American Experience | A Brilliant Madness

Timeline: Treatments for Mental Illness

400 B.C. - 1949 | 1950s - 1992

400 B.C.	The Greek physician Hippocrates treats mental disorders as diseases to be understood in terms of disturbed physiology, rather than reflections of the displeasure of the gods or evidence of demonic possession, as they were often treated in Egyptian, Indian, Greek, and Roman writings. Later, Greek medical writers set out treatments for mentally ill people that include quiet, occupation, and the use of drugs such as the purgative hellebore. Family members care for most people with mental illness in ancient times.
Middle Ages	In general, medieval Europeans allow the mentally ill their freedom -- granted they are not dangerous. However, less enlightened treatment of people with mental disorders is also prevalent, with those people often labeled as witches and assumed to be inhabited by demons. Some religious orders, which care for the sick in general, also care for the mentally ill. Muslim Arabs, who establish asylums as early as the 8th century, carry on the quasi-scientific approach of the Greeks.
1407	The first European establishment specifically for people with mental illness is probably established in Valencia, Spain, in 1407.
1600s	Europeans increasingly begin to isolate mentally ill people, often housing them with handicapped people, vagrants, and delinquents. Those considered insane are increasingly treated inhumanely, often chained to walls and kept in dungeons.
Late 1700s	Concern about the treatment of mentally ill people grows to the point that occasional reforms are instituted. After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds. Yet in other places, mistreatment persists.
1840s	U.S. reformer Dorothea Dix observes that mentally ill people in Massachusetts, both men and women and all ages, are incarcerated with criminals and left unclothed and in darkness and without heat or bathrooms. Many are chained and beaten. Over the next 40 years, Dix will lobby to establish 32 state hospitals for the mentally ill. On a tour of Europe in 185456, she convinces Pope Pius IX to examine how cruelly the mentally ill are treated.
1883	Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and schizophrenia holds to this day.
Late 1800s	The expectation in the United States that hospitals for the mentally ill and humane treatment will cure the sick does not prove true. State mental hospitals become over-crowded and custodial care supersedes humane treatment. New York World reporter Nellie Bly poses as a mentally ill person to become an inmate at an asylum. Her reports from inside result in more funding to improve conditions.
Early 1900s	The primary treatments of neurotic mental disorders, and sometimes psychosis, are psychoanalytical therapies ("talking cures") developed by Sigmund Freud and others, such as Carl Jung. Society still treats those with psychosis, including schizophrenia, with custodial care.
1908	Clifford Beers publishes his autobiography, A Mind That Found Itself, detailing his degrading, dehumanizing experience in a Connecticut mental institution and calling for the reform of mental health care in America. Within a year, he will spearhead the founding of the National Committee for Mental Hygiene, an education and advocacy group. This organization will evolve into the National Mental Health Association, the nation's largest umbrella organization for aspects of mental health and mental illness.
1930s	Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed surgically, an operation called a lobotomy, which is performed widely over the next two decades to treat schizophrenia, intractable depression, severe anxiety, and obsessions.
1935	Schizophrenia is treated by inducing convulsions, first induced by the injection of camphor, a technique developed by psychiatrist Ladislaus Joseph von Meduna in Budapest. In 1938 doctors run electric current through the brain -- the beginning of electro-shock therapy -- to induce the convulsions, but the process proves more successful in treating depression than schizophrenia.
1946	July 3: President Harry Truman signs the National Mental Health Act, calling for a National Institute of Mental Health to conduct research into mind, brain, and behavior and thereby reduce mental illness. As a result of this law, NIMH will be formally established on April 15, 1949.
1949	Australian psychiatrist J. F. J. Cade introduces the use of lithium to treat psychosis. Prior to this, drugs such as bromides and barbiturates had been used to quiet or sedate patients, but they were ineffective in treating the basic symptoms of those suffering from psychosis. Lithium will gain wide use in the mid-1960s to treat those with manic depression, now known as bipolar disorder.

400 B.C. - 1949 | 1950s - 1992