In the past, treatments for mental illness were very flawed. The effects of these treatments are still being studied.
By Alex Gallagher
Web Master
The history of treating mental illness around the world is certainly not without its ethical implications. As the explanation of mental illness, the majority of society in ancient times (originating in ancient Egypt, according to the Mental Health Center of San Diego) used demonic possession and spiritual impurity, which began to enforce the stigma toward those who suffer with mental illness. As society eventually shifted away from emphasizing religion and began to embrace industrialization, the mentally ill were very starkly shunned from society, as societal demands for productivity and strict schedules directly countered what was healthy, not only for the average person, but even worse for the mentally ill. This issue led to the creation of asylums, which proliferated in the United States in the 19th century.
With regard to the ethics of these asylums, they were meant to offer refuge from the stressors of society, but seeking asylum for mental health then became a fate worse than imprisonment; many patients were chained down, abused, and handled roughly by staff at the asylums. The first attempts to treat the mentally ill in the United States, according to the National Institute of Health, were made by Quakers in 1856 in Philadelphia, Pennsylvania, originating as a makeshift hospital in a shackle-filled basement. As the population of those who sought treatment began to increase, the hospital expanded, becoming the first official insane asylum. The idea that the mentally ill should be institutionalized and forced into chains expanded into Williamsburg, Virginia, when the mentally ill began to allegedly cause issues within the area. A similar process occurred; as the capacity decreased, they added onto the hospital accordingly, whilst maintaining the same conditions. The issue with the population increase was not just physical crowding: proper individual attention was no longer available, meaning patients, on top of being chained down, were denied proper treatment due to neglect. By the 20th century, asylums were present all over the United States, but they began to diminish in size as other treatments were made available.
Then, there was the infamous lobotomy craze of the 1950’s, sparked by Phinias Cage’s stark shift in personality, but general well-being after being impaled through the prefrontal cortex with a pipe during a work complication. Portuguese neurologist and inventor António Egas Moniz was a member of the Second International Congress of Neurology in the 1930s when he got the idea for the leukotomy. His intention was to operate through the skull with a leukotome tool, which was essentially a needle-type device whose later designs were said to be inspired by the design of an apple-corer. However, this intended procedure did not occur as planned, as Egas Moniz injected alcohol into his 63-year-old patient’s brain, completely destroying her frontal lobe. Despite the lack of care and follow-up given to the patient, it was seen as an overall success, as the treatment was meant to cure those with severe mental illness which the patient did suffer from. However, from an ethical standpoint, this procedure demonstrates the carelessness of society for those whose mental state was deemed unmanageable – whether that be to themselves or (in the majority of cases) to the people around them. Patient records were kept very poorly: the lack of a recorded name for Egas Mortiz’s aforementioned 63-year-old leukotomy patient a testament to this point. At the time, Egas Mortiz was criticized for this, alongside his lack of a follow-up for such patients, but that does not dismiss the overarching issue of the way society treated and continues to treat those with mental illnesses.
Even when American physician Walter Freeman, an indirect pupil of Egas Mortiz, would reclaim and improve the leukotomy procedure under the name, “lobotomy,” the ethical issues remained deeply rooted in the intentions. By 1946, Freeman’s “ice-pick lobotomy” was a worldwide craze, even marketed to those who exhibit minor forms of mental illness. The most popular instance of the lobotomy procedure was done to Rose Marie “Rosemary” Kennedy, a close relative of former president John Fitzgerald Kennedy, who was described by her own family as “difficult,” “irritable,” and even implied to be sexually promiscuous by her father, Joseph Kennedy. It was Rosemary’s father who consulted Freeman to give her a lobotomy that the Kennedy family proceeded to hide from the public eye. The day of the procedure, Rosemary Kennedy was diagnosed with “irritable depression,” and without the informed consent of her or her mother, she was operated upon. This operation left Kennedy in a vegetative state for the rest of her life – all because her family deemed her too difficult to deal with.
Throughout each historic form of treatment, from exorcisms to lobotomization, there is one constant: an attempt to rid the mentally ill from society, or incapacitate them in some way. However, as society continues to shift toward and further research the use of SSRIs in combination with cognitive behavioral therapy to treat some mental illness, a question is raised: is mental health being less stigmatized than ever? This, and other questions will be further examined in the next article in this series.