A Brief History of Mental Illness
· Healers in Siberia and Malay Archipelago experiment with hypnosis and the beginning of “talk” therapy
· Stone Age — Pointed rocks are used to make holes in the skull, trephining
· 450 BC — Plato implies insanity is an artistic achievement: “There is a…kind of madness which is possession by the Muses…the sane man is nowhere at all when he enters into rivalry with the madman.”
· 470–399 — Socrates records hallucination, describes hearing at least one voice, who he affectionately calls “my daemon,.” He places value on the voice, as it gave him wise advice. It warned him away from contemplated action, as opposed to suggesting one. Socrates spoke of it as “divine madness.”
· 460–377 BC — Hippocrates initiates public thought away from supernatural beings as deliverers of insanity. He transitions power to the “humours”
The Greek term agnosognosia means a blockage of insight into one’s self (it literally means “without knowledge”); the false conviction within a person, that they have nothing wrong in their head
“Whereas Greek physics and biology, no matter how crude, led eventually to modern science, Greek theories of human behavior led nowhere. If they are with us today, it is not because they possessed some kind of eternal verity, but because they did not contain the seeds of anything better”
Greeks (Hipocrates) are the first to use anatomy, chemistry and physiological investigative strategy, along with balancing “humours” — black bile, yellow bile, phlegm, blood — with terms like epilepsy, mania (abnormal excitement), melancholia (abnormal depression), paranoia, hysteria
“Hysteria” literally means ‘of uterus.’ Greeks believed mania came from a dislodged uterus wandering in body. Hysterical women suffered from ovarian mania. Greeks also believed marriage would cure it: “with repeated servicing the uterus would return to proper morrings.”
· 1247 — “Bedlam” is born, eventually becomes first and most infamous madhouse. Starts out small, as religious sanctuary, the Priority of St. Mary of Bethlehem.
· 1403 — “Bedlam” starts accepting handful of “lunaticks” as hospital, monks care for patients. Treatment included trying to beat devils out of [people]
· 1547 — King Henry VIII seizes control of Bedlam, grants City of London a charter to administer desolate cluster of buildings as sanctuary for insane
· 1666 — After the Great Fire of 1666 (London) Bedlam was rebuilt by architect Robert Hooke (contemporary Christopher Wren). It was designed as a mental institution. It was 2 stories with 120 patient rooms. Two gargoyles sat by the entrance gate, sculpted by Danish Caius Gabriel Cibber. One stared out lifelessly and was called Melancholy Madness. The other grimaced, raising a chained arm, and was called Raving.
· 1667 — First blood transfusion experiment takes place, between a Bedlam patient and a sheep
Bedlam keepers torture through beating, shackling, taunting, starving, hygienic neglect, and occasional murder. They “pioneer” use of antipsychotic medicine — giving patients opium, morphine, murky tonics and cathartics or laxatives as “antipsychotic” medicine
· 1728 — James Monro arrives at Bethlem. He bans medical students from premises and turns madness into spectator sport. Public pays coins for access and are encouraged to scoff and jest in inmates faces.
· 1753 — Philadelphia Hospital opens doors to patients (co-founded by Dr. Thomas Bond, Quaker, and Benjamin Franklin). It is the first incorporated hospital of any kind in America.
Benjamin Rush (another signer of the Declaration of Independence) joins staff in 1783 and served until death in 1813. “Father of American psychiatry,” he is the first man of science in America to publicly reject idea that insanity is caused by demons/witches.
· 1773 — Phillipe Pinel enrolls at University of Montpellier, France’s oldest medical academy and source of medical science’s freshest thought. There he encountered refinements on an ancient concept called “vitalism” later refuted by biology/genetics.
· 1784 — Anton Mesmer popularizes magnet therapy by wearing a lilac robe and waving a magnetic wand while soft music plays in the background. Eventually falls out of favor with society when the magnetic wand gets updated to his fingers. An investigation from academics leads to a medical review by none other than Benjamin Franklin, Lavoisier, and Dr. Guillotine.
· 1793 — French Revolution begins. Liberty, equality, and fraternity are popular notions. Soon after, comes first (French) Mental Health Revolution. French doctor Phillipe Pinel asks for rights to be extended to include those hospitalized in mental institutions (emotional disturbances are linked to physical disturbances).
· 1793 — Pinel is appointed as physician-in-chief of infamous Bicetre Hospital for men (converted orphanage, patients kept in shackles, bolted to walls, sleep standing up).
Pinel mandates three things: 1) better quality food, 2) the replacement of feces-and-urine-soaked straw beds and, 3) the creation of exercise regiment for inmate patients. He famously strikes off the shackles of fourty-nine (49) Bicetre inmates and is summoned to justify his actions. His defense is easy as not one of the newly unchained men bolted from his cell, or became violent.
· 1795 —a new apothecary arrived at Bethlem, claims to be expert on mentally ill. Believed patients’ wills had to be broken (beaten).
· 1796 — William Tuke (a coffee merchant who mourned the mysterious death of fellow Quaker, Hannah Mills, who died in York Lunatic Asylum 45 days after entering due to depression from her husband’s death) opens his own asylum. Tuke doesn’t call it an asylum. It is designed by London architect John Bevans, with the belief that an open environment and respectful treatment would cure patients. York Retreat (in opposition to York Asylum) sits on top a hill, with views of woods, meadows, and streams.
· 1798 — Economist and priest Thomas Malthus publishes Essay on the Principle of Population, warns human population expanding at “geometrical” rate, while food supply slogging at slower page. Arithmetic dynamics Malthus predict escalate under “laws of nature” into famine and brutal competition.
· 1818 — former patient Owen Metcalf goes to Parliamentary Select Committee and shares the long string of abuses he witnessed as a “patient.” Stories include patients being dragged and beaten bloody
· 1836 — Beagle arrives at Falmouth Harbor after 5 years abroad. Captain Robert Fitzroy, 23 years old, brings Charles Darwin as company. FitzRoy’s suffers from mood swings and depression. His uncle fatally stabbed himself in the neck in 1822.
· 1838 — Darwin reads Malthus’s Principles and links competition to natural-world predictions
· 1841 — devout Unitarian Dorothy Dix volunteers to teach Sunday school to women confined at East Cambridge (MA) jail, asks to see inmates screaming, jailer tells her “insane can’t feel cold or heat.” The “lunatics” are held as a group in a single, small room.
Dix takes 18-month trip to asylums to view locked insane. In 1843 she joins Samuel Howe to inspire or shame legislature into action (women were not allowed to address legislature in person, so Howe argued for her)
Dix expands her inspection tours (via railroad, steamship, stagecoach, buggy) to all of U.S. She befriends President Fillmore and senators, gives speeches, and cajoles legislators
Dix is credited with founding 32 asylums by 1880. She dies having tea.
· 1844–13 physicians run a small asylum in Philadelphia to form the Association of Medical Superintendents of American Institutions for the Insane. Eventually asylum numbers increase, but old and other sick patients are thrown in and “moral therapy” is seen as unsuccessful.
· 1854 — East Prussia, Ehrlich scientist researching aniline dyes as biological stains (only attach to certain body organ cells)
· 1856 — Emil Kraepeline born
· 1857 — Swiss psychiatrist Eugen Bleuler born
· 1859 — On the Origin of Species is published. Darwin argues human population growth is outrunning growth of food supplies. Argues skewed result of mankind genocides of “surplus” idiots/lunatics/morons/imbeciles/ nuts/etc. The 6th edition (1869) introduces “survival of the fittest” phrase
· 1860 — America’s population swells to 23 million, almost Civil War time (read: jails/asylums are overcrowded)
· 1869 — Darwin’s second cousin Francis Galton, amateur scientist (sexist, racist, white supremacist), publishes Hereditary Genius Its Laws and Consequences which tells the world a person’s intelligence is immutably fixed by bloodline. Also wrote an essay in the London Times that Chinese should relocate to Africa to “shoo away dark savages”
· 1870’s — Robert Koch & Louis Pasteur prove microbes cause infectious diseases (if invading organism could be killed, disease could be cured)
· 1871 — The Descent of Man published by Darwin
· 1883 — Kraepeline at 27 years old, publishes fundamental Compedium der Psychiatrie, argues case for organic causes of mental illness and sets out systems of classification. It is a groundbreaking assertion that goes against the establishment:
He dismisses the idea that illness could be inferred from given symptom, instead constitutes particular, observable combinations of symptoms that can become evident as illness progresses and points to a certain nature (his theory is taken from reading thousands of medical case studies)
He says psychiatry should be joined to medical science — since severe illness results in flawed biological processes in the brain which are measurable
2 categories: exogenous (“reversals of fortune that life can bring” — Freud’s practice addresses, treatable) and manic-depressive/endogenous (inner foreboding, organic brain damage, flawed patterns/deteriorating tissue)
· 1885 — Viennese neuropathologist Sigmund Freud establishes hysteria and other neuroses as disorders separate and distinct from medical AND magical beliefs. “Project for a Scientific Psychology” completed 1895. Downside: not real science. Psychology vs. medicine (tactile, physical, visible). Essentially the 2nd Mental Health Revolution.
Freud builds a conceptual scaffold to understanding irrational. He creates the terms: “the unconscious,” “libido,” “repression,” “denial,” “catharsis,” “parapraxis,” “transference,” “dream interpretation,” “the id,” “the ego,” & “the super ego”
· 1896 — Emil Kraepelin introduces term “dementia praecox”
It is Latin for precocious or premature, defined as biological, perhaps of toxic secretions from sex glands or intestines
· 1896 — Freud introduces the term “psychoanalysis”
· 1900’s — Totalitarianism, lobotomization, eradication via eugenics (neutering/eliminating) those with signs of madness. Nazi’s use live bodies of mentally ill prisoners for experimentation. The U.S. also dabbles in eugenics.
· 1903–39-year-old doctor Alois Alzheimer leaves practice in Frankfurt to join Kraepelin as assistant at Munich medical school.
Some records suggest Kraepelin first diagnosed Alzheimer’s but allowed his new colleague to take credit because he did not want to be seen as the only psychiatrist successfully on the trail of mental illness and organic sources. Diagnoses comes from a fifty-five-year-old patient determined to have died too young. After family consents to an autopsy, thin slices of cortex matter are cut. Plaque and decayed strands of nerve cells are found. They match common flaws found in brains… of ninety-year-olds.
· 1908 — Eugen Bleuler becomes known for being directly in the lives of his patients. He socializes, hikes, arranges theatre productions for, and acts next to, even supervises financials. He convinces his psychiatrist friends to drop the term dementia praecox and use new term schizophrenia. Perhaps not the best choice.
Schizophrenia means “a splitting of the mind.” Bleuler meant “loosening of association” by the split, but it became too close to the demonic split in personality of current times — for example, The Strange Case of Dr. Jekyll and Mr. Hyde (1886), Dracula (1897), Wolf Man (1918, Bram Stoker)
Bleuler accepts Freud’s unconscious, use of hypnotism, and interest in hysteria, but believes psychoanalysis does not cure-all.
Bleuler terms basic and accessory symptoms. Basic: passed along through heredity, deterioration, ultimate breakdown. Accessory: manifestations of breakdowns such as delusions, hallucinations
· 1909 — Elrich tests >900 compounds, finds first magic bullet, aka “salvarsan” which eradicates syphilis microbe from infected rabbits!
· 1909 — Indiana (America) enacts first compulsory sterilization law for mentally ill patients. California soon follows.
· 1926 — The American Eugenics Society is founded
Madison Grant, a titan conservationist and scientific racist, attends Yale in 1884. He is a champion of the natural world, a successful protector of natural lands, loathes Negroes, Jews, and immigrant nationalities invading pristine Anglo-Saxon. Grant is one of the Society’s founders.
Roosevelt in 1913 letter to Charles Davenport (eugenics pioneer):
“Society has no business to permit degenerates to reproduce their kind. It is really extraordinary that our people refuse to apply to human beings such elementary knowledge as every successful farmer is obliged to apply to his own stock breeding.”
· 1930’s/40’s — “Miracle” cures are embraced by asylum psychiatrists. Cures are comprised of a trio of therapies:
1.) Patients get injected with a high dose of insulin, which causes them to lapse into hypoglycemic comas. They are brought back to life with injections of glucose. NYT explained at the time, “short circuits of the brain vanish, and the normal circuits are once more restored and bring back with them sanity and reality.”
2.) Convulsive therapies such as poison (Metrazol) or electroshock are used to induce a seizure in the patient. Then, when the patient awakes, he or she will be free of psychotic thoughts and happier in spirit.
3.) Breakthrough surgical destruction known as frontal lobotomy, an “instant cure”
· 1922 — Eli Lilly learns how to extract hormone insulin from the pancreas glands of slaughterhouse animals. Diabetes treatment is born.
· 1931 — Sterilization laws are enacted in 27 U.S. states
· 1932 — Margaret Sanger (founder of Planned Parenthood) during a public speech in 1932: “We should apply a stern and rigid policy of sterilization and segregation to that grade of population whose progeny is tainted, or whose inheritance is such that objectionable traits may be transmitted to offspring.”
“Knowledge of birth control is essentially moral. Its general, though prudent practice must lead to a higher individually and ultimately to a cleaner race.”
·1933 Hitler is established as the chancellor of Third Reich
· 1939 — Nazi soldiers overrun a psychiatric hospital at Poznan (freshly occupied Poland). Over a thousand patients are ordered out of their beds. They are placed on flatbeds of trucks, driven to a nearby forest, and killed with carbon monoxide gas. Such action is called “disinfection.”
· 1940 — Hilter signs life-taking authorization for physicians “so that patients who, on the basis of human judgement, are considered incurable, can be granted mercy death after a discerning diagnosis.” Hitler maintains the policy does not decree murder. Doctors expand such acts of “disinfection.”
· 1941 — Hitler kills almost one hundred thousand mental patients. He turns to Jews.
· 1941 — Estimates up to 375,000 mostly insane people sterilized by Nazi’s
· 1942 — Scottish R. D. Laing popularizes the belief that the world is in fact mad and those labeled schizophrenic are the sane exception. This is around the same time as Fritz Lang’s Metropolis, a science-fiction film just like Blade Runner
· 1945 — Veterans return from Europe and struggle emotionally
General Lewis Hershey (director of Selective Service System) tells Congress that the nation badly needs to address a problem, he speaks of the war:
“Mental illness was the greatest cause of non-effectiveness and loss of manpower that we met”
Antipsychotic and psychotropic medications — “Wonder Drugs” — are used to control symptoms of schizophrenia and bipolarity (not viewed as disease, rather symptoms). They work by regulating flaws in certain chemicals in brain — such as serotonin and dopamine.
· 1945 — Before a joint session of Congress, President Truman declares:
“..special need for research on mental diseases. We have done pitifully little about mental illnesses…There are at least 2 million persons in the United States who are mentally ill, and as many as ten million will probably need hospitalization for mental illness in the course of their lifetime. Mental cases occupy more than one-half of the hospital beds, at a cost of about 500 million dollars per year — practically all of it coming out of taxpayer’s money.”
· 1946 — Congress passes the National Mental Health Act
· 1949 — Congress creates the National Institute of Mental Health (NIMH) to oversee reform
· 1961 —Thomas Szasz publishes The Myth of Mental Illness, calls mental illness just a range of behavioral choices that others find annoying or threatening. He uses metaphors to write off legitimacy. His views spread.
· 1963 — Freud shifts his emphasis from actual to analogous position, searching for physical irritants à searching for psychological explanations (i.e. weak superego, insatiable ID)
· 1960’s —The Deinstitutionalization Fiasco. Mentally ill patients are released from government funded treatment facilities. They become homeless and are often placed in prison where no prescriptions are available. Punitive segregation and solitary confinement trigger hallucinations and paranoia, among all prisoners. Brutal cycle to lasting psychosis.
· late 1960’s — “Depot” term coined to neutralize anosognosia. Involves a periodic injection performed by clinician, rather than self administered oral dosage
· 1970’s — New Age revolution, shamans and shamanistic thought resurge
· 1975 — Supreme Court decides involuntary hospitalization and treatment violate individual’s civil rights
· 1979 — Between early 1900’s and this year, California neuters 20,000 mental patients
· 1979 — NAMI is founded in San Mateo, California by a group of moms who believe their children are not receiving adequate care and advocacy
· 1983 — UC professor of psychiatry Irwin Feinberg suggests schizophrenia is triggered by excessive pruning of cortical synapses. Such theory is endorsed in 2011 by psychiatric researchers Gabor Faludi and Karoly Mirnics who call it, “a mental disorder with complex etiology that arises as interaction between genetics and environmental factors”
· 1980’s — Dramatic advances of magnetic resonance imaging (MRI, PET, CAT scans) make possible identification of lesion evidence (enlarged ventricles) in brains of schizophrenic patients
· 2014 — Creativity and Mental Illness published by five-person team of PhD’s specializing in psychiatric research, reports 103 studies in recent years suggesting genetic connection between creativity and psychosis
“…schizotypal thinking is often viewed as sharing features with creative thought, such as cognitive flexibility and divergent thinking via unusual but meaningful associations. These commonalities, couples with the observed heritability of both constructs, suggest that there may be genetic factors common to both creativity and schizophrenia.”
· 2014 — Federal prisons: 39% overcrowded medium-security; 52% overcrowded high-security
· 2014 — Jerry Brown signs a new law prohibiting neutralization of mental patients, after news breaks that the state “cleansed” the ovaries of 148 women between 2006 and 2010
· 2014 — Federal District Court judge Lawrence K. Karlton reviews policies and practices employed by the state Department of Corrections and Rehabilitation in dealing with mentally ill inmates (making up 28% of system population). Karlton issues an order ruling the practices as “unconstitutional.”