Mental+health+treatment+-+from+dark+till+dawn

Name: Tory Emblen Student Number: n7159617 Tutor: Michelle Newcomb

= Cultural Artefact  =

[] = = =media type="youtube" key="_0aNILW6ILk" height="315" width="420"=

The youtube footage I have chosen is of Dr Walter Freeman, a neurologist who performed lobotomies on mental health patients in the early 1900's. The original lobotomy was a medical procedure where the neural passages from the front of the brain are surgically separated from those in the back of the brain. The common result of this procedure was the patient forgetting their depressing or discouraging feelings or tendencies. This video shows what was thought to be 'effective' treatment for mental illness in the 1900's.

= **Public Health Issue** = = = This artefact represents the treatment of mental health patients in the 1900’s. This assignment will examine various early treatments including medical and societal management of patients. A mental illness is classified as a ‘health problem that significantly affects how a person feels, thinks, behaves, and interacts with other people’ (Department of Health and Ageing, 2007). It includes such disorders as depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders and eating disorders.

Mental illnesses are known to cause a great deal of suffering to those who not only suffer from it, but also to their family and friends. Furthermore, these mental health problems seem to be increasing. According to the World Health Organisation (WHO), depression will be one of the biggest health problems worldwide by the year 2020.

In the earlier decades, it was stated by some, that those suffering from mental illnesses where known as “lunatics”. It was declared these lunatics were possessed by the devil, and usually they were removed from society and locked away (Leupo, n.d.). Treatment such as lobotomies, insulin shock therapy, electroconvulsive therapy, deinstitutionalisation and drugs like chlorpromazine were common.

= = =**Literature Review** = = = In the 1930’s there were three major physical treatments that emerged in what was regarded as a revolution in psychiatry. Lobotomies, deep insulin coma therapy (DICT) and convulsive therapy, which to do this day, is still a current treatment option (Jones, 2000). The first ever lobotomy was performed by Egas Moniz, in Portugal, 1935 (Foerschner, 2010).They were first performed to treat patients with depression, but later on were used to also treat patients suffering from paranoid delusions and agitation associated with schizophrenia (Lerner, 2005).

It was Walter Freeman that was responsible for popularising lobotomies for treatment of mental health patients (Alexander & Sheldon, 1966). In 1947, Freeman developed the trans-orbital procedure, known as the ‘ice-pick procedure’. This enabled any physician to perform lobotomies a lot faster, and have the patient stable within the hour (Raz, 2009). The procedure was not a pleasant one. An ‘ice-pick’ like instrument was inserted through the top of each eye socket, severing the nerves connecting the frontal lobes to the emotion controlling centres of the inner brain. The outcome of this procedure was to calm an uncontrollable violent patient (Foerschner, 2010).

Some physicians, mainly those who treated many of the mental health patients, welcomed the new procedure, as well as the media, thanks in part to Freeman’s showmanship.He traveled the world promoting his new procedure (Lerner, 2005). Wright (2005) states in research that around 70,000 lobotomies were executed within two decades, over 3000 of which he performed personally. It was only after tens of thousands of mentally ill patients had undergone the lobotomy, people started to notice the undesirable side effects, along with their madness, they lost their personalities (Myers, 2006), and further to this was the twenty-five percent death rate (Butcher, Mineka & Hooley, 2007). The introduction of chlorpromazine and other neuroleptic medications made the lobotomies all but obsolete by the 1960s (Lerner, 2005).

In 1933, Manfred Sakel reported his first experimental findings, testing the efficacy of insulin-shock treatment on schizophrenic patients. Insulin was first administered to the patient in a high enough dose to put them into a coma. Although the therapy seemed to be helping to patients in the early stages (Alexander & Sheldon, 1966), a controlled randomized study performed in 1957 showed that a group of non-insulin patients who received sodium amytal with recovery aided by dexamphetamine, found no significant difference at six months. It was concluded that insulin was not a specific therapeutic agent (Jones, 2000).

In 1938, Italian physicians Ugo Cerletti and Lucio Bini administered the first shock of therapy using electricity, receiving successful results (Alexander & Sheldon, 1966). The treatment soon became very popular, with countries such as America and Europe performing the therapy. The idea of passing an electrical current through someone’s head was meant to be a treatment option to improve their medical condition, the therapy was also used to intimidate, control and punish patients (Butcher et al., 2007).

Research done by Maclay (1952) shows the following deaths of treatments from 1947 to end of June 1952.





A series of successful anti-psychotic drugs were introduced in the 1950s that did not cure psychosis, but were able to control its symptoms. Chlorpromazine (commonly known as Thorazine) was the first of the anti-psychotic medications, discovered in France in 1952. Valium became the world’s most prescribed tranquiliser in the 1960s, and Prozac, introduced in 1987, became the most prescribed antidepressant (Porter, 2002). These drugs gradually replaced previous somatic therapies, including psychosurgery. Joel Braslow has described how “chlorpromazine dealt a fatal blow to doctors’ perceptions of lobotomy’s therapeutic effectiveness (Raz, 2008).

These medications have additionally allowed patients to avoid direct confrontation with their mental health issues, for example, getting help through counselling. Despite successful achievements through therapy, many patients have found it easier to avoid the ‘shame’ associated with mental illness, especially in countries where psychopathology is profoundly stigmatised. Patients treat themselves with medication as they believe it’s easier to hide their problems from their family, friends and community (Blue, 1993).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">If treatments offered to mental health patients in the early 1900’s weren’t damaging enough, the conditions these patients had to live in were. Relatives often committed their loved ones to long stays in understaffed, overcrowded, and often filthy mental institutions (Lerner, 2005). Asylums were notorious for the poor living conditions and cruel abuse sustained by those admitted. For many years, asylums were not facilities aimed at helping the mentally ill or helping them overcome their illnesses. Instead, they were merely reformed penal institutions where the mentally ill were left by relatives or sentenced by the law and faced a life of inhumane treatment. They were hidden away all for the sake of lifting the burden off of ashamed families and preventing any possible disturbance in the community (Foerschner, 2010).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Staff at the asylums often treated the mentally ill patients like animals. Iron cuffs and collars allowed just enough movement for patients to feed themselves, but not enough to lie down at night, forcing them to sleep upright. Attention was rarely paid to the quality of the food or whether patients were properly fed. Patients were not allowed visitors, with the only exception of food delivery. The rooms were never cleaned, even of their own waste. Patients had to also make do with a little amount of bedding provided, which was usually hay to cover the cold floor (Butcher et al., 2007). = =

= = =<span style="font-family: Tahoma,Geneva,sans-serif; text-align: center;"><span style="display: block; font-family: Tahoma,Geneva,sans-serif; text-align: center;">**Cultural and Social Analysis** = = = <span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">In the 1950s, people began getting upset about the occurrence of lobotomies. Protests began, and serious research supported the protesters. The general statistics showed roughly a third of lobotomy patients improved, a third stayed the same, and the last third actually got worse (Boeree, 2001).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">The deinstitutionalisation movement began in the 1960s which brought an abrupt change in the way patients with mental conditions were treated and handled. This movement called for the removing of mentally ill patients from the state and private institutions where these patients received next to little or no care and treatment. This was done in order to give patients the options of medications and therapy (Crotts, 2010).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;"> When this movement began to take place, people began to perceive the general attitude of those with a mental health condition. The idea behind this was to make the public believe that these people were not ‘crazy’ and needed to be institutionalised, but were normal members of the community. This was an important cultural shift, some could say as important as the advances in medication themselves as without the support and acceptance of the community, mental health patients would not have been able to merge with ‘normal’ society (Crotts, 2010).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">The advances in social acceptance of people with mental health issues have continued to grow over the last few decades. There are organisations dedicated to raising awareness of mental health. Some strategies they incorporate are nationally recognised days such as R U OK day were by it’s a national day of action, which aims to prevent suicide by encouraging Australians to connect with someone they care about and help stop little problems turning into big ones. On that day we want everyone across the country, from all backgrounds and walks of life, to ask family, friends and colleagues: "Are you OK?". <span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">R U OK? is an independent, not-for-profit organisation whose purpose is to provide national focus and leadership on suicide prevention by empowering Australians to have open and honest conversations and stay connected with people in their lives (R U OK Day, 2011).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Further to this there is Mental Health Week. It is an annual national awareness event held every year to coincide with World Mental Health Day, which is held on 10 October each year. Mental Health Week aims to raise awareness of the importance of mental health and wellbeing in the wider community (Mental Health Week, 2011).

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Therefore culture and society has enabled the continuing progression in acceptance of people living with mental health issues. The advances made in medication options meant that these treatments were viewed as inhumane and ineffective. People’s attitudes to mental illness were starting to shift .

= = =<span style="font-family: Tahoma,Geneva,sans-serif; text-align: center;"><span style="display: block; font-family: Tahoma,Geneva,sans-serif; text-align: center;">**Analysis of the Artefact and My Learning Experience** = = = The youtube footage of Dr Freeman performing a lobotomy depicts the attitudes of the medical profession to those living with a mental health issue in the early 1900’s. Patients were merely objects to be exploited and experimented with. At this time, society was accepting of the treatment these patients received as it was seen as a quick fix to a problem no-one wanted to deal with. It was easier for society to see Dr Freeman performing these cruel procedures, thus making them feel they were doing something for these poor creatures, than it was to deal with the inhumane treatment of patients in mental institutions.

Personally, this assignment has helped me gain an insight into the relationship between the medical profession and the attitudes and beliefs of society. Atrocities were allowed to happen because society did not value mental health patients as worthwhile members of their community. This shift in beliefs has enabled people to be accepting of others with mental health issues, and for individuals to be comfortable in seeking medical treatment for themselves. = =

= = =<span style="font-family: Tahoma,Geneva,sans-serif; text-align: center;"><span style="display: block; font-family: Tahoma,Geneva,sans-serif; text-align: center;">**References** = = = <span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Alexander, F.G, & Sheldon, T.S. (1966). //The History of Psychiatry: An evaluation of Psychiatric Thought and Practice from Prehistoric Times to the Present//. New York: Harper and Row Publishers.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Blue, A,V. (1993). Greek Psychiatry’s Transition from the Hospital to the Community. //Medical Anthropology Quarterly, 7//(3), 301-318

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Boeree, C, G. (2001). A Brief History of the Lobotomy. Retrieved from __http://webspace.ship.edu/cgboer/lobotomy.html__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Butcher, J., Mineka, S., & Hooley, J. (2007). //Abnormal Psychology// (13th ed.). Boston: Pearson Education.

<span style="font-family: Arial,Helvetica,sans-serif;"> Crotts, C. (2010). How the View of Mental Illness Has Changed Over the Past 50 years. Retrieved from http://www.upublish.info/Article/How-the-View-of-Mental-Illness-Has-Changed-Over-the-Past-50-Years/318628

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Foerschner, A. (2010). The History of Mental Illness: From 'Skull Drills' to 'Happy Pills'. Retrieved from [|__http://www.studentpulse.com/a?id=283__]

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Jones, K. (2000). Insulin come therapy in schizophrenia. //Journal of the Royal Society of Medicine, 93//, 147-149

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Lerner, B. (2005). Last-Ditch Medical Therapy - Revisiting Lobotomy. The New England Journal of Medicine, 353(2), 119-121.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Leupo, K. (n.d.). The History of Mental Illness. Retrieved from __http://www.toddlertime.com/advocacy/hospitals/Asylum/history-asylum.htm__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Maclay, W. (1952). Section of Psychiatry: Death Due to Treatment. //Proceedings of the Royal Society of Medicine, 46//, 13-20

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Mental Health Week (2011). Retrieved from __http://mentalhealthweek.com.au/__

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Myers, D. (2006). //Psychology// (8th ed.). New York: Worth Publishers.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Porter, R. (2002). //Madness: A Brief History//. New York: Oxford University Press.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 15.99px;">Raz, M. (2008). Between the Ego and the Icepick: Psychosurgery, Psychoanalysis, and Psychiatric Discourse. //Bulletin of the History of Medicine, 82//(2), 384-420.

Raz, M. (2009). Psychosurgery, Industry and Personal Responsibility, 1940–1965. //Social History of Medicine. 23//(1), 116-133. doi:10.1093/shm/hkp061

R U OK Day (2011). Retrieved from [|__http://www.ruokday.com.au/content/home.aspx__]

Wright, A.J. (2005). The Lobotomist. A Maverick medical genius and this tragic quest to rid the world of mental illness. //Library Journal, 130//(1), 139

= **Reflections** =

Reflection 1: http://healthculturesociety.wikispaces.com/Young+Men%2C+Mental+Health%2C+Suicide
Such a sad story.

It’s hard to understand what must be going on in someone’s mind, and why they would want to commit suicide. Having gone to school with a guy who also committed suicide, everyone was left asking why? Why didn’t he ask for help? He also had everything going for him, but it obviously wasn’t enough.

Your literature review goes some way in explaining why men don’t seek help when dealing with issues that make them consider taking their life is their only option. I also agree that our culture and society needs a paradigm shift away from the idea that men need to be the strong ones, maybe then they will feel comfortable accepting that they have needs and seek the many medical options available to them.

A very interesting and moving Wiki.

===Reflection 2: http://healthculturesociety.wikispaces.com/%27Face+of+Evil%27+-++The+Stigma+Associated+with+Mental+Illness===

Great Wiki,

It was sad to see that his mental health issues were never dealt with appropriately, and with help, he may not have gone that far. Your artefact was very interesting to watch, and interesting that he was trying to find a reason not to go ahead with the killings.

Some statistics that I found startling were that 74% of prisoners, at some stage, have a mental disorder. It makes sense that it should be the health care system that is called to help these people, rather than the police. It is also sad that many nurses have had inadequate training when dealing with the mentally ill. If the predictions are true and depression will be the leading mental health problem by 2020, then we need to educate ourselves now in how to support, understand and care for people with mental health issues. = = = = = = = =