Evolution of Mental Health Treatment Throughout History

The 1800s brought the first use of the term “psychiatry” and some early attempts at classifying the different psychiatric and mental disorders were made. Psychiatrists were called alienists because they often dealt with people most alienated from society in general. Most psychiatrists were managers who just dealt with the day to day management of people with psychiatric conditions. Asylums were places of abuse and neglect rather than therapeutic places for healing. There were ex-patient advocates who felt that the care of the mentally ill should be more humane.

The three main paradigms seen in the history of mental illness were psychogenic, somatogenic, and supernatural. Those who believed in supernatural causes thought that eclipses, demonic spirits, the displeasure of the gods, sin, and curses were to blame for these disorders. Those who inclined toward a somatogenic cause though that there might be genetic or physical causes or that brain damage or chemical imbalances caused mental illness. Psychogenic causes included maladaptive thoughts, trauma, or stress were responsible.

EVOLUTION OF MENTAL HEALTH TREATMENT THROUGHOUT

HISTORY

The treatment strategies used for mental illness varied according to the differing beliefs that have existed throughout history as to the causation of these diseases. When in ancient times it was mostly believed that the causes of mental illness were supernatural, the treatments were often related to that idea. Trephination has been used since at least 5000 BCE, presumably for the management of mental illness. By having a medicine man or the equivalent bore a hole into the skull, it was thought that evil spirits could have a route of escape from the head in order to cure them. Some people survived the treatment and some might have improved for other reasons, giving validity to the practice.

There were also priests who were doctors in Mesopotamia that used religious rituals and prayer along with exorcisms and other similar spiritual techniques to cure people of their mental illness. Some would punish or threaten sufferers if their original treatments were unsuccessful in changing their “patient’s” behaviors.

Ancient Egyptians were rather progressive for their time when it came to treating the mentally ill. There were Egyptian medicine men who recommended dance, music, painting, or exercise to manage mental illness. Ancient medical texts from about the sixth century BCE identified the brain as a major source of mental dysfunction.

The four humors theory of all illnesses was prominent in ancient times to the Middle Ages. Hippocrates did not at all believe in supernatural origins of mental illness and felt that these mental imbalances had some kind of natural or neurological basis. It was from Hippocrates, Socrates, and Galen that the four humors idea began. If these were not in balance, the end result was some type of illness, including mental illness. Treatments included medications to induce vomiting, purgatives to cause diarrhea, leech application, and cupping in order put the humors back in balance. Bad humors could also be drained to remove bad humors.

Throughout most of history, the sick patient’s family was responsible for caring for the mentally ill family member. The first mental hospital was built in 792 CE in Baghdad. In Europe, there was a great deal of shame about being mentally ill or having a family member who was mentally ill so families hid their sick loved one in their cellar or in cages, often abandoning them to the streets if that didn’t work. Unfortunately, the social stigma around mental illness still exists to a large degree in many parts of the world. The mentally ill brought dishonor to their family and suggested an inherited defect somewhere in the genetic tree.

The stigma was particularly prevalent in the Middle Ages in Europe, when physical punishment like beating or whipping was commonly used to curb what was believed to be undesirable or antisocial behavior on the part of the mentally ill person. Beating illness out of the person was thought to be an acceptable treatment approach to mental illness.

There were other treatments in place throughout the past few centuries—most of which did not help the patient. There were workhouses or other public institutions for poor people. Sometimes, churches housed the mentally ill, providing them with basic needs in exchange for menial labor. Occasionally, general hospitalization was provided. The

clergy were important in helping some of these people receive at least minimal treatment.

At some point, these kinds of options could not keep up with the numbers of the mentally ill so mental asylums began to proliferate. The first real psychiatric hospital in the western world was opened in Spain in 1406. There was no treatment given and conditions were largely inhumane. Abuse was rampant and patients were nothing more than mental prisoners. The main goal was the sequestering of patients from the rest of society.

Other forms of therapy in the last few centuries included hot or cold water treatments that would shock these patients, hopefully forcing them into better mental health. Mental illness was thought to be a choice so the treatment often involved physical restraints and verbal threats in order to force a cure. Strange treatments were sometimes utilized, such as gyrating chairs that would shake the patient until they were free of mental illness.

There were occasional calls for social reform, such as took place in the late 1700s in Paris, France. Theories were developed that, with care and compassion, some of the mentally ill could get better. A hospital was cleaned out and patients were offered exposure to sunshine, exercise, and fresh air as treatments for their condition. The Quaker Society in England picked up on these treatments and placed an emphasis on strict but compassionate treatment of the mentally ill.

While you would think that this kind of treatment would stick, there was a significant trend away from moral treatment in the 1800s in the US by the end of the nineteenth century. Doctors became critical of moral treatment, indicating that it didn’t really work and so asylums once more became places to just house patients who were mentally ill. Poor sanitation and overcrowding were very common.

In 1927, a novel treatment for mental illness, called an insulin coma, began and was used until the 1960s. Patients were placed into a coma using the drug insulin, with the belief that this caused fundamental changes in brain function if used for up to 4 hours. The mortality rate of the treatment was up to 10 percent, so it was largely abandoned in favor of electroshock therapy.