The history of mental health treatment is a terrifying subject. Humanity’s first efforts to treat mental illness were riddled with superstition, ignorance and fear. For centuries, treatments used on the mad — as those with mental illness were then called — were next to torture.
Given the history of mental health treatment, it’s perfectly rational for people in modern times to feel a twinge of fear before seeking help. Thankfully, the dark ages of isolation and sterilization have passed, and modern medicine has lifted the science of treatment into a kind of golden age for people seeking mental health care.
The First Efforts to Treat Mental Illness
The history of treatment for mental illness begins before written records existed. Skulls from 10,000 years ago have holes bored into them, which could make trephination or trepanning the oldest surgical procedure we know about. This wasn’t an uncommon procedure. At a burial site from 4,500 BC in France, 40 out of 120 skulls, or one third, had holes deliberately bored into them. It’s believed that roughly two thirds of the people who underwent the procedure died or developed an infection that killed them soon after.
There could be many reasons ancient people did this. Knowing practically nothing about what causes headaches, hallucinations and disturbed behavior, it’s possible Stone Age surgeons were trying to let something evil out of their patients’ heads. They could have been consciously trying to relieve pressure on the brain, which is one reason the procedure is still done in hospitals.
The practice of trepanning was still mainstream among surgeons until the late 1700s, and even later practitioners offered it as an alternative remedy. In a 1986 interview for Musician Magazine, Paul McCartney told a story about how John Lennon tried to get Paul and his wife Linda to try the procedure “to relieve pressure” in the late ’60s. They declined.
2. Purging and Bloodletting
The ancients believed human health was influenced by four humors: blood, black bile, yellow bile and phlegm. These were associated with various temperatures, wet and dry conditions and signs of the zodiac. To achieve good health, doctors would try to balance a patient’s humors, usually through diet. The idea was somewhat similar to Eastern notions about qi and the flow of life energy through the body that inform early acupuncture.
Blood was assigned the nature of hot and wet, which was associated with madness and violence. Thus, a disturbed person in the Middle Ages was assumed to have too much blood, which would be drained with either cutting or the use of leeches. Women with nervous disorders were thought to have lost too much blood through menstruation, and rebalancing would typically involve purging with emetics to reduce yellow bile or an enema to remove black bile.
The First Dark Age of Mental Health
In the early modern period, there was a dark age of cruelty in mental illness treatment history. From about 1500 to roughly 1930, the history of mental health treatments reads like a horror story.
3. Isolation and Abuse
St. Mary Bethlehem Hospital was founded in London in 1247 as a sanctuary for the ill and a house for the dying. Bedlam, as it became known, came to specialize in housing the insane by around 1400. By the 1800s the hospital had become a perfect storm of cruelty and misery. Londoners deemed insane by authorities were crowded into Bedlam’s cramped hallways and shackled to the stone walls and floor. Orderlies were prone to beat inmates for the smallest infraction, and feedings were irregular and rare. Sanitary conditions were appalling.
The hospital was routinely starved for money. To keep it in operation, trustees eventually made the horrifying decision to open the hospital for public tours. Throughout the Regency era, gawkers could pay a threepence to tour Bedlam and mock the inmates, many of whom had what we would now call Down syndrome, autism spectrum disorder or obsessive-compulsive disorder. Others had schizophrenia, and the jeers and abuse of strangers probably didn’t help their hallucinations. Reform came in 1815, when Parliament formed a committee “on the regulation of madhouses” and started imposing control over institutions like Bedlam.
In 1883, Sir Francis Galton coined the word “eugenics,” by which he meant good genetics or good breeding. The British scientist had no way of knowing what he’d unleashed, but the eugenic approach to mental illness would define treatment from the 1890s to World War II. This approach focused on cutting off the so-called genetic source of ailments by stopping the “multiplication of the unfit,” usually via forced sterilization.
This became big business. Between 1907 and 1963, an estimated 67,000 U.S. citizens were sterilized under various state eugenics laws. This was done for the usual reasons: mixed race children, “poor white trash,” Native American women, black criminals, illegal immigrants and those deemed of low character, such as alcoholics and career criminals, were involuntarily given hysterectomies, vasectomies or even outright castration. In the notorious 1925 Buck v. Bell case in Virginia, Chief Justice Oliver Wendell Holmes infamously opined that “three generations of idiots is enough” while sentencing a young mother and survivor of rape to sterilization in a state hospital.
The Second Dark Age of Science
The human rights abuses of eugenics were a bridge to the primitive science of mental health that prevailed in the early 20th century. Doctors and quacks alike spent decades cooking up new pseudo-scientific theories about the causes of mental illness and how to treat them. The results were about what you’d expect.
5. Shock Therapy
Early in the 20th century, a prevailing theory of mental illness was that the brains of insane people were either over- or underactive and that some kind of shock could regulate them better. This was, of course, just the four humors theory repackaged, but it led to some appalling abuses. The goal was to blank out the mind and allow it to reset, like defibrillating a heart. Methods included:
- Insulin shock: Large doses of the newly discovered enzyme insulin were injected, causing a potentially fatal drop in blood sugar and inducing a coma that could be extended for weeks, causing extensive brain damage.
- Metrazol: Metrazol is a convulsant drug that triggers seizures. Patients given a shot would report feeling impending doom and extreme terror before the convulsions started and then grew so violent that some patients’ muscles would tear free from their bones. Subsequent treatments had to be done after tackling the shrieking patient and forcibly injecting them. Incidentally, this is the origin of the straightjacket and padded room that are stereotypical of old mental health treatments.
- Electroshock: Not to be confused with mild modern stimulation of brain areas, old-fashioned shock therapy involved sending up to 240 volts through patients’ brains in an effort to trigger a seizure. The collapse and exhaustion that followed were usually interpreted as a successful treatment for mental illness.
- Hypothermia: Shock and coma can be induced by lowering the body’s temperature. In the 1940s, this was done by dunking the patient in a bath of ice water and stretching a canvas over the tub to prevent escape. Seizures and coma would eventually follow, and maybe death too.
The ultimate point of these shock therapies was to inflict limited brain damage on the theory that the damaged parts of the brain were responsible for aberrant behavior. To this end, surgeons in the 20th century developed a surgical method for damaging the brain known as a lobotomy.
There were different techniques for this but the most advanced form involved the practitioner inserting a needle through the thin bone behind the eye, into the frontal lobe of the brain, to cut connections in the prefrontal cortex. The 50,000-60,000 people who went through this procedure generally developed a flat personality, memory loss and lifelong difficulty relating to other people.
Consent and Care
All these nightmares came to a head in 1947, during the so-called Doctors’ Trial in Nuremberg. The horrors of human experimentation, forced sterilizations and the evils of covert radiation exposure done for the Manhattan Project had caused a sort of awakening among medical practitioners about the need for informed consent. Beginning with FDA approval for Thorazine in 1956, a medical, pharmaceutical and far gentler era began for mental health treatment.
The modern West has tremendously strict standards of care for treating mental illness. Approved modern treatments require the informed consent of all patients or of their medical decision maker if they’re unable to understand their treatment. Care teams are made up of qualified professionals who operate under best practices guidelines to create a safe, therapeutic environment for people who need help. Less invasive treatments are the first choice for most conditions, followed by evidence-based and carefully controlled drug and procedural therapies. Thanks to the standards promulgated by the Nuremberg Code, people who need mental health care today can count on effective, compassionate care throughout their treatment.
If you have a behavioral, mental health or addiction problem, you don’t have to be afraid of the history of mental health treatment. Contact FHE Health to get started your road to recovery in a healthy, uplifting environment.