The History of Mental Illness: From "Skull Drills" to "Happy Pills"

When electroconvulsive therapy was not effective, patients were sometimes forced to undergo psychosurgery, a practice that developed and was widely practiced in the 1930s to 1950s. It was in Portugal, 1935, that Egas Moniz performed the first lobotomy with the aid of a neurosurgeon, Almeida Lima; Walter Freeman was responsible for popularizing lobotomies in America (Alexander 285). To execute this procedure, the patient was first shocked into a coma. The surgeon then hammered an instrument similar to an icepick through the top of each eye socket and severed the nerves connecting the frontal lobes to the emotion-controlling centers of the inner brain. The intended purpose of the lobotomy was to calm uncontrollably violent or emotional patients, and it did--at first--prove to be successful. Because of the preliminary positive results and the facts that it was easy, inexpensive, and the average time it took to complete the procedure was only about ten minutes, lobotomies quickly spread around the world as a popular practice for severely mentally ill patients who were resistant to other treatments.

It was only after tens of thousands of patients worldwide had undergone this procedure during the following twenty years that people started to take notice of its undesirable side effects. Lobotomies generally produced personalities that were lethargic and immature (Myers 717-718). Aside from a twenty-five percent death rate, lobotomies also resulted in patients that were unable to control their impulses, were unnaturally calm and shallow, and/or exhibited a total absence of feeling (Butcher 620). Not surprisingly, this practice was quickly abandoned with the introduction of psychoactive drugs.

Since the late 1800s, substances such as chloryl hydrate, bromides, and barbiturates were administered to the mentally ill in order to sedate them, yet they were ineffective in treating the basic symptoms of psychosis (Alexander 286, “Timeline”). It was not until Australian psychiatrist J.F.J Cade introduced the psychotropic drug Lithium in 1949 that psychopharmacology really took off. A series of successful anti-psychotic drugs were introduced in the 1950s that did not cure psychosis but were able to control its symptoms. Chlorpromazine (commonly known as Thorazine) was the first of the anti-psychotic medications, discovered in France, 1952 (“Timeline”). Valium became the world’s most prescribed tranquilizer in the 1960s, and Prozac, introduced in 1987, became the most prescribed antidepressant (Porter 206).

The introduction of psychopharmacology is arguably one of the most significant and successful contributions to mental illness treatment, although it did lead to a movement that has been devastating to mental health care systems around the world, especially in the United States. The advent of psychoactive drugs convinced many that all illnesses would soon be effectively managed with medication, leading to the deinstitutionalization movement that rapidly occurred starting in the 1960s.

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It was believed that numerous community-based facilities would be conveniently available to the mentally ill should they choose to seek it out, although this plan was never sufficiently realized. Instead, thousands of the mentally ill discharged from institutions were incapable of living independently, medicated or not, and became homeless as a result of inadequate housing and follow-up care. In the 1980s, it was estimated that one-third of all homeless individuals in America were considered severely mentally ill. Lack of support and guidance led to the incarceration of over 100,000 mentally ill individuals in America as well. A 1992 survey reported that 7.2 percent of the inmate population was “overtly and seriously mentally ill;” over one-fourth of that population was being detained without charges until beds became available in one of the country’s few remaining mental hospitals (“Timeline”).

Psychotropic medication has additionally allowed individuals to avoid directly confronting their mental health issues, for example through counseling. Despite successful advances in therapy, such as Roger’s Client-Centered Counseling and Cognitive-Behavioral Therapy, among many others, mentally ill individuals have found it easier to avoid the shame associated with mental illness in countries where psychopathology is profoundly stigmatized. For instance, since deinstitutionalization, community health centers, day-care facilities, short- and long-term residencies, vocational training programs, and mobile units have all been established in Greece, yet the majority of the mentally ill, aside from those suffering from severe psychosis, still treat themselves only with psychotropic medication as they find it easier to hide their mental ailments from their friends, family, and communities (Blue 312). Supernatural beliefs about mental illness persist in other countries around the world, motivating most individuals to consult traditional healers first to help restore their mental health before they seek out professional, medical assistance.

Workers in Nigerian asylums claimed that individuals were often only admitted after traditional healers has exhausted all treatment possibilities, and even today this country is known for its ethnopsychiatry as its mental health facilities employ traditional healers and frequently incorporate their practices into more modern treatments (Sadowsky 111). It is also common in several countries that mental health is a grossly misunderstood and ignored problem, leading to serious underdevelopment of mental health facilities. Some countries in the Arab world have the highest income per capita, yet all have mental health systems that are severely lacking, including Morocco, Lebanon, the United Arab Emirates, and more.

ndividuals in these countries also continue to hold supernatural beliefs about mental illness and feel ashamed due to stigma, so they often consult traditional healers first with physical complaints, which are more likely psychosomatic symptoms (Okasha). China is another country whose mental health services are limited due to stigma and misunderstanding. Confucian ideals about social order allow no wiggle-room for mental illness. Those afflicted with psychopathology rush to traditional healers, seek out prescriptions for psychoactive medication, or are begrudgingly taken care of by family members; the mentally ill who become disruptive to society are likely to be incarcerated (Phillips 10-15).

This article has examined the major developments in mental health care as well as some interesting details about mental illness treatments throughout world history. Perceptions of mental health have changed greatly since the earliest civilizations and will continue to change as more is learned about the minds of humankind. Although significant advances have been made in this field of study that greatly benefit many individuals suffering from psychopathology, there remains much room for improvement. It will likely be ages before the workings of the human mind will be fully understood, if this is indeed an attainable goal.

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References

Alexander, Franz G., and Sheldon T. Selesnick. The History of Psychiatry: An Evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present. New York City: Harper and Row, Publishers, 1966.

Blue, Amy V. "Greek Psychiatry's Transition from the Hospital to the Community." Medical Anthropology Quarterly 7.3 (Sept. 1993): 301-318.

Butcher, James N., Susan Mineka, and Jill M. Hooley. Abnormal Psychology. Ed. Susan Hartman. 13th ed. Boston: Pearson Education, Inc. , 2007.

Houston, R.A. “Clergy and the Care of the Insane in Eighteenth-Century Britain.” Church History 73.1 (March 2004): 114-138. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.

MacDonald, Michael. Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-Century England. New York City: Cambridge University Press, 1981.

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"Measuring the Unmeasurable: An Introduction to Psychology." Making the Modern World. 2004. ISB fund of the Treasury and the Cabinet Office. 6 Nov. 2007 .

Myers, David G. Psychology. 2006. 8th ed. New York City: Worth Publishers, 2007.

Okasha, A. “Mental Health Services in the Arab World.” Arab Studies Quarterly 25.4 (Fall 2003): 39-52. World History Collection. EBSCO. Scarborough-Phillips Library, Austin, TX. 25 September 2007.

Phillips, Michael R. “The Transformation of China’s Mental Health Services.” The China Journal 39 (Jan. 1998): 1-36.

Porter, Roy. Madness: A Brief History. New York City: Oxford University Press, 2002.

Rosen, George. Madness in Society: Chapters in the Historical Sociology of Mental Illness. Chicago: The University of Chicago Press, 1968.

Sadowsky, Jonathan Hal. Imperial Bedlam : Institutions of Madness in Colonial Southwest Nigeria. Berkeley: Berkeley University of California Press, 1999. 24 Nov. 2007 . Path: Library Home; Research Tools; Online Catalog. Stigma and Mental Illness. Ed. Paul Jay Fink and Allan Tasman. Washington DC: American Psychiatric Press, Inc. , 1992.

"Timeline: Treatments for Mental Illness." American Experience - A Brilliant Madness: Timeline. 1992-2002. PBS. 6 Nov. 2007 .