Living with depression, anxiety and bipolar disorder
April 2008

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The evolution of mental health care:
From insane asylums to lobotomies to antidepressants


 

Have you read these?

 

The mentally ill have been demonized, categorized, lobotomized, psychoanalyzed…and medicated.

Asylum inmate chained  to bedThe early days:  Dungeons and dragons  In the Middle Ages, mental illness was regarded as demonic possession. For centuries, the afflicted were often shackled and shunned and, later, warehoused. French physician Phillippe Pinel, in the late 1700s, took over Bicêtre insane asylum and forbid the use of chains and shackles, removing inmates from dungeons and providing them with sunny rooms. But mistreatment continued in other parts of Europe and the United States.
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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.
Various methods of lobotomies were used for decades beginning in the late1930’s, sometimes involving drilling into the brain to sever nerves thought to be capable of regenerating into healthy connections, says researcher Christine Johnson. But, the most renowned was Doctor Walter Freeman’s technique, in which an ice pick-like object was inserted through the eye socket and tapped into the brain with a rubber mallet. 

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.

 

 

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.

Woman talking to her therapistBehavior therapy: And how does that make you feel? Developed in the mid-1950s, behavior therapy has become a widely used method to help people replace distorted thoughts and beliefs with those that help them feel and function better. Working with a therapist, they can use it to learn to deal with emotions, relate to others in different ways and solve problems. It has been shown to be highly effective and in over a relatively short time. Despite the breakthroughs of experts such as Albert Ellis, Ph.D., Albert Bandura, Ph.D. and Thomas Szasz, M.D., behavioral therapy met with resistance from the old guard who questioned whether changing behavior should be done without a lengthy exploration of the underlying causes of the behavior.

One Flew Over the Cuckoo’s Nest: Maybe we’re all crazy,  This popular 1975 movie based on Ken Kesey's famed 1962 novel, starred a young Jack Nicholson. Set in a state mental hospital in 1965, Nicholson portrays the rebellious Randall Patrick McMurphy who challenges the tyrannical Nurse Ratched. The book and movie raise the possibility that some “mental patients” are simply people who behave in socially unacceptable ways.

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.

Multi-colored pillss of all typesProzac and its descendants: Better living through chemistry The 1990s introduced new and more effective antidepressants, the selective serotonin reuptake inhibitors (SSRIs), which did not have the side effects of the MAOIs or the tricyclics. The first of these, the very popular fluoxetine (Prozac), was released in 1987. Drugs such as SNRIs and NRIs with various selective effects, such as venlafaxine (Effexor), duloxetine (Cymbalta), nefazodone and mirtazapine Remeron followed. New drugs that do not fit into any of these categories, such as Wellbutrin are now popular. Numerous antidepressants, mood stabilizers and anti-anxiety drugs are used today, along with medications designed to treat the side effects they cause. 

 

Related articles
Guide to psych meds
Which therapy is right for me?
Where to get help
Electroconvulsive therapy (ECT)
Myths about mental illness
Cognitive therapy
Dialectical behavioral therapy

Sources:
Women's Intellectual Contributions to the  Study of Mind and Society
Christine Johnson, Remembering the tragedy of lobotomy
Timeline: Treatments for Mental Illness PBS, American Experience
Keith A. Trujillo, Ph.D., California State University San Marcos
Image of asylum patient: U.S. National Library of Medicine

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