Author of Lecture: Joe Garside

Title of Lecture:

History of Psychiatry

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History of psychiatry
Joe Garside
Clinical Lecturer

Overview
Ideas about mental illness
Ideas about sufferers of mental illness
Ideas about treatment of mental illness

Early history
Trephined skulls 5000 BCE
Madness as punishment in Deuteronomy
Hindu demon, Grahi convulsions
Babylonians and Mesopotamians
Spirit invasion
Sorcery
Demonic malice
Evil eye

Greek Tradition - Mythology

Homer
Characters are puppets
External forces gods and demons
Inner life is not important

Greek Tradition - Philosophy

Emergence of introspection
Socrates, Plato, Aristotle
Life is rational
Reflection on madness not from external forces

Greek Philosophy - Theatre

Characters contributing to outcomes
Not just fate and gods
Theatre becoming therapy
Playing out madness, forcing the unthinkable into the
open, restoring reason
Collective catharsis
Internal conflict as a dimension of madness

Greek Tradition - Medicine

Hippocrates (5th century BCE)
All illness is natural
Illness has a rational explanation
The sacred disease epilepsy had a rational
explanation
All madness was within medicines bounds

Four humours
Yellow Bile choler overheats, raving, mania
Black Bile melancholic dejection, depression
Blood sanguine
Phlegm phlegmatic
Providing a somatic theory for madness

Greek Tradition - Late

Aretaeus (2nd century CE)
Description of melancholia and furor
Possible description of mania and depression

Christianity
Man is not rational
Man is a sinner
Mental illness is a manifestation of sin or punishment
Man is the battle ground of god and the devil

European Witch Hunt

1450 1750
Uncertain numbers: 100000 200000
Mostly women
Midwifes
Cooks
Healers
Practiced magic in society
Mostly unmarried

Historical context of hunts

Urbanisation and reformation
Poverty
Inflation

Status of women
Morally and intellectually inferior
No physical or economic power
Must be using sorcery
Easily accused

Mental illness of witches

Nicole Obry
Dull, married, 16 year old lady possessed after being
bitten by a dog
Organised pilgrimage to help dead grandfather
Publically exorcised for months
Blasphemes, masturbates, denounces clergy
Names other witches
Successful exorcism

Decline of witch hunts

Clearly out of control
The Enlightenment
Scientific revolution
Literacy
Rise of professions and bureaucracy
Capitalist centralised economies

Madness of George III

1788
Bizarre behaviour of monarch
Political and constitutional crisis
Reverend Dr Francis Willis
Psychological bullying
Morale boosting
Fixing with the eye
Routine medication such as blistering

Cure of George III

Mental illness could be cured
Moral management
The experienced therapist outwitting the deluded psyche
of his patient

Acute intermittent porphyria

A world without psychiatry

Village idiot
Fool and his staff
Ship of fools
Chained to walls
Kept in holes
Hidden - avoided asylums to avoid shaming the family

Madhouses
Priory of St Mary of Bethlehem (13th century)
Bedlam
Restraints
Treatments
Viewing
Medical involvement

The Great Confinement

Foucault
The taint of unreason hospital detention
Mad
Poor
Petty criminals
Layabouts
Street walkers
beggars

Asylum
18th century
Setting with orderly routines and communal spirit
England Battie and the Tukes
France Pinel and Esquirol
Italy - Chiarugy

Doctor patient relationship moral therapy

As distinct from the traditional madhouse

Themes in British Psychiatry

Moral therapy replaced chains
Physical constraint replaced by moral control
Little role of doctors
Approach resulted in cure, optimism
Concept of partial insanity, could be cured

Action of British Medical

Profession
Medical profession frustrated about lay success

Asserted right as primary diagnosticians

By 1840s had specialised journals
Tried to convince others that public
asylums under medical control was best
1850 Asylum Act
1850s Asylums in full swing. Moral therapy since as humane
and therapeutically sound

The Rise of Criminal Insanity

Legal view; voluntary acts
Medical; deterministic
Rivalry between medicine and law
Early trials

Earl Ferrers 1760

James Hadfield 1800
1800 Criminal Lunatic Act
1830s-40s psychiatry organising as a profession

Rise of criminal insanity

McNaughtons Rules (1843)
Daniel McNaughton and Robert Peel
The trial
The aftermath
McNaughtons rules

Degeneration Theory (1857)

Morel (1809-1873)
Darwin and the Asylum experience

 the degenerate human being, if he is abandoned to

himself, falls into progressive degradation. He
becomes..not only incapable of forming part of the
chain of transmission of progress in human society, he is
the greatest obstacle to this progress through his
contact with the healthy portion of the population..the
span of his existence is limited as that of all
monstrosities (Morel)

Freud (1856-1939)
If told all, using free association, unconscious repressions
which were the basis of neurosis would find release
Personal background
Influences

Charcot/Breuer
Darwin
What he did differently
Sceptics

28

29

Emil Kraepelin

(1856-1926)

Influences

Morel, Kahlbaum, Hecker, Falret

Emphasis on course and prognosis, not on biological
psychiatry
Form v. content
Achievements

Dementia praecox (SCZ) v Manic

depressive psychosis
basis of modern Western psychiatry

Therapeutic Nihilsm

Heroic Psychiatry
Wagner-Jauregg
1883 erysipelas remission from psychosis
1887 suggested malaria for psychosis
Experimented with tuberculin for GPI
1917 inoculated actress with blood from malaria
sufferer
1927 Nobel Prize

Heroic Psychiatry
1920s Sakel Germany
Insulin to relieve opiate withdrawal
Insulin thought to help depression in diabetes
Helped improve appetite
Coma initially inadvertent
Seizure inadvertent
Tranquility
1930s Schizophrenia

Heroic Psychiatry
1935 Moniz Lisbon
Resection prefrontal lobes 20 patients
London conference well received
Freeman and Watts USA
Freeman took it on the road
Office procedure
Ice pick

Heroic Psychiatry
1934 Meduna Budapest
1929 schizophrenia makes epilepsy better
biological antagonism
Camphor
Cardiazol

Electro-convulsive therapy
1938 Ugo Cerletti Rome
Not a cure for schizophrenia
Relief of symptoms
Role in depression

Modern Psychiatry
Standardisation
DSM & ICD
New treatments
Pharmaceutical
Talking therapies

Modern psychopharmacology
Late 1950s
Chlopromazine
Imipramine
Lithium (1940s)
Explosion of psycho-pharmaceuticals

Care in the community

Decarceration since the 1960s
Medication
Patient rights
Crumbling asylums and their expense
Some success

Further reading
Berrios G, Porter R (1995) A history of clinical
psychiatry: the origin and history of clinical diagnoses
Berrios G (1996) A history of mental symptoms:
descriptive psychopathology since the 19th century
Shorter E (1997) A history of psychiatry: from the age of
the asylum to the age of Prozac