History of Psychiatric Treatment

The first organized effort to deal with the mentally ill in England was the 1547 conversion of the Bethlehem Hospital in London to the exclusive purpose of confining the mentally ill. It is from the chaotic conditions inside this institution which the word "Bedlam" derives, "Bethlehem" as pronounced by the local accent (Comer, 1992). Institutions often provided no treatment, or performed bloodlettings as therapy (Hunt, 1993). Conditions within the institutions included poor ventilation, inadequate food and patients chained to beds and walls by their waists and ankles (Brigham, 1844). In 1793, Philippe Pinel promoted the idea that mental illness should be treated with support, moral guidance and kindness rather than with chains and beatings (Comer, 1992). The "moral treatment" movement greatly improved the conditions of some mental institutions (Brigham, 1844). Over the years, conditions declined due to severe money and staffing shortages, overcrowding and society's negative view of mental patients (Comer, 1992). The institutions themselves had pessimistic views of the recovery from mental illnesses, due to the large number of chronic cases despite the adoption of "moral treatment," (Goldman, 1994).

In the 1937, Egas Moniz reported on the "Prefrontal Leukotomy." This procedure consisted of drilling holes in the skull and cutting one centimeter wide cores in the prefrontal areas with a wire loop. Moniz (1937, p 239.) reported that the "Prefrontal leukotomy is a simple operation, always safe, which may prove to be an effective surgical treatment in certain cases of mental disorders."

Other methods produced brain seizures and body convulsions that were thought to improve the patient's condition. This was achieved by the use of the drug Metrazol and the insulin induced coma. The insulin procedure involved administering insulin until the patients blood sugar level was reduced to below levels that could sustain consciousness. The patient would go through seizures and would later be revived by receiving intravenous glucose (Frank, 1990). A patient in the insulin induced coma state may be a disturbing sight. Patients schedules for insulin coma were not allowed to view this procedure, the patient "is prevented from seeing all at once the actions and treatment of those patients further along in their therapy....As much as possible, he is saved the trauma of sudden introduction to the sight of patients in different stages of coma-a sight which is not very pleasant to the unaccustomed eye," (Gralnick, 1944, p 184.).

Electro-Convulsive Therapy induced brain seizures by the application of high voltage electric current. There were may theories that attempted to explain the function of electroshock. One theory suggested that "the personality is brought down to a lower level and adjustment is obtained more easily in a primitive vegetative existence than in a highly developed personality. Imbecility replaces insanity," (Gordon, 1948, p. 399).

The advent of tranquilizers provided an alternative to methods such as electroshock and lobotomy. In the middle 1950s Heinz Lehmann remarked that chlorpromazine may prove to be a pharmacological substitute for lobotomy (Breggin, 1991) The discovery of phenothiazines alone is believed to have made possible the deinstitutionalization of mental patients (Johnson, 1990). The arrival of psychotropic medication occurred during a critical period. In 1954, a National Governors' Conference on Mental Health was held. Representatives from all the 48 existing states agreed that their states would almost certainly go bankrupt if chronically ill mental patients would continue to be supported for life in state mental hospitals (Johnson, 1990). Three months later, thorazine was released. Thorazine was a small, easily administered and inexpensive pill. Much less controversial than lobotomy or electroshock, thorazine was seen as a solution to the conditions of the mental hospitals (Johnson, 1990).