(litho), Lehman, George (d.1870)/Library Company of Philadelphia, PA, USA/The Bridgeman Art Library.
By the 1950s, there were a number of hospital facilities in the United States for those with mental illness. These were administered by both state governments and private organizations. This changed in the 1950s as described in LENS: Closing Mental Hospitals in America.
Lens
Closing Mental Hospitals in America
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During the first half of the twentieth century, state mental hospitals were the main source of treatment and care for those with serious mental disorders in the United States (see W. Fisher, Geller, & Pandiani, 2009; Torrey, 1997). By the 1950s, there were more than a half million individuals in these hospitals. However, during the 1950s and 1960s, a number of events occurred that changed the way individuals with mental disorders were treated in the United States.
One significant event was the introduction of antipsychotic medication. Prior to this, individuals with serious mental disorders such as schizophrenia needed a high level of care and protection. With the introduction of medications that would help treat the disorder, it was possible for some of these individuals to live outside the hospital.
The Community Mental Health Act of 1963, signed into law by President John F. Kennedy, reflected the growing understanding that all but a small portion of those in mental hospitals could be treated in the community. The basic idea was that community mental health centers would offer a variety of programs to help those with mental illness.
Although the population of the United States increased by 100 million between 1955 and 1994, the number of individuals in mental hospitals decreased from 550,239 to 71,619 (Torrey, 1997). The process of moving individuals from mental hospitals to the community was known as deinstitutionalization. Figure 1.12 shows this drastic change.
For some individuals with mental illness today who would have been placed in a hospital in the 1950s, their quality of life in the community is much better than it would have been. However, for many individuals, the ideals of the community mental health movement were never fulfilled. The community facilities for those with mental illness were never fully funded or were not even built. This left many individuals without the type of treatment they needed. Some have found themselves homeless and on the streets. Others, who were disruptive or who concerned the community, found themselves in jails and prisons with little mental health treatment and care. Similar deinstitutionalization occurred in the United Kingdom and other developed countries.
Figure 1.12 When Did the Number of Individuals in Mental Hospitals in the United States Decrease?
Source: E. Fuller Torrey. Out of the Shadows: Confronting America’s Mental Illness. New York, NY: Wiley, 1997.
Thought Question: Our history has shown us that neither institutionalizing nor deinstitutionalizing all individuals with serious mental disorders has been effective. What do you think are some characteristics of a workable solution?
From the Past to the Present
In light of the history discussed thus far, mental illness has been considered from two perspectives. The first perspective involves the devil or supernatural forces. This was seen in the worldview of early humans in which rituals were performed. It was also the perspective of the Church, especially in the Middle Ages. Rituals were performed to remove the demon from the person, which rarely benefited the individual. Even today, some churches offer forms of exorcism. This perspective is largely based on magic. The second perspective is that of psychology and physiology in a broad sense. This perspective uses research and the sciences to understand what mechanisms lead to mental disorders. Treatment involves the manipulation of these mechanisms through psychotropic medications and psychotherapy. The discovery of psychotropic medications greatly changed treatment of mental illness around the world. As noted in the previous LENS, these drugs allowed for individuals to live in a more independent manner. Throughout this book, I will describe the medications used to treat the major mental disorders.
Concept Check
What major advances in our knowledge of the brain and nervous system were made during the 1600s and 1700s?
The research of John Hughlings Jackson has contributed much to our understanding of the brain. Describe his concepts of localization of function, three levels of the brain, and hierarchical integration through inhibitory control.
What are the primary aspects of Charles Darwin’s theory of evolution? How might those processes be reflected in psychopathology?
What did Jean-Martin Charcot mean by the terms symptoms, signs, and syndromes? How did they help bring organization to an understanding of neurological disorders that is still used today?
Indicate whether you agree or disagree with the following: Large institutions for treating the mentally ill should be closed and all treatment given in the community. Choose one side of the debate, and present evidence for your position.
Biological Approaches to Treating Mental Illness
In this section, I want to provide you with a quick overview of current and historical biological approaches to the treatment of mental illness. These treatments range from the widespread prescribing of drugs to deal with psychological disorders to the less-often used but significant measures involving shock or electrical stimulation of the brain to the rarer use of neurosurgery.
Throughout our history as humans, we have used natural substances to treat illness. Often, treatment was a hit-or-miss procedure as people learned which substances were more effective than others. With the development of better chemical methods in the last hundred years, scientists began to modify the substances and create them as drugs. Today, we refer to these substances, when used to address mental illness, as psychotropic medications. The overall category of psychotropic medications can be broken into categories based on what they were designed to accomplish. These categories include mood stabilizers, antianxiety drugs, antidepressant drugs, and antipsychotic drugs.
During the U.S. Civil War, a textbook by Union Army Surgeon General William Hammond suggested that lithium bromide be used to treat manic patients (see Perlis, & Ostacher, 2016). However, it was not until 1949 that the Australian John Cade reported that lithium had a calming effect on animals and humans with mania. As you will see, lithium is still used to treat mania, which we refer to as bipolar disorder today. Drugs that came to be called antidepressants for the treatment of depression, such as monoamine oxidase inhibitors (MAOIs) and the tricyclic antidepressants (TCAs), were discovered through serendipity in the 1950s (Fava & Papakostas, 2016). SSRIs (selective serotonin reuptake inhibitors) such as Prozac were developed later. You will learn about all of these substances in the chapter on mood disorders. Benzodiazepines such as Valium have been used for the treatment of anxiety for at least 50 years.
One significant
