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      Figure 1.12 When Did the Number of Individuals in Mental Hospitals in the United States Decrease?

      Source: E. Fuller Torrey. Out of the Shadows: Confronting America’s Mental Illness. New York, NY: Wiley, 1997.

      Thought Question: Our history has shown us that neither institutionalizing nor deinstitutionalizing all individuals with serious mental disorders has been effective. What do you think are some characteristics of a workable solution?

      From the Past to the Present

      In light of the history discussed thus far, mental illness has been considered from two perspectives. The first perspective involves the devil or supernatural forces. This was seen in the worldview of early humans in which rituals were performed. It was also the perspective of the Church, especially in the Middle Ages. Rituals were performed to remove the demon from the person, which rarely benefited the individual. Even today, some churches offer forms of exorcism. This perspective is largely based on magic. The second perspective is that of psychology and physiology in a broad sense. This perspective uses research and the sciences to understand what mechanisms lead to mental disorders. Treatment involves the manipulation of these mechanisms through psychotropic medications and psychotherapy. The discovery of psychotropic medications greatly changed treatment of mental illness around the world. As noted in the previous LENS, these drugs allowed for individuals to live in a more independent manner. Throughout this book, I will describe the medications used to treat the major mental disorders.

      Concept Check

      Biological Approaches to Treating Mental Illness

      In this section, I want to provide you with a quick overview of current and historical biological approaches to the treatment of mental illness. These treatments range from the widespread prescribing of drugs to deal with psychological disorders to the less-often used but significant measures involving shock or electrical stimulation of the brain to the rarer use of neurosurgery.

      Throughout our history as humans, we have used natural substances to treat illness. Often, treatment was a hit-or-miss procedure as people learned which substances were more effective than others. With the development of better chemical methods in the last hundred years, scientists began to modify the substances and create them as drugs. Today, we refer to these substances, when used to address mental illness, as psychotropic medications. The overall category of psychotropic medications can be broken into categories based on what they were designed to accomplish. These categories include mood stabilizers, antianxiety drugs, antidepressant drugs, and antipsychotic drugs.

      During the U.S. Civil War, a textbook by Union Army Surgeon General William Hammond suggested that lithium bromide be used to treat manic patients (see Perlis, & Ostacher, 2016). However, it was not until 1949 that the Australian John Cade reported that lithium had a calming effect on animals and humans with mania. As you will see, lithium is still used to treat mania, which we refer to as bipolar disorder today. Drugs that came to be called antidepressants for the treatment of depression, such as monoamine oxidase inhibitors (MAOIs) and the tricyclic antidepressants (TCAs), were discovered through serendipity in the 1950s (Fava & Papakostas, 2016). SSRIs (selective serotonin reuptake inhibitors) such as Prozac were developed later. You will learn about all of these substances in the chapter on mood disorders. Benzodiazepines such as Valium have been used for the treatment of anxiety for at least 50 years.

      One significant event came in 1952 when a French naval surgeon was attempting to find medications to give before an operation to reduce stress (Freudenreich, Goff, & Henderson, 2016). What he discovered was that an antihistamine substance, called chlorpromazine, left individuals feeling indifferent about their operation. Noticing its calming effect, he suggested that this might be useful in the treatment of mental disorders. In particular, it was discovered that chlorpromazine (trade name, Thorazine) helped to reduce the symptoms of schizophrenia and became initially an important antipsychotic medication. This, in turn, led to the reduction in the number of patients in mental hospitals as noted in the LENS on page 25. Some of the early antipsychotic medications had problematic side effects. Newer drugs used today have fewer side effects.

      Other treatment approaches seek to influence the individual’s brain by changing the underlying electrical activity. Some of these treatments are seen as noninvasive (Camprodon, Kaur, Rauch, & Dougherty, 2016). That is, there is no requirement that electrodes or other devices be placed inside the brain itself. The oldest of these techniques is electroconvulsive therapy (ECT) in which electrical activity is used to disrupt normal brain activity and produces convulsions (Welch, 2016). ECT has changed over the years with a reduction in motor convulsions and a reduction in the number of brain areas affected. It is seen as an effective treatment for those with severe depression that does not respond to other types of medication or psychotherapy. An alternative to ECT, referred to as transcranial magnetic stimulation (TMS), disrupts brain activity using magnetic stimulation to treat mental disorders, including depression.

      More invasive treatments require that electrodes be placed in the brain that change the existing brain networks. The technique has been referred to as deep brain stimulation (DBS) and has been used for the treatment of motor disorders such as Parkinson’s disease, as well as obsessive compulsive disorder (OCD) and depression. Stimulating electrodes are placed deep in the brain, and these are connected to a pulse generator that is placed under the person’s skin, typically below the neck. Today’s devices allow health care professionals to adjust the stimulation from wireless devices outside the skin.

      The most invasive procedures are surgeries in which different areas of the brain are removed or their connections disrupted. Severe epilepsy, in which a person has numerous seizures and cannot work or function normally, has been treated in this manner. Today, surgical procedures of the brain are limited to very small areas. In fact, gamma rays rather than a knife are used to make the small cuts. Such small cuts in the brain are used with individuals who show no improvement in epilepsy, depression, or anxiety using standard treatments.

      Not all of the biological treatments have been successful. In the first half of the 1900s, as a treatment for mental illness, the frontal areas of the brain were disconnected from the rest of the brain. This procedure, called a frontal lobotomy, was used until the 1950s and then discontinued. It left the person with limited emotional and cognitive abilities. Even during its time, there were serious debates as to its ethics and effectiveness.

      As you will see throughout this book, biological approaches play an important role in the treatment of mental disorders. Determining effective treatment is not an either/or question of psychological and biological approaches but an attempt to combine treatments that work together in an effective way. For example, research from 2015 shows that psychotherapy along with lower levels of psychotropic medication are very effective for treating schizophrenia

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