A brief history Source: www.pbs.org/wgbh/amex/nash/timeline/index.html Mental Illness A brief history Source: www.pbs.org/wgbh/amex/nash/timeline/index.html

Ancient Views of Mental Illness Affected person is possessed by a demon or has become subject to displeasure of the gods Shunned by society Greek medical writers began to prescribe treatments: quiet, use of drugs to purge mental illness Family members responsible for care

400 B.C.: Hippocrates Mental illness is result of disturbed physiology and should be treated as a medical illness.

Middle Ages In Europe, mentally ill mostly allowed freedom, as long as not dangerous In some places, however, treated as witches, as inhabited by demons Some religious orders care for mentally ill Muslim Arabs establish asylums in 8th Century, attempt scientific study First European facility specifically for people with mental illness, established in Valencia, Spain, in 1407

1600’s Europeans begin to isolate mentally ill, putting them with vagrants and delinquents Persons seen as insane begin to be treated inhumanely, chained to walls or kept in dungeons

Late 1700’s Concern about treatment of mentally ill grows, leads to occasional reforms Phillippe Pinel takes over the Bicêtre insane asylum and removes patients from dungeons

1840’s Dorothea Dix discovers that mentally ill people in Massachusetts are jailed with criminals, denied clothing, left in unlit, unheated, windowless rooms Over a 40-year period, she crusades on behalf of the mentally ill and succeeds in establishing 32 state hospitals as asylums for the mentally ill

1883 German psychiatrist Emil Kraepelin develops distinctions among mental disorders, particularly between manic-depressive psychosis and schizophrenia

Late 1800’s State mental hospitals become very popular, then very crowded Original conditions of low staff-patient ratio and humane treatment are replaced by overwhelmed staff and warehouse conditions NYT reporter, Nelly Bly, gets self admitted to Blackwell’s Island and writes exposé on conditions there, resulting in more funding*

Early 1900’s Era of psychoanalysis—the “talking cure” Freud treated wide variety of patients, but most people with psychosis still given custodial care in institutions

1908 Clifford Beers publishes his autobiography, A Mind that Found Itself, describing his dehumanizing experiences in a Connecticut mental institution Calls for reform, founds National Committee for Mental Hygiene—an education and advocacy group This group later becomes the National Mental Health Association

1930’s Drugs, electro-convulsive therapy, insulin-induced comas, and surgery (lobotomy) used to treat people with schizophrenia

Scenes from typical state hospitals in the mid-1940’s Philadelphia State Hospital

More scenes from Philadelphia State Hospital

Philadelphia State Hospital 1942-1946

Philadelphia State Hospital, 1940’s

Publicity on patient conditions helped bring about reform Conscientious objectors during World War II serving as attendants in state hospitals helped publicize the plight of the mentally ill and fought to improve conditions for the patients.

1940’s In 1946, President Harry Truman signs National Mental Health Act, establishing National Institute of Mental Health (1949) In 1949, Australian psychiatrist, J. F. J. Cade introduces use of lithium to treat psychosis. Later this becomes a very useful drug in treating bi-polar disorder.

1950’s Anti-psychotic drugs introduced for treatment of psychosis. First anti-psychotic drug, chlorpromazine (Thorazine). In 1955, there were 560,000 patients in state psychiatric hospitals. The advent of anti-psychotic drugs makes it possible for a dramatic reduction in state hospital populations. Anti-psychotic drugs introduce new problem: sometimes serious side effects

1961 Psychiatrist Thomas Szasz publishes The Myth of Mental Illness, which argues that schizophrenia is not a disease but a reasonable adaptation to a mad world Sociologist Erving Goffman’s book, Asylums, argues that many, if not most, symptoms in patients who have been in psychiatric hospitals for long periods are induced by the institution itself (institutionalization).

1962 Ken Kesey’s novel, One Flew Over the Cuckoo’s Nest, based on his experiences working in a VA Hospital psychiatric ward, is made into an influential movie starring Jack Nicholson as a rebellious patient who appears to be saner than the staff.

Mid-1960’s Deinstitutionalization: number of institutionalized mentally ill people in the US drops from 560,000 to 130,000 by 1980. Deinstitutionalization possible because anti-psychotic drugs control symptoms, but long-term institutionalized people need ongoing mental health treatment and an array of social services that are not uniformly available. Results: homelessness, “revolving door syndrome,” concern in the community about discharged patients

1963 Community Mental Health Centers Construction Act passes, providing federal money to develop a network of community mental health centers. Note that this occurs after deinstitutionalization was well underway.

1979 National Alliance for the Mentally Ill founded—provides support, advocacy, research for people with serious psychiatric illness.

1990 New generation of anti-psychotic drugs introduced—clozapine, etc. Drugs appear to be more effective and have fewer side effects

1992 Survey of American jails finds that 7% of inmates (100,000) are seriously mentally ill Most of these individuals receive little, if any, treatment