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                                   Dr. Candace Cole-McCrea


            The beginnings of mental institutions appeared in the fifteenth century Europe and spread from Spain to other countries, then to the American continents.  The early facilities were similar to medieval dungeons, complete with torture chambers, whips, shackles and chains to control those incarcerated.  Mental illness was perceived as possession by the devil, witchcraft, and/or moral degeneracy; therefore the use of physical force was seen as necessary for treatment and control.  Exorcism was a treatment of choice.  Patients were seen as dangerous and of no value to society.  This view was reinforced throughout western cultural institutions, including religions, governments and medical practice. 

            In l840, Dorthea Dix began a long campaign in America and Europe for the humane treatment of persons with mental illnesses.  She, and others, fought to have persons with mental illnesses perceived, not as unmanageable beasts, but as human beings.  In time, the use of dungeons and many of the restraining devices declined.

            Humane care reached its peak in the mid 1800s, when so-called Moral Treatment incorporated kindness and a wholesome physical environment within small institutions.  This was also known as the Mental Hygiene Movement, which, in its modern form, can be dated from the efforts of another American, Clifford  W. Beers.  He experienced mental illness and unhelpful and harsh treatments in three institutions, finally recovering in a private home.  To educate  the public about the problems of mental illness and the need for enlightened treatment, he published his own story, “A Mind that Found Itself” in 1908.  Beers worked with the psychologist, William James, and the psychiatrist, Adolf Meyer to establish the National Commission for Mental Hygiene in 1909 to help spread the movement.

            Despite these advances, with an ever-increasing immigration of impoverished persons, society continued to force multitudes into ever and ever larger institutions.  These institutions sought quick means of improving behavior and gaining compliance to social norms through medical interventions, such as lobotomies.  The patient population was too large, in most cases, for individual attention or care.  The resulting environment became little more than custodial care, even when at its best.

            Opportunities for life outside of institutions only became politically feasible with the discovery of phenothiazines (chlorpromazine) and reserpine in the mid 1950s.  Chlorpromazine improves mood and and behavior in persons with psychoses by inducing an indifference to external stimuli and a reduction of initiative and anxiety without causing dependence.  In effect, and external building to restrict freedom was replaced with a drug that restricts freedom from within the mind itself.  Reserpine (Serpasil) also has antipsychotic effects while increasing depression.  In 1967, haloperidol was introduced into the United States, soon followed by lithium.

History of Mental Illness—2

            Thus, the medical model became and has remained the dominant model of treatment for mental illness for over 100 years, into today.  Abnormal behavior is assumed to be symptoms of an underlying physiological cause.  This analogy with medical disorders has far-reaching effects in that persons with mental disorders are treated as patients, assigned a diagnosis, given a prognosis, and administered treatment, even when there is no expected cure or recovery anticipated.

            The medical model has not gone unchallenged, however.  Historically, the first major challenge came with the failure to find biological causes for most mental disorders.  Many professions developed around “talk therapy”, as counseling and social work began to play more prominent roles.  One of the leading spokespersons against the medical model has been American psychiatrist, Thomas Szasz, who argued, in his book “The Myth of Mental Illness” (1961) that abnormal behavior is a problem of living rather than a sign of an underlying disease.  In recent decades, American society has developed an amalgamation of medicine, cognitive, and behavior therapies to help more and more people to live independently.  However, much work still needs to be done, especially in the area of children and adolescents with mental disorders, who are commonly placed in group homes, and institutions during adolescence, with entry into the criminal justice system soon to follow in adulthood. Increasingly, also, citizens are recognizing that without opportunities to live, decently, in a community, to support oneself if able, to have friendships and recreation, persons with mental illnesses will continue to suffer and fail to reach their potential.  What began as a religious issue, became a medical issue, and is now seen, comorbidly, as a social issue.