Mental Health and Psychiatry

Issues of human rights have always been intertwined with the history of psychiatry. In the history of many societies, the mentally ill were abused and treated without any respect for their rights or dignity. In some societies, such as medieval Europe, the mentally ill were thought to be possessed by demonic spirits. There were few attempts to cure them or ameliorate their suffering. In the early modern era,rift gold some countries funded “madhouses” for the mentally ill, but these were chambers of horrors, with screaming inmates chained to their beds, abused by ignorant and rapacious wardens. In the early nineteenth century, a new wave of doctors and reformers entered the profession and began to argue that the insane, as they were then called, needed to be treated with more humanity. By the twentieth century, treatment of the mentally ill had improved, but there remained, and remains, widespread human rights issues and abuses connected to mental health and psychiatry.

The right of the mentally ill to proper care is an internationally recognized human right. The United Nations International Covenant on Economic, Social and Cultural Rights (1966) states that everyone has the right to “the highest attainable standard of physical and mental health.” The United Nations expanded on this statement with an additional document addressed directly to the plight of the mentally ill, the Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care (1991).

Treatment for the mentally ill has progressed since the days when they were locked away in madhouses and insane asylums, but abuses still remain. The mentally ill are particularly vulnerable to mistreatment because they are often looked down upon by the rest of society, whose members prefer to forget that they exist. Often unable to voice their concerns and complaints, they are defenseless against the abuses of unscrupulous or uncaring nurses and doctors. But in spite of many abuses, modern mental health facilities, particularly in the industrialized countries, are far better than they once were. Part of the reason for this improvement is the increase in empathy for the plight of the mentally ill, the result of a corresponding increase in respect for the human rights of all people. However, perhaps the most significant change since the eighteenth century is the arrival of a new idea: that mental illness can be treated and either cured or lessened in severity.

In the late 1890s, doctors like Sigmund Freud greatly expanded the field of psychiatry and with it tried to cure those troubled by mental illness. Their successes were real, but limited. Some people could be cured, or helped, by Freud’s talking cure; others, particularly the severely troubled, showed little or no improvement. With the discovery of psychotropic drugs in the 1950s, the treatment of the mentally ill took a giant leap forward, as doctors found that certain chemicals could dramatically improve the behavior and mental state of their patients. Previous abusive treatments, such as electroshock (where a patient was subjected to a series of electric shocks, sometimes damaging their personality or memory) and lobotomies (an operation in which the nerve fibers of the frontal lobes of the brain are severed, often leaving the patient passive and dull, an empty shell of a human being), were abandoned in favor of the new drugs. Although drugs have greatly improved the lives of many mentally ill people—allowing some of them to re-enter the world as happy and productive members of society—they have also sometimes been used in abusive ways. Some institutions have used the drugs to sedate their patients in order to make them easier to handle, rather than out of concern for their well-being.

Places of treatment have also changed since the dark days of the eighteenth century. Insane asylums, themselves an improvement on the old madhouses, were replaced with modern mental hospitals, staffed by trained doctors and nurses. Increased budgets allowed these hospitals to provide various forms of therapy, including painting, theatrics, and other group activities. Nevertheless, abuses continue in hospitals around the world.

In the 1950s, governments in the United States and Great Britain began to release mental patients into the outside world in an effort to deinstitutionalize or mainstream them. The rate of mainstreaming was increased after the early 1970s, when mental hospitals, ignored by much of the country, had reached a low point in their quality of care. This nadir was revealed in 1972, when a young reporter, Geraldo Rivera, smuggled a television camera into Willowbrook, a Staten Island institution for the mentally retarded, and revealed wards crowded with disabled children and fecessmeared walls. Since then there has been substantial, but uneven, improvement in the quality of care.

The main result of reports like Rivera’s, however, was to accelerate the process of mainstreaming, because mental health advocates believed that the mentally ill might be best served by being released from mental hospitals and state institutions. The goal of mainstreaming may have been laudable, but the funds to support the patients in outpatient programs were not sufficient, and many mental patients ended up swelling the ranks of the urban homeless. This decision to leave hundreds of thousands of mental patients without sufficient care was and is a clear human rights violation, as defined by the UN resolutions on mental health. For all its faults, mental health care in wealthy countries like the United States is reasonably good—certainly better than it was fifty years ago. In Third World countries, however, the situation of the mentally ill remains abysmal. Because these countries have too little money to help even the sane and healthy, the mentally ill are often ignored, aided only by the small amounts of money that trickle in from international charities. Abuses reminiscent of the old European madhouses continue in Africa and South America.

In Hidalgo, Mexico, a 1999 investigation by human rights advocates revealed a state mental hospital that epitomized the neglect with which mental patients are treated in much of the world. Inmates in the Hidalgo institution were locked in giant wards, with hundreds of men or women sharing a single dormitory-style room and only a few undertrained hospital personnel to supervise them. The hospital floors were covered with feces and urine, most patients went around shoeless and partially clothed, and some were entirely naked. Many of the patients were not even mentally ill, but rather mentally retarded, yet there were no provisions or plans for releasing them into the kinds of group homes for the mentally retarded that are common in the United States. And as bad as Mexico’s mental health institutions can be, all around the globe there are many institutions that are worse.

One place, worldwide, where the mentally ill continue to face systematic abuse is in prison. Mentally ill prisoners can be the most troublesome, and for that reason prison authorities often treat them with excessive harshness. In many of the new super-maximum security (“super-max”) prisons in the United States, mentally ill patients are locked in small,rift gold isolated cells for twenty-three hours a day. They may be kept in these cells for years, at great cost to their already unbalanced mental state. Human Rights Watch has called this treatment tantamount to torture, a clear violation of the United Nations Universal Declaration of Human Rights, which bans torture and other degrading punishments. Dr. Carl Fulwiler, a psychiatrist who investigated Indiana’s placement of mentally ill prisoners in super-max facilities, said: “To force prisoners with serious psychiatric disorders to live in extreme social isolation and unremitting idleness in a claustrophobic environment is barbaric.”