Mental Hygiene

Question 1

What is the concept of ‘mental hygiene’?

Answer 1

It is a concept about the prevention of mental illness in society as a whole. It involves theories about modern society and mental illness; and has a ‘utopian’ perspective on how psychiatry can be used to make a better world.

Question 2

Although it is in the field of psychiatry, what area is mental hygiene grounded in?

Answer 2

Public health, as mental hygiene is the public health perspective of psychiatry.

Question 3

What does the concept of mental hygiene focus on?

Answer 3

Prevention of mental illness.

Question 4

What did the ‘mental hygiene’ movement do for psychiatry?

Answer 4

It expanded the domain of psychiatry.

Question 5

Where did the impulse for the expansion of psychiatry come from?

Answer 5

From the mental hygiene movement.

Question 6

When was the first mental hygiene exhibit? What did the poster say?

Answer 6

In 1912 and the poster said, ‘A Nation’s Greatness Depends upon the Efficiency of its Citizens.’

Question 7

What was the original belief behind the first Mental Hygiene movement?

Answer 7

National efficiency depends on personal efficiency, a sound mind & sound body, and the organisation of good habits.

Question 8

Who was Brock Chisholm?

Answer 8

• The first director-general of the World Health Organisation in 1948.
• The chief physician of the Canadian Army in WWII.
• In 1948 he had a big address/speech, called, ‘the maintenance of peace-time society.’

Question 9

What did Brock Chisholm’s address in 1948, called ‘the maintenance of peace-time society’ say about psychiatry and the war?

Answer 9

Well, during this time there was great confidence in psychiatry. It was believed that war is caused by human aggression gone wrong and psychiatrists are the one’s who know all about aggression and the human mind.

Thus, he claimed we must rely on psychiatrists if we want to maintain peace.

Question 10

What did Maslow (the humanist) have to say about psychiatry and peace? (similar to Brock Chisholm)

Answer 10

The world will be saved by psychology or not be saved at all.

Question 11

How did Brock Chisholm claim that psychiatry could save the world?

Answer 11

By finding simple principles that would help large groups of people (similar to adding fluoride to water to prevent cavities).
Individual therapy would not work, the world needed to be remodelled.

Question 12

Medicine has TWO perspectives, what are they and where does the mental hygiene theory lie?

Answer 12

In medicine there are two perspectives:

1. curative medicine (deals with sick individuals)
2. public health (deals with populations, statistics, epidemiology, prevalence of disease, etc.)

Mental hygiene is a ‘public health’ perspective on psychiatry.

Question 13

What are the two main interests for public health? And what effect do these ideas have on psychiatry?

Answer 13

1. Interest in prevention: curing disease, treating disease in its early stages, promoting health.
2. Structural solutions: population-wide, structural initiatives.

These ideas expanded the domain of psychiatry.

Question 14

Public health initiatives are often met with conspiracy theorists, what are some examples?

Answer 14

• to prevent dental decay they put fluoride in drinking water: a communist plot?
• immunisation was met with anti-VAXers.

This idea that the state should not dictate what we should do.

Question 15

What are some determinants of health (in a population)?

Is it the number of physicians? Access to health care?

Answer 15

No… it’s the average wealth. People having accomodation and being able to afford adequate nutrition is the biggest determinant of health.

Question 16

What was the McKeown thesis?

Answer 16

A thesis on why the rate of tuberculosis went down in England and Wales, and it was mostly due to social determinants, not the vaccine.

Question 17

In psychiatry, the mental hygiene movement wants to reduce the prevalence of mental illness… what are some pathways?

Answer 17

Some clearer pathways are: less war, less sexual abuse of children, less violence on children, perhaps less poverty (severe forms of mental illness are suffered by those on the lower levels of socio-economic status).

BUT, despite the obvious, the pathways are not always clear.

Question 18

How did ‘mental hygiene’ start?

Answer 18

With Clifford W. Beers, an undergraduate at Yale University. He wrote a book called ‘A Mind That Found Itself’ in 1908.

Question 19

Who was Clifford W. Beers?

Answer 19

The man who started the ‘mental hygiene’ movement. He was an undergraduate at Yale university, he was gregarious, formed many societies. He moved to New York to work in an office where his mental health really declined. One day, he felt so bad he went back home to Newhaven where he eventually attempted suicide. He was taken to a mental hospital, where he became even more delusional and believed that people disguised as his family members were visiting him. Eventually he wrote a letter to his brother asking him to visit him, to see if it really would be his brother that came the next day. It was his brother, and Clifford became manic, he believed he found a solution to his illness. His friends from Yale visited him and helped him start this movement.

Question 20

After Clifford W. Beers founded the mental hygiene movement in the early 20th century, who then took over?

Answer 20

Adolf Meyer, a migrant from Switzerland

Question 21

Who was Adolf Meyer, and what did he do?

Answer 21

Adolf Meyer was a migrant from Switzerland who wanted to chance the conditions in psychiatry.
He tried to get more funding for mental hospitals and began researching the causes of mental illness.
He launched ‘dynamic psychiatry’.

Question 22

What was ‘dynamic psychiatry’ (or the ‘psychiatry of adjustment’)?

Answer 22

It was a theory founded by Adolf Meyer that focuses on the relationship individuals have with their environment, or their ability to adjust and face the challenges of every day.

Question 23

The ‘psychiatry of adjustment’, or ‘dynamic psychiatry’ moved the field of psychiatry from focusing just on mental illness to…?

Answer 23

• maladjustment.
• vagrancy.
• alcoholism.
• homelessness.
• crime.
• prostitution.
• vice, etc.

Question 24

What did the mental hygiene movement do between 1910-1920?

Answer 24

Improved out-patient care that treated lesser forms of mental illness, helped reintegration into the community, informed GP’s, reformed medical education to include mental health.

BUT also! Eugenics became really popular during this time, the idea that people with mental illness should not procreate.

ALSO, to prevent migrants from mental illness from entering the US.

Question 25

Who was Henry Goddard?

Answer 25

He is an American psychologist known for his work in the area of the heritability of mental illness.

Question 26

What happened in the mental hygiene movement between 1920 and 1930?

Answer 26

The focus shifts from severe forms of mental illness to everyday problems, such as:

• juvenile delinquency
• troublesome children
• education for mental health: promoting mental health in all school children
• child rearing: habit breaking

Question 27

What happened in the mental hygiene movement between 1930 and 1940?

Answer 27

Well, this was during the Great Depression and the focus shifted to:

• initially, community mental hygiene projects, but this didn’t really work.
• then, saw society as the patient: social and cultural reconstruction.
• an attempted revolution, with Frankwood E. Williams, who saw the Soviet Union as a model society.

Question 28

Who was Frankwood E. Williams?

Answer 28

He tried to cause a revolution in the mental hygiene movement during the 1930s to 1940s. He believed that the Soviet Union as a model society.

Question 29

In a way, the ‘mental hygiene’ movement can be considered really conservative, why?

Answer 29

Because it was (at times) the adjustment of individuals to society.

Question 30

After 1945, social psychiatry attempted to determine the prevalence of mental illness and maladjustment in society with epidemiology. What did they conclude?

Answer 30

That:

1. most mental illness actually exists outside mental hospitals.
2. most individuals with mental illness never see mental health care professionals.
3. mental illness is related to poverty.

Question 31

After 1945, in 1963, what did President Kennedy do to improve mental illness in America?

Answer 31

He signed the ‘Community Mental Health Centres Act’, which enabled treatment to happen in clinics and not mental hospitals.

This movement DEINSTITUTIONALISED psychiatry.

Question 32

During the mid-20th century, there was another trend in the mental hygiene movement, and that was to ‘diagnose American society’. What did some prominent scholars come up with?

Answer 32

• Karen Horney said that capitalism leads to neurotic insecurity.
• Erich Fromm said the society of mass consumption leads to illusions and problems.
• David Riesman said that America was a ‘lonely crowd.’

Question 33

What were Hans four conclusive points about mental hygiene?

Answer 33

1. that it improved the perspective on common mental illness and mental hospitals disappeared from view.
2. created the community mental health movement, deinstitutionalisation.
3. expanded the field of psychiatry.
4. posed the central question to be between psychiatry and society.