Citation

Stanwell-Smith R. Perspect. Public Health 2019; 139(3): 110.

Copyright

(Copyright © 2019, Royal Society for Public Health, Publisher SAGE Publishing)

DOI

10.1177/1757913919838164

PMID

31074351

Abstract

The diagnosis, or accusation, of insanity is as old as civilisation: skulls dating back over 7000 years show evidence of trephination, where a small part of the skull was removed to cure mental illness or release the evil spirit believed to be causing it. Western medicine, with its origins and literature from the ancient Greek and Arab worlds, rested on the theory of imbalance of four liquid humours to explain both physical and mental illness. Blood-letting, purging and induced vomiting to adjust the humours were frequent treatments that persisted until the 19th century. Isolating the mentally ill in asylums became common from the medieval period onwards, developing into extensive establishments behind high walls in the 18th century. The treatments tended to be physical, such as cold baths or restraints, although the benefits of exercise and gardens were later introduced for privileged patients. Patients with physical ailments along with mental confusion were subjected to harsh treatments due to the limited range of diagnosis: think of those inflicted on poor King George III up to his death in the early 1800s. Electric shock treatment was used as early as the 1st century AD: the Roman Emperor Claudius had a torpedo fish (electric ray) placed on his forehead to relieve severe headaches. Electroconvulsive therapy dates back to the experiments with static electricity during the ‘Enlightenment’ era, but became a standard treatment in the 20th century, along with insulin coma therapy and induced epileptic seizures. Extracting teeth or excising parts of the intestines and the thyroid gland were all championed up to the 1930s, based on an idea that diseased or infected body parts led to mental illness. In 1927, the first Nobel Prize for psychiatry was awarded for the technique of inducing malarial fever by injecting schizophrenics, despite the associated death rate of up to 13%. It seems remarkable now that lobotomy – surgical severance of connections between the prefrontal cortex and frontal lobes – was so valued that it won the Nobel Prize in Physiology and Medicine in 1949: up to 1972, 50,000 lobotomies had been performed in US asylums and an estimated 25% died following the procedure. The reason for these horrendous physical approaches was partly the lack of effective psychiatric medication, developed from the 1950s,3 although opium, morphine and mercury were used in previous centuries. Such brutal therapies were also due to now outdated theories about causation. The psychotherapy pioneered by Freud and Jung in the early 20th century is one of the few persisting historical treatments. Music and art have also been long recognised for their value to mental health, although only recently becoming mainstream.

Advances in diagnosis – and not before time – have accompanied progress in management of mental illness. Any deviant behaviour, especially in women (hence ‘hysteria’ from the Greek term for the womb), could be classed as ‘madness’ in previous centuries and included suspicion of sexual misdeeds as well as not subscribing to the dominant religion of the time. Such ‘deviance’ could lead to indefinite confinement ...

Language: en