What Was Mental Health Like in the Past?

They used to do what...?!

I’ve always found history interesting.

For example, I could be walking down the streets of Ibadan, a town in Nigeria, and wonder what it was like 50-100 years ago. Were these shiny streets previously forests? Was there a palm tree where the traffic light now stands? What was the fashion like (not the ‘vintage’ ones we see on TV now)?

Recently, I’ve been binging Merlin, a series steeped in myth and legend. But I got curious about what the practice of Medicine must have been like in the past. Especially mental well-being and health.

Did they mix potions? Practice sorcery? Treat with empathy?

Let’s explore what I found together.


What is Mental Health, anyway?

“The art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements,” — Isaac Ray (1807-1881)

Over time, I’ve seen this concept go through different phases. As with anything that goes mainstream, there’s the risk of its core message getting diluted.

I liked this definition best. Simply put:

“Good mental health includes the ability to: make the most of your unique potentials, cope with the normal stresses of everyday life, be productive at work or school, and play a full part in your family, workplace, community and among friends.” — Optimal Mental Health: An Everyday Guide, by Dr Jibril Abdulmalik (2021)


A Time to Remember 

Throughout history, several causes have been proposed for mental health disorders. These have ranged from the supernatural (spiritual) to the psychogenic (psychological) to the somatogenic (biological).

As early as 6500BC, mental health disorders were believed to be from demonic possession. If you offended the gods, you were punished by losing your sanity.

Zap.

At the time, a popular technique for treatment was trephination. In this crude method, a stone instrument was used to drill the skull to, you know, create a hole the evil spirit could exit. Although one wonders how it got in, in the first place.

This gave way to exorcism — fasting, prayer, flogging, the works.

Eventually, the father of Medicine, Hippocrates, came up with a suggestion. What if mental health disorders were like physical counterparts? What if they were due to a problem within the brain structure? And perhaps, then, they could be treated?

He also spoke about the 4 humours (as did Galen) that control the entire body’s state:

Blood (heart), black bile (spleen), yellow bile (liver) and phlegm (brain).

Although now outdated, some of his ideas would later form a basis for future findings.

Later on, the philosopher Plato advocated for treating mentally ill patients like, well, human beings. He spoke about the role of support — from the family and community.

Roman physicians treated patients with massage and warm baths because who doesn’t like those?

Meanwhile, the Egyptians used unpleasant odours to move the 'wandering womb', that “caused” this mental infirmity in women, back to its rightful position.

Wonder what they did to the men…


A Vicious Cycle

Then came the Middle Ages. We were back to the beginning. 

Demons.

With the rise of religion and natural disasters, potential medical reasons were discarded. There had to be another reason. The gods had to be offended.

Once again, the cycle repeated itself. The mentally ill were not getting any better. In fact, their numbers increased.

In 1547, the Bethlem (known as Bedlam) Hospital opened up for confinement. I’m not even going to go into the details because it essentially became a “Museum for the Mad”.

Very upsetting.

Reform came in the 18th to 19th centuries.

Ranging from the moral treatment movement of patients to the York Retreat estate (established by William Tuke), it seemed things had taken a positive turn. Of worthy mention is Dorothea Dix, an incredible woman who advocated for the human rights of the mentally ill. She also was able to source funds for their care.

Goodbye to the use of electric shock, straight-jackets and blood-letting.

Fast-forward to the 1950s when medications came into the scene, changing the game.

Now, we use the bio-psycho-social model. This model implies that drugs alone are not sufficient. There’s also the need for psychological and social support.

Thankfully, we’ve seen many patients recover.


What now?

And we’re here in this age, straddling between “it’s demonic” and “it’s scientific”.

An imbalance was correct but not in the humours. More like with the chemicals within the brain.

While scientists have made significant advancements, there’s still a lot of stigma around mental health. It’s one of the reasons I’m fascinated by psychology (as are you). To identify an abnormality, one must appreciate the normal.

There’s still a lot left unknown.

But I found it most interesting how history continues to repeat itself.


🔌 Recommendation of the week!

A note to self: be kind; to yourself and others.