The concept of Mental Illness and its treatment has changed over the centuries -in Eastern as well as in Western Cultures. It seems to be just a reflection of the underlying cultural values of a particular society on a particular point in time. If we consider this fact, we could perhaps also re-consider our view on mental health and on our ways of understanding a mentally ill person. The following information is based on already existing research which illustrates the subjective aspect on the understanding of mental health, which perhaps will bring a more positive and constructive view on this subject.
Information based on the research and personal experience of Sasha Dee about mental health and its cures in the rich cultural variety of India.
This is a brief resume on how a mentally ill person was considered and treated in the western cultures since primitive times.
A project paper by an unknown nursing studentduring first year training Circa 1992
There is evidence that mental illness did exist during primitive times and that there were attempts made to treat it. These primitive people believed that mental illness was created by evil spirits entering and taking over the body. THe so called evil spirits were driven out by medicine men through magic and reincarnation. During the primitive times some of the tribes tried to force the mentally ill out of the community and totally rejected them. On the other hand, some tribes did allow the mentally ill to stay as long as they did not act/behave in any way which scared or frightened anyone. In some tribes witch doctors were called upon to allow mentally ill people to confide in them.
The mentally ill were treated humanely by the ancient Romans, Greeks and Arabs. The care that was given consisted of music, sedation with opium, good hygiene, activity and nutrition. THe Greek physician, Hippocrates (460-377 BC) and Plato (429-348 BC) had concerns about how the mentally ill were treated. Hippocrates did attempt to classify people by the way in which they behaved.There were also two contrasting views about mental illness during this period; Aristotle (345-322 BC) studied anatomy and concluded that the mind was linked to the heart. Galen disagreed, he associated the mind only with the brain.Middle ages (AD 500-1450)The Roman Empire fell in AD 476, the thought of treating the mentally ill humanely was totally forgotten. In came witchcraft, magic, superstition and mysticism. Some patients were treated humanely by religious orders. Usually, the mentally ill were locked in asylums where they were treated brutally; flogged starved and often tortured. Sometimes, however, families did hide the mentally ill, or they were left to roam the streets.
The Renaissance (14th to 17th Century)
The belief that cam from the Middle ages, about mental illness being caused by evil spirits carried on into the Renaissance period. The mentally ill were thought to be a menace were put in prison or locked away in asylums, where there were no professionals to take care of them They were subject to cruel torture often being locked up in closets or cages for being disobedient. Mental illness was considered to be irreversible.Paracelsus (1493-1541) did not believe that evil spirits caused mental illness. But this did not change the general treatment of the mentally ill.The only people who the mentally ill communicated with were other mentally ill people. They were described as dangerous, defective and incompetent. As a result of unprofessional and untrained staff the mentally ill often became more ill. During the 17 Century the first mental hospital opened in England, the Bethlam Royal Hospital, London. It was only the second hospital of its sort in Europe. It was like being in a zoo for the patients, for a small price the public could walk through the hospital. The study of behaviour began to increase, but until the middle of the 18th Century no advancements took place.
During 1733-1815, Franz Mesmer pioneered a therapeutic approach to behaviour. He suggested that the mentally ill could be cured by holding rods filled with iron filings in water. He thought that this gave people balance in the universe. This technique proved to be wrong but the term “mesmerised” is from Mesmer – to be placed in a hypnotic state. Philipe Pinel (1745-1826) removed the chains from 12 patients in Bicetre Hospital in 1792 – this began a move towards humane care and kindness to the patients.
During the 19th Century one of the major influences in the treatment of the mentally ill was a French neurologist; Jean Martin Charcot (1825-1893) who suggested that hypnotism could be used to treat hysteria. Humane treatments became more common. Due to advances in medicine, mental illness was tolerated more and more accepted.
From the mid 19th Century, the asylum population steadily increased to 86,000 detained under the lunacy laws. In 1890 the number increased to 120,344.
The 1930 Mental Treatment Act introduced ‘voluntary’ and temporary patients.During both world wars, many staff members were enlisted by the military leading to overcrowding. The work of the attendants was of containment of large numbers, caused mainly by soldiers suffering from ‘shell shock’. As this was described as a functional nervous disorder, psychiatrists were used to treat them, showing a change in thinking about mental illness. However, allegations of malpractice rose sharply.The result (of men leaving asylum work for the armed services and women leaving for munitions work) was a large increase of the number of patients dying from disease such as dysentery and tuberculosis.
Years later scandal broke out with the publication of Montague Lomax’s book The experiences of an asylum doctor which detailed conditions inside an unidentified asylum during war time. There were alleged tendency towards over liberal use of sedatives and laxatives by nursing staff.Other ‘scandals’ also came to light, with nursing staff being the main target of criticism (Carpenter 1980). These allegations led to pressure from bodies such as the Royal Commission into the lunacy laws, which led to the 1930 Mental Health Act.
Between the wars asylums became mental hospitals and both male and female attendants became nurses. The National Asylum Workers Union became the Mental Health and Institutional Workers Union in 1931.The majority of mental nurses belonged to the National Asylum Workers Union founded in 1910. They were portrayed as hard working, dedicated, lowly paid and identifying strongly with working class ideology, but the Nursing Mirror thought that mental nursing was in need of reform and that it should take general nursing as its model.
In 1923, the council insisted on a preliminary year of training ending with the same examination for all grades of nurses regardless of the field of nursing they wished to enter. But, this did not meet with the approval of mental nurses, many of whom opted for the Medico-Psychological Association’s training. These two training schemes ran concurrent until 1951 when the MPA’s scheme ceased. But the professional status which may be an aspiration for some nurses was not enough. The working conditions, pay and number of hours they worked were appalling. Their request for a pay increase and less hours was refused.
Things continued like this until a report by Dr Montgu Lomax was published in 1922.It was unusual for a doctor to criticise publicly his hospital superior. He lost his job. Lomax observed that training only transmitted knowledge and knowledge alone would not produce a good character. Nurses, he concluded, should be carefully selected for their personalities and dispositions, and training should be such as to help them be of assistance to the patients.Lomax also considered that when nurses were accused of providing a low standard of patient care, this was because nurses were treating patients in the same way as they themselves were being treated.
In 1924 another report published, sought to improve mental health nursing in county and borough hospitals. A number of recommendations were made i.e.:
- institutions that were overcrowded were inappropriate for training purposes
- A through system of classifying patients had to be in operation
- a nurses infirmary would be advantageous
These are only a small number of the recommendations. Finally the report strongly recommended the building of schools specifically suited to the training of nurses. It was hoped that the implementation of these recommendations would render mental nursing an attractive occupation for the right kind of nurses.
The 1930s saw an influx of men into mental health nursing from the depressed areas of the country, which, it was argued hampered attempts to improve standards. Entry requirements involved a candidate being able to take part in organised games, play a musical instrument and being physically fit (Jones 1960).Nurses were instructed to show kindness and forbearance with “example being better than precept” (Regualations and Orders of Springfield Mental Hospital, London 1926). The strictness of the rules gave a regimental impression with little scope for nurses to show any initative. Their duties included the washing and feeding of patients and maintenance of the wards.
The birth of the NHS in 1948 had little effect on the management of patients, the system of admission and their legal rights having remained unchaged since the early 19th Century lunacy laws. This changed in 1959 with the implementation of the Mental Health Act, when mental health professionals regained control from magistrates.However, the treatment of patients changed little, the regimental/segmental approach still being used. The role of the nurse also remained the same with little or no emphasis in equiping patients for a return to society.
The 1960s saw a move away from the institutional approach towards care for the mentally ill within the community. It was assumed at that time that sufficient funds would be made available for this transition, an assumption that would prove to be wrong. Predictions for the future envisaged care being shared equally between community agencies and psychiatric units in hospitals.These predictions did not materailise, with institutional care being run down and community car not being sufficiently built up. This problem is central to mental health service planning at the present time.
The 1970s saw the setting up of community nursing services with mental health nurses (Community Pscychiatric Nurses – CPN) working with clients in their own homes. Initally CPNs accepted clients from psychiatrists, but later took referrals from a much wider source. CPNs were encouraged to undertake specialist post-registration training, becoming professionals who would take a leading role in recommending or determining the care and treatment required by a client.The 1980s saw mental health nurses adopting a more systemaic approach which was client centred and holistic.
This decade also hereldaded the end of the dominance of institutional care and treatment with many nurses working in day units, clinics, health centres, residential homes and in client’s homes. This process has continued into the 1990s with an expansion of educational opportunities an the Project 2000 system of nurse training, which seeks to prepare nurses for a professional, practitioner role.