NRP Spring 2023. Alyssa Thallemer: Evolution of Psychiatric Practices

In 1949, Dr. Antonio Egas Moniz won the Nobel Prize in medicine for inventing the lobotomy, which he named the leucotomy. Approximately 60,000 lobotomies were performed in the United States and Europe between the years 1935 and 1955. By the 1950s, the risks of lobotomies were recognized by physicians across numerous countries.² While the lobotomy is not banned in all countries today, the procedure is performed in extremely rare cases due to the associated ethical and safety concerns.⁶ The publication of the first Diagnostic Statistical Manual of Mental Disorders, DSM-1, in 1952, revolutionized psychiatric practice. Today, the DSM-5-TR, published in 2022, a revised version of the DSM-5, guides the diagnostic and treatment processes of mental illnesses.¹ Furthermore, significant societal effort has helped foster a movement of mental health destigmatization: as more knowledge regarding individuals with mental illness becomes available, integration and inclusion is all the more feasible. However, continued progress is necessary as a correlation between psychiatric diagnosis and lack of program funding, absence of consistent medical treatment, increased incarceration rates, decreased lifespan, and diminished quality of life persists today.²

            In response to the increased number of institutionalized patients in the 1900s, lobotomies and Electroconvulsive Therapy (ECT) aimed to remove psychiatric patients from asylums and hospitals.⁶ These procedures resulted in society viewing people with mental illness as broken, lesser than, and needing to be fixed. Furthermore, the Great Depression placed increased financial strain on institutions.¹ While acute psychosis resulted in institutionalization in the 1900s, conditions that were deemed chronic (i.e., epilepsy, Alzheimer’s Disease, and cognitive impairments) received in-home care. Asylums and psychiatric hospitals subjected patients to poor conditions such as overcrowding, insufficient nutrition, and inhumane treatment.² Dehumanizing practices, including forced sterility, were frequent in the asylums and psychiatric hospitals. Patients were stripped of bodily autonomy: two physicians’ signatures were sufficient to institutionalize a patient indefinitely, against their own wishes.¹

Physicians were also permitted to experiment directly on patients, if they believed the condition might be improved and patient could potentially benefit. The removal of tonsils, spleens, teeth, and ovaries were performed to “free” patients of their psychiatric disorders. Physicians also administered high doses of insulin, followed by glucose, in attempt to put patients into comatose states that were believed to rewire the brain, alleviating the psychosis. These procedures lacked all benefit to patients, while frequently causing cognitive impairment and increased psychological trauma.¹

Thankfully, the development of pharmacological treatments for psychiatric disorders has allowed patients to leave the institutionalized treatment settings and receive higher quality care via community-based programs. In 1952, along with the publication the DSM-1, the first antipsychotic, Chlorpromazine, was released onto the market. This pharmacotherapy allowed individuals with Schizophrenia and related disorders to seek symptom relief and become better integrated and included in society.¹ Today, nearly one in four people over the age eighteen, or fifty million Americans, have prescriptions for mental health medication.⁴

Additionally, individuals with psychiatric diagnoses often receive psychotherapy. Cognitive-behavioral therapy is common in treating depression, anxiety, and PTSD, as it aims to change the thought processes underlying defeating behavior and emotion.³ Humanistic therapy is a practice used to help improve one’s view of self through the idea that every human has the capacity and desire for personal growth and change.⁵ Implementation of psychotherapy is highly effective in treating patients with psychiatric disorders, especially when it is used in conjunction with pharmacotherapy.³

Within the past century, deinstitutionalization and destigmitization of psychiatric conditions has allowed individuals with mental illness to receive higher quality treatment and be part of society.² As the scientific understanding of mental health has progressed, so has the ethical treatment of those with mental illness. However, the mental health crisis is far from resolved, as significant gaps and lack of mental health services continue to hinder quality and quantity of life in people with psychiatric diagnoses.  Although we have come a long way from lobotomies, it is important to continue to advocate for the destigmatization of psychiatric conditions and to actively seek more suitable mental health services.

References

1. America’s Long-Suffering Mental Health System | Origins. (n.d.). Retrieved March 21, 2023, from https://origins.osu.edu/article/americas-long-suffering-mental-health-system?language_content_entity=en
2. Background on Mental Health | Nathan S. Kline’s Zombi in Haiti. (n.d.). Retrieved March 21, 2023, from https://sites.duke.edu/ginalisgh323/background-on-mental-health/
3. Cohen, J., & Mannarino, A. P. (2008). Disseminating and Implementing Trauma-focused CBT in community settings. Trauma, Violence & Abuse, 9(4), 214–226. https://doi.org/10.1177/1524838008324336
4. Pandemic Fuels Mental Health Prescription Rise – QuoteWizard. (n.d.). Retrieved March 21, 2023, from https://quotewizard.com/news/mental-health-prescriptions
5. Person Centered Humanistic Therapy | Glossary | Newport Academy. (n.d.). Retrieved March 21, 2023, from https://www.newportacademy.com/resources/glossary/person-centered-humanistic-therapy/
6. The History of Lobotomy | Psych Central. (n.d.). Retrieved March 21, 2023, from https://psychcentral.com/blog/the-surprising-history-of-the-lobotomy