History of Mental Health

Mental health perception has changed over time due to advancing knowledge. These changes in mental health perception have shifted the view of mental health from blaming people to supporting them. Once upon a time, it was considered the norm to shock someone until they were no longer “insane”. Never mind using this treatment for a good reason; it is no longer acceptable to call someone insane if they have been diagnosed with a mental illness.

Let’s review the history of mental health to see how psychology has evolved into the discipline it is today.

• We will start by reviewing the timeline of psychology.
• Then we will briefly discuss the history of mental health whilst looking into the history of mental health stigma.
• The history of mental health treatment will be reviewed, including aspects concerning the changes in mental health over time.

Timeline of Psychology

As knowledge has advanced through research, how mental health is understood and treated has also evolved. In the past, mental health problems were believed to be an act against God and human nature.

The way behaviour and mental health are understood changed according to the zeitgeist.

The zeitgeist influences the acceptance of particular views/ theories because we accept ideas easier based on existing knowledge rather than something we have to wrap our heads around.

It is generally accepted that biological and environmental problems cause mental issues today.

Fig. 1. The zeitgeist has heavily influenced the accepted psychology approach over the years.

History of Mental Health Stigma

In the 18th and 19th centuries, mental health was thought to be due to the existence of the supernatural. People with mental health problems were considered to be acting against human nature, such as witchcraft.

People kept away and feared people with mental problems. Mental problems had such negative connotations that anyone who showed symptoms was killed or locked away.

Over time, the stigma of mental health has diminished as the understanding of mental health has evolved. In the 2000s, laws were enacted to reduce the stigma of the mentally ill and create equal opportunity.

However, mental health stigma remains, especially in some communities.

History of Mental Illness Timeline

The timeline of popular paradigms used to understand mental illness are:

The Freudian Approach was introduced in the early 20th century.

Sigmund Freud advocated the psychodynamic approach, which assumes we can understand mental health through childhood experiences and conflicts/imbalances in the unconscious mind.

Later in the mid-20th century, Skinner’s behavioural approach was accepted.

This period saw a shift toward psychology as a science. Psychologists sought to understand behaviour through observation. The behaviour therapy approach assumes that behaviour is learned from experience via forming associations or reinforcement.

The cognitive revolution has heavily influenced society from 1960 to the present.

This era saw is characterised by a revolution in technology. The zeitgeist revolved primarily around technology.

Cognitive psychologists proposed the information processing model to explain mental health and behaviour. The model states that humans take in information from their senses and that the brain’s mental processes (called cognition) process that information. As a result, behaviour is outputted, similar to a computer.

From the Late 1970s to the present – the medical model has influenced how mental health is understood.

The medical model explains behaviour using theories from the biological approach. This approach states that mental illnesses have a physical cause, such as:

• Chemical imbalances.

• Neurotransmitters dysfunction.

• Physical trauma.

• Brain abnormalities.

History of Mental Health Treatment

Let’s go over a brief history of mental health treatment strategies.

In 6500 BC, spiritual entities such as evil spirits were thought to cause mental illnesses. And people with mental illnesses were considered possessed beings.

Possession by evil spirits was seen as a result of punishment by God; the typical methods of treatment were trepanation and exorcism.

Some mental illnesses, such as epilepsy, were not considered a disease but evidence of witchcraft. People accused of witchcraft were burned.

From 800 to 400 CE, physicians theorised that mental illnesses were due to physical causes. Hippocrates, an ancient Greek physician, believed that ‘insanity’ resulted from an imbalance of body fluids.

According to Hippocrates, depression could be diagnosed if people had elevated levels of black bile. Laxatives were used to treat the excess of black bile, which was thought to lower depression levels.

Hippocrates played a major role in the history of mental illness; it was no longer assumed people were to blame themselves or that non-physical causes, such as evil spirits, were behind it. Mental health evolved toward science.

From 1200 to the 1700s, views on mental illness went so far that people with mental problems were committed to insane asylums. In the asylums, people were treated inhumanely. They were locked up, chained, and people were rude to them.

History of Mental Health: Contemporary Interventions

During the early 1900s, people began to view asylums as a poor way to treat patients. Psychiatry was recognised in the medical field. Freud presented his ideas within the framework of the psychodynamic approach. The move toward the psychodynamic approach brought with it various methods of treating mental health, including:

• Psychoanalysis: Psychologists and therapists work together to resolve internal conflicts in the psyche that early childhood trauma causes.

• Hypnosis: A trained clinician helps the client tap into the subconscious mind to uncover hidden memories at the root of psychological problems. Whether the psychoanalytic treatment works is still debated.

• Dream analysis.

The psychodynamic approach to mental health has been widely criticised for lacking credibility, verifiability, and falsifiability. For this reason, the paradigm of the zeitgeist has turned away from psychodynamics. It remained a popular mental health intervention until the mid-1900s. However, there are still many psychotherapists today.

The fall of the widely held belief that the psychodynamic approach was the best method for psychiatric intervention paved the way for the medical model to take its place. The medical model remains the common approach to treating mental illness.

The medical model uses treatment methods such as:

• Electroconvulsive therapy (ECT): Electroshocks are administered at a safe, low voltage. This treatment is not used to treat bipolar disorder or major depressive disorder. It is a treatment that is not commonly used.

• Psychopharmacology: The use of medications to alter the chemical balance of neurotransmitters and hormones that may cause mental health problems.

Rosenhan (1973) on Being Sane in Insane Places

Now that we’ve understood the stigma and how the history of mental health, let’s see what research says about diagnosing/“labelling” people with mental illnesses. Rosenhan (1973) investigated whether people can tell whether someone has mental problems or not.

Eight pseudopatients (people without mental illness but pretending to be ill) were admitted to different psychiatric hospitals. Before hospitalisation, participants described symptoms of schizophrenia, such as hallucinations, to psychiatrists.

Once admitted, participants stopped pretending and began behaving as they normally do. Participants had to convince hospital staff they were ‘fit for discharge’.

The study found that all the pseudopatients were admitted to hospitals and stayed between 7 and 52 days. Seven participants were diagnosed with schizophrenia, and the other with manic-depressive psychosis.

Signs of distress shown by participants were considered a result of their ‘illness’ and not the current situation by the hospital staff. The pseudopatients reported feelings of powerlessness and depersonalisation.

History of Mental Health: Rosenhan: Experiment 2

Hospital staff were informed of their diagnostic errors and that one or more pseudopatients might request admission to the hospital within three months (no pseudopatient did so).

Staff had to rate new patients admitted to the hospitals on a scale of 1–10, whether they thought the person was a pseudopatient.

The study found of 193 true patients, 41 were hospital staff thought to be pseudopatients. At least one psychiatrist thought 23 patients were pseudopatients. And 19 were mistaken for pseudopatients by a psychiatrist and another staff member.

A strength of this study is that it has high external validity because hospital staff did not know they were participating in the experiments. Therefore, it was likely their behaviour was consistent with the facts.

In addition, many variables were controlled, resulting in internal validity, e.g., the pseudopatients all presented the same way to the staff when attempting to be admitted to the hospitals.

Some weaknesses, however, are that the study was conducted in America, in American hospitals, so the results cannot be generalised to other countries. The study did not use a representative sample, and ethical issues were raised (deceived hospital staff and staff were not asked if they wanted to participate in the studies).