Deinstitutionalization 

As the inhumane conditions of asylums were critiqued, and other treatments began to be developed, the 20th century saw mental health treatment go through a period of deinstitutionalization. Care was transferred to the community: but the process of closing asylums down was not always a smooth one. There were questions over whether governments were simply absolving themselves of responsibility by reducing state care – as well as gaining financially by selling the buildings off. The number of inpatient beds available in Britain declined from 150,000 in the 1950s to 27,000 60 years later, and there have long been arguments on whether enough was done to look after those who’d been discharged. 

Inpatient beds available in Britain have declined

Today, the majority of people receive help as an outpatient rather than an inpatient, and inpatients stay for days or weeks rather than being consigned for the rest of their lives as in the asylum era. Now, help is available from multiple sources too, like social workers and mental health counsellors, rather than just doctors and nurses.

Psychotherapy and talking cures

As the use of the physical treatments of the asylum era declined, the development of psychotherapy and other talking cures proceeded. Sigmund Freud was, of course, one of biggest names when it came to psychiatry in the 20th century. He posited that many issues were down to repressed thoughts and feelings and that by accessing them through talking, they could be solved. In this line of thought, patients would track their dreams and use their diaries as a tool with their psychiatrist to see patterns in their thoughts and cure their illness. As the decades went on, his methods were criticised for lack of proof of effectiveness, though his ideas were hugely influential. 

CBT or Cognitive Behavioural Therapy

A popular talking approach that is taken today – and with big differences to the psychoanalyst approaches of earlier – is Cognitive Behavioural Therapy. Rather than discussing issues of the past, CBT focuses on working on current feelings and behaviours to change negative patterns and find practical strategies to improve patients’ states of mind. It was originally developed to treat depression, but has been shown to be effective at treating a range of mental health conditions, often in combination with pharmacological treatments.  

Pharmacology 

Pharmacology was one of the major breakthroughs of the 20th century. Surgical interventions that had been popular previously were increasingly seen to have risks that outweighed the possible benefits; medication was explored instead. In 1949, the Australian psychiatrist John Cade introduced Lithium as a treatment for the first time, which controlled psychosis symptoms far better than anything attempted previously. It became a standard treatment, and during the 20th century other drugs like Chlorpromazine and Prozac became household names. Nowadays, there are a wide range of psychiatric medications targeting different conditions, whether they are antidepressants, mood stabilizers or antipsychotics. 

Mental Health Medication

The Modern Era

The way that mental health and mental illness are approached today seems a world away from the ideas of the past. However, those past ideas provided an important background and route for where we are now. Today, a mixture of those views we’ve seen before are taken: rather than attributing mental ill health purely to biological sources or purely to past experiences, we instead point to a combination of different factors. In this biopsychosocial view, mental illness is seen to be caused by a combination of genetic predisposition, psychological stressors and sociocultural influences – all three of which have been touched upon (albeit with different language and reasoning) for centuries before us. 

Thanks once again to Meg Proops, who volunteered her time, mind and her magnificent words for this third of three fascinating blog pieces. You can read the first part here and second part here.

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