8/14/2019 Mental Illnes1

1/3

Mental Illness

I. INTRODUCTION

Mental Illness, disorder characterized by disturbances in a persons thoughts, emotions, or behavior. The term mental illnesscan refer to a wide variety of disorders, ranging from those that cause mild distress to those that severely impair a persons

ability to function. Mental health professionals sometimes use the termspsychiatric disorderorpsychopathology to refer tomental illness.

XI. HISTORICAL PERSPECTIVES OF MENTAL ILLNESS

A. Preliterate Societies

Evidence for trepanning, the surgical procedure of cutting a hole in the skull, dates back 4,000 to 5,000 years. Someanthropologists speculate that Stone Age societies performed trepanning on people with mental illnesses to release evil

spirits or demons from their heads. In the absence of written records, however, it is impossible to know why the operationwas performed.

B. Ancient Societies

The literature of ancient Greece and Rome contains evidence of the belief that spirits or demons cause mental illness. In the5th century BC the Greek historian Herodotus wrote an account of a king who was driven mad by evil spirits. The legend of

Hercules describes how, driven insane by a curse, he killed his own children. The Roman poets Virgil and Ovid repeatedthese themes in their works. The early Babylonian, Chinese, and Egyptian civilizations also viewed mental illness aspossession, and used exorcismwhich sometimes involved beatings, restraint, and starvationto drive the evil spirits from

their victim.

Not all ancient scholars agreed with this theory of mental illness. The Greek physician Hippocrates believed that all illnesses,

including mental illnesses, had natural origins. For example, he rejected the prevailing notion that epilepsy had its origins inthe divine or sacred, viewing it as a disease of the brain. Hippocrates classified mental illnesses into categories that included

mania, melancholia (depression), and phrenitis (brain fever), and he advocated humane treatment that included rest, bathing,exercise, and dieting. The Greek philosopher Plato, although adhering to a somewhat supernatural view of mental illness,

believed that childhood experiences shaped adult behaviors, anticipating modern psychodynamic theories by more than 2000years.

C. The Middle Ages

The Middle Ages in Europe, from the fall of the Roman empire in the 5th century AD to about the 15th century, was a period

in which religious beliefs, specifically Christianity, dominated concepts of mental illness. Much of society believed thatmentally ill people were possessed by the devil or demons, or accused them of being witches and infecting others with

madness (see Witchcraft). Thus, instead of receiving care from physicians, the mentally ill became objects of religiousinquisition and barbaric treatment. On the other hand, some historians of medicine cite evidence that even in the Middle

Ages, many people believed mental illness to have its basis in physical and psychological disturbances, such as imbalancesin the four bodily humors (blood, black bile, yellow bile, and phlegm), poor diet, and grief.

The Islamic world of North Africa, Spain, and the Middle East generally held far more humane attitudes toward people withmental illnesses. Following the belief that God loved insane people, communities began establishing asylums beginning in

the 8th century AD, first in Baghdd and later in Cairo, Damascus, and Fez. The asylums offered patients special diets,baths, drugs, music, and pleasant surroundings.

8/14/2019 Mental Illnes1

2/3

8/14/2019 Mental Illnes1

3/3

shifted their treatment approach from moral therapy to warehousing and punishment. In 1908 Clifford Whittingham Beersaroused new concern for mentally ill individuals with the publication of A Mind That Found Itself, an account of hisexperiences as a mental patient. In 1909 Beers founded the National Committee for Mental Hygiene, which worked to

prevent mental illness and ensure humane treatment of the mentally ill.

G. Deinstitutionalization Movement

Following World War II (1939-1945), a movement emerged in the United States to reform the system of psychiatric

hospitals, in which hundreds of thousands of mentally ill persons lived in isolation for years or decades. Many mental healthprofessionalsseeing that large state institutions caused as much, if not more, harm to patients than mental illnesses

themselvescame to believe that only patients with severe symptoms should be hospitalized. In addition, the developmentin the 1950s of antipsychotic drugs, which helped to control bizarre and violent behavior, allowed more patients to be treated

in the community. In combination, these factors led to the deinstitutionalization movement: the release, over the next fourdecades, of hundreds of thousands of patients from state mental hospitals. In 1950, 513,000 patients resided in these

institutions. By 1965 there were 475,000, and by 1990 state mental hospitals housed only 92,000 patients on any given night.Many patients who were released returned to their families, although many were transferred to questionable conditions in

nursing homes or board-and-care homes. Many patients had no place to go and began to live on the streets.

The National Mental Health Act of 1946 created the National Institute of Mental Health as a center for research and funding

of research on mental illness. In 1955 Congress created a commission to investigate the state of mental health care,treatment, and prevention. In 1963, as a result of the commissions findings, Congress passed the Community Mental Health

Centers Act, which authorized the construction of community mental health centers throughout the country. Implementationof these centers was not as extensive as originally planned, and many people with severe mental illnesses failed to receive

care of any kind.

H

. Recent Developments

One of the most important developments in the field of mental health in the United States has been the establishment of

advocacy and support groups. The National Alliance for the Mentally Ill (NAMI), one of the most influential of these groups,was founded in 1972. NAMIs goal is to improve the lives of people with severe mental illnesses and their families by

eliminating discrimination in housing and employment and by improving access to essential treatments and programs.

During the 1980s, all levels of government in the United States cut back on funding for social services. For example, the

Social Security Administration discontinued benefits for approximately 300,000 people between 1981 and 1983. Of these, anestimated 100,000 were people with mental illnesses. Although the government eventually restored Social Security benefits

to many of these people, the interruption of services caused widespread hardship.

The emergence of managed care in the 1990s as a way to contain health care costs had a tremendous impact on mental health

care in the United States. Health insurance companies and health maintenance organizations increasingly scrutinized theeffectiveness of various psychotherapies and drug treatments and put stricter limits on mental health care. In response to

these restrictions, Congress passed the Mental Health Parity Act of 1996. This law required private medical plans that offer

mental health coverage to set equal yearly and lifetime payment limits for coverage of both mental and physical illnesses.

In 1997 the U.S. Equal Employment Opportunity Commission issued new guidelines intended to prevent discriminationagainst people with mental illnesses in the workplace. The rules, based on the Americans with Disabilities Act of 1990,

prohibit employers from asking job applicants if they have a history of mental illness and require employers to providereasonable accommodations to workers with mental illnesses.

In recent years international agencies, led by the World Health Organization (WHO) of the United Nations (UN) havedeveloped mental health policies that seek to reduce the huge burden of mental illness worldwide. These agencies are

working to improve the quality of mental health services in Africa, Asia, Latin America, the Middle East, and elsewhere byeducating governments on prevention and treatment of mental illness and on the rights of the mentally ill.