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Michael Pronin
Dr. Lori Bedell
CAS 137H
7 November 2014
Paradigmatic Shift in Mental Health

Its hard to find something nearly as controversial and misunderstood as mental health.
Popularized through the media in past years, through movies such as One Flew Over the
Cuckoos Nest, mental health has proven to be a popular talking point in modern society. While
scarcely understood throughout history, there is no doubt that it has been an issue. Different
perspectives and opinions have been introduced throughout the years and have defined the
debate over mental health. However, things have certainly changed throughout this period, from
the debates to the perspectives. From Colonial America to present day, there has been a major
change in the way American people view mental health issues due to better and more humane
psychiatric treatment, fewer barbaric asylums, and better research.
In order to understand the treatment of individuals with mental illness, specifically their
vilification, it is crucial to first examine early perception. In Colonial America, those with
mental issues were referred to as lunatics, a word derived from the root word of lunar, meaning
moon (Leupo). The justification comes from astrological reasoning, which claimed that
insanity was caused by a full moon at the time of birth, or even just from a baby sleeping under
the rays of a full moon (Leupo). Such early, unscientific observation set up an early perspective
on mental health in America and started the debate over what it meant to be mentally ill and how
these individuals should be treated. Taking it a step further, Colonists believed that these babies

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were possessed by the devil, and as a solution, these individuals were often alienated from
society and locked away (Leupo). It wasnt uncommon to fear what was not explainable during
those times, and it was consistent with the times to believe that a person acting strangely may
have been possessed by some an ungodly entity. Still, this set up the perception in a young
America that those with mental illness were evil and had no place in society. At the very least,
it set up those with mental handicaps to be viewed as subordinate to the normal population.
As those with mental illness grew more inhuman in the eyes of the public, inhuman
treatments followed. With the mentally ill falling into two all-encompassing categories, mania
and melancholy, the only medical treatments of the Colonial Era were based on the principle of
catharsis (Leupo). With medical procedures that involved submerging patients in ice baths until
they lost consciousness or violently shocking the brain, the colonists attempted to cure
individuals by undergoing cathartic medical treatment, which was based on the idea of either
catalyzing crisis or expelling crises from the person (Leupo). The time period was characterized
with treatment plans that took little account for human dignity, getting as extreme as using
bleeding practice. The counter effective bleeding practice involved draining the blood from
the individual, a method that often resulted in death or the need for lifelong care (Leupo). These
times certainly began a horrendous trend in mental health perception.
As the 18th century came, methods became slightly more humane. The first transition in
thought was introduced; the idea that mental illnesses could actually be treated and cured through
more caring means (Levin 2013). Inspired by newly developed European asylums that came at
the heels of the Enlightenment, doctors, reformers, and those that worked closely with the
mentally ill, America experienced a change in the way they developed institutions (Haller 2009).
With an added emphasis on therapeutic models of confinement, the insane asylum was

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founded, which cast aside the chains, cages, and prisons which had developed as the norm in the
society for dealing with the mentally ill (Haller 2009). Building on the expertise of William
Tuke and Philippe Pinel, psychiatrists developed a concept known as moral treatment that
peaked during the mid-1800s, which focused on creating surroundings and activities meant to
build moral fiber and uplift negative spirits (Haller 2009). New methods that respected the
humanity of the patient fostered a subtle change in treating the mentally ill. Private asylums
embraced the idea that the best way to treat patients was to improve emotional well-being and
moral responsibility, contrasting heavily with the prisons for the mentally ill that riddled Colonial
America (Haller 2009). This fostered the idea that the mentally ill were not to be punished, but
instead treated in a slightly more sympathetic manner. Still, moral treatment didnt prove as
effective as necessary, since the practitioners of the time didnt know how to integrate it into a
comprehensive system of treatment and its largely improvised manner of implementation
(Haller 2009). Moral treatment didnt continue as a popular treatment, but for the first time the
mentally ill were treated in a humane manner and sparks of this time continued on in small
Naturally, theory and ideology pale in comparison to implementation. It is true that the
moral treatment movement fostered a shift in the way that the medical community viewed
treating the ill, but despite the original intentions of the time with regards to asylums, it was
evident that asylums didnt turn out to be the beacons of morality that they were hoped to be.
Humane methods werent as easy with the heavy population of the asylums of the time. With
limited state funding preventing expansion of the facility and staff, and a lack of criteria for
asylums to turn patients away, patient care suffered greatly (Leupo). As observed by U.S.
reformer Dorothea Dix in the 1840s, mentally ill people were incarcerated with criminals, with

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the jailors making little disparity between the two groups (PBS 2002). She further observes that
men and women in the institutions were left completely naked in the darkness, lacking any heat
or places to go the bathroom (PBS 2002). Even more disturbing, many of the sick patients were
left chained and beaten (PBS 2002). This was just a small glimpse into the realities of the
treatment of these individuals at the time.
With the approach of the 1900s, methods became even more despicable as overcrowding
persisted. Asylums quickly turned into testing grounds for new and controversial treatments.
Among the numerous head turning methods that were introduced was the lobotomy and
electroconvulsive therapy. The lobotomy was used as a medical procedure that separated the
neural passages in the front of the brain from the back (Leupo). The common result of the
procedure was the patient forgetting their depressing or discouraging feelings or tendencies
(Leupo). This naturally followed with complications, including death, but also a complete loss
of self (Leupo). Thought to be a magic cure all for unruly patients, electroconvulsive therapy
was also employed with little scientific backing. It involved sending strong electric current
through the brain, and the results showed that it was an effective treatment for depression
(Hauser 2006). Today, electroconvulsive therapy is implemented in a safer manner, with
consent, and as a last resort, while the mid-1900s saw none of these courtesies (Hauser 2006).
There was little humanity in the asylums and it wasnt long before people began to catch on
towards the latter part of the twentieth century.
The next significant shift came with the drug industry and significant research in the field
of mental illness. In 1954, the medical community introduced an anti-psychotic drug called
Thorazine for treatment (Leupo). This was the first major shift in treatment, since previously the
majority of the treatment centered on either invasive tactics or ineffective treatments that caused

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society to believe that mental illness was not treatable. Shortly thereafter, a swarm of new drugs
came to prevalence, allowing patients to cut the time that they spent in asylums significantly
(Leupo). Naturally, this meant that the overcrowding that plagued the asylums for years,
justifying inhumane treatment, was no longer an issue in society. Once again, society harkened
back to the moral treatment theory of the 1800s, and the state and federal policies in the 1960s
changed procedures to institute using medication to treat patients (Leupo). There was finally a
permanent push for the individual rights of the mentally ill, a significant change after centuries of
treating them as second rate citizens.
With the new shift in place, there was less of a need to institutionalize mass amounts of
mentally ill patients. What followed during the late 20th century was a deinstitutionalization
process. It was becoming apparent that many of the patients were actually able to function in
society and that their presence in the asylums was unnecessary (Leupo). With this followed
more options in the system, including long term patient care, outpatient services, diagnostic
services, and other options that allowed people different choices rather than being sent away to
an institution indefinitely (Leupo). Once sitting at around 500,000 patients, the American
institution system was reduced to 100,000 by 1986 (Leupo). The shift from institutionalization
was extremely significant for the paradigmatic shift of how the mentally ill are perceived. As
seen, early society banished the sick to asylums, not just to get treatment, but also because they
were burden to society. Few productive things happened in these asylums, with the patients
getting very little personalized attention and sympathetic treatment. With a decreased emphasis
on the asylums during the deinstitutionalization process came a new ideology to treating
mental illness. Finally, there was enough research and support to go in the direction that moral
treatment began.

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Throughout the late 20th century came more research and distinctions with regards to
mental illness. With prominent psychologists and the formation of modern diagnostic methods
stemming from the American Psychological Association, many of the illnesses that were grouped
together into single issues were categorized (Abbas and Mahin 2013). The establishment of The
Diagnostic and Statistical Manual of Mental Disorders proved to be revolutionary (Abbas and
Mahin). It provided a collection of research from prominent psychologists in the American
Psychological Association, giving a uniform way to diagnose issues and showing the different
types of illnesses (Abbas and Mahin). What this meant for the mentally ill was that there was no
longer going to be a grouping of all those seen to be mentally inept, but instead there was a
greater understanding that different individuals would need different types of treatment. This
was extremely significant because there werent blanket cures anymore, and it was recognized
that people with issues werent just crazy, but had disorders that needed to be understood and
treated accordingly. Better understanding comes to the root of the shift in perceptions.
The paradigm shift would be meaningless unless there was a true change in perception.
Clearly, treatment and research changed, but most significantly, peoples attitudes changed.
When people were asked in the 1950s the meaning of mental illness, people mentioned behaviors
that were indicative of psychosis, but when asked in 1996, large numbers of the population
broadened their definitions of mentally ill to include less severe problems (Pescosolido 1996).
This meant the public recognized that there were many other illnesses around, and not everyone
can be put in one category. There was a trickle down of knowledge that allowed for the
continuation of the ideological shift. It was a different time than seen before, with more research
and knowledge backing the public. Indeed, there was a decrease in ignorance when it came to
mental illness.

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The significance of the change in the way mental illness is viewed on the front of
medicine, treatment, and public understanding transcends mental illness itself. A group of people
finally received basic human rights and more autonomy, and this serves as a key example that
knowledge trumps ignorance when it comes to groups of people. The paradigm shift seen in
mental illness parallels many other shifts, such as the perception regarding HIV and the
homosexual community. With more research, it was clear that HIV was not solely an infection
that harmed the gay community, and with this came a change in public attitudes. Similarly, it
became apparent that the mentally ill community isnt a group of people that have no place in
society, but instead just need the proper treatment to be fully functioning members of society.
This wasnt just an issue of treating people, this was an issue of individual rights.
With the paradigm shift, it is necessary to examine future developments. Based off trends,
it seems as though that society is moving towards even more acceptance of mental illness. With
more and better technology, as well as medicine, it seems that understanding will only improve
in society, instead of the constant regressions seen throughout the past three centuries. Of course
there were hints of change in treatment and perception throughout history, most notably moral
treatment, but never was there a solid foundation for consistent change. With clear diagnostic
methods and comprehensive treatments that improve with time, it is clear that society is moving
towards more improvement rather than regression.
Society has seen a massive paradigm shift when it comes to mental illness. Colonial
times started a perception that the mentally ill were to be locked away because they had no place
in society. More specifically, the mentally handicapped were vilified throughout that time
period, and it set a very negative trend with regards to the mentally ill. It wasnt long before
inhumane treatments followed and asylums were introduced to society, which came with many

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problems. The mentally ill were second class citizens with no autonomous control over their
lives. Slowly, society saw developments such as moral treatment that gave the first shift in
thought when it came to treating the mentally ill. Furthermore, the advent of different medicines
fostered the most significant change, with there being less of a reason to institutionalize a mass
amount of people. Moreover, more research allowed for better diagnostics, and eventually a
better understanding of illnesses from the public. Through small events, the way mental health is
treated, viewed, and understood has changed significantly since Colonial times.

Works Cited

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Haller, Beth. "Moral Treatment." Encyclopedia of American Disability History. Ed. Susan Burch. New
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Hauser, John. "An Overview of Electroconvulsive Therapy (ECT)." Psych Psychcentral,
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"Timeline: Treatments for Mental Illness." PBS. PBS, 2002. Web. 05 Nov. 2014.