Mental Illness

Mental Illness. During the early Colonial Era, Americans attributed mental illness to both natural and supernatural forces. Folk belief also linked it to the lunar cycles; hence, the term “lunacy.” While ministers talked of “demonic possession,” doctors attributed mental illnesses to an imbalance of the four bodily “humors”: blood, phlegm, choler, and black bile. During the eighteenth‐century Enlightenment, insanity came to be seen as involving defects of reason. In 1812, the Philadelphia physician Benjamin Rush published Medical Inquiries and Observations upon Diseases of the Mind, the first major American treatise on mental illness.

Nineteenth‐century notions of mental illness were shaped by the first generation of physicians to work in large psychiatric institutions. Asylum doctors divided mental illness into four categories: mania (with an important subcategory, monomania), melancholia, dementia, and idiocy. They sometimes added “moral insanity,” later called psychopathy. In 1869, the New York neurologist and prolific writer on medical subjects George M. Beard (1839–1883) coined the term “neurasthenia” to describe a range of less serious but still debilitating nervous conditions, including headaches, insomnia, depression, and anxiety. Finally, in 1899, the German doctor Emil Kraepelin, in The Compendium of Psychiatry, offered a synthesis of the major diagnostic categories of the day, which was rapidly adopted in the United States. Among the illnesses he described were manic‐depression and dementia praecox, a disorder renamed schizophrenia (split mind) by the Swiss psychiatrist Eugene Bleuler in 1911.

By the late nineteenth century, despite much neurological research into the structure and function of the brain and nervous system, the causes of insanity remained unknown. Frustrated by the growing numbers of chronic patients in psychiatric hospitals and influenced by evolutionary theory, many psychiatrists turned to hereditarian explanations. Particularly influential, if extreme, was degeneration theory, which held that degenerates (a category that included criminals, the long‐term mentally ill, and the mentally handicapped) could be recognized by physical and mental characteristics indicative of regressive breeding. Once detected, such persons were to be sterilized or institutionalized for life.

This brief excursion into biological psychiatry was soon overshadowed by psychoanalysis (brought to the United States by Sigmund Freud in 1909) and other psychosocial perspectives on mental illness. Psychiatrists and neurologists paid increasing attention to private patients with neuroses and maladjustments, to the relative neglect of those with serious mental illnesses such as senile dementia and neurosyphilis who filled the large state psychiatric institutions. In 1948, the American Psychiatric Association published the first edition of its Diagnostic and Statistical Manual [of] Mental Disorders, which described both minor problems such as psychosomatic disorders and combat fatigue and major mental illnesses such as depression and schizophrenia.

The later twentieth century brought many changes in popular and medical conceptions of mental illness. Leaders of the antipsychiatry movement of the 1960s, including Thomas Szasz and R.D. Laing, attacked what they called the “myth of mental illness.” Mental illness, they argued, was primarily a social, not a medical, label attached to anomalous or nonconforming behavior. By the 1990s, however, in both professional and popular discourse, this perspective had been swamped by a resurgent biological psychiatry that emphasized the somatic bases of serious mental illnesses and responded to psychic symptoms with powerful drug therapies.
See also Eugenics; Hospitals; Medicine; Mental Health Institutions; Mental Retardation; Psychology; Psychotherapy; Sixties, The.

Bibliography

Lynn Gamwell and and Nancy Tomes , Madness in America: Cultural and Medical Perceptions of Mental Illness before 1914, 1995.
Edward Shorter , A History of Psychiatry, From the Era of the Asylum to the Age of Prozac, 1997.

Ellen Dwyer