INTRODUCTION
Before delving into the history of mental health, it is important to understand what mental health, or mental illness, is first.
According to World Health Organization (WHO), mental health is “a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community”. In other words, mental health involves our emotional, psychological as well as our social well-being. It influences our thoughts, feelings and the way we act. It is a significant part of every stage of an individual’s life, from childhood up until death. Consequently, any imbalance or impact to our mental health leads to mental health disorders that impair our normal functioning. Mental health disorders, or mental illness, can range from mild to severe enough to impair daily functioning.
A state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community
All of the information given above can be considered the most basic knowledge regarding mental health in the contemporary world. However, that has not always been the case. The world of mental health has seen major evolution throughout different eras. This brings us to the history of mental health.
HISTORY OF MENTAL HEALTH
Throughout history, humans have had a diverse number of perspectives regarding the problems that we now label as ‘mental illnesses’. In olden times, people were not aware that there existed something called ‘psychology’ and attributed the strange behavior of people to common superstitions. They came up with various kinds of practices to treat these psychopathologies and mental illnesses. It wasn’t until the late nineteenth and twentieth century that psychological explanations emerged. We will be looking at a brief recap of the history of mental health and psychopathology.
THE ANCIENT SUPERNATURAL BELIEFS
Humans have long grappled with questions like what causes an individual to behave abnormally or what is the reason behind mental illnesses. The search for answers behind these questions has been going on for a very long time. In ancient times, people had strong beliefs that had no logical reasons behind them. These beliefs are what we call superstitions. A common superstition in today’s time can be the belief that if a black cat crosses your path, it is an indication of ‘bad luck’ or ‘misfortune’.
Similarly, the ancient people commonly believed that abnormal behavior was the result of ‘possession by evil spirits’ or ‘punishment by a divine being’. They believed that these behaviors occurred due to an agent outside our bodies. This agent may be a supernatural power, celestial object or a strong phenomenon;
WITCHCRAFT & DEMONOLOGY
The people believed that individuals with mental problems were possessed and controlled by supernatural spirits or demons. They judged the nature of these spirits through the behavior of the individual acting abnormally. If the person showed negative or destructive behavior; he was said to be possessed by a demon or evil spirit. On the other hand, if a person exhibited excessively spiritual behavior; he was possessed by a holy spirit. These people had to suffer through inhumane and torturous treatments like drilling a hole through one’s skull, chaining and bounding to cages, etc. These people went through unfair trials and were labelled as “witches” or “demons” before eventually, being hanged or burned alive.
MOON & STARS
Another common belief was that the movement of moon and the stars is connected to the behavior of individuals and that it had a strong effect on them. In Latin, moon is called “luna”. This is where the term “lunatic” emerged from to refer to people who were deemed as clinically insane or crazy.
MASS HYSTERIA
This phenomenon can be understood as the ‘ripple effect’ of emotions. It is the belief that the emotions of one person spread from him to another and this continues on until a whole community is affected by the same emotion. For example, one person feels fear which will be passed onto others around him before escalating into mass hysteria or panic.
The Supernatural Model, although less prevalent now, has still not been completely wiped out. In lesser developed countries or societies with higher illiteracy rates, superstitions are still believed blindly, and people still turn to magic for the solution of mental health problems.
BIOLOGICAL MODELS
As interest in the scientific study of biology increased, supernatural explanations began to decrease. Another belief emerged wherein mental health problems were considered to be the result of a physiological problem or a biological imbalance.
EARLY GREEK CONTRIBUTIONS (HIPPOCRATES & GALEN)
Hippocrates, the Greek physician, made fun of demonological stories about illness and madness. Rather, Hippocrates postulated that aberrant behavior had natural origins, just like other types of sickness. He believed that, in order to be healthy; an individual should have proper balance in his body, specifically, balance of the four body fluids (blood, phlegm, black bile, and yellow bile). Hippocrates believed that imbalances in any one of these four fluids could lead to a variety of disorders or psychopathologies. Up until the middle of the nineteenth century, Western countries' medical thought was dominated by the Hippocratic approach. Hippocratic tradition-trained medical professionals saw "disease" as a monolithic idea. Put another way, doctors did not differentiate between illnesses other than mental diseases.
Adopting the Hippocratic Theory, the Roman physician, Galen, claimed that the four fluids correspond to Greek environmental ideas such as heat (blood), dryness (black bile), moisture (yellow bile), and cold (phlegm). If any one of these fluids was found in excess, it was treated by regulating the environment so as to decrease it. One example of treatment using the Galen concept is that of King Charles VI who was moved to a less stressful environment due to sickness.
Certain novel therapeutic approaches were used in the early biological models of mental illnesses. One of these was the use of leeches to extract a certain volume of blood in order to reduce violent impulses. This was known as “bloodletting”. Another treatment method was forced vomiting which was said to reduce depression.
NINETEENTH CENTURY (J.P. GREY & E. KRAEPELIN):
J. P. Grey believed that physical factors were the sole reason behind mental disorders. He advocated for proper rest and diet. One of his inventions was the rotary fan, to ensure that people had the proper environment to thrive in.
Kraepelin made contributions to the field of psychological disorder diagnosis and classification. Every psychological disorder has a distinct time of beginning and follows a unique course. His explanations of schizophrenia are still relevant today.
TWENTIETH CENTURY (INSULIN SHOCK THERAPY & ELECTROCONVULSIVE THERAPY)
Manfred Sakel, a physician from Vienna, started administering ever larger dosages of insulin in 1927. The patients experienced convulsions and even went into a coma, but much to the doctors’ surprise, they recovered. This led to the doctors using it more frequently, however, the technique was, eventually, dropped because it was risky, could put a person in a coma, or even kill them.
Following Joseph Meduna's 1920 observation, which later turned out to be inaccurate, that schizophrenia was less often seen in epileptics; his adherents concluded that schizophrenia might be cured by brain seizures. Doctors employed electroconvulsive therapy (ECT) widely and regularly, but it was an arguable technique; some even used it to punish patients who were uncontrollably problematic.
PSYCHOLOGICAL APPROACHES
This view emphasized that humans are such complex creatures with a variety of emotions. These numerous emotional problems cannot be the result of a single biological or organic issue. Therefore, viewpoints that were psychological, cultural or social, emerged as explanations to mental health problems or psychopathologies.
EARLY PSYCHOLOGICAL APPROACHES:
P. Pinel, William Tuke, Benjamin Rush, and Dorothea Dix spearheaded the moral and mental hygiene movement, which promoted considerate and compassionate treatment for patients in institutions. As a result of this movement, asylum laws were changed in Europe and America, and mental health practitioners tried to treat mental disease with humanistic treatment.
Initially, the mentally ill or the “lunatics” were majorly ignored and considered the responsibility of families rather than that of states. In the 1600s and 1700s, the “insane asylums” were established but they were not in any good condition. As years passed, however, and human dignity regained respect; the condition of the mental hospitals began to improve.
Dorthea Dix contended in the 1800s that caring for mentally ill patients in hospitals was both more cost-effective and humane than caring for them in their homes. She stressed on the development of specialized institutions for such patients. Psychiatry emerged as a new profession as a result of the establishment of sizable facilities for the treatment of mentally ill patients.
1844 saw the founding of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). In Worcester, Massachusetts, the state established a publicly funded institution for those suffering from mental illnesses in 1833. The first superintendent of the asylum and the first president of the AMSAII was Samuel Woodward. The Worcester Lunatic Hospital used a combination of ethical and medical practices for treatment.
PSYCHOANALYTIC APPROACH
Sigmund Freud was a pioneer in psychoanalysis (1856-1939). It was in France that he acquired his hypnosis skills and tried a few different hypnosis techniques. Freud urged his patients to openly communicate about their issues and anxieties. He used a variety of techniques like Freudian slips, dream analysis, and free association to uncover the unconscious mind and its role in psychopathology. Freud placed a strong emphasis on early experiences and inner mental processes.
The major elements of this approach are
Analysis of Mental Structures; the mental structures include the id, ego and superego.
Levels of Consciousness; the three levels of consciousness are the conscious, preconscious/subconscious and the unconscious.
Stages of Psychosexual Development; these include the oral stage, anal stage, phallic stage, latency stage and the genital stage.
Anxiety and Defense Mechanisms; the three different types of anxiety identified by Freud include the reality anxiety, neurotic anxiety and moral anxiety.
Psychoanalytic Therapy; it involves an in-depth talk which aims to bring our unconscious or repressed thoughts to the forefront of our minds.
The most common criticisms of the Freudian theory are that his claims are neither verifiable nor falsifiable along with the overemphasis on sexuality.
HUMANISTIC APPROACH
The humanistic perspective places an emphasis on the good things in life, personal development, and free will, contending that abnormality results from a failure to take accountability for one's actions. Carl Rogers and Abraham Maslow argued that our conduct is impacted by how we perceive our circumstances, rejecting deterministic psychoanalysis and behaviorism. Whereas Freud concentrated on psychic continuity and previous antecedents, Rogers promoted self-healing and personal development. Rogers stressed on the ‘here and now’ as opposed to Freud who believed in dwelling on the past.
Some of the important aspects of Roger’s theory are;
Self and Congruence: This is defined as “the organized, consistent set of perceptions and beliefs about oneself”.
Person Centered Therapy: It involves forming a therapeutic relationship which consists of unconditional positive regard, empathy and genuineness.
The most common criticisms surrounding the humanistic approach are the lack of scientific evidence and no bases for verification.
BEHAVIORAL APPROACH
The behavioral perspective, which was shaped by John B. Watson and Ivan Pavlov, emphasizes how learning accounts for both normal and aberrant behavior. Since abnormal behavior is learned similarly to normal behavior, it concludes that behavior is the problem. According to behaviorists like Watson and Skinner, environmental factors and genetic heredity both influence human behavior. They reject the ideas of autonomy, self-determination, and personal freedom. Rather than gaining understanding of how the mind functions; they focus on modifying behavior. From this approach, therapy is more about moulding behavior than it is about comprehending the mind.
Behaviorists believe that there are two forms of learning that shape our behavior:
Role of Classical Conditioning: It is defined as “the process in which an automatic, conditioned response is paired with specific stimuli”.
Role of Operant Conditioning: It is defined as “the process in which a behavior is either reinforced or encouraged through a series of punishments and rewards”.
→ Social-Cognitive Theory: By adding cognition roles and modeling learning through observation, Albert Bandura, Julian B. Rotter, and Walter Mischel's social-cognitive theory builds upon the foundations of classical learning theory. It makes the argument that humans have an impact on their surroundings and that ideas about human nature should be based on observed behaviour. Nonetheless, components of social-cognitive theory indicate that personal elements like objectives and expectancies also contribute to the understanding of behaviour in humans.
→ Behavior Modification: Behavior modification is a treatment method for maladaptive behaviors, utilizing theories of behavioristic approach. It can treat phobias, compulsive disorders, anxiety, etc, through relaxation, desensitization and cognitive behavior therapy.
The most common criticisms surrounding behavioristic theories are that it reduces humans to merely puppets of the environment and doesn’t tell us about what it really means to be a human.
CONCLUSION
The belief held by ancient human societies was that abnormal actions were brought about by celestial bodies, magnetic fields, and supernatural forces. The development of biological sciences, however, led to the rejection of supernatural explanations and the connection between physical illnesses and biochemical imbalances and mental disorders. In order to explain deviant behaviour, psychological perspectives have been developed. These perspectives emphasize the significance of comprehending and resolving impediments to self-actualization.
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