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A Brief History of Mental Healthcare in the 20th Century

In the early twentieth century, the prevailing concept in psychiatry was the demented mind, while drugs that changed one’s mental state (including alcohol) were largely views as “mind-altering substances” [1]. Asylums, largely state-run institutions where people with mental health issues were locked away, were commonplace [2]. Lobotomies, in which a mini icepick was shoved up the nose into the brain, were performed up to the 1950s [3]. In fact, Egas Moniz, who invented this procedure, received the Nobel Prize for Medicine in 1949 for his work, before the practice when into disrepute in the mid-1950s [4].

From the 1930s to the 1950s the prevailing concept in psychiatry was the disordered mind [5]. Of the non-physical treatments available to those suffering from issue of the mind, psychoanalysis, invented by Sigmund Freud, prevailed in the 1930s [6]; psychotherapy, based on classical conditioning (Ivan Pavlov) [7] and operant conditioning (B. F. Skinner) [8] prevailed in the 1940s, and Cognitive Behavioral Therapy (CBT) [9] has dominated the field since the 1950s. 

The arrival of the first anti-psychotic (or neuroleptic) Chlorpromazine in the mid-twentieth century marked a revolution mental health care [10]. There was a shift in mental health care from state-run asylums to the private sector as patients were able to be restrained by the administration of these neuroleptics, which acted as “chemical straitjackets” or “chemical lobotomies” [11]. At first these medications were predominantly seen as “tranquilizers:” temporary measures to calm patients down in order to introduce more long-term treatments [12]. In the 1970s-1980s, these drugs began to be seen as “chemical cures,” and the concept that mental disorders were the result of chemical imbalances started to take hold [13], despite the lack of physical evidence to support the chemical imbalance theory [14]. SSRIs such as Prozac [15] exploded into the public consciousness with the introduction of second generation neuroleptics in the 1990s [16]. 

It was during this time that Dr. Leaf began researching the mind and the brain. Based on her findings, both during her studies and in her practice, she noticed that mind-action is actually the predominant element in mental wellbeing [17]. Dr. Leaf pioneered mind-directed therapy that involved family and/or caregivers in the context of the patient’s life and needs [18]. The patient was highly involved in taking responsibility for their intervention and recovery. Dr. Leaf applied this successfully in many situations, and in the development of her 21 day brain detox program [19]. Her approach is similar to the scientifically researched and successful Open Dialogue Therapy, which is currently becoming very popular for the treatment of mental health [20].

 Through her work, which continues to this day, Dr. Leaf noticed that mental ill-health is not just a biological imbalance that could be “cured” by medication; it is a disorder of the mind that can be caused by a traumatic thought life [21]. In other words, mental ill-health is a thought disorder based in the mind, which changes the brain physiologically. Consequently, Dr. Leaf developed the Switch On Your Brain with the 5-step Learning Process [22] from over three decades of study, clinical practice and research [23]. This learning process, based on her Geodesic Learning Theory [24], has been shown not only to be effective in mental health care, but also treating physical damage to the brain that occurs in Traumatic Brain Injury (TBI),  learning disabilities and to improve learning techniques in both schools and the corporate world [25]. The groundbreaking discoveries of neuroplasticity [26] (i.e. the brain can change) and neurogenesis [27] (new nerve cells are continually produced) in 1990s further support Dr. Leaf’s work, showing how the brain is a complex, living organ and not merely part of a biological machine.

In today’s scientific community, the prevailing concept that chemical imbalances form the basis mental illness is being challenged. David Anderson, a prominent geneticist involved in psychiatric research, has eloquently stated [28] that the chemical imbalance concept promotes the erroneous idea that the brain consists of a “bag of chemical soup.” Taking drugs like Prozac have been shown to be ineffective in a great number of scientific articles [29]. As Anderson notes, taking psychiatric drugs to “fix” mental health issues is like performing an oil change on a car by pouring oil all over the engine: it does more harm than good. In the her ground-breaking book, The Myth of the Chemical Cure [30], Dr. Joanna Moncrieff, a prominent British psychiatrist at University College London, stated that psychiatric drugs actually create abnormal brain states instead of counteracting them, and that the concept of chemical imbalance rather reflects successful marketing by the dominant pharmaceutical industry. Indeed, a recent meta-analysis from Stanford University [31] documenting 193 brain imaging studies on the whole-brain images of nearly 16,000 people turned the dominant brain disease model of psychiatry on its head. The study essentially found that the brains of people with different diagnoses such as schizophrenia, depression and addiction showed similar gray-matter loss. This finding challenges the disease model, which proposes that the different diagnoses have different brain pathologies. Even Tom Insel, a psychiatrist, the Director of the National Institute for Mental Health (NIMH) and a proponent of the disease model of mental health, has admitted to the failure of the present day paradigm of the chemical imbalance concept in successfully treating mental illness. [32] His views were supported by Kenneth Kendler, one of the world’s foremost experts on chemical imbalances, who noted in 2005 that “we have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.” [33]

It is obvious that the disease model of mental health, with its accompanying concept of chemical imbalance and drug use, is not succeeding, as we have more individuals suffering from mental health issues than ever before in human history. Although there has been a 400% increase in anti-depressant use alone since the 1990s, with a similar rise in the use of neuroleptics, more and more people are being locked away in mental health institutions and more and more adults and children are being put on dangerous, mind-altering substances [34]. It is high time for a change.  


  1. Moncrieff, Joanna. “Madness, Drugs and Capitalism: An Exploration by Dr. Joanna Moncrieff.” SOAS. November 20, 2014. Retrieved from https://www.youtube.com/watch?v=ejkWxjdM-ig.
  2. Whitaker, Robert. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. New York: Basic Books, 2010.
  3. Pereira, Erlick A.C. "The Lobotomist." Journal of the Royal Society of Medicine 98, no. 8 (2005): 381-382. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1181846/.
  4. Nobel Prizes and Laureates. “Egas Moniz - Biographical.” Nobelprize.org. Nobel Media AB 2014. http://www.nobelprize.org/nobel_prizes/medicine/laureates/1949/moniz-bio.html
  5. Whitaker. Mad in America; Moncrieff, “Madness, Drugs and Capitalism.”; Scull, Andrew. Madness in Civilization: A Cultural History of Insanity from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton: Princeton University Press, 2015.
  6. Gay, Peter. Freud: A Life for Our Time. London: Papermac, 1995, xv, 32.
  7. Clark, Robert E. "The classical origins of Pavlov’s conditioning." Integrative Physiological & Behavioral Science 39, no. 4 (2004): 279-294.
  8. Staddon, J. E. R., and D. T. Cerutti. "Operant conditioning." Annual review of psychology 54 (2003): 115-144.
  9. Dobson, Keith S., ed. Handbook of cognitive-behavioral therapies. New York: Guilford Press, 2009; Benjamin, Courtney L., Connor M. Puleo, Cara A. Settipani, Douglas M. Brodman, Julie M. Edmunds, Colleen M. Cummings, and Philip C. Kendall. "History of cognitive-behavioral therapy in youth." Child and adolescent psychiatric clinics of North America 20, no. 2 (2011): 179-189.
  10. Moncrieff, “Madness, Drugs and Capitalism;” Ban, Thomas A. "Fifty years chlorpromazine: a historical perspective." Neuropsychiatric disease and treatment 3, no. 4 (2007): 495-500.
  11. Moncrieff, “Madness, Drugs and Capitalism;” Moncrieff, Joanna. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. Basingstoke: Palgrave Macmillan, 2008.
  12. Ibid.
  13. Ibid.
  14. Ibid.
  15. Ibid; Vaswani, Meera, Farzana Kadar Linda, and Subramanyam Ramesh. "Role of selective serotonin reuptake inhibitors in psychiatric disorders: a comprehensive review." Progress in neuro-psychopharmacology and biological psychiatry 27, no. 1 (2003): 85-102.
  16. Ibid.
  17. Leaf. “Ridiculous.”
  18. Dr. Caroline Leaf. “Toxic Thoughts.” Dr. Leaf. 2015. Retrieved from http://drleaf.com/about/toxic-thoughts/.
  19. Dr. Caroline Leaf. “Switch on Your Brain with the 5 Step Learning Process.” Dr. Leaf. 2015. Retrieved from http://drleaf.com/store/dvds/the-switch-on-your-brain-5-step-learning-process-dvdworkbook/; Dr. Caroline Leaf. “21 Day Brain Detox Program.” Dr. Leaf. 2015. Retrieved from http://21daybraindetox.com/.
  20. Dr. Caroline Leaf. “Curriculum Vitae.” Dr. Leaf. 2015. Retrieved from http://drleaf.com/download-dispatch/?fn=/DrCarolineLeaf_CurriculumVitae1.pdf; Seikkula, Jaakko, and Tom Erik Arnkil. Dialogical Meetings in Social Networks. London: Karnac, 2006.
  21. Leaf, Uys, and Louw. “The development of a model for geodesic learning.” Retrieved from http://drleaf.com/download-dispatch/?fn=/TheDevelopmentOfAModelForGeodesicLearning.pdf;
  22. Leaf. “Switch on Your Brain with the 5 Step Learning Process;” Leaf. “Curriculum Vitae.”
  23. Leaf. “Curriculum Vitae.”
  24. Leaf. “Switch on Your Brain with the 5 Step Learning Process;” Leaf. “Curriculum Vitae;” Leaf, Uys, and Louw. “The development of a model for geodesic learning;” Leaf, Uys, and Louw. “Mind-Mapping approach (MMA).”
  25. Ibid; see also Fisher, Melissa, Christine Holland, Michael M. Merzenich, and Sophia Vinogradov. "Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia." American Journal of Psychiatry 166, no. 7 (2009): 805-811.
  26. Berlucchi, G., and Henry A. Buchtel. "Neuronal plasticity: historical roots and evolution of meaning." Experimental Brain Research 192, no. 3 (2009): 307-319.
  27. Riddle DR, Lichtenwalner RJ. “Neurogenesis in the Adult and Aging Brain.” In: Riddle DR, ed.. Brain Aging: Models, Methods, and Mechanisms. Boca Raton (FL): CRC Press, 2007, Chapter 6. Available from: http://www.ncbi.nlm.nih.gov/books/NBK3874/.
  28. Anderson, David. “Your brain is more than a bag of chemicals.” TED. January 2013. Retrieved from http://www.ted.com/talks/david_anderson_your_brain_is_more_than_a_bag_of_chemicals
  29. Moncrieff, Joanna“Why there’s no such thing as an ‘antidepressant’. Joanna Moncrieff. November 27, 2013. Retrieved from http://joannamoncrieff.com/2013/11/27/why-theres-no-such-thing-as-an-antidepressant/; Moncrieff. The Myth of the Chemical Cure.
  30. Ibid.
  31. Goodkind, Madeleine, Simon B. Eickhoff, Desmond J. Oathes, Ying Jiang, Andrew Chang, Laura B. Jones-Hagata, Brissa N. Ortega et al. "Identification of a common neurobiological substrate for mental illness." JAMA psychiatry 72, no. 4 (2015): 305-315.
  32. Insel, Thomas. “Toward a New Understanding of Mental Illness.” TED. January 2013. Retrieved from http://www.ted.com/talks/thomas_insel_toward_a_new_understanding_of_mental_illness
  33. Whitaker, Robert. “Part 1: The Roots - Robert Whitaker - Psychiatric Epidemic - PsykoVision CPH - May 14, 2014.” YouTube. Retrieved from https://www.youtube.com/watch?v=4R6MXO2j0V0.
  34. Leaf, Uys, and Louw. “Mind-Mapping approach (MMA).”
  35. Whitaker, Robert. “Part 1: The Roots - Robert Whitaker - Psychiatric Epidemic - PsykoVision CPH - May 14, 2014.” YouTube. Retrieved from https://www.youtube.com/watch?v=4R6MXO2j0V0; Moncrieff, “Madness, Drugs and Capitalism;” Moncrieff. The Myth of the Chemical Cure.