I will also be doing a series of posts on the history of disability and obviously there are overlaps between this topic and that one. I will also be focusing on England with this post.
With the history of mental health, it’s harder to establish particular attitudes and practices as you get further back in history. Often mental illness and physical illness are conflated or not specific and because of this, I decided not to start with the ancient world today. Obviously our ideas of mental illness today are very different to those in the past and so too is the language used. Please bear this all in mind as you read on.
“Whether a behavior is considered normal or abnormal depends on the context surrounding the behavior and thus changes as a function of a particular time and culture.”
– Noba Project
Very early understandings of mental illness often attributed a supernatural cause, such as being possessed by the devil or having displeased a god. Naturally this understanding of the problem influenced the treatment and in the case of having an evil spirit inside you, trepination may be the answer. It involved drilling a hole in the sufferers skull to release the spirit.
Supernatural causes of mental illness were prevalent between the 11th and 15th centuries as people searched for reasons for natural disasters such as the plagues and famines. This was also when we had the witch trials and I’ll talk more about that in a different post, for now though, I want to note that not everyone thought mental illness was down to the devil. Johann Weyer and Reginald Scot believed that people being accused of witchcraft were actually suffering from mental illness and that the mental illness was down to disease, not demons. The church banned their writings.
As you can see, mental illness was often tied to religion or spirituality and in-keeping with this, it was generally the monks and nuns which provided care for people who were ill.
The first English hospital for the mentally ill was Bedlam. It was established as a hospital in the 13th century and by 1403, ‘lunatics’ made up the majority of the patients. Originally run by monks, Henry VIII seized Beldam during the dissolution. Before he died he transferred control to the Corporation of London making it a civic, not religious, institution. In 1619 Helkian Crook became the first medically qualified ‘keeper’ and shows that mental illness was starting to be seen as a medical issue. Despite this slow change in London, mental illness was still seen by many as supernatural or religious in origin. Symptoms included those that you would expect today but also included not praying, not feeling pious, talking too much, sexual urges and hatred of your spouse. As you can see, some of these symptoms were a way of controlling those who didn’t conform.
On the whole, as was the case with disability, most people were cared for by family or the community although there were a number of mentally ill people who were living on the streets. In the eyes of the law, during the 16th and 17th century, they were seen as unable to reason and responsibility for their affairs was allocated by the Court of Wards.
Around this time, there was a move towards asylums and this was based on the belief that people who were mentally ill could thrive in a clean, healthy institution such as York Retreat. Unfortunately, we also find asylums being treated like zoos. It was considered entertaining to visit and see the patients in Bedlam and I suspect the situation was the same in other asylums. Conditions were dreadful, people were tortured and forced to live or exist in appalling situations whilst also being displayed in a humiliating fashion.
Attitudes towards mental illness inevitably change as science and medicine evolves and prevalent beliefs alter. At the end of the 18th century, with the enlightenment, it was thought that people arrived as a blank slate and your outcome was down to nurture. This obviously affected how people saw disability and mental illness
The industrial revolution brought vast changes to the landscape and the emphasis was heavily on productive workers. At this time, there was a rapid expansion of institutions and people with mental illness were moved from home to asylums. Early ideas focused on moral treatments but professionals quickly lost interest or hope with this approach.
By 1900, more than 100,000 ‘idiots and lunatics’ were living in 120 county pauper asylums and 10,000 in workhouses across the country. It was thought that financial aid to help people live in the community encouraged laziness. They didn’t seem especially concerned that asylums were expensive and often people who went in, never came out, spending a long and miserable life there. Rather, reformers who encouraged the building of asylums, claimed that they would be a safe space to cure people or to teach them useful skills.
The buildings themselves could be made up with long corridors, sometimes ¼ mile long, or rows of blocks. Men and women were segregated and dormitories could consist of up to 50 beds which stripped patients of privacy and space – beds were crammed in and the person next to you could be an arms length away. High walls prevented escape and staff lived on site, making them a self contained world. There was always a cemetery and some even had their own railway station… They were to all intents and purposes a world of their own, and a law unto themselves. This allowed poor practices and abuse to run riot and the outside world were oblivious.
Whilst I’m sure many of the patients did have mental illness, the asylum also feels like it was used as a bit of a dumping ground with people being admitted on dubious grounds. Those who did have mental illness often suffered from things which we see as very treatable today, such as panic attacks, and it’s highly likely that being in the asylum did more harm than good.
In 1948, the NHS was created and asylums etc were no longer separate to the physical side of health. Psychiatrists began to experiment with treatments and physical activity was carried out on the body to help treat the mind eg ECT was widely used to treat depression. Another bodily based treatment involved giving patients insulin to induce a coma, as a way to treat deep seated issues. Whilst this all sounds horrific to us today, it was an important shift towards making the treatment of mental illness more of a science.
In the mid 1950s, over half of the NHS beds were for mental health and was costing a lot of money. A report in 1957 drew attention to the outdated asylums and mental hospitals and highlighted the idea of community care. Around the same time, new drugs were being discovered and created that would control some of the behaviours associated with mental illness that had led to people being sent to asylums. Note I said control, these were often used to tranquillise patients rather than to cure their illnesses. That said, in the late 50s and 60s, specific drugs were available to use for specific disorders. With this huge change, there was less need to confine people and care in the community seemed to be a realistic possibility.
The late 50s and 60s saw the move towards people living in the community and also a better public awareness of the conditions of asylums. To try and improve standards, open door policies were established and freedom was increased for patients. There was also the introduction of occupational therapy which showed that people with mental illness weren’t inherently useless…
In the 70s, with the recession, spending on mental health was cut. Bed by bed, ward by ward, the asylums were closed. As beds were no longer available, people had to be cared for in the community and on the whole it was charities who picked up the pieces. The help that was needed to transition patients from asylum to communities never materialised and many people were left facing a new world without support.
Whilst we are still far from perfect in how we, as a society, support and treat people with mental illness, we have come a long way and, as a user, I am very grateful for the help available today.