A History of Mental Health – Part 2

In part one of mental health, we took a look at a history of mental health up until the 18th century. In part two, we continue with our in-depth look at the development of mental health over the centuries.

The 18th century witnessed the ‘age of enlightenment’, which heralded a move towards ‘reason’ and ‘understanding’. It was a movement which encouraged reformers such as the aforementioned Pinel in France, and English Quaker William Tuke to begin applying a radically different approach which saw patients treated with respect and compassion and given clean, sunny rooms, and crucially, were removed from shackles and restraints and allowed to roam more freely.

The model wasn’t to last, but this enlightened thinking struck a cord, particularly in the United States, a relatively new country, which was receptive to more humanitarian ideals following it’s emancipation from Britain. Dorothea Dix was an American reformer and staunch advocate for the mentally ill, most notably in prisons and mental hospitals and was responsible for many changes in law aimed at improving conditions in mental institutions. These changes culminated in the ‘Kirkbride Plan’ in the mid 19th century, which focussed on architectural designs that resembled European palaces, and was said to have a beneficial effect on inmates. Ultimately, funding issues and overcrowding meant that these institutions failed to live up to the promises, however.

It was a similar story on both sides of the Atlantic, with controversial practices such as lobotomizing, electro-convulsive shock therapy and ice baths commonplace. These were not places to provide patients with any meaningful form of treatment, but merely a “convenient way to remove unwanted people from society”.

The 20th century saw huge comparative advances in the research and development of psychotropic drugs, with Thorazine widely and successfully used to treat schizophrenia. Eugenics (the controversial forced sterilization of the mentally ill) had gained popularity worldwide and in fact was introduced in Belgium, Canada, Brazil, Sweden and the U.S, where it was practiced in many states right up until the 1970’s. In Sweden it continued until 1975.

Psychoanalysis and ‘talking cures’ were now popular, but two successive world wars saw numbers skyrocket in institutions thanks to ‘shell shock’, and conditions were bad in many. Governments on both sides of the Atlantic realized something needed to be done.

By 1960 there were over 500,000 patients in mental institutions across America and ‘Deinstitutionalizing’ became the buzzword, when, with the huge advances made in drug therapies, it became apparent that many patients could, potentially, function in society with just out-patient care. Laws were passed aimed at protecting the rights of mentally ill patients which prevented forced institutionalization. More funding was given and, crucially, laws governing insurance policies changed meaning patients could be treated in private institutions, lifting the burden on state facilities.

But deinstitutionalizing had it critics, not least from many ‘ex-inmates’ who began speaking out against not just the cruelties of the previous system, but for the continued stigmatization and lack of ongoing support for those released into the new one. Many found their families were unable, or unwilling, to provide the type of support needed to facilitate their recovery, and because there were no mechanisms to force individuals to receive treatment, many became homeless and fell into addiction. The resulting social problems prompted society and governments to look at how those with mental health issues are treated inside and outside the system. The fall-out from abusive systems is still very much being felt and exposed through the stories and efforts of mental health advocates the world over.

In recent years, cognitive therapy has gained much support and achieved high success rates in helping patients understand their underlying behaviours. The rise of selective serotonin re-uptake inhibitors (SSRIs) and similar drugs revolutionized the treatment of depression in the 1990’s, and governments are increasingly looking to support research and development of child and youth mental health issues. But there remains much to be done, and, in the wake of yet another tragic shooting in the U.S, the subject of mental health, and particularly that of young people marginalised by modern society because they feel they don’t ‘fit in’ is once again at the forefront of discussion. How we deal with this, only history will tell, but new rules relating to mental health insurance are due to take effect from 2014 and promise to fill in many of the gaps currently felt by the 23 million people in the U.S. who currently don’t have health insurance, many of whom are society’s most vulnerable and in need of it most.

Wherever you reside, ensuring your health policy covers you and your loved ones for all eventualities makes good sense, because peace of mind really is worth its weight in gold.