A History of Medicine with a Focus on Mental Illness – Part 1
Rob’s Personal Note and Introduction
This timeline is only somewhat complete. The information is good and fairly complete up until the 20th century. There are a few things I would like to work on as far as some minor details and formatting up until that point. In the 20th century and beyond, I just cant cover everything, but there are a few more items I would like to get to.
Enjoy!
Before I introduce the timeline, let me give you a little perspective on where I am coming from: what makes me tick and what I believe about history and knowledge in general.
History, or any other body of knowledge for that matter, never happens in a vacuum; rather, a person’s worldview and perspective always shape how we, as individuals, see and interpret the facts. Put another way, there is no such thing as brute facts; all facts are interpreted. The question then becomes: what is the bias of the person relaying the facts?
In today’s marketplace of ideas, people like to pretend they are above this undeniable fact. They demand “neutrality” from themselves or those they read. What winds up happening is an ordering and choosing of facts that bow the knee to popular thought of the day or the top-down thought police of the day or simply humanistic, man-centered religion.
I will tell you right away that my perspective is one that espouses Christianity as truth. Additionally, I believe that Christianity alone is capable of changing man’s heart in a lasting positive direction. As people’s hearts have been changed by the gospel of Christ, society has been changed as a natural outworking of applying the gospel in our relationships with others.
This change of heart and change of behavior regarding our neighbor is true for many areas of life. This document centers on healthcare; however, change in healthcare didn’t happen apart from change in society in general. It is impossible to lay out how all of society interacts to bring about a change, so we are left with snapshots. The important point is to realize that all of society has changed over time as a result of people coming to know Christ, and the change in the rest of society has had an effect on healthcare.
It is not my argument that only Christians have contributed to the growth of healthcare. It is my argument that all of society was winding down everywhere in the world before the coming of Christ. People were becoming and acting more and more savage and base over time as we grew further away from our Creator God. Christ changed all this. As society has changed from the gospel changing individuals, non-believers have lived in a changed society and contributed to the world, as have Christians. The real source of positive change is Christ and His redemption.
This perspective affects all that I say and do. This is the lens I have attempted to apply to this document.
Introduction
This timeline is mostly about the clumsy history of medicine in the West. For example, if I actually were able to document how the ancient Chinese and Indians used herbs, and all the herbal knowledge that has come and gone, this timeline would look very different. So, this history is left out. The knowledge and healing powers of herbs are very real.
So too, I do not cover even more modern movements in detail. I don’t cover modern knowledge of herbs. I don’t cover homeopathic medicine, chiropractic medicine, and much, much more. All of these branches of medicine are very powerful indeed. I can only give a brief sketch of everything, though hopefully you will still gain insight from those things I do cover. Let’s begin.
The Bible has a very favorable view of medicine and caring for those who are ill. King Hezekiah of Judah had a boil that would have killed him without treatment. After Hezekiah prayed, the Lord told Hezekiah that he would recover from his diseased boil. The Lord could have done a miracle and healed Hezekiah, but this was not the process the Lord chose. Hezekiah was told to use a medicinal treatment. The prophet Isaiah said, “Let them take a lump of figs, and lay it for a plaster upon the boil, and he shall recover” (Isa. 38:22, NKJV).
There are numerous other examples of this high view of help through medicine and care in the Bible. Jesus taught the story of the Good Samaritan, who was a true neighbor to the injured person even though the person was of a different culture and country than his own. The Samaritan would bind up and pay for the injured Jew to be cared for from the Samaritan’s own pocket.
These words found in the Bible would inspire Christians to make a difference in healthcare for the poor and strangers. Hospitals didn’t start up immediately, but they would eventually become possible. Christians started hospitals. Christianity would bring about a change that would allow the scientific method to come about and to be applied, books on medicine and physiology to be written, medical schools to start, and more. All this and more would come about over time and slowly change the world.
Mental Illness
Throughout history, there have been differing views of what mental illness is and how to treat it. Some have emphasized the spiritual aspect of life and mental illness; others have said mental illness stems from the mind or in our thoughts, and sometimes a more physical view has predominated.
In part, all three views can be true to some extent. However, the lion’s share of mental health issues is most commonly caused by the brain being out of balance due to illness, stress, malnutrition, genetics, toxic overload, or some such cause. Because I believe this, I agree with the third view listed above for the most part. Even if psychological stress (like from being in war or from facing starvation for a long period of time) was a trigger to push a person toward mental illness, the brain often becomes imbalanced physically as a result. The trigger was psychological; the result is mood-based symptoms; the real problem is the biochemistry of the brain.
Early on in the existence of Christianity, Christians were aiding the mentally ill along with the sick and injured of all sorts. During the later Middle Ages, this spirit of compassion toward the mentally ill was lost by some, though not totally. Eventually, other Christians worked to reform these poor treatments. The Spirit of Christ inspired many reformers, and some would make a good deal of difference in the care of the mentally ill. Additionally, others who were not Christian would contribute to the betterment of the treatment of mental illness.
Not only is it good and right to help heal the mentally ill of their condition due to the physical incapacity it brings, but for Christians, there is another reason. Often, when the mind is befuddled, it can’t hear simple messages; this includes the message of the gospel. Some people who are mentally ill lose touch with reality and may have trouble thinking at all. This is not the case for all mental illness, but for a few.
“God works in people’s hearts through his Holy Spirit, but he has chosen to issue his call and spread the knowledge of himself and his kingdom through the normative means of preaching and teaching his word. He calls people to “come now, and let us reason together” Isaiah 1:18a (NKJV). How can the mentally ill reflect upon or consider the teaching of God’s word without the proper use of their minds? How can they read God’s word, the beginning of wisdom, without the ability to concentrate? Believers and non-believers alike can suffer with mental illness, but neither of these groups of people can function at their full human potential without the help of their family, friends, and the broader community”(1).
Jesus taught us to be good neighbors by teaching the parable of the Good Samaritan. This not only speaks to the value of medicine, but the value of going out of our way to help others is in view as well. Those bound by mental illness can have relief. Too often, in history, this true help has not been given to those who need it. Now is the time for change.
Acknowledgements
A good portion of this history comes from the book How Christianity Changed the World, by Alvin Schmidt. Additionally, another work that was helpful was The End of Mental Illness, by Dr. Daniel Amen, along with his timeline. Numerous other sources were used to fill in gaps and fill out the timeline. Not everything is covered. Time and space forbid the covering of everything that could be said to be relevant.
Ancient History to Birth of Christ
Ancient Times to 5th Century BC
Notes
The history of mental illness treatment before the 5th century can be a debatable topic and one that will only briefly be covered here. Worldviews often play a significant role in how a particular historian will interpret different given facts. Couple this with scant information and surviving documentation, and one can see how difficult it can be to know early history. Another reason for the difficulty in knowing the early history of medicine is the mixing of legend and stories intertwined with actual events and history. The legend of the Greek Asclepius is a good case in point. See below.
As for the ancient history of medicine and mental health treatments, only a few brief points of note will be covered about medicine and mental health treatments. For example, one point mentioned is that Ayurvedic medicine was used early in the history of India. This modality was also applied to the mentally ill.
Additionally, there are many things left out of this ancient history of medicine and treatments. Some of the items of medicine left out include that the ancient Egyptians were thought to have used mold to treat infection. The ancient Chinese and the ancient Indians both knew about the seven electrical spots in the body. These are very real and important. We know the Chinese called these spots the Chi, and the Indians use the word Chakras. This timeline doesn’t cover these points and more. There is just too much to cover everything.
Around 4000 BC?
Trephining (also referred to as trepanning or trepanation)
The practice of drilling holes in the skull to treat head trauma is called trephining. Some have said it was an attempt by the ancients to allow evil spirits to leave the head of the mentally ill. This analysis is dubious.
Trephining has been dated as far back as any medical treatment (7000 years ago?). However, the fact of the matter is that this practice continues to be used today. “According to Verano, modern eyewitness accounts from Africa and the South Pacific state that trepanation is still used to treat head wounds, headaches, or pressure on the brain”(2).
Thus, what some historians have said about trephining and mental illness, and that it was an attempt by the ancients to allow the evil spirits to leave the mentally ill, is very speculative. “In other parts of the world, it’s thought that trepanation might have once been used to release evil spirits, or to treat insanity or epilepsy. But without any written record, we’ll never quite know why these kinds of surgeries were performed in the absence of obvious injury”(2).
Although the assertion that trephining may have been used to treat the mentally ill is speculative and based on educated guessing at best, there are at least two reasons it could have some doubtful validity.
One, some societies believed all illness was a result of supernatural forces, which will be discussed below. If all mental illness is supernatural, it would follow that mental illness would not be different. Any surgery or procedure would therefore be tampering with the supernatural in some sense.
And, two, not too long ago, in the early 20th century, António Egas Moniz introduced the practice of drilling holes in the skulls of the mentally ill for performing frontal lobotomies. Moniz “…drilled holes into the skulls of 20 mentally disturbed patients and used a wire in 13 of them to sever the connections in the brain’s frontal lobes”(3). Frontal lobotomies were practiced till at least halfway through the 20th century. Of course, Moniz was going for a more physical response than a supernatural one, but the misguided notion is similar to what may have been attempted by the ancients, if indeed it was performed on the mentally ill.
These two points notwithstanding, there is no documented evidence that I know of that shows that it was used to treat mental illness specifically. In any event, for sure, it was not a medical procedure used exclusively for mental illness.
Was Mental Illness Considered Supernatural by the Ancients?
The idea that mental illness is a result of supernatural forces has been ascribed to the ancients. More than one historian has stated that many societies in the ancient world thought that mental illness was the result of supernatural forces from the gods affecting the mentally ill. This question will be examined in the next two subsections: Ancient Greek View and Treatments in Egypt, India, and China. Further, King David of Israel will be considered as he feigned mental illness before King Achish.
Ancient Greek View of Illness and Mental Illness
As described above, the ancient Greeks, like some societies, believed that supernatural forces were responsible for all illness. “In ancient Greek medicine illness was initially regarded as a divine punishment and healing as, quite literally, a gift from the gods”(4). So, yes, the Greeks thought mental illness was from the gods, but the point is irrelevant because all illness was ascribed. This thinking was not universal in all societies throughout ancient times.
Super Quick Summary of Mental Health Treatments: Ancient Egypt, India, and China
Mental illness treatments, and medicine in general, were practiced to some extent in the ancient world in different ways. Specifically, in India, Ayurvedic medicine was developed and was applied to mental illness to some degree. Egypt also developed more physical treatments for the mentally ill. Though both societies had a more physical or material treatment of mental illness, they coupled their physical treatments with pagan religious treatments.
Additionally, ancient China practiced medicinal treatments of the mentally ill that may have been less religious in nature than that of Egypt and India. However, it should be noted, “The mentally ill were also thought to have ‘bad fate’ that would negatively influence anyone who associated with the disturbed individual, scaring away potential suitors and leading to the idea that mental illness was contagious”(5).
Summary of Section
The idea that all mental illness everywhere was seen as supernatural by the ancients is likely an overstatement. Additionally, different ideas and different beliefs changed in any one given society over time due to many factors. Ancient societies developed treatments for mental illness in various forms.
Around 3600 BC
The earliest known use of seaweed for treating goiters is documented in ancient Chinese medical writings. This was iodine in the form of an herb.
Around 3000 – 5000
Ancient Civilizations
| Minerals = medicine (to some extent). Herbs were really bigger.
| Egyptians, Chinese, and Ayurveda basically used copper, iron, clays, sulfur, gold, silver, and mineral waters, and perhaps to a lesser extent tin and nickel.
Around 1500 BC
Asclepius (The First Orthomolecular Doctor?)
Before the 5th century, the Greeks honored Asclepius in their mythology. The mixing of legend and history has been blurred by time. Some date Asclepius around 1500 BC. The story of “… the Greek Physician, Asklepios or Æsculapius, who lived about 3,500 years ago,” is instructive.
“He was so effective with his therapy that the Hellenic world deified him, made him a god in their pantheon…
“Asklepiads, centers of healing based upon the precepts introduced by Asklepios, were established all over the Hellenic world. The Asklepian therapy is very familiar to those who practice Orthomolecular Medicine which probably makes him the first known Orthomolecular Physician. He withdrew the patients from the normal stresses of their lives and administered clean water, fresh and unpolluted air, good food, a modicum of spirituality, an appropriate balance of rest and exercise, and time – hence ‘patient’. Of course, once they became well again, they were required to return to their former roles in the Greek culture”(3).
The fact that the Greeks honored Asclepius as the god of medicine shows that they had, at least, a high view of healing the sick in some sense. However, as time went on, and as the Romans took over, some of the compassion necessary for healing was no doubt lost. If the history of the Greek healer Asclepius is true for 1500 BC, the kind of medical practices he started would have likely changed over time. By the time of the Roman rule, the role of physician, healer, and medicine in general had likely changed a good deal.
Around 1012 BC
David before King Achish
The Bible records David, the future king of Israel, pretending to be insane before one of the kings of Philistia, King Achish, the king of Gath. “…and pretended to be insane in their hands and made marks on the doors of the gate and let his spittle run down his beard. Then Achish said to his servants, “Behold, you see the man is mad. Why then have you brought him to me? Do I lack madmen, that you have brought this fellow to behave as a madman in my presence? Shall this fellow come into my house?” (1 Sam 21:13b – 15, ESV).
David expected the king to think he was crazy. There is no mention of evil spirits of any sort. The ancients of Israel did not all think every case of mental illness was the result of evil spirits, as some have reported.
Around 900 BC
King Asa
Medicine is mentioned early in the History of Israel. One case was the story of King Asa. The Bible records King Asa as seeking the “physicians” for the disease in his feet. “And in the thirty-ninth year of his reign, Asa became diseased in his feet, and his malady was severe; yet in his disease he did not seek the LORD, but the physicians.” (2 Chronicles 16:12). The Bible is not saying here that King Asa was wrong to seek the physicians, but that he was wrong to not seek the Lord. King Asa would die of his disease because he relied solely on the physicians. This is instructive to everyone. God is in control. If you seek a physician, you should still pray, ask His help, and give God the glory.
5th Century BC to Birth of Christ
Around 499 – 200 BC
Classical Greek Era
| Hippocrates uses mineral waters, clays, sulfur, and iron.
| Theophrastus writes *On Stones* (first mineral medical text).
460 – 370 BC
Hippocrates
Many historians ascribe the beginning of medicine in a more formal sense to the Greeks at around the 5th century BC. This is primarily due to the writings of Hippocrates. Some historians say the writings of Hippocrates were actually done by many contributors and that Hippocrates was a representative name for many writers. Many treat him as an actual person.
Hippocrates saw the brain as the source of mental illness. Hippocrates would greatly advance the thinking of a certain group of physicians of his day and beyond. According to Dr. Daniel Amen:
“The Greek physician Hippocrates (460–370 BC) believed all mental illnesses came from the brain. He wrote, ‘Men ought to know that from the brain, and from the brain only, arise our pleasures, joy, laughter, and jests, as well as our sorrows, pains, despondency, and tears. …And by the same organ we become mad and delirious, where fears and terrors assail us. …All these things we endure from the brain, when it is not healthy.’ Recognized as the ’father of medicine,’ Hippocrates proposed one of the first classifications of mental disorders, including mania, melancholy, phrenitis (brain inflammation, fever, delirium), insanity, disobedience, paranoia, panic, epilepsy, and hysteria. Some of those terms are still used today”(3).
It should be noted that in many regards, Hippocrates was not followed by society at large on many issues. For example, in the Hippocratic Oath it says not to give a potion causing an abortion, but most of society regularly did this despite what Hippocrates said. Abortion, infanticide, and abandonment were common Greek and Roman practices. Only a certain sect of physicians would take and try to follow the oath. The value and sanctity of human life were not held in the highest regard for much of society. This was especially true for the Roman time period. It was common to see thousands die in a single gladiatorial spectacle, to the delight of a crowd of people watching, for example.
Around 350 BC
Greek Iatreia
The Greek iatreia has been erroneously labeled as a hospital, but it was more of a place to receive a diagnosis and plan of recovery than a place of treatment. Additionally, the principal means of diagnosis was through dreams.
“The Greeks had some iatreia that served as medical facilities to diagnose people’s physical ailments, these units did not function as hospitals where the sick could be treated and get rest and recuperate.”(6) In the iatreia, the principal means to diagnosis was through dreams, or so it was hoped. A person would stay at the iatreia to have a dream. The dream of the person visiting would then be thought to convey advice for a path toward healing. The iatreia were notably religious (pagan) and monuments were often left as gifts to the gods in hope of recovery(5).
No Hospitals Existed at This Time
There is scant evidence of hospitals in early history. There are a few exceptions to this rule.
First, there is some evidence of earlier hospitals in some societies. These institutions did not last because once the leader or patron who started the hospital died, so did the place of healing created by the given leader or patron. Later on, when Christianity entered the stage of world history, hospitals had staying power, and once created, many would last for many centuries. It should be noted that there were very, very few hospitals ever attempted prior to Christian influence.
Second, another exception to the lack of hospitals was the transient places to treat wounded soldiers. For example, the Romans had the valetudinarium for treating soldiers. Civilians were not treated at these places. A few physicians were able to practice medicine and learned from these transient military hospitals.
Third, there is some evidence that as ancient Indian Ayurvedic medicine was developed, there were places of healing for a period of time in history. And there were places of rest developed by Asclepius where one had to be “patient” for healing. However, how many of these places of rest for healing would continue in history?
It should be noted that the lack of hospitals did not mean there were no physicians. There were physicians who earned money practicing the craft of medicine and taking care of the sick in many societies and across differing cultures.
Roman Low View of Life and the Sick
The pagan Romans basically saw sick people as weak and generally were not concerned for them. Sickly, weak babies were routinely discarded at birth, for example.
Caring for others in a compassionate manner was generally an alien concept to Roman society. This lack of compassion resulted in a general lack of concern for human life in general. Abortion, infanticide, abandonment, gladiatorial games, and suicide were all common and glorified. This continued into the 5th century AD and lingered beyond. Additionally, the idea of charity was foreign to most of Rome.
Christianity would eventually, and through great difficulty, begin to change this. According to historian Alvin Schmidt, who quotes historian Howard Haggard:
“…the Romans ‘often fled in fear and left the sick to die without care.’ Haggard further notes that the Romans saw helping a sick person as a sign of human weakness; whereas Christians, in light of what Jesus taught about helping the sick, believed they were not only serving the sick but also serving God”(6).
As was stated, the idea of charity was also foreign to the ancient world for the most part. Without this idea of unselfish care for others, the concept of hospitals never lasted. Self-giving to others and selfless care for others was a historical requisite notion for creating a lasting place of healing or a hospital. Schmidt states:
“…the Greco-Romans really had no concept of charity and compassion, which are necessary values preceding the arrival of hospitals. While modern readers may find the ancient state of medical affairs almost incredible, it was nevertheless true. Thus, the American church historian Philip Schaff summed it up well when he said, ‘The old Roman world was a world without charity’”(6).
Around 200 BC to Around 200 AD
Roman & Hellenistic Medicine
| Galen systematizes mineral pharmacology. Remember herbs were still more useful.
| Galen classifies dozens of minerals by “powers.”
