For
this blog, I decided to do something a little differently. Because I am a
research analyst by trade, I really enjoyed looking up this information and
learned SO MUCH from this blog post!
For
anybody whom has not toured Williamsburg, Virginia’s Asylum for the mentally
ill, it is very enlightening and I highly recommend the visit.
In
1773, known as the Eastern State Hospital, the first
public building in
colonial Williamsburg Virginia, devoted
to treatment of mentally ill, opened. On October 12, 1773, the first patient
was admitted. The "Public Hospital for Persons of Insane and Disordered
Minds" was the first building in North America devoted solely to the
treatment of the mentally ill. The Hospital was situated on 500 acres and consisted
of two patient care buildings, and had a staff of over 900 to care for the 300
patients.
By
then the popular theory of the colonists, entailed mental illnesses being
diseases of the brain and nervous system, in which the mentally ill “chose” to
be irrational. Another theory was these “lunatics” were possessed by the devil,
and removal of these types of individuals from society into an asylum was
essential and off the street society would be safer.
Prolonged
and often permanent confinement in an asylum was not uncommon. In the beginning, patients were subjected to immoral
procedures and often subjected to horrific treatments. Some patients were
continuously restrained in straitjackets and were treated like criminals rather
than individuals with a “sickness.” Additional treatments consisted of the use
of strong drugs, plunge baths, and cold "shock" water treatment until
the patient passed out, which caused bleeding, and blistering salves. Colonists felt that if these “insane”
individuals bled, the draining of the “bad” blood would lead to a cure.
In
Europe around the turn of the 19th century, Europeans created a new
treatment approach for individuals diagnosed as mentally ill. This approach was
known as “Moral Management,” which embraced the belief that environment played an
essential role in treating mental illness. For example, creating a more
relaxing atmosphere for confined patients would help to “calm” them. By placing
pictures, decorations, and providing comfortable beds, it was more likely
recovery could occur and patients would feel more at ease because these surroundings
would mimic the comfort of their home. This was not really an effective tool!
Between
1773 and 1790, about 20 percent of the inmates were discharged as cured. However, there still was severe overcrowding of these
asylums, and how and what to do with these patients was an important issue. The
overcrowding led to a decline in the patient care and use of the harshest
treatment methods were once again utilized to keep patients sedated and quiet.
Around this time, the lobotomy was introduced. Surgeons would open up the patient’s
brain and separate neural passages. The desired outcome was for patients to
forget their depression or tendencies. The result was horrible. Many patients
became comatose, had no memory, or died.
Thankfully,
through the years an increased understanding of emotional and mental illnesses has
lead to further ethical and civilized procedures.
It was not until 1808, the German
physician Johann Christian Reil formulated the term “psychiatry.” This term
literally means the “medical treatment of the mind.” Translated from ancient
Greek, psych=soul or mind; iatros=healer.
By 1840, in the United States, there
still were only eight mental health asylums for the “insane.” Around this time a
woman by the name of Dorothea Dix started crusading for the establishment and enlargement
of many more mental health facilities and removing from jail patients that had
a mental illness and where not just thought of as “crazy”.
In
the 1930s, a treatment method, known as Electroconvulsive Therapy (ECT), was
developed for treatment of schizophrenia. This included the use of electrodes
place on the head, and use of an electrical current that would create a
seizure. Today this procedure is more refined, while back in the 1930s patients
were not put to sleep for the treatments.
In
1949, Lithium was discovered to treat and reduce symptoms for folks diagnosed
with bipolar disorder. In the mid-1950s the development of additional psychiatric
medications for treating mental illness was developed. For example, in 1952
Thorazine, one of the first psychotropic drugs, known as an antipsychotic, was
produced. This medication assisted those with severe psychosis, such as
delusions and hallucinations. Unfortunately, the initial medications came with
unfavorable side effects, which were often unpleasant, and included patients
looking like over sedated “walking zombies.”
Unfortunately, because this field
was slowly emerging, there was a severe lack of medical professionals and
funding to further understanding of the treatment of those with mental
illnesses.
By 1946 politicians, such as
President Truman got on the bandwagon to aid in funding mental health research,
and created the National Mental Health Act. For the first time in the U.S.,
this was the most significant funding to date. Truman created a course that
continues to present day. He put mental health on the radar and now funding,
research programs continue to grow, and advancement in psychotropic medication
is constantly evolving.
Over
the years, fortunately, the development of psychotropic medications has advanced,
and research on medical treatments continues to transpire. Inpatient treatment as
well has changed over the past several decades. In the beginning, patients were
kept sometimes in the asylums for a lifetime. Over the past 30 years,
psychiatric patients were often hospitalized for six months or more. At
present, the average length of stay in a psychiatric facility is one to two
weeks, and psychiatric hospitalization is used as a last resort if outpatient therapy
is not working.
Unfortunately,
for me I have been hospitalized at least 18 times, and usually spend a month at
a time in the hospital. Due to strict guidelines set now by health insurance
companies, the length of stay for individuals needing longer hospitalization is
less likely to be approved because the insurance companies always find “the
need” for continued inpatient treatment as unnecessary. Even times when I have
been severely suicidal, with back up documentation from my psychiatrist, my
insurance has booted me.
As
mentioned above many folks receive psychiatric care on an outpatient basis.
This usually includes the use of a psychiatrist, for prescribing the medications,
and a psychotherapist “for talk” therapy. I have chosen not to go into the history
of psychotherapy in this blog. Please look for further blogs on the history of
the involvement of this type of treatment as well as the various types of treatment
options.
In
terms of diagnosing mental illnesses, in 1952 the creation of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) was developed. Since then this
manual is used as the basis for establishing the diagnosis of all mental
disorders. Every few years the manual is updated and new diagnosis are added or
revised. The fifth addition is schedule to be published in 2013.
Fortunately,
at present, individuals who have a severe and permanent disability can receive Social
Security Disability Income (SSDI) and Medicare. While I am on both of these, I
feel the federal government can do more. Last year I spent over $18,000 on out
of pocket medical expenses, and only a portion I was able to write off on my
taxes!!
Additionally
private health insurance companies are slowly being required to provide additional
coverage for individuals with mental illness, such as being required to set the
same prices on psychiatric care as they do on general Medicare care. In my opinion,
this process has been slow going, and even though legislation upon legislation
is passed, we have such a long way to go! I am sure many of you can relate and
have come across these issues and barriers as well!!!
There
is so much more history I did not include, I included the points, and
information I found interesting. There is so much additional information on current
funding, various research, as well as the production and trials of new
psychotropic medications. As mentioned above I chose not to discuss types of additional
treatments, unrelated to medications, such as psychotherapy, etc. look for this
topic in a future blog, as well as an in-depth discussion of the various
categories and types of psychotropic medications.
Love,
Bipolar
Betty
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