Models of Mental Illness in the Twentieth Century

Another treatment for mental illness was to induce seizures using a simulant called Metrazol. The drug was injected, leading to a rapid seizure onset that was often severe enough to break the patient’s bones. This was used in the middle of the twentieth century but was banned in 1982 because it was both dangerous and not helpful to the patient. This was a precursor therapy to electroconvulsive treatments still used today to treat refractory depression.

The frontal lobotomy was a common treatment for mental illness in the 1940s and 1950s. The goal was to break up brain pathways leading to mental illness. While these were used often, they were always controversial and were only used in severe cases. The prefrontal lobe was essentially separated from the rest of the brain in a procedure that took just minutes to do. The side effects were huge and debilitating so it was discontinued onc medical therapy was developed in its place.

As for talk therapy, psychoanalysis became prominent at the start of the twentieth century. This was the beginning of a vast movement that has expanded to involve 400 different types of psychotherapy in use since then. As you will learn later, there are multiple different approaches that focus on things like cognition, behaviors, psychodynamic issues, and family systems approaches that help to provide a wide range of therapeutic options for every type of mental illness and personality type. Most approaches will work to some degree so you can expect treatment to be successful even if the approach is different.

The first medical treatment for psychiatric diseases was developed in the middle of the twentieth century. There are now a number of psychotropic medications used today to manage diseases as diverse as psychosis, bipolar disorder, major depression, and substance use disorders. There were other treatments used through the 1970s that are now not used much at all because psychotropic medication is so successful in many cases.

MODELS OF MENTAL ILLNESS IN THE TWENTIETH CENTURY

Some things that came out of twentieth century thoughts on mental illness were those that dealt with mental hygiene and mental health rather than mental illness. The

movement began in 1908 when it was first written about and proposed. The concept of humanization of the care of the mentally ill was also proposed in order to reduce the brutality, neglect, and abuse of this population. There was an increased focus on prevention of mental illness with the belief that this started in early life. There was also an increased emphasis on community mental wellness rather than on wellness in one person.

The World Health Organization has always had a part of it that has been focused on mental health of the world’s population. The organization has recognized the value of health as being wellness of one’s social, mental, and physical states rather than value based on a lack of disease.

An additional advancement came with the development of the International Congress of Mental Health in 1948. Out of this came recommendations on issues related to mental health. There was a shift in the terms “mental hygiene” to the terms “mental health”. Mental health was defined as a state where a person has optimal development in the areas of emotions, cognition, and physical states of being. There were four levels of treatment, including custodial treatment, therapeutic treatment, preventative management, and positive management.

As mentioned, the twentieth century was when psychanalysis became popular as a treatment for mental disorders. There was also differentiation between things like mood disorders and psychotic disorders. Asylums were still in existence in the beginning of the century but the term “inmates” was replaced with “patients”. The term “mental illness” became preferred over other labels for mental disorders. Trauma as a cause of mental illness was uncovered when World War I vets developed what was then called “shell shock”.

In World War II and during the time of Nazism in Germany, there was massive sterilization of the mentally ill and euthanasia of these individuals, with about 200,000 being exterminated in the war. Psychiatrists of the time were complicit in these atrocities, deeming these people undesirable along with others, such as homosexuals. Funding in other parts of the world were cut for the care of the mentally ill, although veterans with mental illness were treated better. Mental disorders became classified in

documents like the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Mental Diseases put out by the WHO.

Psychiatrists during the twentieth century became less focused on institutional care and more on individual outpatient care, starting at 8 percent of psychiatrists in 1917 and ending with 66 percent of psychiatrists in 1970. Stress as a term relating to mental illness was first coined in the 1930s. While electroconvulsive therapy, lobotomies, and insulin shock therapy were popular in the middle of the century, so was the use of psychotropic drugs. Deinstitutionalization started in the 1960s, which left many without adequate treatment if there were no community resources available.

Lithium was the first psychotropic drug developed for the long-term treatment of mental illness. This was followed by antipsychotics, barbiturates, benzodiazepines, tricyclic antidepressants, and SSRI antidepressants, among others. Now, just about any mental disorder can be treated with a psychotropic drug.

Sigmund Freud first introduced psychoanalysis in 1896. He also focused on the interpretation of dreams. Others developed their own psychanalytic approach that was built on Freud’s initial work. Freud’s work focused on the subconscious as well as on dreamwork as a way to understand mental illness and its recovery. Most of his work was on case studies rather than on extensive evidence-based practices so his work has largely been in question ever since. Still, he attempted to explain things like hysteria in ways that could be helpful to people. Freud’s work was based on sexually motivated subconscious wishes and dreams but this has largely been discounted since. He did, however, indicate that some of his female patients had symptoms based on sexual abuse in the past but he himself came to disbelieve these memories were true.

By 1905, Freud laid out five psychosexual phases, which were the oral, anal, phallic, latency, and genital phases. He had the idea that people got stuck in one of these stages and used hypnotism and other practices to help improve the patient’s symptoms. He addressed self-destructive behaviors but called it self-masochism. He later expanded his beliefs beyond sexual issues in mental illness to the concepts of self-identification and identification within a group. Finally, he developed the concepts of the ego, superego,

and id. The Oedipus complex was felt to be the center of many neurotic illnesses, among other things.

Freud moved to London in the pre-World War II years as Nazism rose in Europe. He died shortly thereafter but there were other psychoanalysts who took his placed and developed their own ideas, such as attending defense mechanisms rather than exploring the subconscious. Child psychoanalysis became more commonplace. There are still about thirty-five institutes in the US that train doctors and psychologists in psychoanalysis.

The twentieth century became the time when things like electroshock therapy were developed. This and other methods of treatment, like drugs and psychosurgery, were based on a biological approach to mental illness. The belief that people had mental illness because of biochemical imbalances became more prominent but it was more plausible than the four humors ideas of mental illness.

Electroshock therapy was first done in Europe and was found to be helpful but dangerous because of so many side effects and the fear people had around having this type of treatment. Some patients who would not cooperate with other therapies were threatened with electroshock therapy. This type of treatment was modified over time to involve general anesthesia as part of what helped make it more palatable so it is more commonly used now for the management of severe depression.

Psychosurgery was first developed in the 1930s and was initially quite crude, with doctors using an ice pick-like device to cut the nerves connecting the frontal lobes to other brain centers related to emotions. The goal was to calm patients with bipolar disorder, schizophrenia, and hysteria. Again, it was only used in serious patients and was still very controversial. Frontal lobotomies left patients lethargic and unable to control their emotions.

Eventually, lobotomies gave way to psychopharmacology or to the use of drugs to manage psychiatric diseases. While drugs like barbiturates were used as early as the late 1800s, these were short-term treatments. Lithium was the first long-term treatment for mental illnesses, first used in 1949. Antipsychotics were used shortly thereafter and