Slide 1

Mental IllnessA HistoryIncluding developments in Canada

1They all suffer from mental illness

BulimiaSuicide AttemptDepressionBi-Polar& ADHDDepression2

ADHDThey all suffer from mental illness

Bi-Polar

Bi-Polar

Depression

Depression = Death3They likely suffered from mental illness

Lincoln - Depression

Darwin - Agoraphobia

Munch - Panic Disorder

Churchill - Bipolar

Michelangelo - Autism

Beethoven - Bipolar4Example from Media: Obsessive Compulsive Disorder (An Anxiety Disorder)Obsessive-Compulsive Disorder, OCD = Anxiety DisorderRecurrent, unwanted thoughts (obsessions) and/or repetitive behaviours (compulsions).Repetitive behaviours such as hand-washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away.Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.

SHELDON COOPER!5Canadians on Mental Illness46 per cent of Canadians think the term "mental illness" is used as an excuse for poor behaviour and personal failings.1 in 10 Canadians think that people with mental illness could "just snap out of it if they wanted."1 in 4 Canadians is afraid of being around someone who suffers from serious mental illness.1 in 9 Canadians think depression is not a mental illness, and one in two think it is not a serious condition.Statistics show that one in everyfive Canadians will have a mental health problem at some point in their lives

-Stats Canada

6What is Mental Illness? It is a Disorder in the brain caused by a chemical imbalance that causes a person to function differently.

It can be caused through injury or genetics

7THE HISTORY OF MENTAL ILLNESS AND DISEASE8

Trephination is believed to be the very first type of surgery ever practiced. Thereason this surgery was performed has been the subject of much speculation [i]. It isbelieved that the practice took place to allow demons or evil spirits to escape frompersons who were mentally or physically ill. Evidence of this surgery shows thatAmerican Indians practiced this procedure in abundance in Peru and Bolivia [ii]. Itwas practiced during the late Stone Age (although some small tribes still do ittoday). The surgery involved making an opening in the skull by using sharp flakesof flint or obsidian to cut, scrape, or drill. It is known that some patients survivedtrephination, since signs of healing have been found on trephined skulls found inancient burial sites [iii]. Today, modern physicians sometimes still use thisprocedure to relieve pressure on the brain [iv].[i] Philips, 1990[ii] Philips, 1990[iii] Bard & Bard, 2002; Philips, 1990[iv] Kent, 20039

The Greeks believed that an unsound mind was the sign of an unsound body and,therefore, that an illness of the mind is somehow connected to a dysfunction of thephysical body [i]. A Greek physician named Hippocrates, considered to be thefather of modern medical ethics, is best known for the oath doctors take, which actsas an ethical guideline for the practice of medicine [ii]. He suggested that the brainwas the origin of emotion, thought, and mental illness. He believed that, It is thebrain which makes us mad or delirious, inspires us with dread and fear; whether bynight or by day, brings sleeplessness, inopportune mistakes, aimless anxieties,absentmindedness, and acts that are contrary to habit. These things that we suffer allcome from the brain when it is not healthy, but becomes abnormally hot, cold,moist, or dry. [iii]The Greeks believed that there were four basic elements: earth, water, fire, and air[iv]. Hippocrates proposed that the body contained four corresponding humors (vitalsubstances): phlegm, blood, yellow bile, and black bile [v], and health or illnessresulted from their shifting balance [vi]. For example, according to Hippocrates,melancholia (what we now refer to as depression) was the result of excessive blackbile [vii].[i] Solomon, 2001 [ii] Bard & Bard, 2002[iii] Solomon, 2001:286 [iv] Boeree, 2002[v] Kent, 2003 [vi] Porter, 2002[vii] Simmie & Nunes, 200110

Aristotle believed that the heart rather than the brain must be the source of mentalprocesses such as thinking, memory and imagination. When he dissected creatures,he saw that some had no visible brain but could still sense the world around themand act accordingly. Furthermore, the heart was in the centre of the body and thefirst organ he could see developing in a chick embryo. Thus, his logic led him tobelieve that the mind is located in the heart [i]. The heart, Aristotle believed,balanced the four humors when they were disrupted by heat or cold [ii]. He saw thebrain merely as a radiator, cooling the blood for the body [iii] and preventing theheart from overheating [iv]. Many phrases used in English today relate to thisanalogy (e.g. an angry person is sometimes said to have boiling blood).[i] Zimmer, 2004[ii] Solomon, 2001[iii] Mangels, 2003[iv] Bard & Bard, 200211

Galen (129-216? C.E.) was a Greek surgeon to the gladiators, and, as such, couldpeer through the windows ripped open by tridents and spears [i]. Galen alsodissected apes to determine the anatomy of humans, assuming incorrectly that itwas the exactly same [ii]. His investigations led him to believe that the brain wasthe centre of a vast nervous system in which a network of nerves carried sensationsand messages to and from all parts of the body [iii]. He pointed out the fact thatnerves from the sensory organs travel to the brain and not the heart. The brain was,to Galen, nothing more than a pump, and intelligence, he believed, was to be foundin the empty spaces of the brain [iv]. The death of Galen and the decline of theGreco-Roman empire marked the end of scientific investigation of both physicaland mental illness in the West. In the Islamic world, Galens influence continuedand in Baghdad, a physician named al-Razi (865-925) established a place oftreatment for the mentally ill and practiced an early form of psychotherapy [v].[i] Zimmer, 2004:14[ii] Davison et al., 2002: 16[iii] Kent, 2003[iv] Zimmer, 2004[v] Davison et al., 2002:2512

Further theories of how the mind and body interacted began to develop in Europeduring the 16th century. According to Descartes (1596-1650), a human is made up oftwo separate elements: body and mind[i]. He sought an explanation for how the mindinvisible, without shape or size, could control a material body[ii]. The body, accordingto Descartes, is a machine that responds to sensory changes through actions of thebrain, whereas the mind, independent of the brain, acts through the body to producebehaviour[iii]. Descartes claimed that the nerves are filled with animal spirits,carrying sensory and motor information much as hydraulic fluid travels throughmachines[iv]. Descartes wrongly believed that the body and mind communicatedthrough the pineal gland, a structure the size and shape of a grain of rice[v] locateddeep inside the brain. The pineal gland is now believed to regulate the bodys internalclock[vi].[i] Mangels, 2003[ii] Zimmer, 2004[iii] Bard & Bard, 2002[iv] Public Broadcasting Service, 2005[v] Zimmer, 2004[vi] Bard & Bard, 200213

VIDEODuring the Middle Ages, demonic forces were generally blamed for disasters andtroubles, and demon possession as an explanation of mental illness was thought tobe popular. However, historians disagree about how widespread this belief was. Forexample, in England during the 14th century, records show that one hospitalspurpose was to keep those who were mad safe, but these individuals were notdescribed as possessed by the devil [i].During the Spanish Inquisition (15th to 19th centuries), both those regarded aswitches and their bewitched victims were considered demon possessed. However,most of those accused of witchcraft were not mentally disturbed, and their delusionlikeconfessions were more likely the result of torture [ii]. When individualssuffered from symptoms such as uncontrolled speech, convulsions, tics, paralysis,swooning, and trances, and failed to respond to treatment, doctors often blamed iton sorcery. However, historical records show that at least some physicians inEngland during the 16th century attributed the symptoms to physical and mentalillnesses and not demons [iii].[i] Allderidge, 1979 cited in Davison et al. 2002:10[ii] Davison et al. 2002:10[iii] Porter, 2004:514

VIDEOThe London Hospital of St. Mary of Bethlehem was the first known shelter inEurope for those who were mentally ill (1403). Patients who resided in thismadhouse were commonly called lunatics implying that their illness was causedby strange effects of the moon [i]. Treatment included beating and starvation ofpatients (possibly a method of sedating patients) and shackling or placing them insecure cells. By Shakespeares time, the name Bethlehem was shortened to Bedlam,and the word became synonymous with uproar and turmoil and eventually the phraseutter bedlam [ii] was coined. During the 18th and early 19th centuries, as afundraiser, the institute allowed the public to tour the facility on Sundays for a penny[iii].[i] Ohio University, 2001; LaJeunesse, 2002:17[ii] LaJeunesse, 2002[iii] Kent, 2003:5115

VIDEOUntil the early 1800s, medically-based treatments for those with mental illnesssuch as bleeding, cathartics and ice baths or worse - punishment, imprisonment andneglect - were common [i]. In Paris while the French Revolution raged, PhilippePinel introduced moral therapy [ii], unchaining men with mental illness, preventingabuse, and improving living conditions. Most supporters of moral treatmentbelieved madness to be caused both by a physical disease of the body or brain andby the patients social and personal problems [iii]. Thus, instead of a madhouse,patients should have a place of refuge, of shelter from injury, of comfortableretreat, until the storm be overpast [iv]. Such a place was termed an asylum.[i] American Journal of Psychiatry, 1998[ii] Solomon, 2001: 317[iii] Kent, 2003; Davison et al., 2002[iv] LaJeunesse, 2002:1716

REASONS FOR COMMITTAL TO AN INSANE ASYLUMLATE 1800s - 1900

Gall and Spurzheim, German anatomists, tried to explain behaviour traits in termsof the structure of the brain. They observed peoples personalities, measured thebumps on their skulls, and assigned the underlying part of the brain to thatpersonality trait [i]. They believed that the more prominent the trait, the larger thecorresponding organ of the brain would be. Their theory, termed phrenology,was later criticized for its lack of scientific evidence, but it led to research thatlinked certain parts of the brain to specific functions [ii].[i] Porter, 2002[ii] Kessel, University of Georgia, Website18

The first Canadian institute opened in New Brunswick in 1834. Despite theintentions of its founder for moral treatment, living conditions were not unlikeBedlam. According to a survey written in the 1920s, one group of patients wasreportedly put to bed in boxes filled with hay. Wooden slats were then nailed ontop. All boxes except two were secured at night; these two belonged to patientsdesignated as trustees. Their job was to deal with any noisy inmate by urinatingthrough the slats [i].[i] LaJeunesse, 2002: 6819

Known as The Mental, the institute in Brandon opened in 1906. Althoughkindness, solitude, warmth and food were provided, there were also beatings.Treatment still included the use of physical restraint. Patients were locked incupboards, placed in straightjackets for days, shackled in chains, strapped on bedswith metal grills placed over them, and sometimes forced to sleep on woodenshelves when the wards were overcrowded. Lunatics from the North WestTerritories (which later became the province of Alberta) were also sent here [i].[i] LaJeunesse, 2002:2120

The Provincial Hospital for the Insane at Ponoka opened in 1911, intending toprovide moral treatment for a maximum of 250 patients in a relaxed rural setting.The staff were to provide a family-like, tolerant, and loving environment, while thesuperintendent could run the facility in a fatherly sort of way and could controldisruptive thoughts and impulses of patients [i]. It was built to house 250 patients.After a couple of expansions, the institute housed over 1700 patients by the mid-1930s.[i] LaJeunesse, 2002:2821

In an effort to find solutions to the growing population in the Ponoka institute, Dr.Clarence Hincks was hired in 1921 to do a report on the system and makerecommendations. Dr. Hincks was a well-known expert in this area. He was aCanadian pioneer in early intervention and the founder of the first mental healthclinic (Toronto). In addition to holding a degree in medicine, Hincks had a vestedinterest in improving mental health care. Hincks suffered from a mental illnessknown as Manic Depression or Bipolar Disorder. Having suffered from a number ofepisodes, he was fuelled with an interest in psychiatry and endeavored to preventmental illness. He founded the Canadian National Committee for Mental Hygiene,which evolved into the Canadian Mental Health Association in 1918 [i].[i] LaJeunesse, 200222

The Hincks report recommended early intervention, services close to home, wards ingeneral hospitals, social work and occupational therapy, and training for nurses.Hincks was fearful that if another big institution was built, more people would belocked away for long periods of time. At this time, all admissions went through thecourts and people were committed. Since he believed that patients were mad, notbad, he recommended voluntary admissions be an option. While Hincksrecommendations were ahead of his time in many ways, his promotion ofsterilization was highly controversial.23

Through trial and error, the Medical Model was developed. Treatments, which wereviolent, invasive and experimental, reflected the desperate desire of psychiatrists tohelp asylum patients, and the powerlessness of patients at the hands of those doctorswho were reckless [i]. In Austria, when some patients with mental illness sufferedseizures due to insulin shock and unexpectedly their mental state improved, insulincoma therapy was discovered [ii]. Although it is not understood how shock therapyaffects the brain, it does reduce symptoms like depression in the short term. AtAlberta mental institutions, insulin and the drug Metrazol were used beginning in1938 to induce seizures, but used very little due to the physical injuries caused by theseizures. Psychosurgery (frontal lobotomies) began as a treatment in 1950.While treating mental illness involved using medical and surgical procedures,preventing mental illness involved sexual sterilization to avoid passing along such adefect to the next generation. In Alberta, the Sexual Sterilization Act was in forcefrom 1928 to 1971 when it was repealed [iii]. The advent of pharmaceuticalinterventions such as anti-psychotic drugs in the 1950s brought a more humaneapproach.[i] Porter, 1997[ii] LaJeunesse, 2002[iii] LaJeunesse, 200224

A treatment called electro-convulsive therapy was introduced in Ponoka in 1945.Originating in Europe, electroshock therapy was first used on a human patient in1938 by Cerletti and Bini [i]. Since there were no standards for this treatment,doctors were allowed to use it at their own discretion. In some cases, at the AlbertaSchool Hospital in Red Deer Dr. L.J. LeVann would administer ticklers, smalljolts which would be repeated until patients promised to behave in proper ways[ii]. The machines used to administer the shock therapy were primitive and thevoltage levels could not be controlled well. The treatment causes unconsciousnessand a convulsive seizure [iii]. A decade later drugs were introduced to relaxpatients muscles to reduce the number of physical injuries. Memory loss is one ofthe side effects of ECT. This therapy is still used today, but in a much morecontrolled setting and in select cases where other treatments havent worked [iv].[i] Bard & Bard, 2002[ii] LaJeunesse, 2002: 51[iii] Bard & Bard, 2002[iv] Fink, 1999:225

In 1936 Egas Moniz, a Portuguese neurologist, discovered he could reduce anxietyin monkeys by detaching their frontal lobe from the rest of the brain [i], a surgicaltreatment subsequently adapted for humans, and enthusiastically taken up in theUnited States [ii].Ponoka began practicing transorbital lobotomies in which the surgeon drew theupper eyelid away from the eyeball and tapped an ice pick-like instrument with ahammer to get through the tissue. He would then sever fibers in the frontal lobe ofthe brain [iii]. The process took about five minutes and seemed to help patientswho were agitated or compulsive. Unfortunately, while the procedure reduced theintensity of emotion in some disorders such as anxiety and depression, it oftendamaged or destroyed crucial areas of the brain, leaving patients without the abilityto have regard for other peoples feelings, or unable to speak and think clearly [iv].Nevertheless, between 1950 and 1968, 89 patients in Ponoka underwent this form ofsurgery. Ironically, while considered by many to be one of the grimmest episodesin modern mental health treatment [v], Moniz received a Nobel prize (1949) forhis work, one of only two awarded in psychiatry [vi].[i] Bard & Bard, 2002 [ii] Porter, 2002[iii] LaJeunesse, 2002:53 [iv] Kent, 2003[v] Kent, 2003: 99 [vi] LaJeunesse, 200226

In 1954, chlorpromazine was introduced for treatment of patients with psychosisand delusion. Since most psychiatrists appeared committed to ECT orpsychoanalysis as treatments, the American pharmaceutical company holding thepatent for the new medication concentrated on marketing it to politicians for use inmental hospitals.With the use of the medication, by 1956 over half of the patients at the Ponokainstitute were being discharged in less than three months. Within a decade, the useof seclusion, shock therapy and locked doors was decreased. Recreational activitieswere increased, as visiting community organizations felt safer in the asylum.Unfortunately, a revolving door syndrome developed as the medication became thesole treatment after discharge and many individuals chose to discontinue taking it.They found the side effects to be too disabling. Tranquilizers, sedatives andantidepressants came on the market and new anti-psychotic drugs were tested andreleased [i].[i] LaJeunesse, 200227

The introduction of psychotropic drugs marked the beginning of the shift frominstitutional to community-based care for mental illness. De-institutionalization ofmental patients began in 1960 in Alberta. However, few ex-patients had supportfrom their families or communities. In addition, after years of living in institutionsthey were unable to organize their own lives, or find work or housing. Many ofthem became homeless. In 1963, establishment of community-based programs thatwere coordinated and able to provide continuity of care was recommended byCMHA. The centre of care shifted from institutions to psychiatric units in generalhospitals, and outpatient services were developed to help prevent the return ofindividuals with mental illness to institutions. In 1983, a report called forcommunity service organizations and self-help programs to receive more provincialfunding, coordination among services, and creation of work and housing options.Although treatment for people with mental illness has evolved from locking uplunatics in madhouses to community care and early intervention, many gaps remainin services. Individuals who are mentally ill are still feared and shunned in Alberta[i]. The stigma of mental illness lives on.[i] LaJeunesse, 2002:29628

The Alberta government moved forward abandoning Hincks recommendations forsmaller institutions in favour of a new facility housing 1000 to 1500 people. Theyopened the Provincial Institute at Oliver (now the Alberta Hospital in Edmonton) in1923 and a variety of other institutes in Claresholm, Raymond and Camrose. TheInstitute at Oliver was to provide care to the sickest of the Ponoka inmates [i].[i] LaJeunesse, 2002:3229