Treatment of Mental Illness
The attributions and treatments of mental illness have varied throughout history. Typically, early humans considered mental illness an infection of evil spirits. So it was in ancient Hindu scriptures, which described depression and anxiety. Around 600 bce, a document that was part of Hindu Ayurveda (knowledge of life) taught that ill health resulted from an imbalance in the 3 kinds of bodily fluids, which reflected bodily forces (dosha). Different personality types were described, with propensities toward emotional difficulties. Treatments included ointments and herbs, charms and prayers, persuasion and shock treatment.
Similarly, traditional Chinese medicine included treatments of acupuncture, herbs, and emotional therapy. The Yellow Emperor’s Inner Canon (Huangdi Neijing), ~250 BCE, described symptoms and treatments for mental illness, with emphasis on connectivity between organs and emotions, and balancing the flow of bodily energy (yin-yang).
The ancient Greeks had a variety of takes on mental illness. Typically, aimless wandering and violent behavior were taken as signs of madness. Hippocrates classified mental disorders, including melancholy, mania, and paranoia. Homer, Sophocles, and Euripides variously attributed insanity to the whim of the gods, imbalanced humors, or duress.
Socrates saw some positive aspects to insanity, including prophetic ability and other mystical attributes. Socrates admitted that he experienced willful hallucinations. Pythagoras heard voices.
1st-century-BCE Greek physician Asclepiades of Bithynia, who practiced in Rome, advocated humane treatments for the mentally distressed. He had the insane freed from confinement, treating them with wholesome therapies, such as dietetics and massages.
The Romans inherited much Greek culture, including their view on mental disorders. 1st-century Roman physician Aulus Celsus compiled the medical encyclopedia De Medicina largely from Greek sources. Celsus considered insanity a continuous dementia, due to a mind at the mercy of hallucinations. Celsus taught that sanity may be restored by healing the soul through personal fortitude and proper philosophy. Celsus chronicled common treatments, including proper diet, drugs, bloodletting, talk therapy, incubation in temples, incantations, amulets, and exorcism. Celsus also listed less humane methods, such as restraints and tortures, designed to restore rationality through terror, starvation, beating, and stoning.
Mentally ill Romans were typically kept at home with the family, or wandered the streets, subject to abuse.
Jesus ben Ananias
A voice of noise in the city, a voice from the temple, a voice of the Lord that rendereth recompense to his enemies. ~ Jesus ben Ananias [Isaiah 66:5, The Bible
Jesus ben Ananias wandered Jerusalem, prophesying that the city would be destroyed 4 years before the First Jewish-Roman War began in 66 bce. Jewish leaders there turned him over to the Romans for prosecution. He was tortured, but then released as a madman because he had shown no concern for his fate while being tortured.
Ananias persisted with his prophecy until he was killed by a catapulted stone during the Roman Siege of Jerusalem in 70 bce. In the moments before he was struck and killed, Ananias uttered, “Woe once more to the city and to the people and to the temple, and woe to me also.”
The siege ended with the city sacked, the destruction of Jerusalem’s famed Second Temple, 1.1 million Jews killed, and 97,000 enslaved.
The ancient Israelis considered insanity caused by poor relations between a person and God.
Persian and Arabic scholars, like the Romans, were heavily influenced by Greek concepts. Under Islam, the mentally ill were considered incapable by loss of reason yet deserving of humane treatment. This was far superior to Roman practice.
The first psychiatric hospital was founded in Baghdad in 705. Over decades and centuries others followed throughout the Islamic world. Islamic practices varied as views melded with local traditions. Some cultures, such as the Berber in Morocco, believed in animism and sorcery. They considered mental illness to be possession by a spirit (djin), either good or bad. Ridding evil required exorcism, including beatings.
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Madness during the Middle Ages in Europe was met with a mixture of attributions and treatments, many abusive and torturous, though some less dire.
Christian theology endorsed a variety of therapies. The depressed were estranged from God, for which fasting and prayer was the proper treatment. The violently insane were possessed by Satan, whereupon the extremes of exorcism were called for.
Although mental disorders were often attributed by clergy to sinful ways, more mundane causes were considered, including poor diet, alcoholism, overwork, and grief. 13th-century French Franciscan friar Bartholomeus Anglicus suggested that the depressed listen to music.
Consistent with earlier times, lunatics were often cared for by family. The tradition of sometimes treating hallucinations as visions and spiritual insights was also maintained.
As the Age of Enlightenment dawned, and its sun of reason supposedly shone, the mentally ill in Europe and America were imprisoned, often with delinquents, vagrants, and the handicapped. Those considered deranged were typically chained to the walls of dungeons.
The insane were typically viewed as insensitive, wild animals. Torture was seen as therapeutic. Madhouse owners were known to boast of their skill with the whip.
During the mid-19th century, American activist Dorothea Dix tirelessly lobbied for decent treatment of the mentally disabled. She started in Massachusetts in the early 1840s, where the mentally ill of all ages and both sexes were incarcerated with criminals but treated even worse: left naked in the dark without heat or bathrooms. This was typical of treatment in the United States at the time.
Over the next 40 years Dix was able to make a difference. 32 state hospitals were established thanks to her activism.
The culmination of Dix’s work was legislation passed by Congress that would have committed federal funds to help the mentally disabled. President Franklin Pierce vetoed the bill in 1854, with the position that the federal government should do nothing for social welfare: an optional responsibility he thought best left to the states.
By the late 1800s the popular expectation was that hospitals and humane treatment for the mentally ill would be curative. This did not prove out. State hospitals became overcrowded dumping grounds. Mental institutions became a parallel prison system, where keeping control became paramount.
Indecent custodial care and medical experimentation continued for decades. By the 1930s, patients in the United States were variously lobotomized, infected with malaria, repeatedly put into insulin-induced comas, drugged, and given electrical shocks.
In Nazi Germany, institutionalized mental patients were sterilized, and over 200,000 euthanized. German psychiatrists willingly participated without needing to be formally ordered to do so. This program became a blueprint for the later annihilation of Jews, homosexuals, and other undesirables within reach of the Third Reich.
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Modern psychiatry has regressed back to the 19th century, when the predominant view of mental disorders was that they were either hereditary or due to brain disease. Despite evidence to the contrary, modern psychology suggests that the psyche does not induce emotional states like anxiety and depression, and prefers to view them as chemically caused. ~ American physician John Sarno in the 21st century
The jails have become the de facto mental institutions. ~ Esteban Gonzalez, president of the American Jail Association, in 2013
In 1946, President Harry Truman signed the National Mental Health Act to help the mentally disabled veterans who served in the 2nd World War, of which there were hundreds of thousands: enough of a social problem that the authorities were alarmed. This was the federal government’s first foray into social assistance for the mentally ill.
The law established the National Institute of Mental Health (NIMH), which funded psychological research with a $1.5 billion budget by 2010. NIMH’s mission is “to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.”
In 1955 US state mental institutions housed 560,000 patients. By 1977 budgetary considerations had cut that number to 160,000. Mental illness was criminalized when acted out or otherwise ignored by the state.
Institutionalization typically remained forced imprisonment. The 1999 Supreme Court Olmstead ruling gave incarcerated patients a somewhat improved legal opportunity to seek community-based treatment. The Olmstead decision was not enforced by the Republicans in power, as pointed out by President Barak Obama’s 2008 initiative to correct the situation. 75% of nearly 600 federal investigations found civil-rights violations. At least 20 states negotiated settlements with the Justice Department: settlements which did nothing to improve the situation.
Government budget cuts for mental health treatment has meant that more mentally disturbed people are imprisoned rather than given appropriate care. The percentage of mentally ill in prisons throughout the US grew from 0.7% in 1880 to 5% in 1987 to 21% in 2005. That percentage continued to rise in the 2110s as psychiatric hospitals and other mental-health facilities closed throughout the country.
Society was horrified to warehouse people in state hospitals, but we have no problem with warehousing them in jails and prisons. ~ Thomas Dart, sheriff of Cook County
Cook County jail, which covers the Chicago area, is exemplary. Effectively, the jail is one of the largest mental institutions in the country: housing up to 2,500 inmates diagnosed as sick in the head. They wind up there because they cause a public disturbance and there is nowhere else to put them.
~5% of American adults are mentally disabled. They live on urban streets, scrounging in dumpsters for food scraps. Having nowhere else to go, many repeatedly commit nuisance crimes which land them in jail, where they have a relatively safe place to sleep, regular meals, and may receive medication.
The mentally ill in jails and prisons throughout the US cost $100,000 a year or more to keep per person: an estimated $9 billion total in 2013. If they were instead in supportive environments, that cost would be 5 times lower: less than $20,000. Such consideration would require sanity from a society which shows no sign of it.
The Veterans Health Administration is the United States’ largest integrated health care system, serving 9 million veterans in 2018. Its facilities are overwhelmed with erstwhile warriors seeking help for mental problems. Severely understaffed, therapeutic treatment consists largely of prescribing mind-dulling psychoactive drugs.
There is a worldwide pandemic of mental illness. Societal response has generally been consistent with historical indifference to abusive contempt.
Government investment and development assistance for mental health remain pitifully small. Human rights violations and abuses persist in many countries, with large numbers of people locked away in mental institutions or prisons, or living on the streets, often without legal protection. ~ Indian psychologist Vikram Patel, as part of the 2018 Lancet Commission report on global mental health