psychology 4039 PSYC 4039
Popular in MADNESS AND MEDICINE
Popular in Psychology (PSYC)
This 11 page Class Notes was uploaded by Lindsey Notetaker on Thursday September 8, 2016. The Class Notes belongs to PSYC 4039 at Louisiana State University taught by A. Baumeister in Fall 2016. Since its upload, it has received 7 views. For similar materials see MADNESS AND MEDICINE in Psychology (PSYC) at Louisiana State University.
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Date Created: 09/08/16
Finishes up the “mental illness before psychiatry” powerpoint and starts the “asylum era” powerpoint Soranus (A.D. 93-138) o Methodist Solidism The believe that mental illness comes from the solid parts of your body, not the liquids. This is the difference between soranus and Hippocrates Atomism The body is made up of atoms, there must be pores between the atoms. conditions of these pores, whether they were constricted or relaxed, determined health and disease o Wrote “On Acute and Chronic Diseases” Contained chapters devoted to Mania and Melancholia Characteristics of mania (generic term of psychosis back then, not the mania we know today) o Impairment of reason o Sudden emotional change o Delusions Characteristics of melancholia o “downcast”, rarely cheerful o Mental anguish o Longing for death st Aretaeus (1 century AD) o Eclectic (didn’t belong to a particular school) o Wrote “Causes and symptoms of chronic disease” Separate chapters on mania and melancholia Thought melancholia was the “commencement and part of mania” o Often credited as first person to recognize bipolar disorder Galen (A.D. 129-216) o Founder of experimental physiology Distinguished between venous and arterial blood Traced 7 cranial nerves Distinguished between sensory and motor nerves Said that nerves relay impulses to and from brain and spinal cord o Promoted Hippocratic doctrine o In over 200 publications, Galen codified and disseminated medical theory to Medieval world and beyond o Dominated western medicine for about 1500 years “Psychiatry” in the middle ages (400-1400 AD) o Traditional view Main intellectual current in western world was Christianity. Psychiatry was taken over by priests. Naturalism and empiricism in medicine die Supernaturalism and demonology restored Persecution of the mentally ill Mentally ill targeted by the inquisition Mentally ill persecuted as witches Religious authorities of the middle ages are often vilified by modern scholars for their treatment of the mentally ill o Medicine in the middle ages Muslims in middle east preserve much Greek and Roman literature; invent the experimental method of science First universities appear in Europe in late middle ages; dominated by “scholasticism” First hospitals appear in far east ca 400BC In the west, early hospitals constructed by Christians, Jews, and Muslims When Christianity became official religion of roman empire there was a rapid proliferation of hospitals Most early western hospitals were associated with the church The recognized medical authority of the day was Galen Formal practice and teaching of medicine was Hippocratic and based on works of Galen Although there was certainly a spiritual aspect to formal medicine, it was also empirical and to a degree naturalistic o Middle age church doctors Many formally trained physicians in the middle ages were priests Religious institutions were often sources of compassion and care for the mentally ill Torture of mentally ill for witchcraft was probably rare (ex: inquisition aimed at heretics not mentally ill) Ironically, obsession with demonology and persecution of the mentally ill for witchcraft occurred during the Renaissance and after Renaissance (14 -17 centuries) o Comes from French word meaning “re-birth” o Cultural shift in art, literature, politics, education, and science o The scientific revolution began in 1543 (the year of modern science was born) with the publication of: “On the workings of the human body” by Andreas Versalius, founder of modern anatomy, corrected Galen’s errors “On the revolutions of the heavenly spheres by Nicolaus Copernicus, argued for the heliocentric model o Other important figures in Renaissance science: Johannes Gutenberg (1394-1468), Galileio Galilei (1564-1642), Johannes Kepler (1571-1630), Antoni von Leeuwenhoek, Francis Bacon (1561-1626), William Harvey (1578-1657) o Despite these developments Renaissance still dominated by church and scholasticism o Renaissance was a bridge between middle ages and the enlightenment o Malleus Maleficarum (slide 23) Published in 1487. Written by 2 German theologians Johann Sprenger and Heinrich Kraemer. Misogynistic. 3 parts Evidence for existence of witches Identification of witches Trial and punishment Said to have been responsible for deaths of thousands of women and children The Enlightenment o 18 intellectual movement away from authority (particular religious) toward science and reason. o Extended into social realm and medicine o One consequence of enlightenment: the birth of “therapeutic optimism” toward mental illness o Began therapeutic “nihilism” o growing belief that mental illness is curable o key: hospitalization was seen as essential to recovery mental illness o the idea of therapeutic mental hospital gave birth to the specialty of psychiatry and leads to the “modern” period of psychiatry. THE BIRTH OF MODERN PSYCHIATRY Even though physicians had written about mental illness since the time of Hippocrates, psychiatry as a profession did not originate until the 19th century. Not exceptional- except surgery, there were no other specialties either. Development of psychiatry is directly related to evolution of mental hospitals o First “medical” wards and “institutions” for mentally ill first appear in 15th century o Mission was custodial, not therapeutic Protected society from individual Protect and care for individual? o Resembled jails more than hospitals o Some were even “tourist” attractions St. Mary’s of Bethlehem (Bedlam) Lunatic’s Tower of Vienna o About 1750 the idea emerged that hospitalization could be curative o The rise of modern psychiatry is directly related to a shift in mission of mental hospitals from “custodial” to “therapeutic”, outgrowth of the enlightenment Putative Curative Power of Asylums o Interestingly, perceived beneficial effects of mental hospitals were primarily psychological o Removed individual from stress Ideally, asylums were calmative, clean, and located in pleasant setting Provided good food and shelter o Asylums brought order to daily living o Encouraged self-control, disciple, work, recreation o Promoted doctor/ patient relationship The alienists th o For most of the 19 century these doctors were called “alienists”- one who treats mental alienation o Term “psychiatry” coined in 1808 by Reil o From Greek psyche- “mind” + iatreia “healing, care” o Most of the first alienists (psychiatrists) were superintendents of mental hospitals o Original name of the American Psychiatric Association was “Association of Medical Superintendents of American Institutions for the Insane” o Some early Alienists Battie- England Idea of therapeutic hospital originates in England with William Battie Psychiatry begins with him Considered the leading “mad doctor” of his day First person to advocate asylum as a treatment center First alienist Chiarugi- Italy First to experiment with “moral therapy” (moral=mental). Example: encourage hope among melancholic Advocate humane treatment of mentally ill Wrote a book on the specifics of how to “do” moral therapy Pinel- France Name most often associated with origin of moral therapy Became influential in Europe and America due to his book “Treatise on Insanity” published in 1806 Ordered the unchaining of the patients Bnejamin Rush- America Father of American psychiatry Has mixed reputation as a reformer o Often criticize for inhumane treatment, but emphasized humane treatment. Accounts of patients in cells conflict with his humanitarian writing Studied moral therapy in Europe Advocated moral therapy in his writings Actuality his hospital more like old custodial model Believed mental illness had a biological basis Practiced harsh treatments o Copious bleeding o Spinning chair Worked on a theory that mental illness was caused by too much blood in the brain. His procedure was to put mentally ill patients into chairs. The idea was that the forces of motion would drive the blood away from the core of the body o Tranquilizing chair William Tuke Birtish tea merchant and quaker Built the “York Retreat” to care for mentally ill Quakers Well founded on moral therapeutic principles: benevolence, comfortable living, encouraging self- reflection, occupational therapy, gardening, entertainment, hydrotherapy, diet, concept of “therapeutic community” Use of restraints limited, punishment banned Advocated humane care and moral therapy His grandson developed a world-wide reputation because he wrote a book about how moral therapy was practiced at the retreat All of the early Alienists believe mental illness is biologically based Hospital construction boom o Therapeutic hospital and moral therapy increased demand for hospital beds o Belief that metal illness was increasing Dix advocated the building of public hospitals (most hospitals were private) th The early 20 century was still considered to be part of the asylum era, but less hospitals were being built than in the end of the 19 century o Growing humanitarian concern for treatment of the mentally ill Visited a women’s prison to teach how to read and write disgusted by what she sees when she goes in there. She believes many of the prisoners are mentally ill. This kindles her goals to change the mentally ill treatments Spent a lot of her time talking to law makers, making arguments for humanitarian care o The situation ca. 1900 Construction never kept pace with demand The result was severe overcrowding in most public hospitals by the end of the 19 century Overcrowding precluded the type of “moral” therapy envisioned by the originators of the therapeutic hospital Some people say that these moral therapy practices failed- if they did it was because of the overcrowding and it was impossible to keep up with all of them Both the public and professionals generally believed that hospitalization was NOT therapeutic Many hospitals dropped pretense of therapy and reverted to a custodial mission o Reputation of psychiatry suffers Treatment ineffective (number of mentally ill actually increasing) Psychiatrists were viewed by the rest of medicine as intellectually inferior Became the “step-child” of medicine “Whatever the gullible public might believe about therapy, we [neurologists] hold the reverse opinion, and think your hospitals are never to be used save as the last resort.” Weir Mitchell, 1894 th o Early 20 century effort to deal with the hospital problem: prevention and reform Mental hygiene movement Clifford Beers wrote “A Mind that Found Itself” 1908 Yale graduate Became insane in early adulthood- put in private and state hospitals Wrote book of experience Became famous among mental health professionals Died in asylum in 1943 Founded national committee for mental hygiene Mental hygiene was not a new idea It means prevention of mental illness The dark side of mental hygiene: Eugenics The science of preventing the unfit from breeding prevent people with mental illness from having children The problem continued to get worse Hospital populations continued to grow Contributed to perception that mental illness had become an epidemic State financial resources for care of mentally ill became increasingly strained o Overcrowding increased One Ohio institution, a ward meant to hold 25 beds, contained over 100 cots, side by side. To get to one of the ward’s 3 toilets, patients had to climb over each other o Patient/ doctor ratio increased (ex: average 250/1) o High staff turnover Work was often unpleasant and pay was low. High turnover. In 1948 in a Pennsylvania hospital of 600 staff appointed, 350 resigned and 200 fired o Dilapidated physical plant Need new sinks, toilets, sewers, roofs, kitchens etc. o Unhealthy The solution: deinstitutionalization First propose by Grimes in 1934 o Concluded mental hospitals were inhumane and should be closed down Mechanisms of deinstitutionalization o Parole o Foster care o Outpatient clinics- Grimes was one of the earliest advocates for this His report went nowhere. The American psychiatric association made it impossible for Grimes to publish his book. The book exists today because he took his life savings and printed it. Reform, 1940s o WWII reveals the magnitude of the problem of mental illness (approx. 12% of draftees rejected for mental health issues) o WWII conscientious objectors become activists for reform National mental health foundation (1950; merges with other organization to become the NAMH; in 1979 becomes NMHA; in 2006 becomes MHA) These men tried to help the people in these “prisons” they didn’t use violence, they used force. One man brought a camera with him, he took pictures every chance he got and eventually leaked them to the press so everyone could see what we were doing to innocent people we were supposed to be helping. o Nazi extermination of the mentally ill Nazi’s started the Holocaust by killing mentally ill people, people with learning disabilities, etc. Not much different from how we were treating the mentally ill in the asylums/hospitals… o Life Magazine publishes “Bedlam 1946” o Passage of national mental health act (1946), established the national institute of mental health o Albert Deutsch The Shame of the States
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