The History of "Mental Disorders"

Mental disorders have had three major explanations, namely, the supernatural, biological and psychological models.

For much of recorded history, deviant behavior has been considered supernatural and a reflection of the battle between good and evil.

Mental illnesses were well known in ancient Mesopotamia, where diseases and mental disorders were believed to be caused by specific deities. Because hands symbolized control over a person, mental illnesses were known as "hands" of certain deities. One psychological illness was known as "Hand of Ishtar". Others were known as "Hand of Shamash", "Hand of the Ghost", and "Hand of the God". Descriptions of these illnesses, however, are so vague that it is usually impossible to determine which illnesses they correspond to in modern terminology. Mesopotamian doctors kept detailed record of their patients' hallucinations and assigned spiritual meanings to them. A patient who hallucinated that he was seeing a dog was predicted to die; whereas, if he saw a gazelle, he would recover.

(Hand of Ishtar)

In India, ancient Hindu scriptures-Ramayana and Mahabharata-contain fictional descriptions of depression and anxiety. The Charaka Samhita, which is a part of the Hindu Ayurveda ("knowledge of life"), saw ill health as resulting from an imbalance among the three body fluids or forces called Tri-Dosha. These also affected the personality types among people. Suggested causes included inappropriate diet, disrespect towards the gods, teachers or others, mental shock due to excessive fear or joy, and faulty bodily activity. Treatments included the use of herbs and ointments, charms and prayers, and moral or emotional persuasion. In the Hindu epic Ramayana, the Dasharatha died from despondency, which Shiv Gautam states illustrates major depressive disorder.

By the end of the 17th, madness was increasingly seen as an organic physical phenomenon, no longer involving the soul or moral responsibility. The mentally ill were typically viewed as insensitive wild animals. Harsh treatment and restraint in chains was seen as therapeutic, helping suppress the animal passions. 

The 19th century, in the context of industrialization and population growth, saw a massive expansion of the number and size of insane asylums in every Western country, a process called "the great confinement" or the "asylum era".

Asylum, actually Lunatic Asylums were the places were the mentally ill people were treated. Asylums were horrible, because of the way they used to treat the patients and also because of lack of much knowledge regarding psychiatric disorders.

Treatments involved:

1. LOBOTOMY:

A lobotomy, is a form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain's prefrontal cortex. Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed. It was used for treating mental disorders. The procedure was controversial from its initial use, in part due to the balance between benefits and risks.

The consequences of the operation have been described as "mixed". Some patients died as a result of the operation and others later committed suicide. Some were left severely brain damaged. Others were able to leave the hospital, or became more manageable within the hospital. A few people managed to return to responsible work, while at the other extreme, people were left with severe and disabling impairments.

2. BLOODLETTING:

It was used to cure a person of illnesses like leprosy, acne, plague, inflammation, stroke, pneumonia,  herpes and many other ailments. The patient was cut or pierced then drained of blood until they fainted.

A Greek Physician named Galen of Pergamon discovered that arteries were filled with blood, not air. He believed that blood didn’t circulate in the body and that if blood, mucous, black bile and yellow bile were not balanced in the body, it would lead to illness. Galen would map out his patients bodies and cut them in different areas, depending on which area he wanted to treat. He also believed in giving his patients drugs to induce vomiting or urination.

In 19th century, leeches were used to drain blood from patients. France imported approximately 40 million leeches for the purpose of bloodletting. Some French physicians recommended that patients use as many as fifty leeches at a time.

In the nineteenth century, medical practitioners questioned the practice of bloodletting after realizing that it killed more people than it cured. Even though bloodletting began to decline, other dangerous treatments were being used.

3. TREPHINATION:

During this procedure, a hole, or trephine, was chipped into the skull using crude stone instruments. It was believed that through this opening the evil spirit(s)--thought to be inhabiting one’s head and causing their psychopathology--would be released and the individual would be cured. Some who underwent this procedure survived and may have lived for many years afterward as trephined skulls of primitive humans show signs of healing. Pressure on the brain may have also incidentally been relieved. This procedure endured through the centuries to treat various ailments such as skull fractures and migraines as well as mental illness, albeit with more sophisticated tools such as skull saws and drills developed solely for this purpose.

The procedure comes with severe repercussions, which include increased damage to the brain, infection, blood loss, hemorrhage, and potentially death due to the trauma as the skull's protective covering is compromised. The operation leaves very minimal space for error and a high incidence of mortality, if the dura mater is penetrated. Additionally, there is a high risk of infection if the operation is conducted with contaminated tools or improper sanitary wound care.

4. PHYSICAL RESTRAINT:

Physicians had not fully separated mental and physical illness from each other. As a result, some of the treatments in those days were purely physical approaches to ending mental disorders and their symptoms. These included ice water baths, physical restraints (pictured here), and isolation. 

Journalist Nellie Bly captured the asylum atmosphere firsthand when she went undercover at the Blackwell Island Insane Asylum in New York in 1887. Not only was Bly committed without much of an examination to determine her sanity, but the conditions were harsh, cruel, and inhumane.

“For crying the nurses beat me with a broom-handle and jumped on me,” described one patient to Bly. “Then they tied my hands and feet, and throwing a sheet over my head, twisted it tightly around my throat, so I could not scream, and thus put me in a bathtub filled with cold water. They held me under until I gave up every hope and became senseless.”

Hydrotherapy proved to be a popular technique. Warm, or more commonly, cold water, allegedly reduced agitation, particularly for those experiencing manic episodes. People were either submerged in a bath for hours at a time, mummified in a wrapped “pack,” or sprayed with a deluge of shockingly cold water in showers.

Asylums also relied heavily on mechanical restraints, using straight jackets, manacles, waistcoats, and leather wristlets, sometimes for hours or days at a time. Doctors claimed restraints kept patients safe, but as asylums filled up, the use of physical restraint was more a means of controlling overcrowded institutions.

5. INSULIN COMA THERAPY:

Insulin coma therapy was a form of psychiatric treatment in which patients were repeatedly injected with large doses of insulin in order to produce daily comas over several weeks. After the insulin injection patients would experience various symptoms of decreased blood glucose: flushing, pallor, perspiration, salivation, drowsiness or restlessness. Sopor and coma—if the dose was high enough—would follow. Each coma would last for up to an hour and be terminated by intravenous glucose or via naso-gastric tube. Seizures sometimes occurred before or during the coma. Many would be tossing, rolling, moaning, twitching, spasming or thrashing around.

6. ELECTROCONVULSIVE THERAPY:

Electroconvulsive therapy (ECT), formerly known as electroshock therapy, is a psychiatric treatment where seizures in the brain (without muscular convulsions) are electrically induced in patients to provide relief from mental disorders. Typically, 70 to 120 volts are applied externally to the patient's head resulting in approximately 800 milliamperes of direct current passed through the brain, for 100 milliseconds to 6 seconds duration, either from temple to temple (bilateral ECT) or from front to back of one side of the head (unilateral ECT).

Before ECT, this was done with the use of chemicals, usually one called Metrazol. By many reports, patients experienced a feeling of terror after taking Metrazol, just before the seizure started.

The World Health Organization (2005) advises that ECT should be used only with the informed consent of the patient (or their guardian if their incapacity to consent has been established).

7. FEVER THERAPY:

Pyrotherapy (artificial fever) is a method of treatment by raising the body temperature or sustaining an elevated body temperature using a fever. In general, the body temperature was maintained at 41 °C (105 °F). Many diseases were treated by this method in the first half of the 20th century. In general, it was done by exposing the patient to hot baths, warm air, or (electric) blankets. The technique reached its peak of sophistication in the early 20th century with malariotherapy, in which Plasmodium vivax, the causative agent of malaria, was allowed to infect already ill patients in order to produce intense fever for therapeutic ends. The sophistication of this approach lay in using effective anti-malarial drugs to control the P. vivax infection, while maintaining the fever it causes to the detriment of other, ongoing, and then-incurable infections present in the patient, such as late-stage syphilis.

Later analyses have shown this might not have been true since approximately 60% would relapse within 2 years and between 3% - 20% have died from the resulting fevers.

8. ISOLATION:

Asylums were places where people with mental disorders could be placed, allegedly for treatment, but also often to remove them from the view of their families and communities. Overcrowding in these institutions led to concern about the quality of care for institutionalized people and increased awareness of the rights of people with mental disorders. Even today, people with mental illness might experience periods of inpatient treatment reminiscent of the care given in asylums, but society exerts much greater regulatory control over the quality of care patients get in these institutions. 

Philippe Pinel and Dorothea Dix argued for more humane treatment of people with psychological disorders.

               (Dr. Philippe Pinel)



 In the mid-1960s, the deinstitutionalization movement gained support and asylums were closed, enabling people with mental illness to return home and receive treatment in their own communities. Some did go to their family homes, but many became homeless due to a lack of resources and support mechanisms.

Today, instead of asylums, there are psychiatric hospitals run by state governments and local community hospitals, with the emphasis on short-term stays. However, most people suffering from mental illness are not hospitalized. A person suffering symptoms could speak with a primary care physician, who most likely would refer him to someone who specializes in therapy. The person can receive outpatient mental health services from a variety of sources, including psychologists, psychiatrists, marriage and family therapists, school counselors, clinical social workers, and religious personnel.