The Outside Looking In: Social Influences on Mental Health

JP DeFranco is a second year biology/neuroscience major and active in athletics specifically golf, weight training and basketball.  JP has worked extensively with youth coaching basketball and special needs students.  He enjoys spending time with his family and watching movies.

Mental health and mental health treatments have been a trendy contemporary topic in our country. However, it has not always been a popular, well-known subject for the American people. In an era full of scientific discoveries and medical triumphs, mental health was more influenced by the outside world than by the medicine that characterizes it. Mental health is affecting more and more people every day and I believe that it would be advantageous for physicians, lawmakers, and everyday people alike to learn from history. I believe that mental health will not only continue to be influenced by the broader social and political environment, but it also will be responsible for public’s perception of it, as well as methods of funding, research, and treatment.

Mental illness was looked at for a long time as being some form of religious punishment of demonic possession. It wasn’t until the 5th Century B.C. in which people started to consider mental illnesses, as something that could be treated and not rooted in religion or superstition. Hippocrates was a pioneer treating mentally ill people with techniques that focused on changing the mentally ill patient’s environment (and sometimes even their occupation). He even started to administer certain substances as primitive psychiatric medication. [1] During the Middle Ages, the stigma that a mentally ill person was possessed or in need of religion was reawakened. These negative attitudes towards mental illness persisted until the 20th century in the United States. [2]

In the 1840s, Dororthea Dix lobbied for better living conditions for the mentally ill. Her efforts resulted in 32 federally funded state psychiatric hospitals in the United States over the next 40 years. [3] From 1850-1950, the institutionalized care for mentally ill patients was considered the best and most effective way of treatment. However, by the turn of the century, Europe would be pioneering psychiatric treatments and America would be lagging behind with over crowded and underfunded mental hospitals. [4]

In 1887, journalist Nellie Bly posed as a mental patient for ten days in Blackwell’s Island’s (now known as Roosevelt Island) mental institution. This investigative journalism exposed the actual conditions that asylums and their patients were kept in. This public uncovering of the true conditions of psychiatric hospitals led to one of the only mental health reforms in the late 19th century and early 20th century. [5]

In 1917, the United States joined Allied Forces in World War I.  This began a whole new field of psychiatric medicine in America: War Psychiatry. Psychometric screenings were being administered to measure soldier’s intelligence and mental stability. Psychiatrist also offered therapy after the stress of battle. World War I revealed to military leaders and psychotherapists the sensation of shellshock. This condition is when soldiers exhibited signs of intense anxiety after exposure to battles and explosions. These symptoms would be given various names such as “war neurosis,” but looking back, many experts believe that this is the first real diagnosis of post-traumatic stress disorder or PTSD. [6]

Despite the findings of mental trauma during World War I, the country and military did still not find a pressing need for a lot of psychiatric use on the eve of World War II. [7] The military used slightly harsher psychiatric evaluations in the Second World War then the first but other than that psychiatry was practiced basically the same. When it was evident that there were still “psychiatric casualties” despite the harsher soldier vetting process, it was clear that actual research and treatment into these conditions (PTSD) would be needed for the thousands of troops coming home. [8]

William Menninger was a wartime psychiatrist during World War II and he noted that coming back after the war, the general public still did not respect people with mental illness. [9] However, after the increasing need for psychotherapy for “PTSD” (as they did not call it that at the time) soldiers coming back from the war, people would start to accept this mental condition. PTSD was much easier to explain, as they could point to “being exposed to battle” as causation for these symptoms and this condition. Menninger took advantage of the recent respect for mental illnesses and advocate that there should be a new approach for mental illness. After his experiences with veterans, he argues “the maintenance of mental health for the everyman.” He states that to properly diagnose and treat each individual, their personality, environment, and their past experiences need to be taken into consideration. This will allow the psychotherapist to place their symptoms into context, which will allow better treatment of that individual. [10]

Post World War II America was full of change. Twenty million veterans came home from the previous two World Wars. In order to accommodate for the millions of soldiers that would now need psychiatric treatment, the Mental Care Health Act (1946) was passed. This resulted in federal funding for mental health to rise form $374k to $42.6 million from the late 1940s to the early 1960s. This time period would also show the increase in the American Psychological Association as their membership went from 821 to 2376 practicing psychologists. Along with an increased psychiatric practice, there was greater education for mental illnesses and psychiatric conditions. Guides and books were becoming readily available to the general public, which not only increased knowledge of these mental illnesses but lead to the “de-stigmatization” of mental health. [11]

This rise in acceptance of PTSD also made other mental illnesses more acceptable. More people were “coming out” and admitting that they may have a mental health condition. This allowed the psychiatric profession to thrive. The amount of people in America that requests mental health treatment allows for private psychiatric practice to grow. From 1938-1959 the number of psychiatrists in private practice grew from 1,500 to 11,000. However, this still did not solve the growing number of mental health patients in this country. In 1957, the psychiatric hospitals in America reached an all-time high with a total of inpatient population of 559,000 people (1/300 people in the United States). [12] The Community Mental Health Center Act (1963), which provided more federal funding toward community mental health center, accounted for the overflow of mental health patients in the mid-1960s. [13]

Despite post-World War II bringing such promise to mental health care, the 1950s and 1960s would also bring the Communist scare to America. After the 20 year time period after War World II, the country saw federal funding for medical care and mental health significantly decrease as US spending would be centered on domestic safety, foreign crisis, and other expenses that the Cold War brought this country. However, this would not cause a lack of support for national mental health care but rather forcing the country’s people to act and support mental health rather then their government. Two non-federally funded alliances arose in the late 20th century (National Alliance for the Mentally Ill (1979) and National Alliance for Research on Schizophrenia and Depression (1986)) that would prove that mental health treatment and progression can still continue without the government’s help. [14]

Media sources would also be a catalyst for mental health progression and reform. One Flew Over the Cuckoo’s Nest written by Ken Kesey would be published in 1962 and then be turned into a movie, which premiered in 1975 starring Jack Nicholson. Ken Kesey wrote his novel based on his experience from working in a veteran’s mental hospital. Media sources like these and others that depicted the decline of general medical care in this country would prove to have great impact on the continuous advancement of mental health and medical care throughout the end of the 20th century and into the 21st century.

The attack on the Twin Towers and the Pentagon on September 11th, 2001 was a tragic and horrific day for the United States. It did not only affect the thousands of people that experienced it first-hand but the millions of people that watched it on television. The psychological effects that have followed because of the events of that day are widespread, as people have experienced PTSD, depression, anxiety, or other stress-induced mental illnesses. Experiencing 9/11 first hand by seeing the smoke from the pentagon and witnessing the panic among my family members, I always wondered why images and things from that day stick out so vividly. Scientists have done research on the posttraumatic effects of that day. A study was done using multimodal neuroimaging that targeted the amygdala, hippocampus, and other parts of the brain of people who did experience 9/11 to identify the exact cause of these PTSD effects. Since 9/11 is also very unique because it is one day in history, scientists can now do further testing to determine how time effects PSTD. They can do studies on the proximity you were to the Twin Towers or the Pentagon (whether you were in one of the buildings or watching on television) and how that affects your stress-induced symptoms. We have never before had (in modern neuroscience) a specific event that has caused very similar symptoms, so therefore more testing is expected to be done in the future. [15]

To conclude, I do believe the social and political environment and external factors have had a large role in influencing mental health and mental illness treatment in the past. I believe that at our current time in history we may be looking at two more circumstances in which the larger social and political environment will affect mental care treatment and public perception of mental health. First, national data has shown that over the past five to ten years, colleges and universities have reported a double to triple amount of anxiety, depression, or stress related mental health conditions for college student in the United States. [16] Another impact could be the intersection of gun control and mental health as it results in more tragic cases of gun violence in this country. I believe that these two circumstances will influence how we as a society continue experience and perceive mental illness.


[1] “Treatments for Mental Illness.” PBS. 2002. Accessed May 10, 2016.

[2]Mary De Young. Madness: An American History of Mental Illness and Its Treatment. (Jefferson, North Carolina: McFarland & Company, 2010.), 7-33.

[3] Ibid, 183.

[4] Gerald N. Grob. From Asylum to Community: Mental Health Policy in Modern America (Princeton, NJ: Princeton University Press, 1991), 3-4.

[5] De Youg, Madness: An American History of Mental Illness and Its Treatment, 144.

[6] Ludy T. Benjamin, “A History of Clinical Psychology as a Profession in America (and a Glimpse at its Future),” Annual Review of Clinical Psychology 1, (2005): 7.

[7] William Claire Menninger. Psychiatry in a Troubled World; Yesterday’s War and Today’s Challenge. (New York: MacMillan, 1948.), 6-10.

[8] Ibid, 293.

[9] Jonathan Engel. American Therapy: The Rise of Psychotherapy in the United States. (New York: Gotham Books, 2008.), 56.

[10] Menninger, Psychiatry in a Troubled World; Yesterday’s War and Today’s Challenge, 56.

[11] Capshew, James H. Psychologists on the March: Science, Practice, and Professional Identity in America, 1929-1969. (Cambridge: Cambridge University Press, 1999), 165-167.

[12] Ibid, 146-159.

[13] Gerald N. Grob. From Asylum to Community: Mental Health Policy in Modern America. (Princeton, NJ: Princeton University Press, 1991.), 263-264.

[14] Murray Levine. The History and Politics of Community Mental Health (Buffalo, New York: Oxford University Press, 1981.), 198-200.

[15]Barbara L. Ganzel, Pilyoung Kim, Gary H. Glover, and Elise Temple. “Resilience after 9/11: Multimodal Neuroimaging Evidence for Stress-related Change in the Healthy Adult Brain.” NeuroImage. April 2008. Accessed May 10, 2016.

[16] Joel Brown. “A Growing Number of College Students Are Seeking Help for Anxiety, Depression, Stress, and Psychological Disorders | BU Today | Boston University.” BU Today RSS. October 6, 2015. Accessed May 10, 2016.

Further Reading

Jones, Kathleen. A History of the Mental Health Services. London: Routledge and Kegan Paul, 1972.

Nolan, Peter. A History of Mental Health Nursing. London: Chapman & Hall, 1993.

Salter, Susan Steinman. Toward Community Mental Health: A History of State Policy in California, 1939-1969. Berkeley, CA: University of California, 1978.