Throughout history, mental illness has been stigmatized, un-, under- and overdiagnosed, and simply misunderstood, too often resulting in crude, cruel and horrific treatment of those who suffered.
Trephination, or trepanning, is one of the earliest diagnostic tools used to explain mental illness. Prehistoric skulls and cave art dating back as far as 6500 BCE reveal surgical drilling of holes in skulls to allow the release of evil spirits within. Around 2700 BCE, the Chinese medicine identified the yin and yang, positive and negative bodily forces, claiming that an imbalance in these forces resulted in both physical and mental illness.
Papyri from 1900 BCE declared that women with mental illness had a wandering uterus (later named ‘hysteria’). Egyptian and Greek practitioners believed making women smell strong substances would guide their uteri back into proper location.
In the fifth and sixth centuries before the Common Era, it was easy for physicians to fall back on the whims of the gods: only godly displeasure could account for such abnormal behavior.
It wasn’t until the time of Hippocrates that mental illness first became an object of scientific speculation. Around 400, he posited the theory that either a deficiency or excess of one of the ‘humors’ (blood, yellow bile, black bile, and phlegm) was responsible for physical and mental illness. Hippocrates classified mental illness into one of four categories – epilepsy, mania, melancholia, and brain fever – and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. That belief re-emerged and evolved later.
For example, Hindu tradition attributed psychological disorders to sorcery and witchcraft. During the Middle Ages, people believed mental illness was caused by evil spirits or demons. People were subjected to whipping, bloodletting, purges, and once again, to trepanning. Eventually, a common treatment for people with mental illness involved placing them in asylums or ‘madhouses.’
The most (in)famous of these asylums was the Priory of the New Order of St. Mary of Bethlem, which was founded in London 1247 during the reign of Henry III. Known then and still today by its nickname, ‘Bedlam,’ the hospital remains in operation, Europe’s oldest extant psychiatric hospital.
In early American culture, mental illness was likewise thought to be caused by moral or spiritual failings, and punishment and shame were often handed down to the mentally ill and their families. As the population grew and certain areas became more densely settled, mental illness became a social issue, and institutions were established to handle the needs of such individuals collectively.
In 1752, the Quakers in Philadelphia made the first organized effort to care for the mentally ill, but not utilizing the gentle care their name evokes today. When they opened the Pennsylvania Hospital in Philadelphia, they provided rooms in the basement to house a small number of mentally ill patients – complete with shackles attached to the walls.
In Virginia, in 1773, when the need to provide care for the mentally ill became apparent, the legislature provided funds to build a small hospital in Williamsburg – Eastern State, the first psychiatric hospital in the Commonwealth. Today, the hospital sits on 500 acres and consists of two patient care buildings, caring for 300 patients.
In 1774, the Madhouses Act created the first legal framework for regulating madhouses in Great Britain. Before the Act, the mentally ill were either kept in the family home or placed in private houses, whose owners were paid a fee by the Crown. These houses had little to no medical supervision, inviting mistreatment of the truly mentally disturbed, and virtual incarceration of those who were not (often put there as an expediency by a relative.) The Act put an end to such practices by requiring annual licensing and inspections by the Royal College of Physicians.
The nineteenth century saw reformers who sought to create hospitals that treated patients humanely and attempted to cure them. These reformers saw mental illness as the result of an underlying psychological disorder that needed to get diagnosed according to its symptoms, and could become cured through treatment. One such reformer was Dorothea Dix, an author and teacher, whose efforts helped create dozens of new institutions across the United States and Europe, changing perceptions of both the mentally ill and even some prisoners.
In 1812, Benjamin Rush (often called “The Father of American Psychiatry” and a signer of the Declaration of Independence) wrote the first systematic textbook on mental diseases in America, entitled Medical Inquiries and Observations upon Diseases of the Mind. The book went into five editions through 1835 and served as the major such textbook for almost 50 years. Other volumes followed, authored by pioneers in the field like Sigmund Freud, Victor Frankl, Anna Freud, Carl Jung, Fritz Perls and others.
Today, the field of treating patients with psychiatric disorders is guided by a different book, The Diagnostic and Statistical Manual (DSM.) The DSM is published by the American Psychiatric Association, offering a common language and standard criteria for the classification of mental disorders. It is now in its fifth edition, DSM-5, published on May 18, 2013.
Fortunately for the 26.2 percent of adult Americans who suffer from a diagnosable mental disorder in a given year, today’s practitioners – like our cover doctors Maria Urbano at EVMS, Anthony Caterine at Riverside and Dr. Munn at Naval Medical Center Portsmouth – have a wealth of reliable medical knowledge and years of hands-on experience to rely on in treating the individuals who suffer these conditions. They are offering hope to patients and their families alike, and helping eliminate the stigma that has so unfairly attached to them throughout the centuries.
Resources:
“Diagnosing Mental Illness in Ancient Greece and Rome,” Julie Beck, The Atlantic, Jan. 23, 2014.
“History of Mental Illness,” Ingrid G. Farreras, Hood College, abstract of a learning module of the Noba Project.
