MENTAL ILLNESS

1. MENTALILLNESS

2. MENTAL ILLNESS • Brief History and Statistics • Labeling of people • Key People • Legal Actions and Movements • Treatments

4. A BRIEF HISTORY OF MENTAL ILLNESS • During the 1700’s people were locked away by their families • The first mental asylum was built in 1769 and was headed by Benjamin Rush • In the 18th and 19th century asylums and hospitals were built • After World War II, people began to realize that soldiers were having abnormal behavior

6. More History • In 1940s and 1950s medication was actually prescribed to some patients • Many laws were passed to help with regulations of institutions • In the 1960s around 500,000 people were institutionalized and by 1986 the number had reduced to 100,000

7. STATISTICS • From 1880 to 1920 the number of insane patients had increased from 40,942 to 232,680!! And as mentioned before 500,000 by 1960 • Some statistics from 1923…

9. Mental Illness Statistics Today Panic Disorders: 6 million Americans Obsessive-Compulsive Disorder (OCD): 2.2 million Americans Schizophrenia: 2.4 million Americans Bipolar Disorder: 5.7 million Americans Mood Disorders: 20.9 million Americans Post-Traumatic Stress Disorder: 7.7 million Americans

10. MENTAL ILLNESS • Labels • Mythical causes • Types of people who were in mental hospitals • Places

11. Lunatics Crazy Insane Idiots Feeble-minded Brain-sickness Beast Animals Witches Sorcerers Werewolves Madness Possessed Disturbed Maniac Unbalanced LABELS GIVEN TO MENTALLY ILL

12. Mythical causes of Mental Illness Post-partum depression • Old-age • Evil spirits • “blessed by God” • Masturbation

13. Who were in Mental Hospitals? • Wives & daughters who disobeyed their husbands & fathers • Depressed • Menopausal women • Those caught masturbating • Those who didn’t fit the status quo • Alcoholics

14. Places • All people with brain sickness were placed here for people’s amusement. • Cages • Cellars • Closets • Stalls • Pens

15. Important People In Mental Health • Benjamin Rush • Dorthea Dix

16. Benjamin Rush (1745-1826) • He was one of the founding fathers of the United States • He was a staff member at the Pennsylvania hospital • He was also a professor of medical theory and clinical practice at the university of Pennsylvania • After he began to practice medicine he realized that his primary interest was the treatment of mentally ill

17. “Father of American Psychiatry” • He advocated bleeding for almost any illness long after its practice had declined • His favorite method was to tie patients to a board and spin them until all the blood went to their head • Rush was far ahead of his time in the treatment of mental illness • He invented the tranquilizing chair and the gyrator

18. “Father of American Psychiatry” • Rush was an advocate for the insane asylums, believing that with proper treatment mental disease can be cured • He worked toward a more human housing for psychiatric patients. He encouraged hygiene for patients and forms of occupational therapy • Rush disapproved completely of restraints of any kind, for long periods of time • He outlawed the use of whips, chains, and straitjackets and developed his own method for keeping control • Some of his methods we feel he was quite harsh, but in his day his methods were considered exceedingly humane

19. Dorthea Dix (1802-1887) • In 1841, began her moral treatment crusade • She was a teacher and ended up working herself to exhaustion • Took a break and traveled to Europe. While there she met Dr. Samuel Tuke, he was concerned about problems of all people, the sick, poor, and insane • She learned from him that in an environment of compassion and genuine care, mental disease could be more effectively treated

20. Dorothea Dix • Her second job started when she was 39. In 1842 she entered the East Cambridge Jail. She volunteered to teach the inmates Sunday school. When she got there she witnessed horrible images of prostitution, drunks, criminals, mentally ill. The people were chained to the wall in the basement they were under fed and filthy. They were all housed together in a unheated, unfurnished, and foul smelling quarters • When she asked the jailer why they lived in such conditions they said “ the insane can’t feel heat or cold.” • After seeing these conditions she took matters to the court

21. Dorothea Dix • Dorthea was devoted to the right of the sick and insane. She traveled all over the U.S to visit hospitals • She would visit these hospitals repeatedly over time to document the current conditions and the treatment of the patients

22. Dorothea Dix • Because of her status as a female, she was not powerful enough to promote action to help the people in these institutions • In 1848, she attacked the federal government. She made an appeal for 5 million acres to be used for and by the insane, deaf, and the dumb • In 1854, the bill was sent to the senate and house and was passed by a large majority, but was vetoed by president Franklin Pierce

23. Dorothea Dix • As an educator, Dorthea educated the nurses because most of them were often uneducated, crude, and cruel. She taught them ethics and every aspect of hospital care, including exercises • Dorthea believed that the mentally ill would never be cured living in those dreadful conditions by betting the conditions of the inmates, sowed people that mental illness wasn’t all incurable • She played a major role in founding 32 mental hospitals, 15 schools for the feeble minded, a school for the blind, and numerous training facilities for nurses • She also established libraries in prisons, mental hospitals and other institutions

25. Dorothea Dix • Many believed that she was the most useful and distinguished women American has yet produced • She was also known as “the most effective advocate of humanitarian reform in American Mental Institutions during the 19th century

26. Mental Illness • Asylum Movement • Eugenics • Mental Hygiene Movement • Deinstitutionalization • Psychiatric Survivor Movement • Today

27. Asylum Movement • 1843 Memorial to Massachusetts legislature asking for better conditions and treatment for the mentally ill • 1894 State Care Act • Placed financial responsibility on state government instead of local government • By mid 19th century the asylums had deteriorated to horrible conditions like that originally found in the jails

28. Eugenics • The study of improving human genetic qualities • 1865 Sir Francis Galton developed the idea of eugenics for social control of the weak. It would help control the natural selection process • 20th century—laws written to prohibit marriage and force sterilization of the mentally ill

30. Eugenics • Laws were abolished in 1967 • By 1945—45,000 mentally ill patients had been forcibly sterilized • Many people were told they were having other surgical procedures and then were sterilied • Nazis were most famous for the use of eugenics for racial cleansing

32. Clifford Beers Yale educated Went “mad” Wrote “A Mind that Found Itself” 1908 His journey through many asylums Created the National Committee for Mental Hygiene Today it is called the National Mental Health Association, NMHA Mental Hygiene Movement

33. Mental Health Movement • Goals • To improve attitudes toward mental illness and the mentally ill • Improve treatment, services and care • Prevention of mental illness and promote mental health • 1920 created model laws for states • Conducted many studies and research

34. Mental Hygiene Movement • Didn’t like asylums, renamed them mental hospitals • Began psychiatric care of patients with drugs and patient centered care • Wanted early treatment and preventative measures • Believed in outpatient care for discharged patients

35. Deinstitutionalization Movement • Called a social experiment • Removing patients from hospitals and placing them within the community • Problems • Forgotten relatives returned to family members homes • Community not receptive • Psychotropic drugs failed

36. Deinstitutionalization Movement • Pressure to make changes from • Civil Rights Movement • Professionals in the asylums • Discovery of psychotropic drugs • Cheaper care alternatives were available • The number of psychiatric hospitals decreased • 277 hospitals in 1977 • 231 hospitals in 1996

37. Deinstitutionalization Movement • The shift in care was placed on community organizations • 92% of people living in psychiatric hospitals in 1955 were not there in 1994

38. Who was deinstitutionalized? • 50-60% schizophrenic • 10-15% manic depressive or severe depressive • 10-15% brain disease • Alzheimer’s, TBI • The rest—psychosis, mental retardation and brain damage from alcohol and/or drug use

39. Where did they go? • Jail—approximately 10% are mentally ill • Streets • Family • Community based programs • Many were untreated in any capacity

40. "Cast from shackles which bound them, this bell shall ring out hope for the mentally ill and victory over mental illness."

41. Psychiatric Survivor Movement • Initiated by patients • Two types of involvement • Consumers—individuals working to change mental health system from within…reform • Survivors—individuals have fought and survived and overcame oppressive situations with mental health care and fight to be completely free of mental health services

42. Psychiatric Survivor Movement • Goals • They want real change in the mental health system • Partnership with professionals • Employ ex-patients • Expose imbalance of power within the mental health system • Individual change • October 1974 People First Convention • “We are tired of being seen first as handicapped or retarded or disabled. We want to be seen as people first”

43. Today • President Bush created the commission on Mental Health in 2002 • Purpose • To project mental health services for the next 25 years • Criticism • The past commissions, 1960 and 1977, failed to reach their goals • Project for the future • Only provided simple “solutions” • Lack of implementation system has changed but not the care

44. What does the commission need to do different? • Serve various populations • Focus on people and not on the system • 1993 approximately 15% of the adult population use mental health services

45. Treatments & Techniques • Cleansing the body • Hydrotherapy • Motion and Spinning • Terrorizing and Scaring • Restraints • Institutions in North Dakota

46. Cleansing The Body • Bloodletting • Usually by applying leaches to the skin or by incision. • So much blood was taken from the patient that they would become anemic, depleted, exhausted and their blood pressure would drop significantly • Purging • Induced vomiting • Expelled toxic elements • Rational: Calm mentally ill and rid the toxins from the body Leeches? Don’t Worry Mate. The little bit of Blood they do take wont hurt you.

47. Hydrotherapy • Needle Cabinets • Steele boxes, designed for patients to stand upright high pressure water was then sprayed directing onto the skin • Hermann Boerhaave (1668-1738) • Renowned medical teacher • “The greatest Remedy for it [mental illness] is to throw the Patient unwarily into the Sea, and to keep him under Water as long as he can possibly bear without being quite stifled.” • Running cool water over patients’ wrists and ankles to reduce metabolic rate • Restraining them in cold baths

48. Gyrator (Rush) O’Halloran’s Swing Immobile Patients were strapped down and rotated about 100XMinThought to: Stimulate blood circulation of the nervous system Separate the humors of the brain Hollow Wheel Would create goal-directed behavior Hoped that would bring patient out of hallucination and back to relaity Generally patients spent 36-48 hrs in the wheel Came out obedient or so fatigued by the constant pace that there was no problems with managing patient Motion and Spinning

49. Terrorizing or Scaring • One of the earliest psychiatric “treatment” approaches was terrorizing patients back to sanity • Reil’s Immersion Method: • Dunking patients underwater while firing cannons

50. Restraints • Chains • Straight Jackets • Waist Restraints • Utica crib • Tranquilizer Chair • Calm Patient by restricting High sensory input