Frisbie 1

CJ Frisbie

Professor Jan Babcock

English 137H: Rhetoric and Civic Life

Nov. 19th, 2021

The Paradigm Shift in Mental Health Treatment

We, as a population, are more aware than ever of mental health. Fifty-six percent of

Americans are now seeking mental health treatment for themselves or a loved one (The National

Council). But with the Coronavirus abruptly confusing everyone’s schedule, many people sought

out mental health support. But this rapid increase in demand for treatment left many empty-

handed. Since many people now suffer from and seek treatment for mental health, we need to

recognize the strides in mental health has seen in the past century. Treatment in the past was

often primitive, ineffective, and inhumane. This was due to miseducation on diagnosis and

treatment, popular influences on psychology, such as the Bible, and an unfair stigma placed on

those with mental health problems. But thanks to Sigmund Freud and his colleagues, with the

evolution of modern psychoanalysis, moral treatment in asylums, and shifting views on religion

and science, proper treatment and diagnoses are now possible and available. We now have a

treatment network that revolves around psychotherapy, medicine, and moral mental hospitals,

that allows people to remain normal people. Mental health treatment has shifted and evolved

from an era of miseducation and maltreatment to a more effective system with less stigmatization

and proper resources that allows someone who suffers from a mental illness to receive proper

treatment and to recover.

History has not treated mental health patients kindly. Before developments of modern

psychology and more understanding of the brain’s mechanisms, doctors would often base
 Frisbie 2

diagnoses and treatment based on religious knowledge and other “remedies”. In Europe, doctors

classified patients under physical ailment or demonic possession (Baton Rouge Behavioral

Hospital). We might recognize “demonic possession” as a mental illness in modern society, but

when the Bible dictated almost everything, any deviation from normal behavior would grant you

the title of possessed. This was not only a misdiagnosis but also an incredibly harmful stigma,

which would hurt any sort of development in this realm until society would shift away from this

behavior. Other diagnostic measures include the miasma theory and the four body “humors”. The

miasma theory was that disease spread through the air through foul particles, such as rotting

matter, feces, or other odors. The four humors theory was pioneered by the ancient Greek,

Hippocrates. This theory was based on a balance between the four humors: blood, bile, black

bile, and phlegm. A doctor would base treatment on restoring these four humors to their natural

balance. Later, we would see the emergence of germ theory, which spawned our current

understanding of pathology. While these theories might not explain mental health issues, the

shift from basing diagnoses from the Bible and religion to developing more concrete theories of

disease was a step in the right direction to proper education.

Yet, it is clear that the main influence of treatment and stigma was from the Bible. This

text would influence just about any topic in Europe, just like the Quran in the middle east, and

the Vedas in India. These books were the basis for science, philosophy, psychology, and the

cause of conflicts globally. A book, such as the Bible, with that much influence, would be

important in every aspect of life, including health and mental health. The Bible influenced

doctors (who were often religious officials, or affiliates) that any abnormal psychological

behavior is due to demonic intervention, and obviously, to the God-fearing Christians of the

Middle Ages, this would be extremely concerning. This means that most reported cases of

Schizophrenia, epilepsy, and probably even anxiety and depression would be considered
 Frisbie 3

demonic possession. We should also understand that the fear of a “demonic possession”

diagnosis would probably mean that grueling lengths would be taken to avoid this stigma and

title, meaning that even if these mental health disorders were treatable, they would almost

certainly be hidden, ignored, or left untreated. The Bible is unintentionally responsible for

misdiagnosis of mental health issues, that, if properly recognized maybe could have been treated,

or at least avoid the dangerous consequences that come with treatment such as an exorcism or

bloodletting.

While we think of this time where demonic possession was the primary diagnosis as

somewhere in the Middle Ages, where knights, castles, and peasants were everywhere, this

miseducation persists into recent and modern times. The case of Annaliese Michel is particularly

interesting in this discussion. She was diagnosed with schizophrenia and psychoses, but her

hallucinations persisted even after she was taking her prescribed medication. As her condition

worsened, she developed frustration with the medicine and intolerance towards holy objects.

Eventually, her parents convinced a bishop to approve an exorcism after Anneliese had

continued self-harm and consisted psychotic behavior. She underwent 67 exorcism sessions,

spanning over a year, and in 1976 she passed away from malnutrition and dehydration. Doctors

testified that her state was due to epilepsy and a strict religious background, possibly explaining

her hatred of religious objects (Kageyama). This is an unfortunate case of miseducation, where

her parents made a decision, without truly knowing what is behind a mental illness – a decision

that would cost their daughter her life. Even with other similar cases (like that of Vilma Trujillo)

that garnered attention, exorcisms remain popular and increased in frequency recently. Italy

reports that around half a million people seek exorcisms each year (BBC). However, according

to the BBC, “In 1999, the Catholic Church carried out its first major update to the rules

surrounding exorcism since 1614 and distinguished between demonic possession and physical or
 Frisbie 4

psychological illness (BBC).” Thanks to a shift in mental health treatment, the Catholic Church

reformed a dangerous policy that harmed many and lead to mistrust and miseducation.

To understand the shift that triggered changes in other systems pertaining to mental

health, one should look at one of the pioneers in the field of psychology, Sigmund Freud. Freud

was an Austrian neurologist, who earned his medical degree in 1881 (Ackerman). He is

remembered today for many advancements in psychology, mainly psychoanalysis and his models

of the mind. “Freud’s theories center on the two-part human mind — the conscious and the

unconscious. He saw the human personality as the id, ego, and superego (Weinberger).” The first

grouping permeates our culture, with conscious and subconscious being common words in casual

and professional language. Freud used these models to work with patients and diagnose them

with psychoanalysis, a technique he developed, which is often referred to as talk therapy. His

patients noticed that as they talked to him about their experiences, some of their symptoms were

relieved. “The simple idea of talking about a problem to help alleviate it came from his work

with colleague Josef Breuer and one of his patients, Bertha Pappenheim … Pappenheim referred

to the treatment as the “talking cure (Weinberger).”

Sigmund Freud’s developments had an immense impact on the field of psychology, as

many of his methods are currently used, or innovated on by modern psychologists and

psychiatrists. He inspired Carl Jung, who pioneered analytical psychology, and Jacques Lacan,

who focused on language and the unconscious. Many of Freud’s techniques are still used today.

Common treatment regimens consist of a combination of psychoanalysis, psychotherapy, and

medicine. However, new therapies were introduced as alternatives to Freudian treatment. One

such alternative is Behaviorism, with the philosophy that prioritizes healthy behaviors over

mental processes for improvement (Weinberger). Other therapies built on the foundation that

Sigmund Freud set, for example, cognitive behavior therapy, which “aims to change patterns of
 Frisbie 5

sometimes irrational thinking or behavior that are behind people’s challenges to change the way

they think, feel, or behave (Weinberger).” In 1962, Albert Ellis published a book on rational

emotive behavioral therapy, an early form of cognitive-behavioral therapy, one of the most

popular forms of psychotherapy. Sigmund Freud started a shift in mental health treatment. His

ideas on the mind’s defense mechanisms and contributions to psychotherapy and psychoanalysis

inspired other psychologists to further the progress he made. Freud not only pioneered in his

field but also started a change in how mental health was treated. The benefit of this shift lies in

the quality of treatment that a patient receives. Sigmund Freud developed effective and efficient

alternative treatment methods that actually benefitted the patients that he was treating, as

opposed to harmful, standard methods of treatment that existed before.

Similar to the shift that Freud initiated in psychology, we saw a shift at a similar time in

mental hospitals. By the 1870s, most states had at least one state-funded asylum, thanks to

Dorothea Dix, who testified about the benefits and moral treatment that asylums would offer.

Unfortunately, these asylums became overloaded when state governments could put elderly

people in asylums under the guise of “senility” as a psychiatric condition, thereby avoiding the

costs of putting them in public hospitals or almshouses. This burden overwhelmed the capacity

and the resources of the asylums. The Great Depression in the 19030s didn’t help the system

either, as the system saw decreased funding and decrease employment during World War II.

Some psychiatrists would open their own practices within general hospitals. The Mental Hygiene

Movement in the early twentieth century created “outpatient clinics and new forms of private

practice focused on actively preventing the disorders that might result in a psychiatric

hospitalization (D’Antonio).” Nevertheless, in the 1950s, nursing homes were established, taking

in the elderly patients, and inpatient psychiatric care would pass to the community mental health

system. (D’Antonio) The shift from poor and primitive diagnostic and treatment methods to
 Frisbie 6

modern and effective methods is evident in both Freud’s developments in psychology and the

change in asylums to modern inpatient care. Once again there is a benefit in this shift that lies in

the quality of the treatment patients can receive. The mental hospitals of the late 1800s and early

1900s were burdened and under-supported, despite the promise of moral treatment and asylum.

Modern inpatient and outpatient methods are now unburdened and properly supported (ignoring

the sudden change in demand that came because of the Coronavirus), enabling proper treatment

to be provided to patients.

Another area to analyze the paradigm shift in mental health treatment is in addiction.

Drugs have existed alongside humanity throughout our history. Hallucinogens and alcohol have

been found in historical sites as long ago as 7000 B.C.E. (Lesser). Unlike the relatively natural

drugs of the past, we have more types of drugs, more potent drugs, and more dangerous drugs in

the modern era. “Over 50 million people worldwide use heroin, cocaine, and other synthetic

drugs on a usual basis. (Options Behavioral Health Hospital)” Perhaps the most dangerous aspect

of a drug is its ability to destroy the chemical equilibrium in the brain. All animals, including

humans, are driven by neurotransmitters, namely the neurotransmitter dopamine, to perform

certain tasks and actions. If you perform an action that is beneficial to your biological fitness (for

example: eating food, conversing with others, or sex), your brain will release dopamine,

rewarding you with waves of pleasure. This is called the reward circuit of our brains, and it is the

sole reason we perform activities or be motivated to perform them. Most drugs hijack the reward

circuit, causing a release of dopamine, and inhibiting dopamine uptake receptors, causing a

prolonged release of dopamine. This can feel euphoric for a certain amount of time, but

eventually, dopamine levels crash, leaving you tired, unmotivated, and causing withdrawal

symptoms, after prolonged use. Then, the drive to reach that high (often called “chasing the

dragon”) will cause further drug use, leading to addiction.

 Frisbie 7

Now that we understand the pathogenesis behind addiction, it is important to recognize

what addiction really is. Addiction can be called substance use disorder (SUD), which is the

uncontrolled use of a substance despite harmful consequences (American Psychiatric

Association). Psychiatry.org organizes symptoms of SUD into four categories: impaired control,

social problems, risky use, and drug effects (American Psychiatric Association). SUD disorder is

a defined mental illness now, even being a category of mental illness in the DSM-5 (Diagnostic

and Statistical Manual of Mental Disorders Fifth Edition). But this change, which is necessary

for treatment, is still new to society and depends on how society views drug addiction. The first

issue was that addiction was not viewed as an illness. “A century ago, addicts were believed to

be morally degenerate. There was no formal treatment available because addiction was not

viewed as a disease. Addicts would instead be locked away in asylums or imprisoned because of

their behavior and lack of self-control (The River Source).” This view on addiction being more

of a choice than a disorder limited the treatment that addicts could receive. The 1970s finally saw

lawmakers recommend treatment, as opposed to criminal prosecution (The River Source).

However, treatment was still limited to the idea of detox and recovery. According to The River

Source, an addiction treatment and recovery center, “society is finally realizing that addiction is

not a character flaw. Not a moral failure. Instead, it’s a brain disease that is characterized by

chronic, impulsive behavior (The River Source)”. This realization, another component of the

paradigm shift of mental health treatment, is a critical step towards ensuring proper treatment.

We can compare the “primitive” method of treatment to the modern treatment and see a shift

from lack of education/miseducation on addiction, to a better understanding of what addiction is.

This is simultaneous with a shift in stigma as well, where addicts used to be thought of as

morally wrong, but now are viewed as having a mental illness, like that of depression or anxiety.

This shift of stigma allows patients to receive proper treatment for their mental health disorders.
 Frisbie 8

Modern treatment consists of client-centered care. Client-centered care directs focus on an

analysis of a patient’s strengths and weaknesses (The River Source). This calls back to Freud and

his innovations in psychology. Treatment is shifting towards holistic care, highlighting mind,

body, and spirit, instead of just the physical side of addiction (The River Source).

Overall, there is a pattern that one can recognize from these examples. In the past,

methods for diagnosis were primitive and ineffective, leading to miseducation, stigma, and

eventually, poor treatment. Influences of education, stigma, and diagnosis of the past include

things such as the Bible and societal standards. These influences created a barrier towards proper

treatment that patients could receive. Sigmund Freud is one of many figures who helped spark a

paradigm shift in how mental health illnesses are treated. Concurrently, mental hospitals shifted

from overloaded, underfunded systems to modern therapy, consisting of inpatient and outpatient

care. The paradigm shift also exists in part to how societal views have changed over time.

Addiction and substance use disorder have had a stigma partially removed as knowledge on the

topic has improved, causing a shift in how SUD is treated. Treatment focuses on the whole

person, rather than alleviation of physical symptoms. Lastly, we can recognize how the shift in

mental health treatment has seen a positive change from primitive and ineffective to

sophisticated and helpful, along with a lesser stigma and better education. This is not to say that

these issues have completely disappeared.

Miseducation continues today in alternate forms. Media is one of the most effective ways

to convey information across the world, but there are no regulations on many topics that lead to

misinformation, such as vaccines, flat Earth, and sometimes, mental health. Traditional media is

responsible for creating societal norms and standards, standards that lead to stigma, fear, and

miseducation. Often, movies like Psycho create terrifying images of mental illnesses, like split

personality disorder (Resources to Recover). We consume these movies or shows as

 Frisbie 9

entertainment, but for the sake of entertainment, a harmful stigma is created. Similarly, we can

recognize the stigmatization of insane asylums. The whole image of a mental hospital, where a

patient could receive necessary treatment, is tainted by the idea of an insane asylum. A patient or

their family may be hesitant to receive treatment from the hospital, as the stigma provided by

media is disturbing.

Social media also creates norms and standards, but one could argue that the effects of

social media are worse than traditional media. Fitness influencers and models can damage their

young and impressionable audiences into mental health issues like eating disorders. Chelsea

Kronengold, a spokeswoman at the National Eating Disorders Association said “Social media, in

general, does not cause an eating disorder. However, it can contribute to an eating disorder

(Conger).” Sites like YouTube, TikTok, and Twitter may not intentionally promote content that

encourages unhealthy eating habits, but the algorithms that they use are designed to recommend

content tailored to the user, even if the content could potentially be harmful. Promotion of this

content is potentially deadly, as suicide is a particular concern with eating disorders. Individuals

with anorexia nervosa or bulimia nervosa are 18 times and 7 times more likely to die from

suicide, respectively (Smith, Zuromski, Dodd). Additionally, in fitness communities, a term

coined as “bigorexia” characterizes how one may feel that they never have enough muscle on

their body. This can lead them down a path to body dysmorphia, other eating disorders, or

steroid/PED use.

Regardless, there are still good shifts happening in modern society. Social media also

provides an outlet for informal education on topics including mental health. YouTube Channels

like Psych2Go, which has 7.96 million subscribers, offer free education on mental health

disorders, coping mechanisms, and a community for people to come together and learn. There

are also plentiful accounts on any other social media site for people to receive positive
 Frisbie 10

knowledge on mental health. Another media that provides an influence on mental health is

music. As an example, Kanye West’s 2018 album, Ye, delves into West’s struggle with bipolar

disorder and depression. While this provides an insightful window into West’s mental health, it

is also an educational tool and destigmatizes mental health disorders.

In short, society has seen a paradigm shift in mental health treatment from primitive and

unproductive to efficient and effective. This shift is due to a change in education, stigma, and

changing societal norms, such as religious and scientific views. The result of this change allows

patients suffering from mental health disorders to receive proper treatment that can help them

recover. The observed shift doesn’t mean that society is in a good place to rest and stop

innovation. There are still issues plaguing the mental health treatment system, such as increased

demand for treatment due to COVID-19 and increased susceptibility to mental health illnesses

from social media. From the observed paradigm shift, society should observe that mental health

treatment can be improved by educating people on diagnosis and mental health and

destigmatizing mental health.

 Frisbie 11

Works Cited

Ackerman, Kourtney E. “Psychoanalysis: A Brief History of Freud's Psychoanalytic Theory

[2019].” PositivePsychology.com, 9 Dec. 2020,

https://positivepsychology.com/psychoanalysis/.

Clinically Reviewed by Cynthia V. Catchings LCSW-S, et al. “A Brief History of Therapy.”

Talkspace, TalkSpace, 6 July 2021, https://www.talkspace.com/blog/psychotherapy-

history-of-therapy/.

Conger, Kate, et al. “Eating Disorders and Social Media Prove Difficult to Untangle.” The New

York Times, The New York Times, 22 Oct. 2021,

https://www.nytimes.com/2021/10/22/technology/social-media-eating-disorders.html.
 Frisbie 12

D'Antonio, Patricia. “History of Psychiatric Hospitals.” • Nursing, History, and Health

Care • Penn Nursing, https://www.nursing.upenn.edu/nhhc/nurses-institutions-

caring/history-of-psychiatric-hospitals/.

DR, Smith AR;Zuromski KL;Dodd. “Eating Disorders and Suicidality: What We Know, What

We Don't Know, and Suggestions for Future Research.” Current Opinion in Psychology,

U.S. National Library of Medicine, 22 Aug. 2018,

https://pubmed.ncbi.nlm.nih.gov/28846874/.

“Exorcism: Vatican Course Opens Doors to 250 Priests.” Edited by BBC, BBC News, BBC, 16

Apr. 2018, https://www.bbc.com/news/world-europe-43697573.

Jay Boll, Editor in Chief www.rtor.org. “6 Popular Movies That Got Mental Illness Wrong.”

Resources To Recover, Resources to Recover, 9 June 2020,

https://www.rtor.org/2015/10/27/6-movies/.

Kageyama, Ben. “The Criminal Exorcism of Anneliese Michel.” Medium, History of Yesterday,

7 Oct. 2020, https://historyofyesterday.com/the-criminal-exorcism-of-anneliese-michel-

c75c23a28869.

Lesser, Ben. “Ben Lesser.” Dualdiagnosis.org, Dual Diagnosis, 14 Mar. 2021,

https://dualdiagnosis.org/the-history-of-drug-abuse-and-how-its-changed/.

The National Council. “New Study Reveals Lack of Access as Root Cause for Mental Health

Crisis in America.” National Council, https://www.thenationalcouncil.org/press-

releases/new-study-reveals-lack-of-access-as-root-cause-for-mental-health-crisis-in-

america/.
 Frisbie 13

Options Behavioral Health System. “Heroin Addiction Signs, Effects, & Withdrawal Symptoms:

Options.” Options Behavioral Health Hospital, Options Behavioral Health Hospital, 20

July 2018, https://www.optionsbehavioralhealthsystem.com/addiction/heroin/effects-signs-

symptoms/.

“The Surprising History of Mental Illness Treatment.” Edited by Baton Rouge Behavioral

Hospital, Baton Rouge Behavioral Hospital, 2 Apr. 2020,

https://batonrougebehavioral.com/the-surprising-history-of-mental-illness-treatment/.

Theriversource. “How Our Perception of Drug Abuse Has Changed over Time.” The River

Source, The River Source, 23 Feb. 2021, https://www.theriversource.org/how-our-

perception-of-drug-abuse-has-changed-over-the-years/.

“What Is a Substance Use Disorder?” Edited by Hector Colon-Rivera and Alëna Balasanova,

What Is Addiction?, American Psychiatry Association,

https://www.psychiatry.org/patients-families/addiction/what-is-addiction.