So we're going to talk about treatment. Last chapter we talked about diagnosing and understanding what are the components that kind of play into how we diagnose in psychology and in the whole field of mental health. You'll notice that there's conversations about mental illness and mental health. Ever since there was a more positive movement in the whole healthcare system, we've changed our language to mental health rather than mental illness.
And that's a real distinction that I think is important for you to note and you to continue with for moving forward. In that line, one of the things we talked about in the last chapter is that originally mental health issues were considered at a spiritual frame, so witchcraft and maybe demon possession and those kinds of components. That means that the treatments also came from more of a spiritual component.
So you can see going back in history, and it's not as far back as you might think, just a hundred or so years, you will find that exorcism was used frequently as an intervention to help with people that were mentally challenged, particularly if they were dealing with things like schizophrenia, where they might be hearing things or seeing things that was seen as a possession or... oppression from a demonic source. So let's just exercise those spirits.
There were lots of ways that they would go about doing that. I'm not an exorcist and therefore I'm not going to go into the details. Additionally other treatments that are questionable, and these go back hundreds of years, would be to release the demons or the spirits that were captured in your head. So you would find what's called trephining common as a practice and that's drilling a hole in the skull to let the spirits out. This has been going on for, as I mentioned, hundreds of years and we know that because there are skulls that I've found with those holes and they are clearly individuals who lived through the process, went on for some years after that hole in their head was done to release that spirit.
Now There could be pressure in the brain that's causing that and maybe this did have some medical intervention but it wasn't a demonic component in the cases that we consider mental health concerns. So while there may have been improvements there were still challenges and we could see that as we got more from the spiritual into science as the foundation for how we understood things there was a movement. who take these individuals who were seen as crazy or not thinking clearly and put them in a place so they wouldn't be a burden to their family.
We call those asylums. Now to take asylum is to go to a place of safety. And so you might think of these asylums as a place where they were kept safe, but that is not the case. It was a place where they were taken away from being a burden on their family, but the care of these individuals was most often quite poor. Frequently, they were held in shackles, underfed, not given good sanitation, or those kind of components.
And there are a number of horror stories that you could follow up on if you're interested in the historic components of care for the mentally ill individuals. Well, fortunately, there are people that saw that that needed to be dealt with, that that was not the best care for those individuals. And so one of the...
early interveners in this is Philippe Pinel and he was in France, went into Paris and went into this one hospital and felt like there were ways that we could be more humane. These were human beings and they deserved respect, care that would be about supporting their wellness and so Philippe Pinel is one of those first innovators in reformation of mental health care. There were also asylums. Care in those asylums was similar to what I described before. Lots of individuals were placed in these situations which you might think of now if you were to see those conditions as more like a prison.
They were not allowed out, it was a lockdown situation, and they were not being treated humanely. In the U.S. after Piniel, about 75 years later, Dorothea Dix came along. She was a nurse who saw that these were individuals that deserved better care than they were getting and she is the lead reformer in mental health care in the United States. What she developed for us is practical guideline for what would be good health care for mental health in the U.S. The care that was happening in the United States in the asylums here, both before reformation and after, might look rather archaic to you.
Things that were done for those individuals were based on the science of the time. You are living in a day and age when we understand many things down to a microscopic level that we didn't understand at that time. So the kinds of treatments certainly look like they would not be good and humane. Individuals were locked in situations, placed in ice cold water.
All of these components were thought to release the pieces that were causing the problems for them. And as you might imagine, few people actually found these interventions to be helpful for them. That brings us to the 20th century.
We see huge innovations in all healthcare in the United States and in other developing countries. Much of what happened came about because science developed so rapidly and we began understanding the interaction between what we saw as these mental processes and the biological components. And now as we look at what is going on we recognize that what happened in the 1900s changed everything for how we actually put together a treatment plan for someone coming in for mental health care.
In 1954, we saw the development of antipsychotic medications. That was revolutionary. Going back to schizophrenia and those individuals that were dealing with hallucinations and delusions, antipsychotic medications deal with those.
They limit them. They can reduce the severity to a point where... the level of functioning for that individual improves dramatically.
However, as you might know, there are side effects with all medications. And with these antipsychotics, the early ones in particular, we see really severe side effects. So there was a lot of challenge to try and find what worked and what didn't work, and whether the individuals could tolerate the side effects in response. In 1975, there was a movement to deal with what was called mental retardation at that point. We now see it as cognitive challenges.
But at that point, what we had was a number of individuals with cognitive impairment. If it was severe enough, they were placed in residential hospital kinds of settings. And that did not lead to good care for them in some cases.
So again, we saw reform come in. And this is just a... few decades back in the 1970s. Also in the 1960s and 70s we saw a significant movement towards what's called deinstitutionalization.
While we had all these big asylums and they became later known often as mental hospitals or state hospitals, what was the movement was that these were not places of health or healing for these individuals and so many of them were closed down and those individuals were taken back to their homes or that was the intention, but frequently those individuals did not have good, healthy places to return to. And what has happened as a result if we go back and look at the transition from deinstitutionalization to today is a significant increase in homelessness of those with severe mental health issues. So today rather than asylums we have psychiatric hospitals. there's still a need for individuals to have the stability and health care provided at that level. They are limited in scope in terms of just the severe cases.
Usually we're talking about individuals that have severe psychotic representations, other medical concerns, suicidal ideation to the point where they cannot stabilize on their own. And the idea is that they will go into the psychiatric hospital. get some good health care including safety, nutrition, hopefully some increased sleep because often that's the problem and in that find a better way to manage things with a holistic approach to their health care. Getting into a psychiatric hospital can be done either with a voluntary admission of a patient into that or an involuntary admission.
Involuntary admissions are done with individuals who are a threat of imminent danger to self or others. And in those cases, they are placed, depending on the state laws, in a holding situation for safety until it can be determined whether that imminent danger is ongoing. If it's ongoing, they are likely to be admitted into a psychiatric hospital situation until further interventions can be built into a plan for treatment for them.
So that's kind of the history that gets us to the treatments that are in place. I'm going to move into the specific theoretical orientations in the next video. But as we consider what's going on in the United States today, we are seeing increasing rates of people reporting diagnostic symptoms, maybe not a formal diagnosis.
We even have rates in 2020 showing increased Substance use, maybe not to the point of disorders, but additionally comorbid with that, mood disorders and anxiety. All of these could load towards significant need for mental health treatment.