Mental Health Throughout History

Over the past few centuries, the mental health field has undergone drastic transformations. The 20th and 21st centuries are notable among these, representing contrasting periods in public understanding, acceptance, stigmatization, and treatment options. In the 20th century, mental health issues were clouded by mass stigma and ignorance, bolstered by limited scientific understanding and social biases. However, with the progression of time and knowledge, the 21st century has facilitated a widespread shift towards greater empathy, awareness, and acceptance of mental health. Although challenges and areas for improvement exist in both, the 21st century is home to less stigmatization, greater social acceptance, and more government support than the 20th century.

While stigmatization of mental health conditions has remained a prominent issue in the 21st century, a world of progress has been made from the 20th century, which was characterized by a lack of understanding and awareness. A primary contributor to this was the limited scientific knowledge about mental health issues. As the 20th century began, the neurologist Sigmund Freud published theories regarding the unconscious basis for some less severe disorders that couldn't be explained medically. He developed psychoanalysis to treat these "neurotic patients," making it the first treatment for psychiatric outpatients. However, empirical evidence of its efficacy was scarce (Reidbord). Around this time, a new treatment, the lobotomy, was invented, which was performed by drilling holes into a person's skull and using a surgical tool in the frontal lobe to destroy the tissues and nerves. Nevertheless, it became highly controversial because of its adverse effects. For example, Rosemary Kennedy had a lobotomy, which left her incapacitated and unable to care for herself ("Rosemary Kennedy"). It wasn't until the late 1950s and early 1960s that new medications, such as anti-psychotics and anti-depressants, were created. While notable psychiatric advancements occurred at the end of the century, most of the 20th century was marked by limited scientific knowledge (Reidbord). As a result, many fears and misconceptions surrounded the mentally ill, with people labeling them as crazy, insane, and dangerous. This stigmatization peaked in Nazi Germany, where hundreds of thousands of mentally ill people were sterilized or murdered. In global contexts, American sociologist Erwin Goffman observed that no country, society, or culture allocated the same societal value to people with mental illness as those without one (Rössler). Consequently, the mentally ill were ostracized and sent to asylums, where they suffered further neglect and abuse. Despite efforts from reformers such as Dorothea Dix, asylums were filthy, overcrowded, provided little treatment, and often held people for decades. For example, one treatment at Willard Psychiatric Center involved submerging patients in cold baths for long periods. Additionally, electroshock treatment was administered, but the method in which the treatment was given broke many patients' backs. This practice of institutionalization further reinforced the stigmatization of mental illness and the ostracization of these individuals ("Mental Health Treatment").          

As 21st-century advancements in knowledge and awareness occurred, the stigmatization of mental conditions lessened. In contrast to the 20th century, various scientific research and psychological studies have increased understanding. For example, in 2009, the Human Connectome Project led to advances in human neuroimaging and brain connectivity. This research not only helped neurologists understand brain changes from psychiatric and neurologic conditions but also aided in identifying the neurobiological basis of various mental disorders (Tozzi et al.). The National Survey of Children's Health also established national and state-representative statistics on children's physical and emotional health. It emphasized various factors, such as health care access and quality, parental health, family interactions, neighborhood characteristics, and school/after-school experiences ("National Survey"). This information can be used to provide further knowledge on environmental factors and aids in advancing care for children and adolescents. Another critical contribution to less stigmatization was the broader circulation of information through the internet and social media platforms. Many fears and misconceptions prevalent in the 20th century have since been corrected through this continuum of widespread information. These platforms have allowed people to share educational resources and personal stories of struggle and remission, giving people a voice to challenge previous stigma. In addition, the emergence of online awareness groups has opened up a space for mental health discussions. Furthermore, celebrities and public figures have opened up about their experiences to reduce stigma and encourage conversation. For example, Demi Lovato has been open about her mental health following a diagnosis of bipolar disorder. Celebrity testimonies like hers have demonstrated that mental illness can affect anyone. She and many others have helped break down the stigma around mental health and connect with large audiences, creating a foundation for dialogue and acceptance.

The social acceptance of mental health conditions in the 20th century was characterized by limited acknowledgment. At the time, the societal focus was predominantly on physical health and well-being. For example, the 20th century was home to vaccine development and widespread usage, significant reductions in infectious disease epidemics, smallpox eradication, and the decline of several serious chronic diseases. Overall, the healthcare system became more organized, technologically advanced, and garnered more government funds (Fielding). With public health initiatives mainly targeting physical health, mental health received little attention, which fed into its lack of social acknowledgment and acceptance. Additionally, there was widespread dismissal of mental illness as a personal weakness rather than a medical condition. The lack of scientific knowledge on these disorders contributed to this, as many people believed mental illnesses resulted from a lack of willpower and character flaws. This dismissal of mental health conditions and the possibility of professional repercussions led to widespread hesitation to seek treatment. The mentally ill who sought treatment subjected themselves to stigmatization, labels, and prejudice. In turn, this would lead to damaged reputations, limited professional and career opportunities, and job loss, all of which furthered a lack of social acceptance for those with a mental condition.

The 21st century facilitated changing attitudes and cultural shifts toward greater social acceptance of the mentally ill. According to a survey by the Harris Poll on behalf of the American Psychological Association, 87% of American adults believe having a mental health disorder is nothing to be ashamed of ("Americans Becoming More Open"). Part of this change resulted from the growing recognition of the prevalence of mental health issues. Mental illnesses are common in the United States, with an estimated one in five adults living with one ("About Mental Health"). Through mental health advocacy groups like the National Alliance of Mental Illness (NAMI), spreading awareness and debunking misconceptions, people have begun to realize the prevalence of mental illness. Even if they are not mentally ill, statistically speaking, someone they know is affected by one. This phenomenon has helped people become more accepting of the mentally ill. Additionally, there has been an increasing empathy and understanding amongst the general public. With greater scientific knowledge, people have begun to understand various mental disorders, their causes, and how they present, which has helped to demystify the topic of mental health. Furthermore, people have become more willing to share their stories and struggles, fostering empathy amongst the general population. Moreover, empathy has grown with the prevalence of mental illness and people's connection to mentally ill individuals. In addition, the 21st century has been home to cultural movements prioritizing self-care and mental well-being. For example, while there has been criticism of it, wellness culture has become prevalent, shedding light on the importance of improving the self. While some things endorsed by wellness culture, such as healthy eating and exercising regularly, focus more on the body, an aspect of the movement's focus is taking care of your mind, with it promoting therapy (O'Sullivan). Additionally, there have been mental health movements, such as the "It's Okay to Not Be Okay" campaign, which has gained popularity and been adopted by many over the years. It's also been used by local governments, with the Santa Barbara County Department of Behavioral Wellness using this message to normalize the conversation about mental health and create a space for youth to open up about their struggles (Grimmesey).

Poor interventions marked the government's role in mental health in the 20th century. Chief among these was the slow development of mental health policies and services. As a result of the government's focus on public health research and policies, limited knowledge and understanding of mental disorders, and significant societal stigma, mental health policies and services were neglected for a large part of the century. It wasn't until John F. Kennedy's Community Health Care Act (CMHA) of 1963 that change began, creating community-based but federally-funded psychiatric care. The CHMA granted $150 million for the physical construction and initial staffing of 1,500 community mental health centers. However, the CMHA didn't fulfill this, and most community mental health centers didn't provide the basic provisions that individuals with serious mental illness needed. Additionally, because of age, financial, and bureaucratic application barriers, many couldn't qualify for Medicaid and Medicare, leaving care to families, friends, and associates. While the CHMA partly resulted in deinstitutionalization, the last mental asylum didn't close its door until the brink of the 21st century in 1994 (Erickson). Another aspect of poor inventions was the separation of mental health facilities from general healthcare. This further perpetuated the stigmatization of the mentally ill and made many unable to seek treatment. Additionally, because the mentally ill had to seek treatment in psychiatric facilities, they were isolated and far away from emotional and social support networks, which likely hindered their recovery (Funk et al.). Furthermore, there was a lack of funding and support for mental health programs. As previously discussed, even legislation such as the CHMA fell short of its mental health promises, leading to disastrous results for the mentally ill.

As the 21st century began, there was more significant progress and improved support, with comprehensive mental health policies and initiatives being implemented. For example, in 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) required health insurers to give the same level of benefits for mental health treatment as they do for physical care. In addition, the MHPAEA introduced the integration of mental health services into mainstream healthcare, ensuring that individuals could have equal access to mental health services within the general healthcare system. This was a significant step towards breaking down heavily stigmatized barriers and ensuring the mentally ill could receive crucial care ("Mental Health and Substance Use"). Furthermore, there has been increased funding and resources for mental health programs. For example, in 2016, part of the 21st Century Cures Act addressed the opioid crisis and improved mental health service delivery. The legislation was monumental as it required providers to care not just for the physical aspect of a person (Lengyel-Gomez). Additionally, the recent 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $425 million to the Substance Abuse and Mental Health Services Administration (SAMHSA) to address expanding mental health needs resulting from the pandemic. This funding provided emergency response, crisis counseling, and telehealth initiatives, further establishing mental health's importance (Moss et al.).

While the 20th and 21st centuries had differences, they shared challenges and areas for improvement. For example, they both have persistent stigma and prejudice. Prominent among these were lingering societal attitudes affecting acceptance. Despite 21st century advancements, stigma persists, with the Harris Poll recording 33% of respondents who agreed with the statement, "People with mental health disorders scare me," and 39% saying they would view someone differently if they knew they had a mental health disorder ("Americans Becoming More Open"). This persistent stigma and prejudice align with 20th-century attitudes and labels of the mentally ill as dangerous, crazy, and insane. Additionally, both centuries were reluctant to discuss mental health due to the fear of being judged openly. While progress has been made in the 21st century, opening up about mental health can still lead to stigma and discrimination, such as denying someone housing or turning someone down for a job ("Let's Face It"). This parallels the 20th century reluctance to open up because of stigmatization and damaged reputations, limited professional and career opportunities, and job loss. Additionally, the 20th and 21st centuries share inadequate resources and support. A primary aspect of this is insufficient mental health services, particularly in underserved areas. In the 20th century, this was seen in asylums that were filthy, overcrowded, provided little treatment, and often held people for decades. This same phenomenon is seen in the 21st century through inadequate mental health care for underserved communities. For example, people of color and LGBTQIA+ populations face structural barriers in accessing quality treatment (Khaldun and McNulty). There is also a significant lack of access in rural populations, where it's estimated that 65% of nonmetropolitan counties don't have psychiatrists, and over 60% of rural Americans live in designated mental health provider shortage areas (Morales et al.).

In conclusion, while both centuries have various challenges and areas for improvement, the 21st century has less stigmatization, greater social acceptance, and more government support than the 20th century. The 20th century had intense stigmatization toward mental conditions due to a lack of understanding and awareness, a lack of social acceptance because of limited acknowledgment, and poor government interventions. In contrast, the 21st century was home to lesser stigmatization of mental illness because of advancements in knowledge and awareness, greater social acceptance due to changing attitudes and a cultural shift, and progress and improved support from the government. However, both centuries share challenges and areas for improvement, such as persistent stigma and prejudice, and inadequate resources and support. While significant progress has been made, it’s essential to acknowledge the need to address these areas for improvement to create a society that is inclusive of and effectively treats the mentally ill.