The Evolution of Mental Disorder Treatment

By Jenny Lam

Many centuries ago, humans used to believe that mental disorders were the result of demonic possession. Looking back into the past, our current understanding of the mind and mental illnesses has changed drastically. Mental disorders are now known to be health conditions that affect thinking, emotion, feelings, or mood. Some conditions cause difficulty for people to relate with others and function in work, family, or social situations. Both our understanding of psychological disorders and our treatment methods have developed greatly over the course of human history.

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Treatment for psychological disorders dated back as early as 5000 BCE. People during this time period believed that these conditions were caused by supernatural forces such as demonic possession, the evil eye, and sorcery. As a result, patients were treated strangely and brutally. During the Neolithic era, a technique called trephination, which remains the oldest documented surgical procedure, was utilized to treat mental illnesses. Using stone instruments, a hole would be chipped into one’s skull, allowing evil spirits to leave the body. Surprisingly, evidence has shown that people’s skulls have recovered from this procedure. Centuries later, in ancient Mesopotamia, exorcisms, prayers, and incantations were believed to drive out evil forces. Methods that attempted to appeal to the spirit included bribery, punishment, and threats. Contrastingly, Hebrews believed that performing generous deeds would result in purity of the mind and body, since they thought that all illnesses were God’s punishment for their sins.

During the 5th to 3rd century BCE, the idea of evil spirits inhabiting one’s head was abandoned when Hippocrates, a skilled Greek physician, discovered that mental illnesses stemmed from the brain rather than supernatural forces. Building upon his work, Galen, a 2nd century CE Greek physician, discovered the “four essential fluids” in the human body. A combination of blood, yellow bile, phlegm, and black bile constitutes every human’s personality. In the Middle Ages, mental illnesses were thought to be triggered by an imbalance of the four essential fluids. Patients were given debilitating treatments such as emetics, laxatives, leeches, and tobacco to balance out the fluids. At the same time, the number of mentally ill individuals was rising, and a new method was required to handle the increasing number of patients.

Wikimedia Commons @ Muir & Moodie studio, Dunedin

Around the 16th century, the first institutions and asylums were established to resolve the higher population of mentally ill people. Asylums were well-known for cruel abuse, horrid living conditions, and were often compared to jails. People endured harsh treatments, such as solitary confinement, physical abuse, and hair-pulling. Asylums proved to be unsuccessful in curing mental illness. Leaving the mentally ill in these facilities allowed the general public to forget about them and ignore the problem at hand. Nelly Bly, a well known American journalist, posed as a mentally ill woman and documented her brutal experience in an asylum remarking that “I could not sleep, so I lay in bed picturing to myself the horrors in case a fire should break out in the asylum. Every door is locked separately and the windows are heavily barred, so that escape is impossible.” According to Bly, even escaping the asylums seemed impossible and limited the rights of the mentally challenged.

In the 1900s, people began to understand the cause of one’s erratic behavior, and why patients behaved in a way other people classified as “mad and insane.” Sigmund Freud, an Austrian neurologist, attempted to create theories explaining the unusual behavior, and he developed a therapy called psychoanalysis, or the “talking cure,” in which the patient would freely share their thoughts for the therapist to interpret and provide insight on why the patient feels a certain way. After working with neurotic patients, he theorized that mental illnesses were the result of keeping memories deep in the unconscious, so discussing their worries and problems out loud would resurface these memories and thoughts. Fifty years later, psychoanalysis would develop into psychotherapy, the primary treatment utilized today for mental health problems. There are many types of psychotherapy, but they all mainly focus on therapist-patient interactions to resolve difficulties and achieve personal growth with a larger emphasis on social relationships and less on the unconscious compared to psychoanalysis. In addition to the development of new therapies, chemists in the 1950s also experimented with various powders and pills, hoping to relieve chemical imbalances within the brain. The successful development of psychiatric drugs, such as thorazine, an anti-psychotic medication used to treat schizophrenia and manic-depression, effectively treated the symptoms of many mental illnesses. This time period also marked the end of institutions because society realized that the mentally ill needed to be treated instead of locked away in an asylum unable to interact with the outside world. The closing of these institutions and replacing them with less isolated mental health services, or the deinstitutionalization movement, was heavily influenced by World War II, as people saw the similarities between the horrid treatment in concentration camps and mental hospitals. This change in thought allowed mentally ill patients to be transferred into community health centers. Deinstitutionalization allowed the mentally challenged to remain close to their families, start new lives, receive an education, and focus on treatment. Today, one of the most effective treatments for psychological disorders involves combining psychotherapy with medication.

From drilling holes in people’s skulls to asylums and innovative therapies, treatment for mental illness has advanced greatly throughout the centuries. In the earliest civilizations, mental illnesses were thought to be caused by supernatural forces. This belief changed during the third century as humans learned more about the mind. Today, we humans possess much more information about the causes and treatments of many different mental illnesses. Rather than silencing individuals in asylums, experts today encourage patients to open up about their problems with therapies and support groups. As knowledge of the mind and body and perceptions of mental illness change over time, so will the treatment options of mental conditions. Even today, scientists and experts are achieving ground-breaking discoveries about mental illnesses. Treatment will surely keep advancing in the future as we become closer to fully understanding our own minds.

Questions

1. What is trephination?

Trephination, also known as trepanning and trepanation, is the practice of drilling a hole into one’s skill with the intention of releasing evil spirits from the head. Originating in the Neolithic times, trephination is the oldest surgical procedure that there is archaeological evidence of. Because the procedure involves trauma to the skull and contact with the brain, there is a large risk of brain damage, infection, blood loss, and death.

2. How are psychological disorders treated today?

Today, psychological disorders are mainly treated with psychotherapy, the therapeutic treatment of mental illness using verbal and psychological techniques. A trained therapist would help clients tackle their problems, establishing a trusting and supporting relationship with the client and providing hope. It is often paired with prescribed medication. Although medication doesn’t directly cure mental illness, it can help with managing symptoms.

Sources

https://historycooperative.org/a-beautiful-mind-the-history-of-the-treatment-of-mental-illness/

https://www.thebalance.com/deinstitutionalization-3306067#:~:text=Deinstitutionalization%20successfully%20gave%20more%20rights,them%20into%20society%20where%20possible.

http://www.inquiriesjournal.com/articles/1673/the-history-of-mental-illness-from-skull-drills-to-happy-pills

https://dualdiagnosis.org/mental-health-and-addiction/history/

https://www.mhanational.org/mental-health-treatments#:~:text=Psychotherapy%20is%20the%20therapeutic%20treatment,effective%20way%20to%20promote%20recovery

Image Credit:


No changes were made, File:Crânes trépanation âge du bronze.jpg - Wikimedia Commons, License: Creative Commons — Attribution-ShareAlike 4.0 International — CC BY-SA 4.0

No changes were made, File:Hokitika Asylum.jpg - Wikimedia Commons, License: Public Domain

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