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History of Mental Illness
and Early Treatment
in a Nutshell

 
Some four thousand years ago, the ancient Egyptians did not differentiate between mental and physical illnesses; they believed that despite their manifestations, all diseases had physical causes. They thought the heart was responsible for mental symptoms. Hippocrates and the early Greeks believed as well that all illness resulted from a biological malfunction; in the case of depression, from an excess of "black bile".

The ancients may have been off the mark as to specific causes, but their nonperjorative view of mental suffering and their search for medical causes were right on track.  Some of the earliest views of mental illness follow:

Early Egypt:   During this time period mental illness was believed to be caused by loss of status or money.  The recommended treatment was to "talk it out", and to turn to religion and faith.  Suicide was accepted at this time.

Job/Old Testament:   Despair and cognition was the accepted cause of mental illness; faith the cure.

Homer:   Homer believed that mental illness was caused by God's taking a mind away.  He offered no treatment.

Aeschylus:   Demon possession was the theory of Aeschylus to explain Mental illness ; exorcism the cure.

Socrates:   Socrates believed that mental illness was heaven-sent and not shameful in the least.  He believed it to be a blessing, and therefore no treatment was required.

Aristotle:   Melancholia was the cause of mental illness according to Aristotle, and music was the cure.

Hippocrates:   It was the belief of Hippocrates that both melancholia and natural medical causes contributed to mental illness.  He advised abstinence of various types, a natural vegetable diet and exercise as treatment.

Celsius:  Celsus believed mental illness to be a form of madness to be treated with entertaining stories, diversion and persuasion therapy.

Galen:  Psychic functions of the brain were considered by Galen to be the foremost cause of mental illness.  Treatment consisted of confrontation, humor and exercise. 

As history progressed, however, the "mind" view of mental illness came to predominate, and with it the conviction that the victim was to blame. Possession by evil spirits, moral weakness, and other such "explanations" made a stigma of mental illness and placed the responsibility for a cure on the resulting outcasts themselves. The most apparently ill were chained to walls in institutions such as the infamous Bedlam, where the rest of society could forget they existed.

Conditions in these institutions were horrible.  "Inmates" as they were called were crowded into dark cells, sometimes sleeping five to a mattress on dank damp floors, chained in place.  There was no fresh air, no light, very little nutrition and they were whipped and beaten for misbehavior much like wild animals.  No differentiation was made between mentally ill and criminally insane; all were packed together.  Some women were committed at this time simply for the "crime" of attempting to leave their husband, or at their husband's insistence in order to gain control of her assets.

They were not recognized as sick people and were accused of having abandoned themselves to shameful and forbidden practices with the devil, sorcerers and other demons (unbelievably there are people who still believe this today).  The mentally ill were accused of having succumbed to spells, incantations and of having committed many sinful offences and crimes.  They were persecuted without mercy and many of them were burned at the stake.

The few doctors who tried to convince the authorities and general public that the "insane" were mentally ill, and sick people who needed attention and care were ridiculed.  Often they faced danger to their professional reputations and to their person as well.

During the 1700's many people were simply locked away by their families, perhaps for a lifetime.  Poorer individuals were jailed or placed in publicly funded almshouses.  They received basic car, but conditions were undeniably bad.

Institutional Care

During the 18th and 19th centuries, hospitals and asylums assumed the care of the mentally ill.  The first hospital to accept and treat mentally ill patients was the Pennsylvania Hospital founded by the Quakers in 1752.  Treatment there was the same as for other patients…clean surroundings, good care and nutrition, fresh air and light…in short the mentally ill were treated as human beings.

Asylums for the Mentally Ill

The word "asylum" means shelter or refuge.  One definition found in the 10th edition of Webster's Dictionary is "an institution for the care of the destitute or sick and especially the insane".

The first actual mental asylum in America opened in 1769 under the guidance of Benjamin Rush, who became known as "America's first psychiatrist."

Benjamin Rush, who became known as America's first psychiatrist was a professor at America's first psychiatric hospital in 1769.  This hospital, located in Williamsburg, Virginia was to be the only such institution in the country for fifty years.

Rush graduated from Princeton University at the age of fifteen, and studied medicine at the University of Edinburgh in his twenties.  Soon after he began to practice medicine he realized that his primary interest was in the treatment of the mentally ill.  He divided the mentally ill roughly into two groups; those who suffered general intellectual derangement and whose problems seemed only partial.

Rush disapproved completely of restraint of any kind, for long periods of time.  He outlawed the use of whips, chains and straitjackets and developed his own methods for keeping control.  Looking at some of his methods, we may feel he was quite harsh, but in his day his methods were considered exceedingly humane.

The tranquilizing chair seen above (National Library of Medicine, Bethesda, MD drawing) was a device intended to heal by lowering the pulse and relaxing the muscles.  It was designed to hold the head, body, arms and legs immobile for long periods of time and enable the patient to settle.

The gyrator, as its name suggests was a contraption similar to a spoke on a wheel.  The patient was strapped to the board head outward and the wheel was rotated at a high rate of speed, sending the blood racing to his head and supposedly relieving his congested brain.

The circulating swing worked similar to the gyrator with the patient bound in place in a sitting position.

Looking back it is obvious the treatments were still primitive, but a change had been made.

Nearly fifty years later America's second asylum was built near Philadelphia by the Quakers and was called "The American Friends' Asylum".  This asylum, and others that followed embraced the teaching of Englishman William Tuke in providing "moral treatment" for its patients.  No chains were used and violent patients were separated from the others.

In 1841 Dorothy Dix, an American woman, appalled at the conditions in jails and mental institutions where the mentally ill were housed began a forty-year quest to champion the mentally ill.  Through her efforts more than thirty hospitals for indigent patients with mental illnesses were built.

By the mid 1800's many institutions were making the effort to truly help their residents, yet by today's standards their efforts were crude.

Real changes began to occur with the arrival of the twentieth century.  During World War 1 it was discovered that large numbers of soldiers were incapacitated by emotional problems and it was plain to see that not just a few, but many suffered from abnormal behavior.  It was reasoned that if trauma such as the war could cause such widespread symptoms, then it was reasonable to assume lesser trauma, perhaps occurring frequently could produce the same effect.

Mental illnesses began to be recognized as medical in origin and the classification as to type and symptoms proceeded. 

In the 1940's and 50's medication was discovered that helped the severely mentally ill.  Great hope was placed in these drugs, but it was soon discovered they did not cure the illness, although they were quite successful at ameliorating some of the symptoms.  These medicines, the anti psychotics, are still in use today.    ECT and insulin therapy was also discovered, and went a long way to helping especially those in depression.  ECT, in a refined and safer mode is also practiced today.

Several serendipitous discoveries in the next several years nearly revolutionized the treatment of the mentally.  New medications were discovered to help in most cases of severe mental conditions, and more new ones are being found.

Lifelong institutionalization is rare as patients recover enough to be cared for in their own homes and communities.  Community help for the mentally ill has progressed enormously in the past even twenty years.

No, we still do not know the cause of the major mental illnesses, schizophrenia, bipolar affective disorder (manic depression) or clinical depression but treatment is available.  Researchers continue to look at the genetics in an attempt to identify the cause.  Though it may not come in our time, it will for our children and their children.

The stigma of mental illness has not been eradicated, though the move to equate mental illness with physical illness has resulted in greater understanding on some fronts.  We still have a long way to go in this area.
 
 

 

 
 

 

 

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