Mental Health (Encyclopedia of Psychology)
Personal well-being, characterized by self-acceptance and feelings of emotional security.
After decades of concentrating on mental illness and emotional disorders, many psychologists during the 1950s turned their focus toward the promotion of mental health. Attempts to prevent mental illness joined the emphasis on treatment methods, and promotion of "self-help" in many cases replaced the dependence on professionals and drug therapies. American psychologist Gordon Allport (1897-1967) viewed the difference between an emotionally healthy person and a neurotic one as the difference in outlook between the past and the future. Healthy people motivate themselves toward the future; unhealthy ones dwell on events in the past that have caused their current condition. Allport also considered these qualities characteristic of mentally healthy individuals: capacity for self-extension; capacity for warm human interactions; demonstrated emotional security and self-acceptance; realistic perceptions of one's own talents and abilities; sense of humor, and a unifying philosophy of life such as religion.
In the United States, the Community Mental Health Centers Act of 1963 attempted to localize and individualize the promotion of personal well-being. Community mental health centers were established for outpatient treatment, emergency...
(The entire section is 454 words.)
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Mental Health (Encyclopedia of Public Health)
The field of mental health has made many advances, particularly since 1980. These developments include an increased understanding of the brain's function through the study of neuroscience, the development of effective new medications and therapies, and the standardization of diagnostic codes for mental illnesses. However, many questions about mental health remain unanswered, and many people around the world are unable to benefit from the knowledge and treatments that are available.
Seven in ten Americans with a mental illness do not receive treatment. Biases against mental illness and lack of public awareness are among the obstacles that limit access to treatment and affect willingness to seek care. Fewer individuals with major psychiatric illnesses were institutionalized in the United States in the year 2000 than in 1980, but limited community resources had not yet met existing treatment needs. Over one-third of the homeless in the United States have a severe mental illness. The prevalence of dementia is rising as people are living longer, adding to the need for more resources. One of the main challenges for the field of mental health is overcoming the gap between an increasingly sophisticated understanding and treatment of mental illness and the availability of these advances to individuals and populations in need.
Mental, or psychiatric, illnesses are a major public health concern. They adversely affect functioning, economic productivity, the capacity for healthy relationships and families, physical health, and the overall quality of life. They cut across racial, ethnic, and socioeconomic lines to affect a significant proportion of communities worldwide. They tend to develop and manifest in the early adult years, often preventing individuals from leading full and productive lives. The National Comorbidity Survey of 1994 found nearly half of the individuals in its random U.S. sample had a psychiatric disorder over their lifetime, and almost 30 percent had one in the past year. The World Health Organization's World Health Report 1998 lists mood and anxiety disorders among the leading causes of morbidity and mood disorders as the leading cause of severely limited activity. Mental disorders account for a quarter of the world's disability. Comorbidity (having more than one illness) is common and even further increases the risk of disability. Suicide is the eighth leading cause of death in the United States and the third leading cause in the fifteen- to twenty-four-year-old age group. More people die by suicide than homicide.
Dianne Hales and Robert Hales define mental health as
the capacity to think rationally and logically, and to cope with the transitions, stresses, traumas, and losses that occur in all lives, in ways that allow emotional stability and growth. In general, mentally healthy individuals value themselves, perceive reality as it is, accept its limitations and possibilities, respond to its challenges, carry out their responsibilities, establish and maintain close relationships, deal reasonably with others, pursue work that suits their talent and training, and feel a sense of fulfillment that makes the efforts of daily living worthwhile (p. 34).
A healthy pregnancy, adequate parenting, secure attachments to caretakers, regular involvement in groups, and stable intimate relationships all contribute to the development and maintenance of mental health. Mental health does not imply the absence of distress and suffering, or strict societal conformity. Mental health and illness, idiosyncratic beliefs and delusions, sadness and depression, and worry and severe anxiety lie on a continuum. An essential criterion for defining behavioral patterns or symptoms of psychological distress as a mental disorder is that they become significant enough to be functionally disabling and impose substantial increased risks ranging from an important loss of freedom to suffering pain, disability, or death.
Both genetic inheritance and environmental factors influence one's vulnerability to mental illness. Twin and family studies and genetic research have demonstrated the former, though specific genes have been difficult to identify, and there may be multiple genes involved in most psychiatric disorders. Traumatic events throughout one's lifetime, including childhood abuse or neglect, major losses, violence, military combat, and dislocation (as among the urban homeless or wartime refugees) are known to threaten mental stability. Nontraumatic stressors, including unemployment, bereavement, and relational or occupational problems, can impact mental health. Nutritional deficiencies (such as vitamin B12), infections (such as syphilis and HIV [human immunodeficiency virus]), and heavy metal poisoning (such as lead) can all cause psychiatric syndromes. Substance abuse contributes significantly to the exacerbation or even precipitation of other psychiatric illnesses and complicates their treatment. Poverty and home-lessness are risk factors for many of these problems, but may also be the outcome of psychiatric illness and the inability to function independently.
Many models of mental health and illness have been proposed. Emil Kraepelin (1856926) contributed to the development of the precise categorization of mental illnesses, particularly in distinguishing the long-term course of psychotic and mood disorders. Sigmund Freud (1856939) developed the theory of psychoanalysis, through which he claimed that symptoms of psychiatric disorders, as well as many phenomena of everyday life, have unconscious meanings and sources. Erik Erikson (1902994) formulated a theory of human development with specific tasks and crises at different stages of the life cycle. Failure to master these stages can lead to various forms of psychopathology. Neuroscientists have demonstrated molecular models of illness, which involve genetic, developmental, functional, anatomical, and molecular abnormalities of the brain. The biopsychosocial model, proposed by George Engel in the 1970s, integrates the biological, genetic, and molecular mechanisms of illness with a psychological understanding of personality development and response to stress as well as social, cultural, and environmental influences.
The Diagnostic and Statistical Manual of Mental Disorders (its 4th edition, DSM-IV, was published in 1994) is the product of research on standardized diagnostic criteria aimed at creating a common, validated descriptive system for all mental health care providers. It is nearly universally accepted, as it classifies and describes categories of illness and aims to be neutral about controversial theories of etiology (see Table 1). The following descriptions of various mental disorders are based on DSM-IV criteria.
Affective disorders involve a cyclical pattern of significant mood disturbance. A major depressive episode may be precipitated by a stressful life situation but also has genetic factors. Disturbances in appetite, sleep, energy, concentration, and sexual interest are common symptoms. The majority of patients respond to treatment with antidepressant medication and/or psychotherapy. An individual who has long-term (over two years) of minor to moderate depressive symptoms may have
|Lifetime and 12-month prevalence of DSM-III-R disorders|
|Lifetime prevalence (%)||12-month prevalence (%)|
|*Includes schizophrenia, schizoaffective disorder, schizophreniform disorder, delusional disorder, and atypical psychosis.|
|SOURCE: Kessler, R.C. et al. (1994). "Lifetime and Twelveonth Prevalence of DSMII Psychiatric Disorders in the United States: Results from the National Comorbidity Study." Archives of General Psychiatry 51:89.|
|Major depressive episode||12.7||21.3||17.1||7.7||12.9||10.3|
|Any affective disorder||14.7||23.9||19.3||8.5||14.1||11.3|
|Agoraphobia without panic disorder||3.5||7.0||5.3||1.7||3.8||2.8|
|Generalized anxiety disorder||3.6||6.6||5.1||2.0||4.3||3.1|
|Any anxiety disorder||19.2||30.5||24.9||11.8||22.6||17.2|
|Substance use disorders|
|Alcohol abuse without dependence||12.5||6.4||9.4||3.4||1.6||2.5|
|Drug abuse without dependence||5.4||3.5||4.4||1.3||0.3||0.8|
|Any substance abuse/dependence||35.4||17.9||26.6||16.1||6.6||11.3|
|Any of the disorders above||48.7||47.3||48.0||27.7||31.2||29.5|
dysthymia. Substance abuse, medical disorders (such as hypothyroidism), and normal life cycle events in which hormonal changes are prominent (such as the postpartum period) can all cause symptoms of depression and should be considered carefully during an assessment. An adjustment disorder is a milder disturbance of mood that may occur in response to a stressful life situation, such as a personal loss or financial crisis, and that usually resolves when the stress is relieved. About 1 percent of the general population has bipolar disorder, also called manic-depressive disorder, in which manic episodes are present as well as depressive episodes. Mania is characterized by a persistently elevated or irritable mood for at least a week, often with decreased need for sleep, rapid speech, impulsivity in spending and other behaviors, and grandiosity. In more severe manic and depressive episodes, psychotic symptoms may emerge, which can complicate treatment. Bipolar disorder is treated with mood stabilizers, such as lithium or valproic acid, and supportive management. Antidepressant medications alone can precipitate mania in susceptible patients.
Psychotic disorders are characterized by "positive" symptoms such as hallucinations, delusions, and bizarre behaviors, as well as "negative" symptoms such as paucity of speech, poverty of ideas, blunting of affective expression, and functional deterioration. Cognitive problems such as disorganization of thought processes also occur. Schizophrenia is a chronic, disabling illness that affects almost 1 percent of the world population, independent of ethnic or cultural background. Risk factors include a family history and possibly psychosocial stressors. The precise cause is still unknown, but it is clear that certain areas of the brain and certain neurotransmitters are involved. Many of those affected are unable to maintain work or relationships and require supportive services to help them manage basic needs such as shelter and food. Treatment includes antipsychotic medication, comprehensive social services including social and occupational rehabilitation if possible, and substance abuse treatment if necessary. Newer antipsychotic medications such as clozapine, olanzapine, and risperidone have been able to treat more symptoms generally with fewer side effects, allowing many to lead more productive lives. Some patients with schizophrenic-type illness also experience prominent affective symptoms nonconcurrently and may have schizoaffective disorder. These patients often require a mood stabilizer as well as antipsychotic medication. Substance use, especially hallucinogens and stimulants (such as amphetamines and cocaine), can precipitate psychotic symptoms, and these may even endure beyond the period of substance use. Some medical conditions (such as epilepsy and delirium) and some medications (such as steroids) can also cause psychotic symptoms and should be considered in the assessment and treatment of psychosis.
Anxiety disorders are among the most prevalent psychiatric disorders in the general population, and these disorders lead to both psychological distress and increased health care utilization. Panic disorder often manifests with somatic symptoms, such as palpitations, chest pain, nausea, trembling, dizziness, and shortness of breath, and can be easily confused with a medical disorder by both patients and doctors. Patients develop persistent concerns about having further panic attacks. Some develop agoraphobia, or a fear of being in public places where their attacks may be triggered. Other phobias include simple phobia, such as fear of heights or specific animals, and social phobia, which is a marked and persistent fear of certain or all social situations, such as speaking in public or being around others in general. People with obsessive-compulsive disorder have obsessions, characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate, and/or compulsions, characterized by repetitive behaviors or mental acts often performed in response to an obsession. After one experiences a traumatic event, in which actual or threatened death or severe injury is witnessed or experienced, one may develop post-traumatic stress disorder. Intrusive recollections of the event (such as nightmares), avoidance of reminders of the event, and increased arousal (such as increased vigilance for potential threats) can all cause significant distress and impairment following a wide range of traumatic events, including an accident, military combat, torture, or rape. Generalized anxiety disorder is characterized by excessive and persistent anxiety or worry about a number of events or activities, such as work or school performance. For all anxiety disorders, specific psychopharmacologic and psychotherapeutic (such as cognitive-behavioral therapy) techniques of treatment can be effective and complementary.
Substance-use disorders are quite common and occur in all segments of society. They can lead to accidents, violent crime, and major problems in school and at work. They can cause or complicate various medical and psychiatric illnesses. Liver failure, ulcers, heart attacks, cognitive disorders, and depression are among the potential outcomes of various substances. These disorders pose major public health concerns for public safety, health costs, economic productivity, and pregnancy risks, among others. Substance abuse is defined as a maladaptive pattern of use indicated by continued use despite persistent or recurrent social, occupational, psychological, or physical problems caused or exacerbated by the use of the substance; or recurrent use in situations that could be physically hazardous (such as driving while intoxicated). With substance dependence, signs of physical dependence such as withdrawal symptoms are often present, and the person spends a great deal of time involved in substance-related activities, uses more of the substance than intended, is unable to cut down, and continues to use the substance despite social, occupational, or physical problems related to it. The first steps of treatment involve developing insight, acknowledging the problem, and wanting to change. There are various self-help groups (such as Alcoholics Anonymous), comprehensive treatment programs, psychosocial interventions, and medications that can help lead to successful recovery for the majority of those with substanceuse disorders.
Childhood disorders include pervasive developmental disorders, such as autism, which occurs in four out of ten thousand people; mental retardation, which can be caused by a variety of genetic abnormalities or prenatal insults; and attention deficityperactivity disorder, which can lead to significant problems in school and in social relationships. Childhood abuse and neglect are tragically quite common, with one million children affected annually in the United States alone. These can have major adverse effects on development of personality, relationships, and the ability to function in the world.
Personality disorders are usually first evident in late adolescence and are characterized by pervasive, persistent maladaptive patterns of behavior that are deeply ingrained and are not attributable to other psychiatric disorders. Biological and genetic factors, as well as developmental difficulties, are significant contributors. Other disorders described in DSM-IV include eating disorders, with restriction (anorexia) and/or binging and purging (bulimia) and impulse control disorders (e.g., kleptomania). Somatoform disorders cause physical symptoms with no apparent medical cause (e.g., hysterical paralysis).
Gender, race, ethnicity, and culture are important factors in determining the expression and risk of mental disorders, and these factors also impact on treatment considerations. Certain disorders are more prevalent in women, such as depression and eating disorders, and some in men, such as substance abuse. Cultural background may influence the idioms of psychological distress. For example, nervios describes for many Latinos a constellation of somatic, anxiety, and depressive symptoms distinct from particular DSM-IV diagnoses. Psychiatric disorders are the main risk factor for suicide, but rates vary significantly depending on gender, age, race, religion, marital status, and culture.
PAUL J. ROSENFIELD
STUART J. EISENDRATH
(SEE ALSO: Community Mental Health Centers; Dementia; Depression; Schizophrenia; Stress)
Bromet, E. J. (1998). "Psychiatric Disorders." In Maxcy-Rosenau-Last Public Health and Preventive Medicine, 14th edition, ed. Robert B. Wallace. Stamford, CT: Appleton and Lange.
Diagnostic and Statistical Manual of Mental Disorders (DSM IV) (1994), 4th edition. Washington, DC: American Psychiatric Association.
Eisendrath, S. J., and Lichtmacher, J. (1999). "Psychiatric Disorders." In Current Medical Diagnosis and Treatment 1999, eds. L. M. Tierney, Jr., S. J. McPhee, and M. A. Papadakis. Stamford, CT: Appleton and Lange.
Engel, G. (1980). "The Clinical Application of the Biopsychosocial Model." American Journal of Psychiatry 137(5):53544.
Hales, D., and Hales, R. E. (1995). Caring for the Mind: The Comprehensive Guide to Mental Health. New York: Bantam Books.
Jamison, K. R. (1999). Night Falls Fast. New York: Alfred Knopf.
Kaplan, Harold I., and Sadock, Benjamin J., eds. (1995). Comprehensive Textbook of Psychiatry. 6th edition. Philadelphia: Williams and Wilkins.
Kessler, R. C.; McGonagle, K. A.; Zhao, S.; Nelson, C. B.; Hughes, M.; Eshleman, S.; Wittchen, H. U.; and Kendler, K. S. (1994). "Lifetime and Twelve Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results from the National Comorbidity Study." Archives of General Psychiatry 51:89.
U.S. Public Health Service (1999). The Surgeon General's Call to Action to Prevent Suicide. Washington, DC: Author.
World Health Organization (1998). World Health Report 1998: Life in the Twenty-first Century, A Vision for All. Report of the Director-General. Geneva: Author.
Mental Health (American History Through Literature)
A popular contemporary joke says that anyone ahead of you driving slower than you want to go is an idiot and that anyone who passes you is a maniac. If someone disagrees with one's point of view, one might ask, "Are you crazy?" One might describe a chaotic classroom as like bedlam. People freely, even humorously, use the terms of mental health to define not only others but also themselves. The literary critic Shoshana Felman, in her study Writing and Madness, says, "To talk about madness is always, in fact, to deny it. However one represents madness to oneself or others [for example, a novelist to his or her readers], to represent madness is always, consciously or unconsciously, to play out the scene of the denial of one's own madness" (p. 252). Fictional representations of mentally disordered characters appear in the earliest works of American literature. The novel Wieland (1798), by the first professional belletristic writer in America, Charles Brockden Brown (1771810), is narrated by a confessed madwoman, Clara Wieland. Clara's brother, Theodore Wieland, thinks that God has spoken directly to him and commanded him to kill his family, but he has been tricked by a ventriloquist. His sister Clara analyzes her own feelings as she tells this tale of disturbing psychological imbalance.
A number of other classic American novels from the nineteenth century present characters with mental disorders. A mentally unhinged singing master, David Gamut, in James Fenimore Cooper's The Last of the Mohicans (1826), moves freely amid the murderous Magua and his band of Hurons because lunatics received reverential treatment. Nathaniel Hawthorne's (1804864) masterpiece The Scarlet Letter (1850) presents the demoniacally insane character of Roger Chillingworth, whose obsessive desire for revenge against his unfaithful wife, Hester Prynne, and her lover, the Reverend Arthur Dimmesdale, propels the novel's plot. Rather than acknowledge his situation in a stable fashion, Chillingworthimself a physician with an understanding of medicinal herbsisplays neurotic behavior that seeks to rectify his feelings of betrayal by cunningly inflicting misery on others. The literary reputation of Hawthorne's friend and neighbor Herman Melville (1819991) rests with general readers largely on the basis of one novel: Moby-Dick (1851). Melville's character Captain Ahab is most often described by critics as being megalomaniacal (desiring omnipotence) or monomaniacal (pathologically obsessed with one idea) because of his single-minded purpose of using his ship and its crew to get revenge on the white whale that physically harmed him by biting off his leg; Ahab is unable to grasp the extent to which Moby-Dick caused him psychological harm.
Readers of literature typically want to see characters who resemble themselves but who also differ in some degreeetter looking, wiser, more adventurous. Readers' interest also extends to characters who are psychotic, conflicted, emotionally disturbed, especially those who advance the story by means of deviously constructed schemes growing out of some form of mental derangement. In the early twenty-first century one refers to people with various mental disorders with compassion, but not so long ago in America individuals with mental illness were routinely called lunatic, maniac, mad, evil-possessed, deranged, and the like. Manifestations of odd behavior that both amuse and unsettle one have become a staple of American literature, whether in the form of minor characters such as Cooper's David Gamut or central characters in twentieth-century novels such as Frederick Exley's A Fan's Notes (1968) and Ken Kesey's One Flew over the Cuckoo's Nest (1962), both of which are principally set in psychiatric hospitals.
MENTAL HEALTH IN COLONIAL TIMES
The earliest settlers in America clustered for mutual protection and support in villages and towns along the eastern seaboard, so society was "urban" in the sense that people lived in close proximity. Aberrant behavior was readily apparent in these close-knit settlements that grew progressively into towns and cities. The citizen majority who consider themselves sane determine which individuals are not sane. Forms of insanity have always existed in American community life, and novelists and poets reflect these aberrancies in their writings. In literature, corruption, crime, or mental instability typically occur in cities, while the bucolic, scarcely populated countryside represents purity and normalcy. In colonial times, mentally handicapped people in American urban communities were kept by their families in private homes, but some towns housed the violently insane in jails with common criminals or in almshouses with the poor. As communities grew, they began developing institutions for the mentally ill as early as the middle of the eighteenth century.
The first mental hospitals arose in or near major citieshiladelphia, Williamsburg, New York, Boston, Hartford, Lexington. The establishment of these specialized hospitals during colonial times was consistent with the egalitarian attitude that America could cure all its societal ills in its quest to improve upon the European culture from which it sought to dissociate itself. With characteristic optimism, Americans thought that if something was wrong, a solution lay in setting about to correct it. If some individuals were insane, then insane asylums would solve the problem. In 1751, when the first general hospital in the British North American colonies was founded in Philadelphia, Benjamin Franklin urged that it include facilities for the treatment of the mentally ill. In 1766 Governor Francis Fauquier of Williamsburg argued in the Virginia House of Burgesses for the establishment of a mental hospital. Norman Dain notes that Fauquier called attention to "a poor unhappy set of People who are deprived of their Senses and wander about the country, terrifying the Rest of their Fellow Creatures" (p. 7). He called the insane "miserable Objects who cannot help themselves" and called upon the colony to "endeavor to restore them to their lost Reason" (p. 7).
As state mental hospitals appeared, families often relinquished the care and treatment of the mentally ill from the home to the institution. Families were not only relieved of the burden of caring for a loved one in the home but also comforted by the developing medical specialty that treated the mentally afflicted. They did not send relatives away to be chained in a dungeon but to be cared for by trained professionals whose abilities surpassed that of family members. Communities actively sought to establish these facilities as a mark of their cultural progression and civic pride in caring for their citizenry. Nor were these hospitals simply madhouses where pandemonium reigned. Benjamin Reiss writes that the doctors at the New York State Lunatic Asylum at Utica, founded in January 1843, practiced medical intervention with their patients, but they became known for their innovative treatment of insanity as the result of a psychological or moral cause. In a nurturing environment, they closely monitored their patients and engaged them in useful and enriching activities such as reading, writing, performing plays, worshipping at chapel, and learning marketable skills.
MENTAL HEALTH AND SLAVERY
As the nation grew and as hospitals for the insane became widespread, a special problem arose. Before the Civil War, most asylums in the United States, both North and South, either refused admission to blacks or gave them inferior treatment and facilities. Indeed, common knowledge among both medical professionals and lay people held that blacks and whites were so different in every way that they could not even suffer the same forms of mental illness. Peter McCandless writes that South Carolinians admitted slaves to their state mental hospital in 1848 but not necessarily out of a sense of altruism. Politically, the admission of blacks blunted some abolitionists' criticism of the generally harsh treatment of slaves in the South.
The novelist and poet William Gilmore Simms (1806870), one of the most talented writers in the South and a native of Charleston, South Carolina, published his first novel, Martin Faber, a psychological study of a criminal, in 1833. He also spoke out on the issue of slavery and mental illness. Simms argued in an essay titled "The Morals of Slavery" (1838) that the slave system actually encouraged mental stability because the slaves had no concerns about the future, no worries about supporting themselves or their children, and no anxiety about being cared for in old age. Simms's views carried great weight in the South because of his influential position as editor of the prolavery Southern Quarterly Review (1849856), a widely circulated periodical with a strong regional slant that published stories, poems, book reviews, and essays. Others in the antebellum South dismissively thought that distinctive mental disorders occurred in blacks because of their belief in witchcraft, conjuring, spells, and potionshe deeply rooted cultural beliefs that originated in Africa and the Caribbean and were brought to America by the slaves. The African American writer Charles W. Chesnutt (1858932) uses conjuring as a psycho-physiological motif in his short story "The Goophered Grapevine," first published in 1887 but set in the antebellum South. The story depicts a slave whose physical appearance changes with the seasons of the year because of his belief in the power of a conjuring or spell cast on him.
A New Orleans physician, Samuel Cartwright (1793863), believed that slaves sometimes suffered from a peculiar form of mental illness that he termed drapetomania, the abnormality that caused slaves to run away, from drapeto, meaning "to flee," and "mania," "an obsession." Clearly, however, Cartwright had subjective motives for his peculiar example. Harriet Beecher Stowe (1811896), in a very different sense, employed the motif of the runaway slave in her widely influential novel Uncle Tom's Cabin, first published serially in the magazine the National Era in 1851 and 1852. Uncle Tom does not run away because his deep religious faith allows him to transcend his servitude; he will receive his freedom in heaven. But in one of the most memorable scenes in the novel, the slave Eliza Harris, holding her young son Harry, leaps from one ice floe to the other over the Ohio River in her successful escape from Kentucky to Ohio. Her husband, George, later runs away and is united with his wife and child. One of the ironies apparent to modern readers concerning an attempt to invent a medical term for the act of a slave's running away is that the institution of slavery itself represented a sort of regional insane asylum, a vast madhouse populated with slaves as unwilling inmates. To want to escape from a place of madness must surely be a form of sanity, not insanity.
Because mental illness manifests itself in such a variety of individual ways, no single method of treatment or panacea drug is likely to be discovered. Certainly the modern day pharmacopoeia can bring about dramatic improvement in patients suffering from depression, schizophrenia, and other neuroses. In the early to mid-nineteenth century, psychiatry was an unknown term. Patients suffering from mental illness received treatment for their symptoms, not the underlying causes of the symptoms. If patients were violent, they were restrained. If they spouted nonsense and could not communicate, they were isolated from those who could talk sensibly. During this period in American history, some of the cures advocated by respectable physicians seem ridiculous in the early twenty-first century: shaving the patient's head and washing it with vinegar, making the patient stand under a waterfall, or pouring cold water on his or her head. The reasoning behind these practices held that if the patient is "out of his or her head," the problem must lie within the head itself; therefore, the application of physical therapies to the part of the body that is disordered must be the correct medical approach. Other cures called for a regimen of exercise, fresh air, games, special diets, bleedings, purges of the bowels, cold baths, the administration of various tonics, excursion trips to exotic locales, and the imbibing of alcohol.
One can see that the imprecise understanding of mental illness invited all sorts of quackery. Among them, as is now known, was the practice of phrenology (from the Greek phren, "the mind"; hence the word "frenzy"). Commonly misunderstood as simply feeling the bumps of one's skull, a phrenological reading was, in fact, analogous to the palpations of a modern clinician who feels and thumps not simply the exterior of a patient's body but also, and more importantly, the organs within; their sizes, shapes, and sounds can tell a skilled practitioner much about the patient's condition. Similarly, the skull and its bumps are not as crucial as the form of the enclosed brain. A trained phrenologist was believed to be able to read the bumps that reveal the shape of the brain beneath them. These shapes were said to indicate a person's behavioral qualities such as combativeness, wonder, cautiousness, ideality, and benevolence. Once diagnosed, the patients were encouraged to modify their behavior to suppress bad tendencies and endeavor to adhere to the good tendencies.
Enjoying its greatest respectability from the 1820s through the 1840s, phrenology, in its early stages, was a serious attempt at discovering the origins of human behavior. This quasi-scientific field of inquiry now belongs to the netherworld of palmistry, soothsaying, and snake-oil elixir treatments. In an era when devices such as sonograms, computed tomography imaging (CT scanning), magnetic resonance imaging, and X-rays were still yet to be imagined, a group of the most esteemed medical doctors in Philadelphia proposed testing the validity of phrenological theory by measuring and examining the brains of selected individuals who were known achievers, so the first phreno-logical society was established there in 1822. The German neurologist Johann Gaspar Spurzheim taught a course in phrenology at Harvard Medical School in 1832, increasing the discipline's following among physicians and the public in general. In 1839 George Combe, a Scottish phrenologist, delivered a series of lectures at the Philadelphia Museum. Edgar Allan Poe studied Combe's Lectures on Phrenology (1839) for assistance in writing his 1839 short story "The Fall of the House of Usher."
The second edition of Walt Whitman's Leaves of Grass was published in 1856 by Fowler and Wells, a company whose officers were, in fact, phrenologists. The brothers Orson Squire Fowler (a classmate of Henry Ward Beecher at Amherst College) and Lorenzo Niles Fowler along with Samuel R. Wells operated their phrenological cabinet in New York City following the success of their operation in Philadelphia. Lorenzo Fowler examined Whitman's cranium in July 1849, and it is possible to match, as scholars have done, all the qualities of Fowler's reading with selections
Without completely embracing phrenology, most of the principals in the transcendentalist movement showed interest. Amos Bronson Alcott, the leader of the transcendentalists at his commune Fruitlands, gave little credence to phrenology, although he willingly sat for at least four readings in the 1830s, including one reading by Lorenzo Niles Fowler.
Initially fascinated with the promise of phrenology to decipher character, Ralph Waldo Emerson (1803882) later rejected phrenology. Perry Miller quotes Emerson as saying, "Phrenology laid a rough hand on the mysteries of animal and spiritual nature, dragging down every sacred secret to a street show" (p. 499). Even as he condemned its coarser aspects, Emerson credited phrenology with having "a certain truth to it; it felt connection where the professors denied it" (p. 499).
Margaret Fuller, who had a phrenological reading, was more enthusiastic than most of her transcendentalist friends, believing that any effort to understand the mind a worthwhile study; the parallels between idea and nature were central to transcendentalist thought. Theodore Parker, whose keen mind Emerson admired, credited the phrenologists with weakening old ways of thinking and inviting progress in understanding the nature of humankind. The transcendentalists' reaction to phrenology varied, and it never became integral to their movement; they viewed it as they would any scientific inquiry into the mind, and as phrenology's general appeal faded, so did their interest.
A REPRESENTATIVE WRITER
Of all American writers in the mid-nineteenth century, Edgar Allan Poe (1809849) is most often associated with madness or instability. A possible exception to this claim may be made for Jones Very (1813880), a minor poet and tutor in Greek at Harvard who insisted that his sonnets were communicated to him by the Holy Ghost. Very voluntarily committed himself to an insane asylum. Poe's legendary alcoholism and other unusual behavior such as his marriage to his thirteen-year-old cousin suggest an unstable individual. Lorenzo Niles Fowler conducted a phrenological reading of Poe (the date is not certain) and published his reading in the Illustrated Phrenological Almanac for 1851 (1851). The reading wove phrenological theory with the circumstances of Poe's life, such as his mother's career as an actress, his being orphaned at a young age, and his alienation from his foster father, to account for his personal behavior as well as his highly psychoanalytical writings.
Poe is foremost in American literature for using psychological abnormality in poetry and fiction. His poem "The Haunted Palace" (1839) symbolizes a deranged mind, and his most famous poem, "The Raven" (1845), presents a tormented narrator mourning the loss of his lover and imagining a dialogue with a fantasy bird. Among tales in which Poe uses insanity as a theme are "The Cask of Amontillado" (1846), "The Fall of the House of Usher" (1839), "The Black Cat" (1843), and "The Tell-Tale Heart" (1843). Without knowing the modern-day terminology for depression, Poe's unnamed narrator in "The Fall of the House of Usher" describes his friend Roderick Usher as "alternately vivacious and sullen" (p. 721), a clear example of bipolar disorder. As Roderick's mental state deteriorated, he "rocked from side to side with a gentle yet constant and uniform sway" (p. 729). Modern psychotherapists would view this action as part of the rapid cycling that signals the onset of a complete breakdown.
The narrator of "The Tell-Tale Heart" talks to investigating police after he has committed a senseless murder of an old man. He challenges the police: "How then am I mad? Hearken! and observe how healthily, how calmly, I can tell you the whole story" (p. 731). The narrator tells the police that "what you mistake for madness is but over-acuteness of the senses" (p. 731). The more he attempts to appear calm during the interrogation, the more excitable he becomes, especially as he thinks he hears the incessant beating of the heart of his victim lying beneath the boards of the floor. The only way the narrator can expiate himself of his intolerable guilt is to confess. The role of the police in this story is similar to that of a modern-day psychoanalyst. By allowing the narrator to tell his tale, to talk it out, the disturbed person arrives at his own cure: confession.
Because mental healthr mental illness, depending upon one's point of views part of the shared human experience, literature and madness have been intertwined since the earliest forms of storytelling, enriching generations of listeners and readers. In legends, folklore, mythology, and the Bible, evidence abounds that readers and writers have a continuing fascination with the abnormal and the inexplicable, a psychic belief in the supernatural, a fascination with the grotesque, and a respectful awe of the fearful aspects of the human psyche.
See also "The Fall of the House of Usher"; Leaves of Grass; Moby-Dick; Philosophy; Proslavery Writing; Psychology; "The Raven"; The Scarlet Letter; Science; Slavery
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