Lessons from tracing 200 years of perceived causes of mental health challenges

Theories about the causes of mental health challenges have evolved over time.  

In the late 18th century, ‘brain fever’, described as the inflammation of the brain resulting in symptoms like severe headache and confusion, was a common explanation. By the start of the 20th century, poverty and starvation were often listed as perceived causes of mental health challenges among men.  

Many different ideas have emerged and then disappeared as times changed.

What can we learn from reflecting on these theories and how can they impact mental health research today? The History of Causes timeline could provide answers.

The project, commissioned by Wellcome, aims to help researchers understand how perceived causes of mental health challenges have developed with time.

Understanding why and when these theories gain popularity, fall away or resurface can help researchers contextualise emerging ideas about what might cause mental health challenges.

Sarah Marks, Director of the Centre for Interdisciplinary Research on Mental Health at Birkbeck, University of London, is the lead researcher for the project.  

Beyond visualising the history of these theories, she says, "we wanted to show that some of the really contemporary questions in mental health actually have a long history and are connected to theories in the past".

The history of mental health is vast and continuously developing. While this timeline can’t capture it all just yet, it provides key insights for mental health research.  

Here’s what Marks and her team have learned so far:

Perceptions about the causes of mental health challenges are linked

Mental health research tends to look at individual factors that impact mental health. But the History of Causes timeline shows these factors often interact.  

“At first, the research team considered separating biological, psychological and social theories,” Marks explains.  

“But actually, you can never truly single out one idea because they are always interdependent.”

For example, poor nutrition or limited access to high-quality healthy food is linked to economic deprivation and poverty, both theorised as causes of mental health challenges.  

Marks explains that poor nutrition can also impact neural plasticity – the brain's ability to change and adapt – which is linked with depression, anxiety and psychosis.

This highlights the need to consider multiple perceived causes and how they interact to better understand how mental health challenges develop.   

Theories about what causes mental health challenges evolve over time

The timeline shows that perceptions about the causes of mental health challenges are always changing. Marks and her team attribute this to shifting political, social and cultural factors.  

For example, in the 19th century, neurasthenia, was a term used to describe mental health challenges caused by increasingly modern lifestyles and technology, including the rise of railways and urban migration.  

The study of neurasthenia has since declined in mental health research in western Europe and North America. However, key concepts related to it have recently re-emerged in discussions around the impact of the media and screen time on mental health.

“Although you see a theory rising and falling at first sight, when you actually look at it more deeply, some of the core ideas about what might cause mental health challenges actually do have continuity over time, although they might be expressed differently in different periods,” explains Marks.  

The history of mental health must include different contexts

The current timeline is focused on the UK, Europe and the US, because of the volume of available research published in these contexts.  

But that’s just the starting point.

The project team plans to host webinars and tap into mental health networks to expand the timeline globally. Researchers everywhere are also invited to contribute to the timeline through the website’s suggestion box.

“We want to make sure that, going forward, we can incorporate views and science and lived experience communities from other parts of the world,” explains Marks.  

She sees the project as a work in progress.  

“The more ideas we know about, the better we can understand the diversity of experiences, theories and ideas around mental health everywhere.”

Lived experience is essential to understand the history of mental health 

The timeline highlights the need for lived experience in mental health research.  

Veronica Wanyee, Lived Experience Adviser based in Nairobi, explains that, "For a long time, research and practice have been done to, and often even for people with lived experience but often not with people with lived experience. I think that’s a shame.”

“People with lived experience have the unique insights that come from having lived through the very illnesses we theorise about,” she says

Marks' team consulted lived experience advisers at every stage of the project. Experts helped determine who to interview for data gathering and contributed to the timeline’s content and organisation. They also identified gaps for future research and were key to developing a global perspective.  

Meghna Khatwani, Lived Experience Adviser based in New Delhi, explains, “Being lived experience experts not based in the UK or the US, we were able to bring in perspectives of mental health and mental illness, that we had seen in our own experiences and feed that into the narrative.”

According to her, this helped to uncover mental health history in places where research is lacking and shift the focus toward people experiencing mental health challenges.  

For Marks, involving lived experience experts can help researchers understand the implications that theories can have for people in the real world.    

“It's important to remember that aspects of mental health science, research and practice have caused harm to people with lived experience,” Marks explains.  

“We need to recognise those legacies for today.” 

The History of Causes project offers a glimpse into the complex history of mental health.  

One of the biggest lessons for the team is that progress isn’t always linear.

Next, they plan to expand and continuously improve the timeline with input across the field. Researchers are also invited to explore and experiment with the timeline and its potential applications in mental health research. For Marks, the ultimate hope is for the timeline to help guide researchers in deciding what areas of mental health research to pursue next.

“We hope this can generate conversations about how we move forward,” she says. “This includes the theories we want to pursue, the areas that need more research in the future, and what we should be funding.”