Analysis of the State of Mental Illness in the 18th Century - Term Paper Example

Name Institutional Affiliation Introduction Mental health is comprised of an individual’s emotional, psychological and social wellness (Roberts, 2004). Apparently, the mental health status of a person apparently, affects how they think, feel and act. Additionally, the choices we make, how we handle stress and, how we relate to others is determined by our mental health status. Therefore, a person’s mental health at every stage of life from childhood, adolescence all through to adulthood is important (Bennett, 2009). In this assignment, I am going to examine the state of mental illness in the 18th century. This is a period which saw a paradigm shift to humanitarian concerns about those with mental illness resulting in the introduction of lunacy legislation, the widespread building of asylums, and the beginning of moral care. Further, I will analyze how this historical period has informed current mental health/mental health nursing practice (Cohen, et al, 2014). History of Mental Illness Mental illness’ evolution is rather seen as cyclical and less of linear or progressive. An individual’s behavior will be termed as either normal or abnormal subject to their surrounding context; thus it may also be defined by the function of time and culture. Cohen et al, (2014) argued that behavioural deviation from the expected sociocultural norms specific to cultures and time has in the past been used to control individuals or groups. Owing to this, a less cultural relativist point of view to abnormal behavior was established to pay attention and seek to determine whether a behavior may pose a threat to self or others, or pain and suffering such that it interferes with an individual's ability to function or maintain meaningful relationships with family and friends (Fulford, 2006). The historical development of psychiatry and psychiatric nursing can be drawn back to ancient philosophical thinkers even though incoherent (Bebbington & Broome, 2004). The first person ever known to have created a questionnaire for the mentally ill through the use of biographical information to determine the best course for the care and treatment of psychological illness is one Marcus Tullius Cirero. For diagnosis and treatment of mental illness centuries ago, medieval Muslim physicians are known to have used clinical observations (Fulford, 2006). Etiology of mental illness throughout history has been based on the theories of supernatural, somatogenic and psychogenic. Curses, sin, possession by demonic spirits, planetary movement, and displeasure of gods are explanations for supernatural theory as a cause of mental illness, whereas psychogenic’s focus is on stressful experiences, distorted perceptions, learned associations and cognitive maladaptation (Foucault & Dreyfus, 2008). On the other hand, somatogenic theories recognize instabilities in physical functioning that may result from either illness, brain damage or imbalance, and genetic inheritance. These ideas defined the kind of treatment that would be received by the mentally ill individuals during the 18th century (Cohen et al, 2014). The period between mid of 16th century all through the 17th century, the institutionalization of mentally ill people took place. The aim was to protect the public from these people, as the confinement laws so stated (Bebbington & Broome, 2004). Against their will, most inmates were institutionalized. The living conditions in these institutions were deplorable; very filthy with prisoners chained to walls. Sadly also, they were frequently presented for a fee to the public. According to Bebbington and Broome (2004), by this time, mental illness was, however, somatogenically viewed; hence treatment was the same as for physical illnesses. Even though by today’s standards it may seem inhumane, during this time, there was an insanity view of the mentally ill patients as animals. They were seen as creatures with a deficiency to think and reason, unable to exercise control of the self, adept of viciousness despite non-provocation, lacking physical sensitivity to pain and temperature and able to exist without grumbles in wretched conditions (Roberts, 2004). Owing to this, it was believed that restoration of such a disordered mind to reason would only be through fear instillation. The 18th century witnessed the growth of a more humane approach to the mentally ill. This is correctly attributed to the fact that by the 18th century, there were increased protests against the deplorable conditions by which the mentally ill people lived. For instance, an Italian physician, Vincenzo Chiarughi in 1785 and at St. Boniface Hospital in Florence city of Italy, is said to have removed from a mentally ill patient the chains (Woods, 2013). Further, he is said to have cheered for improved hygiene, as well as training of the patients recreationally and occupationally. More physician doctors are similarly said to have advocated for unshackling of patients and placing them in rooms that were well ventilated and lit (Murphy, (2005). They also encouraged for the patients’ freedom and more purposeful activity. Moving to England, religious concerns led to humanitarian reforms. Phillippe Pinel and William Tuke suggested the idea of a safe asylum. Such an asylum was projected to provide protection and excellent care to patients while in the institutions-patients who previously had been abused and enslaved (Woods, 2013). The York Retreat was established upon request by one William Tuke. In this York Retreat, patients were treated as guests and not prisoners. Further, care here was very much grounded in courtesy and dignity in addition to an appreciation for therapeutic and moral value for physical work (Murphy, 2005). During the colonial era of the US, community health nursing practices were adopted by some settlers. People with mental illness and who were viewed as treacherous were either locked up or kept in cages where they were maintained and fully paid by community attendants. Apparently, some wealthy colonists who had mentally ill relatives kept them in their attics and hired aides and nurses to provide care to them (Murphy, 2005). Mentally ill individuals in other communities were even sold on auction as slave labor. Sadly, others were ostracized and send away from the towns. Small institutions established failed in informal community care due to the expansion of colonies. Terms like Lunatics ward were used to define institutions for the mentally ill (Roberts, 2014). The belief by the attendants was that this was a respectful way of treating the patients and that if they handled them as reasonable people, then they would conduct themselves responsibly. Also if given confidence (through those treatment methods), that they would seldom abuse it. Treatment forms used then included purging, bleeding, shock techniques and blistering (Newell & Gournay, 2008). It is, therefore, worth noting that America had institutions for the mentally ill (asylums), even before the 18th century for instance, Philadelphia’s Pennsylvania Hospital which was applying the somatogenic theory to treat mentally ill patients (Fulford, 2006). Later after the establishment of Tuke’s York Retreat, it became the benchmark or all asylum institutions across America. Asylums began applying the psychogenic approach in the treatment of mentally ill patients, i.e. compassionate care and physical labor. Examples of asylums established in the 18th century that used this theory to treat mentally ill patients in the US include Friends Asylum in Frankfurt and Bloomingdale Asylum in New York City (Newell & Gournay, 2008). However, ethical treatment was to be abandoned in the US towards the end of the 18th century. A retired teacher, Dorothea Dix, observed that there was overcrowding in the asylums and they were becoming more custodial as well as devoid of space and the necessary attention for the patients was missing (Fulford, 2006). Dix was in charge of the Union Army Nurses at the time of the American Civil War that was caring both for Union and Confederate soldiers. Upon this negligence’s effects realization, the retired teacher strongly promoted the establishment of 32 mental hospitals both in the US and Canada. Later on, this paved the way for the Mental Hygiene Movement initiated by a former patient, Clifford Beers. Psychiatry was formally recognized as a legitimate modern profession in 1808 (Roberts, 2004) In the 18th century, there still was a breakthrough germ theory which saw the discovery of vaccines for various diseases including typhus, cholera, and syphilis. At this time, there was a regression back to the somatogenic theory of mental illness by the mental hygiene movement (Foucault & Dreyfus, 2008). Dr. William Ellis was among the key activists for mental health nursing to assist psychiatrists in Europe. He fought for a better remuneration for those who cared for the “keepers of the insane’’ by promising to offer them a better pay as well as proper training to the intellectual people who would be appealed to the vocation (Thornton, 2007). In a publication he did in 1836, ‘Treatise on Insanity,’ he amenably argued that through an established nursing practice, stressed patients would be calmed and hope restored to the hopeless (Foucault & Dreyfus, 2008). Psychiatric nursing was not, however, formalized in the US, until 1882 when a school, Boston City College, was opened up by one Linda Richards (Roberts, 2004). It essentially was the first one purposed for the training of nurses in psychiatric care. Even as we see that there were significant improvements in the treatment and handling of mentally ill patients in the 18th century, challenges were also experienced (Shorter, 2008). There was a struggle in the definition of mental illness using somatogenic and psychogenic explanations. The classic example is the definition of hysteria, explained to cause physical symptoms like blindness or paralysis lacking a physiological elucidation (Fulford, 2006). A debate ensued involving numerous scholars with some attributing the symptoms to imbalances of certain universal magnetic fluids of the human body while others saw it as a universal trait that varied across the population (Murphy, 2005). The dispute was, however, dissolve by Sigmund Freud and Jose Breuer who supported the psychogenic elucidation for mental illness through treatment of hysteria and hypnosis and therefore the cathartic method that was to be the precursor for psychoanalysis later in the first half of the 20th century (Fulford, 2006). An analysis of how the state of mental illness in the 18th century has informed current mental health/mental health nursing practice Psychiatric services have shifted from the hospital to the community over the recent years. This is owing to managed care systems. Based on the gradual advances of mentally ill persons’ care and treatment methods, since the 18th century, the condition is not only better understood, but also less stigmatized. According to Shives (2008), Care management systems are more utilized than in ancient times where mentally ill people would be incarcerated, chased away from towns or even auctioned for slave labor (Shorter, 2008). However, there is a need for patients to receive evidence-based care as only a few can receive care consistent with it. Today, patients with severe and constant mental illnesses face significant challenges especially those who are dependent on generic health as well as welfare programs and services that are integrated (Woods, 2013). Evidence-based rehabilitative services are often inaccessible despite the advancement in time and psychiatric treatment expansion (Newell, & Gournay, 2008). Additionally, the consequence of arrest due to messes up in community care have been witnessed. Therefore, there is a need to embrace jail diversion and promote treatment as necessitated (Singh & Singh, 2009). It remains a challenge to achieve a patient-centred care system that is effective in spite of the evolution. However, the concept of mental health has become part of the discussion on broader health care than in the past years (Woods, 2013). Passage of the Mental Health Act and President Jimmy Carter’s Commission on Mental Health enabled the field of mental health to gain power. This power has helped re-shape the care and treatment of the mentally ill even to date (Newell, & Gournay, 2008). This has been accomplished through the incorporation of programs for patients with mental problems (Shives, 2008). A consumer movement was initiated and a national alliance for the mentally ill similarly established. Development of the Systems Act paved the way for the understanding by the public as well as the government that the predicament of the mentally ill was dependent on generic entitlements as well as programs the likes of among others, Supplemental Security Income, Medicaid, as well as Section 8 housing (Thornton, 2007). Despite the fact that mental illness was not key in the national agenda, the collaboration of effort from incisive advocates, effective legislators, and sympathetic policymakers abetted in re-shaping vital generic programs that yielded help to many mental illness patients Fulford (2006). Additionally, it is such efforts that helped mainstream into the medical as well as social sectors the concept of mental health. This has made it easier for today's mentally ill patients as compared to those of the 18th century (Newell, & Gournay, 2008). Deinstitutionalization of patients after the activism for the seizure to confine them led to some significant level of neglect which is also observed to date. According to Thornton (2007), this is particularly when there are no well-organized and sensible community services. Coercive interventions are more difficult due to the enactment of mental health law. Homeless mentally ill people are sometimes seen roaming in the streets with no one to provide care to them. In such a case, the mentally ill person would rather be institutionalized. Moreover, some of the antipsychotic and antidepressants given to the patients have adverse effects such as averseness, which has more often than not caused non-adherence among the patients (Singh & Singh, 2009). Singh (2007), notes that deinstitutionalization of the mentally ill also leaves them a leeway to access drugs and alcohol which upon consumption, leads to a considerable increase of both psychiatric and abused substance commodities issues. However, with the advancement of mental health diagnosis, as well as treatment and the introduction of psychiatry both as a discipline and profession, handling of mental illness patients has become more patient-focused. Further, it is more inclined to neurosciences and biological factors (Shorter, 2008). Freudian and psychodynamic emphasis have been discarded for other treatments such as cognitive therapy which provides for medication and brief, focused psychotherapy (Singh, 2007). There has been an establishment of more effective antidepressants for treat patients with depression and anxiety disorders through the shift to neuroscience (Newell & Gournay, 2008). These newly developed antipsychotic drugs have led to aggressive marketing by pharmaceutical companies on the basis that they are more operative and non-threatening than their prototypes which have resulted in better business in psychiatric pharmaceuticals (Singh & Singh, 2009). However, medication adherence has remained a challenge. Additionally, the cost of drugs for mental illness medication is high and thus a big problem for those with low income (Shorter, 2008). Medical literature and patterns of practice reliability are also questionable considering that pharmaceutical companies are involved in nearly all facets of mental health treatment including advertising both to consumer and physician, professional education and meetings, and the designing of diagnostic practices among others (Roberts, 2004). Experiences of care and management of mental illnesses patient practiced in the 18th century have very much informed and shaped today's practice (Newell & Gournay, 2008). For instance, Managed Behavioral Health Care since the 1990s has been very dominant. Murphy, (2005), contents that mental health issues are not only managed by the public sectors but also very well operated by large and renowned private organizations. In-patient stay length has been reduced as well as hospital admissions through a strict management by the MBHC. Mental health care services are more accessible with care being provided by qualified psychiatrists, also translating to reception of quality care and treatment (Shives, 2008). However, patients with severe and persistent mental illness incidents are disadvantaged in this case as they require service high intensity (Thornton, 2007). Conclusion The historical developments in mental health treatment, care, and management of the 18th century have impacted the current mental health and nursing practice in a tremendous way both positively and negatively. Deinstitutionalization for instance, brought better care for patients at home affording them some level of freedom, whereas some are neglected and would rather be placed in mental care institutions. Again, more effective antidepressants with fewer effects to patients have been established; however, they are costly to some people. Legislation on mental health, stay length of in-patient care, and involvement of pharmaceutical companies in all aspects of mental illness forums have both positive and adverse effects. However, it is worth noting that experience has greatly shaped today's practice; treatment is more patient-centred, and policy makers are also paying more attention to mental health than it was in the past. The public is more accommodative of mental illness although stigma is still high especially for disorders that are psychotic related to substance abuse. References Bebbington, P. E., & Broome, M. R. (2004). Exploiting the interface between philosophy and psychiatry. International Review of Psychiatry, 16(3), 179-183. Bennett, A. (2009). The madness of George III. Faber & Faber. Cohen, A., Patel, V., & Minas, H. (2014). A brief history of global mental health. Global Mental Health: Principles and practice. Foucault, M., & Dreyfus, H. (2008). Mental illness and psychology. Fulford, K. W. M. (2006). Oxford textbook of philosophy and psychiatry. Murphy, D. (2005). Psychiatry in the scientific image. Newell, R., & Gournay, K. (Eds.). (2008). Mental health nursing: an evidence-based approach. Elsevier Health Sciences. Roberts, M. (2004). Psychiatric ethics; a critical introduction for mental health nurses. Journal of psychiatric and mental health nursing, 11(5), 583-588. Shives, L. R. (2008). Basic concepts of psychiatric-mental health nursing. Lippincott Williams & Wilkins. Shorter, E. (2008). History of psychiatry. Current opinion in psychiatry, 21(6), 593. Singh, A. R. (2007). The task before psychiatry today. Indian journal of psychiatry, 49(1), 60. Singh, A. R., & Singh, S. A. (2009). Notes on a few issues in the philosophy of psychiatry. Men's sana Monographs, 7(1), 128. Thornton, T. (2007). Essential philosophy of psychiatry. Oxford University Press. Woods, A. (2013). The voice-hearer. Journal of Mental Health, 22(3), 263-270. Read More