by ©2024 Sarah Becker

In April 2024, City Manager Jim Parajon asked City Council “for $900,000 to solve Alexandria’s mental health staff shortage.” Staff turnover was high and city salaries were lower than the neighboring average. Shortages exist not only in Alexandria but throughout the United States.

World Mental Health Day is October 10. “Everyone, whoever and wherever they are, has a right to the highest attainable standard of mental health,” the United Nations professes. “This includes the right to be protected from mental health risks…the right to liberty, independence and inclusion in the community.” According to INOVA’s 2019 Alexandria Community Health Assessment, mental health is a “top 10 health issue.”

Within the U.S. “about one in five adults experience mental illness annually,” the National Alliance on Mental Illness [NAMI] explained. “Fifty percent of all lifetime mental illness begins by age 14; seventy-five percent by age 24. One in six U.S. youth aged 6-17 experience an annual mental health disorder.”

The influencers: genetics; brain structure and biochemical processes; environment, lifestyle and language isolation. “Compared to Virginia and national averages,” INOVA concluded, “a higher proportion of Alexandria’s population is linguistically isolated.”

Congress created Atlanta’s Marine Hospital Service, the forerunner to the U.S. Public Health Service [USPHS] in 1798. Established to take care of “sick and injured seamen,” the Service history says little about the watermen’s mental health. As for the Founding Fathers:

Massachusettsan and U.S. President “John Adams [1735-1826] is thought to have suffered from depression and anxiety,” Columbia University said. “His diaries recount bouts ‘of great anxiety and distress.’” Chairing twenty-five of the second Continental Congress’ many committees was stressful.

Twice Virginia Governor Patrick Henry [1736-1799] “had a loved one with serious mental illness,” CU continued. “Records indicate that his wife Sarah Shelton Henry developed what appears to be post-partum depression following the birth of their last son. Despite the professional recommendations, Henry refused to institutionalize his wife and instead arranged to care for her at home.”

Pennsylvania’s Dr. Benjamin Rush [1746-1813]—signer of the Declaration of Independence, Surgeon General of the Continental Army, and the father of American Psychiatry—was the first American to write a mental diseases textbook, to study mental health disorders “in a systematic way.”

Dr. Rush developed treatments that relied not only on confinement, but also medical intervention. His mental health treatments included “bleeding and purging, also the use of the tranquilizer chair and gyrator,” the University of Pennsylvania confirmed.  Dr. Rush’s tranquilizing chair “slowed down the fluid movement of agitated patients.” The Doctor’s gyrator, which was a horizontal board on which sluggish patients were strapped and spun, stimulated blood circulation.

Bloodletting is the intentional removal of a portion of a person’s blood. It was the then balance—or imbalance—between the body’s four humors, the four bodily fluids—blood, phlegm, yellow bile, and black bile—that determined a person’s physical and mental health. Blood was moist and warm, phlegm moist and cold, yellow bile dry and warm, and black bile dry and cold.

Physicians, professional leech-ers and cuppers all practiced bloodletting: also, barber-surgeons. The colors in today’s barber pole date from the blood-letting era. Red represents blood-letting; white signifies hygiene, and blue denotes tranquility.

By the mid-1800s blood-letting gave way to Charles Darwin’s theory—the Origin of Species. “[M]ental deviations, i.e. extreme variations, were conceived as having a biological basis; primarily genetic,” the Johns Hopkins Bloomberg School of Public Health concurred. “This view provided little hope for recovery of the mental deviant.” The majority of Dr. Rush’s psychiatric patients were referred to as “Lunaticks” (sic).

Utopian Robert Owen [1771-1858] was one of the few in the industrial Kingdom of Great Britain to demonstrate concern for workers welfare. “The right of mental liberty is inherent in our nature,” Owen declared in 1826. “While man exists in mental health, [it was not] until the Revolution of 1776, [that Americans] acquired the political power…to use that right.”

The term mental hygiene was first introduced in 1843 by Dr. Isaac Ray, a founder of the 1844 American Psychiatric Association. The “province of mental hygiene” is “the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements. The management of the bodily powers in regard to exercise, rest, food, clothing and climate; the laws of breeding, the government of passions, the sympathy with current emotions and opinions, and the discipline of the intellect.”

“When we remember that we are all mad,” Mark Twain penned, “the mysteries disappear, and life stands explained.

It was not until the 1890s that Swiss-born psychiatrist Adolph Meyer “became convinced that…industrialization and urbanization were undermining human potential for continuous adaptability and constructive activity.”

Mental hygiene as described by C.E.A. Winslow, Yale professor of Public Health in 1933: “An organized community response to a recognized community need; and it lays its prime emphasis on the detection and the control of those incipient maladjustments with which the physician qua physician never comes into contact, unless specific community machinery and far-flung education facilities are provided for the purpose.”

“Anxiety disorders are the most common form of mental illness today,” the Mental Health Foundation explained. Anxiety, as defined by Dorland’s Medical Dictionary: “A feeling of apprehension, uncertainty, and fear without apparent stimulus….” The types include floating anxiety, neurologic anxiety, separation anxiety, situation anxiety and political stress.

Other mental illnesses: [1] Post-traumatic stress disorder, phobias, et al., [2] Mood disorders (depression, bipolar disorder, et al.), and [3] Psychotic disorders (schizophrenia, schizoaffective disorder, et al.)

As of April 2022, 69% of U.S. public schools reported an increase in mental health concerns. My question: for what reason does U.S. Surgeon General Vivek H. Murthy, M.D., believe “there are critical gaps in our understanding of mental health, especially children and adolescents’ mental health.”

“Social media use among young people is nearly universal,” the Surgeon General’s Office replied. “Children and adolescents on social media are commonly exposed to extreme, inappropriate, and harmful content; and those who spend more than three hours a day on social media face double the risk of poor mental health including experiencing symptoms of depression and anxiety.”

Dr. Murthy’s oft repeated rejoinder: “It is time to require a Surgeon General’s warning label on social media platforms.” The why for why not: Section 230 of the 1996 Communications Decency Act.

“As algorithms begin to play an increasingly significant role in our online experiences, lawmakers need to find a balance between free speech and consumer safety,” the National Association of Attorneys General said.

“Some social media platforms show suicide and self-harm-related content including even live depictions of self-harm acts, content which, in certain tragic cases, has been linked to suicide and childhood deaths,” the Surgeon General’s Office continued.

In June 2024 the U.S. Supreme Court agreed that the USPHS “should communicate with social media companies” in order to protect, promote, and advance the nation’s health. [Murthy, Surgeon General v. Missouri]  Not long after, Gov. Glenn Youngkin [R-VA] ordered VDOE to draft guidelines for implementation of “cell phone-free education in public schools.” ACPS reportedly agrees: Meta CEO Mark Zuckerberg not really.

Today the American Psychological Association explains mental hygiene as “a general approach aimed at maintaining mental health and preventing mental disorder through such means as educational programs, promotion of a stable emotional and family life, prophylactic and early treatment services, and public health measures.”

For free, confidential, suicide crisis support dial 988—the National Suicide & Crisis 24/7 Lifeline.

Sarah Becker started writing for The Economist while a graduate student in England. Similar publications followed. She joined the Crier in 1996 while serving on the Alexandria Convention and Visitors Association Board. Her interest in antiquities began as a World Bank hire, with Indonesia’s need to generate hard currency. Balinese history, i.e. tourism provided the means. The New York Times describes Becker’s book, Off Your Duffs & Up the Assets, as “a blueprint for thousands of nonprofit managers.” A former museum director, SLAM ’s saving grace Sarah received Alexandria’s Salute to Women Award in 2007. Email: abitofhistory53@gmail.com