In 2007 the UN reported that 1/6th of the world’s population is afflicted by neurological disorders (UNNews). Though about 17% of the world is afflicted with neurological disorders, people with these disorders are still stigmatized. A recent study finds that more than three-quarters of people with neurological disorders believe that they are stigmatized due to their condition and more than a fifth have been bullied or teased (Doward, 2016). This stigma that people with neurological disorders have dealt with has existed for centuries. Those with neurological disorders have been stigmatized differently throughout unique points of history from the belief the mentally impaired where possessed by demonic spirits to their behaviors being viewed as different and irregular within modern societies.
Ancient Views and Mental Health Treatments Treating behavioral disorders isn’t new. In fact, people have been treating behavioral disorders since 5000 B.C. Ancient world cultures believed that mental illnesses were “the result of supernatural phenomena”, with these supernatural phenomena varying from “demonic possession” to “sorcery” and “the evil eye” (Porter, 2002). One of the most common treatments during this era was doing a trephine, which is a chipping a hole into the top of the patient’s head, which in turn would expel the evil spirits out of the patient. While this was a popular ancient treatment there are many more treatments from different ancient cultures. The Ancient Persians believed that mental illnesses were the cause of demons, but they believed sanitation and mental/physical purity was best in preventing and protecting people from mental illnesses. Ancient Egyptians believed mental illnesses should be treated through patients participating in recreational activities, thus Dr. Allison Foerschner considers the Ancient Egyptians, “very advanced in their treatment of mental handicaps.”(Foerschner, 2010). Between 500 and 300 B.C a prominent Grecian philosopher changed the way mental disorders were viewed. Hippocrates started his research with a mindset devoid of superstitious beliefs and solely focused on the medical aspect of mental illnesses. He specifically studied the pathology of the brain and concluded that mental illnesses were caused by imbalances in the brain. He believed that those imbalances were caused by the “four essential fluids”(Foerschner, 2010)4, which are blood, phlegm, bile, and black bile which Hippocrates believed created the “unique personalities of an individual” (Foerschner, 2010). Hippocrates’ research caused Greek physicians to change their treatments to cure the imbalances of the four essential fluids. These physicians used phlebotomies, extreme dieting, purging, etc. to help with these imbalances. These treatments spread quickly around Europe and other nearby nations, yet still many believed in demonic superstitions as the root of mental illness. A mixture of superstitions and bodily imbalances remained the common beliefs behind mental disorders for centuries around the world, yet as time grew on Hippocrates’ theory became an increasingly dominant belief. Due to the emergent dominant belief, people with these mental afflictions were socially outcasted. Especially in East Asian countries such as China and Japan, it was believed that a mentally ill family member meant there was a disability in the bloodline, causing the family’s status to be potentially ruined. Those with mental illness were disowned by their family members and were forced to become homeless so that others wouldn’t associate them with their family. In certain situations, those with mental afflictions were even put in dungeons and confinement because they were viewed as, “dangerous and unmanageable”(Foerschner, 2010). Reformations from Ancient Treatments Throughout the next 1,250 years ideas of demonic possession and bodily imbalances as the root of mental illness was diminishing and new hypotheses primarily focusing on the physiological aspect of the brain were raised. While a new hypothesis regarding the cause of mental illness arose institutions did have some alterations. Those with mental illnesses were placed in workhouses, asylums, and madhouses because families didn’t know how to manage people with their illnesses. The conditions of these institutions were inhumane. People in madhouses were constantly abused and neglected, except for private madhouses owned by the Vatican which had somewhat better conditions. Clergymen tended to assure treatment for the mentally ill with going to church and repenting one’s sins. Those placed in an asylum were constantly abused and neglected. Oftentimes these patients were shackled in iron collars and even put on display. Treatments given in asylums included purging, blistering, sedatives, physical restraints, and boiling or ice water shock treatment. Patients who were sent to asylums wrote books and shared their experiences with the public. Their accounts on the treatment and conditions of the asylums caused for a major reform. In the early 1800’s reformation started to occur once mentally ill patients recounted their experiences in asylums, madhouses, and workhouses through releasing books that gave vivid depictions of the conditions and treatments received. Reformists greatly influenced the spread of this reformation. One reformist was Phillipe Pinel from Paris started the Humanitarian Movement. Pinel believed that the mentally ill could improve if they were treated with more kindness. This is represented through Pinels statement, “I cannot here avoid giving my most decided sufferage in favour of the moral qualities of maniacs. I have no where met, excepting in romances, with fonder husbands, more affectionate parents, more impassioned . . . than in the lunatic asylum, during their intervals of calmness and reason.” (The Oxford Review, 1807) Using this hypothesis Pinel took over La Bicêtre Asylum removing the chains and shackles that patients were once contained by and proceeded with therapeutic interventions for patients. The other reformist who greatly impact the reformation movement was William Tuke who believed that patients should be treated with respect and compassion. Tuke formed The York Retreat which prohibited the use of chains and only allowed for restraints in the most extreme of cases. Tuke used recreational treatments such as exercise, talk therapy, reading, and even excursions to the city or other aesthetically soothing places such as gardens. Visitors of patients was also highly encouraged and suggested improvements made by visitors was used in the improvements of the retreat. 40 years after Tuke and Pinel, a woman named Dorothea Dix would greatly impact how the United States would in the future treat people with mental illnesses. Dorothea Dix was a teacher when she went to Cambridge House of Corrections to teach a class to women inmates. While at the institution Dix saw how most of the modern world treated the mentally afflicted. Dix saw mentally ill patients being contained in the same cells as prisoners, patients lying in there own dirt and fecal matter, patients chained in dark spaced devoid of light, and patients being abused both physically and sexually by staff. Dorothea decided to fight for the rights of the mentally ill and start advocating for more humane conditions and treatments for these patients. Dix took this matter to the courts and fought many hard battles even leaving victorious. She also wrote a book named “Remarks on Prisons and Prison Discipline in the United States”, which outlined what changes she wanted the government to execute. Dix over the next 30 years helped form 32 new hospitals and a government hospital, St. Elizabeth's in Washington, D.C. During Dorothea’s time advocating for the mentally ill the number of mental health institutions in the U.S.A increase by over 100 facilities. When Dix wasn’t helping open new hospitals she helped reorganize, enlarge, and restaff pre-existing hospitals. Mental Disorders in the late 1800’s and 1900’s In the late 1800’s more psychologists deviated from prior hypotheses of the root of mental illnesses and focused on the biological aspect of the mind through a new Darwinian perspective. “Darwinian thinking dominated the biological and social sciences. Within the scientific community, mental deviations, i.e., extreme variations, were conceived as having a biological basis, primarily genetic, representing mutations that were unsuccessful adaptations for survival in the environments in which they appeared” (Riley, 2013). This viewpoint led to both the thought of mental deviations being incurable conditions and a new wave of thinking on how to treat those with neurological disorders. A prominent and emergent movement was the Mental Hygiene Movement. This movement started in 1908 when a man named Clifford Beers wrote the book “A Mind That Found Itself”. This book would rise to be a groundbreaking book recounting Beer’s harsh experience during his years being institutionalized. Beer’s wrote both about his condition and how nothing was done to cure him. He also emphasized how those who were self-sufficient, and passive weren’t treated as poorly due to their self-sufficiency. In contrast patients who needed more assistant were abused and neglected and treatments included isolation in a padded cell without air-conditioning or heat. After Beer’s rise to popularity through his book he began to advocate for improved conditions in institutions through eliminating physical abuse and improve salaries and living conditions for workers so more people would be more passionate about helping patients. A year after Beer’s book was released, Beer organized The National Committee for Mental Hygiene. “The National Committee had a directing board which included several esteemed psychiatrists, medical and public health officials, and politicians as well as lay people” (Lemkau, 1982). Prominent physicians and psychologists including Jane Addams, William James, and Adolf Meyer were involved in the committee. Beer and the committee helped individual states form their own mental health association to correct the horrendous conditions in institutions and asylums. The first association formed was the Connecticut Society for Mental Hygiene followed by multiple other states. By 1922 the committee launched a program specializing in psychiatrists and social workers working with emotionally disturbed children in child guidance clinics. The National Committee for Mental Hygiene concurrently declined as a new movement, the Community Mental Health Movement arose after World War II. Community based models arose as well as state and congressional legislation. Mental health services also increased with home care and outpatient treatment options become readily available. The National Mental Health Act of 1946 created The National Institute of Mental Health (NIMH), "the national focal point of concern, leadership, and effort for the mentally ill” (Foley & Sharfstein, 1983: 19). This Act of 1946 was the first significant legislation aiming to help those with mental health issues. This Act not only created the NIMH but also granted $7.5 million towards, “Fostering and aiding research related to the cause, diagnosis, and treatment of neuropsychiatric disorders; (2) Providing for the training of personnel for the award of fellowships to individuals, and for grants to public and nonprofit institutions, and (3) Aiding states in the prevention, diagnosis, and treatment of neuropsychiatric disorders through grants and technical assistance” (U.S. Congress, 1946: 1; Foley & Sharfstein, 1983: 19). Mental Health Study Act of 1955 was the next significant piece of federal legislation. This act allowed for the formation of the Joint Commission on Mental Illness and Health. Congress approved of giving $1.25 million to the commission so they could “conduct a nationwide study of the approaches to treating mental illness and to make recommendations for improving the care and treatment of the mentally ill.” (Roberts & Kurtz, 1987). In the committee’s final report in 1960, “Action for Mental Health”, the committee called prevention of mental health issues by providing full time mental health clinic accessibility to everyone and there should be a clinic per 50,000 people with the commission stating that these clinics “are a main line of defense in reducing the need of many persons with major mental illness for prolonged or repeated hospitalizations" (Joint Commission on Mental Illness and Health, 1961:XIV). This report made it to the desk of President John. F Kennedy which in response President Kennedy appointed an Interagency Committee on Mental Health. President Kennedy followed the advice of the committee and publicly addressed ways to improve access to mental healthcare and proposed new government aided programs and comprehensive community care. This speech would be known to be considered his “bold new approach” as it was the first time a president openly spoke and proposed legislation for mental health. The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 was released a few months after President Kennedy’s speech. “This important legislation led to the development of over 760 community mental health centers in the next 18 years” (Winslow, 1982: 273). Mental Health Stigmas in the Modern Era Throughout history there have been stigmas surrounding those with mental illnesses. These stigmas have affected not only the way those with mental illness were treated in society but their medical care. The root of mental illness has changed throughout time from demonic possession to the four bodily fluids to bloodline curses. But how do these past stigmas and treatments affect those with mental illnesses in the modern world? While social stigmas in the past are easy to determine from reading books that show the experiences and stigmas present in a specific era, modern stigmas aren’t as easy to determine because while present stigmas can be shown through media. A stigma is “an attribute that conveys devalued stereotypes”(Clair, 2018). protruded by the thoughts of those without mental illness which causes prejudice and discrimination to the mentally ill. To ascertain the social stigmas present in the modern world qualitative research studies conducted by philosophers, psychiatrists, sociologists, and psychologists have been done to see the social stigmas present in the modern world around mental illness. These research studies have shown an array of results and possible conclusions. A specific qualitative study was performed and results showed “46% of these adolescents described experiencing stigmatization by family members in the form of unwarranted assumptions (e.g. the sufferer was being manipulative), distrust, avoidance, pity and gossip,” (Davey, 2013). The same study showed that 62% of these same adolescents experienced stigmatization by peer which subsequently led to social rejection (Connolly, Geller, Marton and Kutcher, 1992). The study also showed that 35% of adolescents “reported stigma perpetrated by teachers and school staff, who expressed fear, dislike, avoidance, and under-estimation of abilities.” (Davey, 2013). The stigmas that were prevalent in Ancient Egypt and 19th century America, while seemingly different from modern day stigmas, they are all rooted in the same principles. These principles are as stated by Sherrie Hurd (a writer who battles mental illness) ignorance, gossiping, misconceived dangers of the mentally ill, and the mentally ill being considered as helpless. (Hurd, 2019). While Ancient societies seem very different from modern day ones, the same root of stigmatization of the mentally ill is the same even if medical treatment is differed. Researched & Written By Joseph DuPree Sources:
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