From Witch Hunts to Moral Therapy: Examining the History of Mental Health Care

Jan 30, 2019

Only 60 to 70 years ago, patients deemed mentally unstable were sent to isolated rooms in mental asylums as treatment. A hundred years ago and beyond, mental instability was explained through demonic possession or other supernatural causes. Since then, we've made massive strides in mental health care. Michael Bordieri, Ph.D., professor of psychology, visits Sounds Good to discuss the history of the treatment of mental disorders.

"For most of human history, the notion of a psychological disorder wasn't really a thing," Bordieri explains. "Those strange behaviors, abnormal emotions, moods, or behaviors, were explained as the supernatural. [This was] predominantly targeted towards individuals who really, looking back through history, display signs of mental illness."  This, of course, led to equally fantastical treatment plans. "If the problem is you're possessed by a demon, spirit, or a witch, the goal is to make the body unfit for for a demon possession. These things include exorcisms, snake pits to ward off the spirits, or, even worse, some of the torture that was often done in the service of treating a supernatural cause."

The first real shift towards a more humanistic approach to the treatment of mental disorders occurred in the 19th century. Moral treatment became the cornerstone of mental health care in the 1800s. According to the British Science Museum's History of Medicine website, moral treatment advocated for the belief that "an asylum patient had a better chance of recovery if treated like a child rather than an animal." Introduced by Quaker asylum director, William Tuke, moral therapy "rejected orthodox medical treatments used in asylums of the time, which mostly involved blood-letting, purging, and physical restraints such as chains and manacles." In this new form of treatment, patients were expected to dine at the table, make polite conversation over tea, consider the consequences of their actions, clean, and garden. 

As medicinal knowledge continued to evolve, the combination of moral therapy and monitered medication became the normal treatment for mental disorders. "We've discovered in the past 50 or 70 years a wonderful array of treatments and medication that can help," Bordieri explains. "But the start of it came from a much simpler idea that when we see others struggle or suffering, we want to approach them with dignity, kindness, and respect. And from that, all these advancements came."

Like all fields of medicine, we still have more strides to take to perfect an efficient and effective form of mental health treatment. Bordieri says, "we have, as a society, gotten better at talking about mental illness, being better about understanding that people with mental illnesses are our neighbors, our family, our friends -- they're people first. So we can provide an environment that's safe and supportive for them. I think we have a ways to go. Some of that is providers, like myself, being better at talking to individuals who are concerned and families that are concerned. Part of it is building better choice into treatment. It's not that you come in and you're locked against your will, and you don't know how long you're staying or what'll happen to you, but we can empower individuals to make their own decisions that are right for them and their families regarding treatment. We can give consumers mental health service options and choices as to what's the best fit for them and their values instead of presuming there's one way."

"I think we have lots of wonderful things happening, and we still need to do better. If you look back at mental health and how we're working today versus 200 years ago, sure, we deserve a pat on the back -- but really just for a second or two. We have to think about where we want to be 50 years, 100 years from now, and how we can do better at meeting the needs of everyone. I think that fundamental piece that we don't want to lose sight of is first and foremost, we want to help humans. We want to see peoples [as] whole, complete persons, worthy of dignity and respect, and involve everyone in this process of building a better and healthier world."