Unit 1 History of Psychiatry

History of Psychiatry
 Presented By
 Sehrish Naz Lecturer INS/KMU
 Acknowledgement
 M. Zubair
 Lecturer INS/KMU
Historical Views of Abnormal
Behavior
 Demonology, Gods, & Magic
 Abnormal behavior often attributed to possession
 “Good” or “Bad” possession depended on the person’s symptoms
 Religious significance of being possessed
 Treatment
 Trephining allowed the evil spirit to escape the head
 Exorcisms used to cast demons out of the body
Hippocrates’ Early Medical Concepts
 Hippocrates (460-377 B.C.)
 "People believe that this disease is sacred simply because
they don't know what causes it? But some day I believe
they will, and the moment they figure out why people have
epilepsy, it will cease to be considered divine."
 Mental disorders due to natural causes
 Brain – central organ of intellectual activity
 Mental disorders – due to brain pathology
 Pointed out that head injuries could lead to
sensory and motor disorders
 Emphasized the importance of heredity
and predisposition
 Doctrine of the four humors
 Blood (sanguis) - generally optimistic, cheerful, even-
tempered, but can be daydreamy to the point of not
accomplishing anything and impulsive (mania)
 Phlegm – consistent, relaxed, and observant, but can be
apathetic and sluggish
 Yellow bile (choler) - a leader, but can be controlling,
easily angered or bad tempered
 Black bile (melancholer) – kind, considerate, can be highly
creative - - but also can be obsessed with tragedy and
cruelty (depression)
 Classification: Three categories
 Mania
 Melancholia
 Phrenitis (Brain fever)
 Based on daily clinical observations and records of patients
 Treatment: “do no harm”
 Humane: “Walking is man's best medicine."
 Specific to diagnosis
 Recognized the importance of environment
 Misconceptions
 Hysteria due to “wandering uterus”
 Four humors
Early Philosophical Conceptions
 Plato
 Diminished criminal responsibility for mentally ill
 Emphasized role of sociocultural factors
 Some supernatural influence on etiology
 Aristotle
 Largely Hippocratic in views
 Rejected the importance of frustration
and conflict in etiology of mental disorders
 Described the role of consciousness –
people strive to eliminate pain and attain pleasure (these ideas
are similar to Freud’s conceptualization of mental illness)
Alexandria, Egypt
 Center of Greek Culture
 Therapies used for mental patients
 Pleasant surroundings
 Activities (dances, parties, walking in gardens, concerts)
 Dieting
 Massage
 Hydrotherapy
 Gymnastics
 Education
 Also used bleeding, purging, mechanical restraints
Later Greek and Roman thought
 Galen (A.D. 130-200)
 Follower of Hippocrates
 Used science to contribute to the field
 Elaborated on nervous system based on animal dissections
 Divided the causes of psychological illnesses into 2
categories
 Physical: injuries to the head, adolescence, menstrual changes
 Mental: shock, fear, love
 Roman medicine
 Pragmatic approaches to medicine
 Wanted patients to be comfortable
 Used physical therapy, warm baths, massage
Middle Ages: Europe
 Mental disorders were prevalent
 Mass Madness
 Often occurs in times of widespread fear and distress
 In the Middle Ages, mass madness was maintained by
oppression, disease and famine
 Tarantism – uncontrollable dancing
 Lycanthropy – belief in possession by wolves
 Plague
Middle Ages: Europe
Etiology and Treatment
 Etiology of Mental Illnesses
 Scientific approaches rarely used
 Saw a return of the belief that mental illness was due to
supernatural causes such as superstition or rituals
 Treatment of Mental Illness
 Left largely to the clergy and occurred primarily in
monasteries
 Generally kind: prayer, holy water, ointments, exorcisms
Middle Ages in the Middle East
Treatment and Classification
 First mental hospital established in Baghdad in A.D.
792
 Avicenna (Arabia: A.D. 980-1037)
 “the prince of physicians”
 Wrote The Canon of Medicine
 Classified and defined diseases
and their causes
 Referred to hysteria, manic reactions,
and melancholia
 Ahead of his time: He described the symptoms and complcations
of diabetes and asserted the Tuberculosis was contagious, which
was argued by Europeans…turns out he was right
Comparing mental health in
Europe and China over time
 Early Chinese medicine was based on natural causes:
imbalance in Yin and Yang – treatment was aimed at
restoring this balance
 During the second century, Chung Ching wrote on
physical and mental illnesses based on his clinical
observations. He believed that both physical and
environmental influences affected mental illness and
that treatment should target both.
 During the Chinese Middle Ages, medicine regressed to
beliefs that mental illness was caused by supernatural
rather than natural forces (ghosts and devils)
Reformation:
Treatment - Establishment of Asylums
 Places to warehouse troublesome people, used harsh
tactics to control unruly or excited patients
 “Bedlam”: Monastery of
St. Mary of Bethlehem in

London commissioned
by King Henry VIII (1547)
 Deplorable conditions
 Violent patients put on display
 Harmless patients forced to beg
Resurgence of Scientific Inquiry in
Europe
 Johann Weyer (1515-1588)
 “Founder of modern
psychopathology”
 First physician to specialize
in mental disorders
 His works were scorned by
his peers and were banned by
the church until the 20th Century
Age of Enlightenment:
Humanitarian Reform – Key People
 Pinel (Paris: 1745-1826)
 Removed chains from patients and treated them kindly as
an experiment – found it was successful!
 Tuke (England: 1732-1822)
 Established the York Retreat, trained physicians and nurses
in treating mental patients with humanity and kindness, and
began to change public opinion
 Dix (America: 1802-1887)
 Aroused worldwide awareness of inhumane treatment for
the mentally ill and established 32 mental hospitals around
the world
Age of Enlightenment:
Humanitarian Reform - Treatment
 Treatment Philosophies
 Moral Management – attempted to help satisfy a person’s
social, occupational, and individual needs; emphasis placed
on rehabilitating a person’s moral and spiritual self rather
than curing the mental illness
 Mental Hygiene Movement – focused on the physical
needs of patients, keeping them comfortable
Twentieth Century
Treatment
 Asylums viewed by public as eerie, strange, and frightening
 Substantial growth in number of mental hospitals
 Lengthy stays
 Little effective treatment
 1946 – 1963: Changing views of mental health services
 National Institute of Mental Health is organized
 DSM-I published
 Mary Jane Ward published The Snake Pit – call to provide more
humane treatments for mental health patients
 Goffman published Asylums – detailed account of the neglect and
maltreatment of mental health patients
 Hill-Burton Act is passed funding community mental health agencies
 Community Health Services Act of 1963
Twentieth Century
Treatment
 1970’s – Deinstitutionalization and Community
Mental Health Care
 In the United States, it constituted a radical shift in
social policy and the way mental health care was
provided
 Replaced inpatient hospitals with community-based
care, day treatment, and outreach programs
 Considered more humane and cost-effective
Twentieth Century
Deinstitutionalization
 Forces that initiated/shaped the movement
 Miracle drugs
 Tricyclics, lithium, etc.
 Anti-psychotics typically reduce the symptoms that are more
“severe”
 Reconceptualization of Mental Illness
 Power of labeling
 Recognition of Institutional Hazards
 Sociocultural isolation
 Powerlessness/Helplessness
 Adjustment to institution lead to passivity and withdrawal
 Economic Incentives
 Transferred the responsibility from the state to private institutions
Twentieth Century
Deinstitutionalization – Did it work?
 Fewer patients spend time in inpatient hospitals
 Patients spend less time in inpatient hospitals
 More patients are re-hospitalized
 Where are they instead?

 Homeless
 Nursing homes
 Group homes
 Jail
Twentieth Century
Deinstitutionalization – Why not?
 Focus on medication
 More stigma than physical illness
 Little economic or social support for mental health
programs
 “Not in my backyard,” little job training or placement,
short-term housing, etc.
 Deinstitutionalization paid more attention to negative
rights than positive rights
 Negative Rights (Autonomy, choice, independence, etc.)
 Positive Rights (Social responsibility norms, education, job
training, etc.)
Contemporary Views
Etiology
 Psychoanalytic thought (Freud)
 Role of the unconscious in avoiding pain
 Catharsis
 Cognitive/Behavioral Theories (Skinner/Pavlov)
 Maladaptive cognitions and behaviors are developed and
maintained through learning and conditioning
 Brain Pathology
 Syphillis was found to caused paralysis and insanity
 The role of neurotransmitters
 Hippocrates (460-377 B.C.): Brain is the center of
intellectual activity and mental disorders are the result of
brain pathology
Contemporary Views
Etiology
 Diathesis-Stress Model
 Genetics
 Heritability of mental illnesses
 Shared environmental influences
 Environmental experiences that people with similar
genetics share (eg. SES, education, religion, etc.)
 Non-shared environmental influences
 Environmental experiences that are individual (eg. peer
interactions, disease, exposure to hormones or toxins, etc.)

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History of Psychiatry

St. Mary of Bethlehem in

 Where are they instead?

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