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Mental health is about the well-being of persons as perceived by themselves, and the acceptance of their behaviour by others as ‘normal’. It has become the umbrella term for mental, as opposed to physical illness, and everything that has to do with it. An early text The Anatomy of Melancholy by Richard Burton (1576 - 1637) precedes the dividing of body, mind and spirit, and is still a marvellous description of illness with mental, emotional and visceral manifestations.
Mental illness very rarely has a demonstrable organic lesion and the benefits of the advances in pathology, which began in the 19th century, did not benefit the diagnosis or treatment of mental illness. There is large variation from one culture to another about what is acceptable as normal or sane behaviour.
Mental diseases were based upon descriptions of behaviour only, and in the absence of any rational treatments the natural history of the diseases was as much a function of the stigma carried by ‘madness’ or by the effects of institutionalization. At the end of the 19th century Sigmund Freud challenged the prevailing views, devised a new descriptive ‘pathology’ and proposed the use of the technique of psychoanalysis to deal with the mental illnesses which corresponded to his descriptions. The rationale for this therapy was for the ill person to freely associate ideas and talk until the cause of his or her illness was revealed. Once the cause was understood, it was assumed that the illness would abate. Many styles of psychoanalysis evolved, but all were time-consuming and expensive. To become available to less wealthy people psychoanalysis was tried on groups of patients, and in time it was observed that the interactions of members of the group were at least as important as the work of the analyst. As styles varied more from analysis the term psychotherapy was devised to describe other talking therapies. Most recently the potential value of psychotherapy has been much enhanced by the introduction of the idea of goal orientation in treatment, thereby limiting openendedness. The group evolved usefully into family and other network therapies.
The drug treatment of mental illness has moved from chloral hydrate, the original ‘knock-out drops’, and barbiturates (downers) and amphetamines (uppers) to anti-psychotic drugs like chlorpromazine and various groups of anti-depressive and anxiety reducing substances. The drugs are still linked with disease models which lack a pathological or biochemical basis, and the intent of therapy does not clearly differentiate whether it is to increase the well-being of the ill person, or to make the behaviour of the person more acceptable to society.
In Western culture the confinement of mentally ill people to institutions is relatively recent—18th to 19th centuries. More recently, attempts have been made to de-institutionalize the care of mentally ill people.
On occasion particular communities have taken on the role of caring for mentally ill people as members of their community. Examples exist in the Netherlands, and in Yorubaland, western Nigeria. TG
See also psychiatry. |
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