2. OVERVIEW
2
A History of Mental Health in Society
How Perspectives Change
Stigma
Cultural Influences
The Role of the Media
Interactive Discussion
3. ANCIENT EGYPT
3
c. 2600BC
Importance of mental health deeply rooted in the
nature of their religion
Egyptian physicians were doctors and priests so
therapies combined practical and magical
components
(Shaw, 2000) (Okasha, 2005)
Imhotep
4. ANCIENT GREECE
4
c. 400BC
Humoral Theory, rejecting supernatural
explanations of illness
Recognition of brain as an organ of mind and
susceptible to disease
Stereotypical association of madness and violence
leading to maltreatment
Hippocrates
(R. D. Forrest, 1982)
5. MIDDLE AGES (5TH – 15TH CENTURY)
5
Christianity:
• Mental illness thought to be due to
divine retribution or diabolical
possession (especially in continental
Europe)
• Mental disorders considered as
moral punishment
• This worldview highly conducive to
persecution
(Roffe, 2000) (Kemp and Williams, 1987)
6. MIDDLE AGES (5TH – 15TH CENTURY)
6
Other views held at the same time:
• Biological understanding common among
scholars
• Little effect on standard of treatment, though
moral stigma reduced
(Lindberg, 2003) (Kroll and Bachrach, 1984)
7. THE ENLIGHTENMENT (18TH
CENTURY)
• New principles become important:
•Religious Tolerance
•Importance of Reason
•Universality of natural rights
•Humanism
• A time of critical questioning in which science
and rationality became important
• Treatments become more humane:
• ‘The insane…are patients whose painful condition
must be treated with all the consideration due to the
suffering of human beings’ (Pinel)
7
(Riese, 1951)
8. GEORGE III (1738 – 1820)
8
• Very public mental deterioration of a popular king
• Significant remission in 1789 brought about
change in public perception of mental illness
(Bewley, 2008)
9. TOWARDS MODERNITY
9
Rise of asylums accompanied by rise of psychiatry
Many treatments tried: lobotomy, ECT,
hydrotherapy
Deinstituionalisation – psychiatric hospitals
replaced by community mental health services
(1960s onwards)
(Fakhoury and Priebe, 2002)
10. TODAY
10
Biopsychosocial Model:
Interaction of biological, psychological and social
factors in manifestation of disease
Links science and humanism
Emphasis placed on social and psychological
rehabilitation
(Smith, 2002)
11. HOW THINGS CHANGE
11
Scientific Revolutions and Paradigm Shifts
Paradigm: a worldview underlying the theories and methodology of a particular scientific subject
Examples of paradigm shifts: - Ptolemaic Cosmology Copernican Cosmology
- Newtonian Physics Einsteinian Relativism
Paradigm shifts occur when scientists encounter anomalies which
cannot be explained by the current paradigm.
Transition between paradigms are times of intellectual conflict.
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but
rather because its opponents eventually die, and the new generation grows up that is familiar with it.” –
Max Planck
“In all affairs, it is a healthy thing now and then to hang a question mark on the things you have long
taken for granted” – Bertrand Russell
12. PERCEPTIONS OF MENTAL HEALTH
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Definitions change:
Drapetomania
Homosexuality
Soviet Psikhushkas (political abuse of psychiatry)
Science and Society often influence each
other (Hope, 2004)
13. EVOLVING UNDERSTANDING
13
Treatment Models: Moral Legal Medical
Changes in public understanding influence
attitudes towards the mentally ill
So the question becomes how does public
understanding change?
14. ROLE OF LITERATURE
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Important in promoting empathy and scientific
understanding
“Literature helps medical students to gain a deeper understanding
of patients and to feel more empathy towards them” (Psychiatrist,
2010; 34:475-9)
15. STIGMA
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Stigma is a prejudice based on stereotype which
leads to discrimination
Three main types:
Public Stigma
Self-Stigma
Label Avoidance
(Thornicroft, 2008)
16. STIGMA IN THE MEDICAL
PROFESSION
16
Doctors and students affected by public stigma of
mental health
Many psychiatrists feel stigmatised within their own
profession
Career in psychiatry seen as less prestigious than
other careers
(Student BMJ; 18:c6946)
17. WAYS OF REDUCING STIGMA
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“Destigmatisation requires demystification” (Strain,
1993)
Social Contact Theory
National Advertising Campaigns
Personal contact + scientific understanding + role
of celebrities together can help to reduce stigma
18. ROLE OF MEDIA
18
Entertainment
Hollywood creation of stereotypes
TV plots/characterisation
News
Disproportionate reporting of crime
Bias towards mentally ill
Effects
Societal association between mental illness and violence
Internalised stigma, isolation of mentally ill
Impact on political decisions
(Psychiatry News, 2001)
19. NEWS REPORTING OF MENTAL
ILLNESS
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• Media’s manner of reporting has an important role
in influencing public opinion and behaviour (National
Media and Mental Health Group,2009)
• Link between mental illness and risk of violence is
main media focus
• Media tendency to sensationalize threat
• Little change in tone in reporting since 1950s (O’Hara,
2011)
20. REFERENCES
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• Depression by R. W. Lam and H. Mok
• A Very Short Introduction to Medical Ethics by T. Hope
• Medical Ethics and Law by D. Sokol and G. Bergson
• ‘Press Coverage of Mental Health and Suicide’ by M. O’Hara
• ‘The Stigma of Mental Illness: Inevitable or Unjustifiable?’ by G. Thornicroft
• ‘The Forsaken Speciality’ by Z. Cruse (Student BMJ)
• ‘Forensic Psychiatry’ by S. Timbrel (Student BMJ)
• ‘The Structure of Scientific Revolutions’ T. Kuhn
• Psychiatrist 2010; 34:475-9
• N Engl J Med, 1993; 328:1133
• The Oxford History of Ancient Egypt by I. Shaw
• ‘Mental Health in Egypt’ by A. Okasha
• ‘Early History of Wound Treatment’ by R. D. Forrest
• ‘[Concept of Insanity in Classical Greece]’ by E. La Croce
21. REFERENCES CONTINUED
21
• ‘Did the Ancient Greeks get their ideas from the Africans?’ by How Stuff Works
• ‘Major Periods of Muslim education and learning’ Encyclopedia Britannica Online
• ‘Demonic possession and mental disorder in medieval and early modern Europe’
by S. Kemp and K. Williams
• When Science and Christianity Meet by D. C. Lindberg
• ‘Sin and mental illness in the Middle Ages’ by J. Kroll and B. Bachrach
• ‘Perceptions of insanity in medieval England’ by D. Roffe
• Philippe Pinel (1745-1846) His Views on Human Nature and Disease. His
Medical Thought by Walther Riese
• ‘Psychiatric therapy in Georgian Britain’ by P. Laffey
• Madness to Mental Illness by T. Bewley
• George III and the Mad Business by I. Macalpine and R. Hunter
• ‘Deinstitutionalization and reinstitutionalization: major changes in the provision of
mental healthcare’ by W. Fakhoury and S. Priebe
• ‘The process of deinstituionalization: an international overview’ by W. Fakhoury
and S. Priebe
22. REFERENCES CONTINUED
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• ‘The Biopsychosocial Revolution’ by R. C. Smith
• ‘Models of Mental Illness’ www.ucl.ac.uk/medical-
education/publications/…in…/Chapter27.pdf
• Psychiatric News, May 4, 2001 Volume 36 Number 9 Page 10
• ‘A Mind-frame Resource for the Mental Health and Suicide Prevention Sectors’
by National Media and Mental Health Group
• ‘The Media & Mental Illness’ by B. Duncan
23. ETHICS AND MENTAL HEALTH
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• Mental Health Act 1983:
• Provides the only situation in which a doctor can treat a competent patient
without their consent, if they have a diagnosis of a mental disorder
(Competence: Clinical capacity to make health care decisions is the
ability to understand the benefits and risks of the proposed health care,
to understand possible alternatives, and to make and communicate a
health care decision.)
Is this Ethical?
24. DEPRESSION IN SOCIETY
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• Lifetime risk of experiencing major depressive disorder
(MDD) is approximately 15%
• Lifetime risk of developing depression in those born after the
Second World War is increasing
“I see all this potential, and I see squandering. God damn it, an entire generation
pumping gas, waiting tables; slaves with white collars. Advertising has us chasing
cars and clothes, working jobs we hate so we can buy shit we don't need. We're the
middle children of history, man. No purpose or place. We have no Great War. No
Great Depression. Our Great War's a spiritual war... our Great Depression is our
lives. We've all been raised on television to believe that one day we'd all be
millionaires, and movie gods, and rock stars. But we won't. And we're slowly learning
that fact. And we're very, very pissed off.” (Fight Club, 1999)
• Do you think that our modern lives are conducive to
depression?
