman Catholic Church’s dominance in the late Middle Ages, which resulted in the rise of the Church and the demise of the Roman Empire. Between the 11th and 15th centuries, mental disorders were once again described as devil possession, and procedures like exorcisms, flogging, prayer, touching relics, chanting, attending religious sites, and holy water were employed to cleanse the individual of the Devil’s control. At this moment, supernatural conceptions of mental illness dominated Europe, bolstered by natural disasters such as plagues and famines. The afflicted were jailed, beaten, and even executed in extreme situations.

Women, particularly those with mental health issues, began to be viewed as witches in the 13th century. The Malleus Maleficarum (1486) was written by two Dominican monks during the peak of the witch trials during the 15th through 17th centuries when the Protestant Reformation had thrown Europe into religious conflict. However, both Reginald Scot’s and Johann Weyer’s writings were condemned by the church’s Inquisition— their writings claimed that mental sickness was not a result of demonic possession, but rather a result of a malfunctioning metabolism and disease. Only in the 1700s and 1800s did witch-hunting begin to wane, after more than one hundred thousand people were accused of being witches and burned to death. [3][4]

Protests against the living conditions of the mentally ill began in the 18th century and during the periods of 1800s and 1900s, a more humane perspective on mental disease emerged. While working at the St. Boniface Hospital in Florence, Vincenzo Chiarughi (1759–1820), an Italian physician and educator, dismantled the chains that bound people there in 1785. Patients were freed from their chains, moved to rooms that were well-ventilated and well-lit, and encouraged to engage in purposeful activity on the grounds of La Bicêtre and the Salpêtrière in 1793 and 1795, respectively, by French physician Philippe Pinel (1745–1826) and former patient Jean-Baptiste Pussin. [5]

Humanitarian changes began in England as a result of religious concerns. William Tuke (1732–1822) pushed the Yorkshire Society to build a retreat in 1796, where patients were treated as guests, not as captives. The standard of treatment was based on dignity and kindness in addition to the therapies and moral value of physical labor. [6]

While in America, Benjamin Rush (1745-1813), the pioneer of American psychiatry, pushed humane treatment for the mentally ill. His profession featured therapies like blood-letting and purgatives, the design of a “tranquilizing chair,” and a strong belief in astrology, which shows that he couldn’t escape the beliefs of his day. Dorothea Dix (1802-1887), a retired teacher worked tirelessly to change the public’s attitude toward persons with mental disorders and to establish institutions where they may get humane treatment. She was the driving force behind the mental hygiene movement, which aimed to improve patients’ physical health as well. She was a proponent of the creation of public hospitals. She aided in the establishment of around Thirty mental facilities in the United States and Canada between 1840 and 1880. [7] In Massachusetts and New York, the first asylums were erected in the 1830s. By 1860, twenty-eight of thirty-three states had established mental institutions (Braslow 1997). People with mental illnesses were able to heal from their illnesses because of moral therapy movements in both the United States and Europe.

However, a large number of academics strongly opposed mental health facilities. This “tale of noble intentions gone wrong” is what Shorter calls the rise of American asylums (Shorter 1997, 33). Asylums were built in the nineteenth century on the premise of “moral therapy,” a theory that maintained that meticulously structured institutions might provide a haven from the chaos of regular life. The mentally ill can gradually adjust to and eventually adopt a sense of normalcy in an orderly setting that encourages regular social interaction, work, and recreation. [8]

Due to a deterioration in morality in the late 19th-century moral treatment approaches led to two rival perspectives – biological or somatogenic and psychogenic or psychology by the 20th century. The biological approach is challenged by the psychological or psychogenic perspective, which asserts that emotional or psychological variables have a role in the development of mental diseases. Emil Kraepelin (1856-1926), a German psychiatrist, noticed that symptoms appeared in clusters, which he referred to as syndromes. These syndromes were distinct mental disorders, each with a distinct cause, course, and outcome. When he released Compendium der Psychiatrie in 1883, he laid the groundwork for the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently in its 5th edition, which is based on his classification system for mental disorders (published in 2013). Clinicians and psychiatrists now use the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) to diagnose psychiatric conditions.

Despite this, not all countries adhere to the latest standards. Many cultures, particularly developing countries, continue to believe brain disorders in the context of metaphysical affiliations, exorcisms, taboos, bad luck to the family, et cetera. Psychological illness is often misunderstood by the general public, which leads to stigmatization and dehumanization of those who are afflicted. To this day so many people are homeless and are left on the streets, where they are mocked, beaten, harassed, jailed, and so on. These countries have very few if any, facilities or resources for mental health care. Many people are stuck in limbo in a state of ignorance, unsure of what might be wrong. People suffering from mental illnesses are dying at an alarming rate, yet they can be saved. Developing countries have an urgent need for education and advocacy for mental health.

References

[1] Restak, R. (2000). Mysteries of the mind. Washington, DC: National Geographic Society.

[2] “1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology.” 1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology, Opentext.wsu.edu, 5 January. 2018, https://opentext.wsu.edu/abnormalpsychology/chapter/1-4-the-history-of-mental-illness/.

[3] Schoeneman, T. J. (1977). The role of mental illness in the European witch hunts of the sixteenth and seventeenth centuries: An assessment. Journal of the History of the Behavioral Sciences, 13(4), 337–351.

[4] Zilboorg, G., & Henry, G. W. (1941). A history of medical psychology. New York: W. W. Norton

[5] Micale, M. S. (1985). The Salpêtrière in the age of Charcot: An institutional perspective on medical history in the late nineteenth century. Journal of Contemporary History, 20, 703–731.

[6] Bell, L. V. (1980). Treating the mentally ill: From colonial times to the present. New York: Praeger.

[7] Viney, W., & Zorich, S. (1982). Contributions to the history of psychology: XXIX. Dorothea Dix and the history of psychology. Psychological Reports, 50, 211–218.

[8] Melissa Schrift, et al. “Mental Illness, Institutionalization and Oral History in Appalachia: Voices of Psychiatric Attendants.” Journal of Appalachian Studies, vol. 19, no. 1/2, Apr. 2013, pp. 82–107. 

Farreras, Ingrid G.. “History Of Mental Illness | Noba.” Noba, Nobaproject.com, https://nobaproject.com/modules/history-of-mental-illness.

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