Historical Context of Mental Health

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Week 2

tab.png Context

It is important that all of us working in health and social care settings, at whatever level, understand about mental health. These figures from the The Mental Health Foundation Links to an external site. in the United Kingdom help to set this in context:

  • 1 in 4 people will experience some kind of mental health problem in the course of a year
  • Mixed anxiety and depression is the most common mental disorder in Britain
  • Women are more likely to have been treated for a mental health problem than men
  • About 10% of children have a mental health problem at any one time
  • Depression affects 1 in 5 older people
  • Suicides rates show that British men are three times as likely to die by suicide than British women
  • Self-harm statistics for the UK show one of the highest rates in Europe: 400 per 100,000 population
  • Only 1 in 10 prisoners has no mental disorder.

So no matter what setting we work in, it is likely that we will come across patients and service users with mental health issues. This course starts with an introduction to some of the background to the study of mental health so that we are able to understand Carol's journey.

tab.png Introduction

This week runs from the 29th September  - 5th October 2014. You will need to:

tab.png Content

Transcultural Perspectives in Mental Health

"Culture, which materializes as a result of human-environment interaction, refers to the shared attributes, belief systems, and value orientations that a group of people have in common and that influence their customs, norms, practices, social institutions, psychological processes, and organisations" (Abdullah &Brown, 2011 page 935)

Attitudes toward mental illness vary among individuals, families, ethnicities, cultures, and countries. Cultural and religious teachings often influence beliefs about the origins and nature of mental illness, and shape attitudes towards the mentally ill. In addition to influencing whether mentally ill individuals experience social stigma, beliefs about mental illness can affect patients’ readiness and willingness to seek and adhere to treatment (Nieuwsma et al, 2011). Therefore, understanding individual and cultural beliefs about mental illness is essential for the implementation of effective approaches to mental health care.

What other groups and/or communities are effected by mental health related issues and why does it matter? See: Black & Minority Community Partnership.  Links to an external site.Why do you think it is important to understand what matters to the individual, when considering their mental health and wellbeing? See: Perspectives on Transcultural Mental Health Links to an external site.

Historical Influences

Foucalt (1970) descrbes how historical concepts remain closely linked to how people understand mental health at any given time period:

"Every culture appears to have its madness and to have found a method of isolating the mentally ill. Some methods have been crude although well intentioned. The point remains, that along the continuum of human behaviour, all individuals at some state referred to or are recognised as mad" (Dear & Taylor, 1982 page 37).

Madness and Melancholia

Think about some for the books you have read, or films you have seen that refer to someone being mad, bad, or sad.
What are the key themes that emerge?
Is mental health regarded as something to be feared?
Consider for example: Jane Eyre (Charlotte Bronte), Silence of the Lambs (Thomas Harris), or have you considered how madness has been depicted in Walt Disney films? 

For more information on Walt Disney films please follow the link.

files1.png Psychiatric Bulletin-Images of madness in the films of Walt Disney.pdf Links to an external site.

A period of 'enlightenment'

In Europe, during the 17th Century, thinkers began to move away from superstition (astrological influence), to considering reason and judgement. In the academy award winning film, the Madness of King George (Bennet, 1994), the treatments and philosophy of the enlightenment period is vividly portrayed. Notions of ‘asylum’ and the need to ‘retreat’ from society where a person’s dignity could be restored, were considered the primary location for finding a cure. It is in the asylums that ‘Psychiatry’ is born (Nolan, 1993). The first asylum for the mentally ill was probably in the Islamic world in the first century, but they became more common in Europe during the Middle Ages. However, these institutions were not great places. The facilities were unsanitary, and treatments involved sometimes horrifying experiments. One of the most notorious asylums was the Bethlem Royal Hospital, known as Bedlam, which was in London. Descriptions of Bedlam from the 18th century show a place of inhumane treatment. During the day, the patients were left to wander in the yard, where tourists and schoolboys watched them and poked fun. At night, they were chained up.

Across the English Channel in Paris, Dr. Philippe Pinel worked as a physician in a mental institution. Horrified by the treatment of patients, Pinel and his predecessor Jean-Baptiste Pussin began a humanitarian movement in the treatment of the mentally ill. They removed the chains from patients who were considered dangerous.

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Phillipe Pinel (1745-1826) was a French physician and a founder of Treatment. He also worked as a medical journalist and then as an unlicensed doctor in a private asylum. Pinel transformed asylum practice, as he believed people under his care should be treated like patients rather than like animals or criminals.

 "Asylum reform advocates in the 1800s celebrated Pinel as the doctor who first ‘freed the mad from their chains’. It was actually Pinel’s assistant, an ex-patient named Poussin, who first unchained the mental patients of Paris in 1797. Little is known about Poussin, who was unofficial ‘governor’ of the Paris men’s asylum from the 1770s. Pinel publicly acknowledged Poussin’s role, arguing that elitist physicians of his time overlooked the practical knowledge developed since the 1600s by medically untrained ‘madhouse-keepers’" (Science Museum, 2014)

 

To the surprise of many people, the men became gentler when treated with kindness and released from chains. The success of Pinel and Pussin led others to join the humanitarian movement, including William Tuke in England and Dorothea Dix in the United States. Slowly, the conditions in institutions became better.

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William Tuke (1732-1822) A friend’s death in the York asylum in 1790 prompted Tuke to raise funds to establish a private Quaker asylum. In 1796 he founded and became Director of the York Retreat, a humane and religion-based sanctuary for Quakers with mental illness. Unlike other asylums of the period, the York Retreat treated patients as people and took into account their basic needs and comforts. This approach became known as moral treatment.

The Retreat Links to an external site. in York founded by Tuke still exists as a not-for-profit specialist mental health care provider, working with the NHS to provide care for people with complex and challenging needs.

 

 Personal Context

Having spent some time considering notions that influence our understanding of mental health today, what cannot be ignored is how mental health affects and effects us all. It is all too easy to think about the mental health of others, but what about your own thoughts, feelings and emotions and how these all work towards creating who you are and how you interact with others.

 tab.png References and Further Reading

Abdullah, T., Brown, T.L. (2011). Mental illness stigma and ethnocultural beliefs, values, and norms: an integrative review.Clinical Psychology Review, 31: 934-948.

Dear, M.J., and Taylor, S.M. (1982). Not on our Street: Community attitudes to mental health care. London: Pion

Nieuwsma, J.A., Pepper, C.M., Maack, D.J., Birgenheir, D.G. (2011). Indigenous perspectives on depression in rural regions of India and the United States.Transcultural Psychiatry, 48(5): 539-568.

Nolan, P. (1993). A History of Mental Health Nursing. Cheltenham: Stanley Thornes.

Science Museum (2014) Philippe Pinel (1745-1826) [Web] http://www.sciencemuseum.org.uk/broughttolife/people/philippepinel.aspx Links to an external site.