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Mental illness in the past and future

Reflections on the Millennium

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Updated June 18, 2014

Even though the celebrations took place on the first day of 2000, the real first day of the new century and new millennium was January 1, 2001. With this in mind, I took the opportunity of that appropriate date to look back and forward.

The science fiction writers whose works I've read mostly seem to have underestimated how long it would take for their predictions to come true (though occasionally they overestimated). Robert Heinlein, one of my favorite writers, forecast that "cold sleep" would be common by 1970, so that people with incurable diseases or any other reason (and enough money) could have themselves put in suspended animation. (In the same book, The Door Into Summer, he predicted water beds would be invented after 2001.) H.G. Wells, in The Time Machine, wrote about a day in 1969 when war would all but destroy civilization -- a prediction that didn't come through and we all hope never will. In Anne McCaffrey's 1973 To Ride Pegasus, scientific proof of psychic abilities such as telekinesis, precognition and telepathy was discovered in the late 20th century (I'm sorry that one hasn't happened yet). And a Warner Brothers cartoon (circa 1950) depicted Elmer Fudd hunting Bugs Bunny with a ray gun in the year 2000.

Medically, cures for cancer and the common cold abound in science fiction. But rarely have I read anything predicting cures for mental illnesses.

Looking Back
Mental illness has been around as long as civilization -- maybe longer. I have no doubt there were depressed people in Mesopotamia and even Atlantis. (In fact, the Atlanteans are reputed to have been so highly creative, there must have been some bipolars among them.) Julia Pesek, writing on "The History of Bipolar Mood Disorder," notes that mania and depression together were first described in the second century A.D.

Hippocrates thought mental illnesses were caused by physical disease or an imbalance of bodily fluids called "humours." During some historical periods, people with mental illnesses were thought to be possessed by demons. In England, the charity hospital Bethlem first began housing "lunatics" in 1403. For most of the next 400 years, "Bedlam," as it came to be called, controlled its inmates by keeping them in chains.

Through the 19th and 20th centuries, mankind learned more and more about both physical and mental health care. Psychiatry was born with Freud and his followers. Lithium was discovered. Tranquilizers successfully treated patients who previously would have been lobotomized. Anticonvulsants were found to work as mood stabilizers. Antidepressants began to work their miracles. Genetics became a science. And along the way came computers, microscopes, magnetic resonance imaging, CT scans.

We've come a long way.

Looking Forward
Socially, we still have a long way to go. There are still countries and cultures where the mentally ill are thought to be afflicted with devils and so are unable to receive proper care. In the United States, a huge percentage of homeless people are mentally ill. The uninsured cannot get proper care, and even those who have insurance struggle with serious coverage limitations where there are no strong parity laws. Nor is there any standard of justice for the criminally insane. And the media, which shapes public perception (in the absence of personal experience), still by and large portrays only extreme conditions of mental illness. It doesn't take a science fiction writer to predict that improvements in all these areas will take place far more slowly than we need.

It has been said by many -- and I agree -- that overpopulation is the single biggest threat facing humanity. Unfortunately, population growth will mean increasing urbanization, poorer nutrition, more stress and more diseases of all kinds, and the incidence of depression and anger disorders in particular will see a frightening increase. Medical care resources will be strained even more than they are now.

But looking at the incredible advances in medicine and psychiatry over the last few decades, there is reason to have hope, too. For example, Positron Emission Tomography (PET) is only a few years old, and has revolutionized the study of the brain. This new science allows doctors to identify which areas of the brain are working under a particular set of circumstances like during an epileptic seizure, or before and after a medication has been given. The implications for neurobiological illnesses are exciting.

There's no doubt now that many mental illnesses are inherited. Scientists continue to search for the genetic markers that point to BP. The future might actually hold some kind of gene therapy for bipolar disorder. Research also continues into the beneficial effects of rapid-rate transcranial magnetic stimulation (rTMS). Could this replace shock therapy (ECT) in time?

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