The mental health crisis in the United States has challenged psychologists since the mid-1800s. The goal of what was called the “mental hygiene” movement was to prevent situations that caused mental health deterioration, though there were few to no definitions of what that constituted. Some believed that mental unwellness was primarily due to socioeconomic struggles; others believed that it stemmed from an imbalance of brain chemicals. Because there were no concrete definitions of mental hygiene, there was no unified approach to helping individuals struggling with mental health.

At the turn of the century, science remained divided about what causes mental illnesses. The definition of mental illness became more clear, but still broadly included all factors that affected a person’s mental wellbeing. Deeper studies led to the development of two distinct approaches to managing the mental health crisis. The first was an approach based on Charles Darwin’s theory of natural selection. The basis was that mental illnesses had a biological cause that stemmed from a failed attempt to adapt to new situations. This approach was less popular because it positioned mental health as unavoidable and untreatable. The second approach was a “life story” based approach, where psychologists talked to patients with mental illness and got their life story.