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Before the Reformation-825502310130Christ casting out a devil Meister Konrad von Friesach00Christ casting out a devil Meister Konrad von Friesach-8255055880People who were mentally ill were referred to as lunatics. This is a word we do not use anymore. The word comes from lunar – or moon – as the phases of the moon were believed to influence people’s state of mind. Beliefs about what caused lunacy (as it was known) came from ancient traditions and the Christian church. The medieval Roman Catholic church thought disturbed minds were the result of a battle between God and the Devil. Older community ideas from folklore beliefs thought hobgoblins, ghosts and wood demons causes lunacy. Ideas about ‘madness’ and ‘melancholia’ were also found in Ancient Greek and Roman writings. They said that states of mind were changed by the balance of four humours in the body. That is, if a person had too little, or too much, of something in their bodies, it was thought that their humours were out of balance.By the later Middle Ages, St Mary of Bethlehem Hospital in London had become a place to put lunatics. The Hospital was nick-named ‘Bedlam’ and had very few patients, but became very famous. Treatment was harsh. Patients were tied up, beaten and regarded as animals. Priests, not doctors, were in charge. Other severely mentally ill people would continue to live with their family, but were often hidden away in cellars or kept in pig-pens. The 16th and 17th Centuries-825501965325King Lear engraving Frederick Wentworth00King Lear engraving Frederick Wentworth03175There was great change in religion in western Europe called the Reformation. Most people in Britain became Protestant and not Roman Catholic. Protestants believed that people’s souls were pre-destined to either heaven or hell. A person could not be certain if they were going to heaven, but was expected to live an excellent life to prove their worth. This created an atmosphere of anxiety and increased mental instability as people looked inwards. Mental illness was still seen as either the work of the Devil, or an imbalance of the body’s humours. There was a fascination with the mind. For example, Shakespeare’s most famous plays have it as a topic; think of Hamlet and King Lear. Many plays involved characters from Bedlam hospital, usually presented as clowns. In 1621 a major book called ‘Anatomy of Melancholy’ was written by Robert Burton from Oxford University. Doctors, rather than priests, worked with the mentally ill. At the start of the period, treatments were still brutal. However, by the late 1600s, whipping of patients was banned at Bedlam. Doctors there began to drug patients and use less tying up methods. Bedlam also provided clothes and some money for its few patients. Some patients were allowed home leave. Bedlam was a charity and needed to show that it was successful in treating people. The Enlightenment0628650001809115Hogarth, The Rake’s Progress00Hogarth, The Rake’s ProgressThis is a name given to a change in ideas that happened in Europe in the 18th century. The reason for this change is often traced back to the ideas of René Descartes in the 17th century. Descartes described the ‘body as object’ in 1637. He thought the mind and body were totally separate but connected. He thought humans were completely different from animals. The mind was a mysterious thing that did not seem to operate like a machine. Mental illness was created when the machine-like body did not communicate well with the odd thing called the mind. People who followed his ideas did not think that the Devil had any connection to mental illness. However, the sexual morals of the Church still had an influence. Sexually transmitted diseases such as syphilis could not be cured and sufferers went insane. Living a Christian life was said to save you from this terrible fate. More study led to other categories of mental illness including: fools, simpletons, inherited madness, female hysteria, nervousness and connections of genius to madness. There was a rise in medical interest in mental health. The theory of the four humours was still followed by doctors. This led to a rise in the sort of treatments that were designed to control the balance of humours in the body. Having too much black bile humour in the body was thought to cause mental illness (we still use phrases such as ‘black looks’ and ‘black thoughts’). There was a rise in weekly treatments such as purging, bleeding, blistering and making people vomit to get rid of black bile. Asylums were opened in other British cities by the end of the 18th Century. People admitted to them were regarded more as child-like than as animals and called patients not lunatics. However, at Bedlam there were un-trained ‘keepers’ not nurses, some of whom were ex-army. It was still a popular pastime to visit Bedlam to stare at the inpatients. This raised money for Bedlam and was partly a moral lesson. Hogarth produced a very popular set of pictures called ‘The Rake’s Progress’ where his character lived an un-Christian life and therefore ended up dumped in Bedlam surrounded by fellow lunatics in the advanced stages of syphilis and rejected by society. The Nineteenth Century5080030353000501652266950French phrenological model00French phrenological modelAs the 18th century ended, the medical profession was still firmly of the view that mental illness was caused by imbalance of the humours. By 1900 the theory of the four humours had been rejected. However, the mind, and therefore mental illness, still remained mysterious. The mind was not regarded as machine-like and the connection between the mind and the machine-like brain was still unknown. Mental illness was often defined as irrational, that is about loss of reason, with a ‘sane person’ being viewed as rational and reasonable. It was also often viewed as the symptom of a diseased brain. There therefore grew a division between people who believed mental illness was a moral matter and those who saw it as a physical illness. Much effort was focused upon treatment. There was also an increasing belief that institutions (buildings) could solve society’s problems. It was a great time of building schools, hospitals, prisons and asylums. By the early 19th century treatment of seriously mentally ill people was thought to be best undertaken in asylums and not in the community. As we have seen, these were not new, but across the 19th century there was a great rise in inpatient treatment and much building of special places for mentally ill people. In 1800, about 10,000 people were in asylums and by 1900 there were about 100,000 inpatients. These asylums were run by charities, local authorities and private companies. There was a trade in caring for people who would previously have been kept secretly at home. However, these asylums also led to the growth of the study of mental illness by doctors and the separate branch of medicine called psychiatry developed. In response to a scandal of poor treatment at the York asylum, a family of Quakers called Tuke set up an asylum called ‘The Retreat’ in 1796. The Retreat did not focus on medical interventions, but instead created a family atmosphere, occupying patients’ time, focusing on good rest, diet and kindness to restore a rational state of mind. The success of this ‘moral therapy’ led The Retreat to become famous across Europe and the USA and its ideas were widely copied. However, as the number of people in asylums went up, the quality of care went down. Also, people were dumped in them and became ‘institutionalised’. By the later 19th century it was clear that moral therapy was not enough to cure mental illness and the use of drugs grew. Twentieth Century-317501626870Ritalin drug for ADHD00Ritalin drug for ADHD08382000In the second half of the 19th century a big divide had grown up between the psychiatrist view, which said mental illness was a physical issue to be treated with surgery and drugs and the psychological view which developed specific theories of the mind. The most famous early 20th century psychologist was the Austrian Sigmund Freud. He developed ideas about the power of the unconscious on human behaviour. He saw mental illness as the expression of repressed parts of the mind of which the conscious was unaware. These ideas became more accepted following the experience of the First World War, when shell-shock (which would now be considered as post-traumatic stress disorder) was first identified. There was also a huge growth in industrial production of chemicals, including medical drugs across the century. In addition, there were developments in ideas about what it meant to be human. Social-Darwinists distorted the theory of evolution to classify humans as superior or inferior. The most famous followers of this idea were the Nazis. After their defeat in 1945 and in the second half of the century, there was a rise in the belief that all humans are equal and are born with inalienable rights (rights that cannot be taken away). This led to an increase in listening to the views of patients and a decrease in the idea that doctors and asylums always knew best. By the end of the century, there was also a growing acceptance of difference and less prejudice. For example, women received care for the newly recognised condition of post-natal (birth) depression, as opposed to being regarded as criminal or insane. In the USA the book identifying mental disorders in 1975 ran to 134 pages. By 2000, the same book contained 943 pages. In the first three quarters of the 20th century, psychiatry was focused upon the use of drugs and surgery. Psychiatrists and general practitioners gave out more and newer drugs to patients inside and outside asylums for mental health problems. These included mood-altering anti-psychotic and anti-depressant drugs. Physical treatment of severely mentally ill people included electric-shock therapy, putting people into coma-like sleeps and even surgical removal of parts of the brain. Shell-shocked war veterans who did not recover were put in asylums. The Nazi government began a programme of killing severely mentally ill people. In the later part of the century, there was an increase in the belief that mentally ill people should be cared for in the community and not in asylums. Asylums were closed and there was an increase in the idea that healthcare professionals should pay more attention to their patients as people, rather than as scientific cases. Psychologists developed a variety of different therapies, including talking, art, music and dance. By the end of the century there was more of an overlap between the two traditions and increasingly a call for people to be treated as individuals with whatever treatment would be most effective for them. ................
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