History of psychiatry
History is a meaningful record of human achievement. It is not merely a list of chronological events, but a truthful integrated account of the relationships between persons, events, time and places.
Psychiatry is the medical specialty concerned with the study of diagnosis, treatment, and prevention of mental illness, abnormalities and mental disorders.
Development of psychiatry in the world
The occurrence of mental illnesses has been identified and documented since ancient times. The earliest predecessor of mental hospitals on record was a Greek sanctuary at Epidauros.
The fourth century AD witnessed the establishment of institutions solely for the mentally ill in Byzantium and Jerusalem. Christian and Muslim religious orders established places of refuge for the mentally ill and patients were treated by a variety of procedures with a religious coloring. The first psychiatric hospitals were built in the medieval Islamic world from the 8th century. In the early 8th century, the first hospital was built in Baghdad (705 AD) followed by hospitals built at Fes and Cairo. The first major modern mental hospital, the Bethlehem Hospital, was started/opened in 1247 in London. By the late 18th century, the condition of mentally ill patients in these institutions was one of neglect, restraint and abuse with poor clothing, unhygienic conditions, poor nutrition, restricted movements due to chaining of hands, feet and lack of stimulation, largely contributed to by scarcity of funds, lack of interest among the ruling aristocracy and over-crowding of mental hospitals.
1. Benchmarks/landmarks in the development of psychiatry
The modern era of psychiatric care can be traced from events that occurred in England and France near the end of the 18th century, a time referred to as the Enlightenment. Before this time, the mentally ill were often regarded as no better than wild animals. As the late 1700s approached, a day of enlightenment dawned, the establishment of the asylum. Five periods stand out as benchmarks in the evolution of modern psychiatric care.
a. Benchmark I: Period of enlightenment
The modern era of psychiatric care began with the involvement of two men, Philippe Pinel Franceand William Tuke in England. Pinel unchained the shackled, clothed the naked, fed the hungry, and abolished the whips and other instruments of abuse.
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William Tuke was planning a private facility that would ensure moral treatment for the mentally ill after he witness the deplorable conditions in public facilities.
Asylum – the concept of asylum developed from the humane efforts of Pinel and Tuke. Understanding that mental illness worsened with stress, these individuals sought to provide an environment relatively free from stressors.
Dorothea Dix (1802-1887), one of the first major reformers in US, was instrumental in developing the concept of asylum; she played direct role in opening 32 state hospitals. The first asylum in US was thc Eastern Lunatic Asylum in Williamsburg, Virginia.
b.Benchmark II: Period of scientific study
Sigmund Freud ( 1856-1939) described anatomy of personality and custodial care for psychiatric patients and given little training for the people who taking care of the clients.
Early scientists – Emil Karcpclin ( 1856-1926) made tremendous contributions to the classification of mental disorders.
Eugene Bleuler coined the term schizophrenia and added a note of optimism to its treatment.
Sigmund Freud developed a theory of motivation, established the usefulness of talking (catharsis), explained the importance of dreams, and proposed to unlock the hidden parts of the mind. He introduced the terms that have become part of our language- psychoanalysis, id, ego, superego, and free association.
c.Benchmark III: Period of psychotropic drugs
· 3rd benchmarks began with the discovery of psychotropic drugs.
· Chlorpromazine, an antipsychotic drug, and lithium, an antimanic agent, were introduced first, and imipramine an antidepressant, was introduced a few years later by Thomas Kuhn in 1958.
· In 1952, Zeller invented MAOI (Mono Amino Oxidase Inhibitors).
· Cohen in 1960 invented Chlordiazepoxoide (Librium).
· Hald 1948 invented Disulfiram.
d.Benchmark IV: Period of community mental health
In 1946,US President Truman signed the National Mental Health Act, enabling the establishment of the National Institute of Mental Health a few years later.
Act legislated funds to build general hospitals that included psychiatric units.
In 1961, the Joint Commission on Mental illness and health appointed by US President Kennedy, published a report entitled Action for Mental Health. It urged increased support for the state hospital system in recognition of the need for improved treatment of the mentally ill population.
In 1963, Community Mental Health Centres (CMHC) act was enacted, which virtually destroyed the state hospital system. Community treatment centres and community living arrangements (e.g., halfway homes) were established.
Eventually, community mental health programs were developed to meet the needs of all those living within the boundaries of a designated area. These programs had the following goals:
· Emergency care
· 24- hour emergency care
· Partial hospitalization care
· Outpatient care
· Consultation and education for the population served by the centre
· Screening services.
Deinstitutionalization– refers to the depopulating of state mental hospitals.
e.Benchmark V: Decade of the brain
The 1990s were declared the Decade of the brain by Congress. During this decade, a steep increase in brain research occurred that coincided with an increased interest in biologic explanations for mental disorders.