Mental disorders are classified as psychological conditions marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. The DSM-5-TR defines mental disorders as syndromes arising from dysfunction in relevant biopsychosocial processes that results in significant disturbances in behavioral responses, emotional regulation, and other cognitive processes. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components, and may impede the individual from functioning normally in society. The acknowledgement and understanding of mental health conditions have changed over time and across cultures; however, stigmatization still persists. There are also significant discrepancies in the diagnosis and treatment of mental disorders across various social, racial and gender groups. There are still variations in the definition, classification, and treatment of mental disorders.
History As society's attitudes towards mental illnesses have substantially changed throughout the years, so have the methods of treatment. Many early treatments for mental illness have since been deemed ineffective and even dangerous. Some of these earlier treatments included trephination and bloodletting. Trephination refers to the process of drilling a small hole into the patient's skull in an attempt to 'let out demons', reflecting an earlier religious and cultural belief that mental disorders were demonic in nature. Bloodletting is when a certain amount of blood is drained out of a person due to the belief that chemical imbalances result in mental disorders. Both treatments were dangerous and ineffective. Similarly, herbs and sexual abstinence were frequently prescribed to women for cases of hysteria as this was believed to be an exclusively female disease until Freud.
During the 17th century, however, it became common for individuals with mental disorders to be locked away in institutions due to a lack of knowledgeable treatment options. Mental institutions became the main treatment for a long period of time. Through years of research and medical developments, safe and effective treatments both psychologically and pharmacologically have become available to patients. Early glimpses of the treatment of mental illness included dunking in cold water by Samuel Willard (physician), who reportedly established the first American hospital for mental illness. Digital Treasures, Samuel Willard ran a "hospital for the insane" l and trained young physicians, East side of Uxbridge Common, (no longer standing) The history of treatment of mental disorders consists of a development through years, mainly in both psychotherapy (Cognitive therapy, Behavior therapy, Group Therapy, and ECT) and psychopharmacology (drugs used in mental disorders).
Different perspectives on the causes of psychological disorders also continued to arise. Some scholars believed that psychological disorders are caused by specific abnormalities of the brain and nervous system. This perspective reflected the principle that they should be approached for treatment in the same way as physical illness, a belief that initially arose from Hippocrates.
Psychotherapy is a relatively new method used in the treatment of mental disorders. The practice of individual psychotherapy as a treatment of mental disorders is about 100 years old. Sigmund Freud (1856–1939) was the first to introduce this concept in psychoanalysis. Cognitive behavioral therapy is a more recent therapy that was founded in the 1960s by Aaron T. Beck, an American psychiatrist. It is a more systematic and structured part of psychotherapy. It consists of helping the patient learn effective ways to overcome their problems and difficulties that cause them distress. Behavior therapy has its roots in experimental psychology. E.L. Thorndike and B.F. Skinner was among the first to work on behavior therapy.
Convulsive therapy was introduced by Ladislas Meduna in 1934. He induced seizures through a series of injections as a means to attempt to treat schizophrenia. Meanwhile, in Italy, Ugo Cerletti substituted injections with electricity. Because of this substitution, the new theory was called electroconvulsive therapy (ECT).
Besides psychotherapy, a wide range of medications are used in the treatment of mental disorders. The first drugs used for this purpose were extracted from plants with psychoactive properties. Louis Lewin, in 1924, was the first to introduce a classification of drugs and plants that had properties of this kind. The history of the medications used in mental disorders has developed a lot over the years. The discovery of modern drugs prevailed during the 20th century. Lithium, a mood stabilizer, was discovered as a treatment of mania by John F. Cade in 1949, and Hammond (1871) used lithium bromide for 'acute mania with depression'". In 1937, Daniel Bovet and Anne-Marie Staub discovered the first antihistamine. In 1951, Paul Charpentier synthesized chlorpromazine an antipsychotic.
Influences Several practitioners have influenced the treatment of modern mental disorders. During the 18th century in Philippe Pinel, a French physician, helped/advocate for better treatment of patients with mental disorders. Similar to Pinel, Benjamin Rush, a Philadelphian physician, believed patients just needed time away from the stresses of modern life. Which he believed was the cause of mental disorders to develop. Benjamin Rush(1746–1813) was considered the Father of American Psychiatry for his many works and studies in the mental health field. He tried to classify different types of mental disorders, he theorized about their causes, and tried to find possible cures for them. Rush believed that mental disorders were caused by poor blood circulation, though he was wrong. He also described Savant Syndrome and had an approach to addictions.
Other important early psychiatrists include George Parkman, Oliver Wendell Holmes Sr., George Zeller, Carl Jung, Leo Kanner, and Peter Breggin. George Parkman (1790–1849) got his medical degree at the University of Aberdeen in Scotland. He was influenced by Benjamin Rush, who inspired him to take an interest in the state asylums. He trained at the Parisian Asylum. Parkman wrote several papers on treatment for the mentally ill. Oliver Wendell Holmes Sr.(1809–1894) was an American Physician who wrote many famous writings on medical treatments. George Zeller (1858–1938) was famous for his way of treating the mentally ill. He believed they should be treated like people and did so in a caring manner. He banned narcotics, mechanical restraints, and imprisonment while he was in charge at Peoria State Asylum. Peter Breggin (1939–present) disagrees with the practices of harsh psychiatry such as electroconvulsive therapy.
Classification German Physician Emil Kraepelin was more interested in the causes of mental disorders and potential classifications rather than focusing on and attempting to treat symptoms of mental disorders. This led to the classification of manic depression and Schizophrenia, as well as the start of a framework for classifying other disorders. However, this method of research/work was ignored until the need for a universal classification system arose. This need would later lead to the creation of the DSM. This not only provided classification of mental disorders but also helped to understand where to start in terms of treatment.
Psychotherapy A form of treatment for many mental disorders is psychotherapy. Psychotherapy is an interpersonal intervention, usually provided by a mental health professional such as a clinical psychologist, that employs any of a range of specific psychological techniques. There are several main types. Cognitive behavioral therapy (CBT) is used for a wide variety of disorders, based on modifying the patterns of thought and behavior associated with a particular disorder. There are various kinds of CBT therapy, and offshoots such as dialectical behavior therapy. Psychoanalysis, addressing underlying psychic conflicts and defences, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of relationships as well as individuals themselves. Some psychotherapies are based on a humanistic approach. Some therapies are for a specific disorder only, for example, interpersonal and social rhythm therapy. Mental health professionals often pick and choose techniques, employing an eclectic or integrative approach tailored to a particular disorder and individual. Much may depend on the therapeutic relationship, and there may be issues of trust, confidentiality and engagement.
To regulate the potentially powerful influences of therapies, psychologists hold themselves to a set of ethical standers for the treatment of people with mental disorders, written by the American Psychological Association. These ethical standards include:Schacter, D. L., Gilbert, D. T., & Wegner, D. M. (2010). Psychology. (2nd ed., p. 620). New York: Worth Pub. Striving to benefit clients and taking care to do no harm; Establishing relationships of trust with clients; Promoting accuracy, honesty, and truthfulness; Seeking fairness in treatment and taking precautions to avoid biases; Respecting the dignity and worth of all people.
Medication Psychiatric medication is also widely used to treat mental disorders. These are licensed psychoactive drugs usually prescribed by a psychiatrist or family doctor. There are several main groups. Antidepressants are used for the treatment of clinical depression as well as often for anxiety and other disorders. Anxiolytics are used, generally short-term, for anxiety disorders and related problems such as physical symptoms and insomnia. Mood stabilizers are used primarily in bipolar disorder, mainly targeting mania rather than depression. Antipsychotics are used for psychotic disorders, notably in schizophrenia. However, they are also often used to treat bipolar disorder in smaller doses to treat anxiety. Stimulants are commonly used, notably for ADHD.
Despite the different conventional names of the drug groups, there can be considerable overlap in the kinds of disorders for which they are actually indicated. There may also be off-label use. There can be problems with adverse effects and adherence. Differences in the frequency of the prescription of medication for treatment of mental disorders exist along social, racial, and gender lines, with marginalized groups being medicated at higher rates. These discrepancies are particularly pronounced in lower socioeconomic status groups and women. This over-reliance on medication as a form of treatment can be harmful to the affected populations, with outcomes such as the potential for addiction, side effects, and recreational misuse.
Antipsychotics