Issues from last class:

Today's Handout:

Historical perspective:

• Greek and Roman attitudes and treatment of insane
• Generally scorned or ridiculed by populace, except for those thought to be divinely inspired
• Care left to families, with no special institutions for treatment or even custodial care
• 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 (St. Thomas Aquinas and Albert the Great)
• Insanity mostly due to physical illness that interfered with proper reasoning
• Also supernatural causes of mental illness
• Astrological forces (main "scientific guide" for physicians during this period)
• Demons possessing the soul
• Constantius Africanus (1020-1087) to medical school in Salerno, Italy (?first medical school in the world, I'm sure some would argue with this)
• Translated Arab translations of Hippocrates into Latin
• Popularity of humoral theories increased
• New idea beyond Hippocrates (enduring) was the better prognosis of patients with depression seemingly due to an acute event in their environment or acute onset in general
• 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"!!
• Treatments (Note the order of who was consulted, not that different from today: family, relatives, friends, neighbors, then educated physicians, lay physicians, priests folk healers, uneducated men or women claiming special psychic wisdom and power)
• 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 (750 AD vs. 1247 AD Christian Western Europe)
• The Renaissance (approximately 14th to 16th century AD); renaissance means: rebirth or revival; humanistic revival of classical art, literature, and learning in Europe
• Witchcraft very big at the start of the Renaissance years
• Landmark reading (1st in must read top 10 for people who needed a group to blame all societal ills on): Malleus Maleficarum (Witches' Hammer) by Henry Kramer and James Sprenger (monks and theologians assigned by the pope)
• The big 150 years of witch hunts followed (proof was most often in the confessions, with suspects tortured until they gave the confession)
• Still unclear why after all these years of witch and demon belief there was this flurry of violence against those thought to be afflicted. Some theories were:
• weakening of authority with decline of old social institutions
• impact of developing of urban capitalism on peasant communities
• hatred engendered by religious wars between Catholics and Protestants
• need to control rising status of women and promote patriarchy
• need for scapegoats for the Inquisition (catholic tribunal for eliminating heresy)
• "displacement" of fear from first major epidemic in Europe (syphilis): what else could have been happening linked to this? (hint: base rate or prevalence of madness)
• Paracelsus (1493-1541)
• More interested than other physicians in mental illness but confusing theories!!
• Get this: mental illness was due to natural causes (as opposed to his colleagues) but also that the insane should be burned to prevent them from being possessed by devil
• Sounds like this was his approach after a "psycho-intellectual" attempt at cure
• Weyer (1515-1588)
• Observed witches for 12 years and wrote about these observations
• Wrote The Deception of Demons, a refutation of Malleus Maleficarum
• Thought witches could cause no harm, and were either melancholics or charlatans trying to impress others with their importance
• May have been first physician to make psychiatry his major interest
• Plater (1536-1614)
• Wrote "two large books ": Practice of Medicine and Observations of Diseases Injurious to body and Mind which classified based on symptoms, signs, causes, and treatment, stressed psychological factors
• May have been first to separate medicine from philosophy and make it a branch of physical science
• Timothy Bright's A Treatise of Melancholie (1586) may have influenced Shakespeare's characterization of melancholy in Hamlet
• Seventeen century
• Decline of demonology and continuation or rise of Galen's concepts of humoral and animal spirit causes of illness
• Thomas Willis and Thomas Sydenham made contributions to mental illness description
• Willis did autopsies showing the uterus actually had not wandered in women with hysteria
• Sydenham wrote about hysteria also and felt it could be present in males (new concept)
• Insane continued to be viewed as socially undesirable but not as demon possessed (much improved status), with their being incarcerated with criminals in prisons, workhouses, and special asylums (note also in this group was paupers, cripples, elderly, prostitutes, religious skeptics, homosexuals)
• This "change" occurred at the beginning of the "Age of Reason" with a need to deny the " unreason" of the insane
• Eighteenth century (time of the "Enlightenment", age of reason)
• Treatment of insane based on belief that these people had incurable illness whose causes were unknown
• Initially asylum administrators believed the best approach to insane was through use of cruelty: intimidation and threats, meager diet, whipping, lowering treatments (into water I believe), and chaining
• Witnessed by public for a price
• Concept of neurosis
• William Cullen first to use term, as a state of dysequilibrium between excitement and collapse in parts of the brain
• Hysteria and other mental disorders included in this category
• Reforms of treatment of insane (Asylum treatment that is)
• Pinel most famous and promoted occupational therapy, exercise, entertainment, good food, attractive surroundings, regular meetings with attendants and groups of patients, and unchaining
• Much of above may have been due to French Enlightenment ideas and the Declaration of Rights in 1789
• Pinel also wrote about the 800 patients he worked with, describing mania, melancholia, dementia, and idiocy. Rejected humoral, animal spirits, and other early theories, favoring genetics and influences from the environment (diathesis/stress; Galen's concept)
• Chiarugi in Italy, Tuke in York, England, Rush in U.S. all influenced by Pinel or part of this new "moral treatment" of Pinel
• Benjamin Rush (1745-1815) considered the father of American psychiatry
• Was half into the moral treatment camp, even arguing for elimination of stigma, but also used many traditional methods of treatment (physical restraint, chastisement, whirling in a rotary chair)
• Franz Anton Mesmer (1734-1815), Austrian physician
• Believed mentally ill could be cured by "mesmerism", which was based on belief that animal magnetism ("subtle fluid") caused problems and could be normalized by placing of hands and channeling this fluid into the air
• Braid (1795-1860), English surgeon
• showed mesmeric influence could be self induced, thought due to impression made on the nervous centers rather than animal magnetism, calling this neuro-hypnotism, then later hypnotism
• Joseph Gall (1758-1828) German physician; founder of Phrenology
• Studied animal and human brains, states first to that that psychic structure and brain structure were related (? semantics here, others felt brain was major player)
• 37 organs in brain, each with different function, and mapped to surface of scalp
• Student Johann Spurzhiem (1776-1858) furthered this approach, very popular!!!

Case vignettes:

• Posttraumatic Stress Disorder

• Obsessive Compulsive Disorder