Samatha A. S. 1114389

Historical  Views of Abnormal Behavior -Toward Humanitarian Approaches

During the Middle Ages and much before that, superstitious beliefs had hindered the understanding and therapeutic treatment of mental disorders. Scientific questioning reemerged as well as emphasis on the importance of particularly human interests and concerns began during the latter part of the Middle Ages and early Renaissance.

The Revival of Scientific Questioning in Europe

 Paracelsus (1490-1541), a Swiss physician, being a critic of superstitious beliefs about possession, asserted that the ‘dancing mania’ was a form of disease that should be treated, and was not possession. He rejected demonology and viewed abnormal psychology through his beliefs in astral influences. According to him, the moon wielded a supernatural act upon the brain, causing abnormal behaviour. He also contented a conflict between the instinctive and apparitional natures of human beings, formulated the idea of psychic causes for mental illness and recommended treatment by "bodily magnetism" which then came to be known as Hypnosis.

John Weyer  (1515-1588), a 16^th century German physician and writer out of concern over the torture, imprisonment and burning of people impeached of witchcraft made a dliberate study and wrote a book called “The Deception of Demons”, published in 1563. His main intention of writing this book was to help people understand that all these people who were tortured, etc. were actually sick in body or mind and did not deserve any such kind of violent treatment. Advocates such as Weyer and others, slowly paved the way for the reemergence of observation and reason which culminated in the development of modern experimental and clinical approaches. Weyer, though he was scorned by his peers as “Weirus Insanus” and was banned by the Church until the 20^th century, he was one of the first physicians to specialize in mental disorder and was known as the founder of modern psychopathology.

The Establishment of Early Asylums and Shrines

 Early asylums were known as “madhouses” which were special institutions exclusively meant for the care of the mentally ill. These madhouses were pathetic and people died because of the astonishing filth and cruelty they were put under. Initially, these type of  asylums were laid down in order to remove the so called  “troublesome” people who could not take care of themselves from the society.  The Valencia mental hospital, founded by Father Juan Pilberto Jofre was the first hospital established in Spain in 1409. The monastery of St, Mary of Bethlehem in London was officially turned into an asylum in 1547 by Henry VIII. The hospital then came to be known as “Bedlam” but turned out to be very infamous or notorious for its wretched conditions and practices. The inmates had iron hoops around their waists and their hands and feet were chained, they were not allowed to lie down in the nights, the cells were full of filth and were never cleaned, water treatment, electric shocks, etc. were some of the harsh and violent treatments the patients had to put through, some for 30 years or so.  The inmates of the asylum were forced to look for charity on the streets, were exhibited to the public for a penny, etc. Soon in other countries as well such asylums for the mentally ill were established. Asylums in Mexico in 1566, France in 1641, and Moscow in 1764 were established. These asylums continued to exist through most of the 18^th century continuing to treat the inmates terribly.

 Humanitarian Reform

At the end of 18^th century, majority hospitals in Europe and America required reform greatly.. It was through Philippe Pinel’s work in France, that the humanistic treatment of patients received great impetus.

Pinel in 1972, shortly after the first phase of French Revolution conducted an experiment on the inmates of The La Bicetre Hospital in France after acquiring permission from the Revolutionary Commune. The aim of his experiment was to test his perspectives that, mental patients must be treated with kindness and consideration. Hence, he got the chains to be removed from some of the inmate, provided them with sunny rooms, allowed them to exercise, etc. and the experiment was proved successful. The previous noise, filth and abuse were replaced by order and peace. Had this experiment been a fail, Pinel might have lost his head.

William  Tuke (1732-1822), an English Quaker established the York Retreat wherein mental patients lived, worked and rested in a kind and religious atmosphere. Soon, trained nurses and supervisors were appointed in asylums. These innovations resulted in the improvement of care of mental patients as well as changed public attitudes toward the mentally disturbed. But during the late 19^th and early 20^th centuries, a lot of prominent mental hospitals evolved which resulted in overcrowding and offered inhumane treatment.

Rush and Moral Management in America

The treatment of mental patients was revolutionized throughout the world, as a result of the success and achievement of Pinel’s and Tuke’s experiments. Benjamin Rush(1745-1813), who was affiliated with the Pennsylvania Hospital in 1783 wrote the first taxonomical treatise on psychiatry in America, “Medical Inquiries and Observations of the Diseases of The Mind(1812)”. He encouraged more humane treatment of the mentally ill, and organized a course in psychiatry, the first American to do so. Apart from founding American psychiatry, he was also one of the signers of Declaration of Independence.

Some of the drawbacks of his medical theory were that it was corrupted with astrology and his principal curatives were bloodshed and aperients. His invention and use of the device he called ”the tranquilizing chair” was more torturous than tranquil for patients.

During the early part of this period of humanitarian reform, “moral management” became very widespread. It refers to a “wide-ranging method of treatment that focused on a patient’s social, individual and occupational needs.” Moral management in asylums stressed on the patient’s spiritual and moral development and rehabilitation of their “character” and not on mental or physical disorders. This was practiced through manual labour, spiritual discussion and humane treatment as effective treatment for disorders were not available.

Though Moral management became famous because it was done without any anti psychotic drugs it was abandoned during the latter part of the 19^th century. The reasons for this were; ethnic prejudice against the rising immigrant population, the failure of the movement’s leaders to train their own replacements and the over elongation and crowding of hospital facilities.

Advances in bio-medical science also contributed to the death of moral management and the rise of the mental hygiene movement.

Dix and The Mental Hygiene Movement

It was in the 19^th century that Dorothea Dix (1802-1887), a New Englander became a champion of poor and ‘forgotten’ people in prisons and mental institutions for decades. As she taught  in women’s prison in 1841, she became familiarized with the miserable conditions in jails, asylums and almshouses. Dix through her campaign she carried for almost forty years elicited people and legislatures to work on the inhumane treatment of the mentally ill. It was through her efforts that mental hygiene movement grew in America, hospitals were built through funds, two large institutions in Canada and  the asylum system in Scotland and many other countries were reclaimed. Finally she ended her career by organizing the nursing forces of the northern armies during the Civil War. The U.S. Congress characterized her as “among the noblest examples of humanity in all history”. However though the establishment of so many hospitals resulted in overcrowding, Dix was a hardworking reformer whose studies helped greatly in changing public attitudes toward the mentally ill.

Mental health treatment was also advanced by military medicine. The first mental health facility for treating mentally disordered was causalities, opened by the Conference Army in the American Civil War.

 Causes and Treatment of Mental Disorders in the Nineteenth-Century were viewed as follows;-

During the early period of this century, effective treatment for mental disorders were unavailable, hence resorted to measures, practices and procedures such as; drugging, bleeding, purging, etc. which did not prove to be very helpful. However, during the latter part of the same century, medical professionals gained control over the asylums and incorporated traditional and moral management therapy into their other fundamental physical-medical procedures. Psychiatrists of that time thought emotional problems were caused due to the expenditure or depletion of bodily energies. They also believed that depression was a result of nervous exhaustion. They also introduced something known as “neurasthenia”, a condition that involved pervasive feelings of low mood, lack of energy and physical symptoms that were thought to be related to “lifestyle” problems brought on by the demands of the civilization.

Mental Health in the Early Twentieth Century: Changing Attitudes Toward Mental Patients

In America, it was the pioneering work of Dix and Clifford Beer’s(1876-1943) book called ‘A Mind That Found Itself’, published in 1908 that brought about changes in people’s minds toward the mentally ill. Beer, a Yale graduate, in his book described his own experience of mental collapse and how he received bad treatment in three typical institutions of the day. He then soon won the interest and support of many public-spirited individuals including the eminent psychologist William James and Adolf Meyer, “dean of American psychiatry”.

Mental Hospital Care in the Twentieth Century

 Though in this period a number of asylums existed and were being established for the mentally ill, the mental patients’ fate was neither entirely positive nor uniform. Mental hospitals during this time consisted of patients who had severe mental disorders such as schizophrenia, depression, organic mental disorders, tertiary syphilis and paresis and severe alcoholism.  In the first half of this century, there was hardly any effective treatment for the patients, instead they were tortured and treated inhumanely.

It was in the year of 1946 that the period of change began. Mary Jane Ward published a book known as ‘The Snake Pit” which helped in creating concern over the necessity of providing more humane mental health care in the community in the place instead of the overcrowded mental hospitals. The National Institutes of Mental Health in 1946, the Hill-Burton Act and the Community Health Services Act of 1963 , helped in creation of far-reaching set of programs to develop outpatient psychiatric clinics , inpatient facilities in general hospitals , and community consultation and rehabilitation programs. Soon the development of efficient medication for several disorders such as the use of lithium in the treatment of manic depressive disorders, introduction of phenothaizenes for the treatment of schizophrenia took place. The international movement, ‘deinstitutionalization’, although motivated by beneficent goals, created many difficulties for many mentally ill patients as well as for many communities. Large numbers of psychiatric hospitals were closed in order to bring the mentally ill people back to the community and treat them humanely. There was significant number of hospitals closed. This was known as the ‘deinstuitutionalization’ movement. The main objective behind the deinstitutionalization policy was to treat people humanely outside the large hospitals which was also cost-effective and would keep them from developing negative adjustments to hospital confinement.

It was by the end of the 20^th century that inpatient mental hospitals had been substantially replaced by community-based care, day treatment hospitals, and outreach programs. Deinstitutionalization has not only created problems for patients but also for the entire society. The role of the psychiatric hospitals in helping those with severe psychiatric problems probably should undergo further evolution as society again finds it hard to deal effectively with problems that severe mental illness can create if ignored or left unattended.