Review of Psychiatry - A Social Stigma! By Dr. Harsha Gopisetty
News paper headlines stating ‘Death of 25 mentally-ill patients, charred beyond recognition, in a devastating fire which engulfed their thatched hostel, pathetically chained to their cots in Ervadi Mental Hospital in Tamil Nadu' and on the other extreme 'States like Haryana do not have a mental hospital' is very revealing of the neglected state of approach to the mentally ill in India. One wonders! Why it is so? When all other sciences have made such great advances in India , Psychiatry has made virtually no headway, and is in a very nascent state.
The first Department of Psychiatry with outpatient facility in a general hospital in India was opened on 1st May 1933, at the then Carmichael Medical College, now known as R. G. Kar Medical College, in Kolkata.
The traditional approach to the care of the mentally ill during the last 200 years was custodial, rather than therapeutic. This approach to “Psychiatric Care Delivery System” was introduced in India from Britain . Mental hospitals were established in isolated areas, often on the outskirts with the object of segregating the patient as troublesome and dangerous to their neighbors. The overriding concern was to protect the citizens without regard for appropriate care and cure of the ailing patients. As a consequence of this objective of the mental hospitals, the quality of care in such hospitals had been very poor. The inmates were subjected to indignity and humiliation for an indefinite period, and once admitted never recovered, or rehabilitated back in their family, but doomed to the inevitable end. The stigma of mental illness thus prevailed.
What really needs to be done...
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...us advances in this field, while we still consider it a stigma even to be referred to a psychiatrist. Mental illness is just another biological or sociological problem, which needs to be dealt with on time, before it’s too late, by a specialist.
It needs to be understood that it is as natural as cancer or AIDS, but can be worse and a living hell for those who are the victims of this illness, and not treated in time. When we can give all the care and attention to other medical problems, and can go campaigning for them; then its time to look at this aspect of illness with same enthusiasm. We cannot afford to neglect this illness. We need more voluntary involvement, and have a better infrastructure developed to build a better future for every person who is suffering, and who is prone to suffer with the current mode of life of high stress and competitions.
Modern psychiatric hospitals evolved from, and eventually replaced the older lunatic asylums. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint with successive waves of reform, and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment, and attempt where possible to help patients control their own lives in the outside world, with the use of a combination of psychiatric drugs and
The fight for improved health care for those with mental illness has been an ongoing and important struggle for advocates in the United States who are aware of the difficulties faced by the mentally ill and those who take care of them. People unfortunate enough to be inflicted with the burden of having a severe mental illness experience dramatic changes in their behavior and go through psychotic episodes severe enough to the point where they are a burden to not only themselves but also to people in their society. Mental institutions are equipped to provide specialized treatment and rehabilitative services to severely mentally ill patients, with the help of these institutions the mentally ill are able to get the care needed for them to control their illness and be rehabilitated to the point where they can become a functional part of our society. Deinstitutionalization has led to the closing down and reduction of mental institutions, which means the thousands of patients who relied on these mental institutions have now been thrown out into society on their own without any support system to help them treat their mental illness. Years after the beginning of deinstitutionalization and after observing the numerous effects of deinstitutionalization it has become very obvious as to why our nation needs to be re-institutionalized.
As medical advances are being made, it makes the treating of diseases easier and easier. Mental hospitals have changed the way the treat a patient’s illness considerably compared to the hospital described in One Flew Over the Cuckoo’s Nest.
In the 1840’s, the United States started to build public insane asylums instead of placing the insane in almshouses or jail. Before this, asylums were maintained mostly by religious factions whose main goal was to purify the patient (Hartford 1). By the 1870’s, the conditions of these public insane asylums were very unhealthy due to a lack of funding. The actions of Elizabeth J. Cochrane (pen name Nellie Bly), during her book “Ten Days in a Mad-House,” significantly heightened the conditions of these mental asylums during the late 1800s.
Continuing budget cuts on mental health care create negative and detrimental impacts on society due to increased improper care for mentally ill, public violence, and overcrowding in jails and emergency rooms. Origins, of mental health as people know it today, began in 1908. The movement initiated was known as “mental hygiene”, which was defined as referring to all things preserving mental health, including maintaining harmonious relation with others, and to participate in constructive changes in one’s social and physical environment (Bertolote 1). As a result of the current spending cuts approaching mental health care, proper treatment has declined drastically. The expanse of improper care to mentally ill peoples has elevated harmful threats of heightened public violence to society.
Until the middle of the last century, public mental health in the United States had been the responsibility, for the most part, of individual states, who chose to deal with their most profoundly mentally-ill by housing them safely and with almost total asylum in large state mental hospitals. Free of the stresses we all face in our lives, the mentally-ill faced much better prospects for peaceful lives and even recovery than they would in their conditions in ordinary society. In the hospitals, doctors were always accessible for help, patients were assured food and care, and they could be monitored to insure they never became a danger to themselves or others. Our nation’s state hospital system was a stable, efficient way to help improve the lives of our mentally disabled.
In 1950s the construction of new psychiatric centres took place in order to treat people with mental disorders. Local authorities provided financial resources to sustain these establishments of psychiatry. Apparently those psychiatric centres were treating the patients in unappropriated ways and inhuman acts as well as demanding them to remain inside the psychiatric centres for the rest of
Until 1851, the first state mental hospital was built and there was only one physician on staff responsible for the medical, moral and physical treatment of each inmate. Who had said "Violent hands shall never be laid on a patient, under any provocation." This improved the treatment of patients but the mentally ill that weren't in this asylum may have
The human brain is a vast, unexplainable, and unpredictable organ. This is the way that many modern physicians view the mind. Imagine what physicians three hundred years ago understood about the way their patients thought. The treatment of the mentally ill in the eighteenth century was appalling. The understanding of mental illness was very small, but the animalistic treatment of patients was disgusting. William Hogarth depicts Bethlam, the largest mental illness hospital in Britain, in his 1733 painting The Madhouse1. The public’s view of mental illness was very poor and many people underestimated how mentally ill some patients were. The public and the doctors’ view on insanity was changing constantly, making it difficult to treat those who were hospitalized2. “Madhouses” became a dumping ground for people in society that could not be handled by the criminal justice system. People who refused to work, single mothers, and children who refused to follow orders were being sent to mental illness hospitals3. A lack of understanding was the main reason for the ineptness of the health system to deal with the mentally ill, but the treatment of the patients was cruel and inhumane. The British’s handling of mentally ill patients was in disarray.
Psychiatry is the medical specialty devoted to diagnosing and treating various mental disorders, such as bipolar disorder or schizophrenia. Although a well-known science, psychiatry and psychiatrists have often been ethically questioned on their “inhumane” methods, dating back to its origins in the 1700s. To the nurses, in varied psychiatric institutions, it was customary to employ the practices of confining, restraining and isolating people with mental problems. In “The Most Shocking Psychiatry Documentary Ever” (MSPDE) the barbaric practices that psychiatry has tried and developed over the years in blatantly revealed and validly proves the need for reconstructing assorted tactics used to cure mental patients around the world.
Once upon a time, long ago in the mists of time, sprawling brick structures housed countless individuals with mental disturbances. These massive structures were known to the world as mental asylums for the insane. In reality, the majorities of these individuals were not insane, but in contrast were suffering from mild mental problems such as depression or anxiety. These people were looked down upon in society and were labeled as "freaks" or "batty" because of their mental disorder. In the early twentieth century, mental issues were considered taboo. If a family had a sibling or relative who was suffering from a mental disorder, they were swept under a rug; to be taken care of at another time. These days, these immense structures are an object of the past, a bygone era. Many asylums still stand tall as monuments to the world of health care, while many do not stand at all.
Dorothea Dix, in 1841, began to lobby to move inmates with mental illness out of the jail system, which was not suited for them, and into an asylum. Within a short amount of time, she was successful in her mission. Many mentally ill were moved into hospitals which were able to treat their specific needs better than the jail system was able to. But the problem resurfaced again, this time in a different form. The mental health facilities were being to become overcrowded and abusive their patients. This is when the thinking changed to move the mentally ill out of asylums and into more of a community setting facility. This movement was called deinstitutionalization and was popular in the 1950’ and 1960’s. Its goal was to replace the psychiatric hospitals which required long stays and were often overpopulated, with community mental health services which were less isolated. It accomplished this by releasing many patients and thus reducing the population size and helping the patients become less dependent by shorting stays and enforcing positive behaviors.
Mental health patients were considered innately inferior and treated as the weaker portion of the human race due to the prevailing dominant theory of Social Darwinism in the 1800s. They were put in mental asylums, where conditions had deteriorated substantially from earlier in the century. (Floyd) The public’s interest about the unsatisfactory care of the mentally ill, championed by Dorothea Dix, led to some reforms, such as higher medical standards, more oversight into asylum practices, and more research into mental health. (Floyd) Nevertheless, the status of the mentally ill did not elevate much higher, and by the 1890s the repeated failure of asylum therapy convinced most that insanity and mental illness was incorrigible. Finding no alternatives, however, patients continued to be sent to asylums to attempt to cure them as much as to isolate them from the rest of society. (Roberts) Unfortunately, people also began to fear the proliferation of the mentally ill. When sterilization became considered, unrealistic, more, cheaper asylums were built as a means of segregated them and preventing an increase in their numbers. (Roberts)
The BBC documentary, Mental: A History of the Madhouse, delves into Britain’s mental asylums and explores not only the life of the patients in these asylums, but also explains some of the treatments used on such patients (from the early 1950s to the late 1990s). The attitudes held against mental illness and those afflicted by it during the time were those of good intentions, although the vast majority of treatments and aid being carried out against the patients were anything but “good”. In 1948, mental health began to be included in the NHS (National Health Service) as an actual medical condition, this helped to bring mental disabilities under the umbrella of equality with all other medical conditions; however, asylums not only housed people
In the article Issues and Controversies says, "Throughout most of human history, people with mental illness were ostracized, isolated, and persecuted." ( Infobase,1) This belief system can give causation of mental illness in different cultures and such influences in a community will always be in a negative manner. Various societies struggle with the notion of mental health. The standards of every culture believe to be considered normal, natural, or healthy. These views lead to disagreements about the causes, diagnosis, and the treatment of the disorders. Many people with mental problems are discriminated against because of their mental disorder. Mental illness and stigma refers to the view of the person with mental illness as having undesirable traits. Stigma leads to negative behavior, stereotyping, and discriminatory behavior towards the person with mental health issues. This stigma causes the affected person to experience denial or shame of their condition. Perceived stigma can result in the patient being scared to seek help. Stigma can be divided into two perspectives, public and self stigma. Upadhyay says, "Public stigma occurs when the general