Mental Illness Through the Ages

In ancient Greek scholars were of the opinion that mental diseases were caused by an imbalance in four humors of the body. The three humors which influenced mental disorders termed melancholia, mania and an acute mental disorder accompanied by fever. This was contrary to the supernatural or divine explanations of illness. The belief that disease was the product of environmental factors, diet and living habits, not as a punishment inflicted by the gods, and that the  treatment depended on which bodily fluid, or humor, had caused the problem. Around 427-347 BC the belief that there were two types of mental illness: divinely inspired mental illness that gave the person prophetic powers and a type that was caused by a physical disease. By 384 BC, the divinely caused mental illness theory was abandoned and the proposal that instead all mental illness was caused by physical problems.

In ancient Greece and Rome, madness was associated the stereotype of pointless wandering and violence.

The Romans absorbed many Greek ideas on medicine, as well as other cultures, through the conquering of nations. The humor theory was discarded and scholars advocated humane treatments, and had insane persons freed from confinement and treated them with natural 

therapy, such as diet and massages. 

Playwrights described madmen as being driven insane by the Gods, imbalanced humors or circumstances. Mania was often used as a term for insanity; there were a variable range of terms for delusion, eccentricity, frenzy, and lunacy. Some physicians argued that insanity is really present when a continuous dementia begins with imaginings. They suggested that people must heal their own souls through philosophy and personal strength. Common practices were bloodletting, drugs, talking therapy, incubation in temples, exorcism, incantations and amulets, as well as restraints and torture to restore rationality; starvation, being terrified suddenly, agitation of the spirit, and stoning and beating. Most, of the mentally ill did not receive medical treatment but stayed with family or wandered the street. The usual symptoms of delusions of the time included people who thought them to be famous actors or speakers, animals, inanimate objects, or one of the gods.

By the middle Ages, Persian and Arabic scholars were involved in translating, analyzing and Greek texts and beliefs. With the expansion of the Muslim world, these ideas were joined together with religious thought. New ideas and concepts were developed over time. Arab texts contained whole discussions of melancholia. Mania and other disorders including hallucinations and delusions were also described. Mental disorder was thought to be caused by reason gone being lost, and diseases of the as well as to spiritual or mystical meaning. Fear and anxiety, anger and aggression, sadness and depression, and obsessions were recorded.

Under Islam, the mentally disordered were considered incapable but deserved humane treatment and protection.  The first psychiatric hospital ward was created in Baghdad in and insane asylums were built in Fes, Cairo in and in Damascus around 1270. Insane patients were compassionately treated using baths, drugs, music and activities. For centuries to come, translations of many scientific Islamic texts, Canon of Medicine became the standard of medical science in Europe together with works of Hippocrates.

 European Christianity in the middle Ages in Europe the basis of mental illness were a mixture of the divine diabolical magical and transcendental. The four humors black bile, yellow bile, phlegm, and blood were employed, some physicians promoted trepanning as a cure to let demons and excess humors escape. Other remedies in general use included bloodletting and whipping. Madness was often seen as a moral issue, either a punishment for sin or attest of faith. Christian theology supported various therapies, fasting and prayer for those who turned away from God and exorcism of those possessed by the devil. Mental disorders were thought to be due to sin although the belief those other factors could be taken in consideration.  Mass dancing mania is reported from the middle Ages. This was one kind of mass delusion or mass hysteria that has occurred around the world through the millennia.

The care of lunatics was the responsibility of the family. In England, if the family were unable or not willing to take custody , representatives of the courts with a local jury and all interested persons, with the individual.  Those considered lunatics had the support and involvement from the community more often than those who have a mental illness today. Visions were interpreted as meaningful spiritual and prophetic insights.

 During the 16th to 18th centuries some mentally disturbed people may have been victims of the witch-hunts that spread in early modern Europe, but those judged insane were admitted to workhouses, poorhouses and jails especially the paupers, some went to the new private madhouses. Restraints and confinement were used for those thought dangerous or harmful to themselves, others or property.

Madness was commonly depicted in literary works, such as the plays of Shakespeare

By the end of the 17th century and into the Enlightenment, madness was increasingly seen as an organic physical occurrence, not involving the soul or moral responsibility. The mentally ill were viewed as wild animals. Restraint in chains was seen as helping contain the animal furies. Treatment in the few public asylums was harsh, inferior only to prisons. The most well known is Bedlam where at one time spectators could pay to watch the inmates as entertainment. Towards the end of the 18th century, a moral treatment movement developed, that implemented more humane, psychosocial and personalized methods.

The 19th century, with industrialization and population growth, saw an expansion of the number and size of insane asylums.  However, very little therapeutic activity occurred in the new asylum system, the little more there was seldom medical attention to patients, except for other physical problems.

Reports of many mental disorders and irrational uncontrolled behavior are common in historical records back to ancient times, some disorders; they were relatively rare prior to the 19^th century.

By the 1870s in North America, officials who ran Lunatic Asylums renamed them Insane Asylums.

The 20th century brought about psychoanalysis.

Asylum administers attempted to improve the image of the asylums. Asylum inmates were referred to as patients and asylums renamed as hospitals. Referring to people as having a mental illness began during this period of the early 20th century.

In Nazi Germany, the institutionalized mentally ill were the earliest victims of sterilization it has been estimated that over 200,000 individuals with mental disorders of all kinds were put to death.

Funding was often cut for asylums, during periods of economic decline, and wartime and many patients starved to death. 

Previously restricted to the treatment of severely disturbed people in asylums, psychiatrists cultivated clients with a broader range of problems, and between 1917 and 1970 the number practicing outside institutions swelled from 8 percent to 66 percent. The term stress was become popular and was linked to mental disorders.

Lobotomies, insulin shock therapy, electro convulsive therapy became commonly used in the mid-century.

In the 1960s deinstitutionalization gradually occurred, with isolated psychiatric hospitals being closed down with the advanced opening of community mental health service.

With the medical advances and newer more effective medications there is still little improvement in the stigma and shame of having a mental disorder. The closure of many of the state hospitals have brought a about the problem that has had little impact on the people with mental disorders.  Instead of learning from the past it seems that there is a revolving door of returning to the past.