Mental illness can effect anyone at any time regardless of income, employment, family life, etc. This issue is much more common than society makes it out to be. In fact, NAMI states that “approximately 1 in 5 adults in the United States experiences mental illness in a given year” (Gilberti). What is not so common, however, is quality treatment for those who are  suffering. Everyone experiences “good” and “bad” days, but a mental illness is much more than emotional reactions to life. Recovery is possible and “With proper treatment, people can realize their full potential, cope with the stresses of life, and work productively and meaningfully contribute to the world.” (Gilberti). While progression has been significant in the last few years, there is still a lot of work to be done to improve effectiveness of treatments and quality of life for mentally ill patients. 

“Attempts to treat mental illness date back as early as 5000 BCE” (Foerschner), when in ancient Egypt, India, and Greece, “many cultures viewed mental illness as a form of religious punishment or demonic possession” (Getler). These beliefs carried on throughout time and into the first “establishment specifically for people with mental illness”(Getler) built in 1407, causing the patients to be treated inhumanely. However, attempts to reform asylums date back as early as the 1800’s. Changes started taking place when “activist Dorothea Dix lobbied for better living conditions for the mentally ill after witnessing the dangerous and unhealthy conditions in which many patients lived” (Staple-Clark). For 40 years, Dix advocated for the mentally ill and in turn, the U.S. government funded 32 state psychiatric hospitals. Instead of being “incarcerated with criminals and left unclothed and in darkness and without heat or bathrooms” (Getler), the patients were now living in hospitals and being treated by staff that was trained specifically to meet their needs. 

Despite Dix’s efforts to give mentally ill patients fair and quality treatment, there was still a lot of work to be done. In the late 1800’s Nellie Bly, a journalist for New York World, went undercover and gained admission to Blackwell Island Asylum. Throughout her time there, she kept a detailed journal of her experiences and how she was treated. These experiences included being fed bland, pink-colored food, frequent beatings, and being forced into ice baths in front of all of the other women. When she was released, she published her journal, full of her atrocious findings, and titled it “10 Days in a Mad-House.” Her journal contained harsh quotes such as “What, excepting torture, would produce insanity quicker than this treatment? Take a perfectly sane and healthy woman, shut her up and make her sit from 6 a.m. to 8 p.m. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.” (Popova). It was not long before Nellie Bly’s book became an instant best seller. The public was shocked. Once word spread about her discoveries it “resulted in a $1,000,0000 increase in New York City’s budget for the care of the mentally ill” (Popova). This gave way to huge transformations in mental health treatment around the nation and the world.

Bly was not the only one to sacrifice herself for her work. Psychologist David L. Rosenhan, and seven of his colleagues, voluntarily gained admission to 12 different hospitals in five different states in order to do research on the treatment of mentally ill patients from the inside. Gaining admission was simple, “after calling the hospital for an appointment, the pseudopatient arrived at the admissions office complaining that he had been hearing voices. When asked what the voices said, he replied that they were often unclear, but as far as he could tell they said ‘empty,’ ‘hollow,’ ‘thud.’” (Rosenhan, 29). Just based off of these conversations the subjects were admitted. The experiment began and “Immediately upon admission to the psychiatric ward, the pseudopatient ceased simulating any symptoms of abnormality.” (Rosenhan, 29). When prescribed medication, the pseudopatient would follow directions, but would not swallow the pill. When the researchers were not busy with activities directed by the hospital, they spent their time writing everything down in their journals. This was not an easy job, and Rosenhan states that “the psychological stresses associated with hospitalization were considerable, and all but one of the pseudopatients desired to be discharged immediately after being admitted.” (Rosenhan, 30). After an average time of 19 days in the psychiatric ward, and a high of 52 days, all pseudopatients were released with a diagnosis of schizophrenia in remission. After reviewing their data, Rosenhan found that the real patients would accuse the pseudopatients of being healthy, but the staff never questioned their sanity. Rosenhan blames “the fact that patients often recognized normality when staff did not” (Rosenhan, 30), on “what statisticians call the Type 2 error. This is to say that physicians are more inclined to call a healthy person sick, than a sick person healthy.” (Rosenhan, 30). In 1973, shortly after the experiment concluded, Rosenhan published his recordings with the title “On Being Sane in Insane Places.” The discoveries from this study opened eyes to flaws in the system that had not been considered. Patient care was completely unindividualized. A patient may truly be suffering from a mental illness, however they will be treated the same as someone who comes in faking an illness and vice versa.

In contrast to these studies and research, psychiatrist and psychoanalyst, Thomas Szasz challenges the concept of “mental illness” as a whole. In 1960, Szasz published his book The Myth of Mental Illness. As one may assume from the title, Thomas Szasz’s “aim in this essay is to raise the question "Is there such a thing as mental illness?" and to argue that there is not.” (Szasz). The author backs up this controversial claim by telling his readers that a “mental illness" is just the side effect of every day living. He believes that “the concept of mental illness is unnecessary and misleading. For what they mean is that people so labeled suffer from diseases of the brain” (Szasz). Thomas Szasz goes on to say that in order for there to be an illness, regardless of if it is physical or mental, there has to be a deviation from the norm. With mental illness, how can we define a norm? To answer this question, Szasz comes to the conclusion that “sustained adherence to the myth of mental illness allows people to avoid facing this problem, believing that mental health, conceived as the absence of mental illness, automatically insures the making of right and safe choices in one's conduct of life. But the facts are all the other way. It is the making of good choices in life that others regard, retrospectively, as good mental health!” (Szasz). While Szasz can be applauded for so strongly supporting his opinions and claims, his book offended and outraged many, specifically those who were, in fact, suffering from a mental illness.

To spread awareness and validate that mental illness is real and needs attention, Eleanor Longden took the stage at a TEDtalk in 2013. In the talk titled “The Voices in My Head,” Longden shares her personal account of dealing with schizophrenia. Longden was in her second semester of her freshman year of college when she first showed symptoms of schizophrenia. At first the voice in her head narrated every move she made, but as time went on it began to take over her actions. She sought help, was hospitalized and drugged, and was constantly dismissed by the system and looked at as crazy. After fighting without any results, she was finally put in good hands and learned that listening to the voices and taking control of them, or as she describes it “a sane reaction to insane circumstances,” (Longden) was the way to peace. After many years of suffering and recovering, Longden earned her “BSc and MSc in psychology, the highest classifications ever granted by the University of Leeds, England” (TEDtalk). This goes to show that the authority of Longden’s message is valid, as it was a personal experience. Her perseverance discredits Szasz’s claim by showing that she did in fact suffer from a mental illness, and she ended up flourishing more when under the pressures of everyday life. More importantly, Eleanor Longden is proof that without the proper care, improvement is impossible. When she was finally put in contact with a provider who listened, instead of staring in disbelief by her story, she was able to recover.

Another advocate for better mental health treatment is author and doctor of sociology and criminology, Bruce A. Arrigo. In 2002, Arrigo published his book Punishing the Mentally Ill: A Critical Analysis of Law and Psychiatry. Through his work, Arrigo aims to show the connection between the justice system and mentally ill patients. He specifically touches on how the law-psychiatric system punishes the mentally ill for being “different.” To show that he supports change, the author states, “This book specifically considers why efforts at reform, particularly during the last 25 years, have failed, mindful of how punishment underscores decisions made at the crossroads of law and psychiatry” (Arrigo, xix). Because of Bruce Arrigo’s background in sociology and criminology, it makes his claims hard to question. One chapter in particular stresses the negative effects society and law have on the view of mentally ill patients. Within the conclusion of the chapter, Arrigo says “Not only has the stigma of mental illness been further advanced by psychiatric and legal commitment practices, but the entire system of care has fallen short of its responsibility to deliver much-needed services” (Arrigo, 30). Perhaps this statement is directed towards hardheaded psychiatrists much like Thomas Szasz. Regardless, the author provides the needed information to back up his claims, and to show that the law psychiatric system needs reform.

Aside from participant-observer style studies and book publications on the matter, psychologists around the world are researching the most effective treatments for mentally ill patients. In 2009, the German Network for Mental Health began implementing home treatments with the goal of reducing the need for inpatient care. Author and psychologist Erik Bauer, and six of his colleagues, studied 17 regional home treatment networks to find out if the patients were improving after their time there. Although the 17 networks provide similar care, they are individual nonetheless. To compare the networks, the researchers drew data from three sources: “routine assessments of psychosocial functioning, questionnaires on structures and processes applied to the networks, and health care claims data for the patients enrolled on the NWpGs.” (Bauer). Routine assessments were completed by each patient’s case manager who was blind to the study’s purpose, and HoNOS completed the psychosocial functioning assessment. Questionnaires were filled out by both network managers and staff directly involved in patient care. Network managers were asked questions about “number of staff, the staff to patient ratio, the staff professions and outside cooperation partners of the networks.” (Bauer). Staff members were asked questions about “time and frequency of home visits, time spent with patients but also job satisfaction and psychosocial stress in the work place.” (Bauer). The health care claims included information on “patient demographics, use of inpatient treatment, medication, somatic and psychiatric diagnoses and use of outpatient care.” (Bauer).

Data collection stopped after the set time of six months and the researchers were able to draw some conclusions. Their data showed that better patient outcomes were more likely when the staff is experienced in mental health care, put in a lot of effort, and are satisfied with their income. Positive outcomes are also more likely when the patients are provided with treatment plans, sociotherapy, and psychoeducation. In contrast, when patients had a higher amount of contact with staff or home visits, or when more patients were assigned to one case manager, association with less improvement increased. The researchers concluded that while even though more observation time for this naturalistic study might have lead them to stronger results, “the home treatment networks observed in this study succeed in providing a higher intensity of care.” (Bauer).

While each of these sources come from authors with different backgrounds and provide data in different ways, they all help form a sufficient answer to the question “How effective and progressive is the treatment of mentally ill patients?” The answer is simple. Progression has been significant in the last few years, but there is still a lot of work to be done to improve effectiveness of treatments and quality of life for mentally ill patients. Mental illness, no matter the diagnosis, can quickly take over someone’s life. This deserves more attention. The public has a tendency of ignoring this issue, even if it is affecting them directly, and casts stigmas onto people with mental illnesses as if they are outcasts. The author of one of my sources, David Rosenhan, states that “a broken leg does not threaten the observer, but a crazy schizophrenic?” (Rosenhan, 34). By this, he means that humans are afraid of what they do not know. If we all paid more attention, were more educated on the topic, and were more aware of how prevalent mental illness is, treatment would be much more effective and much more personalized. Until we are fully educated, it is almost impossible to ensure that treatment will be equal for those with a physical disability and those with a mental disability. 
