‘It’s good to talk openly about mental health.’

That’s what we’re increasingly told these days, whether it be by Prince William, Lady Gaga or the World Health Organization, which asserts that mental illness is the leading cause of ill health and disability worldwide.  Mental health problems once kept hidden – or literally locked up in asylums – are now mainstream.  Spurred in part by Steven Fry’s 2006 documentary The Secret Life of a Manic Depressive, celebrities now routinely discuss their mental health.  Even athletes are now willing to share their stories: in the last three years, there have been over 150 stories about mental health on the BBC Sport website.

Such openness about mental health is commendable.  It reduces stigma, helps people get treatment and support and has undoubtedly saved lives.  But is talking all that we should be doing to deal with the current mental health crisis, which has been made all the more challenging by COVID-19? 

As co-editors of the Palgrave book series ‘Mental Health in Historical Perspective’, we believe that history has an important role to play in shaping both our understanding – and response to – mental health and illness today. 

One of the first things history shows is that ideas about mental health have changed remarkably across time and in different places.  Religion, for instance, has long been associated with madness, whether it be the curse from the gods or a sign of demonic possession. 

Humoral medicine, which influenced western medicine for nearly 2,500 years, emphasised the importance of balancing one’s humors: blood, yellow bile, black bile and phlegm.  Moreover, people had humoral personalities that mapped onto each of these humors, respectively: sanguine, choleric, phlegmatic and melancholic.  While we might chuckle at someone getting bled or purged of one’s humors for the sake of their mental health, the broader humoral concept of balance remains highly relevant.

But we don’t have to plunge the depths of time to see how concepts of mental health have changed over time.  Simply going back to the end of the Second World War provides a plethora of different perspectives.

In 1945 psychoanalytical explanations for mental health dominated in many parts of the world.  The psychoanalytical theory was rooted in the ideas of Sigmund Freud and his followers, who saw early childhood conflict as central to mental illness.  While it became popular initially in central Europe, psychoanalysis spread rapidly into Britain, the Americas and elsewhere during the 1930s and 1940s, when hundreds of Jewish psychiatrists fled the Nazi atrocities for safer futures.  Psychoanalysis not only became a popular therapy (albeit mainly for the middle classes), but it also imbued literature, film and art for much of the twentieth century.

But it was not alone.  Wartime research on combat stress helped to spur the emergence of social psychiatry after the War.  Often associated with therapeutic communities and community mental health, social psychiatry was also a preventive approach to mental health that linked mental illness with harsh socio-economic conditions.  It would contribute to the decline of the psychiatric asylum and the rise of community mental health centres. One area ripe for an investigation now is a focus on the social determinants of mental health. What we are now witnessing globally is an increased experience of fear about environmental degradation, anxiety that was heightened before the impact of COVID-19.

Medical models of mental illness have also become a touchpoint for debate.  Neurological explanations for mental illness gained traction during the 1950s, not least because of the growth of psychopharmacology.  Somatic treatments for mental illness, ranging from hydrotherapy and electroshock therapy to insulin shock therapy and lobotomy were prevalent in asylums throughout the world.  The new antipsychotic and tranquilising drugs that began to emerge, however, appeared much more humane – at least at first.  By the 1980s, and the introduction of SSRIs (selective serotonin reuptake inhibitors), biological psychiatry was predominant.  While neurological explanations for mental illness made psychiatry appear more ‘scientific’, psychiatric drugs provided a much quicker, cheaper and apparently more effective treatment than that offered by psychoanalysts.

The availability of psychoanalytical, social and biological explanations, however, did not satisfy everyone.  Paralleling the civil rights movements then occurring, many argued for a radical rethink of mental health and illness.  Arguing that mental illness was a ‘myth’ and a tool for social control, some advocated for antipsychiatry.  Others demanded that the views of patients, ‘psychiatric survivors’ or simply the ‘mad’ be taken more seriously, giving rise to mad people’s and democratic psychiatry movements.  New and future book titles in our series take up these questions of the importance of talking about mental illness, as well as sharing histories of activism, peer advocacy, and the worlds of mental health support services.

Such ideas influenced more recent movements, including the ‘hearing voices’ movement and the neurodiversity movement.  Both suggest that variations of human experiences, such as hearing voices and the characteristics of autism, are too often explained away as mental disorders.  Rather than changing people to make them more ‘normal’, such movements argue that society should be more accommodating of difference. This difference might include an increasing focus on gender diversity, greater awareness of Indigenous mental health concepts, and the potential for thinking about social inclusion as a tool in fostering mental wellbeing.

These are but a few ways in which our understandings of mental health – and, indeed, ourselves – have changed in the last 75 years.  As the growing list of books in our series demonstrates, the origins of such changes are not typically to be found in medical science but in cultural, social and political changes. And as societies continue to evolve, we can expect our understandings of mental health to change as well. 

History, in other words, can deepen and add nuance to our attempts to talk about mental health.  It can add the perspectives of those whose views have not been heard and have not been given the opportunity to shape our current attempts to deal with mental illness in modern societies, including the voices of those with lived experiences of mental illness, and their carers.  Above all, it empowers us to transform society in ways that will both prevent mental illness and improve the lives of those who suffer from it.

Catharine Coleborne is Professor and Head of the School of Humanities and Social Science at the University of Newcastle, Australia. With Matthew Smith, she edits the Mental Health in Historical Perspective series for Palgrave. Her previous publications include Insanity, Identity and Empire: Colonial Institutional Confinement in Australia and New Zealand, 1870–1910 (2015). Catharine is currently second Chief Investigator on two Australian Research Council Discovery Projects focused on histories of mental health and psychiatry in Australia spanning the nineteenth and twentieth centuries.   

Matthew Smith is Professor of Health History at the University of Strathclyde’s Centre for the Social History of Health and Healthcare.  In addition to co-editing Mental Health in Historical Perspective, he has also co-edited the Palgrave volumes Deinstitutionalisation and After: Post-War Psychiatry in the Western World and Preventing Mental Illness: Past, Present and Future.