Psychology Addict # 60 | A Journey Through The History of Madness.

in #psychology5 years ago (edited)

Disclaimer: In this post words such as lunacy, insane, madhouse, among others, have been adopted to communicate the ways psychological distress has been regarded and expressed across history.

The Madhouse - BS.jpg

In a previous post of mine I briefly discussed mental illness through looking into some of the criteria that defines it and discussed the way with which the general public perceives it at present. I then thought it would be interesting to take you on a journey across history and have a quick glimpse of how psychological distress was understood and treated in bygone times. This maybe a journey dotted by the suffering of the vulnerable and powerless, but it is also one that shows how far we’ve come with regard to the knowledge of psychological distress.

One thing that we humans sure do is to observe the behaviour of others, but it doesn’t stop there. For, people also have a knack for finding causes for these behaviours. Thanks to this sort of approach it has always been understood that mental disorders don’t simply emerge spontaneously. Rather, they result from something that caused them to occur. There are accounts from the 16th century, for instance, of unfulfilled erotic desires being one such cause [1]. A dangerous one indeed that led to the devastating ‘lovesickness’.

[…]intense unfulfilled erotic desire is classified as a species of melancholy, with mental and physiological aetiologies and cures […] a burning in the blood and liver, as a humoral imbalance, as an image fixed in the mind[…]
(Dawson, 2008, p. 2)

The humoral imbalance mentioned in 16th century literature as a reason for mental illness dates back to ancient Greece, when Hippocrates proposed that the human body is comprised by 4 vital different types of ’humours’ (fluids). These were: blood, choler (yellow bile), phlegm and melancholy (black bile). The belief was that while healthy people owed their psychological stability to a fine-tuned balance between the different humours; mentally distressed individuals either had their fluids in disarray, or one of them in excess [2].

How to treat such issue, then?

A popular treatment prescribed for “humour imbalance” was purging and/or removal of an amount of blood (bloodletting). Later termed Depletion Therapy, this mode of treatment for “lunacy” was still popular in the 1700’s and was largely adopted by the great names of psychiatry of the day. A famous enthusiast of Depletion Therapy was the American psychiatrist Benjamin Rush, who practised it not only on asylum patients, but also patients with diseases such as yellow fever [3].

I saw no inconvenience from the loss of a pint and even 20 ounces of blood at a time. I drew from many persons 70 and 80 ounces in five days, and from a few a much larger quantity.
(Benjamin Rush)

Of course, purging and bloodletting became increasingly popular treatments for the mentally ill in Europe and the U.S at a time when psychological disorders were not so heavily attributed to supernatural forces. When the Catholic faith became predominant in Europe, for example, a number of mental disorders were explained as the taking over of the body by demons [4], with exorcism being the means to cure it (a practice which, worryingly, has made a popular come back in Argentina over recent years [5]).

But as from the 17th century onwards these methods began to seem irrational for the enlightened Europeans, the secularization of madness took place. The ‘possessed” were no longer prosecuted, religion was reduced to psychopathology and new scapegoats were found: vagrants, the socially inadequate and beggars – the lunatics [6]. Those who burdened families and society as a whole. Consequently, confinement became the solution. A solution that in the words of Michel Foucault: “hid away unreason, and betrayed the shame it aroused” [7].

The Madhouse.

William Norris = BS.png

(Depiction of William Norris – A violent man who was kept in Bedlam for decades.)

London was one of the first cities to house a hospital built with the purpose to look after the “insane”. Bethlehem (later on Bethlem and then Bedlam) was founded in 1247, but only in 1403 was turned into a “madhouse”. Although Bedlam only had a few dozens of in-house individuals its fame became quite widespread. It even featured in the works of William Shakespeare:

The country gives me proof and precedent

Of Bedlam beggars who with roaring voices

Strike in their numbed and mortified arms

Pins, wooden pricks, nails, sprigs of rosemary.

(King Lear, 2.2.169–73)

Unfortunately, Bedlam was mostly known for the appalling conditions which it kept its people. In spite of this, in the midst of the 18th century Bedlam opened to the public. Tourists could tour around and gawk at the “mad”. One of its most affluent visitors was Charles Dickens [8], another was William Tuke. While the former seemed to have been in search of inspiration for his works. The latter was both horrified and moved by what he found: many of the patients were kept in inhumane conditions: some seemed as if they had just been locked up and forgotten, while others were chained to walls and beds. Tuke was a devout Quaker. He believed that the “insane” should be looked after with kindness not cruelty. He and his family then proceeded to open the York Retreat, an asylum with the aim to reverse the ethos of the other institutions: “to protected the mentally ill from society”, rather than the other way round.

The approach adopted in the York Retreat was termed Moral Treatment [9], and it entailed encouraging patients to politely interact with one another, eat at a dining table and occupy themselves with works such as gardening. Although said to be an influential, cornerstone treatment in the early 1800’s, the care for the mentally ill was not predominantly under its framework. Particularly through the 1900’s when techniques of medical therapies were the ones largely employed in the 100,000 patients housed in the 100 mental hospitals across the United Kingdom[10] , for example.

ICT, ECT & The Talking Cure.

ICT = BS.png

Being able to treat mental health conditions by means of medical intervention brought a much sought after scientific credibility to the field of psychiatry [11]. Some of such interventions included psycho-surgeries like lobotomy, which I wrote about 2 years ago here on my Steemit blog, insulin coma therapy (ICT), and electro convulsive therapy (ECT).

ICT consisted in injecting patients with insulin to the point their blood sugar levels went so low they slumped into a coma. The idea behind it was to completely relax the mind and enable the brain to set its paths anew with the return of consciousness. To achieve this, the procedure was repeated week in week out [12]. ECT regarded inducing seizures in patients through passing electrical current through the brain. This is a treatment still in use today, though, in cases of drug-resistant major-depressive disorders [13].

The early 1900’s also saw the works of Sigmund Freud gaining space in the field of psychiatry, Freud proposed that mental illness is a consequence of supressed fears, childhood memories and desires, which could all be unveiled through the free association method and dream analyses. Kent [14]argues that Freud didn’t exactly see his method as a means to treat patients confined in asylums, but ‘the talking cure’ did influence psychiatric treatment in patients housed in mental health institutions [15].

Psychotropic Medication & The DSM.

However, it was only in the 1950’s and 1960’s that a big shift started to take place in the treatment of psychological and psychiatric disorders. A shift that took place following the development of anti-depressant and anti-psychotic drugs. Despite the adverse-effects this new medication caused in patients, the alleviation of depressive and psychotic symptoms they brought forth enabled doctors to discharge patients from mental institutions. The 1950’s also witnessed the development of the Diagnostic Statistical Manual of Mental Disorders (The DSM), a guide used by professionals which contains standard classifications of mental disorders.

Both the DSM and psychotropic drugs are key components in the diagnosis and treatment of psychological conditions nowadays. Moreover, there is now a number of means individuals can turn to to address and treat their mental distress. Family therapy, group therapy and behavioural modification are just a few of several options. Whilst medication helps the symptoms of mental health problems become manageable, therapy aims at helping people to deal with their emotional suffering and uncover the causes that gave rise to their psychological issues (e.g. personal history or patterns of relating to others).

It has indeed been a lengthy, rocky journey. From bloodletting, through lobotomy to the talking cure much has been tested and understood at the expense of the powerless and vulnerable. The dark side of science? Not so fast! Keep in mind each of these procedures were carried out with the objective to ameliorate suffering or reach a cure. Note that the DSM and medication aren’t immune to criticism either. Freudians, for example , argue that medication stops individuals from accessing the root of their problems as its effects mask symptoms. And a debate exists linking the rise of psychological disorders diagnosis and drug-prescription with the influence of the pharmaceutical industry [16] . Further, stigmatization and limited understanding still surrounds the lives of those diagnosed with a mental health problem [17].

The journey continues.


Image source: 1,2, 3.

Refenrence List:

1 Dawson, L (2008) Lovesickness and gender in early modern English literature, Oxford, Oxford University Press.

2 Humour

3 Benjamin Rush, MD: assassin or beloved healer?

4 Making sense of the Supernatural - Demons, possession and exorcism..

5 What I learnt when I met a real life exorcist..

6,15 Porter, R. (2003) *Madness: a brief history. Oxford. Oxford University Press.

7 Foucault, M. (1965) Madness and Civilization. New York. Random House.

8 The most dreadful visitation

9 Moral Treatment

10Jones, K. (1993) Asylums and after: a revised history of the mental health services from the early eighteen century to the 1990s. London: Athlone Press.

11,12 Performing a cure for schizophrenia: insulin coma therapy on the wards..

13 Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression.

14 Kent, D. (2003) Snake pits, talking cures and magic bullets: a history of mental illness. Minneapolis, MN: Twenty-First Century Books.

16 Is psychiatry for sale?

17 Mental Illness - A Straight Forward Discussion about a Non Straight-Forward Topic..



redline.png

Unreason was hidden in the silence of the house of confinement, but madness continued to be present on the stage of the world.
(Foucault, Madness and Civilization)

Thank you my dear reader for taking the time to accompany me on this journey 😊

Sort:  

Beautiful and educative as always. The mention of Bedlam reminded me of one of the most popular James Blunt's album 'Back to Bedlam'

It is sad to know that even till today, a lot of psychological and psychiatric disorders are attributed to the so-called demons and extraterrestrial causes, especially by religion. and it is not uncommon to see people with these problems in chains, churches or other spiritual establishments.

I'm quite surprised that bloodletting came up again as one of the obsolete ways of dealing with a psychiatric problem. I once wrote on bloodletting and all the pseudoscientific beliefs associated with it but I would have loved so see statistics on the effectiveness of that method in dealing with the problems back then.

I believe in DSM and psychotropic medication because of past experience. Someone who had a psychiatric problem was taken to a hospital (after days of praying in the church without result), after regaining her senses to a certain extent, she refused to take the drugs anymore, claiming that she's heard about the adverse side effects of the drugs. Although she was eventually convinced to continue taking the drug and she's perfectly fine now. This particular experience always remind me that a lot of mentally unstable folks I see roaming the streets around here could have been saved by a couple of drugs if only we can stop attributing these things to spiritual attacks and demons.

My dearest @gentleshaid. How wonderful to see you around! <3

Thank you very much for leaving such an insightful comment. I very much agree with you. Despite the criticism that exist surrounding the DSM and psychotropic medication, there is no doubt that many lives have been saved because of them. Both with respect to preventing people to resort to extremes to end their suffering and providing those with psychological distress to leave with more dignity and peace.

I trust everything is fine with you & the family.
Lots of love from Portugal (especially for the little one!) :*

And again, thank you for stopping by. It means the world to me!

Loading...

Hi Abigail

Just a short one to thank you for continuing to produce excellent content each week for Steem!

I must admit that blood-letting is a new one to me with regards to cleansing the mentally unwell. 'Bedlam' i have heard of though via my mother who used the word to describe my brother and I when we were causing a 'fuss' or getting out of hand - now I know why after all these years!

With regards to developments in cure/relief from madness/depression, I'm not so sure we have made any progress over the years and feel the best approach is a change in lifestyle - although some minds may be beyond repair.

Have a lovely day!

Asher

Hi Asher :) Thank you for taking the time to leave your always kind and motivating feedback. I understand that things are pretty tight for you these days, timewise.

my mother who used the word to describe my brother and I when we were causing a 'fuss' or getting out of hand - now I know why after all these years!

LOVED this! 😃 I'm actually chuckling at it! :D

I have to agree with you on your observation about depression. The intrinsic pressures of modern life and the extra ones we inflict on ourselves (consumerism, peer pressure and so forth ...) are not doing our mental well-being any favours.

You take care Asher,
Wish you & your daughter (and mum) all the best! :)

Thank you very much Abigail, have a lovely week :)

@abh12345,

...my mother who used the word...
That´s funny, mine too, as well as my father, I remember hearing it a lot, my childhood must have been 'Bedlam' for my parents. 😏

Coincidentally, I had a conversation with someone tonight regarding their stay in a psychiatric ward and he praised his doctors for sincerely trying to discover a cause for his behaviors. He's fine now and although they misdiagnosed him and failed to treat any of his problems back then, he was impressed with their methods and their desire to find a cause. Lately I've been interested in learning more about how psilocybin can heal trauma. Definitely a journey.

I'm pleased to hear about this case @geke. And thank you for taking the time to contribute to our discussion with it. It's a shame they couldn't diagnose him accurately. But, then again, there is still a long way to go. I suppose that in the end what matters in this instance is that he is better, and felt he was treated with dignity.

I'm familiar with psilocybin as a means to treat depression. I know very little about its use in the treatment of trauma. I could do some digging and look into some research. And, who knows, I might even write about it in the future? :D

Thank you for stopping by Geke :* <3

What a journey! And it seems to me there are just as many if not more "insane" people around us even still. I still see most people steer clear of any one considered crazy, so their being alone can't be helpful in learning how to engage "sanely". It's a quandary for the ages apparently.
These are all western approaches to the insane. I believe other cultures, native American for instance, considered a person we would call crazy as imbued with supernatural powers, the good kind.

I believe other cultures, native American for instance, considered a person we would call crazy as imbued with supernatural powers, the good kind.

This is interesting information @owasco. I wonder what characteristics needed to be displayed for a person to be regarded mad in those kind of civilizations. I know that every ancient civilization explained madness from a supernatural perspective. Archeologists have unearthed skulls that were dated from back to 5000 BC, which had been trepanned (a surgical intervention in which a hole is drilled the skull).

It is understood that was because the individual was thought to have been possessed by demons, and the hole would allow them to escape. But, of course, what kind of behaviour they were displaying for such conclusions to be made is unknown. A safe bet is epileptic seizures.

Treppanned Skull.jpg

Thank you @owasco for your constant support & thoughtful comments :)

Somehow, everything comes by four in the ancient times. First the elements and now the humour fluids. I smiled when I read about it. But stopped smiling right after that (cf. fluid removal :/ ).

I am actually quite surprised that the DSM was so recent. Mental disorders were observed for so long that it sounds weird that no one ever thought about documenting them in the first place before the 20th century. But as you said, this was a lengthy (and rocky) journey…

Even if disorders are categorised for almost 70 years, can we really treat those patients? I mean, I associated the disorder with something wrong at the level of the brain. Therefore, there should not be really any cure, shouldn’t it?

Good observation @lemouth :)

Mental disorders were observed for so long that it sounds weird that no one ever thought about documenting them in the first place before the 20th century.
This is mostly because psychological disorders were all lumped together and explained as a result of "an over-active brain". This is why treatments like bloodletting, waterboarding and more recently ICT and ECT were developed in order to "slow down" brain activities (through inducing patients into a coma). Nevertheless, diagnostic classifications were already taking place in Germany in the late 1800's (I don't remember which year exactly). Emil Kraepelin was in charge of that. He was the first to come forward and suggest that mental distress are of distinct prognosis and consequently are manifested differently from patient to patient.

Thank you for asking the following questions @lemouth.

can we really treat those patients? * Therefore, there should not be really any cure, shouldn’t it?
Yes. With the exception of psychopathy (which can still be addressed via therapy). Both psychological and psychiatric conditions can be treated. The more severe ones (e.g. the psychoses and bipolar disorder) can be treated with psychotropic medication and therapy. You can think of someone who lives with such conditions as person, for example, who lives with a heart condition and needs to be very diligent with their meds and healthy routine in order to function well in life.

As for the less severe ones (mild depression and specific fears) not only can they be treated, but also completely cured through therapy only. There is a huge body of evidence demonstrating the efficiency of Cognitive Behavioural Therapy in both bringing these disorders (and a few others) to a halt, and preventing relapses.

Thank you for stopping by once again & taking the time to meaningfully interact with my work here! I appreciate it very much.

Happy weekend for you & the family 😊

Thanks a lot for this long and detailed answer! And please pardon me for my stupid and naive questions (but this is not my field for my defense ;) )

I hope you had a nice week-end. We were in Brussels for a couple of days!

Please don't apologize for anything @lemouth. It's very important that this sort of clarification gets out there. Your questions have contributed to this :)

Brussels! Nice :D The last time I went there was just over 10 years ago. Time flies! We did have a very nice,relaxing weekend. Thank you <3

Time flies... that is one of the only certainties we have... ;)

My my! Truth is the process through mental illness from history through time is really mind boggling however what baffles me is that even through all these process of treatment down the centuries we can't still play a reason I mean a cogent and definite answer as to the real reason why mental illness originates. I told you then that my mother suffered and this suffers from it and there was really no medical conclusion as to why she still remained the same after series of treatment really. In other words I'm thrilled by your contents and it's raised a whole lot of questions as well.
Thanks for your beautifully written content Abi, please stay blessed.

Hello dear @josediccus :)

I remember you told me about your mum's experience with psychological distress.
How is she doing these days?

I hope things are going well for you & your family <3
Thank you very much for your kind words my dearest!

Much love from Portugal.

The title of this post really got me smiling

My comment may be a little unrelated to the post but I'll drop it anyway because the issue of madness is raised.

I once heard a very funny statement a while ago when someone said that everyone has their own period of "madness". I did not want to argue with him, because we may end up exhibiting some "madness" and thereby proving his statement right.

Even though I don't know if to agree with him or not, but I do know that there are some behaviours that are exhibited by the so called sane people, and people will just appreciate mad people. Okay I know I'm being sarcastic, but there's truth in it.

Just like the place where I grew, there's a level of provocation you'll give to someone and you'll hear something like this...

shey u dey mad ni? Try am again, u go see say I dey craze

This translates to "...if you try this again, I'll show you madness".

This has made the term "madness" often used by hommies without really knowing what it means.

Nice post as usual dear Abbey. Much love from Nigeria

Sammi :) <3

Oh! I truly appreciate that you take the time to share here with me the conversations you have with your friends and acquaintances about mental health topics. I find important because it gives me the chance to see how these issues and concepts are perceived in the world out there (first hand!) 😊

The title is "crazy", right? ;)

Take care dearest Sammi,
Lots of love from Portugal :*

Another amazing and very interesting post! What i find fascinating is how we move forward. Through the course of time we had blood extraction, lobotomy and other ways that nowadays me even consider a criminal act but it was all for the sake of those sick people. Ofc there would be many times that people without actual issues would suffer just because someone said they have a problem and need for a example a lobotomy. Politics and stuff also had they fair share regarding the whole thing.

Deep down though the actual scientists and some other philanthropists wanted to help people in need. Each one of them tried to help in his/her own way the amazing is that the next generation of scientists either based on these previous ideas, or evolved them or even triggered their brains to actually find a more viable solution. In other words it's like we have a longass stair and each step forward we take is thanks to our previous one!

therapy aims at helping people to deal with their emotional suffering and uncover the causes that gave rise to their psychological issues (e.g. personal history or patterns of relating to others).

How amazing is that we came to this. Just by "simple" talking we can help other people change their whole lives. Nowadays i think a lot and i mean a lot of people face many issues that derive from their past experiences (bullying, abuse,immaturity etc etc). that issues may lead them to hideous actions like, abusing-bullying others, assaulting, harassing, be illogical, even hurting both other sand themselves. That behavior can change with just a couple of hours of talking and ofc self effort. I think the hard part is for the person to understand his/her issue and decide to change!

“to protected the mentally ill from society”

that phrase summarizes everything, also it reminds me of the new Joker film :P

And here he is with another incredibly insightful comment. You are a very sensitive person @filotasriza :)

First of all thank you for saying the following:

How amazing is that we came to this. Just by "simple" talking we can help other people change their whole lives.

This is true, true, true and I wish more people understood this. More often than not, all individuals undergoing psychological distress need is to have someone who objectively and non-judgmentally help them to restructure their mode of thinking and, subsequently, reorient their approach to life. After all, as I stated on a previous post :

there exists an inner self-healing, self-righting capacity that people mobilise – provided that they have the right tools - no matter how emotionally troubled they are.

It's wonderful having you around in the Steemit community once again my dear :)

And here he is with another incredibly insightful comment. You are a very sensitive person @filotasriza :)

stop it stop it i am blushing

It's wonderful having you around in the Steemit community once again my dear :)

thanks a lot and it's great seeing familiar people around here as well!

It's pretty crazy how people with mental health concerns were treated back then. "Tourists could gawk at the mad" - wow... its crazy that that occurred back then.

It's very interesting to learn about the history of mental health and how it has progressed over the ages. The terminology (as you pointed out) can be pretty strange as well when we look back on it.

Something that I read recently was about how the social political atmosphere of the time largely effects how mental health concerns are recieved, portrayed, developed and understood which I found very interesting. For instance, the history of hysteria is quite facinating. In the past, Hysteria was basically a female mental disorder at the time. Individuals with similar symptomology today would probably fall into the classification of borderline personality disorder or more simply an individual who had experience complex trauma. Freud and a few other psychiatrists studied hysteria among patients in "mad houses" and determined that the symptoms that these women presented were largely due to having been exposed to severe ongoing physical and sexual abuse starting at a young age - most likely committed by their parents or close relative. The idea was accepted in the begining because the women held in facilities like the ones you described in your post, mostly came from low socioeconomic backgrounds (poor families). It seemed that the idea that the poor abuse their kids was not only accepted but basically "common sense." The philosophy on hysteria started out very victim centric in that the symptoms that these women experienced were largely based on the trauma that they experienced. However, as the field of psychology grew the psychiatrists began to study more and more individuals from a wider variety of backgrounds (not only those contained in mad houses) and they began see that hysteria was also relatively common among wealthy families. The public did not like the implications of that finding though - the notion that some wealthy aristocrats abused their kids in the same way that the poor do was not well recieved. So Freud and the other psychologists shifted their reasoning and philosophy on hysteria and began viewing it under a psychosexual theory that Freud eventually became known for and one that is mostly obsolete and irrelevant today. Under the theory, it was a females disfunctional sexual drives and desires that led to their hysteria.

So the philosophy shifted from blaming the situational trauma inflicted on the women as being the cause for their mental health concern to blaming them for it.

When I read that I found it super interesting because it parallels this moment in history as well. We can see similar situations happening today. For instance, the #metoo movement is happening and we are still seeing some of the same victim blaming taking place in society. It's interesting to me that social politics play a role in the perception and acceptance of mental health.

Anyway, that's super long winded. Your articles always make me stop and think about the topics in depth. Awesome article, well done as usual! I hope you and your husband enjoy the rest of your week and weekend.

Posted using Partiko Android

Hello @leaky20 😊

This is how I understood that hysteria was rationalized and theorized by Freudians.

it was a females disfunctional sexual drives and desires that led to their hysteria.

I was unaware that there had been a shift in the way it was perceived because of socio-polotical influence. Thank you for all that info :)

But, I believe that social politics always play a role in the way mental health is accepted and perceived in instances which involve a perpetrator and a victim. Then, key aspects become (1) the way perpetrators can be shown to be bad (or mad) - something which depends on their social status, gender and race, and (2) what was the victim's part in their becoming a victim - e.g. was it a housewife or a sex worker?

It's upsetting to see that not even diagnosis escapes bias!

Ps: not sure whether you saw the message I left you a couple of days ago about Haidt's video. Just in case you didn't. It's awesome, as all things Haidt! thanks so much for directing me to it ;)

Wishing the same to you, your wife and the doggies.

Well, that was according to the book I read anyway (i.e. Trauma and Recovery by Judith Herman). That's so true what you said about social politics always playing a role when there is a victim and a perpetrator. Great point.

I actually didn't see that comment about the video. The app that I use (Partiko) has been quite buggy lately. The notifications for votes and comments/replies stop coming in for a few days then I get like 100 or so all at once Haha. I'm glad you liked it. I found it quite interesting and will probably read his book - at some point.

Posted using Partiko Android