In recognition of Mental Health Month, my recent shareposts this month have traversed some of the history of mental illness. Let's conclude with a quick review of the stress-mental illness connection. Last month, as part of two talks I gave to the Kansas State DBSA conference, I asked my audience if anyone knew what the word “asylum” meant?
Almost immediately, the reply came back - shelter.
Back in the old days, I reminded the gathering, insane asylum was not a dirty word.
Then I related a story of how, out of idle curiosity, I checked out the very first issue of the American Journal of Psychiatry, which came out in 1844. Back then it was called The Journal of Insanity.
The American Journal of Psychiatry is published by the American Psychiatric Association, which was also founded in 1844.
The modern brain science is showing that stress makes us sitting ducks for all kinds of mental illness and other weird behavior, but psychiatry already knew this back in 1952 when the first DSM came out. Much of the DSM I and (and its successor DSM II of 1968) had to do with a Freudian artifact called “neurosis.”
According to these ancient DSMs, depression was a form of neurosis driven by anxiety, just about all of which was seen as the result of a maladaptive response to stress. The DSM-III of 1980 and its successor editions moved away from this principle, but the modern brain science is pulling us back in. As it turns out, the idea was already old hat back in 1844.
Of all things, this first issue of the Journal of Insanity had a long article dealing with Shakespeare. This from King Lear:
“Be comforted, good Madam, the great rage You see is cured in him, and yet it is danger To make him even o’er the time he has lost; Desire him to go in, trouble him no more Till further settling.”
As the Journal observed:
“Now we confess, almost with shame, that although near two centuries and a half have passed since Shakespeare thus wrote; we have very little to add to his method of treating the insane.”
The Journal goes on to say:
“To produce sleep and to quiet the mind by medical and moral treatment, to avoid all unkindness, and when patients begin to convalesce, to guard, as he directs, against everything likely to disturb their minds, and to cause a relapse is now considered the best and nearly the only essential treatment.”
"Hold on a second," I challenged my audience. "Wasn’t 1844 supposed to be the Dark Ages? Weren’t asylums terrible places where they locked away - 'the insane'”?
It turns out the 1830s and 40s was a great reform era. Abraham Lincoln came of age around this time. This was a time of enlightened science meeting enlightened Christianity. Have you had a look at the buildings and grounds of these old institutions? They were beautiful. Palatial country estates.
They even had farms attached to them.
Talk about coincidence. It turns out that this same 1844 Journal - the one that had a long piece on Shakespeare - also had a report describing an institution in Utica, then in operation for 18 months. According to the report, of 433 patients admitted, 123 had recovered.
Not long after I came across that 1844 psychiatry journal almost three years ago, I happened to hear a talk by a leading authority in psychiatric rehabilitation, Robert Liberman of UCLA. To my surprise, Dr Liberman started telling us how the insane asylums of old were very enlightened places, with high recovery rates.
Dr Liberman went on to say in so many words that mental illness was a product of the industrial age. Jam people into cities and watch what happens. Asylums were built to get people away from all that. Only later, he explained, did cash-strapped state governments give up on us.
Dr Liberman is one of the leading proponents of what they call the “diathesis-stress” model (refined to stress-vulnerability protective factors), namely that certain individuals are more genetically disposed than others to break down under stress. (That’s us.)
Brain science studies are coming in thick and fast validating stress-vulnerability-protective factors. It's only a matter of time before we rip up our standard diagnostic manuals and start from scratch. Well, actually not from scratch - from 1952, from 1844, from Shakespeare, earlier ...
Published On: May 29, 2010
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