History of Mental Health

Mental health perception has changed over time due to advancing knowledge. These changes in mental health perception have shifted the view of mental health from blaming people to supporting them. We will briefly discuss the history of mental health whilst looking into the history of mental health stigma, the history of mental health timeline including the changes in mental health that have occurred over time, and the history of mental health treatments.

Timeline of mental health

As knowledge has advanced through research, the way mental health is understood and treated has also evolved. In the past, mental health problems were believed to be an act against God and human nature. The way behaviour and mental health are understood changed according to the zeitgeist. Today, it is generally accepted that biological and environmental problems cause mental issues.

Timeline of Mental Health Treatment, StudySmarter Original

History of mental health stigma

In the 18th and 19th centuries, mental health was thought to be due to the existence of the supernatural. People with mental health problems were considered to be acting against human nature, such as witchcraft. People kept away and feared people with mental problems. Mental problems had such negative connotations that anyone who showed symptoms was killed or locked away.

Over time, the stigma of mental health has diminished as the understanding of mental health has evolved. In the 2000s, laws were enacted to reduce the stigma of the mentally ill and create equal opportunity. However, mental health stigma remains, especially in some communities.

History of mental illness timeline

The timeline of popular paradigms used to understand mental illness are:

The Freudian approach of the early 20th century

Sigmund Freud advocated the psychodynamic approach, which assumes that we can understand mental health through childhood experiences and conflicts/imbalances in the unconscious mind.

Mid-20th century – Skinner’s behavioural approach

This period saw a shift toward psychology as a science. Psychologists sought to understand behaviour through observation. The behaviour therapy approach assumes behaviour is learned from experience. Behaviour is learned through:

1. Association

2. Reinforcement

1960–present – cognitive revolution

This era saw a revolution in technology. The zeitgeist revolved primarily around technology.

Cognitive psychologists proposed the information processing model to explain mental health and behaviour. The model states that humans take in information from their senses and that the brain’s mental processes (called cognition) process that information. As a result, behaviour is outputted, which is comparable to a computer.

Late 1970s–present – the medical model was introduced

The medical model explains behaviour using theories from the biological approach. This approach states that mental illnesses have a physical cause, such as:

1. Chemical imbalances

2. Neurotransmitters dysfunction

3. Physical trauma

4. Brain abnormalities

History of mental health treatment

Let's go over a brief history of mental health treatment strategies. You can refer to the infographic at the beginning of this explanation as you read.

6500 BC – Spiritual entities

Mental illnesses were considered to be the result of evil spirit possessions. Possession by evil spirits was seen as a result of punishment by God. The typical methods of treatment were trepanation and exorcism. Some mental illnesses, such as epilepsy, were not considered a disease but evidence of witchcraft. People accused of witchcraft were burned.

800–400 BC

Physicians began to theorise that mental illnesses were due to physical causes. Hippocrates, an ancient Greek physician, believed that ‘insanity’ resulted from an imbalance of body fluids.

According to Hippocrates, depression could be diagnosed if people had elevated levels of black bile. Laxatives were used to treat the excess of black bile, which was then thought to lower depression levels. Hippocrates played a major role in the history of mental illness; it was no longer assumed people were to blame themselves or that non-physical causes such as evil spirits were behind it. Mental health evolved toward scientificity.

1200–1700s

Views on mental illness went so far that people with mental problems were committed to insane asylums. In the asylums, people were treated inhumanely. They were locked up, chained, and talked down to. Religion and punishment still dominated this era, which influenced the treatment of mental illness.

Early 1900s

People began to view asylums as a poor way to treat patients. Psychiatry was recognised in the medical field. Freud presented his ideas within the framework of the psychodynamic approach. The move toward the psychodynamic approach brought with it various methods of treating mental health, including:

• Psychoanalysis: Psychologists and therapists work together to resolve internal conflicts in the psyche that the early childhood trauma causes.

• Dream analysis

• Hypnosis: A trained clinician helps the client tap into the subconscious mind to uncover hidden memories at the root of psychological problems. Whether the psychoanalytic treatment works is still debated.

The psychodynamic approach to mental health has been widely criticised for lacking credibility, verifiability, and falsifiability. For this reason, the paradigm of the zeitgeist has turned away from psychodynamics. It remained a popular mental health intervention until the mid-1900s. However, there are still many psychotherapists today.

The fall of the widely held belief that the psychodynamic approach was the best method for psychiatric intervention paved the way for the medical model to take its place. The medical model remains the common approach to treating mental illness. Medication and cognitive behavioural therapy are usually used for treatment. The medical model used treatment methods such as:

• Electroconvulsive therapy (ECT): Electroshocks are administered at a safe, low voltage. This treatment is not used to treat bipolar disorder or major depressive disorder. It is a treatment that is not commonly used.

• Psychopharmacology: The use of medications to alter the chemical balance of neurotransmitters and hormones that may cause mental health problems.

Rosenhan (1973) on being sane in insane places

Rosenhan (1973) investigated whether people can tell whether someone has mental problems or not. The reason for this was that the classification systems in use at the time, such as the DSM, proved to be poor diagnostic tools.

Experiment 1 procedure

Eight pseudopatients (people without mental illness but pretending to be ill) were admitted to different psychiatric hospitals. Before hospitalisation, participants described symptoms of schizophrenia such as hallucinations to psychiatrists. Once admitted, participants stopped pretending and began behaving as they normally do. Participants had to convince hospital staff they were ‘fit for discharge’.

Experiment 1 Results

The pseudopatients were all admitted to hospitals, where they stayed between 7 and 52 days. Seven of the participants were diagnosed with schizophrenia and the other with manic-depressive psychosis. If any of the participants became distressed by the behaviour of the staff, it was considered to be a result of their ‘illness’ and not the current situation. Staff stayed away from patients except for administrative or practical tasks, and there were cases of physical abuse. The pseudopatients all experienced powerlessness and depersonalisation.

Experiment 2 procedure

Hospital staff were informed of their diagnostic errors, and that one or more pseudopatients might request admission to the hospital within three months (no pseudopatient did so). Staff had to rate new patients admitted to the hospitals on a scale of 1–10 whether they thought the person was a pseudopatient.

Conclusion of both experiments

It is difficult to distinguish between ‘sane’ and ‘mentally ill’ people in psychiatric institutions – psychiatric diagnoses are imprecise. Patients in hospitals experience powerlessness and depersonalisation. All their behaviour is attributed to their illness rather than unfair situations or other factors. Staff are insensitive to patients’ feelings.

Evaluation of the experiments

A strength of this study is that it has high external validity because hospital staff did not know they were participating in the experiments. Therefore, it was likely their behaviour was consistent with the facts. The study shows the lack of reliability and validity in diagnosing mental illness. Many variables were controlled, resulting in internal validity, e.g., the pseudopatients all presented the same way to the staff when attempting to be admitted to the hospitals.

Some weaknesses, however, are that the study was conducted in America, in American hospitals, so the results cannot be generalised to other countries. The study did not use a representative sample, and ethical issues were raised (deceived hospital staff and staff were not asked if they wanted to participate in the studies).