Friday, April 27, 2012

The History of Your Treatment

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.


Bipolar Betty

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