brief history of mental illness

Pre-history to the modern day: the progression of understanding mental illness

Pre-history (eg Stone Age)

Trepanning (drilling holes in the skull) is used to get rid of evil spirits.

Approx. 400 BCE

Hippocrates treats mental illness as a problem of the body rather than a punishment sent by
the gods.

1377 CE
Opening of the Bethlem Royal Hospital in London, also known as ‘Bedlam’.

1600s
Chains, shackles and imprisonment are largely used to restrain and control the mentally ill.

1850s
Asylums built.

1870s
Normal ovaries are removed to treat ‘mental madness’ and ‘hysterical vomiting’ in some
women.

1879
Wilhelm Wundt opens the first experimental psychology lab at the University of Leipzig in
Germany.

Early 1900s
Psychoanalysis inspired by Sigmund Freud, Carl Jung and others.

1911
Swiss psychiatrist Eugen Bleuler first uses the term ‘schizophrenia’.

WWI
Patients with shell shock are counselled – the precursor of modern treatment for post-
traumatic stress disorder.

1936
Lobotomy (surgical removal of part of the brain).

1938
Electro-shock therapy for schizophrenia and manic depression (now called bipolar disorder).

1949
Lithium for psychosis and manic depression.

1952
The first anti-psychotic drug, Thorazine, for psychosis.
Mid-1950s
Behaviour therapy for phobias.

1960–63
Librium and Valium for nonpsychotic anxiety.

1970s–1980s
A move away from asylums, mental institutions and hospitals to community-based
healthcare.

1980s
Selective serotonin reuptake inhibitors for depression.

1990s
New generation of anti-psychotic drugs for schizophrenia.

2000s
Mindfulness meditation becomes an increasingly important tool in mainstream psychiatric
and psychological care.

2012
The link between hearing voices (previously thought to be a symptom of brain disease) and
childhood trauma is found to be stronger than the link between smoking and lung cancer.

2014
LPM570065, a triple reuptake inhibitor (TRI), rapidly reduces depression in rats. This class
of drugs is being considered as an alternative treatment for depressed people

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Module 2: A Brief History of Mental Illness

and the U.S. Mental Health Care System
The history of mental illness in the United States is a good representation of the ways in
which trends in psychiatry and cultural understanding of mental illness influence national
policy and attitudes towards mental health. The U.S. is considered to have a relatively
progressive mental health care system, and the history of its evolution and the current state of
the system will be discussed here.

Early History of Mental Illness(1)

Many cultures have viewed mental illness as a form of religious punishment or demonic
possession. In ancient Egyptian, Indian, Greek, and Roman writings, mental illness was
categorized as a religious or personal problem. In the 5th century B.C., Hippocrates was a
pioneer in treating mentally ill people with techniques not rooted in religion or superstition;
instead, he focused on changing a mentally ill patient’s environment or occupation, or
administering certain substances as medications. During the Middle Ages, the mentally ill
were believed to be possessed or in need of religion. Negative attitudes towards mental
illness persisted into the 18th century in the United States, leading to stigmatization of mental
illness, and unhygienic (and often degrading) confinement of mentally ill individuals.

Mental Health Hospitals and Deinstitutionalization

In the 1840s, activist Dorothea Dix lobbied for better living conditions for the mentally ill
after witnessing the dangerous and unhealthy conditions in which many patients lived . Over
a 40-year period, Dix successfully persuaded the U.S. government to fund the building of 32
state psychiatric hospitals.(2)

This institutional inpatient care model, in which many patients lived in hospitals and were
treated by professional staff, was considered the most effective way to care for the mentally
ill. Institutionalization was also welcomed by families and communities struggling to care for
mentally ill relatives.(3) Although institutionalized care increased patient access to mental
health services, the state hospitals were often underfunded and understaffed, and the
institutional care system drew harsh criticism following a number of high-profile reports of
poor living conditions and human rights violations.(4) By the mid-1950s, a push for
deinstitutionalization and outpatient treatment began in many countries, facilitated by the
development of a variety of antipsychotic drugs.(5) Deinstitutionalization efforts have
reflected a largely international movement to reform the “asylum-based” mental health care
system and move toward community-oriented care, based on the belief that psychiatric
patients would have a higher quality of life if treated in their communities rather than in
“large, undifferentiated, and isolated mental hospitals”.(6)

Although large inpatient psychiatric hospitals are a fixture in certain countries, particularly in
Central and Eastern Europe, the deinstitutionalization movement has been widespread,
dramatically changing the nature of modern psychiatric care.(7) The closure of state
psychiatric hospitals in the United States was codified by the Community Mental Health
Centers Act of 1963, and strict standards were passed so that only individuals “who posed an
imminent danger to themselves or someone else” could be committed to state psychiatric
hospitals.(8) By the mid-1960s in the U.S., many severely mentally ill people had been
moved from psychiatric institutions to local mental health homes or similar facilities. The
number of institutionalized mentally ill patients fell from its peak of 560,000 in the 1950s to
130,000 by 1980.(9) By 2000, the number of state psychiatric hospital beds per 100,000
people was 22, down from 339 in 1955.(10) In place of institutionalized care, community-
based mental health care was developed to include a range of treatment facilities, from
community mental health centers and smaller supervised residential homes to community-
based psychiatric teams.(11)

Though the goal of deinstitutionalization – improving treatment and quality of life for the
mentally ill – is not controversial, the reality of deinstitutionalization has made it a highly
polarizing issue. While many studies have reported positive outcomes from community-based
mental health care programs, (including improvements in adaptive behaviors, friendships,
and patient satisfaction,) other studies have found that individuals living in family homes or
in independent community living settings have significant deficits in important aspects of
health care, including vaccinations, cancer screenings, and routine medical checks.(12)(13)
Other studies report that “loneliness, poverty, bad living conditions, and poor physical
health” are prevalent among mentally ill patients living in their communities.(14) However,
some studies argue that community-based programs that have proper management and
sufficient funding may deliver better patient outcomes than institutionalized care, and are
“not inherently more costly than institutions”.(15)

Critics of the deinstitutionalization movement point out that many patients have been moved
from inpatient psychiatric hospitals to nursing or residential homes, which are not always
staffed or equipped to meet the needs of the mentally ill. In many cases, deinstitutionalization
has also shifted the burden of care to the families of mentally ill individuals, though they
often lack the financial resources and medical knowledge to provide proper care.(16) Others
argue that deinstitutionalization has simply become “transinstitutionalization”, a phenomenon
in which state psychiatric hospitals and criminal justice systems are “functionally
interdependent”. According to this theory, deinstitutionalization, combined with inadequate
and under-funded community-based mental health care programs, has forced the criminal
justice system to provide the highly structured and supervised environment required by a
minority of the severely mentally ill population.(17)

Opponents of the transinstitutionalization theory contend that it applies to a small fraction of

mentally ill patients, and that the majority of patients would benefit from improved access to
quality community-based treatment programs, rather than from an increase in the number of
inpatient state psychiatric beds. These opponents claim that the reduced availability of state
hospital beds is not the cause of the high rates of incarceration among the mentally ill,
arguing that deinstitutionalized patients and incarcerated individuals with serious mental
illnesses are “clinically and demographically distinct populations”. Instead, they suggest that
other factors such as “the high arrest rate for drug offenses, lack of affordable housing, and
underfunded community treatment” are responsible for the high rates of incarceration among
the mentally ill.(18)

Though the deinstitutionalization debate continues, many health professionals, families, and
advocates for the mentally ill have called for a combination of more high-quality community
treatment programs (like intensive case management) and increased availability of
intermediate and long-term psychiatric inpatient care for patients in need of a more structured
care environment.(19) Many experts hope that by improving community-based programs and
expanding inpatient care to fulfill the needs of severely mentally ill patients, the United States
will achieve improved treatment outcomes, increased access to mental health care, and better
quality of life for the mentally ill.

U.S. Mental Health Policy(20)

Mental Health America (MHA), originally founded by Clifford Beers in 1909 as the National
Committee for Mental Hygiene, works to improve the lives of the mentally ill in the United
States through research and lobbying efforts. A number of governmental initiatives have also
helped improve the U.S. mental healthcare system . In 1946, Harry Truman passed the
National Mental Health Act, which created the National Institute of Mental Health and
allocated government funds towards research into the causes of and treatments for mental
illness. In 1963, Congress passed the Mental Retardation Facilities and Community Health
Centers Construction Act, which provided federal funding for the development of
community-based mental health services. The National Alliance for the Mentally Ill was
founded in 1979 to provide “support, education, advocacy, and research services for people
with serious psychiatric illnesses”. Other government interventions and programs, including
social welfare programs, have worked to improve mental health care access. For a discussion
of current challenges in mental health care and proposed solutions, please see Module 6:
Barriers to Mental Health Care and Module 8: Improving Mental Health Care

A History of Mental Illness Treatment:

Obsolete Practices
Posted October 14, 2016 | By Tricia Hussung
Facebook37TwitterGoogle+EmailLinkedInShare

Mental illness affects many individuals in the United States. According to the National
Alliance on Mental Illness, approximately one in five American adults experience mental
illness each year. That’s 43.8 million people, or more than 18 percent of the population.
Children are affected as well, with about 13 percent of those ages 8 to 15 experiencing a
severe mental disorder at some point during their lives.

With data like this, it’s no surprise that attitudes toward mental health have changed for the
better in recent years. Though stigma still exists, CNN reports that 90 percent of Americans
value mental and physical health equally, according to a 2015 survey by the American
Foundation for Suicide Prevention (AFSP), the National Action Alliance for Suicide
Prevention and the Anxiety and Depression Association of America. “People see connection
between mental health and overall well-being, our ability to function at work and at home and
how we view the world around us,” Dr. Christine Moutier of AFSP told CNN. This change
comes as mental health approaches continue to focus on community-oriented, holistic care.

This hasn’t always been the case, however. Mental health treatment has undergone extensive
change over the years, with some strategies being ineffective and even dangerous: “Many of
the treatments enacted on mentally ill patients throughout history have been ‘pathological
sciences’ or ‘sensational scientific discoveries that later turned out to be nothing more than
wishful thinking or subjective effects’” rather than actually benefiting patients, History
Cooperative says. The following are just some of history’s strangest obsolete mental illness
treatments.
History of Mental Illness Treatment
Trephination

As one of the earliest forms of mental health treatment, trephination removed a small part of
the skull using an auger, bore or saw. Dated from around 7,000 years ago, this practice was
likely used to relieve headaches, mental illness or even the belief of demonic possession. Not
much is known about the practice due to lack of evidence.

Bloodletting and Purging

Though this treatment gained prominence in the Western world beginning in the 1600s, it has
its roots in ancient Greek medicine. Claudius Galen believed that disease and illness stemmed
from imbalanced humors in the body. English physician Thomas Willis used Galen’s writings
as a basis for this approach to treating mentally ill patients. He argued that “an internal
biochemical relationship was behind mental disorders. Bleeding, purging, and even vomiting
were thought to help correct those imbalances and help heal physical and mental illness,”
according to Everyday Health. These tactics were used to treat more than mental illness,
however: Countless diseases like diabetes, asthma, cancer, cholera, smallpox and stroke were
likely to be treated with bloodletting using leeches or venesection during the same time
period.

Isolation and Asylums

Isolation was the preferred treatment for mental illness beginning in medieval times, so it’s
no surprise that insane asylums became widespread by the 17th century. These institutions
were “places where people with mental disorders could be placed, allegedly for treatment, but
also often to remove them from the view of their families and communities,” Everyday
Health says. Overcrowding and poor sanitation were serious issues in asylums, which led to
movements to improve care quality and awareness. At the time, the medical community often
treated mental illness with physical methods. This is why brutal tactics like ice water baths
and restraint were often used.

Insulin Coma Therapy

This treatment was introduced in 1927 and was used for several decades until the 1960s. In
insulin coma therapy, physicians deliberately put the patient into a low blood sugar coma
because they believed large fluctuations in insulin levels could alter the function of the brain.
Insulin comas could last anywhere between one and four hours. Patients were given an
insulin injection that caused their blood sugar to fall and the brain to lose consciousness.
Risks included prolonged coma (in which the patient failed to respond to glucose), and the
mortality rate varied between 1 and 10 percent. Electroconvulsive therapy was later
introduced as a safer alternative to insulin coma therapy.

Metrazol Therapy

In metrazol therapy, physicians induced seizures using a stimulant medication. Seizures

began roughly a minute after the patient received the injection and could result in fractured
bones, torn muscles and other adverse effects. The therapy was usually administered several
times a week. Metrazol was withdrawn from use by the FDA in 1982. While this treatment
 was dangerous and ineffective, seizure therapy was the precursor to electroconvulsive therapy
(ECT), which is still used in some cases to treat severe depression, mania and catatonia.

Lobotomy

This now-obsolete treatment won the Nobel Prize in Physiology and Medicine in 1949. It was
designed to disrupt the circuits of the brain but came with serious risks. Popular during the
1940s and 1950s, lobotomies were always controversial and prescribed in psychiatric cases
deemed severe. It consisted of surgically cutting or removing the connections between the
prefrontal cortex and frontal lobes of the brain. The procedure could be completed in five
minutes. Some patients experienced improvement of symptoms; however, this was often at
the cost of introducing other impairments. The procedure was largely discontinued after the
mid-1950s with the introduction of the first psychiatric medications.

Mental Health Treatment Today

As we learn more about the causes and pathology of various mental disorders, the mental
health community has developed effective, safe treatments in place of these dangerous,
outdated practices. Today, those experiencing mental disorders can benefit from
psychotherapy along with biomedical treatment and increased access to care. Treatments will
continue to change along with scientific and research developments, and as mental health
professionals gain more insight.

If you are interested in the treatment of mental disorders and relevant topics in psychology
like those covered here, consider Concordia University, St. Paul’s online Bachelor of Arts in
Psychology. This program equips students with the knowledge and tools necessary to excel in
the field of psychology

Historical perspectives on the theories,

diagnosis, and treatment of mental
illness
Issue: BCMJ, vol. 59 , No. 2 , March 2017 , Pages 86-88 MDs To Be
By: Marc Jutras, BBA, UBC Medicine, Class of 2018

A walk through the drastic transformation of attitudes toward mental illness throughout
history.






A+ A-

Attitudes and views toward psychopathology in the medical and larger social
community have undergone drastic transformation throughout history, at times
progressing through a rather tortuous course, to eventually receive validation and
scientific attention. Departing from a simplistic view centred on supernatural causes,
modern theories in the early 20th century began to recognize mental disorders as
unique disease entities, and two main theories of psychodynamics and behaviorism
emerged as potential explanations for their causes. With the increasing acceptance
of mental illness as a unique form of pathology, official diagnostic classification
systems were adopted, new avenues of research spawned, and modern approaches
to treatment incorporating pharmaacotherapy and psychotherapy were established.
Although much scientific progress has been made in the fields of diagnosing and
treating mental illness, at a societal level the recent psychiatric deinstitutionalization
movement has been met with mixed success, calling into question how to most
effectively implement into clinical practice the knowledge that has been gained over
the previous centuries.

The prevailing views of early recorded history posited that mental illness was the
product of supernatural forces and demonic possession, and this often led to
primitive treatment practices such as trepanning in an effort to release the offending
spirit.[1] Relatively little in the way of improvements were achieved throughout the
European Middle Ages, and the oppressive sociopolitical climate saw many sufferers
of mental illness being submitted to physical restraint and solitary confinement in the
asylums of the time.[2] It was not until the late 19th and early 20th centuries that
modern theories of psychopathology began to emerge.

Around this time, two main theoretical approaches began to inform our
understanding of mental illness: the psychodynamic theory proposed by Austrian
neurologist Sigmund Freud (1856–1939), and the theory of behaviorism advanced
by American psychologist John B. Watson (1878–1958).[2] Freud’s theory of
psychodynamics centred on the notion that mental illness was the product of the
interplay of unresolved unconscious motives, and should be treated through various
methods of open dialogue with the patient.[2] Behaviorism, on the other hand,
suggested that psychopathology was more closely related to the effects of
behavioral conditioning, and that treatment should focus on methods of adaptive
reconditioning, using the same principles of classical conditioning elucidated by the
Russian physiologist Ivan Pavlov (1849–1936).[2]

Against the backdrop of these broad theoretical frameworks, modern approaches to

the diagnosis and treatment of psychopathology began to emerge and, along with
these, the need to systematically categorize mental illness became apparent. In
post–Second World War North America a need for a formal classification system
was recognized in order to provide more efficient and targeted mental health
services for veterans.[3] This led to the creation of the first edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) in 1952, which was largely drawn
from the World Health Organization’s sixth edition of the International Classification
of Diseases (ICD-6).[3] Early editions of the DSM described mental disorders in
terms of “reactions,” postulating that such illnesses should be classified with
reference to antecedent socio-environmental and biological causative factors.[3]
However, in 1980 with the publication of the third edition, the DSM shifted its focus
and intentionally remained neutral on the potential etiological causes of the various
forms of mental illness. This position was maintained in subsequent editions,
including the current DSM-5, published in 2013.[3]

With theoretical frameworks and a classification system in place, the study and
treatment of mental illness began to expand significantly in the mid-20th century.
Important developments in this period laid the foundation for modern pharmacologic
and psychotherapeutic approaches aimed at addressing mental illness. From a
pharmacological perspective, the catecholamine hypothesis, published in the 1950s,
was an influential milestone although perhaps overly simplistic. Following research
into the actions of drugs like reserpine and monoamine oxidase inhibitors, the
catecholamine hypothesis proposed that depression and other affective disorders
were likely caused by decreased levels of catecholamines such as
norepinephrine.[4]

The field of psychotherapy, with its early roots in Freud’s psychodynamic theory, also
saw new developments in this period. In particular, individuals such as American
psychologist Albert Ellis (1913–2007) and American psychiatrist Aaron T. Beck (b.
1921) began adopting treatment approaches aimed at addressing the maladaptive
cognitions and emotions underlying mental disorders.[5,6] When combined with
principles of behaviorism, this approach led to the eventual development of
cognitive-behavioral therapy (CBT), the current gold standard psychotherapeutic
approach in the treatment of anxiety disorders.[7] Taken together, the catecholamine
hypothesis and the development of CBT have had a substantial impact on the
modern treatment of depression and anxiety, the two disorders accounting for the
highest proportion of disability-adjusted life years among mental illnesses across the
globe.[8]

In the latter half of the 20th century, various factors gave rise to the more recent
psychiatric deinstitutionalization movement in North America, including the advent of
antipsychotic drugs and the recognition that mental health expenses could be
reduced by using community-based outpatient settings in favor of inpatient care in
psychiatric hospitals.[9] In response to the recommendations of the Canadian Mental
Health Association in the 1960s,[10] deinstitutionalization was adopted in Canada
and is ongoing today.[2] Unfortunately, throughout Canada, the increase in
community-based mental health services has not kept pace with the closure of
psychiatric hospitals,[11] contributing to problems of homelessness and crime
among many sufferers of mental illness.[2] The closure of Riverview Hospital, a
mental health facility in Coquitlam, serves as a poignant local example. Amid
debates about how to best deal with addiction and mental health problems in BC,
Riverview Hospital is currently slated to reopen by 2019,[12] and it will be interesting
to see how other regions across the country respond to the ongoing challenges of
mental health care.

Western civilization’s relationship with mental illness has had a complex and varied
history, characterized by periods of relative scientific inertia and ostracism of those
afflicted, as well as periods of great theoretical insight and progressive thinking.
Following the abandonment of supernatural explanations/theories and with the
emergence of logical thought and experimental reasoning after the Middle Ages, the
stage was set for a transition to a humane method of treating mental illness. This
shift led to the advent of modern theories of mental illness, dedicated classification
systems, as well as theoretical approaches to treatment based on clinical evidence.
Despite such progress, there remain ongoing public health concerns with respect to
effectively implementing the most appropriate model of mental health care for
society, and these will likely serve as major themes in the next chapter of the history
of mental illness.

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History of mental disorders

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Contents

 1 Historical conceptions of abnormal behavior

o 1.1 Supernatural tradition
o 1.2 Biological tradition
o 1.3 Psychological tradition
 2 Ancient period
o 2.1 Mesopotamia
o 2.2 Egypt
o 2.3 India
o 2.4 China
o 2.5 Greece and Rome
o 2.6 Israel and the Hebrew diaspora
 3 Middle ages
o 3.1 Persia, Arabia and the Muslim empire
o 3.2 Christian Europe
 4 Modern period
o 4.1 16th to 18th centuries
o 4.2 19th century
o 4.3 20th century
o 4.4 21st century
  4.4.1 USA
 5 History of mental health treatment
o 5.1 Prehistory
o 5.2 Antiquity
o 5.3 Medieval era
o 5.4 19th Century
o 5.5 20th Century
o 5.6 21st century
 6 See also
 7 Notes and references
 8 Further reading

Historical conceptions of abnormal behavior[edit]

Explanations of abnormal behavior derive from theories or models popular at the time. Three
major models, namely, supernatural model, biological model and psychological model.[1]

Supernatural tradition[edit]

For much of our recorded history, deviant behavior has been considered a reflection of the
battle between good and evil. When confronted with unexplainable, irrational behavior and
by suffering and upheaval, people have perceived evil. In fact, in the Great Persian Empire
from 900 to 600 B.C., all physical and mental disorders were considered the work of the
devil.[2]

Biological tradition[edit]

Physical causes of mental disorders have been sought in history. Important to this tradition
are a man, Hippocrates; a disease, syphilis; and the early consequences of believing that
psychological disorders are biologically caused.[3]

Psychological tradition[edit]

This was a precursor to modern psychosocial treatment approaches to the causation of

psychopathology, with the focus on psychological, social and cultural factors. Well known
philosophers like Aristotle, Plato, etc., wrote about the importance of fantasies, dreams,
cognitions, and thus anticipated, to some extent, later developments in psychoanalytic
thought and cognitive science. They also advocated humane and responsible care for
individuals with psychological disturbances.[4]

Ancient period[edit]
Mesopotamia[edit]

Mental illnesses were well known in ancient Mesopotamia,[5] where diseases and mental
disorders were believed to be caused by specific deities.[6] Because hands symbolized control
over a person, mental illnesses were known as "hands" of certain deities.[6] One psychological
illness was known as Qāt Ištar, meaning "Hand of Ishtar".[6] Others were known as "Hand of
Shamash", "Hand of the Ghost", and "Hand of the God".[6] Descriptions of these illnesses,
however, are so vague that it is usually impossible to determine which illnesses they
correspond to in modern terminology.[6] Mesopotamian doctors kept detailed record of their
patients' hallucinations and assigned spiritual meanings to them.[5] A patient who hallucinated
that he was seeing a dog was predicted to die;[5] whereas, if he saw a gazelle, he would
recover.[5] The royal family of Elam was notorious for its members frequently suffering from
insanity.[5] Erectile dysfunction was recognized as being rooted in psychological problems.[5]

Egypt[edit]

Limited notes in an ancient Egyptian document known as the Ebers papyrus appear to
describe the affected states of concentration, attention, and emotional distress in the heart or
mind.[7] Some of these were interpreted later, and renamed as hysteria and melancholy.
Somatic treatments included applying bodily fluids while reciting magical spells.
Hallucinogens may have been used as a part of the healing rituals. Religious temples may
have been used as therapeutic retreats, possibly for the induction of receptive states to
facilitate sleep and the interpretation of dreams.[8]

India[edit]
This section relies largely or entirely on a single source. Relevant discussion may be found
on the talk page. Please help improve this article by introducing citations to additional
sources. (December 2016)

Ancient Hindu scriptures-Ramayana and Mahabharata-contain fictional descriptions of

depression and anxiety.[9] Mental disorders were generally thought to reflect abstract
metaphysical entities, supernatural agents, sorcery and witchcraft. The Charaka Samhita from
circa 600 BC, which is a part of the Hindu Ayurveda ("knowledge of life"), saw ill health as
resulting from an imbalance among the three body fluids or forces called Tri-Dosha. These
also affected the personality types among people. Suggested causes included inappropriate
diet, disrespect towards the gods, teachers or others, mental shock due to excessive fear or
joy, and faulty bodily activity. Treatments included the use of herbs and ointments, charms
and prayers, and moral or emotional persuasion.[10]

China[edit]

The earliest known record of mental illness in ancient China dates back to 1100 B.C.[11]
Mental disorders were treated mainly under Traditional Chinese Medicine using herbs,
acupuncture or "emotional therapy". The Inner Canon of the Yellow Emperor described
symptoms, mechanisms and therapies for mental illness, emphasizing connections between
bodily organs and emotions. The ancient Chinese believed that demonic possession played a
role in mental illness during this time period. They felt that areas of emotional outbursts such
as funeral homes could open up the Wei Chi and allow entities to possess an individual.
Trauma was also considered to be something that caused high levels of emotion. Thus,
trauma is a possible catalyst for mental illness, due to its ability to allow the Wei Chi open to
possession. This explains why the ancient Chinese believed that a mental illness was in
reality a demonic possession.[12] According to Chinese thought, five stages or elements
comprised the conditions of imbalance between Yin and yang. Mental illness, according to
the Chinese perspective is thus considered as an imbalance of the yin and yang because
optimum health arises from balance with nature.[13]
China was one of the earliest developed civilizations in which medicine and attention to
mental disorders were introduced (Soong, 2006)As in the West, Chinese views of mental
disorders regressed to a belief in supernatural forces as causal agents. From the later part of
the second century through the early part of the ninth century, ghosts and devils were
implicated in “ghostevil” insanity, which presumably resulted from possession by evil spirits.
The “Dark Ages” in China, however, were neither so severe (in terms of the treatment of
mental patients) nor as long-lasting as in the West. A return to biological, somatic (bodily)
views and an emphasis on psychosocial factors occurred in the centuries that followed. Over
the past 50 years, China has been experiencing a broadening of ideas in mental health
services and has been incorporating many ideas from Western psychiatry (Zhang & Lu, 2006)
[14]

Greece and Rome[edit]

Main article: Mental illness in ancient Greece

In ancient Greece and Rome, madness was associated stereotypically with aimless wandering
and violence. However, Socrates considered positive aspects including prophesying (a 'manic
art'); mystical initiations and rituals; poetic inspiration; and the madness of lovers. Now often
seen as the very epitome of rational thought and as the founder of philosophy, Socrates freely
admitted to experiencing what are now called "command hallucinations" (then called his
'daemon'). Pythagoras also heard voices.[15] Hippocrates (470–ca. 360 BC) classified mental
disorders, including paranoia, epilepsy, mania and melancholia.[16]

Through long contact with Greek culture, and their eventual conquest of Greece, the Romans
absorbed many Greek (and other) ideas on medicine.[17] The humoral theory fell out of favor
in some quarters. The Greek physician Asclepiades (ca. 124–40 BC), who practiced in Rome,
discarded it and advocated humane treatments, and had insane persons freed from
confinement and treated them with natural therapy, such as diet and massages. Arateus (ca.
AD 30–90) argued that it is hard to pinpoint from where a mental illness comes. However,
Galen (AD 129–ca. 200), practicing in Greece and Rome, revived humoral theory.[18] Galen,
however, adopted a single symptom approach rather than broad diagnostic categories, for
example studying separate states of sadness, excitement, confusion and memory loss.[15]

Playwrights such as Homer, Sophocles and Euripides described madmen driven insane by the
gods, imbalanced humors or circumstances. As well as the triad (of which mania was often
used as an overarching term for insanity) there were a variable and overlapping range of
terms for such things as delusion, eccentricity, frenzy, and lunacy. Physician Celsus argued
that insanity is really present when a continuous dementia begins due to the mind being at the
mercy of imaginings. He suggested that people must heal their own souls through philosophy
and personal strength. He described common practices of dietetics, bloodletting, drugs,
talking therapy, incubation in temples, exorcism, incantations and amulets, as well as
restraints and "tortures" to restore rationality, including starvation, being terrified suddenly,
agitation of the spirit, and stoning and beating. Most, however, did not receive medical
treatment but stayed with family or wandered the streets, vulnerable to assault and derision.
Accounts of delusions from the time included people who thought themselves to be famous
actors or speakers, animals, inanimate objects, or one of the gods. Some were arrested for
political reasons, such as Jesus ben Ananias who was eventually released as a madman after
showing no concern for his own fate during torture.
Israel and the Hebrew diaspora[edit]

Passages of the Hebrew Bible/Old Testament have been interpreted as describing mood
disorders in figures such as Job, King Saul and in the Psalms of David.[18] In the Book of
Daniel, King Nebuchadnezzar is described as temporarily losing his sanity.[19] Mental
disorder was not a problem like any other, caused by one of the gods, but rather caused by
problems in the relationship between the individual and God.[citation needed] They believed that
abnormal behavior was the result of possessions that represented the wrath and punishment
from God. This punishment was seen as a withdrawal of God's protection and the
abandonment of the individual to evil forces.[20]

From the beginning of the twentieth century, the mental health of Jesus is also
discussed.[21][22][23]

Middle ages[edit]
Persia, Arabia and the Muslim empire[edit]

Persian and Arabic scholars were heavily involved in translating, analyzing and synthesizing
Greek texts and concepts. As the Muslim world expanded, Greek concepts were integrated
with religious thought and over time, new ideas and concepts were developed. Arab texts
from this period contain discussions of melancholia, mania, hallucinations, delusions, and
other mental disorders. Mental disorder was generally connected to loss of reason, and
writings covered links between the brain and disorders, and spiritual/mystical meaning of
disorders.[24] wrote about fear and anxiety, anger and aggression, sadness and depression, and
obsessions.

Authors who wrote on mental disorders and/or proposed treatments during this period include
Al-Balkhi, Al-Razi, Al-Farabi, Ibn-Sina, Al-Majusi[25] Abu al-Qasim al-Zahrawi,
Averroes,[26] and Unhammad.[27]

Some thought mental disorder could be caused by possession by a djinn (genie), which could
be either good or demon-like. There were sometimes beatings to exorcise the djin, or
alternatively over-zealous attempts at cures.[28] Islamic views often merged with local
traditions. In Morocco the traditional Berber people were animists and the concept of sorcery
was integral to the understanding of mental disorder; it was mixed with the Islamic concepts
of djin and often treated by religious scholars combining the roles of holy man, sage, seer and
sorcerer.[29]

The first bimaristan was founded in Baghdad in the 9th century, and several others of
increasing complexity were created throughout the Arab world in the following centuries.
Some of the bimaristans contained wards dedicated to the care of mentally ill patients,[30]
most of whom suffered from debilitating illnesses or exhibited violence.[24] In the centuries to
come, the Muslim world would eventually serve as a critical way station of knowledge for
Renaissance Europe, through the Latin translations of many scientific Islamic texts. Ibn-
Sina's (Avicenna's) Canon of Medicine became the standard of medical science in Europe for
centuries, together with works of Hippocrates and Galen.[31]
Christian Europe[edit]

Conceptions of madness in the Middle Ages in Europe were a mixture of the divine,
diabolical, magical and transcendental. Theories of the four humors (black bile, yellow bile,
phlegm, and blood) were applied, sometimes separately (a matter of "physic") and sometimes
combined with theories of evil spirits (a matter of "faith"). Arnaldus de Villanova (1235–
1313) combined "evil spirit" and Galen-oriented "four humours" theories and promoted
trephining as a cure to let demons and excess humours escape. Other bodily remedies in
general use included purges, bloodletting and whipping. Madness was often seen as a moral
issue, either a punishment for sin or a test of faith and character. Christian theology endorsed
various therapies, including fasting and prayer for those estranged from God and exorcism of
those possessed by the devil.[32] Thus, although mental disorder was often thought to be due
to sin, other more mundane causes were also explored, including intemperate diet and
alcohol, overwork, and grief.[33] The Franciscan friar Bartholomeus Anglicus (ca. 1203 –
1272) described a condition which resembles depression in his encyclopedia, De
Proprietatibis Rerum, and he suggested that music would help. A semi-official tract called
the Praerogativa regis distinguished between the "natural born idiot" and the "lunatic". The
latter term was applied to those with periods of mental disorder; deriving from either Roman
mythology describing people "moonstruck" by the goddess Luna[34] or theories of an
influence of the moon.[35][36]

Episodes of mass dancing mania are reported from the Middle Ages, "which gave to the
individuals affected all the appearance of insanity".[37] This was one kind of mass delusion or
mass hysteria/panic that has occurred around the world through the millennia.[38]

The care of lunatics was primarily the responsibility of the family. In England, if the family
were unable or unwilling, an assessment was made by crown representatives in consultation
with a local jury and all interested parties, including the subject himself or herself. The
process was confined to those with real estate or personal estate, but it encompassed poor as
well as rich and took into account psychological and social issues. Most of those considered
lunatics at the time probably had more support and involvement from the community than
people diagnosed with mental disorders today.[39] As in other eras, visions were generally
interpreted as meaningful spiritual and visionary insights; some may have been causally
related to mental disorders, but since hallucinations were culturally supported they may not
have had the same connections as today.[40]

Modern period[edit]
The examples and perspective in this section deal primarily with Western culture and do
not represent a worldwide view of the subject. You may improve this article, discuss the
issue on the talk page. (December 2016) (Learn how and when to remove this template message)

16th to 18th centuries[edit]

Some mentally disturbed people may have been victims of the witch-hunts that spread in
waves in early modern Europe.[41] However, those judged insane were increasingly admitted
to local workhouses, poorhouses and jails (particularly the "pauper insane") or sometimes to
the new private madhouses.[42] Restraints and forcible confinement were used for those
thought dangerously disturbed or potentially violent to themselves, others or property.[32] The
latter likely grew out of lodging arrangements for single individuals (who, in workhouses,
were considered disruptive or ungovernable) then there were a few catering each for only a
handful of people, then they gradually expanded (e.g. 16 in London in 1774, and 40 by 1819).
By the mid-19th century there would be 100 to 500 inmates in each. The development of this
network of madhouses has been linked to new capitalist social relations and a service
economy, that meant families were no longer able or willing to look after disturbed
relatives.[43]

Madness was commonly depicted in literary works, such as the plays of Shakespeare.[44][45]

By the end of the 17th century and into the Enlightenment, madness was increasingly seen as
an organic physical phenomenon, no longer involving the soul or moral responsibility. The
mentally ill were typically viewed as insensitive wild animals. Harsh treatment and restraint
in chains was seen as therapeutic, helping suppress the animal passions. There was
sometimes a focus on the management of the environment of madhouses, from diet to
exercise regimes to number of visitors. Severe somatic treatments were used, similar to those
in medieval times.[32] Madhouse owners sometimes boasted of their ability with the whip.
Treatment in the few public asylums was also barbaric, often secondary to prisons. The most
notorious was Bedlam where at one time spectators could pay a penny to watch the inmates
as a form of entertainment.[46][47]

Concepts based in humoral theory gradually gave way to metaphors and terminology from
mechanics and other developing physical sciences. Complex new schemes were developed
for the classification of mental disorders, influenced by emerging systems for the biological
classification of organisms and medical classification of diseases.

The term "crazy" (from Middle English meaning cracked) and insane (from Latin insanus
meaning unhealthy) came to mean mental disorder in this period. The term "lunacy", long
used to refer to periodic disturbance or epilepsy, came to be synonymous with insanity.
"Madness", long in use in root form since at least the early centuries AD, and originally
meaning crippled, hurt or foolish, came to mean loss of reason or self-restraint. "Psychosis",
from Greek "principle of life/animation", had varied usage referring to a condition of the
mind/soul. "Nervous", from an Indo-European root meaning to wind or twist, meant muscle
or vigor, was adopted by physiologists to refer to the body's electrochemical signalling
process (thus called the nervous system), and was then used to refer to nervous disorders and
neurosis. "Obsession", from a Latin root meaning to sit on or sit against, originally meant to
besiege or be possessed by an evil spirit, came to mean a fixed idea that could decompose the
mind.[48]

With the rise of madhouses and the professionalization and specialization of medicine, there
was considerable incentive for medical doctors to become involved. In the 18th century, they
began to stake a claim to a monopoly over madhouses and treatments. Madhouses could be a
lucrative business, and many made a fortune from them. There were some bourgeois ex-
patient reformers who opposed the often brutual regimes, blaming both the madhouse owners
and the medics, who in turn resisted the reforms.[43]

Towards the end of the 18th century, a moral treatment movement developed, that
implemented more humane, psychosocial and personalized approaches. Notable figures
included the medic Vincenzo Chiarugi in Italy under Enlightenment leadership; the ex-patient
superintendent Pussin and the psychologically inclined medic Philippe Pinel in revolutionary
France; the Quakers in England, led by businessman William Tuke; and later, in the United
States, campaigner Dorothea Dix.

19th century[edit]

The 19th century, in the context of industrialization and population growth, saw a massive
expansion of the number and size of insane asylums in every Western country, a process
called "the great confinement" or the "asylum era". Laws were introduced to compel
authorities to deal with those judged insane by family members and hospital superintendents.
Although originally based on the concepts and structures of moral treatment, they became
large impersonal institutions overburdened with large numbers of people with a complex mix
of mental and social-economic problems.[42] The success of moral treatment had cast doubt
on the approach of medics, and many had opposed it, but by the mid-19th century many
became advocates of it but argued that the mad also often had physical/organic problems, so
that both approaches were necessary. This argument has been described as an important step
in the profession's eventual success in securing a monopoly on the treatment of lunacy.
However, it is well documented that very little therapeutic activity occurred in the new
asylum system, that medics were little more than administrators who seldom attended to
patients, and then mainly for other physical problems.[43]

Clear descriptions of some syndromes, such as the condition that would later be termed
schizophrenia, have been identified as relatively rare prior to the 19th century,[49] although
interpretations of the evidence and its implications are inconsistent.[50]

Numerous different classification schemes and diagnostic terms were developed by different
authorities, taking an increasingly anatomical-clinical descriptive approach. The term
"psychiatry" was coined as the medical specialty became more academically established.
Asylum superintendents, later to be psychiatrists, were generally called "alienists" because
they were thought to deal with people alienated from society; they adopted largely isolated
and managerial roles in the asylums while milder "neurotic" conditions were dealt with by
neurologists and general physicians, although there was overlap for conditions such as
neurasthenia.[51]

In the United States it was proposed that black slaves who tried to escape were suffering from
a mental disorder termed drapetomania. It was then argued in scientific journals that mental
disorders were rare under conditions of slavery but became more common following
emancipation, and later that mental illness in African Americans was due to evolutionary
factors or various negative characteristics, and that they were not suitable for therapeutic
intervention.[52]

By the 1870s in North America, officials who ran Lunatic Asylums renamed them Insane
Asylums. By the late century, the term "asylum" had lost its original meaning as a place of
refuge, retreat or safety, and was associated with abuses that had been widely publicized in
the media, including by ex-patient organization the Alleged Lunatics' Friend Society and ex-
patients like Elizabeth Packard.[34]

The relative proportion of the public officially diagnosed with mental disorders was
increasing, however. This has been linked to various factors, including possibly humanitarian
concern; incentives for professional status/money; a lowered tolerance of communities for
unusual behavior due to the existence of asylums to place them in (this affected the poor the
most); and the strain placed on families by industrialization.[43]

20th century[edit]

The turn of the 20th century saw the development of psychoanalysis, which came to the fore
later. Kraepelin's classification gained popularity, including the separation of mood disorders
from what would later be termed schizophrenia.[53][page needed]

Asylum superintendents sought to improve the image and medical status of their profession.
Asylum "inmates" were increasingly referred to as "patients" and asylums renamed as
hospitals. Referring to people as having a "mental illness" dates from this period in the early
20th century.[34]

In the United States, a "mental hygiene" movement, originally defined in the 19th century,
gained momentum and aimed to "prevent the disease of insanity" through public health
methods and clinics.[54] The term mental health became more popular, however. Clinical
psychology and social work developed as professions alongside psychiatry. Theories of
eugenics led to compulsory sterilization movements in many countries around the world for
several decades, often encompassing patients in public mental institutions.[55] World War I
saw a massive increase of conditions that came to be termed "shell shock".

In Nazi Germany, the institutionalized mentally ill were among the earliest targets of
sterilization campaigns and covert "euthanasia" programs.[56] It has been estimated that over
200,000 individuals with mental disorders of all kinds were put to death, although their mass
murder has received relatively little historical attention. Despite not being formally ordered to
take part, psychiatrists and psychiatric institutions were at the center of justifying, planning
and carrying out the atrocities at every stage, and "constituted the connection" to the later
annihilation of Jews and other "undesirables" such as homosexuals in the Holocaust.[57]

In other areas of the world, funding was often cut for asylums, especially during periods of
economic decline, and during wartime in particular many patients starved to death.[58]
Soldiers received increased psychiatric attention, and World War II saw the development in
the US of a new psychiatric manual for categorizing mental disorders, which along with
existing systems for collecting census and hospital statistics led to the first Diagnostic and
Statistical Manual of Mental Disorders (DSM). The International Classification of Diseases
(ICD) followed suit with a section on mental disorders.

Previously restricted to the treatment of severely disturbed people in asylums, psychiatrists

cultivated clients with a broader range of problems, and between 1917 and 1970 the number
practicing outside institutions swelled from 8 percent to 66 percent.[59] The term stress,
having emerged from endocrinology work in the 1930s, was popularized with an increasingly
broad biopsychosocial meaning, and was increasingly linked to mental disorders.[60]
"Outpatient commitment" laws were gradually expanded or introduced in some countries.

Lobotomies, Insulin shock therapy, Electro convulsive therapy, and the "neuroleptic"
chlorpromazine came into use mid-century.

An antipsychiatry movement came to the fore in the 1960s. Deinstitutionalization gradually

occurred in the West, with isolated psychiatric hospitals being closed down in favor of
community mental health services. However, inadequate services and continued social
exclusion often led to many being homeless or in prison.[61] A consumer/survivor movement
gained momentum.

Other kinds of psychiatric medication gradually came into use, such as "psychic energizers"
and lithium. Benzodiazepines gained widespread use in the 1970s for anxiety and depression,
until dependency problems curtailed their popularity. Advances in neuroscience and genetics
led to new research agendas. Cognitive behavioral therapy was developed. Through the
1990s, new SSRI antidepressants became some of the most widely prescribed drugs in the
world.

The DSM and then ICD adopted new criteria-based classification, representing a return to a
Kraepelin-like descriptive system. The number of "official" diagnoses saw a large expansion,
although homosexuality was gradually downgraded and dropped in the face of human rights
protests. Different regions sometimes developed alternatives such as the Chinese
Classification of Mental Disorders or Latin American Guide for Psychiatric Diagnosis.

21st century[edit]
This section needs to be updated. Please update this article to reflect recent events or newly
available information. (December 2016)

USA[edit]

DSM-IV and previous versions of the Diagnostic and Statistical Manual of Mental Disorders
presented extremely high comorbidity, diagnostic heterogeneity of the categories, unclear
boundaries, that have been interpreted as intrinsic anomalies of the criterial, neopositivistic
approach leading the system to a state of scientific crisis.[62] Accordingly, a radical rethinking
of the concept of mental disorder and the need of a radical scientific revolution in psychiatric
taxonomy was proposed.[63]

In 2013, the American Psychiatric Association published the DSM–5 after more than 10 years
of research.[64]

History of mental health treatment[edit]

[65]

Prehistory[edit]

There is archealogical evidence for the use of trepanation in around 6500 BC.[66]

Antiquity[edit]

Hippocrates mentions the practice of bloodletting in the fifth century BC.[67]

Medieval era[edit]

In 1377, lunatics were moved from Stone House to Bethlem, one of the first psychiatric
institutions.[68]

19th Century[edit]

The "oldest forensic secure hospital in Europe" was opened in 1850 after Sir Thomas
Freemantle introduced the bill that was to establish a Central Criminal Lunatic Asylum in
Ireland in May 19, 1845.[69]

20th Century[edit]

In early 20th century, lobotomy was introduced till the mid-1950s.

In 1927 insulin coma therapy was introduced and used till 1960. Physicians deliberately put
the patient into a low blood sugar coma because they thought that large fluctuations in insulin
levels could alter the function of the brain. Risks included prolonged coma. Electroconvulsive
Therapy (ECT) was later adopted as a substitution to this.

21st century[edit]
This section needs to be updated. Please update this article to reflect recent events or newly
available information. (December 2016)

See also[edit]

 Care in the Community

 DSM-IV codes
 Eugenics
 History of psychiatric institutions
 Involuntary commitment
 Mad Pride
 Neurology
 Political abuse of psychiatry in the Soviet Union
 Psychiatric hospital
 Psychiatric medication
 Psychiatric survivors movement
 Psychoanalysis
 Retrospective diagnosis
 Sigmund Freud
 Structured Clinical Interview for DSM-IV (SCID)
 Timeline of psychiatry
 Animal psychopathology

Notes and references[edit]

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providers (3rd ed.). London: HarperPerennial. pp. 339–342. ISBN 978-0-06-095076-7.
OCLC 681395244. Torrey comments that very early mental illness descriptions do not seem
to fit schizophrenia, there is a ‘sporadic presence’ from the 17th century, and then c. 1800
“suddenly… it appeared.”
50. ^ Heinrichs, R. Walter (Fall 2003). "Historical origins of schizophrenia: two early madmen and
their illness". Journal of the History of the Behavioral Sciences. 39 (4): 349–63.
doi:10.1002/jhbs.10152. PMID 14601041. (Subscription required (help)).
51. ^ "Neurology and Psychiatry: Together and Separate". Tempus et Hora: Time and the Hour
(ANA 125th Anniversary). American Neurological Association. Archived from the original on
26 September 2006. Retrieved 24 July 2008.
52. ^ Harris, Herbert W.; Felder, Diane; Clark, Michelle O. (September 2004). "A Psychiatric
Residency Curriculum on the Care of African American Patients". Academic Psychiatry. 28 (3):
226–239. doi:10.1176/appi.ap.28.3.226. PMID 15507559. (Subscription required (help)).
53. ^ Berrios, German E.; Porter, Roy, eds. (1995). The History of Clinical Psychiatry: The Origin
and History of Psychiatric Disorders. London: Athlone Press. ISBN 978-0-485-24211-9.
OCLC 32823926.
54. ^ Mandell, Wallace (2007). "Origins of Mental Health: The Realization of an Idea". Johns
Hopkins Bloomberg School of Public Health: Department of Mental Health. Archived from the
original on 6 July 2008. Retrieved 9 August 2008.
55. ^ Kavles, Daniel J. (14 August 1999). "Eugenics and human rights". BMJ. 319 (7207): 435–
438. doi:10.1136/bmj.319.7207.435. PMC 1127045. PMID 10445929.
56. ^ Livingston, Kathy (16 August 2003). Deciding Who Dies: Evaluating the Social Worth of
People With Mental Illness during the Holocaust. Annual Meeting of the American
Sociological Association. Atlanta Hilton Hotel, Atlanta, GA: American Sociological
Association.
 57. ^ Strous, Rael D. (27 February 2007). "Psychiatry during the Nazi era: ethical lessons for the
modern professional". Annals of General Psychiatry. 6: 8. doi:10.1186/1744-859X-6-8.
PMC 1828151. PMID 17326822.
58. ^ Fakhoury, Walid; Priebe, Stefan (August 2007). "Deinstitutionalization and
reinstitutionalization: major changes in the provision of mental healthcare". Psychiatry. 6 (8):
313–316. doi:10.1016/j.mppsy.2007.05.008. (Subscription required (help)).
59. ^ Rosenthal, Susan (19 May 2008). "Mental Illness or Social Sickness?". Dissident Voice.
Retrieved 3 December 2010.
60. ^ Viner, Russell (June 1999). "Putting Stress in Life: Hans Selye and the Making of Stress
Theory". Social Studies of Science. 29 (3): 391–410. Bibcode:1989SoStS..19..127L.
doi:10.1177/030631299029003003. JSTOR 285410.
61. ^ Torrey, E. Fuller; Stieber, Joan; Ezekiel, Jonathan; Wolfe, Sidney M.; Sharfstein, Joshua;
Noble, John H.; Flynn, Laurie M. (1992). Criminalizing the Seriously Mentally Ill: The Abuse of
Jails as Mental Hospitals (Report). National Alliance for the Mentally Ill & Public Citizen
Health Research Group. ISBN 0-7881-4279-8. OCLC 604003248.
62. ^ Aragona, Massimiliano (March 2009). "The role of comorbidity in the crisis of the current
psychiatric classification system" (PDF). Philosophy, Psychiatry, & Psychology. 16: 1–11.
doi:10.1353/ppp.0.0211.
63. ^ Aragona, Massimiliano (June 2009). "The concept of mental disorder and the DSM-V"
(PDF). Dialogues in Philosophy, Mental and Neuro Sciences. 2 (1): 1–14.
64. ^ "DSM History". www.psychiatry.org. Retrieved 2018-06-07.
65. ^ |url=https://online.csp.edu/blog/psychology/history-of-mental-illness-treatment |journal=
Hussung, Tricia "A History of Mental Illness Treatment: Obsolete Practices" |
66. ^ Capasso, Luigi (2002). Principi di storia della patologia umana: corso di storia della
medicina per gli studenti della Facoltà di medicina e chirurgia e della Facoltà di scienze
infermieristiche [Principles of History of Human Pathology: History of Medicine Course for
Students of the Faculty of Medicine and Surgery and of the Faculty of Nursing Sciences] (in
Italian). Rome: SEU. ISBN 978-88-87753-65-3. OCLC 50485765.
67. ^ "Degeneration of Medicine and the Grisly Art of Slicing Open Arms". BBC. 29 November
2002. Retrieved 2009-07-12.
68. ^ 1922-2010., Jones, Kathleen (1972). A history of the mental health services. London:
Routledge and Kegan Paul. p. 12. ISBN 978-0710074522. OCLC 603321.
69. ^ "History of Central Mental Hospital". archive.li. 2014-11-17. Retrieved 2018-06-07.

Further reading[edit]

 Millon, Theodore (2004). Masters of the Mind: Exploring the Story of Mental Illness from
Ancient Times to the New Millennium. Hoboken, NJ: Wiley. ISBN 978-0-471-46985-8.
OCLC 54460256 – via Google Books.
 Kent, Deborah (2003). Snake Pits, Talking Cures & Magic Bullets: A History of Mental Illness.
Brookfield, CT: Twenty-First Century Books. ISBN 978-0-7613-2704-2. OCLC 50253057 – via
Google Books.
 Scull, Andrew (1989). Social Order/Mental Disorder: Anglo-American Psychiatry in Historical
Perspective. Medicine and society. 3. Berkeley: University of California Press. ISBN 978-0-520-
06406-5. OCLC 17982761 – via California Digital Library.
 Foucault, Michel (1961). Histoire de la folie à l'âge classique [Madness and Civilization].
Collection Tel (in French). 9. Gallimard. ISBN 978-2-07-029582-1. OCLC 45404661.
 Quétel, Claude (2009). Histoire de la folie : De l'Antiquité à nos jours (in French). Paris:
Editions Tallandier, Texto. ISBN 978-2-84734-927-6. OCLC 818987861.
  Hurd, Henry M.; Drewry, William F.; Dewey, Richard; Pilgrim, Charles W.; Blumer, G. Adler;
Burgess, T.J.W. (1916). Hurd, Henry Mills, ed. The Institutional Care of the Insane in the
United States and Canada. 1. Baltimore, MD: Johns Hopkins Press – via Google Books.

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Our History
Mental Health America (MHA) – founded in 1909 – is the nation’s leading community-based
non-profit dedicated to helping all Americans achieve wellness by living mentally healthier
lives. Our work is driven by our commitment to promote mental health as a critical part of
overall wellness, including prevention services for all, early identification and intervention
for those at risk, and integrated care and treatment for those who need it, with recovery as the
goal. All of our work is guided by the Before Stage 4 (B4Stage4) philosophy – that mental
health conditions should be treated long before they reach the most critical points in the
disease process.

Mental Health America was established by former psychiatric patient Clifford W. Beers.
During his stays in public and private institutions, Beers witnessed and was subjected to
horrible abuse. From these experiences, Beers set into motion a reform movement that took
shape as Mental Health America.

Read about the Mental Health Bell—The Symbol of Our Movement

Our work has resulted in positive change. We have educated millions about mental illnesses
and reduced barriers to treatment and services. As a result of Mental Health America's
efforts, many Americans with mental disorders have sought care and now enjoy fulfilling,
productive lives in their communities.

Our History by Decade

Looking Back: The History of Mental Health America

The history of Mental Health America is the remarkable story of one person who turned a
personal struggle with mental illness into a national movement and of the millions of others
who came together to fulfill his vision.

Around the turn of the twentieth century, Clifford W. Beers, a recent graduate of Yale
College and a newly-minted Wall Street financier, suffered his first episode of bipolar
disorder (manic depressive illness) following the illness and death of his brother. In the throes
of his illness, Beers attempted to take his own life by jumping out a third story window.
Seriously injured but still alive, Beers ended up in public and private hospitals in
Connecticut for the next three years.

While in these institutions, Beers learned firsthand of the deficiencies in care as well as the
cruel and inhumane treatment people with mental illnesses received. He witnessed and
experienced horrific abuse at the hands of his caretakers. At one point during his
institutionalization, he was placed in a straightjacket for 21 consecutive nights.

Upon his release, Beers was resolved to expose the maltreatment of people with mental
illnesses and to reform care. In 1908, he published his autobiography, A Mind That Found
Itself, which roused the nation to the plight of people with mental illnesses and set a reform
movement into motion. In the book, Beers declared, “As I penetrated and conquered the
mysteries of that dark side of my life, it no longer held any terror for me. I have decided to
stand on my past and look the future in the face.”

On February 19, 1909, Beers, along with philosopher William James and psychiatrist Adolf
Meyer, embraced that future by creating the National Committee for Mental Hygiene, later
the National Mental Health Association and what we know today as the Mental Health
America.

The organization set forth the following goals:

 to improve attitudes toward mental illness and the mentally ill;

 to improve services for people with mental illness ; and
 to work for the prevention of mental illnesses and the promotion of mental health.

From that momentous day, Mental Health America built a legacy of change and progress.
The following are selected highlights from Mental Health America’s nine decades of
service.

1900s

Clifford Beers sparked the mental health reform movement with an insightful autobiography,
A Mind That Found Itself, which chronicled his struggle with mental illness and the shameful
conditions he and millions of others endured in mental institutions throughout the country.
(1908)

Beers founded the Connecticut Society for Mental Hygiene in 1908, which would expand a
year later to form the National Committee for Mental Hygiene. The Committee was the
predecessor to the National Mental Health Association, which later became Mental Health
America on Nov. 16, 2006. (1908)

1910s

Mental Health America facilitated the creation of more than 100 child guidance clinics in the
United States aimed at prevention, early intervention and treatment. (1910)

At the request of the Surgeon General, Mental Health America drafted a mental ‘hygiene’
program, which was adopted by the Army and the Navy, in preparation for the First World
War. (1917)

1920s

Mental Health America produced a set of model commitment laws, which were subsequently
incorporated into the statutes of several states. (1920)

1930s

Mental Health America convened the First International Congress on Mental Hygiene in
Washington D.C., bringing together more than 3,000 individuals from 41 countries. (1930)

1940s

The “National Mental Health Act,” which created the National Institute of Mental Health,
passed as a result of Mental Health America’s advocacy. (1946)

Mental Health America launched Mental Health Week (which eventually became Mental
Health Month) with the Jaycees to educate Americans about mental illness and mental health.
(1949)

1950s

To symbolize its mission of change, Mental Health America commissioned the casting of the
Mental Health Bell from chains and shackles that restrained people with mental illnesses in
decades past. (1953)

Mental Health America joined and supported the Commission on Mental Illness and Mental
Health, which was created and funded by Congress. (1955)

1960s

Mental Health America convened the National Leadership Conference on Action for Mental
Health, in which 100 national voluntary organizations participated. (1962)
Congress passed the “Community Mental Health Centers Act” (CMHC) authorizing
construction grants for community mental health centers. Mental Health America played a
key role in having this legislation enacted and signed by President Kennedy. (1963)

Community Mental Health Centers Act calls for deinstitutionalization and increased
community services. (1963)

Mental Health America successfully advocated for inclusion of mandated mental heath
services in Medicare. (1966)

Mental Health America advocated for renewal of the CMHC Act and for increased
appropriations. (1969)

1970s

Mental Health America produced and distributed the film Only Human, which aired on more
than 150 television stations, to improve public understanding of mental illness and public
acceptance of persons with mental illnesses. (1971)

President Nixon impounded funds appropriated for the National Institute of Mental Health.
Mental Health America was instrumental in reversing the decision. (1972)

Acting on a lawsuit in which Mental Health America participated, a federal judge ordered the
release of $52 million in impounded funds voted by Congress for community mental health
centers. (1973)

The U.S. Civil Service Commission acceded to Mental Health America’s demand that a
“Have you ever been mentally Ill?” question be removed from federal government
employment forms. (1974)

President Carter established the President’s Commission on Mental Health, the first
comprehensive survey of mental healthcare since the 1950s. Many Mental Health America
volunteers were named to the Commission and its task forces. (1977)

1980s

Mental Health America helped to form the National Alliance for Research on Schizophrenia
and Depression (NARSAD), a foundation formed with the purpose of raising private sector
funds to support research on mental illnesses. (1981)

Mental Health America sponsored the National Commission on the Insanity Defense public
hearings, co-chaired by former Sen. Birch Bayh and Mental Health America President-Elect
Thomas H. Brinkley. (1982)

EEOC chief Patricia Roberts Harris chaired Mental Health America’s National Commission
on Unemployment and Mental Health. (1983)

Mental Health America’s public policy initiative resulted in the passage of theProtection and
Advocacy for the Mentally Ill Act by Congress. (1985)
Mental Health America and the Families for the Homeless launched the development of a
major nationwide photographic exhibit depicting the human side of “Homeless in America.”
(1987)

Mental Health America organized the National Action Commission on the Mental Health of
Rural Americans to study service and policy issues regarding the delivery of mental health
services to citizens living in rural areas whose lives have been impacted by major social and
economic change. (1987)

Mental Health America released its Report of the Invisible Children Project, which revealed
the gross neglect and over-institutionalization of children with emotional disorders in the U.S.
(1989)

1990s

Mental Health America and the American Red Cross jointly published and distributed more
than 250,000 copies of When the Yellow Ribbons Come Down, a guidebook to help
Operation Desert Storm veterans and their families cope with readjusting to life at home.
(1990)

Mental Health America played a leading role in the development of the Americans with
Disabilities Act, which protects mentally and physically disabled Americans from
discrimination in such areas as employment, public accommodations, transportation,
telecommunications, and state and local government services. (1990)

Mental Health America launched its National Public Education Campaign on Clinical
Depression with an unprecedented media launch reaching millions of Americans through
public service announcements and advertising. (1993)

Mental Health America, in conjunction with the Congressional Black Caucus and the
National Institute of Mental Health, organized the first comprehensive conference on The
State of Mental Health and Mental Illness in Black America. (1994)

Mental Health America helped secure passage of the “Mental Health Parity Act,” the first
federal legislation to bring more equity to health insurance coverage of mental health care.
(1996)

Mental Health America was instrumental in President Clinton’s decision to end

discrimination in mental health insurance coverage for 9 million federal workers and their
families by enacting mental health insurance parity for federal workers. (1998)

Mental Health America released a nationwide study that revealed the top reasons individuals
refused to seek help for anxiety disorders, the most common mental illnesses, which included
shame, fear, and embarrassment. (1998)

2000s

Mental Health America released the first-ever survey of children that reported that 78 percent
of teens who were gay or thought to be gay were teased or bullied in their schools and
communities. (2002)
Mental Health America released the results of a survey on national awareness of bipolar
disorder, which showed that two-thirds of Americans hold limited, if any, knowledge of this
common illness. (2003)

Mental Health America’s advocacy resulted in a landmark Supreme Court ruling declaring
the death penalty for juvenile offenders unconstitutional, thereby removing 73 individuals
from death row. (2005)

Mental Health America, along with a coalition of mental health agencies and advocates,
succeeded in getting the Mental Health Parity Act signed into law. (2008

 home
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Mental health

Official asylum records in the Medical History of British India Mental Health collection highlight the colonial

context of psychiatry in British India and colonial ideas about the native body.

The rise of the asylum

In Britain, legislature for the building of asylums began in the 19th century:

 Lunacy Act 1808

 County Asylums Act 1828
 Lunacy Act 1845.

The rise of capitalism, urbanisation, and the power and prestige of the medical community assisted the

development of the asylum. Before the 19th century, those deemed ‘lunatics’ were not usually institutionalised,
but were cared for by family, friends, or parishes. In other cases they were housed with the poor and the
criminals.

Changes after the Indian Rebellion

While there existed houses for the detention of mentally ill sepoys in India, the situation was much the same, and
did not change significantly after the 1857 Indian rebellion.

The rebellion prompted Britain to take a more direct role in India and its institutions. This included medicine, and
by extension psychiatry, a field that was gaining respectability in the west.

The first Lunacy Act in India was enforced in 1858 and throughout the latter half of the 19th century asylums for
both Europeans and natives were established throughout British India.

The Mental Health collection depicts this expansion, allowing evaluation of the quality of asylum care and
conditions from 1867 to 1948. Colonial doctors' explanations for the improvement or deterioration of asylum
conditions are also offered in the reports.

Labelling mental illness

The epidemiology of mental illness during the British rule of India can be mapped in the statistical tables which
identify and categorise mental illness.

The regular addition to physical causes of insanity such as small-pox, venereal disease and typhoid up to the

early 1900s demonstrates that, as some historians have argued, there was more focus on physical conditions

than mental. The inclusion of masturbation, syphilis and witchcraft as causes of insanity in the Bengal reports
uncovers some of the British cultural and social perceptions of madness and of their colonial subjects.

From the 1860s until 1912, types of insanity appear as various forms of mania and dementia, melancholia and

imbecility. From 1912 types and causes were merged, but retained many physical categories, and still listed
alcohol and cannabis as causes of mental illness.

The role of asylums in India

Reports offer the user the opportunity to view and explore colonial rhetoric concerning the role of the asylum and
reveal that it served both as a mechanism for social control and as a therapeutic place.

Colonial personnel wished to civilise or constrain the indigenous population, frequently admitting members of

wandering gangs and those accused of 'mischief'. The testing of new therapies on patients by staff can be
viewed as exploitative and motivated by the desire for professional recognition.
Yet the reports reveal that asylums actively encouraged improvement and many emphasise the intention to

alleviate and understand patients' suffering whether native or European. Notably, disparaging descriptions of the

local population evident in other collections of the Medical History of British India are missing from references to
asylum patients and their behaviour.

Patient management

British efforts and motivation to provide asylum care based on the increasingly popular, more humane 'moral
management' system can be examined in the Mental Health collection reports.

Authors of reports emphasise the need to treat patients kindly, to maintain cleanliness and to provide a good diet

alongside occupational therapy. Treatment within the asylums represented the norms and values of 19th and
early 20th-century Britain and the desire to transplant these into colonial India.

Occupational therapy introduced a ‘normal’ working routine to the patients and was the primary method of trying
to improve the patients' wellbeing.

The reports describe patients working in the asylum grounds and producing goods such as matting, coir and oil.

Statistical tables show the revenue from 'lunatic labour'. The British idea of a sane, healthy, functioning person
was one that involved submissiveness, obedience, self-regulation, and productivity.

Notably, there was a gendered division of the work in the asylums – female patients performed gardening tasks

while buildings were maintained by men. The reports allow us to explore the extent to which British, western

capitalist values were communicated through the treatment of the patients and how these values were
subsequently categorised as normal.

Restraints and rewards

The abuse of patients by staff is deemed intolerable, with staff being dismissed for such offences. Mechanical

restraint of 'excited' and unruly patients, such as belts, sheets, bags and hand cuffs were used in some asylums
– for example, Dullunda and Patna – but in others it was fervently discouraged.

'Moral treatment' – including sedation with drugs – which aimed at keeping patients docile and disciplined

reduced the need for mechanical restraint, although the reports show that there were debates about the
appropriateness of both.

Parties, lantern slides, outings and fireworks were also deemed good for the patients' wellbeing and mood,

particularly those who were usually seen as 'apathetic'. In some institutions patients made pets from local wildlife
and were rewarded with outings.

Drug treatment
Drug treatment included digitalis, hypodermic injections of morphia, hydrocyanic acid for mania and atropine,

bromide and sodium dilantin for epileptic seizures. In the 1930s chemical treatments such as cardiazol

'convulsion' and insulin 'shock' or 'coma' therapy gained popularity in treating schizophrenia. Colonial doctors

travelled to other countries and corresponded with others, trialling drugs and sharing results, as documented in
Ranchi Indian Mental Hospital, Bihar.

Descriptions of 'nitrogen gas inhalation' and 'prolonged continuous sleep treatment', which were in vogue in

Canada and America respectively, allow analysis of the spread and success of emerging therapies. By 1939

Electric Convulsion Therapy (ECT) from Italy was viewed as a cheaper replacement for cardiazol convulsion
therapy in India, around the same time as it was in Britain.

Health link to asylum conditions

Morbidity and mortality rates within the asylums can be tracked from tabular data, providing a view of patient

health over time and relating to changing conditions in the asylums. Government medical personnel consider how

best to maintain a sanitary environment and tackle the problem of overcrowding – for example, dry-earthing and
building extensions.

Patients and staff

Asylum patients were primarily from a poor social background, and of a low caste. Statistics and returns in the

reports show gender, race, class, occupation and ethnicity of those admitted. Most asylums housed natives only,
although some asylums were built exclusively to shelter Europeans, such as Bhowinapore in Bengal.

Reports up to the late 1870s list asylum patients by name, providing information on native and European
ancestors for genealogists.

Europeans deemed mentally ill, including 'military insanes', were quickly despatched to Britain and the reports
show that they were invalided or sent to private or public asylums.

Historians have argued that this measure was taken to preserve the image of the colonial rulers as healthy, elite,

and superior. Housing Europeans in the asylums of India could risk revealing weakness to the natives,
compromising the perception of the British as a superior race, thus threatening the colonial order.

European and native staff

The Indian asylums were staffed by both Europeans and natives. As in Britain, asylum work was unpopular.

Despite the difficulty in finding people willing to work in the asylums, Indians were excluded from all but the
lowest of posts.
The records contain praise for the native staffs, as well as complaints, most often about the inefficiency of the

wards – accompanied, however, by recognition that the pay for these already undesirable positions was so low
as to provide no motivation for a good work ethic.

The staff as a whole had little formal training in psychiatry, and psychiatry itself was still in the early stages of
understanding mental illness.

It was common practice, for example, to incarcerate those with epilepsy as insane. However, following the Indian
Lunacy Act of 1912 the emphasis is placed, for example, in Agra and Oudh, on offering advice and treatment.

From 'lunatics' to 'patients'

From 1920s when the term 'lunatic asylum' is replaced with 'mental hospital' the reports reflect the changes in

psychiatry occurring in Britain where the purpose of the asylum shifted from refuge to hospital. More specialist
staff are employed and 'lunatics' become 'patients'.

Yet, as late as 1945, the Assam Mental Hospital in Tezpur is described as in 'a mixed state of a prison, an
asylum and a mental home'.

Cannabis and insanity

Diagnosis of the insane, as seen in the Mental Health collection, reflects early and incomplete understandings of
mental illness. The asylum records distinguish between moral and physical causes of insanity.

The most frequently listed physical cause was the abuse of intoxicating drugs – specifically hemp, as J C Penny,

Superintendent of the Delhi lunatic asylum, stated in 1872: 'Insanity or permanent disorder of the mind is a result
of the evil habit of over-indulgence in this narcotic.'

However, the tendency to pinpoint cannabis as the main cause of insanity in Indian asylums was later revealed

as flawed. The Indian Hemp Drugs Commission 1893/1894 ruled that asylums statistics were unreliable, with

drug abuse being used as the default cause of insanity by persons – usually policemen – unqualified in
psychiatry.

It was also during this period that ideas of addiction developed and became medicalised – for example,
'Cannabis Indica Psychosis' is listed as a mental disease from the late 1920s until 1951.

While excessive use of cannabis was considered dangerous, the idea that moderate use caused insanity was

increasingly refuted. Furthermore, the asylum reports show that cannabis and opium were actually used on
occasion in the asylums for the purpose of calming patients.

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Plan of Bankipore Lunatic Asylum, 1870 »

Plan of Rangoon lunatic asylum, 1882 »

Block plan of Rangoon lunatic asylum, 1893 »

Plan of criminal enclosure, Madras, 1894 »

European patients, Bengal, 1871 »

Alleged causes of insanity, United Provinces, 1900 »

Forcible feeding of asylum patient, Rangoon, 1893 »

Treatment and occupation, Madras, 1881-1882 »

Influence of the moon, Bengal, 1868 »