A Brief History of Mental Illness

By Taylor Haynes

Mental illness and the concept of mental health are not new. They have existed as long as we have. There exist accounts from as early as the third century CE of the confinement of mentally ill people in Syrian Catholic churches. Institutional care for the mentally ill can be traced back as early as the 1400s, and the first psychiatric hospital in North America opened in 1773 in the colony of Virginia¹.

One would think that this history, along with the later development of effective pharmacological and psychosocial interventions for a range of conditions, might have resulted in the recognition that mental disorders were a public health priority. This, unfortunately, is not true. The key impetus for the emergence of the field of global mental health did not come until the publication of the World Development Report 1993. This report featured the initial findings of the Global Burden of Disease study, the first study to use DALYs to measure the global burden of disease. Much to the surprise of many people, computation with DALYs showed that approximately 8% of the global burden of disease was due to mental health problems². Several other publications followed, culminating with the publication of the Lancet series on global mental health in September 2007. Only then was the global mental health movement officially launched.

In the eight years since the Lancet series, the field has experienced a surge of attention, research, and public support. One of the most interesting, and most controversial, pieces of literature to come out of this surge is the 2010 New York Times piece by Ethan Watters entitled “The Americanization of Mental Illness.” In the piece, Watters suggests that a kind of psychiatric-cultural imperialism has been foisted on other countries and cultures by “the West.” Specifically, Watters claims that, “For more than a generation now, we in the West have aggressively spread of our modern knowledge of mental illness around the world… There is not good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments, but also the expression of mental illness in other cultures³.”

Though the Watters thesis has its merits, it is also shallow and simplistic in many of its assumptions and conclusions. I found it hard to agree completely in light of several unfounded claims. In discussing anorexia in Hong Kong, for example, Watters fails to consider alternative explanations for the rise in “westernized” anorexia presentation. Could it perhaps be attributed to better understanding and recognition of a disorder that had not been fully studied or appreciated in the past? Considering the history of PTSD in the United States, wherein clinical presentation has been described for centuries, while the diagnosis has been clarified and categorized only recently (the 1980s)⁴, this is certainly possible. Additionally, I found Watters’ claim that a biological interpretation of mental illness results in harsher treatment of the mentally ill shortsighted. Were those thought to have a biological determinant of disease really treated more harshly, or were they treated like someone without a mental illness? It is important to consider this control (or lack thereof) in analyzing his claim.

The rise of the global mental health movement has greatly helped to publicize, personify, and reduce global suffering due to mental illness. It has also, however, shown the limitations of the current approach to global mental health care. There is thus an urgent need for continuing research, in low-/middle-income and high-income countries alike, that addresses the questions of etiology, treatment, and cultural variations that scholars such as Watters have brought to light.

References 

1. Cohen, A., Patel, V., and Minas, H. (2014). A brief history of global mental health. In V. Patel, H. Minas, A. Cohen, and M. Prince (Ed.), Global Mental Health: Principles and Practice (pp. 3-26). New York: Oxford University Press.
2. World Bank. (1993). World development 1993: Investing in health. New York: Oxford University Press.
3. Watters, E. (2010, Jan 8). The Americanization of mental illness. The New York Times. Retrieved from http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html
4. Friedman, M.J. (2013). History of PTSD in veterans: Civil War to DSM-5. Retrieved from http://www.ptsd.va.gov/public/PTSD-overview/basics/history-of-ptsd-vets.asp

Living in the Shadows

by Phoebe Huo

41% of countries do not have a mental health policy.

25% of countries have no legislation on mental health.

28% have no separate budget for mental health.

37% of countries do not have mental health community care facilities.

These statistics present the current situation of global mental disease burden. However, behind the statistics, the reality shows more cruel pictures: discrimination and stigmatized images around people with mental disorders and shortage of mental health professionals lead the marginalized population to live in the shadow.

Like the person who has been locked in the wood house for ten years in the video we showed in the class, many people with mental disorders are victimized for their illness, and become the target of discrimination. Some stigma are from general population, as Dr. Maselko mentioned in her lecture, because the definition of mental illness is so vague and incomplete in developing countries, people may hesitate to search for help because they do not even have the knowledge of the symptoms. Therefore, due to inaccurate information of mental disorders, many people believe that the disease is untreatable, and the person with the disease needs to be excluded from population. On the other hand, abundant evidence from Western countries indicates that people with mental disorders are stigmatized and discriminated against by health professionals. Specifically in developing countries, treatment suggestions from health professionals to those with mental disorders include a wide range of proposals, some of them are punitive and discriminatory, and far from official guideline recommendations. These negative social attitudes towards people with mental disorders have an adverse effect on prevention and early treatment. And these attitudes are pervasive even though the United Nations has provided a basic standard for people with mental disorders:

All person with a mental illness, or who are being treated as such person, shall be treated with humanity and respect for the inherent dignity of the human person. All person with mental illness, or who are being treated as such person, have the right to protection from economic, sexual and other forms of exploitation, physical or other abuse and degrading treatment.

United Nations Principles for the Protection of Persons with Mental Illness

However, most countries of the world are far from complying with this principle.

As Dr. Maselko and Dr. Shirey mentioned in their lecture, there is a global disparity of receiving mental health care between high-income and low or middle-income counties. For over 30 years, international organizations such as World Health Organization have been encouraging developing countries to increase their mental health facilities, however, the progress in achieving well-equipped facilities for the care of mental disorders has been slow. Almost one-fourth of developing countries have no system for providing basic mental health treatment for citizens. Even among countries that have such a system, the health facilities lack trained professionals who can provide good mental health services. Most of the facilities contain few doctors and many non-professional health workers. The doctors are usually too busy for managing patients who need specialized care, and have no time to supervise other health workers. 

“ Where is the mental health hospital I can go for help? ” asked by the father in the video. He is still searching for a mental hospital that can provide accurate information and appropriate treatments for her daughter.  As well as the father, we still have a long way to go to bring people with mental disorders fully out of the shadows.