How did mental illness treatment evolve in the 19th century. What were the main approaches to treating psychiatric disorders in the 1800s. Why did asylums become the primary care facilities for the mentally ill. How did early forms of psychotherapy emerge at the end of the century.

The Rise of Asylums in 19th Century Mental Health Care

The 19th century marked a significant shift in the treatment of mental illness. Prior to this era, individuals with psychiatric disorders were primarily cared for by their families in rural settings. However, the Industrial Revolution and subsequent urbanization brought about new challenges and perceptions regarding mental health.

As cities grew more crowded, public fears about the potential dangers posed by those with mental illnesses increased. This sentiment became the driving force behind the establishment of asylums, which were designed to confine and treat psychiatric patients away from the general population.

Public vs. Private Asylums

By the mid-1800s, many states had opened public psychiatric asylums. These institutions primarily served the poor, as wealthier patients could afford to seek treatment in private, philanthropic asylums such as McLean Hospital in Massachusetts.

The disparity between public and private care facilities became increasingly apparent as the century progressed. Public hospitals often struggled with overcrowding and deteriorating conditions, while private asylums offered more personalized care and better accommodations.

The Emergence of Home-Based Care for the Wealthy

Towards the end of the 19th century, a new trend emerged in mental health care for affluent patients. In response to the declining conditions in public hospitals, some physicians began opening small, private asylums within their own homes.

These home-based care facilities offered a “home away from home” experience for wealthy psychiatric patients. The intimate setting and personalized attention provided a welcome alternative to the often impersonal and overcrowded public institutions.

Influence of European Reformers

The concept of small, private asylums drew inspiration from early 19th-century European reformers such as Phillipe Pinel (1745-1826) and William Tuke (1732-1822). These pioneers advocated for a more humane approach to treating mental illness, emphasizing the importance of routine and a pleasant environment—a method known as “moral therapy.”

While larger public hospitals struggled to implement these ideals due to financial constraints and overwhelming patient numbers, private asylums were better equipped to offer individualized care and attention.

Popular Treatments in 19th Century Asylums

Throughout much of the 19th century, the prevailing medical view held that mental illness resulted from defects in the nervous system. This somatic understanding of psychiatric disorders influenced the types of treatments offered in both public and private asylums.

• Hydrotherapy: The use of water in various forms to treat mental health conditions
• Electrical stimulation: Applying electrical currents to the body in an attempt to correct perceived nervous system imbalances
• Rest therapy: Prescribing extended periods of bed rest and isolation to alleviate mental distress

These physical treatments remained popular well into the early 20th century, even as new psychological approaches began to emerge.

The Shift Towards Psychological Understanding

Between 1890 and 1918, when private asylums were at the peak of their popularity, a significant shift in medical thinking began to take place. A small but growing number of physicians started to move away from the purely somatic view of mental illness, adopting a more psychological understanding of psychiatric disorders.

Boris Sidis and the Birth of Psychotherapy

One notable figure in this transition was Boris Sidis (1867-1923), a physician who had also earned a PhD in psychology from Harvard University under the guidance of William James. Sidis’s psychological training set him apart from many of his contemporaries in the field of mental health.

Sidis argued that consciousness, rather than the nervous system, should be the primary focus of psychological study. He also believed in the concept of the subconscious mind, which would later become a cornerstone of psychoanalytic theory.

Hypnosis and Memory Recovery

In his treatment approach, Sidis utilized hypnosis to access patients’ subconscious memories. He believed that by bringing these hidden memories to conscious awareness, patients could experience relief from their symptoms. This method was an early precursor to more advanced forms of psychotherapy that would develop in the 20th century.

The Sidis Psychotherapeutic Institute: A Bridge Between Old and New

In 1910, Boris Sidis opened the Sidis Psychotherapeutic Institute on a wealthy New Englander’s estate in Portsmouth, New Hampshire. This private asylum represented a unique blend of traditional and innovative approaches to mental health treatment.

Sidis advertised his institute in psychological journals, hoping to attract referrals from colleagues who shared his interest in psychological approaches to mental illness. He emphasized the availability of his “special psychopathological and clinical methods of examination, observation and treatment.”

Balancing Luxury and Treatment

Interestingly, Sidis’s promotional materials focused heavily on the luxurious accommodations and picturesque setting of the institute. He described “beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, and private farm products.”

This emphasis on comfort and opulence suggests that wealthy patients and their families still expected a certain level of luxury in their mental health care, even as treatment methods began to evolve.

Combining Traditional and Innovative Treatments

Despite his advocacy for psychological approaches, Sidis continued to offer traditional somatic treatments such as hydrotherapy and electrical stimulation at his institute. This combination of old and new therapies reflects the transitional nature of mental health care during this period.

Challenges in Adopting Psychological Approaches

The reluctance of many physicians to fully embrace psychological methods of treating mental illness can be attributed to several factors:

1. Established medical views: The long-standing belief in the somatic origins of mental illness was deeply ingrained in medical education and practice.
2. Patient expectations: Wealthy patients often expected traditional medical treatments, making physicians hesitant to adopt radically new approaches.
3. Association with controversial movements: Psychology was sometimes linked to popular “mind cure movements” such as Christian Science, which were viewed skeptically by the medical establishment.

These factors contributed to the slow adoption of psychological treatments in mainstream psychiatric care, despite the efforts of pioneers like Boris Sidis.

The Legacy of 19th Century Mental Health Care

The evolution of mental health treatment in the 19th century laid the groundwork for many of the approaches and debates that would shape psychiatry in the 20th century and beyond. The tension between biological and psychological explanations for mental illness, the role of institutionalization versus community-based care, and the importance of humane treatment all have their roots in this transformative period.

Impact on Modern Psychiatry

Many aspects of 19th-century mental health care continue to influence modern psychiatric practice:

• The recognition of environmental factors in mental health, as emphasized by moral therapy advocates
• The importance of individualized treatment plans, exemplified by private asylums
• The ongoing debate between biological and psychological approaches to mental illness
• The development of early forms of psychotherapy, which would evolve into modern talk therapies

Understanding the historical context of mental health treatment provides valuable insights into current practices and ongoing challenges in the field of psychiatry.

Ethical Considerations in 19th Century Mental Health Care

The treatment of mental illness in the 19th century raises several ethical questions that continue to resonate in modern discussions of mental health care:

Institutionalization and Personal Freedom

The widespread use of asylums to confine individuals with mental illness sparked debates about personal liberty and the rights of psychiatric patients. How can society balance the need for public safety with the rights of individuals with mental health conditions?

Socioeconomic Disparities in Care

The stark differences between public and private asylums highlight the impact of wealth on access to quality mental health care. This disparity remains a significant issue in many healthcare systems today. How can equitable access to mental health treatment be ensured across all socioeconomic levels?

Experimental Treatments and Informed Consent

As new treatments emerged, questions arose about the ethics of experimenting on vulnerable populations. The concept of informed consent was not well-developed during this period. How can the need for medical progress be balanced with the protection of patients’ rights and well-being?

These ethical considerations continue to shape discussions about mental health policy, patient rights, and treatment approaches in the modern era.

The Role of Gender in 19th Century Psychiatric Care

Gender played a significant role in the diagnosis and treatment of mental illness during the 19th century. Understanding these historical gender dynamics provides insight into the evolution of mental health care and the challenges that persisted well into the 20th century.

Gendered Diagnoses

Certain mental health conditions were strongly associated with gender in 19th-century psychiatric practice:

• Hysteria: Primarily diagnosed in women, often attributed to supposed defects in the female reproductive system
• Neurasthenia: More commonly diagnosed in men, associated with the stresses of modern life and overwork

These gendered diagnoses reflected and reinforced societal expectations and stereotypes about men and women’s roles and vulnerabilities.

Treatment Disparities

The gender of patients often influenced the type and intensity of treatments they received:

• Women were more likely to be subjected to invasive treatments, such as gynecological surgeries, based on the belief that reproductive organs influenced mental health
• Men were more often prescribed treatments focused on rest and recuperation from the perceived strains of professional life

These disparities in treatment approaches highlight the intersection of gender biases and medical practices in 19th-century psychiatry.

Women in Psychiatric Professions

The late 19th century saw the gradual entry of women into psychiatric professions:

• Nursing: Women played a crucial role in providing day-to-day care in asylums
• Physicians: A small but growing number of women began to practice psychiatry, often facing significant barriers and discrimination

The increasing presence of women in mental health professions began to challenge some of the gendered assumptions prevalent in 19th-century psychiatric theory and practice.

Understanding the historical context of gender in mental health care provides valuable perspectives on ongoing efforts to address gender biases and promote equality in modern psychiatric practice.

A home way from home

Until the 19th century, people with mental illness were cared for by family members, who quietly attended to their needs in rural areas. But with the dawn of the Industrial Age, and its accompanying growth of crowded cities, many people feared people with mental illness were a threat to public safety.

That perceived threat provided the impetus for the creation of asylums to confine psychiatric patients. Consequently, by the second half of the century, many states had opened public psychiatric asylums. These sanctuaries ultimately became the hospitals for the poor, since the better-off patients could take refuge in the private philanthropic asylums, such as McLean Hospital in Massachusetts, which required patients to pay their own way.

The closing decades of the 19th century saw another shift in the care of mentally ill people: In response to the deteriorating conditions of the public hospitals, a number of physicians opened small, private asylums in their own homes for psychiatric patients. For the wealthy patient, hospitalization in a doctor’s residence—a “home away from home”—was undoubtedly a welcome alternative to public care.

To some extent, the small private asylums resembled the early 19th-century hospitals promoted by two European reformers, Phillipe Pinel (1745–1826) and William Tuke (1732–1822). Critical of the harsh treatment of the mentally ill in Europe at the time, Pinel and Tuke advocated using a regular routine and a pleasant environment—or moral therapy as it was called—as tools for treating mental illness. The large public hospitals, facing financial constraints and a growing patient population, simply could not offer this type of attention to patients.

Psychotherapy emerges

For the most part, private asylums offered the treatments that were popular at that time. In the late 19th and early 20th centuries, most physicians held a somatic view of mental illness and assumed that a defect in the nervous system lay behind mental health problems. To correct the flawed nervous system, asylum doctors applied various treatments to patients’ bodies, most often hydrotherapy, electrical stimulation and rest.

From 1890 to 1918, however, when the private hospitals were at the height of their popularity, medical thinking about the etiology of mental illness also began to change. A small number of physicians abandoned the somatic view of mental illness and adopted a more psychological understanding of the disease. Among them was Boris Sidis (1867–1923). Before obtaining his medical degree, Sidis had earned a PhD from Harvard University under the tutelage of William James (1842–1910). Sidis’s psychological training distinguished him from other asylum doctors. He argued that consciousness itself, rather than the nervous system, was the “data” of psychology. Sidis also believed in the subconscious. In his treatment, Sidis hypnotized patients to gain access to memories buried in their subconscious. After he roused patients from the hypnotic trance, Sidis described their memories to them. Patients’ awareness of their hidden memories, according to Sidis, eliminated all of their symptoms.

In 1910, Sidis opened a private asylum, the Sidis Psychotherapeutic Institute, on the Portsmouth, N.H., estate of a wealthy New Englander. Hoping for referrals from psychologically minded colleagues, he announced the opening of his hospital in the Psychological Bulletin and advertised it in the Journal of Abnormal Psychology, which he had founded. The ad noted that he would treat patients by “applying his special psychopathological and clinical methods of examination, observation and treatment.”

Sidis touted the luxury of the asylum’s accommodations and setting, even more than the availability of psychotherapy. “Beautiful grounds, private parks, rare trees, greenhouses, sun parlors, palatial rooms, luxuriously furnished private baths, private farm products,” wrote Sidis in his brochure describing the institute. Moreover, he offered his patients the somatic treatments of hydrotherapy and electrical stimulation, as did his less psychologically minded colleagues. The emphasis on luxury combined with the availability of the popular somatic treatments, even in an institution created by an “advanced” thinker like Sidis, suggests that wealthy patients expected a traditional, medical approach to treatment.

Sidis’s writings point to another reason for physicians’ reluctance to adopt a psychological approach to psychiatric disorders. At the end of the 19th century, psychology was linked to the popular “mind cure movements,” as William James called them, such as the Christian Science Church and the Emmanuel Movement. Mary Baker Eddy founded the Christian Science Church, which advocates prayer for healing disease. The Emmanuel Movement also had religious origins. Elwood Worcester started that movement, offering lectures for nervous patients. In an era when medical practitioners were struggling to establish a scientific footing for their treatments, doctors may have distanced themselves from any psychological therapy because of its link to treatment offered by the clergy, who had no medical training. Sidis addressed this issue in an article about his institute. “Psychotherapy … is diametrically opposed to the superstitious and anti-scientific practices of lay healers and non-medical practitioners. This point cannot be too strongly emphasized,” he declared.

Rich vs. poor

As the Sidis Institute illustrates, life in the small, private asylums contrasted sharply with conditions in the late 19th-century public institutions. Patients at public hospitals were usually involuntarily committed, and they typically displayed violent or suicidal behavior before their hospitalization. The public hospitals were overcrowded and dirty, with bars on the windows. The staff was poorly paid and frequently treated patients harshly. Given these terrible conditions, well-to-do patients used their wealth to take shelter in a physician’s home and escape the fate of the poor. Not surprisingly, the cost of a private hospitalization was steep. Sidis, for example, charged $50 to $100 and “upwards” a week ($50 would be equivalent to roughly $1,000 today). “Bills are payable in advance,” he informed his prospective patients.

For their money, patients received personal, attentive care. Fanny Farmer (1857–1915), the noted cookbook author, stressed the importance of pampering patients to improve their health. Speaking to the staff at one institution, Farmer recommended that patients be given individual custard servings, rather than ladling the custard from a large, common bowl because patients want to feel that they are “being particularly looked out for.”

Compared with the public hospitals, where the gender ratio was almost even, the small, private asylums, at least in New England, cared for many more women than men. There are two likely explanations for this gender difference. First, women were typically less aggressive than men and may have appeared to be more suitable patients for hospitalization in a doctor’s home. It is possible, however, to view the psychiatric hospitalization from a different angle; in an era when most wealthy women’s lives were largely confined to the domestic realm, an institution that advertised its comfortable, homey setting may have provided an acceptable, even fashionable, retreat from the world for well-to-do women. In any case, the differing ratio of women to men in the small, private asylums demonstrates that gender intersected with social class in the history of late 19th and early 20th century psychiatric care.

The small private asylums were quite successful for a number of years. There were only two in Massachusetts in 1879 and more than 20 by 1916. In addition, the asylums frequently started small and grew. The Newton Nervine asylum was a case in point. In 1892, N. Emmons Paine, a Boston University Medical School instructor, opened the Newton Nervine in his own home with four patients. Over the next 10 years, he added three buildings to accommodate a total of 21 patients. A reported increase in the number of mentally ill individuals over the course of the 19th century may have contributed to the success of the private asylums. “A good many people are beginning to realize that nervous diseases are alarmingly on the increase …. Nerves are the most ‘prominent’ complaint of the 19th century,” wrote one reporter in an 1887 issue of the Boston Globe.

After World War I, mental health treatment changed yet again. The growing recognition that baths and electricity were not curing psychiatric illness combined with the failure of autopsies of mentally ill individuals to demonstrate brain lesions raised question about somatic explanations of psychiatric illness. Psychotherapy, which may well have been a tough sell to both patients and medical professionals before the war, clearly overtook the somatic treatments. While private asylums for the wealthy did not completely disappear, psychotherapy, which clinicians could offer in their offices, became the new standard of care for America’s well-to-do.

Ellen Holtzman, PsyD, is a psychologist in private practice in Wakefield, Mass. Katharine S. Milar, PhD, of Earlham College is historical editor for “Time Capsule.”

Treatments for Mental Illness | American Experience | Official Site

A Brilliant Madness |

Timeline

400 B. C.
The Greek physician Hippocrates treats mental disorders as diseases to be understood in terms of disturbed physiology, rather than reflections of the displeasure of the gods or evidence of demonic possession, as they were often treated in Egyptian, Indian, Greek, and Roman writings. Later, Greek medical writers set out treatments for mentally ill people that include quiet, occupation, and the use of drugs such as the purgative hellebore. Family members care for most people with mental illness in ancient times.

Middle Ages
In general, medieval Europeans allow the mentally ill their freedom — granted they are not dangerous. However, less enlightened treatment of people with mental disorders is also prevalent, with those people often labeled as witches and assumed to be inhabited by demons. Some religious orders, which care for the sick in general, also care for the mentally ill. Muslim Arabs, who establish asylums as early as the 8th century, carry on the quasi-scientific approach of the Greeks.

1407
The first European establishment specifically for people with mental illness is probably established in Valencia, Spain, in 1407.

1600s
Europeans increasingly begin to isolate mentally ill people, often housing them with handicapped people, vagrants, and delinquents. Those considered insane are increasingly treated inhumanely, often chained to walls and kept in dungeons.

Late 1700s
Concern about the treatment of mentally ill people grows to the point that occasional reforms are instituted. After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds. Yet in other places, mistreatment persists.

1840s
U.S. reformer Dorothea Dix observes that mentally ill people in Massachusetts, both men and women and all ages, are incarcerated with criminals and left unclothed and in darkness and without heat or bathrooms. Many are chained and beaten. Over the next 40 years, Dix will lobby to establish 32 state hospitals for the mentally ill. On a tour of Europe in 1854-56, she convinces Pope Pius IX to examine how cruelly the mentally ill are treated.

1883
Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and schizophrenia holds to this day.

Late 1800s
The expectation in the United States that hospitals for the mentally ill and humane treatment will cure the sick does not prove true. State mental hospitals become over-crowded and custodial care supersedes humane treatment. New York World reporter Nellie Bly poses as a mentally ill person to become an inmate at an asylum. Her reports from inside result in more funding to improve conditions.

Early 1900s
The primary treatments of neurotic mental disorders, and sometimes psychosis, are psychoanalytical therapies (“talking cures”) developed by Sigmund Freud and others, such as Carl Jung. Society still treats those with psychosis, including schizophrenia, with custodial care.

1908
Clifford Beers publishes his autobiography, A Mind That Found Itself, detailing his degrading, dehumanizing experience in a Connecticut mental institution and calling for the reform of mental health care in America. Within a year, he will spearhead the founding of the National Committee for Mental Hygiene, an education and advocacy group. This organization will evolve into the National Mental Health Association, the nation’s largest umbrella organization for aspects of mental health and mental illness.

1930s
Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed surgically, an operation called a lobotomy, which is performed widely over the next two decades to treat schizophrenia, intractable depression, severe anxiety, and obsessions.

1935
Schizophrenia is treated by inducing convulsions, first induced by the injection of camphor, a technique developed by psychiatrist Ladislaus Joseph von Meduna in Budapest. In 1938 doctors run electric current through the brain — the beginning of electro-shock therapy — to induce the convulsions, but the process proves more successful in treating depression than schizophrenia.

July 3, 1946
President Harry Truman signs the National Mental Health Act, calling for a National Institute of Mental Health to conduct research into mind, brain, and behavior and thereby reduce mental illness. As a result of this law, NIMH will be formally established on April 15, 1949.

1949
Australian psychiatrist J. F. J. Cade introduces the use of lithium to treat psychosis. Prior to this, drugs such as bromides and barbiturates had been used to quiet or sedate patients, but they were ineffective in treating the basic symptoms of those suffering from psychosis. Lithium will gain wide use in the mid-1960s to treat those with manic depression, now known as bipolar disorder.

1950s
A series of successful anti-psychotic drugs are introduced that do not cure psychosis but control its symptoms. The first of the anti-psychotics, the major class of drug used to treat psychosis, is discovered in France in 1952 and is named chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs.

Mid-1950s
The numbers of hospitalized mentally ill people in Europe and America peaks. In England and Wales, there were 7,000 patients in 1850, 120,000 in 1930, and nearly 150,000 in 1954. In the United States, the number peaks at 560,000 in 1955.

A new type of therapy, called behavior therapy, is developed, which holds that people with phobias can be trained to overcome them.

1961
Psychiatrist Thomas Szasz’s book, The Myth of Mental Illness, argues that there is no such disease as schizophrenia. Sociologist Erving Goffman’s book, Asylums, also comes out. Another critic of the mental health establishment’s approach, Goffman claims that most people in mental hospitals exhibit their psychotic symptoms and behavior as a direct result of being hospitalized.

1962
Counterculture author Ken Kesey’s best-selling novel, One Flew Over the Cuckoo’s Nest is based on his experiences working in the psychiatric ward of a Veterans’ Administration hospital. Kesey is motivated by the premise that the patients he sees don’t really have mental illnesses; they simply behave in ways a rigid society is unwilling to accept. In 1975, Kesey’s book will be made into an influential movie starring Jack Nicholson as anti-authoritarian anti-hero Randle McMurphy.

Mid-1960s
Many seriously mentally ill people are removed from institutions. In the United States they are directed toward local mental health homes and facilities. The number of institutionalized mentally ill people in the United States will drop from a peak of 560,000 to just over 130,000 in 1980. Some of this deinstitutionalization is possible because of anti-psychotic drugs, which allow many psychotic patients to live more successfully and independently. However, many people suffering from mental illness become homeless because of inadequate housing and follow-up care.

1963
In the U.S., passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act provides the first federal money for developing a network of community-based mental health services. Advocates for deinstitutionalization believe that people with mental illness will voluntarily seek out treatment at these facilities if they need it, although in practice this will not always be the case.

1979
A support and advocacy organization, the National Alliance for the Mentally Ill, is founded to provide support, education, advocacy, and research services for people with serious psychiatric illnesses.

1980s
An estimated one-third of all homeless people are considered seriously mentally ill, the vast majority of them suffering from schizophrenia.

1986
Advocacy groups band together to form the National Alliance for Research on Schizophrenia and Depression. In pursuit of improved treatments and cures for schizophrenia and depression, it will become the largest non-government, donor-supported organization that distributes funds for brain disorder research.

1990s
A new generation of anti-psychotic drugs is introduced. These drugs prove to be more effective in treating schizophrenia and have fewer side effects.

1992
A survey of American jails reports that 7.2 percent of inmates are overtly and seriously mentally ill, meaning that 100,000 seriously mentally ill people have been incarcerated. Over a quarter of them are held without charges, often awaiting a bed in a psychiatric hospital.

What are culturally specific mental disorders

Schizophrenia is best treated where people, hearing voices in their heads, treat them not as a splitting of consciousness, but as a mystical experience: less stress, easier course, more favorable prognosis.

Studies show that culture influences not only how patients relate to their disease, but also how the disease proceeds, to the point that some syndromes and conditions are culturally specific. The Boston Globe tells how psychiatrists study the influence of culture on the psyche – T & P publish a translation of their material with slight cuts.

The patient, a 20-year-old male, was visibly disturbed and agitated. He claimed that insects were crawling under his skin.

It looked like schizophrenia, but the medical student conducting the initial examination decided to contact her supervisor, clinical psychologist and professor at the University of Argosy in Virginia, Dr. Brian Sharpless.

Is he a Nigerian by any chance? Sharpless asked.

– Yes! How did you find out?

– This is not schizophrenia – this is ode ori , Sharpless replied. – He’s having a panic attack.

In the culture of the Nigerian Yoruba peoples, ode ori is a manifestation of acute stress. It seems to a person that insects are crawling in his head and under his skin, noise rises in his ears, heartbeat quickens. These sensations both express and accompany anxiety. This condition is treated far from the same as schizophrenia.

“A doctor could misdiagnose a mental disorder — in the West, these symptoms are associated with schizophrenia,” says Sharpless, who published a book in 2017 on rare mental illnesses. “To be honest, I myself only learned about this syndrome a few months ago.”

“Savage Syndrome”

Culture shapes us and our personality, so it is not surprising that it influences how emotions, stress, and mental disorders manifest themselves. This brings complete confusion to modern psychology and psychotherapy, no matter how hard experts try to sort out all illnesses.

Since their inception, psychology and psychiatry have sought to standardize the diagnosis and treatment of mental disorders in order to bring at least some certainty to a seemingly chaotic field. But more and more practitioners talk about the disadvantages of standardization. Effective patient care requires something broader and more flexible—models of care that take into account the characteristics of hundreds of different cultures. And if we take into account the fact that each individual patient perceives culture in his own way, we are talking about super-personalized mental health care.

In the late 1800s and early 1900s, scientists described ailments that psychologists soon called “cultural psychoses and syndromes”—disorders that occur only in people belonging to a particular culture.

Thus, in 1894 Arctic explorer Josephine Peary first described piblocto , or arctic hysteria. The women of the Inuit people who worked for Piri and her husband during the expedition suffered from it. After a short gloomy silence, the women suddenly started screaming and sobbing, tore off their clothes and ran out into the frosty darkness. Arctic hysteria can last for hours until a person collapses without strength, falling into a deep sleep; after he comes to, he remembers nothing about his insanity and quickly recovers.

Throughout the 20th century, psychologists and psychiatrists who studied pyblocto came to different conclusions. Some drew on racist and colonial optics and concluded that the women and men who experienced piblocto were mentally handicapped because they belonged to the culture that raised them as savages. This explained why piblocto did not affect people from the West (except in a few cases when European sailors, surrounded by ice, behaved in a similar way). Later, other researchers suggested that this disorder did not exist prior to Inuit contact with Americans and Europeans. They viewed pyblocto as a kind of psychosocial manifestation of cultural fears, stresses and anxieties as a result of the clash of civilizations. Another group of scientists suggested that the reason for everything is an excess of vitamin A, which drives people mad, or a lack of calcium.

Today, the Diagnostic and Statistical Manual of Mental Disorders (the handbook of American mental health professionals) states that piblocto is a culture-specific dissociative disorder, expressed in the involuntary occurrence of hysterical reactions, which occurs in various cultures.

According to the American Psychiatric Association, this is a shift from “just a list of culturally specific syndromes” to “cultural conceptions of disorders”. The new wording reflects professional awareness of how

Cultural affiliation influences the manifestation of mental disorders—for example, symptoms of depression in one culture differ from those in another.

The new approach also shows how doctors are trying to stop the exoticization of manifestations of disorders in different cultures, and calls for intercultural dialogue in the language of compassion.

“Psychologists are now better aware of the influence of culture, we have gone far ahead of what was in practice in 1980s,” Sharpless says. — But such categories are very difficult to measure and evaluate. We are taking steps in this direction, but there is still much we do not understand.”

Mask. Nepal. 1960s

“How do we know how we feel?”

Culture and social environment can shape and even anticipate typical mental disorders and conditions such as depression and anxiety. But do the fundamental mechanisms of the psyche depend on culture?

Julia Chentsova-Dutton, a doctor of psychology at Georgetown University who studies culturally specific manifestations of mental disorders, notes that most studies involve white people, and the study design assumes that all subjects are the same. But even a careful researcher can be wrong. Chentsova-Dutton tells how she conducted a survey among the inhabitants of Ghana. The questionnaire included questions about how people feel during the day. The researcher noticed that filling out a questionnaire, which would have taken an American a few minutes, took Ghanaians more than half an hour. She asked why.

They said, “How do we know how we feel?”

In Western culture, people are prepared for these questions: we have names for different emotional states, and we learn to use them from childhood. But this situation is not observed everywhere, and certainly not in Ghana. “This ability is not inherent in birth . .. If you start a local study without knowing anything about the local culture, if you do not know how to listen and carefully check the facts, it is very easy to make a mistake.” In the end, with the participation of her Ghanaian colleagues, Chentsova-Dutton radically changed the design of her study.

Even attempts to define overt disorder as a disorder run into the problem that what looks like an illness in one culture may be considered an “obsession” or “gift of communication with higher realms” in another. In a major 2015 study, Stanford anthropologist Tanya Luhrmann and colleagues compared how people with schizophrenia in the United States, Ghana, and India experienced their auditory hallucinations. Americans for the most part perceived voices as an intrusion from outside, a violation of their mental integrity, while Ghanaians and Indians developed positive relations with voices: Indians described playful and friendly voices, Ghanaians heard God.

According to the researchers, the findings suggest that “everyday, socially oriented expectations change not only how what is heard is interpreted, but also what patients actually hear. ” This kind of research makes a huge contribution to the treatment of schizophrenia. For example, it was concluded that

in developing countries schizophrenia responds better to treatment than in developed countries: the benevolence of voices in the head allows you to choose a milder course of treatment and gives hope for a quick effect.

According to the 2017 Bulletin of the American Psychiatric Association, “the burden of mental disorders is disproportionately higher for racial/ethnic minorities” (it also states that people from racial/ethnic minority groups are less likely to receive mental health care). The bulletin lists seven barriers to decent mental health care; four of them are culturally related:

• mental illness is more stigmatized among minorities;

• lack of diversity among mental health care providers;

• lack of knowledge about cultural diversity among those who provide assistance;

• language barrier.

All of this, the Psychiatric Association has suggested, worsens the diagnosis of mental illness in racial or ethnic minorities.

Mask. Vanuatu. Mid-20th century

Disease standards, crop standards

Standardization of diseases implies that two different doctors, having examined the same patient, must make the same diagnosis. There are biological mechanisms that do not depend on cultural characteristics, gender or ethnicity. But

no disease lends itself to rigorous standardization—not even malaria or tuberculosis;

says Dr. they do not follow the standards – not to mention diseases associated with personal experience.

Trying to put mental disorders into neat boxes leaves little room for cultural, social, and even individual differences. This tightness becomes more and more unbearable as cultures collide, mix and change. For example, according to Pew Research, by 2065 America will not have a single racial or ethnic majority.

For psychiatrists and psychologists, the patient’s background and culture should be part of the history. For example, at the Montreal Jewish General Hospital, with the participation of McGill University’s Department of Social and Transcultural Psychiatry, a Cultural Counseling Service led by Dr. Andrew Ryder is organized, which helps to describe the patient’s condition with the involvement of anthropologists, cultural scientists and other cultural mediators. All this helps the attending physician to build a course of treatment.

So, doctors are realizing the impact of culture on themselves and their patients – now it’s all about learning.

Psychiatry is still dominated by the “cookbook” approach, where there are chapters on different groups and everyone who belongs to one group is, as it were, reduced to a common denominator. This does more harm than good,

complains Chentsova-Dutton. But the most serious distortion is the belief that a person is similar to us if we have the same skin color, or we speak the same language, or come from the same region. “It’s understandable: to explain the world, we use the categories that we have,” Sharpless explains. “But not everyone has the same categories.”

Since the 1990s, the term “culture” has moved away from purely ethnic, religious and national connotations to a broader interpretation that now includes aspects such as class, gender, sexual orientation, age, profession, region, social group, level education and even the level of familiarity with modern technologies. According to Dr. Lewis-Fernandez,

culture is how a person is aware of his experience, and how this experience is associated with belonging to certain social groups.

“Contextual approach is what should be introduced into clinical practice, not labeling,” says Dr. Ryder. He himself, while teaching colleagues, constantly uses the term “informed curiosity”, meaning that a doctor must constantly learn new things, even in those areas in which he considers himself an expert.

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without psychedelics there would be no neuroscience – T&P

Science is gradually rehabilitating psychedelics – there has recently been a resurgence of interest in experimental research on psilocybin and other psychoactive substances. It is useful to remember how it all began: at 19In the 1960s, mind-expanding experiments became a treasure trove of new information for psychotherapists and neuroscientists. In particular, it was thanks to them that the role of serotonin in the functioning of the brain became clear – and all modern psychopharmacology grew out of this discovery. T&P, with the support of MAPS, publishes a translation of an article by Nicholas W. Cozzi, MD, about what neuroscience owes to the discoveries of Hofmann and Shulgin.

In the middle of the 20th century, the prevailing hypotheses in psychology and psychiatry were the hypotheses that mood, desires, feelings, memory, behavior and personality are determined by the environment, childhood experiences, the relationship of reward, punishment, repression and reinforcement of the subconscious mind and, among others, other, psychosexual mechanisms. Brain activity was thought to be electrical in nature. Up to 19In the 1940s and early 1950s, the view that consciousness was influenced, if not conditioned, by the actions of brain chemicals was completely foreign to the medical community. The important events that influenced the change in existing paradigms and gave birth to neurochemistry and neuropharmacology and led to the immediate development of psychopharmacology as a scientific discipline are actually centered around the discovery and study of the psychoactive effects of lysergic acid diethylamide (LSD), N, N-dimethyltryptamine (DMT), psilocybin and other psychedelic substances.

Perhaps the most important discovery in psychedelic drug research was the role of serotonin in mental processes. Serotonin, whose chemical structure was determined in 1949, has been known since the late 1800s to be present in clotted blood. Here we discover its hemostatic role: in case of tissue damage, it helps prevent bleeding. In the event of injury, serotonin is released from platelets, causing local vasoconstriction and stimulating further platelet aggregation, helping to form a clot and stop bleeding. Serotonin was also discovered in brain tissues in the early 1950s, which indicated its potential role in the functioning of the brain and consciousness. The discovery of serotonin in the brain was made independently and simultaneously by a group of scientists in the United States and another group of scientists in Edinburgh, Scotland, led by Sir John H. Geddam. However, in the formation of early theories regarding the participation of serotonin in the processes of consciousness, Geddam’s experiments with LSD, carried out on himself, were of particular importance.

John H. Geddam

Sir John H. Geddam, British pharmacologist, was involved in the original research on serotonin. Four times in 19In 53, Geddam took LSD to learn about its effects on his body. No doubt, partly through these self-experiments and partly through his laboratory experiments with LSD and serotonin, Geddam was the first to suggest a connection between LSD and serotonin, and then to suggest that LSD’s effects on serotonin functions were responsible for the psychedelic effects of LSD. His handwritten notes on his own experiment with 86 micrograms of LSD dated June 1, 1953 are as follows:

“9:48 My hand looks weird, like it’s a monstrous hand drawing that writhes until I focus on it. She has amazing color contrasts. I see as if more than a real drawing, which causes a rather strange feeling – as if it belongs to someone else. Everything in the room is pretty unstable.” Methedrine did not eliminate the effect on sensations. He continues: “Evidence for the presence of HT (serotonin) in some parts of the brain can be used to support the theory that the mental effects of lysergic acid diethylamide are due to interference with HT (serotonin).” Thus, in the personality of Sir John Geddam, personal experience of LSD use and scientific understanding merged, which gave impetus to the emergence of chemical neuroscience.

“Endogenous DMT plays an important role in states of consciousness such as rapture, daydreaming, creativity, clinical death”

Independently, D. Woolley and E. Shaw in New York suggested, “… that mental disorders caused by lysergic acid diethylamide should be attributed to the interference of the acid with the action of serotonin in the brain. In addition, they state that “Geddam was also aware of the mental effects of lysergic acid diethylamide and the action of serotonin in the brain. We assumed that he was thinking the same thing as us, about the relationship of serotonin to mental disorders caused by the substance. Unlike Geddam, there is no evidence regarding Woolley or Shaw that they took LSD.

They later wrote: “These pharmacological discoveries indicate that serotonin plays an important role in mental processes and that suppression of its action causes mental disorder. In other words, the lack of serotonin is the cause of the disorder. If the deficiency of serotonin in the central nervous system is the result of a metabolic disorder, and not caused by pharmacological agents, one can expect the manifestation of the same mental disorders. Perhaps such a deficiency is responsible for the natural occurrence of diseases … Thus, we put forward the following assumptions: serotonin probably plays a role in maintaining normal mental processes; lack of serotonin caused by metabolism can contribute to the appearance of some mental disorders; serotonin, or a long-acting derivative of it, can alleviate mental disorders like schizophrenia.”

These early reports can be seen as the source of the current research and development of modern psychotherapeutic drugs that have spawned a billion-dollar pharmaceutical industry aimed at changing the action of serotonin and other neurotransmitters in the brain to treat mental illness.

DMT has also greatly influenced the evolution of our understanding of normal and extraordinary states of consciousness. In 1961, Nobel laureate Julius Axelrod made a remarkable discovery that mammalian tissue (rabbit lung) has the ability to synthesize DMT.

Serotonin

This discovery came under extensive scrutiny in the early 1970s when it became known that biopsied human brain tissue could perform the same biotransformation. The discovery that human brain tissue can produce, at least under laboratory conditions, small amounts of DMT has led to a heated discussion about the possible role of DMT in human consciousness. However, the analytical technologies of that time were not as sensitive or reliable as they are today. While some researchers have been able to confirm the presence of DMT in human tissues and fluids, others have failed. Some scientists at that time believed that the result of laboratory observations by Axelrod and other researchers was more of an artifact than an objective phenomenon. The issue remained unresolved for almost 30 years.

Then, in 1999, Michael Thompson and colleagues at the Mayo Medical Institute in Rochester, Minnesota, using molecular biology techniques—cloning and sequencing—discovered a human gene that codes for an enzyme that synthesizes DMT from tryptamine. Thompson’s discovery renewed numerous discussions and fully strengthened the hypotheses that endogenous DMT plays an important role in such states of consciousness as an ecstatic state, daydreaming, creativity, clinical death, and others. The point of view that the presence of DMT in mammalian tissues is just an artifact that is not characteristic of the object, and distorts the results of the study, turned out to be untenable.

Since the time of Geddam, research on psychedelics, serotonin and other neurotransmitters and their receptors has continued at an accelerated pace. Building on the early theories of Geddam, Wooley, and Shaw on the role of serotonin in the pharmacology of LSD, in the 1980s, Richard Glennon and colleagues at the Virginia Commonwealth University Graduate School of Pharmacy were the first to determine that the serotonin receptor 2- (now called the receptor type 5- HT2A) is the main target for psychedelic agents such as lysergamide, phenylalkylamine, and indolalkylamine. Over the next two decades, additional binding sites were discovered; 40 or more additional receptor sites for psychedelic drugs are currently recognized. Although 5-HT2A is still considered to be a common receptor for the effects of psychedelic drugs, more and more researchers are coming to the conclusion that activity in this receptor alone is not enough to explain all the effects of psychedelics […].

DMT molecule

Obviously, the simultaneous action of psychedelic drugs on many or even all of the 40+ currently identified receptor sites, with each psychedelic agent having a unique receptor binding and activation profile (pharmacological “fingerprint”), forms a set of subjective sensations caused by these substances. Thus, although the term “psychedelic” is often used as a simplistic term, psychedelic drugs, although they cause similar subjective effects in people, do not produce the same subjective effects, as people who have taken these drugs readily report. The effect of LSD is quite different from that of mescaline, which in turn is different from DMT, which is different from TMA-2, which is different from psilocybin, which is different from 2C-B, and so on.

Although these materials typically use in vitro and behavioral animal data to study these materials, these approaches are limited in that they tend to blur qualitative, empirical differences between psychedelic drugs—differences which people can easily identify. Test-tube laboratory data and animal data can complement, but not replace, human experience, which is undoubtedly a sine qua non for testing psychedelic effects.

The problem of defining uniform criteria for defining psychedelic substances and the experiences they cause is, of course, not new. As Alexander Shulgin said: “If there is confusion in the choice of a term to describe the class of drugs that we will call [psychedelic drugs], then when agreeing on the description of their action, we will come to a complete mess.” One approach, proposed in the 1970s, was to define psychedelics as drugs that mimic the effects of LSD.

Although this definition is self-contained, it has placed the psychedelic experience at the center of the discussion. Lester Greene Spoon and James Becalar suggested the following: “A drug will be considered psychedelic or not, depending on how and in what way it resembles LSD; the similarity must be judged by the cultural role of the drug, as well as by the range of its psychopharmacological effects. From this point of view, the group of psychedelic drugs has a well-defined center and a blurred periphery … “.

“Research with psychedelics provides a deeper understanding of brain function and continues to influence psychopharmacology”

Linking drug molecular action to animal behavior and human experience remains a tempting but not fully realized goal. Much of the progress that has been made in this area has been made possible by the work of Alexander Shulgin, who developed, synthesized and characterized over 200 new psychedelic substances in his private laboratory. Shulgin’s compounds have been used by many other scientists around the world to study receptor binding and drug activation in the laboratory, for computer modeling of substances and mapping of receptor forms, for studying the electrical activity of neurons, for studying animal behavior, etc. Shulgin’s developments also made a significant contribution to diversity of human psychedelic experience.

It is clear from the review of the literature above and elsewhere that much of the current research on neurotransmitters and drugs that affect their function in the brain stems from the experiments and work of scientists studying the mechanisms of action of LSD, DMT, and other psychedelic compounds.

In the light of these discoveries in neurochemistry, the assumptions of psychology and psychiatry regarding the origin and nature of consciousness and mental illness have had to be revised. It has become necessary for psychology and psychiatry to incorporate observations from neuroscience into models of mental functioning. Neurochemistry and neuropharmacology began to play a dominant role in the study of consciousness and in the treatment of mental illness by the end of 1950s and into the 1960s. For example, it has become mandatory for psychotherapeutic practices to use psychoactive drugs, which were obtained on the basis of the experimental discoveries of neuropharmacology, as the main approach for psychological treatment. Thus, psychopharmacology emerged as a medical and scientific discipline. While there is still much that can be improved, the effectiveness of these drugs has undoubtedly saved countless lives.

Although human clinical trials of psychedelics were temporarily suspended at the end of 19In the 1960s and 1970s, research into their basic chemistry, pharmacology, and neuroscience continued. In academia, research with the chemical synthesis and pharmacological investigation of psychedelic drugs has been concentrated in the laboratories of the aforementioned Richard Glennon and David Nichols at the Purdue University College of Pharmacy in West Lafayette, Indiana, George Aghajanian at the Yale University School of Medicine in New Haven, Connecticut, which is largely contributed to our understanding of the effects of psychedelics on the neural signaling and brain systems. Other scientists, whose names we will not mention due to their large number, have used various animal behaviors to study these substances.

Current academic research focused on the study of psychedelics takes place in various pharmaceutical and medical institutes and in the departments of medicinal chemistry, neurology, pharmacology, psychology and psychiatry. If an interested student diligently studies the scientific literature (PubMed is perhaps the most useful tool for this), potential research opportunities can be identified in institutions around the world.

For a person who is seriously interested in such research, especially when it concerns psychedelic drugs, a Ph.D. or M.D. degree is indispensable for academic or clinical research. Several years of postdoctoral training may eventually lead to the role of principal researcher in basic science or clinical research leader in human research. In any case, after completing a bachelor’s degree and entering graduate school, the number of opportunities in this field will increase, whether it is the role of a team member in conducting research with psychedelic drugs at a university, a drug company, the National Institutes of Health or a private research foundation.

As described above, psychedelic drugs have been used over the past few decades to answer mechanistic questions about receptors, neural processes, and animal behavior. Research using psychedelics provides a deeper understanding of brain function and continues to influence psychopharmacology and drug development for the treatment of mental illness. However, until recently, research into the possible enrichment of people’s lives through psychedelic experiences has stagnated. Over the past few years, there has been a resurgence in clinical research using psychedelic drugs in human volunteers. Today it is recognized that their use has a positive effect on therapy and personal growth. A list of planned, ongoing, and completed clinical trials with psychedelics can be found at clinicaltrials.gov; type in the search for the words “psilocybin” or “psychedelic”.

The renewed interest in human research on these drugs is good news for those interested in the psychological and psychotherapeutic aspects of psychedelic substances, as well as for those interested in the non-medical uses of these substances, including their apparent value in self-knowledge, increased creativity, improvement learning process, problem solving, and spirituality.