R15 Information Sheet on the History of Mental Illness and Mental Health Problems Definition and range of conditions



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R15 Information Sheet on the History of Mental Illness and Mental Health Problems

Definition and range of conditions

The term ‘mental illness’ is generally used when someone experiences significant changes in their thinking, feelings or behaviour.  The changes need to be strong enough to affect how the person functions or to cause distress to them or to other people.


Psychosis is viewed as the most serious and is a severe mental impairment involving a loss of contact with reality, frequently with hallucinations, delusions or altered thought processes, with or without a known organic origin. These conditions would include bi-polar, schizophrenia and personality disorder. In the UK and USA at any one time around 1% of the population are affected. In the past this group have been described as mad or insane.
A larger group have depression "a melancholic state often accompanied by feelings of inadequacy and a lack of energy”. In use since the 17th century as a general word for dejection, but in the 20th century adopted as a clinical term. In acute cases this can become so severe that it stops physical functioning and thinking clearly.

There are a wide range of other conditions. The World Health Organisation identifies that over a third of people in most countries report problems at some time in their life which meet the criteria for diagnosis of one or more of the common types of mental health issues. Common would be anxiety, eating and sleeping impairments, tics such as Tourette’s, drug dependency and adjustment impairments. There are also impairments where the brain degenerates, such as dementia or Alzheimer’s.



Throughout history, only those who could not care for themselves or were a danger to themselves or others were viewed as having severe mental health problems. c:\users\richard\pictures\british museum images\gateas of bedlam 1782 after cius gabriel cibber an00652966_001_l.jpg

Bedlam, for more than 700 years was a hospital for the mentally ill and divided them into Melancholic and Manias, the latter being shackled.

The way people were treated varied depending on the ideas of the time.
Old Statue, Gates Bedlam Hospital-British Museum
The ‘insane’ were often called Lunatics, as it was believed people were affected by the Moon or there had been a full moon when they were born. It was thought up until the 1850s that some people were like this because they were possessed by ‘spirits’ or ‘demons’ and that these had to be driven out by shocking the body with loud noises, ice cold baths, or letting blood from their veins. Lunatics were viewed as less than human and were often chained and locked up or later kept in straightjackets.c:\users\richard\pictures\dhm historic images\james norris bedlaam restrained.jpg
Gradually social reformers argued that a sympathetic and supportive treatment would help the ‘mad’ recover and that they should be separated into different areas of the hospital, workhouse or asylum. The better off cared for their relatives at home or placed them in private ‘licensed’ houses to be cared for. c:\users\richard\pictures\dhm historic images\interior of bedlam 1763 hogarth.jpg
However, the tendency to exploit, mistreat and make fun of the inmates continued. This political sketch of the artist Hogarth in the moral tale the ‘Rakes Progress’ shows society ladies visiting Bedlam to be entertained by the inmates . See Film on the history of Bedlam http://topdocumentaryfilms.com/bedlam-the-history-of-bethlem-hospital/
In England, control over persons considered dangerous due to their mental impairments was first with Justices of the Peace or Local Magistrate and Doctors. The County had to set up Asylums from 1808. The 1850 Mental Lunacy Act came under the Home Secretary through a Board of Control. Increasingly people with Mental Illness were rounded up and placed in ‘Lunatic Asylums’ of which over 100 were built in the second half of C19th. These, like the Mental Deficiency Hospitals, were built outside the large towns in the country and housed both voluntary patients and those who were placed there against their will - the certified. Doctors determined if someone was ever fit to leave. At their height 150,000 patients lived in them.

Devon County Asylum-Outside Exeter.c:\users\richard\pictures\dhm historic images\devon-county-pauper-asylum-exeter.jpg
The branch of medicine that dealt with mental illness was Psychiatry. Many dangerous practices were developed in the next hundred years, such as lobotomy - cutting the frontal lobes of the brain, and Electro Convulsive Therapy (ECT) where large currents of electricity are passed through the brain. Both were continued as they suppressed the behaviours that had led to people being classed as mentally ill.
Film ‘Mental: A History of the Madhouse’, BBC4. Watch first 20 minutes or the 59 minute documentary http://www.youtube.com/watch?v=wZrKcu8RjSo telling the story of High Royds Asylum. This is very informative about the treatments given to patients in the mental hospitals and the negative impacts these had on them. Write an account of the development and demise of the Asylums and what it must have been like to live there.
From the early 1950s pressure grew to close the asylums. The 1959 Mental Health Act supported the closure of the hospitals and moving patients into the community, though little happened for nearly 20 years. These moves were pushed further by a new Survivors or Users of the Mental Health System Movement and further exposure of scandals. http://www.nsun.org.uk/modules/downloadable_files/assets/on-our-own-terms.pd
In the last 50 years with the closing of long stay asylums, the new psychotropic drugs were increasingly used and are now relied upon even more. These drugs, like earlier more brutal treatments, suppress the symptoms of ‘insanity’ and make living in the community possible.
Unlike other forms of medicine, psychiatry has not really made any progress in reducing mental illness or curing people, according to psychiatrist Richard Bentall1 . After a wide review of the evidence he finds no evidence of an ability to treat severe mental illness. He argues the main reason is a medical model approach, which relies on an idea that people with severe mental health issues have a genetic predisposition to mental illness. http://i123.photobucket.com/albums/o295/sixxfingers/rubbish/highroydsmap20-10-21.jpg

http://www.wharfedaleobserver.co.uk/resources/images/804087.jpg?type=articlelandscape

An alternative view is that the environmental and social circumstances people find themselves in, can for some people, lead to major bouts of mental distress. Giving them care, support and mechanisms for coping, can help people with mental health issues to take more control of their condition. They may need a combination of therapy and some reliance on drugs.


The Pharmaceutical Industry strongly promotes drug treatments. It is less labour intensive than providing therapy, which may help people live worthwhile lives in the community. These contradictions still need to be addressed and resolved.
However there is still considerable fear and stigma towards people with mental health issues. Reactions to some high profile attacks on people by former patients of the mental health system have led to a halting of the Care in the Community programme. A broad piece of legislation was introduced giving doctors widespread new compulsion powers on medication of patients, rather than specific legislation to address the relatively few people who are a danger to themselves and others (Mental Act 2007).
Recently the Survivors’ Movement/Users Movement, has made progress in challenging compulsory treatments against the patient’s will, in Article 12 of the United Nations Convention on the Rights of Persons with Disabilities. http://www.mindfreedom.org/mfi-faq/go/now.

For Survivors Poetry

http://www.survivorspoetry.org/the-poetry/publications/poetry-express/

To get a wider historical understanding go to the Mental Health History Timeline http://studymore.org.uk/mhhtim.htm



1 Richard Bentall ‘Madness Explained’ 2004 or Meredith Small ‘The Culture of Our Discontent : Beyond the Medical Model of Mental Illness’ 2006 Joseph Henry Press.



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