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Ava Paravati

English 137H Section 006

Professor Babcock

How New Treatments of Mental Illness Reflect a Change in Societal Stigma

“Crazy,” “insane,” “dramatic,” “unstable,” and “dangerous” are common descriptions of

those suffering from mental illness, stemming from the influence of negative societal stigma. In

American society, mental illness is a topic that has been subject to harsh judgement and

criticisms. According to the American Psychiatric Association, mental illness is defined as a

“health condition involving changes in emotion, thinking or behavior” and is associated with

“distress and / or problems functioning in social, work or family activities.” Those suffering from

mental illnesses not only struggle with the symptoms related to their conditions but are also

targets to members in society who often have improper perspectives on mental health, therefore

discrediting their symptoms and experiences. Improper perspectives on mental health promote

stigma in society, which is defined as a “mark of disgrace associated with a particular

circumstance, quality or person” by the Oxford English Dictionary. This stigma against mental

illness not only harms the mental health community and the progression of symptoms, but

severely impacts the quality and availability of treatments. Treatment options for mental illnesses

have evolved throughout the years, as more scientific research has been performed and the desire

for efficient, humane treatments arose in society. The history of treatment methods for mental

illness directly reveals the stigma of these illness in society. Spanning from the 1930s to present

day in the United States, changing views of mental illness due to social media, policy changes

and scientific research has contributed to shifts towards humane treatment and the decrease of

societal stigma.
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Statistically, mental illness is very prominent in our society. However, many people are

shocked when learning the statistics of mental illness, since those who are struggling often suffer

in silence, afraid of judgement and ridicule. There are two generally accepted classifications of

mental illness, according to the National Institute of Mental Health: Any Mental Illness (AMI)

and Serious Mental Illness (SMI). Any Mental Illness (AMI) includes all mental illnesses, while

Serious Mental Illness (SMI) is a smaller subset of severe mental illnesses. Those with any

mental illness show varying symptoms ranging from mild to moderate. When symptoms begin to

substantially interfere with a person’s everyday life and function, it is classified as a serious

mental illness. 1 in 5 adults in America experience any mental illness each year and in 2019, 51.5

million people were recorded to have had a mental illness (Mental Health by the Numbers,

NAMI). Additionally, 1 in 20 adults in America experience serious mental illnesses and in 2019,

13.1 million people were recorded to have had a serious mental illness (Mental Health by the

Numbers, NAMI). 50% of all mental illness appear around age 14 and 75% by age 24. 24.5% of

females and 16.3% of males will experience a mental illness within their lifetime. It is also

important to recognize that many people struggling with a mental illness will not be diagnosed

and therefore, will not be represented through statistics.

44.8% of adults with any mental illness and 65.5% of adults with serious mental illness in

the United States were treated in 2019. However, the average delay between the first appearance

of symptoms and treatment of mental illness is 11 years (Mental Health by the Numbers,

NAMI). While the numbers regarding treatment may seem encouraging, there is still an

enormous population of people suffering from mental illness that do not, cannot and will not

receive the necessary treatment. Treatment options are dependent on location, availability, and

healthcare costs. 55% of counties in the US do not have a single practicing psychiatrist, which
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limits the accessibility of quality treatment. Healthcare costs and insurance also play a major role

in treatments, as approximately 11.4% of adults with mental illnesses had no insurance coverage

of treatment. This economic restraint further limits who is able to receive treatment and whether

the treatment received is of the quality needed (Mental Health by the Numbers, NAMI). Viewing

the statistics and demographics of mental illness prompts an important question that can be

answered through historical and societal context: If such a large population within the United

States suffer from mental illness, why is it still so stigmatized?

Looking at historical context assists in answering the long-standing question regarding

stigmatization in society. Beginning in the 1930s, the United States saw a surge of mentally ill

citizens within society. The 1930s in America was a time greatly associated with the Great

Depression, a severe worldwide economic depression. The extreme financial hardships placed on

families impacted their psychological state and mental health. During the Great Depression,

suicide rates rose more than 30% and 3 times as many people were admitted into mental

hospitals. Suicide became a topic in everyday conversation, as many families lost their homes,

possessions, and any aspirations for the future. Many upper class and wealthy families filled

psychiatric offices, seeking to cope with the stress and shame related to losing their money

(Psychological Impact of the Great Depression, Encyclopedia.com).

Due to the economic crisis, funding of doctors and hospitals were dramatically cut,

resulting in a decrease in quality and availability of treatment options. Treatments during the

1930s had to be swift and cost effective, as limited funding and high populations of patients

overwhelmed hospitals. Common treatments of the time include lobotomies, electroshock

therapy treatments, insulin-shock therapies, and admittance into asylums or hospitals. When the

lobotomy was invented, there was no proven way to treat mental illness and people were
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desperate for relief and intervention (Lewis). The first lobotomy was performed in the United

States by psychiatrist Walter Freeman in 1936 on a Kansas housewife. Freeman believed that

cutting certain nerves within the brain could eliminate excess emotion, which he believed was

the cause of mental illness, and stabilize the patient’s personality (Tartakovsky). To promote

efficiency, Freeman’s lobotomy was further developed into a 10-minute transorbital procedure

known as the “ice pick lobotomy.” The process of the transorbital lobotomy was made to be

swift and was able to be performed multiple times within a day. First, the patient was rendered

unconscious through means of electroshock therapy. Freeman would then insert a sharp metal

“ice pick” into a patient’s eye socket that was hammered into the brain to sever the connections

of the prefrontal cortex. Lobotomies left patients in a docile state, which was seen as a great

success since they were commonly used to treat schizophrenia, severe anxiety and depression.

The United States performed more lobotomies than any other country, ranging from 40,000 to

50,000 between the mid 1930s to the early 1950s (Tartakovsky). Next to lobotomies,

electroshock therapies were frequently used as treatments for mental illnesses such as severe

depression, severe mania and catatonia associated with schizophrenia (ECT Treatment: A

History of Helping Patients, McLean Hospital). Electroshock therapies were regularly used

within hospitals and asylums, usually performed twice a week on patients. The shocks sent

through patient’s brains were used to induce seizures, which could potentially counteract the

effects of schizophrenia (Neuroscientifically Challenged). Seizures would leave patients in a

temporary state of comatose and paralysis, therefore it was viewed at as a success. Yet another

treatment method that subjected patients to comatose states was insulin-shock therapy. Insulin

shock therapy was primarily used to treat schizophrenia. Injections of insulin were given to

patients to produce this comatose state with time of treatment ranging from 15 to 60 minutes
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(APA Dictionary of Psychology). Finally, the most common treatment of mental illness during

the 1930s was institutionalization. Those suffering from mental illnesses were subjected to harsh

conditions within mental hospitals, as facilities were run down due to lack of funding. Staff

within these facilities were overworked and given too much power over patients, leading to

abuse. Restraints, shock therapies and coma therapies were common in mental institutions.

Doctors at mental institutions used patients as subjects in experimental surgeries and treatments

(Fabian). Asylums and mental facilities were seen at as a way to keep those suffering separate

from the public, therefore promoting isolationism and negative societal stigma.

Stigma surrounding mental illness in the 1930s heavily impacted treatment options, as

well as the quality and money spent on them. Although mental illness was quite prominent in

society, there was still many negative reactions towards those who were suffering. American

society was focused on surviving each day and being able to find enough money to do so. Mental

illness was yet another hardship families had to go through, which led to feelings of resentment

towards those who were suffering. People believed that those who were mentally ill were

incompetent and unable to function in their daily lives. The mentally ill were shamed and feared

causing the population of asylums and institutions to rise dramatically. Due to the limited

education and research done on mental illness in the 1930s, misconceptions and false

information was spread, as well as stigma. With lack of time and funding available to doctors,

research was rarely performed accurately. Lack of accurate research led to misdiagnosing, which

was a common phenomenon in the 1930s as well, as many people believed mentally ill people

were making up symptoms. Stereotypes also shined through and caused further misdiagnosing,

as women were targeted due to “hysteria” and high emotions. Men and women could be
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diagnosed with the same disorder, yet given different treatment options simply due to their

gender.

A physical and figurative shift is seen regarding mental health and its treatments during

the early 1940s to late 1950s, due to the introduction of medication and various calls for reform.

The harsh and inhumane treatments of the 1930s led to activists and families of patients speaking

out. The influence of World War II also contributed to the need to reform the way mental illness

was treated and viewed in society. Thousands of soldiers returned from war with heavy

psychological impacts, riddled with post-traumatic stress disorder (PTSD) and severe anxiety or

depression. In 1946, President Truman signed the National Mental Health Act, which established

the National Institute of Mental Health. The National Mental Health Act redirected funding and

supervision of mental health programs from the state to federal level (Nimh (National Institute

Of Mental Health), Encyclopedia.Com). Newly established and federally funded, the National

Institute of Mental Health lead research efforts relating to mental health, psychiatric disorders,

and behavior. Through new research and observation of treatments in the past, psychologists

began to realize that the mentally ill would benefit from proper evaluation and treatment than

from institutions with abusive conditions (Nimh (National Institute of Mental Health),

Encyclopedia.Com). This realization led to deinstitutionalization, meaning the movement of

mentally ill people from asylums back into society and closure of large state facilities

(Deinstitutionalization - Special Reports | The New Asylums | FRONTLINE, PBS).

Deinstitutionalization spread rapidly after the introduction of antipsychotic medications in 1955.

The first effective antipsychotic created was chlorpromazine, a drug used to treat the symptoms

of schizophrenia through blocking postsynaptic dopamine receptors in the brain

(Chlorpromazine, National Center for Biotechnology Information). Chlorpromazine did not cure
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patients’ psychosis, yet it did control and improve the symptoms of 70% of patients with

schizophrenia (The History of Mental Illness, HealthyPlace.com). Chlorpromazine and other

developing antipsychotics not only reduced costs for mental health centers, but also allowed

patients to transition back into society with their families and loved ones.

Along with the physical shift in treatment options for mental illness, society underwent a

figurative shift in stigma as well during the early 1940s to late 1950s. While new research and

treatments were being developed, the general public had limited knowledge on the science of

mental illness. Misconceptions and improper education on mental illness contributed greatly to

the spread of stigma in society. People felt that the mentally ill were unpredictable, dangerous,

and regularly displayed violent behavior (Baker). This association of violent behavior in

mentally ill patients is seen as a reaction towards patients’ psychosis. However, with the

introduction of antipsychotics, psychosis symptoms were significantly decreased. Therefore, that

fear of violence was being reduced as well. Policy changes made by the government also played

a role in the reduction of stigma. Hearing the government and President validate mental illness

and provide resources for those suffering helped the likelihood of the public to be more

accepting. Perhaps the biggest factor contributing to the shift in societal stigma was the process

of deinstitutionalization. Deinstitutionalization showed people that the mentally ill were not

dangers or threats to society; they were simply regular citizens with a medical condition.

Releasing patients from institutions to be reincorporated into society assisted in the public’s view

of mental illness, as they were able to observe people with mental illness as functioning and

nonthreatening. While stigma was still high during this period, society was beginning to show

openness to research and mental illness in general.

Society and science continued to progress throughout the late 1900s and ultimately,

reached a peak in the shifting views of mental illness and their treatments during the time of the

early 2000s through present day. After decades of research, doctors and psychologists have

developed specific treatment plans and options for each mental illness. The most common

treatments in today’s society include medications, therapies, lifestyle changes, and

hospitalization. Many treatments are recommended to be used in combination with another, to

ensure that the patient is using every resource available to improve their symptoms. Medication

for mental illness has significantly improved since the creation of chlorpromazine in 1955. As

science has gotten more technologically advanced, researchers have been able to identify the

areas and parts of the brain that are causing symptoms of mental illness. While there is no cure

for a mental illness, medications provide alternatives that help control symptoms and assist the

patient in functioning. The most common medications prescribed for mental illness include

antidepressants, anti-anxiety medication, antipsychotics, and mood stabilizers/ stimulants. The

classification and dosage of a person’s medication is heavily dependent on what disorder they

have, how intense are their symptoms, and previous health conditions. Patients must also meet

with a psychiatrist, psychologist, or mental health professional to be recommended for

medication. Medication is strongly recommended to be taken and combined with other

treatments such as therapies and lifestyle changes. Therapy, also known as psychotherapy, is yet

another common treatment of mental illness that comes in a variety of forms. Psychotherapies

are conducted by a wide array of health professionals including psychiatrists, psychologists,

mental health professionals, and social workers (Mental Health Providers: Tips on Finding One).

Different types of psychotherapies include Psychodynamic Therapy, Cognitive Behavioral

Therapy, Dialectical Behavior Therapy, Eye Movement Desensitization and Reprocessing

Therapy, Exposure Therapy, and Mentalization-Based Therapy. When people think of therapy,

they typically think of Psychodynamic Therapy, also known as talking therapy. The goal of

psychodynamic therapy is to recognize negative patterns of behavior stemming from past

experiences. Cognitive Behavioral Therapy (CBT) is used for a variety of mental illnesses such

as depression, anxiety disorders, eating disorders, and schizophrenia (Psychotherapy | NAMI:

National Alliance on Mental Illness). CBT focuses on the core principles of identifying false or

negative beliefs and testing or reconstructing them. Dialectical Behavior Therapy (DBT) is

primarily used for patients with a bipolar disorder diagnosis, emphasizing validation and

acceptance of uncomfortable feelings. Other methods of therapy include Eye Movement

Desensitization and Reprocessing Therapy (EMDR) for post-traumatic stress disorder, Exposure

Therapy for obsessive compulsive disorder, and Mentalization-Based Therapy (MBT) for bipolar

disorder (Psychotherapy | NAMI: National Alliance on Mental Illness). Finally, an alternative

option for those severely unstable is hospitalization. Hospitalization for mental illness can be

either voluntary or involuntarily and is usually used as a last resort option. Patients who are

hospitalized for their mental illness are in serious danger of harming themselves or others,

having psychotic breakdowns and have had extreme challenges in daily function. However,

mental hospitals today are far from the asylums of 1930s. Hospitals today offer medications,

therapies, activities and visiting hours for families and loved ones. In 2014, hospitalization

associated with mental illness accounted for about 6% of all hospital stays (Carroll). The

majority of hospitals stays are associated with mood disorders such as bipolar disorder and major

depression (Carroll). Mental illness does not have a cure, yet patients have a greater chance of

reducing their symptoms and managing their illness through these treatment options. New
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treatment options also directly reflect the evolving societal beliefs regarding mental illness and

its stigmatization.

In modern society, mental illness is now being viewed at in a different light than that of

the past. Stigma prevents those suffering from mental illnesses in accessing treatments,

understanding their condition, and speaking about their experiences. People suffering from

mental illness often intercept societal stigma and internalize negative beliefs, causing further

distress (American Psychological Association). 12.9% of mentally ill people did not receive care

due to the fear of negative opinions from their communities, 12% did not receive care due to the

potential negative impacts it would have on their job and 9% did not receive care because they

did not want others to discover their condition (Clark). However, mental health and illness is

slowly becoming more accepted in society. Improper education and personal bias contribute to

negative stigma, yet public figures and scientists are frequently spreading education and

awareness. Through heightened awareness, relatability in the media and personal experiences,

stigma is slowly being decreased in society. In a survey measuring mentally ill patients’ view on

stigma, results showed that more people felt comfortable talking about their mental illness, more

people stated that they would tell their friend about their illness and fewer people stated that they

would be reluctant to seek help due to stigma (HealthPartners). The presence of negative stigma

is not completely expelled from society, it is slowly being chipped away at. Without the presence

of stigma, the mental health community will continue to grow stronger.

Mental illness does not discriminate, as it affects practically every age, gender, race,

religion, and sexuality. The impact that mental illness has on a person ripple into their families,

friends, communities, and society. With the presence of societal stigma, it is extremely difficult

to provide the support and treatment for those who desperately need and deserve it. However,
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there has been a steady decline in the stigmatization of mental illness throughout the past 100

years. Treatment options are now humane and are scientifically proven to improve symptoms of

mental illnesses. Society is becoming increasingly open about their experiences with mental

health and illness. The current and future generation now not only has control over their future

but the future of mental health. It will not be easy or simple, yet it’s a fight society must endure

for the sakes of others and ourselves. It’s time that society recognizes the importance of mental

health, and that journey starts within each and every person. Break the stigma.
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Work Cited

“APA Dictionary of Psychology.” American Psychological Association Dictionary of

Psychology, 2020, dictionary.apa.org/insulin-shock-therapy.

Baker, Judy. “Stigma of Mental Illness | Disease Prevention and Healthy Lifestyles.” Lumen

Learning, courses.lumenlearning.com/diseaseprevention/chapter/stigma-of-mental-

illness. Accessed 19 Nov. 2021.

Carroll, Heather. “RESEARCH WEEKLY: Hospitalization Trends in Mental Illness.” Treatment

Advocacy Center, www.treatmentadvocacycenter.org/fixing-the-system/features-and-

news/3877-research-weekly-hospitalization-trends-in-mental-illness. Accessed 19 Nov.

2021.

Clark, Maria. “30 Statistics on Mental Health Stigma Infographic — Etactics.” Etactics |

Revenue Cycle Software, 21 July 2021, etactics.com/blog/statistics-on-mental-health-

stigma.

“Deinstitutionalization - Special Reports | The New Asylums | FRONTLINE | PBS.” PBS, May

2005, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.

Dingfelder, S. F. (2009, June). Stigma: Alive and well. Monitor on Psychology, 40(6).

http://www.apa.org/monitor/2009/06/stigma

“ECT Treatment: A History of Helping Patients | McLean Hospital.” McLeanHospital.Org, 13

Mar. 2018, www.mcleanhospital.org/essential/ect-treatment-history-helping-patients.

Fabian, Renee. “The History of Inhumane Mental Health Treatments.” Talkspace, 29 June 2021,

www.talkspace.com/blog/history-inhumane-mental-health-treatments.
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HealthPartners. “Stigma of Mental Illnesses Decreasing, Survey Shows.” HealthPartners,

www.healthpartners.com/hp/about/press-releases/stigma-of-mental-illnesses-

decreasing.html. Accessed 19 Nov. 2021.

“The History of Mental Illness.” Healthy Place, 23 Oct. 2019, www.healthyplace.com/other-

info/mental-illness-overview/the-history-of-mental-illness.

Thompson School District. “The Depression Devastates People’s Lives.” Thompson School

District, https://www.thompsonschools.org/cms/lib/CO01900772/Centricity/Domain/

3627/Effects%20of%20the%20Great%20Depression.pdf. 

Lewis, Tanya. “Lobotomy: Definition, Procedure and History.” Livescience.Com, 13 Oct. 2021,

www.livescience.com/42199-lobotomy-definition.html.

“Mental Health By the Numbers | NAMI: National Alliance on Mental Illness.” National

Alliance on Mental Illness, Mar. 2021, www.nami.org/mhstats.

“Mental Health Disorders That Warrant Hospitalization.” SBH Carolina Dunes,

www.carolinadunesbh.com/news/mental-health-disorders-that-warrant-hospitalization.

Accessed 19 Nov. 2021.

“Mental Health Providers: Tips on Finding One.” Mayo Clinic, 16 May 2017,

www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health-

providers/art-20045530.

“Mental Illness.” National Institute of Mental Health (NIMH), 2021,

www.nimh.nih.gov/health/statistics/mental-illness.
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National Center for Biotechnology Information. "PubChem Compound Summary for CID 2726,

Chlorpromazine" PubChem,

https://pubchem.ncbi.nlm.nih.gov/compound/Chlorpromazine. Accessed 19 November,

2021.

Neuroscientifically Challenged. “The Disturbing Story of the First Use of Electroconvulsive

Therapy.” Neuroscientifically Challenged, 26 July 2019,

neuroscientificallychallenged.com/posts/first-use-electroconvulsive-therapy.

“Nimh (National Institute Of Mental Health) | Encyclopedia.Com.” Encyclopedia.Com, 18 May

2018, www.encyclopedia.com/social-sciences-and-law/law/crime-and-law-enforcement/

nimh-national-institute-mental-health.

“Psychological Impact of the Great Depression | Encyclopedia.Com.” Encyclopedia.Com,

www.encyclopedia.com/economics/encyclopedias-almanacs-transcripts-and-maps/

psychological-impact-great-depression. Accessed 18 Nov. 2021.

“Psychotherapy | NAMI: National Alliance on Mental Illness.” National Mental Health Alliance,

www.nami.org/About-Mental-Illness/Treatments/Psychotherapy. Accessed 19 Nov.

2021.

“Stigma.” Oxford English Dictionary,

www.oed.com:443/start;jsessionid=6DF3F3B0C7A8D0BD9FF055BE89A2AB74?

authRejection=true&url=%2Fview%2FEntry%2F190242%3Frskey%3DQCdWPc

%26result%3D1#eid. Accessed 16 Nov. 2021.

Tartakovsky, Margarita M. “The Surprising History of the Lobotomy.” Psych Central, 21 Mar.

2011, psychcentral.com/blog/the-surprising-history-of-the-lobotomy#1.
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“What Is Mental Illness?” American Psychiatric Association, Aug. 2018,

www.psychiatry.org/patients-families/what-is-mental-illness.