So now, we're going to talk about the kind of treatments that are available in mental healthcare and for mental illness. And as we've done with everything else, we're going to think about how the social context affects what treatments are available in the given context. We start with a definition of treatment. Just like the definition of diagnosis, it puts us firmly in the arena of medicine and medication. In mental health however, there are a range of treatments that are biological, psychological, and even social as you would expect based on the biopsychosocial perspective of mental health. We often make distinctions between medical or biological treatments and psychosocial interventions, but sometimes treatment is referring to what is done in all three areas. We have touched on this in a few ways through the course, that there's been this pattern of oscillation between medical and psychological, or psychosocial emphasis in mental health, and this has been reflected in the treatment options available to people who are diagnosed with mental illnesses. In the early 20th century, there really wasn't much available way of treatment for mental illness. But there was a belief that mental illness had biological origins and therefore required biological treatments. At the time, the kind of things that were available were cold baths and exercise. But eugenics was also considered an important intervention at the time because madness was thought to be something in the genes. So, the Mental Hygiene Movement was literally about cleaning up the gene pool so society would deal with madness less. Of course, eugenics eventually fell out of favor when it was associated with nefarious practices like mass murder and forced sterilization. After the first World War, psychological treatments came into favor. As we've already discussed, this was partly encouraged by the need to find a way to deal with returning soldiers who were suffering from shell shock. Suggesting that they were mentally ill because they were of inferior genetic stock, which was the accepted explanation up to that point, was considered treasonous. So, psychological explanations for illness and psychological treatments became acceptable. And as this was a time when awareness of psychotherapeutic interventions were growing, these were leading methods of intervention. Things shifted in the 1920s and 30s to favoring biological models again. If you remember the 1924 exhibit by the Canadian National Committee For Mental Hygiene, the descriptions of insanity and feeble mindedness were grounds in biological reasoning and biological treatments we proposed as part of new more scientific era of psychiatry. This was when some damaging and dangerous treatments were developed and used. Things like insulin coma, which involved inducing seizures, and then a coma to calm the mind. Lobotomies, which were surgeries on the brain believed to calm people. And early versions of ECT, that used high levels of electrical current to induce seizures that could result in broken bones. After World War II, these treatments were declined in favor of the new medications. Then called major tranquilizers, these medications are often credited with facilitating the institutionalization, although you hopefully remember that the story is more complex that that. Of importance to our chronology of the oscillation treatment preferences in mental health, the introduction of the major tranquilizers in the medications that would soon follow, ushered in what now seems to be a very long and extreme shift towards biodeterminism and the established doctrine that mental illnesses are biological disorders that are to be treated using biological methods. After the 1960s, which included the antipsychiatry movement, of course, the popularization of psychotherapy and the emergence of a biopsychosocial perspective on mental health started the beginning of an integration of all three type of interventions into mental healthcare. However, because mental health is located in the health care system, medical authority is established and was maintained by the dominance of biological or biomedical treatments. Some would suggest that this was important for maintaining the status of psychiatry as a medical specialty on par with other medical specialties. The psychiatrist prescribe medication just like everyone else. Another consideration is that a pharmaceutical industry has been able to use their tremendous power and influence to support the dominance of pharmacological treatments for mental illnesses. Biomedical treatment is precede as preferable to other treatments for many reasons which include, biomedical treatments are less costly to the state than investing in the human resources required for psychosocial treatments or investing in the social resources required to deal with social ills. And the biomedical treatments can be administered involuntarily and without consent so they are useful for the control of disruptive behavior and unwilling patients. Here are, here is a list of some of the biological or pharmacological treatment options that are most widely available. The minor tranquilizers refers usually to medication that treat anxiety. Antipsychotic medications are used to treat psychosis and then what are used to be called major tranquilizers. And anti-depressants are usually for treating depression. Mood stabilizers treat mood disorders like bipolar disorder, bipolar disorder. Some of you may be in places where they refer to that illness as manic depression. Electroconvulsive therapy is still used in the treatment of mental illness but in much safer forms and without the side effects that were seen in its earlier versions. This is not an exhaustive list, of course. And some would include treatments like exercise and biofeedback as biological interventions, although they are not pharmacological, of course. When we talk about the pharmacological interventions, there are concerns that have been raised about them. People can become psychologically or physically dependent on medications. Many medications have side effects or if we're more precise about it, they have effects that are undesired in addition to the effects that are desired. And this can make taking those medications very uncomfortable and some would suggest more uncomfortable than dealing symptons of an illness, a mental illness. Another concern is that people can become ill or relapse even if they are taking medications. So, they are not the guarantee of good health that is sometimes suggested. And finally, there are people who have suffered significant damage or injury from biological treatments. You may remember, in the first sector, that Caroline Quock referred to being in a coma because of problems with medications she received during a hospitalization. In the consumer movement many people complained about permanent damage they had suffered. Permanent movement disorders and tremors from pharmacological treatments, permanent memory loss from electroconvulsive therapies. So, many people are quite resistant to biological treatment for mental disorders and believe that these treatments are at least unhelpful and potentially quite harmful. At the same time, many people are tremendously helped by psychopharmaceuticals. You may remember Dr Ellen Sachs talking about how she believes medication saved her life and has been a large part of why she has been able to live such a full life instead of succumbing to some of the very negative consequences that can befall many people. In the area of psychological treatment options, there are so many psychotherapies available, it would impossible to create any kind of representative list of them. Psychotherapies can be something that is used for individuals, groups or families, and they are used across all kinds of mental disorders. I'm sure many of you will know that it is also used to support people who don't necessarily meet criteria for any kind of mental disorder. There are many people who think that all mental disorders should be treated with psychological therapies because they perceive them as universally helpful and more appropriate for dealing the emotional mental problems. However, it is not true that there are no potential harms associated with psychotherapies. In the hand of untrained, unethical or incompetent therapists, psychotherapy can be quite dangerous. Psychotherapy can definitely cause harm to vulnerable people. If you look at the history of mental health, there is a story to be told about how psychotherapeutic interventions have been dangerous. For example, therapies have been used to control and contain people whose are socially disruptive in the same way that biological therapies have been used. There's potential for dependence on psychotherapy as well. Psychotherapy and psychotherapist can be seen as an industry that wants to maintain its privilege and clientele just like the pharmaceutical industry. Just as with biological treatments, people can become ill or relapse into illness even if they are receiving psychotherapy and have already alluded to the potential for damage and injury. But just as with the biological therapies, there are many people who get tremendous help from psychotherapy. We currently have a lot of psychotherapies available that have been demonstrated to be just as effective as biological treatments or able to make biological treatments work even better. Finally, there are also social treatments available. I've included family and group interventions in the social treatment section because these are therapies that are designed to alter the social environment for people and that can be a very important intervention from a biopsycho perspective. Case management is a type of social therapy. Case management, the term case management is a rather unfortunate one and that, it has a way of turning an individual who has a personhood into a case, but the interventions that it refers to are designed to support an individual integration, intergration into the social fabric of the community. So, case managers support the social aspects of maintaining mental health, things like having good social support, living in safe, stable housing, having meaningful and purposeful activities, etc. Case managers are also involved in the kinds of things, you see, I have listed under community interventions, because they work to facilitate a person being in the type of social environment that will help them maintain optimum mental health. Therapeutic environments are not seen as much as now as they once were but you may recall that some of the leaders in the anti psychiatry movement established therapeutic environments. Places in which people diagnosed with mental illness could feel accepted and fulfilled. This is also the intent of many of the social clubs and club houses that are sometimes available for people diagnosed with mental illnesses. I have the spiritual interventions here because spirituality is something we are understanding more and more as being relevant to recovery for mental illness and maintaining mental health. I list it as a social intervention because it often involves feeling connected to other people who share the same spiritual outlook. It's also interesting that recently I was listening to a BBC interview with somebody who had actually investigated the mental health benefits of organized religion versus spirituality. And the finding was that people who engaged in organized religion were less likely to become mentally ill than people who, who identified themselves as being spiritual. So, there's something I think about the social aspect of that that's important. And finally, the community interventions that I've already mentioned would ideally represent a community committing to creating social environments that promote mental health. That's something we'll talk more about in our final lecture. Of course, there are some shortcomings to social treatments as well but they are different than the ones we've seen with the biological and psychological treatment options. Social treatments and investment in creating health-promoting environments is very costly. And these are costs that the public, up this point, has not really been willing to pay. Also the effects of social interventions are difficult to measure or capture. And in an era where everyone wants to know what is the evidence behind practices, social interventions are at significant disadvantage.