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 16th 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 20th 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
Humanitarian Reform
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.
Dix and The Mental Hygiene Movement
It was in the 19th 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.
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
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 16th 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 20th 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 18th century continuing
to treat the inmates terribly.
Humanitarian Reform
At the end of 18th 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 19th and early 20th 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
19th 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 19th 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 20th 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.
