History of Mental Health Treatment

Imagine you are a person living in the 1800s. Lately, you have been experiencing what the physicians and your family are calling “melancholy.” You have been so depressed that you have barely gotten out of bed for the last two weeks. Your family is concerned, and they ask the physicians who have come to examine you what they should do. Ultimately, your family takes the advice they are given and sends you away secretly to an insane asylum for treatment.

Not ideal, is it?

• We will consider what the early historical developments in psychological treatment were.
• What was mental health treatment like in the 1800s?
• What was mental health treatment like in the 1900s?
• What are some of the inhumane and controversial mental health treatments of the past?
• What are the major events inthe history of the treatment of mental illness?

Historical Developments in Psychological Treatment

Mental disorders are nothing new. However, the way we understand and treat mental health struggles has changed dramatically throughout history. Our understanding of these matters continues to change and evolve, hopefully for the better! We can trace the history of mental health treatment back to ancient Greece. Hippocrates, the ancient father of the medical field, taught that mental disorders, like other ailments, have physical causes. He thought that they should be treated like other ailments, with rest and bodily care.

Another ancient Greek named Galen taught that mental disorders are caused by imbalances in the body. His ideas were called the four humors theory. These humors were what Galen and Socrates thought were the basic substances of the body: bile, black bile, blood, and phlegm. They thought that the body needed certain amounts of these substances, and imbalances in the four humors caused mental health problems. These ideas somewhat resemble what we now know to be true about mental health, the brain, and the body!

Mental Health Treatment in the 1800s

Prior to, and during the enlightenment, and then continuing up through the industrial age, mental health struggles were often attributed to spiritual or religious causes, like demonic possession or punishment from God for evil. Naturally, this caused a lot of shame and stigma towards those with mental disorders. Since the causes were believed to be spiritual or religious in nature, the treatments often were as well.

Institutionalization

Even though institutions for those with mental illnesses existed before this time, more of them were established and used during and after the industrial revolution. Families moved from rural areas to cities, and those that struggled with mental health were sent away so their families could avoid societal shame and stigma. The wealthy in a community would provide funds to build and run a mental asylum. The first US mental asylum was built in Virginia in 1768.

18th Century Painting of Bedlam, Wikimedia Commons

Moral Treatment

Things were pretty bad, even though the founders of these institutions often had very good intentions. However, not everyone treated those with mental disorders badly. Two individuals advocated for widespread reform in treating mental disorders: Philippe Pinel in France in the 1700s, and Dorothea Dix in the US in the 1800s. They taught that treatments should be morally sound or humane. Rather than viewing mental illness as bad and hopeless, they viewed it more like a regular sickness. Treating people well was important in helping them get better.

Living conditions in the asylums were poor. Dorothea Dix believed that improving environmental conditions would help those struggling with mental illnesses. She wanted those with severe symptoms to be cared for in a hospital by trained doctors and nurses. It took a long time, but her advocacy efforts resulted in 32 new psychiatric hospitals!

Dorothea Dix in 1838, Wikimedia Commons

Mental Health Treatment in the 1900s

Along with more cities, the industrial age brought advances in science, medicine, and psychiatry. In many ways, the history of mental health treatment parallels the history of the medical field. Scientists and doctors were quickly learning more about the body and the brain, and new medical tools and treatments were becoming available. This led to the formation of another kind of institution: hospitals.

Psychoanalysis

Hospitals were being established specifically to treat those with mental disorders. It was the beginning of the field of psychiatry. Something big happened at the turn of the 20^th century. The mental health field began to diverge from the medical field when a Jewish Austrian named Sigmund Freud published his first writings on a new method of mental health treatment, called psychoanalysis. All the psychiatrists after this point were trained in Freud’s therapy. Psychotherapy today still owes many of its elements to Freud’s work!

Freud in 1924, Wikimedia Commons

Deinstitutionalization

In 1955, the mental asylums reached peak capacity. Treating those with mental disorders by placing them in institutions was clearly not working well. What would happen if the care system was changed? Could those who were previously institutionalized be released into society? How would families and the community take care of them?

In answer to this problem, President Kennedy signed a law in 1963 that provided state funds for community mental health centers. We still use these centers today, even though there are many private treatment options available as well.

This was a good thing, right? Well, it has become a subject of debate. Deinstitutionalization improved living conditions for some individuals with mental disorders, but others ended up homeless or in worse conditions than before. Asylums were replaced with many smaller institutions, like treatment centers and group treatment homes. Some individuals with mental illness need continuous, ongoing care, and that kind of care is hard to provide outside of an institutional setting.

Psychoactive Drug Treatments

The first medication treatment for mental disorders was a drug called Thorazine. It is categorized as an antipsychotic medication. It wasn’t originally designed to treat mental illness, but it ended up being helpful in treating those placed in institutions. Medication played a critical role in deinstitutionalization. Medications helped mental disorder symptoms to improve so much that very severe cases became less common and institutions became less needed. Now there are more than 50 psychotropic medications commonly used to treat mental disorders.

The History of Inhumane Mental Health Treatments

Like the history of the medical field, the history of mental health treatments is questionable and sometimes horrifying. When medical practices were still primitive, trephining, vomiting, bleeding, and purging (through laxatives) were common treatments for mental disorders. Trephining or trepanning involved drilling a hole in the skull.

Spiritual or religious treatments included inflicting punishment, prescribing religious rituals, or attempting exorcisms. Mental illness was viewed as something caused by the person who was struggling, so getting rid of anything considered bad or evil in their life was supposed to help cure them. Abuse and horrible living conditions were common in mental asylums, and death rates were extremely high.

Later on, individuals with mental disorders were purposefully infected with malaria, placed into diabetic comas, and subjected to induced seizures. A brain surgery called a lobotomy became a common treatment, involving inflicting severe damage to the frontal lobe of the brain. A practice called conversion therapy, which has since been banned by therapeutic ethical codes, attempted to change someone’s sexual orientation or gender identity through harmful, punitive means.

A Timeline of the History of Mental Illness Treatment

That was a lot of information! Do you need a visual aid to help you remember and organize all of it?

History of Mental Health Treatment Timeline, StudySmarter Original