Since the founding of the United Nations the concepts of mental health and hygiene have achieved international acceptance. As defined in the 1946 constitution of the World Health Organization, “health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” The term mental health represents a variety of human aspirations: rehabilitation of the mentally disturbed, prevention of mental disorder, reduction of tension in a stressful world, and attainment of a state of well-being in which the individual functions at a level consistent with his or her mental potential. As noted by the World Federation for Mental Health, the concept of optimum mental health refers not to an absolute or ideal state but to the best possible state insofar as circumstances are alterable. Mental health is regarded as a condition of the individual, relative to the capacities and social-environmental context of that person. Mental hygiene includes all measures taken to promote and to preserve mental health. Community mental health refers to the extent to which the organization and functioning of the community determines, or is conducive to, the mental health of its members.
Throughout the ages the mentally disturbed have been viewed with a mixture of fear and revulsion. Their fate generally has been one of rejection, neglect, and ill treatment. Though in ancient medical writings there are references to mental disturbance that display views very similar to modern humane attitudes, interspersed in the same literature are instances of socially sanctioned cruelty based upon the belief that mental disorders have supernatural origins such as demonic possession. Even reformers sometimes used harsh methods of treatment; for example, the 18th-century American physician Benjamin Rush endorsed the practice of restraining mental patients with his notorious “tranquilising chair.”
The history of care for the mentally ill reflects human cultural diversity. The earliest known mental hospitals were established in the Arab world, in Baghdad (AD 918) and in Cairo, with that special consideration traditionally given disturbed people, the “afflicted of Allāh.” Some contemporary African tribes benignly regard hallucinations as communications from the realm of the spirits; among others, Hindu culture shows remarkable tolerance for what is considered to be bizarre behavior in Western societies. The Western interpretation of mental illness as being caused by demonic possession reached its height during a prolonged period of preoccupation with witchcraft (15th through 17th century) in Europe and in colonial North America.
So-called madhouses such as Bedlam (founded in London in 1247) and the Bicêtre (the Paris asylum for men) were typical of 18th-century mental institutions in which the sufferers were routinely shackled. Inmates of these places often were believed to be devoid of human feeling, and their management was indifferent if not brutal; the primary consideration was to isolate the mentally disturbed from ordinary society. In British colonial America, mentally deranged persons frequently were auctioned off to be cared for (or exploited) by farmers; some were driven from towns by court order, and others were placed in almshouses. Only after more than a century of colonization was the first British colonial asylum for the insane established in Williamsburg, Va., in 1773. In the 1790s, the French reformer Philippe Pinel scandalized his fellow physicians by removing the chains from 49 inmates of the Bicêtre. At about the same time, William Tuke, a Quaker tea and coffee merchant, founded the York (England) Retreat to provide humane treatment. Benjamin Rush, a physician and signer of the Declaration of Independence, also advocated protection of the rights of the insane. Despite this progress, more than half a century of independence passed in the United States before Dorothea Dix, a teacher from Maine, discovered that in Massachusetts the insane were being jailed along with common criminals. Her personal crusade in the 1840s led to a flurry of institutional expansion and reform in her own country, in Canada, and in Great Britain.
While these pioneering humanitarian efforts tended to improve conditions, one unplanned result was a gradual emphasis on centralized, state-supported facilities in which sufferers were sequestered, often far from family and friends. Largely kept from public scrutiny, the unfortunate inmates of what fashionably were being called mental hospitals increasingly became victims of the old forms of maltreatment and neglect.
The modern mental-health movement received its first impetus from the energetic leadership of a former mental patient in Connecticut, Clifford Whittingham Beers. First published in 1908, his account of what he endured, A Mind That Found Itself, continues to be reprinted in many languages, inspiring successive generations of students, mental-health workers, and laymen to promote improved conditions of psychiatric care in local communities, in schools, and in hospitals. With the support of prominent persons, including distinguished professionals, Beers in 1908 organized the Connecticut Society for Mental Hygiene, the first association of its kind. In its charter, members were charged with responsibility for the same pursuits that continue to concern mental-health associations to this day: improvement of standards of care for the mentally disturbed, prevention of mental disorder and retardation, the conservation of mental health, and the dissemination of sound information. In New York City less than a year later, on February 19, 1909, Beers led in forming the National Committee for Mental Hygiene, which in turn was instrumental in organizing the National Association for Mental Health in 1950.
While philosophic and scientific bases for an international mental-health movement were richly available, Beers seems to have served as a catalytic spark. Charles Darwin and his contemporaries already had shattered traditional beliefs in an immutable human species with fixed potentialities. By the time Beers began his public agitation, it was beginning to be understood that developing children need not suffer some of the crippling constraints imposed on their parents. A newly emerging scientific psychology had revealed some of the mechanisms by which the environment had its effects on individual adjustment, fostering hopes that parents and community could provide surroundings that would enhance the growth and welfare of children beyond levels once thought possible. In this spirit, the mental-health movement early inspired the establishment of child-guidance clinics and programs of education for parents and for the public in general.
Psychiatric and psychological developments during and after World War I provided fresh impetus to the movement. Over the same period, the European development of psychoanalysis, initiated by Sigmund Freud in Vienna, placed heavy emphasis on childhood experiences as major determinants of psychiatric symptoms and led worldwide to increasing public awareness of psychological and social-environmental elements as primary factors in the development of mental disorders.
Beers formed an International Committee for Mental Hygiene in 1919. By 1930, the time of the First International Congress of Mental Hygiene in Washington, D.C., there were mental-hygiene societies in 25 countries. In London at the third international congress in 1948, the World Federation for Mental Health was formed. It provides consultants and shares informal reciprocal functions with several United Nations agencies, including the World Health Organization (in which a mental-health unit was established in 1949). The federation has convened international study groups and expert committees, held regional and international meetings, and developed close contacts with mental-health workers worldwide. In almost every country there is increasing recognition of the interrelationship between mental health, population pressures, and social unrest. With growing urgency, people almost everywhere seek to promote mental health and to educate the public to pursue conditions conducive to individual growth and peaceful development.
For more than a century before World War II, the mental hospitals of many countries had been the responsibility of local government. Under the British National Health Service Act of 1946, however, the task of providing hospital care fell almost completely on the national government through boards of hospital administration acting as regional agencies for the Ministry of Health. In the same year, existing privately supported mental-health organizations combined to form the (U.K.) National Association for Mental Health. This voluntary national group provides resident facilities for disturbed persons, offers follow-up services, and trains mental-health personnel, in addition to carrying on educational programs. The Mental Health Act of 1959 nullified earlier British laws governing policies toward psychiatric disturbance and retardation. The act provided that a person requiring treatment for a psychological disorder could obtain it in a hospital on the same basis as any medical complaint. Community mental-health services were placed under the jurisdiction of local health authorities working in close association with hospital and outpatient centres. British research into mental-health problems is mainly under the direction of the government-financed Medical Research Council.
Provisions for treating and caring for mentally disturbed persons and for encouraging mental hygiene are generally organized in this manner over most of the continent of Europe. In communist countries, the state, either through the central or regional governments, had the task of providing and maintaining facilities for disturbed or retarded persons. In countries of the European Economic Community, government shares its mental-health function with religious groups or with other nongovernmental agencies. Many innovative mental-health services have been initiated in Europe, including the concept of integrated community services, the use of tranquillizing drugs, the sheltered workshop, and the employment of nonprofessional workers in positions of responsibility.
Imported European ideas combined with the traditional reliance on self-improvement and adjustment already present in Canadian and U.S. culture to give the mental-health movement in those countries additional momentum in the 1930s and early 1940s.
World War II and the postwar problems of returning veterans stimulated further public interest in mental health. The mental-health movement and the mass media discovered each other, and a flood of exposés swept Canada and the United States, notably Albert Deutsch’s The Shame of the States in 1948. Published in 1946, Mary Jane Ward’s book The Snake Pit became a Hollywood film success and was followed by many more honestly realistic portrayals of mental problems on screen and television. A psychodynamic approach to the understanding and guidance of children infused North American popular culture. The introduction of pharmacotherapy (e.g., tranquillizing and mood-elevating drugs) stimulated further progress.
In 1946 the passage of the National Mental Health Act in the United States made possible the creation of the National Institute of Mental Health (NIMH) in 1949 within what later became the Department of Health and Human Services. State hospital systems were reorganized with increased budgets, while significant federal funds were made available for research, training, and clinical facilities. NIMH is the major funding resource in the United States for basic and applied research in mental health and in the behavioral sciences, for demonstration projects, and for the training of mental-health professionals. It has developed special programs in a broad range of social problem areas, from drug addiction to suicide prevention. The National Clearinghouse for Mental Health Information, operated by NIMH, is a valuable resource, as is the periodical publication Mental Health Digest. Additional sources of support for mental health in the United States include the National Institute of Child Health and Human Development, the Veterans Administration, the Department of Education, the Social and Rehabilitation Service, the National Science Foundation, and the medical sections of the Department of Defense. Charitable foundations also have provided generous support over the years.
The situation in Australia and New Zealand is similar to that of North America and Europe. Developments in Latin America, Africa, and Asia commonly have been hampered by a shortage of trained institutional staff members and of local sources of support. In many so-called developing countries, mental health and hygiene depend heavily on missionaries, intergovernmental aid programs, and the efforts of agencies of the United Nations.