Mental illness is a series of disorders and diseases that affect the intellectual, emotional, and psychological makeup of individuals. Causation is wide ranging (from organic and genetic maladies to environmental triggers; from poor nutrition and poverty to psychological trauma) but many times unknown. Because of the myriad of disorders under the label of mental illness, a generalized "cure" has not been developed. Measures to ameliorate the effects of the spectrum of disorders include therapy of various forms, counseling, and pharmacological interventions.
Mental illness does not exist in a social vacuum, independent of the context of time and place. Its assumed etiology (causes) and manifestations are reflections of the social setting in which it exists. The twentieth century saw a large increase in the number of individuals exhibiting symptoms of mental illness. Whether this resulted from better reporting methods, shifting levels of category description, or a generalized increase in the number of individuals afflicted is still open to debate. It is apparent, however, that children at the turn of the twenty-first century were suffering from an epidemic of mental illness. More children in the United States in 2003 suffered from psychiatric illness than from AIDS, leukemia, and diabetes combined. The solutions proposed to the problems caused by mental illness in children reflect the underlying assumptions of society. That these solutions have changed over time similarly reflect that American society itself has reshaped its intellectual presuppositions throughout history.
Traditionally, emotional and psychological problems in children were viewed through the prism of religion. Children experiencing visions, hearing voices, or enduring seizures were seen as individuals touched by either God or Satan. Etiology was considered as otherworldly; therefore, alleviation of the disorder would come through supplication to the Deity. This was in the form of prayer, Scripture reading, and personal admission of sin and guilt.
The Salem, Massachusetts, witchcraft crisis of 1692 provides the most familiar example of how childhood mental illness was perceived and dealt with during the colonial American era. Dozens of young women were involved in a wide-ranging frenzy of accusations of witchcraft, punctuated by visions, spells, physical maladies, and the belief that Satan was actively working to control individuals in and around Salem Village. Historians have argued over the "actual" cause of these happenings, positing economic, cultural, psychological, and medical explanations. What is known, however, is that contemporaries had only one explanation–the young women participating in the naming of witches were not mentally ill in the modern sense of the term: they were victims in the ongoing battle between God and Satan for the souls of mankind. Cotton Mather, the influential Puritan clergyman, expressed this belief most clearly in his book Wonders of the Invisible World, published in 1692. Mather and other Puritan leaders saw young women, because of their age and dependent condition, as especially susceptible to the hallucinations and physical assaults caused by this cosmic battle. Prayer for the afflicted, as well as punishment for those bewitched by Satan himself, were seen as cures for the physical and mental ailments of the girls involved in the witchcraft hysteria.
By the eighteenth century, the hysterical outbursts associated with witchcraft and Satanic possession subsided, lending credence to the belief that social, rather than religious, causes led to the maladies. Incidences of childhood mental disorders were not as visible, or seemingly as prevalent, during this period. Childhood was viewed as a time of unrequited joy, when children did not face the problems and toil of adult life. Adults exhibiting overt signs of mental disorder were treated in differing ways depending on their class and status in society. Upper-class individuals who showed signs of mental problems were usually cared for within the family and labeled as strange or eccentric. Members of the lower class who gave signs of mental disorder often were not able to take care of themselves or their families and were "warned out" of communities or placed in poorhouses, with other undifferentiated categories of dependent individuals. Separate institutions for the mentally ill were developed in the late colonial or early national period throughout the United States and treated their patients (often called inmates) with a combination of primitive medical care (such as purging or bleeding), forced work to give the mind discipline, and moral care based on the treatment plans developed by the French physician Philippe Pinel (1745–1826). Few children, however, were admitted to these new institutions (often called asylums, as their founders saw them as refuges from the problems of an increasingly complex society). Children appeared more often as the victims of familial mental disorder, as wards forced to depend on private and religious philanthropies or the state to raise them.
The nineteenth century saw an increasingly gendered differentiation in the maladies that comprised the spectrum of mental disorder. The Industrial Revolution that swept over western Europe and the United States in the first half of the nineteenth century was both a cause and consequence of the emerging separation of the sexes by occupation and position. Dubbed the notion of "separate spheres," this vision of society was one in which men worked outside the home as providers and women ran the household as protectors of the domestic sphere. Changing perceptions of women's emotional, intellectual, and sexual makeup accompanied this paradigm shift. Seen as needing male protection to survive, women were classified into a larger category of dependent individuals, a category that also included children. By the middle of the nineteenth century, women and young girls were exhibiting a series of mental maladies that doctors and social critics tied to the specific problems of female anatomy and emotionalism. Running the emotional gamut from depressive melancholia to hyperemotional hysteria, these disorders could be acute or chronic, incapacitating or simply bothersome. Attempts at cures ranged from bed rest, asylum stays, and dietary changes to medical interventions such as water treatments and purgatives. Most regimens were not successful, but many women recovered to live what seemed to be "normal" lives.
These disorders were inordinately centered in young women of the upper and middle classes who were among the first of their sex to achieve higher levels of formal education, an education that may have been in strong conflict with the prevailing assumptions of female dependency. By the last quarter of the century, medical doctors had developed a name for these emotional illnesses–neurasthenia, or a weakness of the nervous system. Popularized by the American neurologist George Beard and the American physiologist S. Weir Mitchell, the term became a catchall category for the mental problems associated with feminized nervous energy. That young upper-class males also began to be diagnosed with the disease (for example, the American psychologist and philosopher William James was incapacitated for almost a year with nervous problems) led doctors to decry the feminization of American culture. A strident dose of "the strenuous life" was recommended to cure "weak" young males of this malady.
Neurasthenia was not seen as a problem among young people from the working class. The emotional problems these people exhibited were thought to arise from their inferior intellectual makeups or their genetic background. With the advent of massive streams of immigrants from southern and eastern Europe in the last twenty years of the nineteenth century, the composition of the American working class took on an increasingly foreign character. Medical doctors (almost exclusively from white American backgrounds) viewed foreigners as inferior and unable to handle the problems associated with complex modern societies. The lack of assimilation into mainstream American society, the petty crime that many young immigrant males seemingly engaged in, and the perceived inability of young immigrant women to rise to standards of appropriate feminine behavior all contributed to notions of immigrant inferiority. The increasingly foreign composition of state institutions for those with mental problems seemed to validate that belief. These mental problems among immigrants were not thought to be curable, as they were believed to be manifestations of inherited, and therefore, unchangeable traits.
By 1900, childhood and ADOLESCENCE were clearly viewed as separate stages of life, with their own problems and possibilities. The development of separate public institutions designed around the needs of children became a key component of Progressive-era changes during the first two decades of the twentieth century. Historians debate whether JUVENILE COURTS and specialized facilities for young offenders that arose during this period were instruments of social reform or social control. What is not at issue, however, is the notion that children were to be treated differently because they had different needs and concerns. Because of this seminal shift, historian Theresa R. Richardson, following the lead of reformer ELLEN KEY, has called the twentieth century "THECENTURY OF THE CHILD."
With this transition, doctors began to examine the issue of childhood diseases as a separate category of analysis. The mental disorders of children were not immune from this alteration. Simultaneously, the development of psychology as a discrete discipline saw the bifurcation of the understanding of what caused and what constituted mental disorders. The neurasthenic problems were increasingly viewed as emotional or intellectual problems, rather than somatic illnesses (those affecting the body). They could be cured or alleviated through therapy and counseling, not medical intervention. The more serious mental illnesses, often labeled around the catchall phrase of insanity, still remained the purview of medical doctors, who were marginalized as employees of large state institutions. Insanity appeared incurable, but by the 1920s and 1930s doctors experimented with such invasive techniques as electroshock therapy and lobotomy surgery with decidedly mixed results. Finally, problems that had been categorized as mental disorders, particularly those associated with young boys such as theft and truancy, were increasingly viewed as social, rather than medical, disorders. As such, they became issues for social workers and JUVENILEJUSTICE officials, rather than psychologists or medical doctors.
The social, psychological, and medical paradigms competed for control over the issues of mental disorder in general, and childhood mental illness more specifically, throughout the twentieth century. By approximately 1975, the success of the medical model in establishing hegemony over the field of what became known as mental illness was a seminal moment. The medicalization of problems in adjusting to social situations led to a reliance on both over-the-counter and prescription pharmaceuticals to solve disorders previously assumed to be social in nature. New advances in genetics revealed the importance of biological characteristics in the development of such disorders as drug addiction and alcoholism. Finally, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association drastically increased the type and number of mental disorders from 112 in the first edition, published in 1952, to 374 in the fourth edition, published in 1994. Many of these newly defined disorders deal specifically with mental illnesses of childhood. As the twenty-first century began, childhood mental illness was defined as a major social problem. Solutions and cures appeared difficult to come by, as contentious arguments continued over the efficacy of medical interventions and the true nature of childhood mental disorders.
Exacerbating the issues surrounding the medicalization of childhood mental disorders are concerns over both the increasing number of children exhibiting these illnesses and of the class, racial, and gendered nature of these problems. Whereas some disorders, such as conduct disorders and oppositional defiance, occur overwhelmingly in young males, others, especially eating disorders such as ANOREXIA and bulimia, are mainly female in character. The epidemics of attention deficit hyperactivity disorder (ADHD) and autism similarly show significant male components, whereas anxiety disorders occur largely in females. Physicians and researchers search for stronger connections between genetics and disorders such as childhood schizophrenia, while rates of teen SUICIDE continue to increase. Teen violence–despite high-profile cases such as the Columbine High School shootings in middle-class, white, suburban Littleton, Colorado, in 1999–is overwhelmingly centered in poor, minority, urban neighborhoods. Physicians report that minority youths receive approximately one-third the support given to white youths suffering from similar mental health problems. National Institutes of Health reports show that in 2001, one out of ten children and adolescents suffered from a mental disorder severe enough to cause some level of impairment, yet only about 20 percent of those affected received needed treatment. The issue of mental illness in children will remain a pervasive national concern to Americans well into the twenty-first century, as citizens debate the nature of these disorders and their relationship to broader social trends.
See also: Child Psychology.
Gijswijt-Hofstra, Marijke, and Roy Porter, eds. 2001. Cultures of Neurasthenia: From Beard to the First World War. Amsterdam: Rodopi.
Lutz, Tom. 1991. American Nervousness, 1903: An Anecdotal History. Ithaca, NY: Cornell University Press.
Richardson, Theresa R. 1989. The Century of the Child: The Mental Hygiene Movement and Social Policy in the United States and Canada. Albany: State University of New York Press.
Safford, Philip L., and Elizabeth J. Safford. 1996. A History of Childhood and Disability. New York: Teachers College Press.
"Childhood Mental Health." Available from www.childhooddisorders.com.
"Mental Disorders in America." Available from www.nimh.nih.gov/publicat/numbers.cfm.
STEVEN NOLL