Being Mentally Healthy – 9. Mental Illness Treatment

People in antiquity commonly considered mental illness an infection of evil spirits in the mind. So it was in the ancient Hindu scriptures known as the Vedas. Vedic texts featured descriptions of depression and anxiety.

Ayurveda, which translates to “knowledge of life,” is the traditional Hindu health guide. By the 7th century before the common era, Ayruveda taught that ill health resulted from an imbalance in the 3 doshas. A dosha is a distinct energetic bodily flow. Different personality types were described, with propensities toward emotional difficulties. Ayurvedic treatments included ointments and herbs, charms and prayers, persuasion, and shock treatment.

Similarly, traditional Chinese medicine included treatments of acupuncture, herbs, and emotional therapy for mental disorders. The Yellow Emperor’s Inner Canon, written in the 3rd century before the common era, described symptoms and treatments for mental illness. The emphasis was on connectivity between organs and emotions, and balancing the flow of bodily energy, which was called yin and 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.

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In the 1st century before the common era, Jesus ben Ananias wandered Jerusalem, prophesying that the city would be destroyed. This was 4 years before the war between the Romans and Jews began, in the year 66 before the common era.

Jewish leaders in Jerusalem turned Ananias over to the Romans for prosecution. Ananias 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 the year 70 before the common era. 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.”

Ananias’ prophecy proved true. The siege ended with the city sacked, the destruction of Jerusalem’s famed Second Temple, 1.1 million Jews killed, and 97,000 enslaved.

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Greek physician Asclepiades of Bithynia practiced medicine in Rome in the 1st century before the common era. Asclepiades 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 a medical encyclopedia 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.

The ancient Israelis considered insanity caused by poor relations between a person and God. Mentally ill Jews suffered neglect or abuse for their spiritual incontinence.

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. Others followed throughout the Islamic world.

Muslim therapeutic 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. Ridding evil required exorcism, including beatings.

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Madness during the Middle Ages in Europe was met with a mixture of treatments, many abusive and torturous, though some less dire.

Christian theology endorsed a variety of therapies. Following Jewish thought, the depressed were estranged from God. Fasting and prayer were 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 should listen to music.

Consistent with earlier times, medieval 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 chained to the walls of dungeons.

The insane were often viewed as insensitive, wild animals. Torture was seen as therapeutic. Madhouse owners were known to boast of their skill with the whip.

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In 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, feeling that the federal government should do nothing for social welfare.

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By the late 19th century, the popular expectation was that hospitals and humane treatment for the mentally ill would be curative. That 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 medical treatment of severe mental illness has been based upon the false assumption that it has a physiological cause.

Electroshock therapy induces brain seizures which can cause irreparable damage, but, astonishingly, has been considered safe and effective for depression, mania, and catatonia. Electroshock is commonly combined with drug treatment.

Surgically severing supposed connections in the brain – lobotomy – was common in North America and Britain during the 1940s and 1950s for mentally disturbed people. The majority of lobotomies were performed on women. The after-effects were often severe. A depressing number of those who had lobotomies ended up committing suicide. Lobotomies were discontinued from the 1950s, first in the Soviet Union and continental Europe.

The replacement for lobotomy was psychiatric drugs which reduce disturbing symptoms but may turn those treated into compliant vegetables. The drugs invariably dim awareness. Even those who say that their minds are more manageable feel that their spirit has ineffably been diminished.

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In 1946, US President Harry Truman signed the 1st federal statute to help mentally disabled veterans who had served in the 2nd World War – of which there were hundreds of thousands: enough of a social problem that the authorities were alarmed.

In 1955, US state mental institutions housed 560,000 patients. By 1977 budget cuts had slashed that number to 160,000. Instead of any pretense of care, mental illness was criminalized when acted out, or otherwise ignored by the state.

Neglect and abuse of severe mental illness has not much changed in the US in the past half century. Rather than given appropriate care, mentally disturbed people are imprisoned. Psychiatric hospitals and other mental health facilities have closed throughout the country.

Thomas Dart is sheriff of Cook County, Illinois, where Chicago sits. Dart: “Society was horrified to warehouse people in state hospitals, but we have no problem with warehousing them in jails and prisons.”

Cook County jail is one of the largest mental institutions in the nation: 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.

Around 5% of American adults are mentally disabled. They live rough in urban areas, 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 at least $100,000 a year per person: some $10 billion total in 2018. 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-numbing psychoactive drugs.

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There is a worldwide pandemic of mental illness. Societal response has generally been consistent with history, ranging from indifference to abusive contempt. The depressing situation in the US is mild compared to many nations, especially those countries with poor human rights records. There is a strong stigma against those who are mentally ill in all societies.

Indian psychologist Vikram Patel, who was part of an international commission on mental health that reported in 2018: “Government investment for mental health remains pitifully small. Human rights violations and abuses persist in many countries, with large numbers of people locked away, or living on the streets, often without legal protection.”

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In the next lesson we examine how the mind works. Our exploration moves from conventional miscomprehension to understanding the how and why of mental health.