Is modern mental health treatment working?

Is modern mental health care effective, or just mumbo jumbo? 

 

Restraint Was An Early 'Modern' Treatment

 

A recent radio debate had a number of callers describing their dependence upon medications to control their mental conditions. In fact many of them appeared to exhibit a drug addicts dependence upon these drugs. “If I don’t get them I act desperately” was a typical sort of opinion. Oddly it was almost as though it was the tablet, not its content that was the need.

The placebo effect, is when a number of people are given a ‘sugar’ drug as a trial control when the real drug is tested. Often the “cure” results for the placebo are as good as, or better than, the actual drug being tested.

This series of callers with their seeming dependence upon the tablet and not the drug, made me wonder exactly how far we have come since Freud rediscovered that people’s anxieties lessened when they talked about them to a therapist. Of course being a doctor, the person they had to talk to had to be a ‘therapist’.

I am not in anyway disparaging Freud’s attempts to organise the study and treatment of mental illness, or his discovery that repressed traumas, such as childhood abuse, often manifest in physical ailments later in life. These were important discoveries and insights; however I do wonder how far treatments have come in the last 100 yrs? The main tools of treatment today are drugs (anti-depressants) and therapy (talking), and how different is that from amulets and a chat with the local shaman?

There is an old English adage that “A trouble shared is a trouble halved”, which surely is the same as Freud’s discovery that talking about troubles eased the mental stress that they caused. In the pre-industrial period people lived in extended families, and naturally talked to them about their problems, but these extended families started to break up when people moved to cities for work, and the incidence of mental health problems appear to have grown ever since.

 

Delirium Tremens May Be The First Human Induced Mental Illness.

 
Before Freud:

In prehistoric times, there was no division between medicine, magic and religion. In the Stone Age there is evidence of trepanning the skull, and also that parts of the cut skull were used as amulets. In other words a medicine man (Shaman) would treat you with an operation, a religious belief (drugs), and a placebo (an amulet), that warded off further incidences of the illness as long as you believed.

The Egyptians refined this treatment of mental illness, and added occupational therapies and trips down the Nile. Not so different from today!

The Mesopotamians (according to the Code of Hammurabi), were the first to apparently separate mental illness and physical injuries, with Priests handling the mental illnesses. These priest-physicians, known as the Asu, used psychotherapy, and studied dreams which were regarded as showing the will of the gods. Every physician had his own god, and every disease its own demon. Diseases and drugs were codified, and the doctor was responsible for his patient, whose life story was studied in a holistic approach. In other words the earlier periods of a patient’s life were seen as having impact in later illnesses.

The Jewish traditions of mental health care are in the Talmud, with Rabbi Asi in ancient Judea recommending that disturbed patients should talk freely about their worries, showed a similar approach (although the stoning of the ‘possessed’ may have limited this approach). In ancient Greece, either Solon or Thales (sources differ) gave the famous advice, 'Know thyself' which is surely a call to self analysis.

In fact the ancient Greeks showed remarkable understanding and tolerance of mental illness, with notable philosophers discussing aspects of this affliction.

• Melampus mythically pioneered the use of white hellebore for treating delusions.
• Hippocrates, described melancholia, postpartum psychosis, mania, phobias and paranoia, and was called as a psychiatric witness in trials. Hippocrates also believed that thoughts and feelings occur in the brain, rather than the heart as was more commonly thought at that time.
• Plato proposed a view of the soul (psyche) as a charioteer driving two horses, one noble, the other driven by base desires. The charioteer struggles to balance their conflicting impulses. This is similar to Freud's theory of the superego, ego and id. Plato also discussed the origin of dreams, as well as the nature of sexual sublimation.
• Asclepiades invented a swinging bed which had a relaxing effect on emotionally disturbed patients, found music helpful, and spoke out strongly against incarceration of mentally ill people. The sleep-therapy was in luxurious surroundings, taking great care with patients' diet and exercise.He disliked the term 'insanity', referring to 'passions of sensations', and differentiated between hallucinations and delusions. (Asclepiades also waged a strong campaign against bleeding, which in fact went on for another 1500 years).

In the 2nd century AD his follower, Soranus of Ephesus, said that patients should be kept in light, airy conditions, should not be beaten, kept in the dark or given poppy to make them drowsy, and he stressed the importance of convalescence and after-care. He also took social background and culture into account and insisted on the importance of the doctor-patient relationship. 

Although he described mental distress in terms of an organic disturbance he treated it by psychological methods, minimising the use of drugs and other physical treatments. But he also suggested that mania should be treated with the alkaline waters of the town. These waters contained high levels of lithium salts. Lithium treatment was rediscovered for manic depression by John Cade, an Australian psychiatrist, in the 1940s.

The Muslim ruled world was more benign during this period, as it had no fixed concept of the devil and demons at this time. Rhazes (Al-Razi) was chief physician at Baghdad hospital where there was a psychiatric ward, and, because the Arabs had no fear of demons, patients were kindly treated. They used the writings of Galen and Aristotle to guide them, and appear to have made use of forms of behaviour therapy.

The early Romans largely had held a similar outlook to the Greeks (although there were a few advocates of whipping, such as Cornelius Celsus) and also applied electric shock treatments (via eels). Many of the Roman methods of diagnosis as devised by Cicero were carried on in England by monks until the dissolution of the Monasteries (sadly this event was a backward step in the treatment of mental illness in England for the next 400 years). It was about this time that witch burnings started to come back to the fore, and mental illness was treated with violence across Europe for the next 300 yrs.

Bedlam and the other degradations that were inflicted upon the mentally ill were all by products of the “Renaissance” with its religious wars and the Christian fear of demonic possessions. There were a few enlightened voices such as Robert Burton's Anatomy of Melancholy (1621), who noted the aggression that often lies behind depression, and proposed a therapeutic programme of exercise, music, drugs and diet, with a stress on the importance of discussing problems with a close friend, or, if one is not available, with a doctor. But they were drowned out in the view that treating people with violence, and like animals was the way forward.

Anyone who has seen “The Madness of King George” will have an idea of how poorly even the rich mentally ill were treated at this time. In fact it was on the back of this period of thought that modern psychiatry has developed. Had the understanding and treatment of mental illness remained as it had been in the kinder periods described above, we may never have gone down the road we are on now.

In Africa today, traditional doctors in Africa can only qualify for their profession by first having undergone convulsions and sickness themselves and a thorough exposure of their dreams. They are still used by over half the population, even in South Africa the most developed of Southern African nations.

This brings me back to treatment and its success. The evidence that we have any more success in treatment with our drugs and therapy than the ancients, is not really there. The traditional healer of South Africa, employing methods that would have not been out of place in Europe in the Roman times, and that would have been enlightened during the 16th to 19th century, appear to be at least as successful in curing mental stress as our ‘modern’ Western approach.

Maybe in the future, our permanent dispensation of drugs as a suppressant of the conditions, rather than as a cure, will be considered as the same sort of barbaric practises, as we now look up on the treatments of the 18th century? Certainly some of the early pre-renaissance pioneers of the treatment of mental health illnesses would probably consider that little progress had been made.

Therapy via a stranger, has all but replaced friends and family, and we are now creating a whole group of drug dependent, mentally ill people, who are not cured; they are just controlled by the drugs, or rather their own expectations of what taking the drugs will do. 

Link:

Rosenhan Experiment - research into the effectiveness of Psychiatric evaluations.

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