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Mental health in the 18th century, no matter if we’re speaking about Europe, Asia or America, wasn’t pretty. People were facing social isolation, emotional torment and physical pain, and there were no treatments because medical experts knew little about the subject. In the last years of the century, colonial America had treatment facilities for those suffering from severe mental health issues. Still, they were barbaric and crude, even if the ones who applied them weren’t cold-blooded. Often, the ones behind the masks were intelligent people searching for the best treatment solutions for their patients. 

The society’s priority was to minimise the trouble mental health patients were causing to the community. When possible, they were left at their homes for their families to care for them. When they caused a nuisance to the community, committed crimes or posed dangers to someone, they were imprisoned in the local jail. Publicly run hospitals were in practice in countries like England and France for a century, but other societies found it difficult to follow the example.

Were there any therapeutic regimens for people struggling with mental health problems?

Most evidence about the therapies medical experts designed for mentally ill patients is based on the prescriptive literature or medical case notes practitioners held. When one patient committed a crime, those with knowledge about their behaviour testified in court, to offer examples of their acts, speech, and activities that would suggest if the patients were showing symptoms of distress. The testimonies focused on the previous months and even years, and their attempts to cure themselves of the condition they experienced. 

Medical practitioners were also invited to testify, but most witnesses were people who lacked medical training. Information from asylum admission petitions was often added to these testimonies to show that the relatives of the deranged individual searched for help. Most times, no matter the conditions, patients were diagnosed as suffering from madness, melancholia or hypochondria. The documents show that often the diagnose was more the result of a negotiation between the patients, their relatives and the practitioner. 

Once the patient was diagnosed with a mental health problem, a sort of medical treatment was used to alleviate their symptoms. The medical experts’ efforts to cure or improve the symptoms covered a wide range of medical therapies. A common approach was to apply evacuants and counter-irritants, but in severe cases, the practitioners also added shocks, water cures and other remedies, to the patient’s treatment regimen. 

Most approaches started with the restoration of humours. A wide array of solutions were available for doing it, from opium to blood-letting, evacuations, warm and cold bathing, purgatives, blistering agents, belladonna, antispasmodics, mercury, cathartics and digitalis. The galenic theory states that for people to recover their vital forces must be restored to a state of equilibrium. When the fluids in the body got off balance, the patient fails to behave accordingly to norms. 

There was a routine treatment for all conditions. 

People who showed anger signs were treated with bleeding therapy because it proved to have a sedative effect. Testimonies show that patients who were restless and uneasy achieved a calm state once the practitioners used bleeding. But in some cases, the families of patients took this method in their own hands, and when individuals showed signs of extreme anger and even the intention to commit crimes, they would expose them to more extreme therapies. For example, one time, a mother put her son in the hands of a cow-herd of a mountebank to cause him bleeding. His body was so exhausted that he was no longer able to walk and engage in murderous attempts. The records state that the patient’s judgement stayed the same; only his body was lacked from fury and uneasiness. 

The therapies used, at the later part of the 18th century, were based on the new belief about the origin of diseases that have taken over from Renaissance humoralism. Some physicians considered that the nerves cause all mental health issues. Robert Whytt promoted nervous physiology, and it soon became a landmark for treating mental health conditions. Whytt thought that the nerves are the instruments of sensation, and their influence determines the way people react and move. By knowing their distribution, structure and functions, medical experts could treat mental illness. 

Conventional medical wisdom, on the other hand, recommended restricting the freedom of action for patients with severe medical conditions, for both medical and safety purposes. Back in the 18th-century treatment regimens implied both maniacs and melancholic patients to be restrained from alleviating their symptoms. Nowadays, patients experiencing depression, one of the conditions that were characterised as melancholia in the past, are exposed to therapy treatments. In cases of mental health issues like depression, therapy works great because it allows the patient and the practitioner to identify the cause of the condition and treat it.  

Dr William Cullen was one of the most notorious practitioners dealing with patients with mental health issues in the 18th century, and he suggested using restraint for patients with mania, but in a way that doesn’t harm their physical health. He considered that it’s best to isolate people behind doors than to use other people to retrain them because they would struggle, and the process would prove hurtful. When isolated, all objects the patient was formerly acquainted with must be removed, so they could no longer make associations. He also recommended separating the patients in another environment than their house because the appearance of spaces they are accustomed to, excited their emotions. 

Other practitioners like Dr William Buchan disagreed with the restraint practice and recommended exercise, amusement, and a proper diet. He stated that the best way to restore people to their senses is to provide them with a change of scene that would calm their nervous fear and restore their abilities. When the family afforded, they would take the patient on a voyage, often overseas. Voyages removed the stressful stimuli they were exposed to at home, and because many had seasickness, they no longer dealt with their gloomy thoughts. 

If for many medical conditions, the 18th century was the age of scientific advance and medical optimism, for mental health, it was the worst period to exist.