Transcript Mental Illness - Stockton University

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
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400 B.C.: Hippocrates
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Mental illness is result of disturbed
physiology and should be treated as a
medical illness.
Middle Ages
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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
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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
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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
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1883
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German psychiatrist Emil Kraepelin
develops distinctions among mental
disorders, particularly between manicdepressive psychosis and
schizophrenia
Late 1800’s
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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
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1908
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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
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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 19421946
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.
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1950’s
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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 antipsychotic drugs makes it possible for a
dramatic reduction in state hospital
populations.
 Anti-psychotic drugs introduce new problem:
sometimes serious side effects
1961
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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
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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
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Deinstitutionalization: number of
institutionalized mentally ill people in the US
drops from 560,000 to 130,000 by 1980.
 Deinstitutionalization possible because antipsychotic drugs control symptoms, but longterm 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.
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1979
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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
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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
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