.

Greco-Roman Thought

Rejecting the idea of demonic possession, Greek physician, Hippocrates (460-377 B.C.), said that
mental disorders were akin to physical disorders and had natural causes. Specifically, he suggested
that they arose from brain pathology, or head trauma/brain dysfunction or disease, and were also
affected by heredity. Hippocrates classified mental disorders into three main categories –
melancholia, mania, and phrenitis (brain fever) and gave detailed clinical descriptions of each. He
also described four main fluids or humors that directed normal functioning and personality
– blood which arose in the heart, black bile arising in the spleen, yellow bile or choler from the liver,
and phlegm from the brain. Mental disorders occurred when the humors were in a state of
imbalance such as an excess of yellow bile causing frenzy/mania and too much black bile causing
melancholia/depression. Hippocrates believed mental illnesses could be treated as any other
disorder and focused on the underlying pathology.

Also important was Greek philosopher, Plato (429-347 B.C.), who said that the mentally ill were not
responsible for their own actions and so should not be punished. He emphasized the role of social
environment and early learning in the development of mental disorders and believed it was the
responsibility of the community and their families to care for them in a humane manner using
rational discussions. Greek physician, Galen (A.D. 129-199) said mental disorders had either physical
or mental causes that included fear, shock, alcoholism, head injuries, adolescence, and changes in
menstruation.

1.3.3. The Middle Ages – 500 AD to 1500 AD

The progress made during the time of the Greeks and Romans was quickly reversed during the
Middle Ages with the increase in power of the Church and the fall of the Roman Empire. Mental
illness was yet again explained as possession by the Devil and methods such as exorcism, flogging,
prayer, the touching of relics, chanting, visiting holy sites, and holy water were used to rid the
person of the Devil’s influence. In extreme cases, the afflicted were confined, beat, and even
executed. Scientific and medical explanations, such as those proposed by Hippocrates, were
discarded at this time.

Group hysteria, or mass madness, was also seen in which large numbers of people displayed similar
symptoms and false beliefs. This included the belief that one was possessed by wolves or other
animals and imitated their behavior, called lycanthropy, and a mania in which large numbers of
people had an uncontrollable desire to dance and jump, called tarantism. The latter was believed to
have been caused by the bite of the wolf spider, now called the tarantula, and spread quickly from
Italy to Germany and other parts of Europe where it was called Saint Vitus’s dance.

Perhaps the return to supernatural explanations during the Middle Ages makes sense given events
of the time. The Black Death or Bubonic Plague had killed up to a third, and according to other
estimates almost half, of the population. Famine, war, social oppression, and pestilence were also
factors. Death was ever present which led to an epidemic of depression and fear. Nevertheless, near
the end of the Middle Ages, mystical explanations for mental illness began to lose favor and
government officials regained some of their lost power over nonreligious activities. Science and
medicine were once again called upon to explain mental disorders.

1.3.4. The Renaissance – 14th to 16th Centuries

The most noteworthy development in the realm of philosophy during the Renaissance was the rise
of humanism, or the worldview that emphasizes human welfare and the uniqueness of the
individual. This helped continue the decline of supernatural views of mental illness. In the mid to late
1500s, Johann Weyer (1515-1588), a German physician, published his book, On the Deceits of the
Demons, that rebutted the Church’s witch-hunting handbook, the Malleus Maleficarum, and argued
that many accused of being witches and subsequently imprisoned, tortured, hung, and/or burned at
the stake, were mentally disturbed and not possessed by demons or the Devil himself. He believed
that like the body, the mind was susceptible to illness. Not surprisingly, the book was met with
vehement protest and even banned from the church. It should be noted that these types of acts
occurred not only in Europe but also in the United States. The most famous example was the Salem
Witch Trials of 1692 in which more than 200 people were accused of practicing witchcraft and 20
were killed.

The number of asylums, or places of refuge for the mentally ill where they could receive care, began
to rise during the 16th century as the government realized there were far too many people afflicted
with mental illness to be left in private homes. Hospitals and monasteries were converted into
asylums. Though the intent was benign in the beginning, as they began to overflow patients came to
be treated more like animals than people. In 1547, the Bethlem Hospital opened in London with the
sole purpose of confining those with mental disorders. Patients were chained up, placed on public
display, and often heard crying out in pain. The asylum became a tourist attraction, with sightseers
paying a penny to view the more violent patients, and soon was called “Bedlam” by local people; a
term that today means “a state of uproar and confusion” .

AGE OF REASON AND ENLIGHTMENT-17 th Century

. Reform Movement – 18th to 19th Centuries

The rise of the moral treatment movement occurred in Europe in the late 18th century and then in
the United States in the early 19th century. Its earliest proponent was Phillipe Pinel (1745-1826) who
was assigned as the superintendent of la Bicetre, a hospital for mentally ill men in Paris. He
emphasized the importance of affording the mentally ill respect, moral guidance, and humane
treatment, all while considering their individual, social, and occupational needs. Arguing that the
mentally ill were sick people, Pinel ordered that chains be removed, outside exercise be allowed,
sunny and well-ventilated rooms replace dungeons, and patients be extended kindness and support.
This approach led to considerable improvement for many of the patients, so much so, that several
were released.

Following Pinel’s lead in England, William Tuke (1732-1822), a Quaker tea merchant, established a
pleasant rural estate called the York Retreat. The Quakers believed that all people should be
accepted for who they were and treated kindly. At the retreat, patients could work, rest, talk out
their problems, and pray (Raad & Makari, 2010). The work of Tuke and others led to the passage of
the County Asylums Act of 1845 which required that every county in England and Wales provide
asylum to the mentally ill. This was even extended to English colonies such as Canada, India,
Australia, and the West Indies as word of the maltreatment of patients at a facility in Kingston,
Jamaica spread, leading to an audit of colonial facilities and their policies.

Reform in the United States started with the figure largely considered to be the father of American
psychiatry, Benjamin Rush (1745-1813). Rush advocated for the humane treatment of the mentally
ill, showing them respect, and even giving them small gifts from time to time. Despite this, his
practice included treatments such as bloodletting and purgatives, the invention of the “tranquilizing
chair,” and a reliance on astrology, showing that even he could not escape from the beliefs of the
time.

Due to the rise of the moral treatment movement in both Europe and the United States, asylums
became habitable places where those afflicted with mental illness could recover. However, it is often
said that the moral treatment movement was a victim of its own success. The number of mental
hospitals greatly increased leading to staffing shortages and a lack of funds to support them. Though
treating patients humanely was a noble endeavor, it did not work for some and other treatments
were needed, though they had not been developed yet. It was also recognized that the approach
worked best when the facility had 200 or fewer patients. However, waves of immigrants arriving in
the U.S. after the Civil War were overwhelming the facilities, with patient counts soaring to 1,000 or
more. Prejudice against the new arrivals led to discriminatory practices in which immigrants were
not afforded moral treatments provided to native citizens, even when the resources were available
to treat them.

Another leader in the moral treatment movement was Dorothea Dix (1802-1887), a New Englander
who observed the deplorable conditions suffered by the mentally ill while teaching Sunday school to
female prisoners. She instigated the mental hygiene movement, which focused on the physical well-
being of patients. Over the span of 40 years, from 1841 to 1881, she motivated people and state
legislators to do something about this injustice and raised millions of dollars to build over 30 more
appropriate mental hospitals and improve others. Her efforts even extended beyond the U.S. to
Canada and Scotland.

Finally, in 1908 Clifford Beers (1876-1943) published his book, A Mind that Found Itself, in which he
described his personal struggle with bipolar disorder and the “cruel and inhumane treatment people
with mental illnesses received. He witnessed and experienced horrific abuse at the hands of his
caretakers. At one point during his institutionalization, he was placed in a straightjacket for 21
consecutive nights.” (http://www.mentalhealthamerica.net/our-history). His story aroused
sympathy in the public and led him to found the National Committee for Mental Hygiene, known
today as Mental Health America, which provides education about mental illness and the need to
treat these people with dignity. Today, MHA has over 200 affiliates in 41 states and employs 6,500
affiliate staff and over 10,000 volunteers.

For more information on MHA, please visit: http://www.mentalhealthamerica.net/

1.3.6. 20th – 21st Centuries

The decline of the moral treatment approach in the late 19th century led to the rise of two
competing perspectives – the biological or somatogenic perspective and the psychological or
psychogenic perspective.

1.3.6.1. Biological or Somatogenic Perspective

Recall that Greek physicians Hippocrates and Galen said that mental disorders were akin to physical
disorders and had natural causes. Though the idea fell into oblivion for several centuries it re-
emerged in the late 19th century for two reasons. First, German psychiatrist, Emil Kraepelin (1856-
1926), discovered that symptoms occurred regularly in clusters which he called syndromes. These
syndromes represented a unique mental disorder with its own cause, course, and prognosis. In 1883
he published his textbook, Compendium der Psychiatrie (Textboook of Psychiatry), and described a
system for classifying mental disorders that became the basis of the American Psychiatric
Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) that is currently in its 5th
edition (published in 2013).

Also noteworthy was the work of American psychiatrist John P. Grey. Appointed as superintendent
of the Utica State Hospital in New York, Grey asserted that insanity always had a physical cause. As
such, the mentally ill should be seen as physically ill and treated with rest, proper room temperature
and ventilation, and a proper diet.

The 1930s also saw the use of electric shock as a treatment method, which was stumbled upon
accidentally by Benjamin Franklin while experimenting with electricity in the early 18th century. He
noticed that after experiencing a severe shock his memories had changed and in published work,
suggested physicians study electric shock as a treatment for melancholia.

Beginning in the 1950s, psychiatric or psychotropic drugs were used for the treatment of mental
illness and made an immediate impact. Though drugs alone cannot cure mental illness, they can
improve symptoms. Classes of psychiatric drugs include antidepressants used to treat depression
and anxiety, mood-stabilizing medications to treat bipolar disorder, antipsychotic drugs to treat
schizophrenia and other psychotic disorders, and anti-anxiety drugs used to treat generalized anxiety
disorder or panic disorder

A result of the use of psychiatric drugs was deinstitutionalization or the release of patients from
mental health facilities. This shifted resources from inpatient to outpatient care and placed the
spotlight back on the biological or somatogenic perspective. Today, when people with severe
mental illness do need inpatient care, it is typically in the form of short-term hospitalization.