Lessons from the History of Psychiatry
Presenting Author(s): Dr. Roger Bland
Date and time: 24 Mar 2018 from 15:10 to 16:00
Location: Wildrose Salon C
Learning Objectives:
- Understanding of the background to current treatments.
- Appreciate the 'accidental' nature of much of psychopharmacology.
- Recognize the problems of stigmatization.
Literature references:
Cooper, J. E.; Kendell, R. E.; Gurland, B. J.;Sharpe, L.; Copeland, J. R. M.; and Simon, R. J.Psychiatric Diagnosis in New York and London: A Comparative Study of Mental Hospital Admissions.(Maudsley Monograph No. 20) London: Oxford University Press, 1972
Angst J, Perris C. Nosology of endogenous depression, a comparison of the findings of two studies. Arch. Psychiat. Nervenkr. 210:373, 1968
Goffman E. Asylums: essays on the social situation of mental patients and other inmates. Doubleday, New York 1961
Mental Illness in the Community: the Pathway to Psychiatric Care. Goldberg D., Huxley P. (1980) London:Tavistock.
Strömgren E. Contributions to Psychiatric Epidemiology and Genetics. Acta Jutlandica XL: 4, 1968.
Schneider, K. Clinical Psychopathology. New York: Grune and Stratton. 1959.
Abstract
In this workshop I will briefly review the history of Western psychiatry, starting with the "ancients" and their use of lithium, convulsive therapy, psychotherapy (CBT), humane institutions and surprisingly current classifications. The "dark ages" followed, characterized by witchcraft, demonology, persecution and inhumane institutions. Reformers e.g. Pinel, developed humane institutions, scientific care and reduced stigma. The classifiers and psychopathologists were astute clinical observers providing the basis for most of our current diagnostic practices.
The mid-1800s to early 1900s were characterized by a search for organic causes but met with only one major success; the treatment of cerebral syphilis (cases of which occupied 50% of mental hospital beds in 1900).
The early psychotherapists produced a confusing number of 'schools' with little evidence, now good support for e.g. CBT, IPT, DBT.
Epidemiological studies demonstrated that psychiatric disorders were much more common than previously thought, that the majority were untreated, and the economic cost was considerable.
Psychopharmacology, while having changed the practice of psychiatry largely resulted from accidental discoveries e.g. the MAOIs, phenothiazines, TCA's and benzodiazepines.
Genetic studies have shown no simple inheritance and that the nature/nurture debate is largely irrelevant. New questions are being posed e.g. the possibility of individually tailored treatment.
'New reformers' since the 1950s led to the closure of impossibly large institutions, the development of community care options (lagging) with an increase in prison populations.
Some discarded treatments and practices will also be briefly reviewed.