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Some history of psychiatry and the DSM
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Some History of Psychiatry and the DSM
"Psychiatric diagnosis is seeing something that exists, but with a pattern shaped by what we expect to see"
~Allen Frances
Context is Important
Mental illness viewed without psychiatric diagnosis.
Traditional Cultures and Healing
Different Perspectives
-Behaviors that are seen as mental illness by western psychology are seen differently- even positively- in other cultures/societies.
-The start of a spiritual awakening?
-A transitional period from one state to the next
- Some cultures don't even have words for experiences like depression, schizophrenia or bipolar.
Different Perspectives
What happens when a person has a "break"?
The person is taken to the shaman or medicine man and seen as having potential to be a healer!
Training begins...
A Healer Is Born
Possession, Curses and Taboos
*The reason for mental illness:
-Psychosis is demonic possession?
-Psychosis is a curse?
-Psychosis is caused from breaking a taboo?
*The treatment for mental illness:
-Ceremony, entering into the spirit world
-Use of herbs or plants
-The person enters into another world or reality
The Priest Replaces the Shaman
"Whatever man did that seemed beyond himself was attributed to the actions of a divinity."
Priests and Gods
The job of the priest was to keep balance between humans and the gods.
The cure was a pilgrimage to a healing temple, dreaming and hopefully a message from a god.
Who is responsible anyways?
Keep the gods happy!!
The goddess Mania- her job was to drive men out of their minds
The goddess Hera- jealousy
The goddess Athena- violence
Madness was a punishment and way to off load responsibility- The Gods Made Me Do It!
Is it all bad?
No! You might have special gifts linked to your madness:
-Divine inspiration
-Seeing the future
-Creativity
-Or a big crazy party that gave you a break from everyday life! (Dionysus)
Madness is closer to the gods
Enter (and exit) Science
Modern Medicine
A shift from unseen supernatural forces to close observation of the natural world
Bye bye gods, priestly authority, sacrifice and rituals
The brain is the star player and responsible for everything
Psychiatric problems come from imbalances of the four basic humors: blood, yellow bile, black bile and phlegm
Enter demonic possession as the cause for mental illness and bad things only come form that!
Hippocrates
Hippocrates
-Clustered symptoms into new diseases
-Described mania, melancholia, phrenitis and phobia
-Illness is a part of nature
-Focused on the prognosis and that decided treatment
-Chose interventions only if they were more likely to help than harm
Galen
-Personality/temperament comes from an imbalance of the humors
-Personality and health were linked
-Recognized that mental illness could have many causes other than imbalance of the humors
-Treatment was seen as a focus on bringing balance to ones life
Galen
The Dark Ages
Out goes the understanding and pragmatic view of mental illness held by the Greeks.
Enter the worst time to be experiencing mental illness!
The Dark Ages
Mental illness was demonic possession
These demonic forces were highly contagious
Think exorcisms, inquisition, torture and burning at the stake
No bueno! The devil's handiwork
The doctor is the church
Malleus Maleficarum
1487- written by catholic clergyman Heinrich Kramer
Rationale and legal force for inquisition of the mentally ill
Mad were judged by god and man to be witches and demons, deserving no mercy
Malleus Maleficarum
Thankfully??
Thankfully this??
Sin replaces possession
Torture and death as treatment take a back seat
Mental illness is not the direct intervention of the devil but born out of "immoral and ungoverned" free will
Physical punishment, attempts to enhance spiritual life and morality backed by a strong hand are the preferred treatment
And on a good note Christian charity hospitals pop up and the mentally ill are at least cared for
Modern Psychiatry
Some people are catching on- science to the rescue!!
A much needed separation between the church and mental illness
Way ahead of Europe!
AD 700-AD 1500
The Arabs are the first people to introduce quantitative experimental science.
The Koran has a different view of mental illness- a practical problem to be dealt with on human and humane terms.
Yay!!!
The Arab World
They invent psychiatry along the way and it is a separate specialty
-The mental hospitals were well run and working towards understanding problems
-Made accurate observations, sorted syndromes and developed treatment approaches
-Created a classification system similar to the DSM!
-Treated with: counseling, cognitive psychotherapy, dream interpretation, drugs, baths, music and work therapy.
Mental Hostpitals
No more Demons.
Instead Enlightenment
Dawn of the Enlightenment
Europe is retaught the Hippocratic method of medicine and psychiatry
Seventeenth Century
Thomas Sydenham
No more demons or dogmas
"You must go to the bedside. It is there alone you can learn disease."
A master at describing syndromes and diseases
Recognized that over treatment of a patient's psychological distress could make it worse.
Seventeenth Century
Eighteenth Century
Carl Linnaeus
Created a detailed classifiaction system of plants and animals
Why is this important you might ask?
The human body and brain are extremely complex and make classification difficult.
The downfall of Psychiatry in terms of causal answers
Eighteenth Century
19th Century
The industrial revolution changes it all, bad news for the menatly ill.
Philippe Pinel is the father of psychiatry
And we all know about Freud- or do we?
19th Century and Freud
Philppe Pinel
Philippe Pinel
Created the profession of psychiatry in the western world.
A humanist and a scientist- treat patients as people! (literally took chains of the patients)
Mental illness is not demon possession, but comes from natural causes.
Created a "moral" treatment for mental illness that combined education, cognitive therapy, reality testing, work, exercise, and support.
Thought that mental illness was a combination of heredity, physiological damage to the brain. psychological and social stress and previous bad treatment.
Freud
Helped fill the gap with outpatient experience
He was originally a neuroscientist, but couldn't get a job at a university so worked in an outpatient setting. Only studied psychiatry for a few months.
Also worked on classifying mental illness
Started outpatient psychiatry
Gave us the concept of the unconscious and ventured into areas that were not talked about previously. But his work didn't "hold" to current understanding and research.
Freud
Something good comes out of war???
Psychiatry comes into the mainstream