Evolution of Mental Illness Treatment: From Lobotomies to Medications

1. Early –Mid 1900s • Different beliefs about the origins of mental illness continued to give rise to different methods of treating it • 1) Mental hygiene movement • Instead of focusing on the treatment of mental illness, mental hygienists emphasized early intervention, prevention, and the promotion of mental health • Also looked at more humane care – addressed things at a small community level • At this time, people were realizing that human beings could change and that children could be different from their parents – particularly if their environment was improved

2. 2) Psychoanalysis was developing at this time, particularly in Europe • examined one’s personality for mental deviations • most famous was Sigmund Freud • this movement focused on examining the unconscious mind • largely looked at childhood as a contributor to mental illness • Also interested in dreams, repressed emotions, etc.

3. 3) Somatic Treatments • Belief that that mental diseases, were caused by pathological alterations of the brain, chemical or structural. • Mental illness was considered to be more of a physical disease • Various drugs/chemicals administered to patients (eg. (Eg. Put into an insulin coma) • Shock therapy, lobotomies

4. The Lobotomy • It was developed by a The Portuguese neurologist, Egas Moniz, believed that patients with obsessive behaviour were suffering from fixed circuits in the brain. In 1935, in a Lisbon hospital, he believed he had found a solution. "I decided to sever the connecting fibres of the neurons in activity," he wrote. • Moniz reported dramatic improvements for his first 20 patients. The operation was seized on with enthusiasm by the American neurologist Walter Freeman who became an evangelist for the procedure, performing the first lobotomy in the US in 1936, then spreading it across the globe. • In the early 1940s, it began to be seen as a miracle cure in the UK, where surgeons performed proportionately more lobotomies than even in the US. “When I visited mental hospitals… you saw straitjackets, padded cells, and it was patently apparent that some of the patients were, I'm sorry to say, subjected to physical violence," recalls retired neurosurgeon Jason Brice. The chance of a cure through lobotomy seemed preferable to the life sentence of incarceration in an institution. "We hoped it would offer a way out," says Mr Brice. "We hoped it would help." • In 1949, Egas Moniz won the Nobel Prize for inventing lobotomy, and the operation peaked in popularity around the same time. • WATCH The Lobotomist - https://www.youtube.com/watch?v=CUgtGjA6VvA

5. The Lobotomy continued… • Psychiatrist Dr John Pippard followed up on several hundred of (lobotomy) patients. He found that around a third benefited, a third were unaffected and a third were worse off afterwards. Although he himself had authorised lobotomies, he later turned against the practice. "I got increasingly conservative about it because I don't think any of us were ever really happy about putting in a brain needle and stirring the works," he says. "Not a nice thought.“ • From the mid-1950s, it rapidly fell out of favour, partly because of poor results and partly because of the introduction of the first wave of effective psychiatric drugs. Decades later, when working as a psychiatric nurse in a long-stay institution, Henry Marsh used to see former lobotomy patients. • "They had been lobotimised 30-40 years ago, they were chronic schizophrenics and they were often the ones were some of the most apathetic, slow, knocked-off patients," he says. • Mr Marsh, who is now one of Britain's most eminent neurosurgeons, says the operation was simply bad science. "It reflected very bad medicine, bad science, because it was clear the patients who were subjected to this procedure were never followed up properly. • "If you saw the patient after the operation they'd seem alright, they'd walk and talk and say thank you doctor," he observes. "The fact they were totally ruined as social human beings probably didn't count.” • Between 1936 and 1951, at least 50,000 lobotomies were performed in the US alone

6. Late 1900s • lobotomies tapered off after Lithium was introduced in 1949 • A very successful drug – still widely used for bipolar disorder, in particular • Many more drugs developed in the next few decades to help control symptoms of mental illness(eg. Valium, Prozac) • A new belief developed, that medications would successfully treat or manage all those with mental illness

7. Late 1900s - today - The belief that meds would resolve mental illness led to deinstitutionalization - hospitals for the mentally ill began shutting down - Thousands of mentally ill became homeless as they were incapable of living on their own • Lack of support and guidance also led to thousands being incarcerated for various offenses • As a response, new community mental health facilities started opening

8. Today, while the idea of an asylum is outdated, the prison system has started to boom and people with mental illness and a lack of available treatment — or lack of a helpful place in society — often find themselves there instead, out of the same lack of understanding of their condition and how to treat it. • In 2009, Heather Mac Donald wrote in City Journal that “jails have become society’s primary mental institutions…though few have the funding or expertise to carry out the role properly.” We need to be careful that the mistreatment Bly discovered upon her admittance to Blackwell’s is not repeated today in a new location.

9. Bly’s piece is important to remember because it opens the conversation about the actual treatment of people deemed “insane,” and the irresponsible manner in which so-called professionals diagnose and treat them. We need to constantly second-guess ourselves on what we deem “insane” and “proper treatment.” • We cannot allow ourselves to forget about these people, and to keep them on that island. Out of sight, out of mind is an all-too appropriate idiom to apply to the plight of the mentally ill, so we need vivid works such as Nellie Bly’s to remind us of what is happening while we look away. • https://medium.com/legendary-women/what-nellie-bly-exposed-at-blackwells-asylum-and-why-it-s-still-important-4591203b9dc7

10. SUMMARY • Remember that mental illness is not something absolute and unchangeable, but a concept that is constructed in a social context • Stigma and discrimination towards people experiencing mental health problems have existed throughout history • Need to dream of a better world for people with mental illness