If you’re over the age of 30, you probably remember the days of mental health only being talked about in hushed tones or behind closed doors. We all had that one aunt, maybe a teacher, or someone at church who “had some personal problems” but no one knew exactly what the issue was because it was taboo to discuss. Heaven forbid a couple let it slip that they were in marriage counseling. That could only mean a doomed marriage and, of course, unending gossip about whose fault it was. People didn’t seek therapy for self-care or cathartic maintenance like they do today. Therapy was only prescribed for very broken, outwardly traumatized, or mentally ill individuals.

Thankfully, as the years have passed, we’ve progressed beyond these harmful stigmas. We couldn’t let Mental Health Awareness Month go by without shedding some light on the history of mental health, how far we’ve come, and how far yet we still must go.

Mental Health vs. Mental Illness

Before we dive into the deep history of mental health, let’s first define an important distinction between mental health and mental illness. Although these terms are often used interchangeably, they are not the same. Mental health refers to the state of one’s mental or emotional well-being. It can be good, bad, or anywhere in between. Everyone deals with their mental health in one way or another, whether they are aware of it or not.

Mental illness, on the other hand, is a diagnosable condition as defined by a clear set of criteria. It typically affects a person’s behavior, mood, and thoughts. When left untreated symptoms can last months or even years. Like a lot of other illnesses, mental illness does not discriminate. It’s often attributed to genetics, brain chemistry, or trauma and can affect anyone regardless of age, sex, class, sexual orientation, or race. Unfortunately, we all know that many of these demographic groups absolutely do experience discrimination in other ways though. This type of hateful discrimination can and has led to poor mental health issues and contributed to or brought to light pre-existing mental illnesses.

How It Started – 5000 BCE

Depending on how far back we go, the history of mental health and the treatment of those with mental illness gets a little blurry and a lot barbaric. If we go all the way back to 5000 BCE (yes, that far back!), anthropologists have found evidence of a practice widely used for a few centuries called trephining. Settle in while we describe what now sounds like something from a Stephen King novel.

Trephining

It’s believed that around 7,000 years ago, those who displayed symptoms of mental illness were possessed by evil spirits. Imagine, showing symptoms of bipolar or clinical depression and just being written off as being demon-possessed. Living in 2022 does have its benefits. So, to rid patients of these ‘evil spirits’, a hole was drilled into the top of their skull to release the spirit and cure the individual. Believe it or not, some people survived this procedure. Anthropologists found human skulls with evidence of healing long after a trephining (also called trepanning) procedure was performed.

Spiritual Rituals

For centuries, mental health issues (we can’t be sure if they were diagnosable mental illnesses or not) were treated by priest-doctors or shamans. Therapists, psychologists, and the like did not exist. People didn’t even have the luxury of passive-aggressive status updates on social media. These were seriously tough times. The majority of symptoms were chalked up to demon possession. Thankfully the answer wasn’t always to drill a hole in the top of the skull. But it was nearly always to perform some sort of spiritual ritual based on religion or superstition.

It was believed that the afflicted person was being punished by God or gods. In order to cure them, the priest-doctor needed to perform different prayers, atonements, incantations, or exorcisms. If that didn’t work, they would try to negotiate a bribe or threaten the demon to leave. Sounds reasonable, right?

Egyptian Progression of Mental Health Treatment – 1550 BCE

It wasn’t until around 1550 BCE that the Egyptians began to realize that the brain, or at the time more notably the heart, had something to do with mental health. They realized that treatments of the past, like external magical incantations from shamans and priest-doctors, were ineffective. They began experimenting with more patient-focused treatments like sleep therapy & dream interpretation, music, dancing, or even painting.

The Four Humors – 460 – 375 BCE

The Egyptian theories on mental health, along with the widely accepted beliefs of evil spirits possessing you when you were depressed and whatnot, stuck around for far longer than they should have. But, as human nature does, slowly but surely, we progressed. Around the 5th century BCE (460-375 BCE) Greek physician Hippocrates first postulated the Humoral Theory. If the name Hippocrates sounds familiar to you, it’s probably because you’ve read a book or watched TV or a movie, or been alive in the past few centuries. He’s known as the father of medicine. Every doctor, to this day, must take the Hippocratic oath to swear to do no harm and treat every patient. He’s a pretty big deal.

Treatments of Humor Imbalance

These humors, or fluids, each correlated with a different psychological temperament respectively: melancholic, sanguine, choleric, and phlegmatic… or in 21st-century mental health terms: depressed, manic, angry, and apathetic. Each imbalance was treated accordingly using “regimens”, to restore proper humor balance by bloodletting, vomits, enemas, and other purges like diet and lifestyle changes. Sometimes medication was even given based on the person’s individual environment.

The Asylum is Born – Mid 1300s

Although there is mention of the first mental hospital in the world being built in Baghdad in the year 705, Iraq entered into the dark ages shortly thereafter. So, the details are fuzzy and inconsistent depending on where you look. It wasn’t until around the mid-1300s that the first true asylum was established. The Bethlem Royal Hospital, later known as the Bedlem Asylum, was originally donated to the city of London to care for the sick and needy. At some point, the hospital monks began accepting patients with symptoms of mental illness rather than physical disability or illness. By 1403, “lunatic” patients were the majority of patients who took up space in Bethlem’s beds. This included those with learning disabilities, “the falling sickness” (epilepsy), and dementia.

As with many stories you hear of asylums both in the US and abroad, the treatment of patients was inhumane. Patients were chained to beds, locked in stocks, and isolated from others until they “came to their senses”. During these times, the well-being of the patient was never a priority. It was more about keeping them or their illness hidden from polite society.

Some Hope for Moral Treatment – 1792

Asylums stuck around for a few hundred years. It wasn’t until 1792 when the “founder of the moral treatment”, Philippe Pinel, a psychiatrist in Paris, began treating patients with care and kindness. He took over the famous Hospice de Bicêtre in Paris and had the facility cleaned up. He unchained the patients and allowed them to roam around the hospital grounds freely, get exercise, and experience sunlight on their skin. This improved their quality of life and mental health.

Around the same time, across the Atlantic, Benjamin Bush, who is commonly referred to as “the father of modern psychiatry”, was working in the first-ever mental asylum in the United States. They were still practicing some treatments like bloodletting. But Bush believed that mental illness could be cured. His influence on the earliest institutions in the U.S. was mostly good in that the superintendents knew each of their patients and their stories. They weren’t just prisons or storage facilities to hide away the mentally ill. They were trying to help them become functioning members of society by teaching them things like exercise, religious training, and good hygiene.

Unfortunately, as the population increased, the number of mentally ill did as well. So, this didn’t last long. The need for state-funded facilities grew and grew, while the number of qualified doctors like Benjamin Bush dwindled. This is when asylums pivoted from treating patients back to just housing them. Thankfully, society had progressed past seeing the mentally ill as demon-possessed, although just barely at this point. We were just about a century past the Salem Witch Trials of the late 1600s. By the late 1700s and early 1800s, we at least were aware that mental health was associated with the brain. 

The Next 200 Years – 1800 – 2000

A lot happened over 200 years in the history of mental health. Entire volumes of books have been written. We could teach entire classes on just the past 200 years. So, to save some time, let’s sum it up!

Dorothea Dix

Dorothea was a force to be reckoned with. She was an activist who fought for both the mentally ill and indigenous populations. She was a modern-day Stacey Abrams. In the mid-1800s, she toured mental hospitals and couldn’t stand the living conditions that the patients were being subjected to. So, over a four-decade period, she spent her time fighting relentlessly and persuading the U.S. government to fund the building of 32 state psychiatric hospitals.

Sigmund Freud

Known as the “father of psychoanalysis”, or “Siggy” if you’re a fan of Bill and Ted’s Excellent Adventures, we can’t forget to mention Sigmund Freud while talking about the history of mental health. Freud’s work spanned from 1895 to 1939 and covered topics from dreams, to hysteria, to the ego, to the theory of sexuality, the unconscious, wish fulfillment, and of course the ever popular Freudian slip.

Electroconvulsive Therapy

Developed in the 1930s, ECT (Electroconvulsive Therapy) has a long and controversial history. It’s received a bad rap in film and television. Movies like “One Flew Over the Cuckoo’s Nest” depict cruel asylum staff administering electric shock therapy to unwilling patients who are strapped to chairs writhing in pain. TV shows like “Stranger Things” go as far as to suggest that this type of therapy, combined with psychedelic drugs, is a great way to create awesome kids with telekinetic superpowers, named Eleven.

In reality, these brief electrical stimulations of the brain, while the patient is under anesthesia, are still being used today under the watchful eye of trained medical professionals. Carrie Fisher, America’s favorite galactic Princess, famously published a memoir titled “Shockaholic”, in which she declared her voluntary use of ECT to treat and fight the stigma against her public battle against depression. It should be noted that she also talks about other forms of more modern, less controversial therapy, like talk therapy in the book.

Lobotomy – 1940s

Mental health treatment, like a lot of health treatments, has evolved drastically over the years. From the early years of trephining to release evil spirits, to the more recent years of psychosurgery. In the 1930s, the lobotomy was introduced. This is a practice that was last used in the 1970s. Quite simply, surgeons would cut out parts of the brain that they believed caused mental health disorders. Thankfully, this didn’t last long, in the grand scheme of things as it rendered patients physically unable to care for themselves… as you would imagine cutting out parts of your brain might do.

Talk Therapy – 1880

Today’s therapy as we know it, forms like cognitive behavioral therapy (CBT) first originated with a Viennese physician named Josef Breuer. He treated a patient known as “Anna O.” who suffered from a nervous disorder. Breuer’s “talking cure” as he called it proved highly effective and cathartic. This caught the attention of Sigmund Freud. The two worked together to co-author “Studies on Hysteria” in 1895 and are each credited with founding modern-day psychotherapy as we know it. Many modalities we still practice today were derived from these studies. In fact, Freud’s apprentice Aaron T. Beck developed CBT as we know it today.

Modern Day Mental Health Care

In 1946, the National Mental Health Act was passed. This was the first sign that the federal government in the United States was attempting to legislate and make mental health a priority. Though we still have a long way to go, each year we progress a bit more. In the United States, we have a responsibility to use our privilege and freedom to share and openly talk about mental health with others. In 1998, President Clinton passed a law ending discrimination in mental health insurance coverage for 9 million federal workers and their families by enacting mental health insurance parity for federal workers.  

Our founder Claire recalls that in 2017, when she studied abroad in Fiji, the governing laws stated that only women were legally permitted to receive mental health treatment. She witnessed people walking through the streets in the middle of the day talking to themselves, with clear mental health disturbances. When visiting a rural village in Jamaica in 2002, another member of our team recalls a child around the age of 10, being locked in a literal cage with bars and a padlock. When asked what was wrong with him, she was told that he had a learning disability.

Reducing the Mental Health Stigma

We know now that the history of mental health is long and complex, sordid, brutal, and too often confounded. Today, the facts are that nearly half of all U.S. adults and one in six children ages 6-17 will experience mental illness at some point in their life. Some of the easiest steps (not only during Mental Health Awareness Month), to help reduce the stigma around mental illness are:

• Educate yourself
• Show compassion and be empathic
• Don’t be afraid to ask for help
• Talk openly about mental health (good and bad)
• Use correct terms (mental health vs. mental illness, etc.)
• Normalize mental health treatment (therapy, medicine, etc.)
• Remember that physical and mental health are equally important

As always, if you are struggling with your mental health, we’re here for you. We offer many forms of therapy both in our Scottsdale office and online. Please don’t hesitate to reach out today to schedule your appointment with one of our experienced and compassionate therapists.

Sending you light and love,
Claire & The Claibourne Team

~ You are worthy. You are capable. You are enough! ~