The History of Psychiatric Treatments

One of the oldest “treatments” was trepanning or making holes in the skulls for the spirits to escape These are some examples of trpanning tools)

The patient would literally have a hole drilled in his head. While this may relieve pressure for patients with brain injury, mental illness is rarely cured by a hole in one’s head.

Look at this skull. The hole is from trepanning but more interesting is the fact that there is evidence of healing around the hole. Yep, you guessed it…the patient lived after the surgery long enough to heal.

In the early 16 th century the witch trials started in Europe and spread to America.

Many people who were mentally ill were thought to be witches and dunked in cold water (if they were “witch” they would float and thus be burned at the stake if they sunk they were innocent but probably dead).

Several water treatments, usually involving cold water, were used through the years to shock the patient into mental health

Cold water was meant to “snap” the patient out of “it” and warm water was meant to relax them

Doctors in the Elizabethan time believed in the Four Humors and believed these must be balanced to be healthy. Humour Body substance produced byElementQualities Complexion and Body type Personality Sanguinebloodliverairhot and moist red-cheeked, and obese amorous, happy, generous, optimistic, irresponsible Cholericyellow bilespleenfirehot and dry red-haired, thin violent, vengeful, short- tempered, ambitious Phlegmaticphlegmlungswater cold and moist Obese Sluggish, pallid, cowardly Melancholic black bile gall bladderearthcold and drysallow, thin Introspective, sentimental, gluttonous

Doctors then tried what is called phlebotomy or blood letting to rid the body of an overflow of one of the humors.

Phlebotomy tools used in history included a pan for the blood and instruments to make different size holes

They then moved on to what amounted to torture These devices spun the patient to redistribute the humors

Some treatments were meant to make them tired This is the “Gerbil Wheel” which was purposely spun to make the patient run inside until “calm”.

Benjamin Rush believed that mental diseases were caused by irritation of the blood vessels in the brain. His treatment methods included bleeding, purging, hot and cold baths, and mercury, and he invented a tranquilizer chair (pictured below) and a gyrator for psychiatric patients. He published many medical papers and gave medical lectures to physicians and students.

Dorothea Lynde Dix( ), the foremost advocate for the humane care of the mentally ill during the 19th century. Her efforts are credited with the establishment of 32 state mental hospitals throughout the United States.

The Question of Patient Restraint From the beginning, doctors believed that mechanical restraint was necessary in their hospitals It was to be employed at a minimum and never as punishment. But early on Dr. Amariah Brigham employed a cage- like “crib bed” at Utica designed after a European model, and thereafter restraint of one sort or another was used in American institutions well into the 20th century.

These are “Bird Cages”

Later these were made from metal These confine the patients until they tire out, calm down, and can be handled, some staff abused this and left the patients in them for days.

The Case of Mrs. Packard and Legal Commitment In 1860, Elizabeth Packard, who differed with the theology of her clergyman husband, was forcibly placed in an Illinois state hospital. She remained there for 3 years. At that time, Illinois law stated that "married" women could be hospitalized at a husband's request without the evidence required in other cases. Mrs. Packard was able to obtain a release by an action of the hospital, but on her return home, she was locked up by her husband who planned for her admission to an asylum in her native Massachusetts. She eventually gained her freedom in 1863 through a habeas corpus hearing in a local court. Mrs. Packard then embarked on a vigorous campaign to protect women's rights. She published three books on her asylum experience and that of other women, including The Prisoner’s Hidden Life (Chicago, 1868) and Modern Persecution, or Insane Asylums Unveiled (Hartford, 1873).

Straight Jackets were popularized in the late 1800’s and are still used today

Straight Jackets keep the patient from hurting themselves or others and are made from cotton ticking so they are strong but still soft on the skin

Lobotomies were introduced at the beginning of the 20 th century. Originally introduced in Europe, the first lobotomies made slices through the frontal part of the brain. In the United States we streamlined the process and using the natural opening of the eye socket to hammer a metal stylus into the frontal lobe. Essentially lobotomies did calm the patient but it was due to the brain damage inflicted. These went out of style when pharmaceuticals were introduced in the 1950’s.

As we entered the 20 th Century new treatments were used As we became enamored with machines Steam Therapy was used but was short lived.

Hydrotherapy is actually based on the scientific fact that warm water relaxes the body The canvas covering was for privacy and restraint- notice it is tied on. Also indoor plumbing allowed for the water to be drained and refilled. Some hospital staff abused this ability and kept the patients in there for many hours and sometimes days.

One of the more recent was, however, Electric Shock or Electroconvulsive Therapy Electrodes are placed against the temples with gel that helps conduct the electricity. Then electricity is passed through the brain to stimulate it.

Later more humane therapies were introduced that treated the patients like human beings. Music therapy was introduced The newest art therapy includes adult coloring books to relieve stress

The future seems to be in medications but we have many issues today as well… The biggest questions currently debated are:  How young do we start to medicate those with mental health issues?  Should we be able to force the mentally ill to take medications?  How can we better fund facilities and the growing use of meds?  How do we get the general population to see the mentally ill as human being without a stigma attached?