Early treatment of insanity in 19th century England

Abstract

Early intervention in psychosis emerged in the 1980s and has gradually become a new paradigm in mental health service worldwide. Yet, very few studies on the history of early intervention in mental illness exist even to date. This dissertation explored the situation in 19th century England when Britain was the only superpower in the world and at the same time was plagued by the rising number of insanity cases that she could only cope with by building more and bigger asylums.

The idea of early treatment of insanity was found in various publications written by different physicians in the first half of 19th century. A few of them also proposed primary preventive measures as they believed that a good and disciplined life style could help to avoid the illness. They also saw that insanity could be hereditary. Meanwhile, the debate over the nature of insanity whether it is purely biological or goes beyond the physical body was happening in England as in continental Europe. The physicians supporting the idea of early intervention were also those who subscribed to the theory that insanity has a biological origin. The staging concept in the development of mental illness was well conceived by some physicians. There were also attempts to identify the symptoms in incipient insanity which is close to the modern concept of prodromal stage. Some medical professions also put forward detailed theories on the pathology of the illness based on their knowledge on brain physiology and its interaction with other organs of the body.

During this period, professionalization of psychiatrists was advancing. In this process, there was clash between two schools of thoughts. One considered that the profession should move along a scientific path while the other considered that more effort should be devoted to pragmatic issues such as those concerning asylum management. This conflict had in some way hindered the advancement of early treatment.

Another major obstacle to the provision of early treatment was the distrust of the society towards psychiatrists. After a number of notorious cases involving people being wrongly confined in the asylums had been widely publicized, the law was tightened to limit the authority of psychiatrists in certifying insanity and in treating uncertified cases. This had resulted in a serious blockade on the road to early treatment. Stigmatization of mental illness in the society was also a major factor in deterring people from seeking early assistance.

From the experience in 19th century England, it was found that medicalization of mental illness, professionalization of psychiatrists, establishment of mutual trust between psychiatrists and the society, as well as de-stigmatization of mental illness would be conducive to the development of an early intervention paradigm.