Explain the understanding and treatment of mental illness and depression in the 1920's England. What has changed since then? by Clara Fretault

Depression was not yet categorized as "discrete, modern mental disorder". Its definition, terminology, classification, and clear boundaries from other disorders were not defined.

Terms like "melancholia", "neurasthenia" and "cyclothymia" were used to describe depression, which created confusions and caused problems for potential treatments.

cfretault20261_1 — 2025-10-05 17:27:00 UTC

The classification structure used at the time was influenced by Emil Kraepelin.

In this framework, depression and mania were grouped together as sub-categories of MDP, a "dramatic compression" of all psychotic illness into 2 categories: MDP and schizophrenia.

Depression, at the time, was often categorized into types based on level and symptoms: simple depression, depression with delusions and hallucination, and stuporous condition (a state of near-complete immobility, lack of response to external stimuli, and mutism)

cfretault20261_1 — 2025-10-05 17:32:15 UTC

The understanding of mental illness and depression had shifted towards a more "emotional" component defining it as a "disease of depressed or painful emotion" or a feeling of misery that was "in excess of what is justified by the circumstances."

This marked a contrast with the 18th century, where "melancholia" was compared to insanity and neglected the emotional state of the patient.

cfretault20261_1 — 2025-10-05 21:27:04 UTC

Psychiatrists blamed heredity or "morbid predisposition" as the cause. Kraepelin claimed "hereditary taint" was responsible for about 80% of his cases.

Environments, conditions, or influences (like a relative's death) were considered only "contributory" factors.

Influenza

cfretault20261_1 — 2025-10-05 21:35:35 UTC

Before and during the pandemic of 1918, clinicians recognized effects beyond the lungs, therefore, it was not seen only as a respiratory illness.

A range of severe mental illnesses appeared in patients either during influenza infection or after recovery.

These could involve hallucinations, delusions or even schizophrenia.

Additionally, the infection created other things like Encephalitis Lethargica, which is an inflammatory disease with psychotic symptoms. There were documented manifestations of neurasthenia, melancholy and hysteria (creating fatigue, depression, seizures).

This correlation between the flu and mental illnesses became a common in the medical field and practice.

cfretault20261_1 — 2025-10-05 21:47:44 UTC

British psychiatry in the 1920s was a system that consisted of huge, overcrowded, asylums.

The emphasis was often on "care and control rather than cure" as many hospitals were overcrowded and underfunded, and the majority of patients were "doomed to spend most of their lives there."

Admission to an asylum usually required the patient to be recognized as a "lunatic", a process that required magistrate's confirmation and meant the patient lost their right to leave.

cfretault20261_1 — 2025-10-05 22:01:34 UTC

Psychiatrics sought to fix a pattern for mental illness, the 1920s was filled with experimental approaches known as "heroic therapies."

Insulin Coma Therapy method, it involved giving patients increasing doses of insulin to create a coma state. They were then revived with glucose. This method was adopted quickly. It was dangerous procedure due to risks of heart failure, brain haemorhage, or death.

Other horrible treatments were tried such as the practice of pulling out patient's teeth or removing their intestines to stop their "madness."

Early experiments such as lobectomy on chimpanzees inspired human leucotomy (psychosurgery), that was first performed in 1935.

cfretault20261_1 — 2025-10-05 22:09:36 UTC

The Legislative Reform/ The Mental Treatment Act of 1930 made a few changes to psychiatry and treatment philosophy:

The Act now permitted voluntary admission to hospitals on the patient's request (written), and temporary admission for those who it will likely help but are unable to express it.

Voluntary patients could now discharge themselves with 72 hour warning.

It legally replaced the term "asylum" to "mental hospital" and "lunatic" to "patient."

It established outpatient clinics, which means that people with symptoms, or patients newly released, could receive care (diagnosis or therapy) while living in their own homes, which reduced the stigma associated with institutional confinement.

It provided "Aftercare" to help them reintegrate society and prevent relapse (recovery > control).

Influenza

cfretault20261_1 — 2025-10-05 22:46:18 UTC

Some incorrectly believed influenza was caused by bacteria. As a result, many used disinfectants and gargled their throats and washed out their nostrils.

Avoiding the cold, unnecessary travelling, and crowded places could help.

The open-air treatment , which consisted of fresh air, sunlight, meticulous hygiene, and reusable face masks, substantially reduced deaths among patients and infections.

cfretault20261_1 — 2025-10-05 22:59:04 UTC

Modern views adopted the "Biopsychosocial Model" , which is a model that pictures illness as being caused by the interaction of genetic susceptibility, personality, stressful events, and the patient's social context

It mandates a holistic approach where the clinician considers the patient's personality, emotional reserves, and environmental conditions.

Research suggests that human experiences, whether traumatic or therapeutic, have influence on brain function and can modify the neuronal connections of the brain.

The understanding of mental illness evolved to seeing it as manageable and requiring social and medical care.

cfretault20261_1 — 2025-10-05 23:15:54 UTC

The National Health Service and Community Care Act of 1990 drove this change. Current mental health services in the UK are trying to adapt themselves to "beyond the asylum".

The modern system supports mental health in the community.

Management of the illness now relies on the psychoeducation of patients and their relatives, in order to improve treatment compliance and help achieve the recovery.