The individuals detailed here are associated with key milestones in the history of treating mental illness. Explore their stories.
1792 Philippe Pinel: A humane approach Statue of Philippe Pinel in Paris, France. The humanitarian approach to mental illness was pioneered by Pinel, who reformed the barbaric treatment of mental patients in Paris. Before the Enlightenment, the mentally ill were treated in inhumane ways - such as being chained, beaten and starved. There seemed to be no effective treatment available. In 1973, Pinel challenged this idea when he removed the chains from patients at the Asylum de Bicêtre in Paris. He replaced purging, bleeding and blistering with simple humane psychological treatments such as separating patients and categorising them according to different disorders, along with observing and talking to patients. Before Pinel, 60% of the patients at Asylum de Bicêtre died of disease, suicide or other causes within their first 2 years of admission. Under Pinel's supervision, this decreased to less than 20%. Pinel thought that those suffering from mental illness could be rehabilitated and released back into society. His theories on mental illness were the first to span both physiological and psychological explanations. He suggested that mental illness was the consequence of having too much social or psychological stress, or the result of either hereditary causes or damage to the body. He is credited as the first person to keep written case studies on patients, which concentrated on their long-term treatment. Pinel saw asylums as places for treatment and not places to hide the mentally ill. They were to be places where patients were seen as sick human beings deserving of dignity, compassion and medical treatment. Under Pinel, who lived from 1745 to 1826, the place of residence for the mentally ill was converted from a mad house into a hospital. His reforms were soon emulated all over Europe.
1848 Phineas Gage - Neurological advance Skull and death mask of Phineas Gage. Biological and neurological approaches to mental illness were envisaged after Gage survived an iron rod blown through his head. Phineas Gage, a Vermont railwayman, was an affable person until an incident in 1848. The 25 year old was blasting the ground prior to laying train tracks. This technique involved putting explosive powder with a fuse into a hole, covering the hole with sand and lighting the fuse. Unfortunately, Gage accidentally tamped the powder into the hole before sand was poured in. When the powder was struck with the tamping rod, it ignited. The blast drove the rod through Gage's head. The inch-thick shaft entered through his left cheekbone and left eye and exited through his skull. Gage survived the accident and within 2 months he could walk, talk and was generally aware of his surroundings. However, his once affable personality had been replaced by less desirable qualities and characteristics such as lying, excessive use of abusive language and non-dependability. He was no longer recognised as the same man: 'The equilibrium . between his intellectual faculties and animal propensities seems to have been destroyed', according to Harlow, a physician from Boston, 1868. Gage eventually died from epilepsy 13 years after the incident and his skull was donated to medical research. Upon examination, it was found that the change in personality was a result of severe damage to the frontal lobes of the brain. Early theories concerning Gage's sudden change in behaviour were not readily accepted. There was scepticism at the time about whether the brain could govern human behaviour. More recently, neurologists have returned to the case to ascertain the full extent of the damage to his brain. It appears that the frontal lobes necessary for language and motor function were unaffected whilst the underside of the frontal lobes were heavily damaged, causing the anti-social behaviour. This phenomenon has also been detected in present day cases of people suffering from tumours, accidents or neurosurgery. The case of Phineas Gage was the first to be publicised that demonstrated a biological basis for behaviour. It therefore became an early explanation for abnormal behaviour and mental illness - a seminal case in the detection and causes of medical illness.
1900 Sigmund Freud: Psychoanalysis Sigmund Freud published The Interpretation of Dreams outlining his theory of Psychoanalysis. The Austrian neurologist, known as the founder of psychoanalysis, is pictured here in the 1920s. Freud, after studying with Jean Charcot at the Salpetrière in Paris, began to investigate the workings and inner depths of the mind as an alternative explanation for the increasing epidemic of hysteria in turn of the century Europe. This led Sigmund Freud to develop the technique of psychoanalysis in Vienna in the 1890s. Psychoanalysis was concerned primarily with understanding and treating mental disorders. For Freud the mind is active and complex with some mental processes operating unconsciously. Treatment of an individual could only be successful if the conflicts within the unconscious are acknowledged and then investigated in the conscious arena of therapy, thereby rendering the unconscious conscious. It is argued that Freud's book 'The Interpretation of Dreams' is one of the most significant books of the twentieth century, representing both the birth and formation of modern Psychoanalysis. Discoveries and legacy According to Freud, the unconscious mind is hidden, and various techniques are necessary in order to unearth its conflicts. These techniques as developed by Freud are: Free Association The patient lets their mind wander, saying the first thing that comes into their head Para praxes Involuntary slips of the tongue or pen, commonly known as Freudian slips Projective tests Ambiguous images that the patient is required to describe or create a story about Dream analysis The patient is requested to revisit their dreams, as it is believed that they represent wish fulfilment of hidden desires. Freud believed that dreams represent 'the royal road to the unconscious'
1936 Dr Moniz - Brain surgery Dr Moniz was the first to have success using the lobotomy technique (also known as Psychosurgery or brain surgery) for curing patients of mental illness.The earliest form of brain surgery was called trepanning. It involved the hand drilling of a 2.5-5cm hole in the skull of a conscious patient. However barbaric this may appear, it did have some limited success as it often led to the alleviation of pressure on the brain. Out of 400 skulls investigated by one researcher, 250 indicated some form of recovery. Psychosurgery continued to be used in one form or another, with varying levels of success until it was completely revolutionised in the twentieth century. In 1936 Dr Moniz, a Portuguese neurologist, introduced the psychosurgical technique of lobotomy (the removal or severing of certain connections in the brain). Moniz's first 20 patients survived the operation and the technique soon achieved a credible international reputation. Despite being shot in the leg by one of his patients, Moniz argued that the potential benefits of the operation outweighed the costs of the behavioural and personality changes that resulted from a lobotomy. In 1949, he received the Nobel Prize for developing this radical treatment of mental illness.
1937 Cerletti - Shock therapy Ectonustim 3 ECT machine with scalp electrodes, in use from 1958 to 1965. Cerletti was the first to use electro-convulsive shock therapy on humans - to treat schizophrenia. In the 1930s, Ugo Cerletti, an Italian psychiatrist was investigating the use of electricity as a technique to induce a seizure. After experimenting on dogsand observing the use of electricity to slaughter pigs, Cerletti tested ECT on a human patient. In 1938 a Milanese man, who was found mumbling incoherently in the railway station, was chosen to be the first recipient of this new cure. Electrodes were applied to both temples, a rubber tube was inserted between his teeth to stop him biting his tongue and the electricity was conducted between the electrodes. The patient's muscles jolted as he remained conscious throughout the operation, and he pleaded, 'Not again it is murderous'. Despite this, after ten treatments he spoke more coherently and Cerletti claimed that the patient was released 'in good condition and well oriented' and a year later had not relapsed. Although arguments about whether Electro Convulsive Therapy is therapy or cruelty persist, it is still used today, primarily as a last resort in the treatment of severe depression. Some psychiatrists state that it has proved the most effective treatment in many cases.
1952 Laborit - Drug therapy Laborit discovered 'chlorpromazine', the world's first antipsychotic drug used to treat schizophrenics. The introduction of Neuroleptic drugs, including antipsychotics and major tranquillisers in the 1950s, often meant that there was less need for physical restraint. The world's first antipsychotic drug - chlorpromazine - used to treat schizophrenics, was, discovered by Laborit. A patient was sedated as well as experiencing a reduction in delusions and hallucinations. Neuroleptics are used mainly to treat schizophrenia but also other severe disorders including mania and amphetamine abuse. The most widely used group is the phenothiazines. They are used in the acute phase of schizophrenia when psychotic experiences are most intense and disturbing. Afterwards they can be used intermittently when the patient is unwell or stressed. One explanation of schizophrenia concerns an excess of the neurotransmitter 'Dopamine' and most neuroleptics block the build up of dopamine in the brain. They are reported to be effective with 60% of patients. However, there are many side effects, some irreversible, such as muscular rigidity, uncontrolled fidgeting and uncontrolled spasms. More recent neuroleptics, introduced in 1990, are seen to be more effective and cause fewer side effects. 'They have revolutionised the treatment of schizophrenia,' according to Comer, 1998.