LECTUREOUTLINE•HistoryoftheTreatmentofMentalIllness•Theintroductiontopsychotherapy•Theintroductiontobiologicaltherapies•ThefutureHistory:ExplanationofDeviantMembers•Supernaturalforces•Demonology–Invasionofspirits,Gods,ordemons–Priestswereappropriatetreatment•MedicalModel–Defineanddiscoversolutions–Helpedtoremovestigma–Notesymptoms,revealdiseaseprocess,treatmentandprevention•PsychologicalModel:FreudHISTORY:AncientTimesInancientcivilizationstherewasabeliefthatspiritsinfluencedhumanconductandnaturalphenomena.Illnesswastreatedasadisturbanceinthebodycausedbyanevilspirit.•Stoneageskullshavebeenfoundwithsmallholesinthem(trephination)toreleaseevilspirits.•Shamanperformsthetreatment.•AncientEgyptandMesopotamia–Anatomicalstudiesasabyproductofpreparationofthedead–Exorcismsandprayer•AncientGreeks(500BC-500)–Asklepios:chieftainturnedgod–Mentalillnessresultedfrommischiefofthegods–Patientssleptatthetempleovernight–TreatmentbasedonvisionsseeninsleepGreece:Asklepios(Aesculapius)MiddleAges(A.D.600-1350):MysticismanddemonologyALossofReason•DiseasewasconsideredapunishmentfromGod•Evilisdrivenoutofthebodythroughtorture•Thepriestwastheprimaryhealer“Amanorawomanwhohasaghostorafamiliarspiritshallbeputtodeath;theyshallbepeltedwithstones;theirbloodguiltshallbeuponthem.”-Leviticus20:27PersecutionofWitches•ThebookofMalleusMaleficarium•PopeInnocentVII•DunkingtestDunkingtestInquisitorialDueProcess:Questioningofaccusedandwitnesses“…commonjusticedemandsthatawitchshouldnotbecondemnedtodeathunlesssheisconvictedbyherownconfession.”Whilenotallaccusedofwitchcraftwerementallyill,almostallmentallyillpeoplewereconsideredwitches,sorcerers,orbewitched.Asylum(A.D.1400-1700)•Priortothemid/late-18thcentury,wherewasthementallyillperson?•Beggarswanderingtheroads•“Villageidiot”•Burdenonfamily•OftenkeptinhorribleconditionsEurope:EstablishmentofAsylums•Placestowarehousetroublesomepeople,usedharshtacticstocontrolunrulyorexcitedpatients•“Bedlam”:MonasteryofSt.MaryofBethleheminLondoncommissionedbyKingHenryVIII(1547)•Asylumsviewedbypublicaseerie,strange,andfrighteningPrioryofSt.MaryofBethlehem(1247)•BicetreHospital•ThegeneralhospitalcommissionedbyLouisXIV(1656)AsylumsinFranceReformationofAsylums:France(As1800approached)•PhilippePinel(1745-1826)–encouragedhumanetreatmentforthementallyillinParis.Conditionschangedconsiderably!Theuseofcompassion,understanding,andencouragingindividualdignityreplacedconfinementandisolation.PinelbreakingthechainsattheBicetreBenjaminRush(1745-1813)•Alternativestorestraints–tranquilizingchair,gyratingchair•Devoteeofpurging,bloodletting•Listenedtohispatients;humanetreatmentWilliambsburg,PublicHospital(1773-1885)(Virginia,USA):TherapeuticAsylumCommonElements•Purgatives,emetics,enemas•Bloodletting•Medications•+/-Restraints•Baths,hydrotherapy•Sortingbyprognosis,diagnosisTherapeuticAsylumCommonElements•Activities,work,exercise•Music,arts•Cleanliness,freshair,openspaces•Kindness•Doctor-patientrelationshipastherapeuticagentThebeginningofmentalhealth(19thCentury)•DortheaDix(1802-1887)–Conceptof“Mentallyill”–Asylumswereturnedintohospitals.•CliffordBeers(1842-1910)-1908publishedbookaboutexperienceinasylum:“Amindthatfounditself”TheFirstBiologicalPsychiatry(thelately19thCentury)•Germany:Worldleadersinpsychiatryin19thcentury•Early19thcenturyGermanydominatedbyRomantics•Byendofcentury,biologicalpsychiatristshelddominion(soundfamiliar?)Attemptedtoanswer“whatismentalillness?”bystudyingtheanatomyofthebrainEarlypsychiatrists•EmilKraepelin(1856-1926)–Fatherofmodernpsychiatry–EmphasisonclassificationAloisAlzheimer(1864-1915)-GermanneurpathologistandpsychiatristTheSecondBiologicalPsychiatry(20thCentury)•FeverTherapies•InsulinComa•ConvulsiveTherapy•Psychosurgery•EarlyPharmacotherapies•“Modern”PharmacotherapyTherapeuticUseofFever•JuliusWagnervonJauregg(1857-1940)•Observedremissionofinsanityaftererysipelasinfection•AwardedNobelPrizeinMedicineandPhysiologyin1927InsulinComa•1921:BantingandBestdiscoveredinsulin•1927:ManfredSakelinjectedinsulinintoaddicts•TreatedschizophrenicpatientsConvulsiveTherapy•ElectroconvulsiveTherapy(ECT):UgoCerletti,1937•Mistakenlythoughttherewas“biologicalantagonism”betweenschizophreniaandepilepsy•WantedlessdangerousalternativetometrazolModifiedElectricConvulsiveTherapy,MECTPsychosurgery•SurgicalApproachtoinsanityasoldasmedicalpsychology•Archaeologicalevidence40,000yearsoldTrephinationinChina5000yearsoldTrephinationinIndianPsychosurgery•Trepanningdoneto“liberate”demonsorbadspiritsPsychosurgery•Medieval“quack”doctorsextractedthe“stoneofmadness,”purportedtocausementalillnessPsychosurgery•EgasMoniz•Cerebralangiography•Learnedofeffectsoffrontalablationonchimpbehavior•1935-6:Moniz&Limadid20frontal“leucotomies”•AwardedNobelPrizeinMedicineandPhysiologyin1949Psychosurgery•WalterFreemanpopularized“lobotomy”(1936)•1946:Developedtransorbitallobotomy•TraveledalloverU.S.Whitematterinfrontallobesdisrupted•Usedicepick-likeinstrumentandhammer•Localanesthetic•Effectivelyreducedtension,agitation,violence•Adverseeffects:apathy;impaireddrive,initiative,emot
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