Mental Health at the Beginning of the 20th Century: An Individual Need

From a historical perspective, the development of psychological disciplines aimed at exploring individual distress is inseparable from the birth of modern social structures between the late 19th and early 20th centuries. Although practices of caring for existential malaise have their roots at the dawn of time, with different therapeutic knowledge and figures over the centuries, it is only with the evolution of industrialised, urbanised, and capitalist societies that the issue of psychological suffering asserts itself—marked by the need forspecialised, technical knowledge that could offer targeted intervention strategies. From the outset, from both a cognitive and operational perspective, the general strategy for responding to psychological needs and pursuing practical goals has been the clinical approach. This approach asserted itself strongly, particularly due to its operational form, which aligned closely with individualistic socio-economic frameworks and its scientific reference model, which adopted medicine as the guiding orientation for its practice. Indeed,  the clinical approach makes it possible to address psychological distress at the level of the individual—understood as the bearer of a problem in relation to social equilibrium. It provides medical-diagnostic lenses and a specific lexicon, and locates in the individual, and their capacities, the ability—or inability—to confront the challenges posed by life.  This view of mental health as a disorder or dysfunction of the individual, which can be restored through clinical intervention, was extremely widespread and hegemonic until the early 2000s, is undoubtedly effective and pertinent, but its scope - legal, epistemological, and social - is limited.

Second Half of the 20th Century: A Gradual Paradigm Shift

Soon, indeed, scientific communities across various fields began to question not only the characteristics of the individual that make them vulnerable to psychological distress but also the social processes in which they participate, and the health-generating (salutogenic) or detrimental roles these processes may play. Similarly, at the legal-legislative level, there has been increasing reflection on the responsibility that social and institutional frameworks not only to protect mental health, but also to actively promote it. It is therefore no coincidence that institutional attention to the development of legal-legislative frameworks, policies, and interventions aimed at supporting psychological health —particularly in Western, educated, industrialised, rich, and democratic (WEIRD) countries—emerged in the second half of the 20th century, prompted by the dramatic political, social, and military events that had shaken the world to varying degrees. It is within this context that both transnational legal and legislative instruments— such as the Universal Declaration of Human Rights— and scientific, health, and social orientationssuch as the World Health Organization's (WHO) definition of Health—began to assert themselves almost simultaneously. In parallel, albeit at different and sometimes uncoordinated paces, individual nations and scientific communities further developed their conceptual and operational proposals within a legal framework that recognised  and protected mental health across its various domains, contexts, and dimensions of expression. Starting from the 1950s and 1960s,, fundamental reflections in the legal, legislative, bioethical, scientific, health, and public health fields have continued to emerge up to the present day. These reflections have increasingly emphasised the need to shift—or rather, to complement—the focus on individual and personological determinants with insights drawn from social and community psychology.

Particularly in Latin American countries, the United States of America, and Europe, the clinical perspective was quickly complemented by a social-community approach. The defining feature of this latter perspective lies in its emphasis on the critical, active, and formative role of individuals’ living contexts, with their formal, informal, implicit, or explicit rules,in shaping healthy environments. It is not so much the rejection of a clinical-individual perspective as a shift in emphasis towards the extent to which socially and culturally shared norms influence individual towards healthy lifestyles and behaviors and belonging to sensitive, equitable, and horizontal communities, in which individual uniqueness could be harmoniously aligned with social diversity and oriented towards cohesive living.