From trepanations to psychoanalysis, how we have treated mental illness

As concern for mental health grows in our world, we are faced with the problem of caring for it, preserving it and recovering it when it is lost, which requires a greater understanding of the mechanisms that produce different conditions, from anxiety and depression to bipolar disorder. or schizophrenia.

The concern comes from ancient times, when mental problems were explained by supernatural influences: spirits, demons or witchcraft, an idea that prevailed in different forms for thousands of years, from ancient Mesopotamia where mental illnesses were generally attributed to the action of various gods, until the idea began to develop among the Greeks and Romans that alterations in perception and behavior were diseases like those that affected the body. It was the passage from the supernatural hypotheses to the two naturalistic visions: the somatogenic one, which identifies problems derived from a malfunction of the body due to illness, heredity, brain damage, chemical imbalances and other factors, and the psychogenic one, which addresses the problems due to traumatic or stressful experiences, associations and cognitions that leave their mark, distorted perceptions and all alterations that do not depend on the physiology, anatomy and chemistry of the body.

The different explanations that were given to the strange behaviors and declarations of the lunatics, the madmen, had as a consequence, of course, different approaches. Leaving exorcisms, incense, prayers, amulets and magic potions aside, some interventions have left us, literally, traces in the remains of ancient humans. Such is the case of trepanation, which consists of making a hole in the skull, removing a circle of bone, which was expected to treat headaches or mental illness... or, perhaps, allow the exit of the demons that possessed the unhappy patient.

The first evidence we have found of trepanation is a skull found at a Neolithic site in France, dating back 7,000 years. What is remarkable, however, is that the trepanned subjects often survived the operation uneventfully and lived for many years longer, as evidenced by bone growth at the edges of the burr hole.

Inca trepanations.

four humors theory

In ancient times and until the appearance of medical science, treatments alternated according to the beliefs of the moment. Galen's theory of the four humors was also applied to mental illnesses, which involved the use of enemas, emetics and bloodletting to 'balance the humors', as was done with any illness, generally with terrible results because in addition to not having no therapeutic effect, weakened and made the patient uncomfortable.

As of the 17th century, asylums appeared, which instituted isolation as a preferred treatment, already practiced in some cases since the Middle Ages. This was more to reassure a society that feared those with serious conditions than the patients themselves, who were usually 'treated' with beatings, cold water, or restrictions such as the 'straitjacket' invented in the late 18th century.

In the 19th century, psychotherapies began to be developed where it was intended to solve the conditions by speculatively analyzing the ideas of the patients, in particular the psychoanalysis of Freud and the variants of his many followers. Although it was a breakthrough to try to understand the origin of disorders and became very popular, its effectiveness has been unprovable.

Sigmund Freud, father of psychoanalysis.

It was not until the beginning of the 20th century when the most scientific approaches to mental problems introduced treatments that were effective in some cases, although enormously dangerous, such as insulin shock therapy, which was used between 1927 and 1960 in which a coma was caused by insufficient sugar. in the blood with an injection of insulin. Other contemporary shock therapies were electroconvulsive, deep sleep and psychosurgery, controversial treatments whose effectiveness in treating schizophrenia in particular is under discussion, but their dangers are not.

The most terrible therapy, which began so promisingly that it was awarded a Nobel, turned out to be prefrontal lobotomy.

The most terrible therapy, which began in such a promising way that it was awarded a Nobel, turned out to be the prefrontal lobotomy, which became a fashion that left thousands of patients with problems of apathy, passivity, lack of initiative , inability to concentrate and a superficial and limited emotional life.

It was less than a hundred years ago, in the 1950s, that the combined advances in psychology and psychiatry opened the door to safe and effective treatments for many mental problems. Pharmacological drugs have shown great efficacy, especially in cases of problems with psychotic experiences or loss of contact with reality, such as schizophrenia, bipolar disorder and schizoaffective disorder. Used correctly, antipsychotics allow a normal life for many patients who in the past would have been confined to a mental hospital, victims of their distorted perceptions of reality.

Other medications, such as those for depression and anxiety, are effective but ultimately problematic, and are often accompanied by evidence-based, proven and developed therapies that only began to develop in the 1990s. and the first that was subjected to randomized studies such as those carried out for chemical drugs, is cognitive behavioral therapy, which is used above all for depressive and anxiety symptoms, but which is also useful in the treatment of eating disorders, substance abuse, bipolar disorder, post-traumatic stress disorder, and other conditions.

are you crazy

Time and time again, different dictatorships have argued that anyone who opposes them clearly has a psychiatric problem. This was called, in the Soviet Union, the 'psychopathological mechanism of dissidence' and in China 'political psychiatric danger'. Other countries that have used the pretext of mental problems to persecute their dissidents are Nazi Germany, Japan, Cuba, Norway, Romania and the United States, where it was even claimed that the desire to escape that black slaves had was a metal disorder.

But there is still a long way to go: neither drugs nor therapies are effective in all cases and there is still much to know about how our nervous system and its function, the mind, are affected by various factors. In many ways, we are still in the infancy of mental health care, but at least we are past the most violent and ignorant times.

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