How were mental illnesses treated once?

Since 1992 the organization of the united nations has called world mental health day for 10 october to promote awareness and defense against social stigma. Let’s retrace how the attitude of science and medicine regarding mental illness has evolved over the centuries – and how it has been “updated”, consequently the way to deal with it – in this article taken from the archives of Focus History.

Purges, bloodletting, torture and segregation: in the past everything has been tried to cure mental illness. But before talking about treatments, we need to make a premise. Not always the “crazy” have been considered subjects to be treated, indeed. According to historians and anthropologists, in ancient times those who had strange obsessions were held in high regard. Just think of ancient Greece, where the insane were not considered sick, and instead of imprisoning and containing them they let themselves circulate freely, but not only.

Not only in archaic times. Probably the prophets and oracles were people with personality disorders (epileptics, according to some) capable of having visions and “hearing voices” and therefore considered in contact with the world of spirits and gods. And it did not happen only in archaic times: up to the nineteenth century, in the Slavic tradition it was thought that the “fools in Christ” acted on God’s inspiration. End of the premise. And also of the “good side” of madness. Yes, because the attempts (started centuries ago) to understand the mechanisms of the mind and to fix them when they “jam” have led to attitudes, in the face of mental illness, that are anything but understanding.

WHAT MOOD ARE YOU IN? It was Hippocrates (ca. 460-370 BC) the first to think that the evils of the mind, and in particular epilepsy (formerly called “sacred disease”), were neither more divine nor more sacred than other pathologies. For him it was all a question of “moods”: their imbalance could also affect the functioning of the brain. It was enough for the yellow bile, from the liver, to invade him that the person became dangerously excited and was suffering from mania. If, on the other hand, it was the black bile secreted by the spleen that corrupted him, he became gloomy and melancholy. If there was an excess of blood, the temper became sanguine; while the phlegm, wet and cold, extinguished the fire of the intellect.

The role of the first shrinks was therefore to restore the compromised balance, eliminating from the head the substances that intoxicated it. It was done with hot and cold baths, purges, bloodletting; opium was given if the patient was agitated, or an infusion of hellebore roots if he was inhibited.

Hellebore is a ranunculacea that was used for its powerful laxative effects, but today it has been shown to contain alkaloids that have the power to increase dopamine, a neurotransmitter implicated in many mental illnesses. In short, the road had somehow been traced.

Crazy remedies … Hippocrates ‘humoral theory reached Rome, where Galen (ca. 129-216), Marcus Aurelius’ personal physician, treated the emperor’s depression and debasement with ambrosia, a cocktail of Falernian wine, licorice, honey and tears of opium. In the most serious cases, on the other hand, bloodletting and the application of stripping suckers to the nape of the neck were associated with “pharmacological” therapy, with the usual aim of freeing the brain from the harmful substances that polluted it.

Dioscorides Pedanius (ca. 40-90), who lived in Imperial Rome under Nero, in his voluminous pharmacology treatise On medical herbs – which remained the basic text of medical and psychiatric therapy for 1,800 years – had indicated the extract for mental disorders of beaver testicles, an animal that considered itself very active on a sexual level. Evidently the remedies did not always work, given that Celio Aureliano, a doctor who lived in the fifth century, insisted on advising not to bind the sick and to make at least one attempt with music therapy.

Disease becomes SIN! In the Middle Ages, the rational approach was undermined by faith, and mental illness considered a punishment from God: the mentally ill was possessed by evil spirits who infiltrated the humors and infected the whole body. The doctors were replaced by exorcists, who “healed” with blows of prayers, holy water, holy oil and a massive dose of violence: on the other hand what was engaged in was a real struggle for liberation from the devil. For centuries, even after the end of the Middle Ages, mental illness continued to be confused with scandal and sin. Hospices, chronicles, correctional and work houses were filled with poor people, vagabonds and “hotheads” who kept company with criminals, prostitutes and disturbers of public order.

In 1579, the illustrious poet Torquato Tasso was also imprisoned for seven years due to his persecution. The main concern now was to keep the insane out of the sight of the “normal”. In many German cities the fools were handed over to sailors and merchants who had the task of driving them away on board their river boats, called “ships of fools”.

Asylums are born. It was between the end of the 1700s and the beginning of the 1800s that the concern to put an end to the tragic conditions of the insane began to make its way among men of science.

The madman had to be brought back to normal, first of all distinguishing him from those who were not mad. The Parisian psychiatrist Philippe Pinel (1745-1826) made a sensational act: in 1793 he freed all the madmen chained in the Bicêtre prison hospital, near Paris. His thesis? Insanity had to be freed from superstition and treated as a disease: in particular, those who suffered from schizophrenia or severe forms of depression had to be isolated.

Thus were born asylums, specialized treatment centers in which the sick, divided by disorder, were subjected to physical trauma, frozen baths, restraint beds, straitjackets, chains, bloodletting, but also to “moral” therapy to induce the patient to recognize their mistakes and recover rationality. It was in France that the asylum care project found its maximum implementation. But also Germany, England and the United States, in the first half of the 19th century, worked to create institutions for the shelter of the insane, far from the city walls, in the open countryside. In short, the madman was released from prison … to be imprisoned in an asylum.

A work for the mind. It was Wilhelm Griesinger (1817-1868) who proposed completely overturning Pinel’s model. He thought of institutes on the outskirts of the cities, with few beds and a high turnover of patients thanks to hospitalizations never exceeding a year. On this wave the first university psychiatric clinics and the first agricultural colonies “for the insane” were born in Europe, such as that of Gheel in Belgium, where mental disorders were treated with work in the fields. With scientific progress, the first “real” cures arrived, even if still at the beginning of the twentieth century the phreniatrists – as psychiatrists called themselves since 1875, from the Greek phrén“mind” – they had made very little progress compared to the methods of the past.

The new century began with a shock: shock therapies promoted by doctors made their debut, who stopped at nothing to heal the “mad”, even winning Nobel prizes for this.