Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
1.3 20th century mental health care
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En provenance du cours de University of Toronto
The Social Context of Mental Health and Illness
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À partir de la leçon
Welcome and A Brief History of Madness
We begin with a quick orientation to the course and continue with our first lecture topic: A brief history of madness.
Rencontrer les enseignants
Charmaine WilliamsAssociate Professor
Faculty of Social Work
So we left the asylums in a state of disrepair and abandonment.
Social pressures that were going to emerge in the twentieth century would be
the impetus for change. This was a time when psychiatry would
begin it's bid to be seen like other medical specialties.
This contributed in part to the shift of naming institutions as hospitals, rather
then asylums. But also contributed to a desire to
engage the public in understanding that mental disorder was something that could
be managed by the appropriate medical specialty.
Engaging the public in this was given a tremendous boost by the publication of a
very influential book called A Mind That Found Itself that was written by Clifford
Beers. Clifford Beers was a former patient in an
asylum, and in his autobiography he detailed the abuses he had suffered
during his time there. The public attention that this brought to
the horrible conditions in the asylums led to the establishment of the mental
hygiene movement in which medical professionals sought to educate the
public about the biological and genetic basis of mental illness and developmental
disorders and the importance of early detection, prevention, research and
treatment. We're going to be looking at this period
in mental health care history, by taking a look at the Canadian National Committee
for Mental Hygiene. The Canadian National Committee for
Mental Hygiene's origins were announced in the June 1918 edition of the Canadian
Medical Association Journal, which described it, as poised to deal with,
"Vexed problems of crime, prostitution, papalism and unemployment.
Problems in which mental factors are of primary importance.
It is also hoped, that the organization will be able through its influence, to be
of assistance to the country in solving. Some the difficult problems connected
with the return to civil life of the mentally abnormal soldiers as well as
those raised by immigration. The images you're going to see in this
section are from a training exhibition of posters and artifacts that they did to
launch the organization across Canada in the early 1920's.
The Canadian National Committee on Mental Hygiene was one of many mental hygiene
organizations around the world similarly concerned with the prevention of mental
illness, and to some extent, eugenics and the restriction of immigration.
Most of these organizations would later abandoned these latter pursuits.
Focusing on the promotion of mental health.
And they would change their name accordingly.
For example, this committee eventually became the Canadian Mental Health
association. And these materials are held in the
Canadian mental health association archives.
That are now housed at the CAMH archives. If you ever have the opportunity, if
you're around Toronto or are visiting Toronto.
The archives of the Center For Addiction and Mental Health hold a lot of really
interesting things that detail the history psychiatry.
Particularly over the last 100 years or so.
And I really recommend giving it a visit. And I want to thank the CAMH Archives for
generously sharing these images for use in the course.
So try to imagine that you are walking down the street, shopping in 1924, and
you see a store window that is full of these placards.
they were really taking this directly to the public, because they really needed to
engage a public that had been disengaged around these issues.
And some of the placards listed the names of influential people that just at the
time that were behind this effort to, to To, put mental health and mental hygiene
on the agenda. In their attempt to establish a sense of
urgency in the public. They, pointed to issues like.
The cost associated with hospitalization. The cost associated with policing.
Because it was understood. Or they were presenting mental
abnormality as related to rising crime in the cities.
An then also, the costs associated. With clinics that treat disease.
And, you have to consider. That we're talking about sort of an
industrial area. Era of time.
So, the cities were growing tremendously. there were.
There were a lot of problems with crowding, disease, poverty.
but what was happening here is that psychiatry decided to.
Define these as problems that were associated with mental abnormality.
And, really position themselves as able to manage them.
I'm making this message that needed to be communicated to the public, that this was
a new era of mental health treatment that changed from calling these places lunatic
asylums to insane asylums had signaled less investment in spiritual or
supernatural explanations for madness. But, the switch from asylums to hospitals
really signaled the confidence that psychiatrists had that madness was like
any disorder of the body and could be treated scientifically and effectively.
So, when I look at these images, I try to imagine what message they wanted to get
across to the public. On the left, there's clearly a message
about the need for more hospitals, but I can't help thinking that there's also a
message about how these hospitals will be kept far, far away from civilized
society. As you will see, that the absence of
these hospitals is going to be linked to threats in the communities, is going to
be linked to threats to the community in the slides that come next.
On the right, the sophisticated atmosphere of the mental hospital is
presented as a counter-narrative to what was known then about the deplorable
conditions of the asylum. Before the establishment of the Canadian
National Committee on mental hygiene, members of the committee head toward the
country and discovered horrible conditions.
Together with the compelling testimony of Clifford Beers' book, it was clearly
important to establish that the modern psychiatric hospital was not a place of
abuse, neglect, or the kind of filth that had been described by Joseph Workman or
by Clifford Beers. An image like this was meant to restore
the confidence of the public. And perhaps to some extent to address
some of the fear and stigma that prevented people who needed help from
seeking it at that mental hospitals. In the next slide we get a glimpse of the
kind of social problems that are mentioned in the announcement from the
Canadican, Canadian Medical Association Journal.
On the left, a mother identified as insane is the source of tragedy for her
young family. And desperately needs treatment.
On the right, a woman described as mendably, mentally abnormal is producing
illegitimate children who are likely to be mentally abnormal as well.
These and other images in the exhibit reinforce a connection between mental
health problems and social disorder. You've hopefully also noticed by now that
at the time intellectual and developmental disabilities were still
being gripped together with mental disorders unto the spectrum of mental
disease and abnormality. As we move on these images of slavin leek
conditions do to feeble mindedness and on the left alcoholism as well so you'll see
that there is a. Bottle there.
This person is asleep, and if you look very carefully there is a baby on the
floor. they're presented in a way that doesn't
allow you to remain neutral. Remember that the asylums kept these
problems far away from the public. What the mental hygiene movement wanted
people to understand was that the public was no longer protected from this.
The assertion on the right, that these people need to be under supervision,
hints at the suggestion that the public needs to support initiatives to remove
these problems from their neighborhoods. All of the previous images focused on
adults and the consequences they created for their families, but you will see
there's also an interest in the mental health of children.
In fact, as you'll see in the next few slides, examination and screening of
children was a large thrust of mental hygiene activity.
This young man is described as people-minded, and anti-social, and big
trouble because he likes to steal cars. It's nothing that as they say a firm
colony won't fix though I can't imagine putting this little cutie into a firm
colony. Psychiatry was positioning itself as
useful beyond the walls. Mental hospitals.
So situations like these could be helped by appropriate consultation to child
welfare services and social services. As a side note, the growing importance of
psychiatry was important for other fields like social work as well.
Their growing conviction that there were scientific solutions to social problems
would have a great influence on the practice of case work by social workers
at the same and that would would be a great boom to the development of that
profession too. So having identified the problems, what
solutions were proposed by early twentieth century psychiatrists?
Certainly early identification was key. There was a lot of optimism about the
possibility of preventing mental disorder, so the idea that psychiatrists
should be let into classrooms to identify future problems seemed promising.
Although the psychiatric armamentarium was still pretty small there was a belief
that the methods available at the time some of which were very similar to moral
treatment of the previous entry could make a difference.
So the possibility that there were children with mental abnormalities in
every classroom was alarming as suggested here, but manageable.
Insanity could be prevented. Feeble mindedness could be controlled and
mental health could be promoted for all of these children.
Part of presenting psychiatry as a scientifically based specialization.
Required the field to look more like other medical sciences.
Although the anti psychiatry movement wasn't really going to arrive for another
30 years or so, there was already. There were already those that were highly
skeptical of the knowledge base of psychiatry.
Hence this classification of, four types of mental deficiency.
And four types of insanity. Is used to suggest that the field has
advanced to a point where it can classify disorder.
With reliability and validity. You will see that the terms used to
describe, these sub types of disorder reflect.
Noseology of the time and of course reflects some of the work by European
psychiatrists who were much further ahead with this scientific approach to mental
illness largely due to the work of phillipeanel who I mentioned in the last
segment. In the late 1800s.
You will see that they imply that there are specific treatments available for
each type of disorder. Bear in mind that although the asylums
are now called hospitals, they, they still need to deal with the public that
believes them to be. Places that are ineffective in treating
the mental ill, mentally ill. So this is, kind of assertion is very
important. The type of science that could be offered
at the time was still fairly limit, limited.
But much of what the mental hygiene movement was hoping to stimulate was
interest in investing in research to develop better screening and treatment.
Some of what we see here should be familiar from the sick documentary that
you saw earlier in the lecture. Here we're just looking at a research.
Facility. But over on the right, we see the slides
depicting settings for hydrotherapy, over here.
Which had patients sitting in lukewarm water to keep calm.
light therapy, I think these are actually both hydrotherapy but, they had light
therapy to treat depression, and electrotherapy which, was not the same as
electro-convulsive therapy that would come later.
These are electrotherapy machines down here.
and, they are actually used for the restoration of muscle tissue, and may
have been used for treating wounded soldiers.
The next slide is depicting farm work and drill exercises, treatments for mental
abnormalities. Should remind you of the moral treatments
that was done in the asylums. I'm particularly struck by how the work
of the so called feeble minded, to reclaim farmland, is presented as useful
to them, and also useful to the community.
This is, of course, more unpaid labor by patients.
The drill on the right. Continues the tradition of using exercise
as treatment of men, mental illness, calisthenic exercises may seem
particularly appropriate given that there were a significant number of patients at
the time that were ex soldiers and of course, they would have been familiar
with drill. Now, here we have what is being promised
as the outcome of this new enlightened scientifically derived treatment.
On the left. We are presented with a home for the
feeble minded. And the cost savings that were realized
by having them build it themselves. Of course nothing new about having
patients build the place that their going to be kept.
On the right, the emergence of occupational therapy.
With the claim that it will prevent mental deterioration and cure mental
illness part of the exhibit was a display of materials that had actually been
produced by patients as part of their occupational therapy.
although the picture on the left is talking about the need for places to
house patients who are unable to live outside of institutions, the promotion of
occupational therapy was linked to treatment in the immediate moment and the
future livelihood of patients who they hoped would be cured and able to leave
the hospital. In this sense it was actually a very
optimistic time. So, things were going to get her.
It seemed, at least for a little while. If you want to get a sense of how mental
health was being dealt with then, and how it was being portrayed to the public.
I recommend you go to the resource section, and check out the, the public
service film. I think it's called Mental Health
Treatment in the 1950s, or the Mental Hospital in the 1950s.
Because there, you get a real picture of the kind of problems that they were sort
of saying they could deal with, and how they dealt with them.
And it's sort of pre-, it's a bit sanitized, in the sense that, of course,
they. They were other places that you could go
and see betrayals of the hospital that were much less flattering.
So for example, I saw a movie just a couple nights ago called Autumn Leaf,
starring [LAUGH] Joan Crawford and Cliff Robinson.
And I know it sounds funny that I'm bringing in this film, but they, the,
the, the thing is that somebody in that film ends up going to a psychiatric
hospital. And, they, they certainly portray it as a
positive outcome, but the portrayal of the treatment itself is quite harsh.
So this is where a lot of people got their ideas about what ECT is like and
all that sort of thing, but. And after those harsh treatments, we also
see him engaging in psychotherapy, and engaging in occupational therapy.
And getting much better. And able to return to the arms of Joan
Crawford later. So that's a 1956 film.
Which is interesting, because things really started to change around then.
They changed quite dramatically. So where we're going next is to the
middle of the twentieth century to take a look at how the changes in the
surrounding social environment began to have a real effect on what was happening
inside mental hospitals.
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