Mental Health and Social Work

Mental Health and Social Work Impact of 20th Century Ideas and Innovations

Concepts of Mental Health Ideas have varied over time: • 400 B.C Greek physician Hippocrates regarded mental disorders as diseases. • The Christian Church divided, some leaders regarding “madness” as manifestations of sin, others as an illness that should be treated. • 1400s – Europeans create special hospitals for people with mental illness. • Early American settlements either isolated the mentally ill in ‘madhouses’ or left their care in the hands of family. • Early 1800s Benjamin Rush, a contemporary of Washington and Jefferson, publishes a book on diseases “of the mind.” • Asylums created in most major cities, 1820-1860.

Reform Efforts and New Methods 1840’s Dorothea Dix works to establish 32 state insanity hospitals. Late 1880s: Nellie Bly poses as an inmate to expose poor asylum condition. Her studies shame city and state governments into improving conditions. 1900 -- 1930’s: new drugs developed, new methods include electro-therapy, and surgery (including lobotomy).

Adolf Meyer A Swiss physician, Meyer inaugurated better treatments for patients in public mental facilities, basing his idea on relating the illness and treatments to the “social and environmental background” of the patient.

Ugo Cerletti Ugo Cerletti (1877-1933) develops electro-shock methodology for treating depression, schizophrenia. Results are controversial.

American Practitioners On February 6, 1940, Doctors J. Impastato and Renato J. Almansi treated their first patient at Columbus Hospital, New York City, using a machine brought by Almansi from Italy. Many praise electroshock for helping patients, critics charge that it is used by family to make children, elderly, “docile.”

Patients Selected Potential suicides Those suffering from depression Those with violent tendencies Those diagnosed with schizophrenia and mood disorders. Side effects include memory loss, depression, headaches, nausea. By the 1950s many states began to regulate or forbid electroshock.

Social Work and Electroshock Today About 100,000 patients are treated annually in U.S., mostly for schizophrenia and severe depression. About 5 die each year from procedures. Two-thirds treated are women. A social worker may suggest options of treatment for individuals that are experiencing mental illnesses or depression. Social workers will also play the of an educator in which they will provide individuals and their families with information about electroshock. Also, social workers may deal with individuals that have had treatments and are now effected psychologically.

Lobotomy – Invasive Surgeryof the Brain Chronic Pain, Suicidal Ideation, Tension, Apprehension, Anxiety, Depression Insomnia, Delusions, Hallucinations, Crying spells, Melancholia, Obsessions Panic states, Disorientation, Psychalgesia (Pain of psychic origin) Nervous Indigestion, & Hysterical Paralysis

Steps in a Lobotomy Typical procedure: Electroshock to induce unconsciousness (older patients single shock, younger patients may need several shocks) Brain is entered from eye sockets An incision is made in the brain using a stylus modeled after an ice pick (orbiclast) Incision makes a lateral cut - the frontal lobe needs to be separated from the thalamus Repeat the process in the other eye Patient's blood is then injected into the brain to destroy brain tissue in regions where the orbiclast couldn't reach

Lobotomy Developed Friederich Golz (1890s) Conducted surgical experiments removing the temporal lobes of dogs This made the dogs more tame and calm compared to untreated dogs Gottlieb Burkhardt (early 1900s) Physician and supervisor of an asylum in Switzerland who use Golz method on patients Dr. John Fulton (US, 1930s) Removed the frontal lobes of chimps, and then humans.

Walter Freeman Intrigued by the promise of the lobotomy Freeman (1895-1972) developed a “fast technique” and used it to perform some 4000 lobotomies from 1948-1960. He travelled in van he modified as an “operating theater” (the “lobotomobile”)

Controversy Arguments for and against lobotomy paralleled those in the case of electroshock: that it helped with those who were violent or suicidal or depressed; that it was used to “control patients” who didn’t really need it. With the development of Thorazine, an anti-psychotic drug, in the 1950s, lobotomies declined. Freeman was widely attacked and discredited. The procedure is used sparingly today.

Psycho-therapy --Wilhelm Wundt Wilhelm Wundt, a German physician, established a school for “study of human psychology” (Greek for knowledge of character) in Leipzig in 1879. IN keeping with the growing faith in science, Wundt held the belief that “every physical event has a mental counterpart” which could be analyzed, measured and recorded.

Freud Freud studied the ideas of Wundt and others, and entered private practice in 1886. Within 10 years he had developed a method of working with hysterical patients which he called 'psychoanalysis'. Others such as Alfred Adler, Karl Abraham and Otto Rank received some training from Freud before becoming psychoanalysts in their own right. While parts of Europe embraced the idea of “psychoanalysis,” it remained unknown in America until after 1910.

William James William James, and eclectic scholar and professor at Harvard, helped to establish a “lab in psychology” at Harvard and found one of Wundt’s students to direct it. In 1890 he published his book PRINCIPLES OF PSYCHOLOGY, which remained the basic work for over 25 years.

Social Work as a Profession In 1914, Abraham Flexner, a physician and educator in medical ethics, gave a paper in which he argued that “social work” met all the criteria of being a professional occupation (having organizations of practitioners, a code of ethics, and education standards for training. A link between social work and medical issues was of long standing.

Pop Psychology Origins The 1920s was a decade of major changes in American culture, with the advent of motion pictures, radio, changes in fashion, literature, markets, and morals. Freud and “psychology” suddenly became popular.

Carl Rogers Carl Rogers (1902-1987), was a very influential American psychoanalyst who played a major role in developing “client-centered therapy” as opposed to determinist theories like Freud, etc. As a variable approach to dealing with behavior, this well-suited the American fondness for pragmatism.

B. F. Skinner B. F. Skinner, another influential force in psychological theory, drew upon educational ideas to develop his behavior-centered ideas. By the 1940s, social work (which had risen out of religious and voluntary reform roots) was stressing psychology as an important component of training.

DSM – The Mental Health Guide The first edition of the DSM was published in 1952. Few realize that this was first developed by a committee of psychiatrists as a new classification scheme, called Medical 203, issued in 1943 as a "War Department Technical Bulletin."

Mental Health Social Work evolved as a profession from voluntary reform movements aimed at improving communities by attacking problems related to poverty, homelessness, etc. Improving individual habits and judgments by use of psychology and mental health was thus viewed as a means of strengthening the community rather than an end result – making a “better” individual

Alcohol as an example Social Work efforts in relation to alcohol is based on an accepted theory and certain treatments drawn from medicine and psychology; the aim to control or eliminate the use of alcohol. This • Decreases problems in society due to alcohol • Crimes • Violence • Helps individuals grow and be useful to society • Increase in will-power and “character” • Less of poverty (drain on community resources)

Alcohol Defined as Illnessor Addiction Alcoholism -- “A chronic disease, or disorder of behavior, characterized by the repeated drinking of alcoholic beverages to an extent that exceeds customary dietary use or ordinary compliance with the social drinking customs of the community, and which interferes with the drinkers’ health, interpersonal relations or economic functioning” (Richard G. Schlaadt & Peter Shannon, Drugs, Use, Misuse and Abuse (1994) Had alcoholism continued to be seen as a “character defect” health insurance would not provide coverage for treatments.

Alcohol and Social Work Social Work approaches to alcohol mix medical approaches with “character building” efforts. • Food and shelter assistant (helps individual and society by reducing crime, etc.) • Referrals to mental health counselors, addiction programs, and self-help groups (eg. AA, etc.) • Referrals to medical/psychological specialists for medication, in-patient & out-patient treatment of alcoholism as an addiction. Thus it is appropriate to treat alcohol abuse in both medical and psychological ways. By contrast, no one seriously considers trying to treat Alzheimer's as a psychological problem.

Prescription Since the 1950s, hundreds of new prescription medications have been developed and approved for use by the Food and Drug Administration. Understanding these, their uses and side effects have become so complex that social workers generally refer clients to pharmacists or medical experts – which has an impact on the trust factor in client-worker interactions.

Behavior Modification Traditional methods: faith, education, etc. Psychotherapy Medication Challenges to Social Work Prior to 1900, modifying a person’s behavior

Mental Health and Social Work