Training Mental Illness Professionals

Article excerpt

Historically, new knowledge about psychiatric illnesses has been slow. Unlike doctors in other branches of medicine, where specialists had easy access to diseased organs, psychiatrists have had to cope with limited access to the brain. Only recently have neuroscientists had technology that allows new insights into basic brain functions, architecture, and chemistry. According to Dr. Lewis Judd, past director of the National Institute of Mental Health, 95 percent of what we now know about the human brain we have learned since 1980.

And yet very little significant change is happening inside the universities. Many faculty in schools of psychiatry, social work, psychology, and nursing continue to teach what they were taught in their own graduate educations. Psychiatric theory often becomes a matter of the professor's personal choice. Psychiatric residents learn psychopharmacology that is current and accurate, but their knowledge about the effects of major mental illnesses on families and persons suffering from these tragic maladies is incomplete and flawed. Yet a large proportion of severely ill people live with their families, who have become primary caregivers and caregivers of last resort. On the other hand, social workers learn about community resources but little about the biological bases for brain disorders and about pharmacological agents that control these disorders.

A Historical View of Care of Psychiatrically Ill Persons. We find that severe mental illness has been present in the world as far back as biblical times, and stigma against the mentally ill has had a long and inglorious history in western civilization. For centuries, the mentally ill have had to suffer an unremitting cycle of exile, extermination, and inhumane confinement. They have had few advocates. Ignorance about brain illness has fueled the theory that mentally ill persons are demon-possessed. To our disgrace, even today there are those who still hold that belief and act on it. In the Middle Ages, a few enlightened centers of care, such as the community at Gheel in Belgium where a group of compassionate monks reached out, have provided support and caring to people suffering from mental disorders. The center at Gheel continues to offer foster care and asylum in 1993. But it is a notable exception. More prevalent practices have been to exile the mentally ill, burn them as witches, or set them adrift on overcrowded ships to wander between European ports. Pope Innocent VII authorized the extermination of witches in 1484, and a Dominican publication, the Malleus Maleficarum, detailed the recognizable behaviors of "witches." These behaviors would be clearly recognizable to any modern psychiatrist as the same symptoms of schizophrenia, manic-depression, and severe depression that are detailed in the present Diagnostic and Statistical Manual III-R. Nine editions of Malleus Maleficarum were published, and thousands of mentally iii people were burned as witches in France, Germany, and England.

Societies and mental health professionals continued to be puzzled about what constituted an appropriate approach to severely ill people whose behaviors and expressions frightened their neighbors. In eighteenth-century England, citizens visited Bedlam hospital, where a circus atmosphere surrounded the exhibition and exploitation of the "lunatics," who, like wild animals, were put on display in their cages for the townspeople's amusement. In colonial America, mentally ill persons wandered the outskirts of towns, living in the woods and in caves, much as many of the homeless mentally ill do today.

Dorothea Dix, a visionary reformer in nineteenth-century America, challenged civic leaders to establish asylums or sanctuaries in rural areas where ill persons could receive food, shelter, and humane treatment. Fresh air, farm-grown food. and a pastoral setting were seen as healing and nurturing for severely troubled persons. Self-contained communities sprang up in every state in the Union, with populations varying from several hundred to ten thousand patients. …