The History of Western Mental Health Treatment


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Mental health treatment in western cultures has evolved significantly over the centuries, but has only been considered a distinct subset of medicine itself since the early 19th century. The trends and beliefs of mental health treatment have always been tied up in larger debates about the assumed political, moral and spiritual facets of illness and disease, frequently leading to harsh and ineffective methods for curing or managing mental afflictions.

Ancient Mental Health Treatment

In ancient times, most cultures attributed mental health diseases to demonic possession and other supernatural causes. In the west, the Greek physician Hippocrates was the first prominent scholar to assert that mental illness is caused by the interplay between environmental conditions and “natural occurrences in the body.” He eventually folded mental illness into his wider biological philosophy centered on four vital fluids or “humors” in the body: phlegm, blood, yellow bile and black bile.

This belief in the role of vital fluids would eventually become dominant in most European cultures, leading to a single-minded focus on addressing all mental and biological ills by adjusting the four humors through methods like bloodletting, prescribed medicinal diets and purging (vomiting.)

Interestingly, they believed that diet and digestive issues played an important role in mood and mental health. These theories were mostly suppressed over the years with the advent of new medications, but recently research has been re-emerging linking depression and other mentalities with our digestive systems.

Mental Illness in Iron Age and Medieval Europe

While the four humors remained an important part of how illness was treated in the West, spiritualism and supernatural beliefs were equally prevalent. As Christianity became an institutionalized component of daily life in Europe, the old beliefs pointing to the influence of demons and other un-godlike actors in mental illness were adapted to the new religion and often overrode all other concerns.

As a result, patients suffering from mental illness were increasingly viewed as dangerous or unholy factors in society and, accordingly, locked away in “madhouses” or other forms of imprisonment. Religious concerns were usually intimately tied to how a society treated its mental illness sufferers, exemplified by Spain, which opened the world’s first dedicated mental health facility in the early 1400s–a few decades before the Inquisition reached its zenith.

With no widespread standards for treatment–and a focus on mental illness as religious punishment–the experience of patients was dependent entirely on the whims of each madhouse’s staff and leadership. However, in every case, isolation from society was the primary goal, with actual cures or therapies being considered secondary or even impossible concerns.

Mental Treatment in the Industrial Age

The madhouse and religious model for mental treatment remained the standard well into the modern age, save for isolated actors like French physician Philippe Pinel, who advocated for more humane treatment of patients in the late 1700s and even laid the first groundwork for talk therapy-based methods.

However, it wasn’t until the mid-19th century that American activist Dorothea Dix prompted the first widespread reforms of mental healthcare spurred by her horror at the conditions endured by patients across the country.

As a result, the United States opened its first dedicated mental asylums, a treatment method that became nearly universal across western cultures by the end of the century.

Modern Mental Health Treatment

The asylum model massively increased access to treatment for mental illness patients but was usually just as ineffective as ancient methods where actual outcomes were concerned. And unfortunately for Dix and other humanitarian-minded reformers, conditions in institutionalized mental asylums were often just as horrific as older models. Technology eventually enabled the development of nightmarish treatment protocols like primitive electro-shock therapy, heavy tranquilization, lobotomies and forced sterilization.

The outcry against asylum conditions reached a tipping point in 1963, when the US Congress passed legislation creating a new framework of community-based treatment options, spurring a wave of de-industrialization and asylum closings across most western countries.

Today a number of different hospital models exist and new treatments are still being tried all the time. Some more experimental forms of treatment have become popular in countries such as Brazil, where they have been attempting to avoid the use of medications in the treatment process. As more research comes out in the coming years hopefully many more hospitals can shift their treatments and even shut down entirely.

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  1. Irma August 9, 2017 10:34 pm

    Wow! Scary stuff, though personally I think that being handed medications and then being stranded with brain fog is pretty much equivalent to a lobotomy, at least in my case.
    Getting off drugs and learning some coping strategies like EFT and journaling has helped me the most.
    It will be a great day indeed when those drugs are a thing of the past. Thank you for this informative post.
    Any idea what black bile is?

    • Laurel August 11, 2017 1:24 am

      Black bile was one of the four humors which was a liquid thought to come from the spleen and kidneys. Too much of this was thought to cause melancholy, depression and some digestive disorders. It’s fascinating how today research is showing that depression and other mental disorders are so closely connected to diet and digestion, when evidence was showing this hundreds of years ago.

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