April 2008
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April 2008
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The evolution of mental health care: |
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you read these? Essential information
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The mentally ill have been demonized, categorized, lobotomized, psychoanalyzed…and medicated.
Revolution by an American heroine: Demure dynamo, powerful persuader Beginning in 1841, American heiress and early social worker Dorothea Dix spent fifteen years in the United States and Europe inspecting mental institutions for mistreatment, which included inmates being housed with criminals, unclothed, beaten and kept in darkness. Her heroic effects toward legislation, at a time when women had little voice in social change, are still being felt today in the way mental patients are treated. Classifications of mental illness: No more one-size-fits-all In the late 1800s, Emil Kraepelin distinguished differences between different types of mental illness, including the difference between manic-depressive psychosis and schizophrenia. Patients were no longer seen as simply “insane.” Freud and psychoanalysis: It all began with my mother. Psychoanalytic therapies ("talking cures") were developed by Sigmund Freud and others, such as Carl Jung, around the turn of the century. “Our notions of identity, memory, childhood, sexuality, and, most generally, of meaning have been shaped in relation to--and often in opposition to--Freud's work,” quotes an exhibition of the library of Congress. Lobotomies: Just a little off the top. At least fifty thousand people, including “the mentally ill,” “delinquent” young adolescents and unhappy housewives were lobotomized by various techniques. Some were severely disabled by the procedures. Electroconvulsive therapy (ECT): Shocking! ECT, introduced in the 1930s, used a brief electrical stimulus to induce a cerebral seizure. In the early years, according to the Mayo Clinic, “electroconvulsive therapy could be painful and downright dangerous. It was administered with neither anesthetics nor muscle relaxants, and the electrical current was much higher than today. Powerful seizures racked the body with a force that could break bones.” The procedure is still used, in more humane ways, but can have complications, such as memory loss and confusion. Lithium: Mental metal Australian psychiatrist J. F. J. Cade in 1949 introduced the use of lithium to treat psychosis. Lithium gained wide use from the mid-1960s to treat those with manic depression, now known as bipolar disorder. Lithium is a naturally occurring mineral that is similar to sodium and potassium. As a medication, lithium affects chemical messengers by which nerves communicate with each other.
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The drug revolution: “He's sooo much calmer now.” Several successful anti-psychotic drugs were introduced in the 1950s, including the powerful chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs. Later in this decade came the discovery of the monoamine oxidase inhibitors (MAOIs) and the tricyclic antidepressants.
De-institutionalization: There’s the door. In the 1960s, many thousands of patients formerly housed in mental institutions were released to be directed toward decentralized clinics to receive new medications and social services. However, many have had problems accessing services and some are now living on the streets without medications or assistance. Approximately one-third of homeless people are estimated to be untreated mentally ill. National advocacy: Power to the people! In the 1980s, national organizations, such as the National Alliance for the Mentally Ill, the National Mental Health Association (now Mental Health America) and others, were formed to protect, support, educate, and advocate for the mentally ill.
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