The Oldest Medical Books in the World
When violence wasn’t used, priest-doctors (like those in ancient Mesopotamia) would use rituals based on religion and superstition since they believed that demonic possession was the reason behind mental disturbances. Such rituals would include prayer, atonement, exorcisms, incantations, and other forms of tribalistic expressions of spirituality. However, shamans would also resort to threats, bribery, and even punishment if the ritualistic methods proved unsuccessful in changing the behavior of a tribe member.
This belief persisted through the Middle Ages. Doctors of the time would give patients laxatives, emetics (substances that would induce vomiting), leeches, and cupping therapy to restore the body’s proportions of humors. Recipes consisting of aloes, black hellebore, and colocynth, for example, would cure a patient of depression. Tobacco imported from the Americas was used to make patients vomit out the excess humors. Other treatments saw doctors extracting blood from the forehead or tapping veins across the body to drain the guilty humors away from the brain.
Less invasive therapies included specialized diets, such as a regimen of salad greens, barley water, and milk for “raving madmen,” who were told to abstain from red wine and meat.
Caring for the Mentally Ill
Typically, the patient’s family was responsible for custody and care of the patient. Outside interventions and facilities for residential treatment were rare; it wasn’t until 792 CE in Baghdad that the first mental hospital was founded. In Europe, however, family having custody of mentally ill patients was for a long time seen as a source of shame and humiliation; many families resorted to hiding their loved ones in cellars, sometimes caging them, delegating them to servants’ care, or simply abandoning them, leaving their mentally unhealthy flesh and blood on the streets as beggars.
From Workhouses to Asylums
However, there were some options for treatment beyond the limitations of family care (or custody). These including putting up the mentally unhealthy in workhouses, a public institution where the poorest people in a church parish were given basic room and board in return for work. Others were checked into general hospitals, but they were often abandoned and ignored.
Clergy in respective churches played a key role in the treatment mentally ill people received since some medical practice was considered a logical extrapolation of priests’ duty to do what they could to tend to the ailments of their people. If a family could afford the care, they could send their loved one to a private home, owned and operated by members of the clergy who would do what they could to offer some treatment and comfort. Countries with majority (or politically established) Catholic populations would often staff their mental health facilities with members of the clergy; Russia’s Orthodox monasteries housed most of the nation’s mentally ill until the rise of asylums.
Not entirely dissimilar to the methods advocated by shamans and witch doctors from millennia prior, European clergy had long recommended regular church attendance, as well as religious pilgrimages, as a cure for mental distress. Patients were encouraged to repent of their sins and throw themselves at God’s mercy, but such methods had little success. However, the treatment offered by facilities run by clergy and nuns was markedly more humane than the alternate methods of the time.
But workhouses and monasteries could not keep up with the full scope of the population that needed mental health treatment, which opened the door for asylums to take over. The Actas Españolas de Psiquiatría writes of how the first psychiatric hospital in the world was founded in Valencia, Spain, in 1406, but historians note that this is not remembered as a cause for celebration. Asylums like the one in Valencia offered no real treatment or comfort to the mentally ill, forcing patients to live in inhuman conditions and subjecting them to cruel abuse. Such facilities were, in effect, prisons in everything but name, and sometimes even worse than penal institutions. There was no concept of actively caring for mentally ill individuals, only sequestering them away from their families and societies at large, and minimizing the perceived harm they could do to their communities.
The Roots of Reform
While bloodletting and inducing vomiting were still the preferred form of treatment (when staff actually deigned to help their wards), additional forms of “therapy” included dousing the patients in extremely hot or cold water, the idea being that the shock would force their minds back into a healthy state. The belief that mental disturbance was still a choice prevailed, so staff used physical restraints, straitjackets, and even threats to further try to “cure” patients. Drugs were sometimes given to the more dangerous and difficult patients. A Dutch doctor even developed a “gyrating chair” that was supposed to literally shake up the body’s anatomy and blood to try and restore the balance of the humors, but only succeeded in rendering patients unconscious with no improvement in their condition.
As word spread of the subhuman environments within asylums, a call for reform arose in the latter part of the 19th century. An example of this took place at an asylum in Devon, England, which abandoned methods of treatment based on restraint.
As a result, the York Retreat came to resemble a pleasant country house, more so than the filthy prisons of asylums past. The focus was on creating a home-like environment that would be conducive for patients to live, work, and rest. The Quaker traditions of treating all people, even the mentally ill, with respect and kindness manifested in how staff handled patients: with equal doses of humility and humanity.
Moving away from Moral Treatment
The radical nature of moral treatment made waves on the other side of the Atlantic Ocean. When the moral method reached the shores of the United States, doctors understood it to be a comprehensive way of treating mentally ill people by working on their social, individual, and occupational needs. This was the first time that the idea of rehabilitating mentally ill people back to recovery, and eventual reintegration with their families and communities at large, was floated. Doctors would encourage their patients to participate in manual labor and intellectual conversation, effectively training them to be healthy and contributing members of society again.
Moral treatment was highly effective (especially compared to the systems it succeeded), but it died out in the waning years of the 19th century. Critics argued that the method did not really treat patients but made them dependent on their doctors and the asylum staff for comfort. In the 20th century, historians and contemporary doctors argued that the moral method simply substituted one form of control for another.
Notwithstanding the end of the moral treatment movement, the conversation about mental health treatment was ready to take a big step forward. A major figure in that progression was Sigmund Freud. The famous Austrian neurologist and psychiatrist developed his theory of psychoanalysis, which gave rise to the practice of “talking cures” and free association, encouraging patients to talk about whatever came to mind. Freud’s theory was that the avenues of conversation would open a door to the patient’s unconscious mind, granting access to any kind of repressed thoughts and feelings that might have compelled the mental instability.
One of the most infamous chapters in the history of mental health treatments was psychosurgery. First developed in the 1930s, a patient would be put into a coma, after which a doctor would hammer a medical instrument (similar to an icepick) through the top of both eye sockets. The process would cut the nerves that connected the frontal lobes (which regulate behavior and personality) to the centers of the inner brain that regulate emotion. The idea behind lobotomies was to induce calm in patients who were uncontrollably hysterical or emotional, especially in conditions like schizophrenia, manic depression, and bipolar disorder.
Psychosurgery was highly controversial from the outset, and many doctors decried the sheer invasiveness and risk of physically tampering with patients’ brains in the hopes of affecting behavior changes. But lobotomies were relatively simple and quick to perform, and the practice took off around the world.
From Lobotomies to Psychopharmacology
However, the process rendered patients immature and lethargic, which may have seemed preferable to their previously uncontrollable behavior but was soon recognized as not being a “cure” in any sense of the idea. A 2011 article published in the Journal of Neurosurgery noted that patients also reported vomiting, loss of bladder and bowel control, problems with their vision, and unnatural states of apathy, lethargy, and hunger. As more and more evidence of the harmful effects of lobotomies started piling up, and other treatments became more popular, psychosurgery was relegated to horror movies and urban legends.
Mental Health and Treatment in the 21st Century
As lithium became the standard for mental health treatment, other drugs like chlorpromazine (better known as Thorazine), Valium and Prozac became household names during the middle and latter decades of the 20th century, becoming some of the most prescribed drugs for depression across the world. There are now hundreds of psychoactive drugs in circulation, all targeting a variety of mental health disorders and allowing patients a degree of comfort and privacy with how their conditions are treated.
An unexpected side effect of this is that the need for dedicated facilities to house mentally ill persons declined; inpatient treatment centers usually see clients for a few months at a time, and outpatient centers operate on the basis of there being no overnight stays. As welcome as this was, it created the problem of people with severe mental health problems, but with no social or family networks to support their recovery (or who could not afford the fees or insurance plans for rehabilitation) being moved to jails and prisons.
Similarly, the rise of prescription medication has also created a massive black market for illicit trading of expensive and hard-to-obtain pills as well as an epidemic for abuse, either by desperate patients with legitimate medical needs or people looking for a legal way to obtain a recreational high.
Both realities speak to the complexities of treating mental illnesses. Where incantations and brain surgery have fallen short, drug therapy and counseling have picked up the treatment baton for the 21st century, helping millions of people achieve health and recovery. However, this evolution has come at a price, with many thousands falling prey to addiction and falling through the cracks of the modern healthcare system. The challenges indicate that proper treatment for mental health will not be easy or straightforward, but the evolution and advancements suggest that the improvements of today are infinitely better than anything that has come before.
 ” The History of Mental Illness: From Skull Drills to Happy Pills.” (2010). Inquiries. Accessed November 22, 2016.
 “Art Therapy Institute Draws on Healing Power of Creating.” (November 2016). The News & Observer. Accessed November 23, 2016.
 “A Beautiful Mind: The History of the Treatment of Mental Illness.” (March 2015). History Cooperative. Accessed November 23, 2016.
 “The Founding of the First Psychiatric Hospital in the World in Valencia.” (January-February 2008). Actas Españolas de Psiquiatría. Accessed November 23, 2016.
 “Psychologists Conducting Psychotherapy in 2012: Current Practices and Historical Trends Among Division 29 Members.” (December 2013). Psychotherapy (Chic.). Accessed November 24, 2016.
 “Egas Moniz (1874–1955) and the ‘Invention’ of Modern Psychosurgery: A Historical And Ethical Reanalysis Under Special Consideration of Portuguese Original Sources.” (February 2011). Journal of Neurosurgery. Accessed November 25, 2016.
 “TIMELINE: Deinstitutionalization And Its Consequences.” (April 2013). Mother Jones. Accessed November 25, 2016.