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Mental illness isn’t a uniquely modern phenomenon. The genetic influences that stand behind some types of mental illnesses, along with the physical and chemical assaults that can spark illnesses in some people, have always been part of human life. But the ways in which impacted people are treated by their peers, as well as the help ill people might get from their doctors, has undergone a significant amount of revision. In fact, the ways in which modern cultures both understand and deal with mental illnesses have undergone a radical transformation. However, much work remains to be done, if people who have mental health concerns are to reach their true potential.
A Feminine Example
Nowhere is the sea change the mental health field has undergone more evident than in treatments for women. Parsing this one example could make the reams of data in this article just a little easier to understand.
In Victorian times, a woman could be considered unbalanced due to a variety of causes, including: Menstruation-related anger Pregnancy-related sadness Post-partum depression symptoms Disobedience Chronic fatigue syndrome Anxiety
Some of these conditions are still considered mental health conditions. But some of these situations are simply part of living as a woman in the world, and they wouldn’t be treated at all by modern practitioners. However, Victorian woman could be placed in institutions due to these conditions, which doctors often labeled “hysteria,” and once there, these women were cared for by a doctor who typically ruled the facility in the same manner in which a Victorian father might rule a home. Women had few, or no, rights, and disobedience was often met with severe punishment.[1]
By D.M. Bourneville and P. Régnard [Public domain], via Wikimedia Commons
Much has changed since then. A modern woman with a true mental illness might get treatments that are somewhat tailored due to her gender, but the underlying fundamental theories of mental illness don’t shift from man to woman, and a practitioner is required to respect the rights of the patient at all times. A woman in a modern facility might also have the opportunity to weigh in on the therapies she does, or does not, accept, and she might be allowed to leave as soon as she feels at least somewhat recovered. It’s a huge shift, and it’s been made via a series of small, difficult-to-measure steps.
Illness in the 1840s
In the early part of America’s history, people who had mental illnesses were placed in institutions that were quite similar to jails. Once inside these facilities, people simply weren’t given the opportunity to leave, no matter how much they might want to do so. In addition, some of these facilities had terrible procedural rules that allowed people with illnesses to be treated in ways that were unspeakably cruel. In the 1840s, a woman in Boston, Dorothea Dix, began to research conditions in traditional mental health institutions. It’s been suggested[2] that Dix had a mental illness of her own, and she was more receptive to the plight of the ill as a result, but no matter the underlying motivation, Dix spent years conducting interviews with experts and patients, and her results were startling. In a piece she wrote to the General Assembly of North Carolina, she outlines cases in which the mentally ill were chained to their beds, kept in filthy conditions and even
(http://dualdiagnosis.org/wpabused. She begins her report with this series of sentences: content/uploads/2014/04/The_Joint_Counties_Lunatic_Asylum_Erected_at_Abergavenny._3375647.jpg) See page for author [Public domain], via Wikimedia Commons “I admit that public peace and security are seriously endangered by the non-restraint of the maniacal insane. I consider it in the highest degree improper that they should be allowed to range the towns and country without care or guidance; but this does not justify the public in any state or community, under any circumstances or conditions, in committing the insane to prisons…”[3] Rather than committing the mentally ill to prisons, Dix hoped to open a series of institutions devoted to mental health, and she hoped these facilities would provide work, recreation and understanding to the ill. It’s one of the first documents to outline compassionate care, although it wasn’t widely implemented due to the work that Dix did.
History Timeline
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Pre 1400
Ancient civilizations like the Romans and Egyptians considered mental health problems to be of a religious nature. Some thought a person with a mental disorder may be possessed by demons, thus prescribing exorcism as a form of treatment. During the 5th century BC, Greek physician Hippocrates, however, believed that mental illness was physiologically affiliated. As a result, his methods involved a change in environment, living conditions, or occupations.
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1400 to Early 1900s 1407: The first facility specifically for mental health is established in Spain. 1700s: Advocacy for mentally ill persons occurred in France. Phillipe Pinel, displeased with living conditions in hospitals for those with mental
disorders, orders a change of environment. Patients are given outside time as well as more pleasant surroundings like sunny rooms. He forbids the use of shackles or chains as restraints. 1840s: Dorothea Dix fights for better living conditions for the mentally ill. For over 30 years she lobbies for better care and finally gets the government to fund the building of 32 state psychiatric facilities. 1883: German psychiatrist Emil Kraepelin studies mental illness and begins to draw distinctions between different disorders. His notes on the differences between manic-depressive disorder and schizophrenia are still used today. Early 1900s: Using psychoanalytical theories, Sigmund Freud and Carl Jung treat their patients for mental illness. Many of the theories they employed are still discussed today and used as a basis for the study of psychology.
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1930s to Today
After the 1920s, the United States saw yet again another shift in society’s view on mental health. A Mind That Found Itself, a book by Clifford Beers, prompts discussion on how mentally ill people are treated in institutions. His ideas begin the roots of the National Mental Health Association. Countless other books like Ken Kesey’s One Flew Over the Cuckoo’s Nest in 1962 also offered an interesting perspective on how people are treated in psychiatric hospitals. This early period of the 20th century marked a big movement in advocacy and care standards for mental health care. After the 1920s, the United States saw yet again another shift in society’s view on mental health. A Mind That Found Itself, a book by Clifford Beers, prompts discussion on how mentally ill people are treated in institutions. His ideas begin the roots of the National Mental Health Association. Countless other books like Ken Kesey’s One Flew Over the Cuckoo’s Nest in 1962 also offered an interesting perspective on how people are treated in psychiatric hospitals. This early period of the 20th century marked a big movement in advocacy and care standards for mental health care. 1946: President Harry Truman signs a law that aims to reduce mental illness in the United States, the National Mental Health Act. This law paved the way for the foundation of the National Institute on Mental Health (NIMH) in 1949. 1950s to 1960s: A wave of deinstitutionalization begins, moving patients from psychiatric hospitals to outpatient or less restrictive residential settings. Institutionalization was often thought of as the best method of treatment but overstaffing and poor living conditions prompted a push to outpatient care. This movement also sparks the development of antipsychotic drugs, so as to make a person’s life outside an institution more manageable. In fact, over a 30-year period the number of institutionalized patients dropped from 560,000 in the 1950s to 130,000 in 1980. 1990s: A new generation of prescription antipsychotic drugs emerge, as well as new technology in the medical field. 2008 to 2010: The Wellstone and Domenici Mental Health Parity and Addiction Equity Act passes into law. This made it so insurers who did provide mental health coverage could not put limitations on benefits that are not equal to limits on other medical care coverage.
Wider Outrage in the 1880s
Placing the mentally ill in facilities allowed members of the general public to ignore the problem. They didn’t see anyone who had a mental illness roaming the streets, and if they placed a person in an institution like this, they may not have come back to visit or shared stories of any visits they did make. The people just seemed to disappear. Much of that changed in the late 1880s, due to the work of a writer named Nelly Bly. She agreed to pose as a mentally ill woman on an assignment for a local newspaper, and she documented everything that happened to her in a series of articles, which were later turned into a book. Bly was a wonderful writer, and her descriptions were hard to ignore.
(http://dualdiagnosis.org/wpcontent/uploads/2014/04/512px-Nellie_BlyMad-House-08.png) By McD (Penn University library) [Public domain], via Wikimedia Commons
(http://dualdiagnosis.org/wpcontent/uploads/2014/04/Nellie_Bly-MadHouse-16.png) By McD (Penn University library) [Public domain], via Wikimedia Commons
(http://dualdiagnosis.org/wpcontent/uploads/2014/04/Nellie_Bly-MadHouse-14.png) By McD (Penn University library) [Public domain], via Wikimedia Commons
“… I could not sleep, so I lay in bed picturing to myself the horrors in case a fire should break out in the asylum. Every door is locked separately and the windows are heavily barred, so that escape is impossible. In the one building alone there are, I think Dr. Ingram told me, some three hundred women. They are locked, one to ten in a room. It is impossible to get out unless these doors are unlocked.”[4] In addition to describing the physical building, Bly describes the harsh treatments she obtained, including solitary confinement, hair pulling and more. Bly’s book was a sensation, and according to news reports,[5] the institution in which she lived was reformed as a result of her work. But she also managed to outline what living in a facility like this was actually like and how it didn’t seem to help anyone to get better, and that may have deepened the discussion people in this country had about mental illness, and it may have spurred experts to come up with radical treatments that could actually effectively treat mental illnesses. If housing them and isolating them didn’t work, they needed to find something else that would.
Innovative Therapies in the 1930s
In the early part of the 1900s, experts began to try to understand what might make a person behave in an erratic way, and what kinds of thoughts and opinions might be attached to what outsiders would deem “madness.” Sigmund Freud was a major influence here, obviously, as he developed a number of theories that attempted to explain unusual behavior, and he devised therapies that aimed to help people who might once have been placed in a prison with no help at all.[6]But work advocated by Freud could take months or even years to complete, and some people didn’t seem to get better when they were under the guidance of the so-called “talking cure.” As a result, practitioners began dabbling in radical cures in the 1930s,[7] hoping to eliminate mental illnesses altogether with one big gesture.
(http://dualdiagnosis.org/wpcontent/uploads/2014/04/Sigmund_Freud.jpg) By Cesar Blanco from Mexico (Sigmund Freud Uploaded by Viejo sabio) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
(http://dualdiagnosis.org/wp-
content/uploads/2014/04/Turning_the_Mind_Inside_Out_Saturday_Evening_Post_24_May_1941_b_detail.jpg) By Photography Harris A Ewing (Saturday Evening Post, 24 May 1941, pages 18-19) [Public domain], via Wikimedia Commons (https://commons.wikimedia.org/wiki/File%3ATurning_the_Mind_Inside_Out_Saturday_Evening_Post_24_May_1941_b_detail.jpg)
Techniques that were used on the mentally ill included: Insulin-induced comas Lobotomies Malarial infections Electroshock therapy
(http://dualdiagnosis.org/wpcontent/uploads/2014/04/512pxBergonic_chair.jpg) By Otis Historical Archives National Museum of Health and Medicine (originally posted to Flickr as Reeve041476) [CC-BY-2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
This work continued in some institutions well into the 1940s and 1950s, and in some cases, it did help some people who had serious illnesses. But many of these techniques fell out of favor, and in the years to come, an entirely different method of treatment began to take prominence in people with mental illnesses.
Chemical Interventions
In the 1940s and 1950s, chemists began to experiment with different powders and pills that could calm imbalances inside the brain and deliver real relief to people who had mental illnesses. Rather than strapping people down to their beds, or asking people to simply talk about their problems, these chemists hoped to use a form of chemical restraint. People would feel better, and they might behave better, and no institutionalization would be needed at all.To a large extent, this was a successful project. Medications like lithium seemed capable of soothing people with very severe cases of bipolar disorder, while antipsychotic medications seemed capable of helping people with schizophrenia. At the same time, the number of people hospitalized due to mental illness had reached staggering proportions. [8]
It was a global problem, and experts began to wonder if they could take people out of the institutions and provide them with medications they could use at home.
Relevant Videos
Deinstitutionalization Movement
Beginning in the 1950s, experts began moving people out of institutions and into communities, and the number of people enrolled in formal institutions dropped dramatically in just a few short years.[9]Unfortunately, communities were slow to adapt to this onslaught of people who needed very intense care. Few were able to provide the support needed, such as: Housing assistance Job training Psychiatric counseling Life skills training Social support
As a result, many people who moved out of terrible facilities moved into situations that were merely different, not noticeably better. For example, in a grueling piece from The New York Times, [10] a story emerges of a number of very young men who were removed from state institutions and forced to work in a turkey-processing plant for years, for less than $100 per month. These men had no contact with their families, no opportunities to learn life skills and no way to get out. “A lucky few returned South for a week’s vacation every year. Others tried to stay in touch with family by schoolhouse telephone, some of them calling disconnected numbers, over and over, year after year. Or they lingered at the post office, where there was rarely anything for them, other than the candy on the counter … But every once in a great while, a lucky man received a birthday card or Christmas letter, sent from another world.”
They were left there until 2009, when inspectors from the federal Department of Labor, as well as officials from nearby communities, reported conditions that they felt were abusive. Those who weren’t shipped to programs like this sometimes slipped between the cracks altogether, and they made a life on the streets, sleeping in cardboard boxes, begging for food and railing at the sky when the days were bad. In one study of the issue,[11] conducted in 1988, researchers found that 28 percent of the homeless people they studied had a diagnosable mental illness. That’s a remarkably high number. In the 1990s, experts discovered that many people with mental illness entered the criminal justice system, due to a combination of drug use and mandatory sentencing rules.[12] Administrators of these facilities scrambled to keep up with the demand for services from people who were profoundly ill and unable to get the help they needed on the outside.
Modern Therapies
Community agencies have worked for years to provide people with the help they need to manage their conditions without entering a facility for life. Social workers, mental health counselors and more have all been involved in this movement, and while it’s safe to say that some communities provide help that’s superior to the level of assistance seen in other communities, it’s clear that people have options for treatment today through community resources that just didn’t exist a decade or so ago. Laws have also changed, and they now allow concerned family members and community members to place people with mental illnesses inside therapeutic facilities for a short period of time, until they gain control. Some state laws even force people with mental illnesses to take medications, even if they don’t wish to do so.[13]
It’s easy to view these legislative changes as a method that can allow people in the community to live with people who have mental illnesses, without worrying about their health and harm. But people who have mental illnesses have rights, and some don’t wish to accept this kind of treatment. Some patients want to manage their own conditions, using online resources as well as their doctors, and they’d like to have much more autonomy.[14] It’s unclear what role this might play in the future. But it is clear that practitioners now respect people with mental illnesses to an unprecedented degree, compared with previous years. Rather than silencing them with restraints and drugs, experts now want to partner with patients and help them. This could bring about a form of mental health treatment everyone could support. If you’d like to know more about how mental health issues are treated in Foundations Recovery Network facilities, we urge you to give us a call. Our admissions coordinators are here 24/7 to answer your questions.
[1] “Women and Psychiatry (http://www.sciencemuseum.org.uk/broughttolife/themes/menalhealthandillness/womanandpsychiatry.aspx).” (n.d.). Science Museum. Accessed March 14, 2014. [2] Parry, M. (April 2006). “Dorothea Dix (1802-1887) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470530/).” American Journal of Public Health. Accessed March 14, 2014. [3] “Dorothea Dix Pleads for a State Mental Hospital (http://www.learnnc.org/lp/editions/nchist-newnation/4748).” (n.d.). Learn NC. Accessed March 14, 2014. [4] “Nellie’s Madhouse Memoir (http://www.pbs.org/wgbh/americanexperience/).” (n.d.). American Experience. Accessed March 14, 2014. [5] DeMain, B. “Ten Days in a Madhouse: The Woman Who Got Herself Committed (http://mentalfloss.com/article/29734/ten-days-madhouse-womanwho-got-herself-committed).” (2011). Mental Floss. Accessed March 14, 2014. [6] “Sigmund Freud (http://www.nndb.com/people/736/000029649/).” (n.d.). NNDB. Accessed March 14, 2014. [7] “Timeline: Treatments for Mental Illness (http://www.pbs.org/wgbh/americanexperience/).” (n.d.). American Experience. Accessed March 14, 2014. [8] Ibid. [9] Koyanagi, C. (August 2007). “Learning from History: Deinstitutionalization of People with Mental Illness as a Precursor to Long-Term Care Reform (http://www.kff.org/medicaid/report/learning-from-history-deinstitutionalization-of-people-with/).” Kaiser Commission on Medicaid and the Uninsured. Accessed March 14, 2014. [10] Barry, D. (March 9, 2014). “The ‘Boys’ in the Bunkhouse: Toil, Abuse and Endurance in the Heartland (https://www.nytimes.com/interactive/2014/03/09/us/the-boys-in-the-bunkhouse.html?_r=0).” The New York Times. Accessed March 14, 2014. [11] Koegel, P.; Burnam, M.A. & Farr, R. (December 1988). “The Prevalence of Specific Psychiatric Disorders Among Homeless Individuals in the Inner City of Los Angeles (http://archpsyc.jamanetwork.com/article.aspx?articleid=494439).” JAMA Psychiatry, Accessed March 14, 2014. [12] Diamond, P.; Wang, E.; Holzer, C.; Thomas, C. & Cruser, A. (September 2001). “The Prevalence of Mental Illness in Prison (https://link.springer.com/article/10.1023/A:1013164814732#page-1).” Administration and Policy in Mental Health and Mental Health Services Research. Accessed March 14, 2014.
Further Reading About History of Mental Health Treatment Common Disorders in Young Adults (https://www.dualdiagnosis.org/mental-health-and-addiction/common-young-adults/) Common Health Issues Among Women (https://www.dualdiagnosis.org/mental-health-and-addiction/common-issues-women/) Does Having a Disorder Mean You Need Treatment? (https://www.dualdiagnosis.org/mental-health-and-addiction/need-treatment/) History of Mental Health Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/history/) Medications for Mental Health Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/) Medications for Bipolar Disorders Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/bipolar-disorderstreatment/) Medications for Sleeping Disorders Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/sleepingdisorders-treatment/) Medications for Substance Abuse Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/substanceabuse-treatment/) Medicine for Anxiety Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/medications-anxietytreatment/) Medicine for Schizophrenia Treatment (https://www.dualdiagnosis.org/mental-health-and-addiction/medications/schizophreniatreatment/) Most Common Disorders in Men (https://www.dualdiagnosis.org/mental-health-and-addiction/most-common-in-men/) Muscle Dysmorphia and Substance Abuse (https://www.dualdiagnosis.org/mental-health-and-addiction/muscle-dysmorphia/) Post Traumatic Stress Disorder and Addiction (https://www.dualdiagnosis.org/mental-health-and-addiction/post-traumatic-stress-disorder-andaddiction/) Causes of PTSD (https://www.dualdiagnosis.org/mental-health-and-addiction/post-traumatic-stress-disorder-and-addiction/causes/) Medications for PTSD and Risk of Abuse (https://www.dualdiagnosis.org/mental-health-and-addiction/post-traumatic-stress-disorderand-addiction/medications/) The Classification of Mental Health Disorders (https://www.dualdiagnosis.org/mental-health-and-addiction/classification/) The Connection Between Mental Illness and Substance Abuse (https://www.dualdiagnosis.org/mental-health-and-addiction/the-connection/) U.S. Legislation on Mental Health (https://www.dualdiagnosis.org/mental-health-and-addiction/us-legislation/)
Co-occurring mental health conditions and substance abuse affect nearly 8.9 million yearly. Only 7.4% receive appropriate treatment. Few programs specialize in treating dual diagnosis. Research reveals that people with co-occurring disorders need specialized integrated treatment.
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