History of

Mental Illness
Julie Lapenskie MScAH
Mental Illness vs. Mental
Health
Mental Illness
Characterized by alterations in thinking, mood, and/or
behaviour associated with significant distress and
impaired functioning
More than 400 mental illnesses/disorders in ICD
Mental Health
WHO: a state of well-being in which the individual
realises his or her own capabilities, can cope with the
normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her
community
Mental health and mental are NOT mutually
exclusive
 Supernatural Causes of Mental
Illness
Pre-historic times
Evil spirits
Treatment
Spells
Trephination: Drilling/scrapping/cutting holes in the
skull (oldest surgical procedure)
Ancient Greece: Hippocrates
Physiological & natural basis
4 Humors: blood, phlegm, yellow bile, black bile
Blood letting, purges
Influence of angry gods: abuse, public humiliation
Supernatural Causes of Mental
Illness Cont.

Middle Ages (approx. 400AD - 1500s)

Demonology & witchcraft possession by the
devil
Treatment: exorcisms, attending mass/religious
ceremonies, torture, burned at the stake,
hanging, decapitation
Strong religious influence (Christianity)
1600s & Early 1700s

Mental illness was an

impaired physical state due
to excess passion
Use of physical restraints,
abuse, confinement
Chained, kept in cages
Role of Family/Community
Up until the late 1700s, if an individual with
mental illness could not be cared for by family
at home, they were placed in jails and
poorhouses (or thrown to the street)
Severe overcrowding, poor sanitary conditions,
inadequate food/water, no
treatment/interventions
Considered morally unfit/sinners
Lasting religious influence from the middle ages
Criminalization of Mental Illness

Lasting influence!!
How is mental illness still criminalized today
in the 21st century?
1997: Provincial strategy to coordinate
human services and criminal justice
systems in Ontario
Industrial Revolution: 1760-1830
Treatment: purges (use of emetics),
blood-letting
Start of institutionalization
Poorhouses for deranged individuals
where people could pay to walk through
the institutions as spectators
Function?
Entertainment for spectators,
economic for poorhouse owners
Institutionalization (Moral
Hospitals): Early Success

Pinel (1745-1826)
Director of 2 institutions in Paris
Led mental health reform
Humane approach to treating mental
illness
Known as moral treatment
Development of psychiatry as a discipline
 Institutionalization:
Humanitarian Approach
Moral Hospitals, later termed insane asylums
1714: Hotel-Dieu in Quebec
1835, 1885: St. John
1841: Toronto
Was an abandoned jail
Dr.Richard Bucke & Dr. Charles Clarke (1870-
1890s)
Superintendents of asylums in London & Hamilton,
Kingston, ON
Ceased to restrain patients
Treated physical ailments (hospital vs. asylum)
Cultural and sports events for patients to participate
Torontos Provincial Lunatic
Asylum, 1868
Institutionalization (1900-1960)
Bythe early 1900s, asylums became more
similar to the jails and poorhouses
Poor living conditions, severe over-crowding
Impersonal & paternalistic, insufficient staff,
physical abuse, restraints, inhumane
treatments, involuntary admission
Institutions isolated from the rest of society:
removing individuals with mental illness from
the public sphere
However
British
Lunatics Asylums Act (1853)
Consent of person not applicable
Treatments of Mental Illness in
Institutions (early 20th century)
https://www.youtube.com/w
atch?v=1Izmyru5T_w
Other
Hypnotism
Opioids
Sterilization
Attempt to explain mental
illness
biologically/physiologically
ECT/Shock Therapy

Based on the belief that epileptic

convulsions and schizophrenia symptoms
could not occur concurrently
Various methods: insulin, electrical current
The start of the end of
institutionalization
Dr. Clarence Hinks & Clifford Beers (1900s)
Lived experience of mental illness
Call for treatment outside institutions
National Committee for Mental Hygiene
now CMHA
Idea of prevention/early detection in
mental illness
First
International Congress on Mental
Hygiene (1930)
 WWII: 1939-1945
Peak number of individuals in Canadian
institutions (66 000)
Realization that apparently healthy people had
mental illnesses
Influenced public attitudes
1947: Nuremberg Code
1948: Federal government established the
Dominion Mental Health Grants
1951: First Mental Health Week in Canada
1950s: Anti-depressants & Anti-
psychotics
Paved the way for de-institutionalization
Allowed effective treatment in the
community
End of lobotomies
Chlorpromazine
Hope for a cure
How does this influence research and
policy at the time and ongoing?
 Antecedents of De-
institutionalization
High cost of psychiatric hospitals/insane asylums
Studies demonstrating negative effects of long-
term institutionalization
Poor living standards in institutions
Extreme over-crowding (more patients in mental
institutions than those in non-psychiatric hospitals)
Operated at over 100% capacity
Restrictions on the involuntary admission of
individuals to psychiatric institutions
Civil Rights movement
De-institutionalization: Policy
1963:
National Scientific Planning Council of the
CMHA release More for the Mind
Mental illness should be dealt within the same
organizational, administrative, and professional
framework as physical illness
Call for integration of mental and physical health
services
1964: Royal Commission on Health Services
Emmett Hall: Any distinction in the care of
physically and mentally ill individuals should be
eschewed as unscientific for all time.
 De-institutionalization (1960
onwards)
From hiding or elimination people from society to a
model of healing
Rights to refuse treatment introduced (only in
Ontario legislation in 1979)
Caveat: increase in psychiatric units in general
hospitals (1960s & 1970s)
47 633 beds in psychiatric institutions in 1960 compared
to 15 011 in 1976
844 psychiatric hospital(general) beds in 1960
compared to 5 836 in 1976
Pros? Cons?
Time to think
Whatare some of the negative
consequences of de-institutionalization?
Consequences of De-
institutionalization (1960s & 1970s)
Individualswho had lived in institutions for the
majority of their life
Lack of ability (psychological and social skills) to
live outside of this setting and interact with society
Homelessness
Outpatient services not prepared for volume of
individuals or for more severe mental illnesses
Imprisonment
Relapse
Revolving door in hospitals
De-institutionalization (1970s-
1980s) Mental Health Reform
Focus on community mental healthcare &
supports
Provincial funding for mental health services
outside of the hospital setting
Income support, vocational rehab, housing support
case management
Siloed from hospital settings
Majorresearch advances in improved
medications, neurotransmitter systems implicated
in mental illness, brain function, role of genetics in
mental disorders
 1988: The Graham Report:
Plan for the development &
implementation of a comprehensive
community mental health system
Uniform Mental Health Act
Protect persons from dangerous behaviour
caused by mental illness & treat it in the
least restrictive manner
 De-institutionalization (1990s
onwards) Mental Health Reform
Outreach services, mobile crisis teams, self-help groups
Emphasis on empirical research to determine
effectiveness
Evidence based approach
Focus on collaboration from individuals with lived
experience & families
Increased cooperation and continuity between
hospital & community-based care
1993: Reform of Mental Health Services in Ontario
10-year plan with goal to reverse funding structure such
that 60% of mental health funding went to community
1998: funding not yet allocated to implement reform in
community significant funding in 2004
My Lovely Wife in the Psych
Ward

Does institutionalization
still exist?
Changes in goals
Break
 Definitions of Mental Illness
Idiots, imbeciles, lunatics, moochers, lazy
Sick, possessed, dangerous
DSM: first version published in 1952
Classification as early as 1880 (mania, melancholia,
dementia, monomania, paresis, dipsomania, & epilepsy)
ICD-6: first version including a section for mental
disorders
Influence of U.S. Army & Veterans Administration
Simply acted outside of the norm/socially acceptable?
Drapetomania: diagnosis in 1800s disorder of slaves who
have a tendency to run away from their owner due to an
inborn propensity for wanderlust
 Homosexuality
Considered a mental illness in the DSM until 1973
Instead: Sexual Orientation Disturbance or Ego-
dystonic Homosexuality
Removed in 1987
In ICD removed in 1990
From mental illness/disease to mental health
What does this experience tell us?
Diagnoses and the constructs of illness and disorder
are partly social with social consequences
Concept of homosexuality didnt even exist until the late
19th century
Scientific evidence changes over time: pathology to
sexology
Influenced by sociopolitical forces
Menstruation
https://www.youtube.com/watch?v=U1L
OuRY5IyY

The idea of women being ritually unclean while

menstruating is found in the Bible, where the Old Testament
states that anyone who touches a woman during her period
will be unclean until evening. In 690 AD, Bishop Theodore of
Canterbury took this idea and ran with it, forbidding
menstruating women from even visiting the English church,
-Womenstrong International
 Schizophrenia
Term coined in 1911
Schizo = split, phrene = mind
Victims
of institutionalization, particularly
inhumane treatments
Lobotomies, convulsive therapies
Mad, crazy, delusional
Danger to society stereotype of violence
Hearing voices movement:
https://www.youtube.com/watch?v=_NQGzEmGZc
c
If Interested Ted Talk:
https://www.youtube.com/watch?v=syjEN3peCJw
Stigma
What does this mean?
How has the history of mental illness
(dating back to prehistoric times)
influences our current view of mental
illness and mental health?
 Current Landscape
Mental illness is the primary cause of short- and
long-term disability in Canada
Approximately 1in 7 Canadians use health
services specifically for a mental illness
More likely among adults, specifically older adults
(1 in 4 older adults)
Why?

Largest increase in service use among

adolescents (age 10-14)
 Canadian Policy: Mental
Health Reform
Canadian increased funding and prioritization
of mental health issues
Mental Health Commission of Canada
(developed in 2007)
2012: Changing Directions, Changing Lives: The
Mental Health Strategy for Canada
Canadas first mental health strategy
Lifecourse approach, access to services, mental
health disparities (Indigenous mental health),
whole-government approach
Canadian Policy & Legislation
1996: Health Care Consent Act
Admission to hospital
Administration of treatments
Issues of Capacity vs. Competency
POA
SDM
Tribunal for review via Consent & Capacity
Board
Canadian Policy & Legislation
Cont.

Involuntary admission
Probable physical & mental harm
Involuntary treatment
Capacity to consent
Quick Question
Can you think of any other policies or
legislation/laws throughout history that are
implicated in mental illness and mental
health?
 Canadian Policy: Mental
Health Reform
2016:
Better Mental Health Means Better Health
Moving Forward: Second Annual Report of
Ontarios Mental Health and Addictions
Leadership Advisory Council
Three strategic considerations:
1. Promote, prevent, & intervene early
2. Close service gaps: youth addictions,
psychotherapy, & supportive housing
3. Build foundations for system transformation:
continuity of care
Some things to think about
What do you think is missing from these strategic
priorities?
What other trends in mental health and health care
in Canada suggest a need for increased
prioritization and policy focus/planning on mental
health?
Potential appointment of a secretariat to manage
and improve mental health in Canada
What implications will this have for mental health
services in Canada?
What are the implications on the overall Canadian
health system?