History of Psychiatry

References

• History of Psychiatry

Notes

History of psychiatry is the study of the history of and changes in psychiatry, a medical specialty which diagnoses, prevents and treats mental disorders.

Ancient

• Specialty in psychiatry can be traced back to Ancient India. Some of the first hospitals for curing mental illness were established during the 3^rd century BCE.
• During the 5^th century BCE, mental disorders, were considered supernatural in origin, a view which existed throughout ancient Greece and Rome.
• The beginning of psychiatry as a medical specialty is dated o the middle of the nineteenth century, although one may trace its germination to the late eighteenth century.
• Some of the early manuals about mental disorders were created by the Greeks. In the 4^th century BCE, Hippocrates theorized that physiological abnormalities may be the root of mental disorders, He wrote that he visited Democritus and found him cutting open animals to find the cause of madness and melancholy.
• Religious leaders often turned to exorcism to treat mental disorders.

Middle Ages

• Specialist hospitals were built in medieval Europe from the 13^th century to treat mental disorders, but were utilized only as custodial institutions and did not provide any type of treatment.

Early Modern Period

• During the early modern period, mentally ill people were often held captive in cages or kept up within the city walls, or they were compelled to amuse members of courtly society.
• From the 13^th century onwards, sick and poor people were kept in newly founded ecclesiastical hospitals, such as the Spittal sente Jorgen erected in 1212 in Leipzig in Saxony, Germany. Here, those with serious mental problems were isolated from the rest of the community in accordance with contemporary European practice.
• The Bethlem Royal Hospital in London, one of the oldest lunatic asylums, was founded in the 13^th century.
• In the late 17^th century, privately run asylums for the insane began to proliferate and expand in size. In 1632, it was recorded that the Bethlem Royal Hospital had below stairs a parlor, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in.
• In 1621, Oxford University mathematician, astrologer, and scholar Robert Burton published one of the earliest treatises on mental illness, The Anatomy of Melancholy, What it is: With all the kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections, Members, and Subsections. Philosophically, Medically, Historically, Opened and Cut Up. Burton thought that there was no greater cause of melancholy than idleness, no better cure than business.
• In 1713, the Bethel Hospital Norwhich was opened, the first purpose-built asylum in England, founded by Mary Chapman.

Humanitarian Reform

• In Saxony, a new social policy was implemented at the beginning of the 18^th century in which criminals, prostitutes, vagrants, orphans, and the mentally ill were incarcerated and re-educated in the concepts of the enlightenment.
• Attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim.
• In 1758, William Battie wrote his Treatise on Madness which argued for the tailored management of patients, good food, fresh air, and distraction from friends and family. He argues that mental disorder originated from dysfunction of the material brain and body, rather than the inner workings of the mind.
• King George III was known to have a mental illness.
• At the end of the 18^th century, patients began to be allowed to move freely around the hospital grounds, eventually dark dungeons were replaced with sunny, well-ventilated rooms.
• The York Retreat, founded by the Quakers and the Tuke family, was a small community where about 30 patients lived and engaged in a combination of rest, talk, and manual work. The Tuke family became known as founders of moral treatment.
• • The Tuke retreat inspired similar institutions in the United States.
• Physical restraint remained widespread in the 19^th century.

Institutionalization

• The modern era of providing care for the mentally ill began in the early 19^th century with a large state-led effort. Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act.
• The Lunacy Act 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment.
• In 1838, France enacted a law to regulate both the admissions into asylums and asylum services across the country.
• In the United States, the erection of state asylums began with the first law for the creation of one in New York, passed in 1842. Many hospital in the United States were built in the 1850s and 1860s on the Kirkbride plan, an architectural style meant to have curative effect.
• At the turn of the century, England and France had only a hew hundred individuals in asylums. By the late 1800s and early 1900s, this number had risen to the hundreds of thousands. The idea that mental illness could be ameliorated through institutionalization was soon disappointed.
• The reputation of psychiatry in the medical world reached an all time low at the end of the 18^th century.

Scientific Advances

• By the early 1800s, psychiatry made advances in the diagnosis of mental illness by broadening the category to include mood disorders, in addition to disease level delusion or irrationality.
• The term psychiatry was coined by Johann Christian Reil in 1808.
• The early diagnosis of depression was defined as an excessive attention to one thing.
• Emil Kraepelin studied and promotes the ideas of disease classification for mental disorders. The initial ideas behind biological psychiatry, stating that the different mental disorders were all biological in nature, evolved into a new concept of nerves and psychiatry became a rough approximation of neurology and neuropsychiatry.
• Psychopharmacology became an integral part of psychiatry starting with Otto Loewi's discovery of the neuromodularity properties of acetylcholine, thus identifying the first neurotransmitter. Neuroimaging was first utilized as a tool for psychiatry in the 1980s. The discovery of chlorpromazine's effectiveness in treating schizophrenia in 1952 revolutionized treatment of the disorder, as did lithium carbonate's ability to stabilize mood highs and lows in bipolar disorder in 1948.
• Now, genetics are once again thought by some prominent researchers to play a large role in mental illness.

The genetic and heritable proportion of the cause of five major psychiatric disorders found in family and twin studies is 81% for schizophrenia, 80% for autism spectrum disorder, 75% for bipolar disorder, 75% for attention deficit hyperactivity disorder, and 37% for major depressive disorder.

Deinstitutionalization

• Asylums: Essays on the Social Situation of Mental Patients and Other Inmates, written by sociologist Erving Goffman, examined the social situation of mental patients in the hospital. It played a key role in the concept of denationalization. At the same time, psychiatrist and psychoanalyst Thomas Szasz began publishing articles and books that were highly critical of psychiatry and involuntary treatment, including his work The Myth of Mental Illness, in 1961.
• In 1963, JFK introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centers for those being discharged from psychiatric hospitals (this was mainly utilized by those with acute mental illnesses). Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.

Psychiatry, like most medical specialties, has a continuing, significant need for research into its diseases, classifications and treatments. Psychiatry adopts biology's fundamental belief that disease and health are different elements of an individual's adaptation to an environment. But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural, and interpersonal elements. In addition to external factors, the human brain must contain and organize an individual's hopes, fears, desires, fantasies and feelings. Psychiatry's difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.