From The Mad House and Asylum: Welcome to Contemporary Mental Health

Sometime last year, I discovered Coursera and it has proved to be a brilliant way to work on New Year’s Resolution #3: to learn – new things and old alike – and to have a blast doing it.

I signed up for a large number of interesting courses and in February, I genuinely started. One of the most interesting classes so far has been The Social Context of Mental Health & Illness by Charmaine Williams.

The first week focussed on the history of mental health from the 18th century on. It’s been a trip down memory lane as we discussed the Victorian work houses, prisons and later asylums. It’s rather discouraging to be reminded how the history of mental health has been plagued by huge swings from high optimism to low pessimism, and constant underfunding and a lack of resources.

The Dutch museum Het Dolhuys (The Mad House) in Haarlem also discusses the history of mental health. The museum, built in an old asylum, still retains some of the old cells in which patients were held. Near the beginning of the exhibition, you are invited into one of the cells. The door closes behind you and you are left in darkness. The museum is a trip through psychiatry’s history and sheds some light on this history from various perspectives, including that of patients. It also discusses contemporary views on madness and mental health, which leads to the fundamental question: what is madness? Is it merely ‘a normal response to a mad world’? And why are mental health problems still stigmatized so terribly within contemporary society?

Both the museum and the course have a clear goal: to promote understanding and tolerance for mental health issues.

Het Dolhuys does this through highly interactive and engaging exhibitions. The Coursera course does this through lectures, assignments and a forum in which people from all over the world can discuss these controversial issues. (There are 27,000 people signed up as of mid-February, from 90 different countries. Quite the cosmopolitan community.)

The course includes a number of writing assignments the first of which asked to comment on how four terms (named in the text below) reflected the way societies have viewed mental health and illness over time in 300 words or less:

The (lunatic) asylum has a two-sided image: a place of abuse and of care, refuge and healing (2). Initially, the asylum was substantially better than its predecessors – the work house and prisons. Unlike there, patients were not mechanically restrained nor subjected to harsh treatment (2). Instead, they were offered treatment and care by isolating them from society and its pressures, and given moral therapy beneficial to both patients and society.

The name change to ‘insane asylum’ signaled a change in the perceived origin of mental problems – supernatural and spiritual explanations for madness were increasingly discarded (3).
By late 19th century, however, decrease of funding, overcrowding and lack of adequate (permanent) treatment had led to deplorable conditions within the asylums similar to that in the earlier work houses and prisons (exposed by e.g. Clifford Beers (3)).

The subsequent professionalization of psychiatry led to the rise of ‘Mental Hospitals’, a name to signify that psychiatry desired to be taken seriously as a medical profession (3). Mental Hospitals were sanitized, and increasingly sophisticated treatment was offered (ECT, medication). Psychiatrists increasingly held power concerning patients’ treatment – with or without patients’ consent. Madness was considered a disorder which ‘could be treated scientifically and effectively’ (3). Psychiatry profiled itself as useful ‘beyond the walls of the hospital’ to include social service and welfare (3).

By mid-twentieth century, abuses within the Mental Hospitals were exposed such as the potential damage of medication and the power psychiatrists held. This led to the anti-psychiatry movement and deinstitutionalization, where patients were released back into the community (5). Patients were given more autonomy (6) and increasingly relied on their families and a network of counselors (5). The name changed to ‘Mental Health Centre’, which denotes a more positive image – a focus on general ‘health’ instead of ‘illness’.

The numbers correspond to the lectures of the Coursera course The Social Context of Mental Health & Illness
2 – lecture 1.2 Why the asylum?
3 – lecture 1.3 20th century mental health care
5 – lecture 1.5 Deinstitutionalization
6 – lecture 1.6 Community-based mental health care

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