A Little History of Mental Health

Mental Health, via Dall-E

Humanity’s understanding and perception of mental health has evolved significantly throughout the years. In ancient times, mental illness was often attributed to supernatural forces or divine punishment, where exorcisms or drilling holes in the skull were seen as the best cures. Throughout the Middle Ages and Renaissance, asylums and more humans (although not quite) came into play. Later in the Enlightenment period, advocates for compassionate treatment, psychiatric institutions, and diagnostic frameworks came to change the way mental health was viewed until the 20th-century psychoanalytic breakthrough and the movement towards community-based care changed the landscape once again.

In current times, society has witnessed groundbreaking advancements in mental health treatment including psychopharmacology and new therapy approaches. That being said, there is a mountain of information to be yet discovered. Examining the past makes it possible to gain a deeper appreciation for the progress, but also should be a motivator to never stop promoting mental health research and awareness.

Part I: Ancient Beliefs and Early Approaches

Ancient civilizations held diverse and often mystical beliefs about mental health, intertwining it with spiritual and supernatural beliefs.

In ancient Mesopotamia, mental illnesses werethought to be the result of divine intervention or curses. The ancient Babylonians believed that spirits or gods were responsible for mental disorders, and performednrituals, prayers, and offerings to alleviate an individual's suffering. Native American cultures had a largely spiritual perspective as well, with multiple ceremonies and rituals, and the involvement of medicine people or shamans to restore balance and healing.

Another prevalent mental health treatment in ancient times were exorcisms, or the practice of driving out evil spirits or demons believed to possess an individual. Exorcisms were conducted by religious figures or individuals with specialized knowledge of rituals and prayers. The process typically involved ceremonies, incantations, and symbolic acts aimed at expelling the perceived malevolent entities from the affected person. Exorcism was considered a spiritual intervention rather than a medical treatment, reflecting the prevailing belief systems of the time.

A more gruesome ancient mental health treatment was trephination, or the removal of a small section of the skull, creating a hole or opening. In many ancient cultures, this procedure was believed to release evil spirits or relieve pressure inside the skull. The exact success rate of trephination is uncertain, but skulls have been found with signs of healing around the trephination holes, indicating that at least some patients survived the operation.

Lastly, herbal remedies, while used to treat all kinds of conditions, were often used in ancient civilizations to treat mental illnesses. Plants and herbs were believed to possess medicinal properties that could alleviate symptoms or restore balance within the body.

In ancient Egypt papyrus scrolls documented the use of herbal remedies such as frankincense, myrrh, and opium to address symptoms such as anxiety, depression, and insomnia. Ancient Chinese medicine also incorporated herbal remedies to treat mental health imbalances. Influenced by Taoist and Confucian philosophies, Ancient Chinese societies viewed mental health imbalances as disruptions in the flow of vital energy, or ‘qi’. Specific plants and formulations were used to regulate the flow of energy (qi) and promote harmony within the body and mind. Their treatments also included acupuncture and meditation.

While these early herbal remedies may have had some beneficial effects, their efficacy varied and was often based on traditional knowledge, observations, and cultural beliefs rather than scientific evidence.

Despite the large level of misconceptions that ancient societies held about mental health, several mental health pioneers have been noted. Egyptian physicians have already observed the relationship between the brain and behavior, although their knowledge was limited compared to contemporary understanding. Greek physician Hippocrates, often regarded as the father of modern medicine, was the first to suggest that disturbances in bodily fluids, known as “humors”, were responsible for psychological imbalances. The four humors—blood, phlegm, yellow bile, and black bile—were believed to affect a person's temperament and mental well-being. While imperfect, his theory was the first to link physical imbalances with mental disorders.

He made multiple other contributions to early psychiatric theory, including the emphasis on careful observation and documentation, as wel as creating the first classification of mental disorders, recognizing conditions such as mania, melancholia (depression), and hysteria. He also advocated for the interconnectedness of mind, body, and environment, believing that a balance was crucial for overall well-being.

Part II: Middle Ages and Renaissance

In the Middle Ages, spanning from the 5th to the 15th century, attitudes towards mental health underwent significant shifts. In Europe, the Christian Church played a central role in people’s lives during this period, and mental disorders were frequently attributed to spiritual causes, such as demonic possession or divine punishment. Exorcisms and religious rituals remained common.

Unfortunately, mental illness during these times was often associated with fear, superstition, and misunderstanding. Mentally ill people were often stigmatized and isolated, often ending up in early forms of asylums, with little understanding or adequate care.

In the late 15th century, a publication called The Hammer of Witches by Heinrich Kramer and Jacob Sprenger was published. The text has a massive, lasting impact on mental health perception, associating it with witchcraft and female hysteria, suggesting that women were more susceptible to demonic possession than men.

Medical knowledge continued to be limited. While theories from ancient times, such as that of Hippocrates, persisted, it was only to a small extent. Some individuals sought alternative explanations for mental health issues, such as Persian physician Ibn Sina who made significant contributions including his version of an illness classification system or acknowledging the interplay between the brain and its environment.

Following the Middle Ages, The Renaissance was a period of intellectual revival in Europe, with an emergence of humanism. Humanists focused on the study of human nature, achievements, and potential, allowing them to acknowledge individual experiences and emotions.

During this time, Ancient and Medieval supernatural explanations for mental issues began to fade away. Mental health during this period was based on direct observation, and greatly contributed to observing repeating symptoms. René Descartes, a French scholar, created a framework connecting the physical brain and mental processes, which layed the groundwork for future scientific study of the brain.

Emergence of Asylums

The late 18th and early 19th centuries experienced a need for more structured and human care, resulting in the emergence of asylums. The first such asylum was founded in England in 1796.

Asylums were initially established with good intentions to provide humane care for individuals with mental illnesses. However, inadequate funding, lack of trained staff, and limited understanding of mental health conditions contributed to deplorable conditions in many institutions, including resorting to isolation and physical restraint.

The lack of sufficient space and resources led to cramped living conditions, where patients were often confined to small and unsanitary rooms. Asylums became warehouses for the mentally ill, with little focus on providing therapeutic treatment or rehabilitation. Furthermore, the prevailing attitude towards mental illness was often characterized by fear, stigma, and misunderstanding, further contributing to mistreatment.

One individual known for fighting this was Dorothea Dix. In the mid-19th century, she conducted extensive investigations into the conditions of asylums in the United States and Europe, allowing for widespread awareness of the appaling conditions in these institutions. She continuously pushed governments for provision of better care for the mentally ill. Thanks to her and many others, in the 20th century, asylums began losing popularity in favor of community-based care and outpatient services.

Part III: Enlightenment and the Birth of Psychiatry

The Enlightenment era, spanning the 17th to 18th centuries, continued the shift towards more rational and scientific approaches to understanding and treating mental illnesses. Supernatural explanations for mental health issues have been rejected completely. Scholars adopted systematic methods of studying mental illnesses, along with their underlying causes.

There are two figures that particularly contributed to this chance. Philippe Pinel, a French physician, is often regarded as the founder of modern psychiatry. He challenged the practice of using physical restraints on patients and introduced human approaches and therapy. Another influencial figure, William Tuke, was an English philanthropist who founded the first ever compassionate health institution, with moral, respectful treatment and therapeutic activities.

Another important aspect of the Enlightenment period was the the DSM, of the Diagnostic and Statistical Manual for Mental Disorders, published by the American Psychiatric Association in 1095. Today, the DMS (currently on its fifth version) is a tool used worldwide to classify and diagnose mental health conditions.

Part IV: The 20th Century

In the 20th century, Sigmund Freud, the founder of psychoanalysis, proposed a revolutionary theory emphasizing the influence of the unconscious mind and early life on mental health. Freud’s work sparked the development of various psychotherapeutic approaches and laid the foundation for modern psychodynamic therapies.

The period was also characterised by the introduction of community-based care, seeking to provide individuals with mental illnesses the opportunity to live in less restrictive environments while still receiving support. It included outpatient clinics, crisis centers, and residential programs.

Part V: Modern Era: Integration and Holistic Approaches

Advances in psychopharmacology have revolutionized the treatment of mental health conditions. It all began through the discovery of chlorpromazine in the 1950s, providing relief to individuals with schizophrenia and other psychotic disorders. The introduction of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and other antidepressants revolutionized the treatment of depression and related mood disorders. Mood stabilizers, such as lithium, became effective treatments for bipolar disorder. Anxiolytics like benzodiazepines addressed symptoms of anxiety disorders. These medications improved the lives of countless individuals.

There has also been a growing recognition of the importance of integrating psychotherapy with medication medication, including cognitive-behavioral therapy (CBT), psychodynamic therapy, or family therapy.

Recent years experienced a rise of holistic approaches such as mindfulness, yoga, meditation, and nutrition counseling. These interventions aim to promote overall well-being and can be effective in managing stress, anxiety, and certain mood disorders.

Humanity has made massive progress in destigmatizing mental health, with many communities and cultures now being able to opelyn talk about it. Public figures, organizations, and mental health advocates have been vocal about their own experiences with mental health challenges, normalizing the conversation around mental health. Still, lots of work is still to be done to completely destigmatize these conditions, however we are on an excellent upwards trend.

Conclusion

The history of mental health is marked by both progress and challenges. By learning from the past, we can create a present and future that prioritize mental well-being, challenge stigma, and provide inclusive and compassionate care for all. Together, we can be agents of change, supporting mental health initiatives and advocating for a society that values and prioritizes mental well-being.

Let us remember the words of Dorothea Dix: "In a world where you can be anything, be kind."

As we encourage open conversations about mental health, let us remember that empathy, understanding, and support can be the catalysts for positive change in the lives of those facing mental health challenges. Together, we can create a society where mental health is valued, supported, and nurtured—a society where each individual can thrive and find solace in the knowledge that they are not alone in their journey towards mental well-being.