Healthy New Jersey

New Jersey Governor's Council on Mental Health Stigma

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The Evolution of Stigma

Historically, Mental Health Was Separated from Mainstream Health

Allowed mental health to be separated from mainstream health. As a result, the journey through time has seen individuals living with mental illness suffering a myriad of consequences because of stigma and ignorance. Clearly, we are not where we need to be. However, by looking back, we can achieve perspective as to how and why we are where we are. In gaining perspective, perhaps we can gain insight into how to shape a future that is stigma free.

Ancient Egyptians Viewed Mental and Physical Illness as the Same

Egyptians perceived mental and physical illness as both having physical causes. Though the science was ancient, in some ways, the Egyptians were ahead of their time with this early concept of parity. In ancient times, religion played a powerful role in all aspects of people's lives. As such, in addition to early holistic treatment, the cure for mental illness was also thought to lie in faith and religion.

Viewpoints on Clinical Care Were Varied

However, for the most part, perspectives were enlightened in ways that resemble the "New Age" philosophies of today's world. The idea of simple talking and storytelling was likely the precursor to therapy and counseling. Aristotle believed music could cure mental illness while Hippocrates saw biological causes and thus, focused on nutrition. Galen thought humor and exercise were effective. These early visionaries were laying the foundation of modern mental health care.

Some Individuals Were Less Enlightened

For example, Aeschylus thought mental illness was demonic possession and Homer believed that God simply took the mind away. Socrates, on the other hand, had a unique point of view. He saw mental illness as a gift from God and so his philosophy was not to cure it, but embrace it. Interestingly enough, in spite of belief in God during this period in history, suicide was completely acceptable.

As Time Went on, Blame Became Prevalent

During into the Dark Ages, those living with mental illness were blamed for their condition. As religious intolerance took hold, so did the stigma of mental illness. Those with mental illness were thought to be possessed by demons and riddled with moral decadence. They were not treated for mental illness, but instead, punished for it and imprisoned. Individuals, perceived as stepping outside the "norm" at a time when society was drowning in ignorance and fear, were sent to institutions where they were chained to walls in an environment that was completely inhumane. By the 18th century, this extremely depraved level of thinking began to dissipate. In its place, however, families simply sent those with mental illness "away" for life. Those without financial resources were relegated to publicly funded facilities that were wholly inadequate.

In the Mid-18th Century, Institutionalized Care Became Popular

Institutionalized care became the answer to centuries of mistreatment of individuals with mental illness. The nation's first hospital - Pennsylvania Hospital - opened its doors in 1753 "to care for the sick-poor and insane who were wandering the streets of Philadelphia." It was during this time that health care revolutionary Dr. Benjamin Rush - otherwise known as the father of American psychiatry - espoused the belief that mental illness is a disease of the mind and not possession of demons or moral decay. Though his methods seem rather barbaric by today's standards, Dr. Rush took the treatment of mental illness out of the dungeon and into an age that held the promise of quality care with dignity and compassion. Unfortunately, there was still a long road ahead.

One Hundred Years Later, Dorothea Dix Openly Fought Stigma

Dorothea Dix became one of the first individuals to openly fight the stigma of mental illness. Through her efforts, more than 30 new hospitals were built specifically for the purpose of treating mental illness. Clearly ahead of her time, Dorothea lobbied Congress for $5 million to be invested into mental health care. She wanted the government to play a role in the care of disadvantaged individuals who had mental illness. Although the bill passed - approved by both houses - it was vetoed by then President Franklin Pierce.

Since World War II, Deinstitutionalization Has Been Embraced

Since World War II, mental health advocates and those living with mental illness have embraced deinstitutionalization as a liberating, humane policy alternative to restrictive care. With the introduction of medications that could effectively treat mental illness, the idea of individuals receiving treatment while remaining a part of the community became a reality.
Deinstitutionalization, seen as an empowering concept for those living with mental illness, is based on the concept of wellness and recovery. Although the goal of the deinstitutionalization movement was to shift clinical services from longer, custodial care to shorter outpatient care, the results have been mixed. Today, with need outweighing resources, the process of deinstitutionalization has been resulting in a growth in homeless individuals with mental illness. It is painfully clear that the stigma of mental illness continues to compromise the development of a treatment and post-treatment structure to support the deinstitutionalization process. Hospital- and community-based services have grown over several decades; however, the need continues to increase dramatically as the behavioral healthcare workforce is declining.

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