Discussions of mental health often refer to a range of mental illnesses, including psychotic disorders like schizophrenia, mood disorders like depression or bipolar disorder, personality disorders, anxiety, trauma, as well as eating disorders and substance abuse disorders. However, mental health encompasses a broader concern with psychological wellbeing and the effective and prevention treatment of mental illness.
According to the Mental Health Commission of Canada, 1 in 5 Canadians experience mental health challenges over the course of any year, but only 1 in 3 will seek treatment. Mental health support and telehealth services are becoming more common as part of health insurance plans. The history of mental health and its treatment is complex and the notion of mental health being related to general healthcare only took root with the rise of scientific study of the workings of the mind the 19th century.
This list comprises some important milestones in the history of mental health:
1. Mental illness in the Ancient World
Perspectives on mental illness for much of human history before the arrival of psychiatry, looked at mental disorders as being caused by supernatural forces, physical (biological) conditions or diseases. Most often, treatment fell to family members, law enforcement or even clergy. Very often, mental illness was viewed as a product of evil spirits if not the devil himself. The Greek medical pioneer Hippocrates sought to find physical causes and remedies for what today we would consider mental illness.
Ancient Romans believed that mental illness could mitigate responsibility for criminal behaviour, introducing into law the concept of non compos mentis (“not of sound mind”). The compassion of ancient Greek and Roman attitudes toward mental diseases would continue in the emerging Muslim world, while views in the European Middle Ages could lead to cruelty.
The oldest asylum for the mental ill was founded in London in 1247 during the reign of Henry II. Known by various names including Bethlem Royal Hospital and St Mary Bethlehem, it is not known when exactly the hospital became primarily an asylum for the mentally unwell, but it mentioned as such in Geoffrey Chaucer’s Canterbury Tales, which was published in 1476. Bedlam notoriety for its ill-treatment of its patients, who were caged and restrained by ropes and chains, would follow it into the 19th century.
This is an important milestone in the history of mental health. By that time, onlookers could visit the hospital to gawk at patients. Bedlam became synonymous with mental illness. Its cruelties reflect a philosophy that sought to isolate, ostracize or imprison people with mental disorders, who were often held alongside vagrants and criminals.
3. Lunatic Asylums
The earliest asylum in North America was opened in Williamsburg, Virginia, a few years before American independence. Asylums in North America and Europe had loose requirements for admittance. People with epilepsy, depression, speech disorders, or even becoming pregnant outside of marriage could be committed. The Enlightenment brought a new scientific attitude toward most health problems beginning in the 18th century, and the category of mental health began to emerge.
4. Tranquilizing Chair
Typical of the harsh treatments of mental illness in the 18th and 19th centuries is the “Tranquilizing Chair,” developed by Dr. Benjamin Rush, a Philadelphia physician and signer of the American Declaration of Independence. Rush believed mental illness to be a disease, and likely caused by swelling of the brain. His tranquilizing chair was a mechanical device for the treatment of madness, wherein the patient would be confined in a seated position as the device used pressure controlled blow flow to the brain.
5. Dr. Joseph Workman (1805-1895)
While serving as medical superintendent of the first Provincial Lunatic Asylum in Toronto, Ontario, Canada, the psychiatrist and educator Joseph Workman sought to import more enlightened attitudes toward the care and treatment of the mentally ill to Canada. He authored a number of papers on the topic of insanity. He advocated for dignified care and eschewed using medicine in the treatment of mental disorders.
6. Nellie Bly (1864-1922)
In 1887, journalist Nellie Bly posed as mentally ill in order to write an exposé about conditions in the Women’s Lunatic Asylum in New York. Writing for the New York World, Bly’s “Ten Days in a Mad-house,” outlined the deplorable and inhumane state of the conditions within the asylum, prompting social outcry that led to reforms.
7. Mental hygiene
When William Sweetser coined the term “mental hygiene” in the middle of the 19th century, it signaled the rise of a growing movement to treat mental illness as a disease. A Massachusetts school teacher named Dorothea Dix (1802–1887) helped popularize the term and advocated on behalf of its sufferers, forming the basis of the “mental hygiene movement.”
8. New medical treatments
The 20th century saw the medicalization of mental health, as new treatments for common mental diseases like schizophrenia, depression and other persistent conditions proliferated. These new treatments include drugs, electro-convulsive therapy, and a new surgical procedure called the lobotomy first developed in 1936. Thorazine, the first antipsychotic drug in the US, was approved for medical use by the FDA in 1954.
In the history of mental health, The Canadian National Committee for Mental Hygiene plays an important role. Later renamed as the Canadian Mental Health Association (CMHA), the organization was founded in 1918 and continues to promote mental health research and treatment to this day.
10. US National Mental Health Act of 1946
President Harry Truman established the National Institute of Mental Health in 1946 with the mission of carrying out research about neuropsychiatric issues.
11. One Flew Over the Cuckoo’s Nest
Ken Kesey’s novel based on his experience working in a psychiatric hospital becomes international bestsellers on its release in 1962. Actor Kirk Douglas options the film rights, which he eventually sold to his son Michael Douglas, who produced the highly successful 1975 film version.
12. Deinstitutionalization and decline
With the number of patients in US public psychiatric hospitals peaking at 560,000 in 1955, President John F. Kennedy signed the Community Mental Health Act of 1963 allocated federal funding to build community-based mental health facilities devoted to the preventive, care and treatment of mental disorders. The project was never realized and it signals the last major effort to secure significant federal public funding for mental health institutions in the US.
By the 1980s, President Ronald Reagan would follow trends toward divesting of funding for mental health institutions. Just four years later, a study of the homeless in Ohio revealed that as much as 30 percent of the local homeless population suffers from serious mental illness. Experts believe that mentally ill people in the US have increasingly become homeless or fallen into the prison system.
13. Mental illness in Canada
The Canadian healthcare system includes coverage for some mental illness conditions, but excludes coverage for others. Recent years have seen growing awareness in issues of substance abuse treatment and management programs, but their implementation can be controversial. In the private sector, the telecommunications giant Bell Canada launched the Let’s Talk campaign to raise funds and awareness of mental health issues in January 2011. Mental illness remains a major health problem in Canada, with many Canadians seeking treatment outside the mental health system.