How has our understanding of Mental Health Changed?

Diego Vieira

The idea of what constitutes health is a product of its time. The essence of this idea has followed humanity throughout time.

Greek philosophers saw the use of reason to contemplate the world, but it was only after some great time, with the thoughts of famous French philosopher René Descartes, that the idea of using reason to improve health and the world was first popularised. This directly opposed older thinking that the rage of gods upon humans was the reason behind the suffering and the rise of diseases and the possibility of a cure was pure fiction. In this world, faith was the first kind of ‘treatment’ that could possibly change what was so called fate, giving people something to do about it other than doing nothing. The exploration of nature and the usage of herbs were brought into consideration and so humans were no longer at the mercy of fate or gods, now having an actual method for fighting disease – being more responsible for their own recovery, the concept of health and prevention/cure growing more prevalent in human society and thinking. Some ages later, the ‘material’ health was considered the only possible reason for evaluation, in other words, what could be seen, could be treated. Much was studied about the human body. Anatomy and Physiology was vastly explored, drawing a path to the field of Psy.

The great contributors in the first steps for the creation of the study of the mind were English and German philosophers and physiologists like Francis Bacon, Ernst Weber, John Stuart Mill, and many others. They helped lead science into the field of the study of the mind that later became Psychology. It’s a matter of fact that even though Psychology was being developed as science, what was studied was how the mind functions, and mental illnesses were not even a concept. Whilst mental illnesses have always existed, our acknowledgement of them and our attempts to deal with them have only recently become mainstream.

Some of the most remarkable research of the human mind was carried out by neurologist Sigmund Freud, founder of Psychoanalysis, which tried to explain the formation of personality based on the conflicts of the conscious and the unconscious mind, and how the human mind is driven by the concept of trieb (German word for instinct, libido). Certainly though, Freud’s work is not without controversy – the debate about its accuracy, if not its findings, is one of great debate. Other memorable researchers included Watson, Skinner, and Pavlov, who studied how external stimulus could influence our behaviour, leading to the development of mental functions.

These two different references approach the study of the mind and the environment to understand how humans live through a psychological perspective, but the actual understanding of mental health wasn’t known to be what it is today. The concept of madness is a historical construction, before the 19th century there was neither the concept of mental illness nor a division between reason and madness. The path of development from the Renaissance era to today is marked by a growing separation between those experiencing mental conditions and the rest of society, with the development of asylums being the most famous example.

The Renaissance is regarded as the era of self-realization and the growth of the scientific model. To be a true Renaissance person required on to develops his intellectual, moral, religious, physical, and aesthetic capacities. The Renaissance was strongly characterized by art and literature and men had been upon the grace of culture and internalized the sense of civilization and refinement, meaning that those straying from the circle of culture were excluded and taken out of the sight of the civilization. The criteria used to determine who was or was not eligible to be part of society had no solid fundamentals. For that reason, substance abusers, the homeless, homosexuals, and everyone who were deviant from the “normal” acceptable behavior would be locked in mental asylums, where they had no basic conditions of in-habitation. These disorders were seen as an incapability to handle normal life situations, and so began attempts to understand patterns based on biological and sociological knowledge. This resulted, in 1952, in the creation of the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association. One major flaw was that there was no divided line between normality and abnormality – this was left up to interpretation.

The creation of a manual to identify mental disorders was to have a large effect of the numbers of diagnosis for mental health, and a need for a standard was pertinent because professionals around the world had their own ways to treat these cases, and unifying the knowledge from different diagnosis explored by different professionals all around the world would serve as standard for a better medical practice and facilitate researches in the field of mental health. The DSM was possible because of commissions that reunited the mental health professionals to create criteria to better understand and deal with the people affected by mental disorders.  Since its creation in 1952, the DSM has gone through 5 revisions to review its findings and increase the number of studied diagnosis that were found in psychiatric researches conducted, for instance, by Robert Spitzer and Emil Kraepelin.

The U.S. National Institute of Mental Health sponsored researches between 1977 and 1979 to test the validity of the diagnosis’s, allowing more knowledge to complement their understandings. With the International Statistical Classification of Diseases and Related Health Problems – ICD, created in 1893, further contributions and collaborative work with the DSM.

The DSM in its fifth and most up to date revision from 2013, counting with approximately 300 categories of disorders and is used internationally as an instrument to guide treatment and research into mental health, allowing professionals to correctly approach patients and have an oriented practice, guaranteeing their practices under scientific research and no longer relying on presumptions or personal perspectives, which previously clouded the ability of psychologists to accurately diagnose disorders.

#DiegoVieira #MentalHealth