Why look at history?
Mental illness is an illness like any other. But for centuries people did not understand it. They feared it. Looking at history shows why a nurse today uses respect, consent and community care. It also shows how new ideas replaced old fears, step by step.
History of psychiatric care
1. Fear and hiding (old times)
Many societies thought the illness came from spirits, curses or weak character. Some ancient doctors, such as Hippocrates in Greece, said it came from the body and brain. But for many people, the answer was to hide or lock the person away. There was little real treatment.
2. Kind care (from the late 1700s)
Reformers such as Philippe Pinel (France) and William Tuke (England) asked for gentle, respectful care called moral treatment: calm place, regular day, useful work, kind words.
3. Medicines and the community (1950s onward)
In the 1950s the first medicines for severe symptoms (for example chlorpromazine) were found. Patients could be calmer and leave hospital sooner. From about the 1960s many countries closed or shrank large hospitals and built community care. This is called deinstitutionalisation.
Advocacy for people with mental disorders
Advocacy means speaking up for a person's rights, or helping them speak for themselves.
- Patients speak. In 1908 Clifford Beers, a former patient in the USA, wrote a book about his bad experience and started the mental hygiene movement.
- Families and groups. Family groups and self-help groups ask for better services and fight stigma.
- International rules. The United Nations adopted principles to protect people with mental illness in 1991, and the Convention on the Rights of Persons with Disabilities in 2006.
The main rights: respect, privacy, informed consent (the person agrees after understanding), the right to complain, and the right to live in the community.
Nurse's role: explain things simply, protect privacy, ask for consent, and report ill-treatment.
History of mental health and welfare systems
Laws show how thinking changed. Early laws were mostly about keeping the public safe by confining people. Newer laws are about care, rights and welfare.
Example: Japan
- 1900: law on custody of mentally ill persons (confinement at home).
- 1950: Mental Hygiene Act, hospital care becomes the system.
- 1987: Mental Health Act, after cases of ill-treatment in hospitals were exposed. It brought voluntary admission and patient rights.
- 1995: Mental Health and Welfare Act, adds welfare support to return to society.
- 2000s onward: disability support laws bring community living services.
Example: India
- 1912: Indian Lunacy Act (mostly confinement).
- 1987: Mental Health Act (care focus).
- 2017: Mental Healthcare Act (right to care, dignity, community living).
The direction is the same in every country: from confinement to care, rights and welfare.
Try it
Draw a four-box timeline on paper: Fear, Kindness, Rights, Laws. Under each box write one change in how a person with mental illness is treated. Then ask an elder how people in your area spoke about mental illness long ago, and compare with today.
Key formulas and definitions
- Fear and hiding → Kind care → Rights and voices → Laws for care and welfare
- Deinstitutionalisation = from big hospitals to community care
- Informed consent = the person understands, then agrees
Worked examples
1. Why did medicines in the 1950s change care?
Medicines reduced severe symptoms, so patients were calmer, could leave hospital sooner and live in the community. This supported the move away from large hospitals.
2. A nurse asks a patient before giving a treatment and explains it simply. Which right is she protecting?
The right to informed consent, together with respect.
3. How is a 1950 law different in spirit from a 1995 law (Japan example)?
The 1950 law was about hospital care. The 1995 law added welfare support so people could return to society.
Common mistakes
- Thinking mental illness always came from spirits or weak character. It is an illness of the brain and mind.
- Thinking big hospitals are the best place for long-term care. Today care is mostly in the community.
- Mixing up advocacy (speaking up for rights) with treatment (medicine or therapy).
- Thinking laws only protect the public. Modern laws also protect the patient.