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Alyssa White

Professor Jan Babcock

ENG 137H

26 October 2023

Paradigm Shift: Shift in the treatment and stigmatization of mental illness

Mental health is one of the most widely discussed topics in the 21st century. New resources and

advancements have aimed to raise awareness about the issue and to stop the stigmatization.

However, humanity required many years to reach this point of understanding and has a rough

history of development through centuries. People with mental illness have been discriminated

against in various forms throughout history and even today. Although advances in medicine and

knowledge emanating into our society have propelled treatment and awareness surrounding

mental health, mental illness continues to be one of the most stigmatized and judged issues, as it

is still perceived as a sign of weakness and shame. Many people with mental illness suffer from

prejudices and social exclusion, which worsens their illness and self-esteem. Because of this

people tend to hide their psychiatric problems as the fear of judgment and stigmatization leads to

repressed secrecy, which is one of the biggest obstacles in mental health and prevents the

discovery of the illness and neglects the proper help needed. However, secrecy and isolation

were not the only struggles for those suffering with mental health throughout the years.

Prejudices and ignorant beliefs about mental illnesses have destroyed the lives of thousands of

people.

For centuries, mentally ill individuals have been suffering not only from their condition but also

the prejudices and stereotypes about mental illnesses. Overwhelming anxiety, depression,
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traumatic life experiences, and mental disorders have always been a part of every society

because mental health disorders do not discriminate. Meanwhile, various treatments have sought

to address mental illness, from more brutish and ineffective methods in earlier centuries to more

humane and effective treatment methods in modern eras. In early 19th century America, care for

the mentally ill was almost non-existent; those suffering were usually neglected in prisons,

poorhouses, or put under inadequate supervision by their families. Though the idea was that

people were sent to asylums to be treated, it was often so that families could hide relatives they

were ashamed of. A common practice in the early 19th century was "warning out" individuals

with disabilities and others considered “menaces to society” (Durkheim, 1893). Warning out was

informing an unwanted individual that he or she was not welcome in their town. Attitudes,

physical barriers, and legal action kept those mentally struggling essentially incarcerated to keep

them separate from society and interfered with their rights as American citizens. Treatment, if at

all provided, corresponded to harsh medical treatments of the time including bloodletting, and

purgatives. The treatments within institutions were brutal and often caused physical harm to a

patient with little to no relief of their symptoms. Confinement and isolation were a popular

treatment for patients who were experiencing nervous breakdowns. Confines included

straitjackets, chains, waistcoats, and actual cages. This was an inhumane treatment that required

the patient to be placed in a small and cramped cage, locked inside for hours until they were

eventually sedated. Needless to say, many patients were left with permanent psychological and

physical damage after these types of treatments. In a wave of concern for the oppressed,

Dorothea Dix was a leading social reformer for the establishment of state supported mental

asylums and was a leading advocate of those struggling with mental illness. She investigated
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across the United States how those who were poor and mentally ill were cared for and discovered

an underfunded and unregulated system that bolstered abuse of those mentally struggling.

Through her passionate appeals, the first state hospitals were built in New Jersey and

Pennsylvania. She did this by continuously lobbying state legislatures and Congress to set up and

fund these institutions. She and other reformers fought for humane, individualized care with the

rich and poor housed together to ensure proper standards for all. Through this, Dix helped to

prepare the way for other public institutions. Dix was able to get the government to support the

construction of 32 public psychiatric facilities in a 40 year span (Jones & Beauvais). State

hospitals were usually under-resourced and following a succession of high profile revelations of

terrible living conditions and human rights breaches, the systemic medical system aggregated a

lot of criticism (Grob, 2019). Unfortunately mental illness was continually proded and analyzed,

and “cures” were prescribed by the scientific and other lay communities. Mental asylums and

institutions offered little treatment and often kept people for decades against their will. There

were no distinctions between those who were suffering from more severe mental illnesses such

as schizophrenia to those who were mentally disabled or had learning difficulties until the 1886

Idiots Act, which enabled the building of “Idiot Asylums” or “mental impairment colonies.”

People struggling mentally were often degraded and viewed as “idiots” or “insane” through the

19th century, and separate ‘Idiot asylums,’ which later became hospitals for the mentally

handicapped, were built. The Idiots Act permitted the detention of the mentally impaired and

handicapped in Idiot Asylums run by volunteers, which were not intended to provide long term

care. These became overcrowded and were eventually closed down. Today, social and medical

care occurs more widely in the community. Historical paradigms have reflected a shift from
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traditional and inhumane treatment of mental health disorders to a more scientific, humane, and

professional approach, contributing to improved wellness in society.

Blossoming advancements in medicine and treatments have changed the trajectory of how those

struggling with mental illness were treated. During the first half of 20th century, the principal

approaches to the treatment of mental disorders were psychoanalytical and included forms of

psychotherapies (Magnavita 2006). However, in the 1930s, these methods began to be

supplemented by physical approaches using drugs, electroconvulsive therapy, and forced

controversial surgeries such as lobotomies (Eisenburg, 2007). The decades after marked the first

safe and affective applications of medications in the treatment of mental illness. Prior to the

1950s, sedatives such as barbiturates had been used to quiet and sedate patients, but these drugs

lacked effect and did not target symptoms of mood disturbances or physcotic disorders.

Further developments in the mental health profession increased after World War II as the number

of mental health professionals increased. Many psychiatric social workers also became

pshycotherapists and played pivitol roles in mental health centers and new roles emerged for

nurses, including behavior therapy, and management of chronic mental illness was on the rise. In

the 1950s and 60s a new type of therapy, called behavior therapy, was developed. As opposed to

existing psychotherapies, its techniques were based on theories of learning derived from research

on classical conditioning by Ivan Pavlov and from the work of other American behaviorists

(Ferraras 2020). Pharmaceuticals and antiphsychotic medication quickly began to take over the

field of psychiatry and overshadowed psychotherapeutic approaches. The study and treatment of

mental illness began to expand significantly over the years. Important developments in medicine

and science laid the foundation for modern pharmacological approaches to mental health.

Families then were more accepting of the move of individuals out of institutions back into the
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homes due to the ability for individuals to care for themselves as well as displaying more

‘normal’ behavior. Stigma against the mentally ill was at a steady but slow decrease and the

health care and societal perspectives of the mentally ill were less stigmatizing to those that had

‘curable,’ disorders. At this point in time, medicine became a natural science and psychiatry was

deemed a field of medicine. Psychiatric treatment now has a strong foundation in neuroscience

and drug development which has helped properly identify and treat mental health disorders.

Mental illness shifted from a mythological perception to an illness of the brain with the

somatogenic theory and further influx of research (Farreras, 2020). The variety of medications

used in the treatment of mental illness has continued to grow as new drugs are developed or new

applications of existing ones are discovered. Not only can change be noted in diagnoses and

treatment, a slight decrease in social stigma is also evident.

With the increase and advancement of technology, scientists and physicians are able to seize a

better understanding of the causes behind mental illnesses and possible cures and treatment

options. Treatment and understanding of mental illness have come a long way and there is still so

much more to learn both from a medical and societal point of view. Nowadays, treatments are

not only knowledge-based and effective, but they are more morally performed. In recent years

we can see how the COVID-19 pandemic has led to a drastic increase in the number of mental

health patients and with online counseling, more people feel comfortable to seek help. Today,

technological advancements and resources have been seminal in allowing people to find

resources to treat their struggles with easy access. Mental health information and support have

been easily accessible through thousands of mental health apps that help an individual with their

struggles. Modern technology has opened limitless opportunities in mental health care and has
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allowed the public and health care providers new ways to access help and increase understanding

of mental wellbeing.

Although this has lead to many beneficial improvements there still is setbacks in regards to how

society views and treats mental health and those struggling with mental illness. Stigma is a

significant barrier for those struggling mentally and is often rooted in lack of knowledge or fear.

As we see throughout the years the negative connotations that came along with mental illness

from lack of knowledge, inaccurate or misleading media representations of mental illness also

hugely contribute to the stigma of mental illness. A review of studies on stigma shows that while

the public may be inclined to accept the medical and genetic factors of mental health disorders

and need for treatment, many people still have a negative view of those with mental illness (Pw

Corrigan 2002). Research has identified three main types of stigma surrounding mental health

which includes; Public stigma, self stigma and institutionalized stigma. Public stigma involves

the negative or prejudiced attitudes that other people have about mental illness (Corrigan 2005).

Self stigma, which refers to the fatalistic attitudes, including internalized humiliation, that people

with mental struggles have about their own condition. Institutionalized stigma, is more

systematic, involving the policies of government and organziations that limit progress for people

with mental illness (Corrigan 2005). An example of this may include inadequate funding for

mental illness research. Stigma has a significant impact on not only those suffering from mental

illness, but it is a mental health crisis that impacts all of society. Eliminating the mental health

stigma remains a huge obstacle for mentally ill individuals. The stigma prevents people from

seeking help and promotes silent suffering.

Stereotyping and discrimination toward the mentally ill now feature daily in the news and on our

TV screens. Although the media can be used to spread awareness and be used as a platform for
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those experiencing mental struggles, the representation of mental illness in media is highly

negative. The media is guilty of perpetuating stigma and tends to shift its focus on the mentally

ill individual instead of bringing attention to mental illness as a societal issue. People who

consume the media daily are often more likely to blame a person for the mental illness rather

than support them. With the media in this technological age being an incredibly powerful tool, it

has the ability to change society’s opinions toward the mentally ill. If media campaigns to reduce

stigma on mental illness were to work, it needed to be utlized correctly. In the 90s and 2000s,

mental health campaigns appeared with great prevalance and outreach largely attributed by the

media. There have been extensive efforts to improve public understanding about mental health

problems, charity campaigns promoted on television, online, interventions within schools,

workplaces, and many disclosures from pop culture celebrities and other public figures about

their own experiences with mental illness. The use of the media for mental illness activism has

and is playing a part in the reduction of stigma.

The 21st century has brought improved technological and advent legislation, becoming a time of

forward progress for mental health. The United States first featured antistigma campaigns after

the White House Conference on Mental Health in 1999. The battle against stigma have

transformed given the many resources of groups like the American Psychiatric Association and

American Psychological Association, advocacy groups like the National Alliance on Mental

Illness (NAMI) and Mental Health America and pharmaceutical companies. Mental health was

becoming a topic of discussion in legislation and in the media resulting in laws that improved the

disparities resulting from stigma. The Protection and Advocacy for the Mentally Ill Act of 1985

was amended in 2000 which protected rights of those with mental illness in public institutions,

outpatient communities and issues of maltreatment. When Congress passed the Mental health
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Parity and Equity Act in 2008, it was a major milestone allowing insurance providers to offer

coverage for mental health, substance abuse and physical care. These peices of legislation are

just some of many that have emphasized the need of improved treatment of those mentally

struggling. Not only did they improve access to resources and lay foundation to the improvement

of mental health care, but it solidified to the public that is alright to have mental illness.

For most of history, society did not treat people suffering from depression, anxiety,

autism, schizophrenia, and other mental illnesses much better than criminals and has continually

looked down upon those struggling with mental health issues. Through advancements in

knowledge, revolutions in medical research, legislation, and reforms, we begin to see redefined

treatment and perception of those struggling with mental illness. Today people receive proper

and humane treatments and have many accessible resources. Although stigma still persists and

clouds society’s judgements, we have come a long way in improving the lives of those mentally

struggling and have greatly improved the treatment of mental health not only in healthcare but in

the societal attitudes toward mental illness. Efforts of advocacy and advancement of knowledge

throughout history have and will continue to positively impact mental health rights and views of

mental illness.
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Works Cited

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Robb-Dover, Kristina, and About Kristina Robb-DoverKristina Robb-Dover is a

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