A Brief History of Mental Health Care in the Twentieth Century

Written by Dr Caroline Leaf

In the early twentieth century, the prevailing concept in psychiatry was the demented mind, while drugs that changed one’s mental state (including alcohol) were largely views as “mind-altering substances” [1]. Asylums, largely state-run institutions where people with mental health issues were locked away, were commonplace [2]. Lobotomies, in which a mini icepick was shoved up the nose into the brain, were performed up to the 1950s [3]. In fact, Egas Moniz, who invented this procedure, received the Nobel Prize for Medicine in 1949 for his work, before the practice when into disrepute in the mid-1950s [4].

From the 1930s to the 1950s the prevailing concept in psychiatry was the disordered mind [5]. Of the non-physical treatments available to those suffering from issue of the mind, psychoanalysis, invented by Sigmund Freud, prevailed in the 1930s [6]; psychotherapy, based on classical conditioning (Ivan Pavlov) [7] and operant conditioning (B. F. Skinner) [8] prevailed in the 1940s, and Cognitive Behavioral Therapy (CBT) [9] has dominated the field since the 1950s.

The arrival of the first anti-psychotic (or neuroleptic) Chlorpromazine in the mid-twentieth century marked a revolution mental health care [10]. There was a shift in mental health care from state-run asylums to the private sector as patients were able to be restrained by the administration of these neuroleptics, which acted as “chemical straitjackets” or “chemical lobotomies” [11]. At first these medications were predominantly seen as “tranquilizers:” temporary measures to calm patients down in order to introduce more long-term treatments [12]. In the 1970s-1980s, these drugs began to be seen as “chemical cures,” and the concept that mental disorders were the result of chemical imbalances started to take hold [13], despite the lack of physical evidence to support the chemical imbalance theory [14]. SSRIs such as Prozac [15] exploded into the public consciousness with the introduction of second generation neuroleptics in the 1990s [16].

It was during this time that Dr. Leaf began researching the mind and the brain. Based on her findings, both during her studies and in her practice, she noticed that mind-action is actually the predominant element in mental wellbeing [17]. Dr. Leaf pioneered mind-directed therapy that involved family and/or caregivers in the context of the patient’s life and needs [18]. The patient was highly involved in taking responsibility for their intervention and recovery. Dr. Leaf applied this successfully in many situations, and in the development of her 21 day brain detox program [19]. Her approach is similar to the scientifically researched and successful Open Dialogue Therapy, which is currently becoming very popular for the treatment of mental health [20].

Through her work, which continues to this day, Dr. Leaf noticed that mental ill-health is not just a biological imbalance that could be “cured” by medication; it is a disorder of the mind that can be caused by a traumatic thought life [21]. In other words, mental ill-health is a thought disorder based in the mind, which changes the brain physiologically. Consequently, Dr. Leaf developed the Switch On Your Brain with the 5-step Learning Process [22] from over three decades of study, clinical practice and research [23]. This learning process, based on her Geodesic Learning Theory [24], has been shown not only to be effective in mental health care, but also treating physical damage to the brain that occurs in Traumatic Brain Injury (TBI), learning disabilities and to improve learning techniques in both schools and the corporate world [25]. The groundbreaking discoveries of neuroplasticity [26] (i.e. the brain can change) and neurogenesis [27] (new nerve cells are continually produced) in 1990s further support Dr. Leaf’s work, showing how the brain is a complex, living organ and not merely part of a biological machine.

In today’s scientific community, the prevailing concept that chemical imbalances form the basis mental illness is being challenged. David Anderson, a prominent geneticist involved in psychiatric research, has eloquently stated [28] that the chemical imbalance concept promotes the erroneous idea that the brain consists of a “bag of chemical soup.” Taking drugs like Prozac have been shown to be ineffective in a great number of scientific articles [29]. As Anderson notes, taking psychiatric drugs to “fix” mental health issues is like performing an oil change on a car by pouring oil all over the engine: it does more harm than good. In the her ground-breaking book, The Myth of the Chemical Cure [30], Dr. Joanna Moncrieff, a prominent British psychiatrist at University College London, stated that psychiatric drugs actually create abnormal brain states instead of counteracting them, and that the concept of chemical imbalance rather reflects successful marketing by the dominant pharmaceutical industry. Indeed, a recent meta-analysis from Stanford University [31] documenting 193 brain imaging studies on the whole-brain images of nearly 16,000 people turned the dominant brain disease model of psychiatry on its head. The study essentially found that the brains of people with different diagnoses such as schizophrenia, depression and addiction showed similar gray-matter loss. This finding challenges the disease model, which proposes that the different diagnoses have different brain pathologies. Even Tom Insel, a psychiatrist, the Director of the National Institute for Mental Health (NIMH) and a proponent of the disease model of mental health, has admitted to the failure of the present day paradigm of the chemical imbalance concept in successfully treating mental illness. [32] His views were supported by Kenneth Kendler, one of the world’s foremost experts on chemical imbalances, who noted in 2005 that “we have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.” [33]

It is obvious that the disease model of mental health, with its accompanying concept of chemical imbalance and drug use, is not succeeding, as we have more individuals suffering from mental health issues than ever before in human history. Although there has been a 400% increase in anti-depressant use alone since the 1990s, with a similar rise in the use of neuroleptics, more and more people are being locked away in mental health institutions and more and more adults and children are being put on dangerous, mind-altering substances [34]. It is high time for a change.



Join me in Dallas, TX on Saturday, June 4th for my workshop entitled Think and Eat Yourself Smart.


About Will Myers

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