Issues from last class:

Handout for today:

Historical perspective:

• Roman "psychiatry" generally followed Greek thought (consistent with Roman approach, best from conquered) but some new ideas from:
• Aretaeus, 1st century AD
• Primary contributions were in realm of differential diagnosis
• Galen (130-200 AD) "greatest Roman physician" (in history of medicine and psychiatry)
• See attached chart for essentials of theory
• Soul again divided into three parts, with locations!!
• Three types of pneuma (humors) postulated
• Four "qualities" existed and determined an individual's temperament
• Diseases due to and adverse condition (external) acting on a predisposing temperament (abnormality of the humors/pneuma). Today this is seen as the interaction of genetic and environmental factors. A "new" formulation by Zubin & Spring (1980ish) was the diathesis stress model of mental illness (does not sound very new, but they got tons of credit for this contribution!!, a major breakthrough)
• Treatment was to oppose what the disease exhibited (moist with dry, heat with cold etc.)
• Note that this was how physical and mental disorders came about and were treated
• Special note: speculated that psychological disorders could cause physical problems and vice versa. This is now called the study of psychosomatic illness.
• Abnormality was a continuum and after it reached a threshold, a disease state was formed, with its own form (once beyond the threshold, a new entity formed with its own form)
• Note that despite this very detailed list of humors, spirits, qualities, etc. his description of melancholy went right back to the Hippocratic theory of excess black bile!! He also discussed phlegm in his writings
• "consolidated" and "eclectically augmented" Greek ideas is a good description it seems Note: Roman empire fell apart around 300 AD and things were rather stagnant I'm not really sure the confessions of St. Augustine are part of the history of psychiatry, and if so, as K&S chapter suggests, only for those who believe that intense introspective writing was the precursor of psychoanalysis.
• The Medieval Period (the 1,000 years after fall of Roman Empire, 400-1,400 AD)
• Little semblance of scientific approach in most of Christian Western Europe
• Soul was divine therefore couldn't become ill
• Insanity mostly due to physical illness that interfered with proper reasoning
• Also supernatural causes of mental illness
• Astrological forces
• Demons
• Mohammedan Empire (Arab world in K&S)
• Some physicians translated ancient texts regarding mental illness (Galen, Hippocrates)
• Rhazes and Avicenna also noted physical problems causes psychological difficulties that responded to some sort of psychotherapeutic approach (not described)
• Avicenna's The Canon of Medicine was a textbook of medicine that was studied by Arab and Christian physicians and considered "the most influential textbook ever written"!!
• Treatements
• Exorcism of demons
• Physical and medical treatments recommended by Hippocrates and Galen
• Folk remedies: animal parts, plants, horn of mythical unicorn, bark from the tree of paradise, these all seemed to help
• Asylums built based on the belief that care for the insane was a religious duty. Note the much earlier development of hospitals/asylums in the Arab world
• The Renaissance (to be continued)

• Generalized anxiety disorder

• Panic attacks