Issues from/after last class?

• Hypomania and Dysthymia questions?
  
• Self as a barometer. Your own nervous system very sensitive to others' state.

Handout for today:

Historical perspective:

• Greek psychiatry
• Hippocrates (450-355 BC [I'm sure!!])
• Brain as center of affect and mental disorder
• Four essential humors: Blood, Phlegm, Yellow Bile, Black Bile secreted by different organs (which?), and possessed different qualities varying with seasons (not enduring but major interest in this today!!)
• Treatment based on restoring balance of humors
• "The Hippocratic authors" gave first rational classification to mental diseases
• Epilepsy "The Sacred Disease"
• Mania
• Depression
• Paranoia
• Phobias
• Hysteria ("wandering uterus" problem cured by marriage and intercourse),
• Treatments (get rid of those excess humors!! at any cost!!)
• Bathing
• Dieting
• Improved personal hygiene
• Hellbore (cathartic for insanity) and other purgatives and emetics
• Bleeding (but shouldn't this have been only for dementia? [or a really really sanguine personality that you just can't stand?)
• Plato (427-347 BC; 80 yr!! ok, "enduring pattern" of agedness in early psychiatric thinkers and philosophers!, kinda like the finding that reading a lot keeps you from getting senile?)
• Really a philosopher who really made a mark but not a "physician" or psychologist
• Divided soul into three parts (different body parts)
• Rational and divine (one part, how about that for a synonym for rationale!) located in the brain
• Spirited-affective (where is this located?)
• Appetitive (peremptory desires, physical lusts, and greed; I'd take a guess where these guys are located but probably would be wrong)
• Rationale and appetitive in conflict (rationale keeping appetitive at bay), with the spirited- affective able to work for either side!
• Note the comparison to Freud's "topographic" concept with id, ego, and superego (it's true, nothing is new)
• Postulated two types of "madness"
• Those caused by human ailments (rational loses to appetitive: sounds like mania or psychosis)
• That caused by divine disturbances of the soul (inspired or destructive behavior: are we talking about saints and demon possessed type stuff here?)
• Treatments of these maladies of the soul Rx was music and a verbal dialectic between patient and philosopher (development of knowledge, first psycho-educational psychotherapy?)
• Aristotle (Plato's pupil, 384-322 B.C.; ok, not so great, just 62 y/o)
• Emphasized the heart, and not the brain as the center of emotion (pupil going a bit off his mentor's original theory I'd say)
• Soul the center of psychic life, resided in the heart and derived its energy from natural heat; which in turn was affected by:
• Temperatures (naturally)
• Black bile
  Emotions
  
• Cold black bile ->
• Apoplexy (affliction), numbness, fearfulness, being disheartened (depressed?)
• Hot black bile ->
• Cheerfulness, bursting into song, ecstasy, and "eruption of sores" (mania with dermatitis? [maybe the manics he saw didn't wash much])
• First to "accurately" describe desire, anger, fear, courage, envy, joy, hatred, pity
• "Passions" caused bodily changes by disturbing the natural heat in the heart (sounds like a psychophysiologist specializing in cardiovascular measures)
• Epicurians and Stoics
• Passions and unsatisfied desires acted on the soul -> mental illness
• Mental illness could be controlled by achieving ataraxia (lack of perturbation), through thoughts and conduct (some feel this was first cognitive behavioral therapy)
• In addition to the somatic (medical) treatments mentioned above, three psychological therapies developed by the Greeks
• "the therapy of the world" verbal therapies, particularly dialectic and development of knowledge (Plato's approach)
• Induced Sleep (at the temples of Asclepian, where snake licking was very in vogue, and the snake about the rod became the symbol of Asclepios and the medical profession)
• Dream divination ("On the Interpretation of Dreams", you think Freud knew?)
• Classification of psychiatric illness (Trimble C.2; not written for faint of heart or tired)
• Evil spirits -> diseases with single pathogen [extremes]
• Disharmony vs. objective entity
• Theories of disease as result of evils of society
• Many authors wrote of this over last few hundred years
• Most controversial and modern Thomas Szasz (Syracuse University, belief that mental illness is a fiction, produced to label and hide those we don't want to accept into society)
• Not at all sure why Trimble doesn't feel diseases were described until 17th century
• Hippocrates speculated on specific syndromes with humoral abnormalities (see A, 2 for list of disorders described and what K&S say was the "first rational classification to mental diseases"
• Plato, Aristotle, Galen, etc.
• Concept of "reaction"
• Described in one light (negative, in terms of psychoanalytic, non-descriptive, individual oriented, non-scientific)
• Actually, neuroscience now sees reaction as very important to many disorders, with the original pathogen or insult, as well as the brain's response to it as defining the "syndrome" that results (Science!! and reactions)
• Statistical approaches to biological phenomena, disease, and even personality in this century
• Signs, symptoms, syndromes, and disease
• Symptoms: phenomena reported by patient (subjective)
• Signs, phenomena observed by physician, patient, friends, relatives etc. (more objective)
• Syndrome as constellation of signs and symptoms
• Uses GPI like we all know what it is (general paresis of the insane, central nervous system syphilis)
• Good example of syndrome progressing to disease
• Others include Parkinson's and dementia (once thought to be "neurotic" disorders)

Case vignettes:

• Schizoid personality disorder

• Personality change due to medical condition

DSM IV terminology and some mental status findings