For centuries, any discussion or reference to a mental illness was making people increasingly uncomfortable. More often than not, mental afflictions were and still are kept as a dark secret. An unusually big dark secret: the statistics show that, in the US alone, around 46% of the population is diagnosed with a mental illness, of them 27. 7% is co-morbid with two or more mental ailments and 17. 5% with three or more.
It is inevitable that, with almost half of the population being affected, the “secret” will need to be confronted and discussed; the solution to help the affected population will need to be sought; the proverbial “home” for such people will need to be found. Then, the questions arise: where will such “home” be? Would it benefit all concerned parties if such individuals were integrated within or segregated from the society? Can the society afford to segregate them and, what’s more, can the society afford to integrate those that are severely impaired?
What impairment will require institutionalization, and what can be treated without resorting to the confinements of the mental health facility? In order to arrive at a weighted conclusion, it seems prudent to examine the history that led to the modern view on institutionalization and its systematic establishment and demise throughout the centuries and the millenniums. 16th century BC Egyptian papyri provided some evidence to the earliest treatments of deceases and behaviour disorders (30).
Some of the papyri give a perspective on a treatment, which, more often than not, was reliant on magic and incantations; then, there was minimal differentiation between medicine and magic, with trepanation used as the “cure” for the mental ailment. Back in 400BC, Hippocrates, recognising the importance of the environment, often removed the patient from their families. He was followed by Plato, who made “hospital” provisioning to treat mental cases.
Ultimately, these initiatives made the 400BC the inception age of the first mental institution. Thereafter, during the Middle Ages, the history took its turn, with Europe abandoning the institutionalization and resorting to exorcism and killings to cure from demonic possession associated with mental illnesses. Subsequently, the society views have advanced, and 15th and 16th centuries saw the establishment of the early mental “hospitals” (asylums), which, unfortunately, were known for their deplorable conditions and practices (37).
The more humane approach came to mental asylums with the works of Pinel and Tuke and culminated in the Country Asylum Act, which was passed in 1845 (39); however, only towards the second half of the 20th century harsh and punitive treatments of the mentally-ill were begging to fade. The development of alternative therapies, such as ECT, and the further advancement of psychopharmacology modernised the effectiveness of and the approach to treating mentally ill patients.
In addition, it made patient’s reintegration into the society more effective, and overall, possible. Deinstitutionalization became an international movement, with the original impetus being that it was more humane and cost-effective (43). It has proven to be a debatable conclusion. The results were astonishing: forty short years between the 1963 and 2003 saw the number of institutionalized patients decrease by five times, whilst the number of imprisoned ones quadrupled and the number of homeless ones increased eightfold.
Yet, the number of those integrated in the society remained unchanged (Lecture notes: New York Times, PBS, National Coalition for the Homeless, Human Right Watch). The empirical evidence suggests that deinstitutionalization, even if it appears as a more humane and a cost-effective option, solves the dilemma neither for society, not for the mentally-ill patient. The witch-hunt and exorcism are not longer in prevalence, yet the modern society does not appear to be educated enough and willing enough to integrate the mentally ill patients into its midst.
With regards to the cost-effectiveness, it is arguable that the society will save anything by abandoning institutionalization, and instead, spending the taxpayers’ money on prosecution, imprisonment, and the consequences of homelessness. It is abundantly clear that further evolution of mental facilities is necessary. Together with an improvement in diagnosis and a further edification of the society, it will assist the increase of understanding and the decrease of the stigma of a mental disorder. None of the changes will happen overnight, and the road to improvement will be a long and an arduous one.
In the interim, and perhaps, for a long while, the controlled institutionalizations of the mentally impaired patients that will benefit from a hospitalization seem the only rational approach. It is unreasonable to expect the society, even the educated one, to become an adequate substitute for the medical supervision and attendance. In fact, it will be inhumane to refuse to help those that require it, and instead, thrust them into the society that is unable, even if willing, to assist. Works Cited James N. Butcher, et al. Abnormal Psychology. Pearson, 2012.