Mental illness has long presented an enigma
By Jonathan L. Stolz and M.D.
Unlike individuals who are afflicted with physical maladies, those tormented with mental disorders commonly live under a cloud of the public's misunderstanding about the nature of their ailments. This misconception sometimes becomes more apparent in conversations after tragedies, such as the recent school shooting in Florida.
Here, as in similar past events, determination of the potential reasons for the calamity often focus on whether the perpetrator has a psychiatric disorder. In the discussion of the suspect's mental state, sometimes unconfirmed reports, anecdotes and nonprofessional opinions can inadvertently portray mental illness inaccurately.
This, unfortunately, may help perpetuate long-held and mistaken stereotypes within the general public's mind about what constitutes the broad range of psychiatric afflictions and how it may affect someone.
This agnosia about mental disorders is not new to society. Today, with one-fifth of Americans suffering from some sort of mental illness, an understanding of how psychopathology was viewed in the past can give one an appreciation of why it still remains such an enigma.
Mental illnesses are unique because they have always been defined by the assessment of a person's symptoms or behavior rather than by physical, chemical or anatomical tests. While psychiatry as a medical field was first named in 1808, madness itself has been recognized since the earliest times.
In the 16th century, those in Europe with unruly behavior in some villages were sent away with hired sailors paid for by the citizens, hence the origin of the phrase "ship of fools." By the 18th century, mental illness became incorporated into the medical model. "Mad doctors" or "alienists" placed deranged persons into asylums, removing them from the concerned populace. These institutions were the last resort for hopeless cases. By the end of the 19th century, psychiatry, unlike other fields of medicine, had not made any discoveries that could explain, predict or cure the demented.
Beginning in the 1930s, psychiatrists, in an effort to control those with depression and schizophrenia, tried radical treatments: electroshock therapy and prefrontal lobotomies. But following World War II, a new generation of physicians came to the forefront who emphasized social factors in mental health. At the same time antipsychotic drugs emerged. Chemotherapy became the preferred method of treatment as it moved to the outpatient setting.
As a consequence — and to the chagrin of many — there was a deinstitutionalization of the mentally ill that began in the 1960s.
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With the mass exodus of patients, society was unprepared for the influx of unstable individuals that came to their communities. Many of these former inpatients, without any support system outside the hospital, became homeless and were shunned. There was inadequate funding to help and few advocates to obtain more.
In the past 30 years, better drugs, based upon the growing understanding about chemical imbalances in the brain, have come to the marketplace. But, as it has for past generations, the stigma of what constitutes the spectrum of mental disorders remains a riddle for many.
The abundance of positive information about advances in surgery and medicine make the headlines. Stories featuring psychiatry not only seem to emerge less frequently, but, when present, they often come with a negative context, such as reporting on tragic events.
It's no wonder that most people today do not see the equivalency between physical and mental disorders. That needs to change.
Stolz is a retired physician living in James City County with a longstanding interest in the history of medicine.