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26.01.2012 Abnormality Behavior, thinking processes and feelings deemed Brief History of Psychopathology undesireable and therefore subject to control or change. Mag. Dr. Barbara Griesser History of Psychopathology 1 Criteria of Psychopathology History of Psychopathology 2 Theories of psychopathology Criterias based on personal standards Theories of psychopathology and the ways to treat it were made in earlier periods of history by Physicians Philosophers Theologians Lawyers Discomfort - Psychological pain (sadness, anxiety, ,..) Disability or Impairment Criterias based on social standards Deviance Unpredictable, bizarre or dangerous behaviour Sources: extant writings, medical treatises, church and legal documents, historical narratives, diaries, literature History of Psychopathology 3 4 Historical Concepts of „Madness“ Connecting Treatment to Etiology Attitudes about a disorder influence treatment Supernatural tradition Abnormal behaviour caused by demons, spirits, influence Different treatment of mental disorder due to: History of Psychopathology of moon, planets and stars Weakness of character Sinfulness Heredity Physical environment Social environment Psychological paradigma Focuses on humanistic, cognitive and behavioural causes and effects of psychopathology Biological paradigma Includes physical factors (genetics, neurochemistry) History of Psychopathology 5 History of Psychopathology 6 1 26.01.2012 Supernatural concept Supernatural Concept Possession of a person by evil spirits responsibel for Paracelsus (1493-1541) strange behaviour Behavior influenced by movements of the moon and star Book of Leviticus 20:27 (third book of the Hebrew Bible) 700 B.C: „A man or a woman that hath a familiar spirit ... Shall surely be put to death: they shall stone him with stones.“ History of Psychopathology 7 History of Psychopathology 8 Hippocrates’ Early Medical Concepts Biological Tradition Psychological disorders are attributed to biological Hippocrates (460-367 B.C.) “father of medicine” causes Brain is the primary center of thought emotion and intelligence Mental disorders are located in the brain History of Psychopathology 9 History of Psychopathology Hippocrates’ Early Medical Concepts 10 Hippocrates’ Early Medical Concepts Classification: Three categories Four basic temperaments Phrenitis – fever and delirium Mania – extreme excitement Melancholia – excess of black bile (melancholer) Established tradition of case history Choleric – yellow bile Melancholic – black bile Sanguine - blood Phlegmatic - phlegm Importance of relationship: diagnosis and treatment Treatment: “do no harm” Diet, massage, music, remedies promoting sleep and rest, bloodletting, even marriage History of Psychopathology 11 History of Psychopathology 12 2 26.01.2012 Early Philosophical Conceptions Plato (429-347 B.C.) Claudius Galenus (Galen) (A.D. 131-201) – Greek physican at the court of the Roman Emperor Marcus Aurelius Aristoteles (384-322 B.C.) Theophrastrus (371-286 B.C) Elaborated the „theory of humors“ Aretaeus (30-90 A.D.) Greatest eclecticist physician Treatment in the Hippocratic-Galenic tradition till 12th century History of Psychopathology 13 Middle Ages: Middle East Treatment and Classification 14 History of Psychopathology Middle Ages: Middle East Treatment and Classification First mental hospital established in Baghdad in A.D. 792 Avicenna (Arabia: A.D. 980-1037) “Galen of Islam” Najab ud-din Unhammad (870-925, Arabian Canon of Medicine psychologist) Nosology of nine categories of mental disorders which Medical textbook in European universities from 10th through 15th century included 30 different mental illnesses (obsessivecompulsive disorders, delusional disorders, degenerative diseases, involutional melancholia, states of abnormal excitementA) History of Psychopathology 15 16 History of Psychopathology Middle Ages: Europe (A.D. 500-1300) Renaissance Etiology of Mental Illnesses: Paracelsus (1493-1541) Folk myth, theology, occult beliefs Theophrastus Bombastus von Hohenheim Astrologer and alchemist Behavior influenced by movements of the moon and stars Pope Gregory IX established the Inquisition in 1233 Heinrich Kramer and Johann Sprenger: „On the diseases which deprive men from health and Malleus Maleficarium - „The Hammer Against Witches“ reason“ (1487-1489) Taxonomy of perceived deviant behavior and proposed Lunatici (moon) guidelines for prosecuting Insani (familiy heritage) Vesani (food or drink) History of Psychopathology 17 Melancholici (temperament) History of Psychopathology 18 3 26.01.2012 Reformation: Europe (16th Century) Treatment - Establishment of Asylums Places to warehouse troublesome people, used harsh Thomas Sydenham (1624-1663) tactics to control unruly or excited patients the „English Hippocrates“ Developed organized and comprehensive hierarchical classification systems “Bedlam”: Monastery of St. Mary of Bethlehem in London commissioned by King Henry VIII (1547) One of the first mental institutions Wealthy people paid to peer at the insane for entertainment Origin of the term “Bedlam” 19 History of Psychopathology 20 History of Psychopathology 18th century 18th century Francois Boissier de Sauvages (1706-1767) William Cullen (1710-1790) Leading taxonomist Influenced by Thomas Sydenham and the biological Most influental nosologist Pioneer of neuropathology taxonomy of Carl Linnaeus Classification of mental disorders 10 classes 295 genera 24000 species 21 History of Psychopathology 18th century History of Psychopathology 22 Humanitarian Reform – Key People Philippe Pinel (1745-1826): influenced by Cullen Philippe Pinel (Paris: 1745-1826) Founder of modern psychiatry Wrote 1. Textbook on psychiatry: Physician-in-chief of the Bicêtre Hospital (asylum) in Paris in 1792 Restored the „Moral treatment“ „Traité Médico-Philosophique sur la Manie“ (1806) removed chains from the patients Film: Stairways to light (1945) History of Psychopathology 23 History of Psychopathology 24 4 26.01.2012 Humanitarian Reform – Key People William Tuke (England: 1732-1822) Jean Esquirol (1772-1840) (Pinel´s successor) Establishment of “York Retreat” – Calming environment Patients engaged in purposeful but calming activity Talked with attendants 5 broad classification syndromes of mental disorder Lypemanie Monomanie Manie Dementia Imbecility/idiocy 25 History of Psychopathology Humanitarian Reform – Key People 26 History of Psychopathology Humanitarian Reform – Key People Benjamin Rush (1745-1813) Dorothea Dix (America: 1802-1887) Co-founder of the American Psychiatric Association “Moral Treatment” in Philadelphia hospital Influenced by “moral model” and medical sciences Fought for establishment of state mental hospitals for the mentally ill 32 states established at least one mental hospital 27 History of Psychopathology 28 History of Psychopathology 19th century 19th Century Johann Christian Reil (1808) Jules Baillarger (1809-1892) „Folie à double form“ coined term „Psychiatry“ Jean-Pierre Falret (1794-1870) „la folie circulaire“ alternating mania and depression Karl Ludwig Kahlbaum (1828-1899) & Ewald Hecker Dysthymia, cyclothymia, catatonia, paranoia, hebephrenia Wilhelm Griesinger (1817-1868) advanced unitary scheme based on concept of brain pathology History of Psychopathology 29 History of Psychopathology 30 5 26.01.2012 20th Century Emil Kraepelin Proposed 15 categories Emil Kraepelin (1856-1926): Pioneered classification of mental illness based on biological causes Psychogenic neurosis, psychopathic personality, syndromes of defective mental developement, homosexuality.. Published 1st psychiatry text „Compendium der Psychiatrie“ (1883) Proposed two major syndromes Dementia praecox (later renamed schizophrenia) Mental illness as syndrome Catatonia, hebephrenia, dementia paranoides Cluster of symptoms that co-occur Manic-depressive psychosis paranoia 31 History of Psychopathology Eugen Bleuler History of Psychopathology 32 Biological Approaches Eugen Bleuler (1857-1939); Generalparesis Introduction of the term schizophrenia Degenerative disorder with psychological symptoms Caused by the tertiary stage of syphilis (Krafft-Ebbing) History of Psychopathology 33 Biological Approaches 34 Biological Approaches Since general paresis had biological cause, other Phenothiazine mental illness might also. Originally used as tranquilizer for surgery patients Early Biological treatments: Chlorpromazine Insulin shock therapy (Sakel, 1935) Electroconvulsive (electric shock) Therapy (ECT) (Cerletti and Bini, 1938) Prefrontal lobotomy (Moniz, 1937) approval as antipsychotic drug in US in 1955 1955: 559,000 patients in state mental hospitals 1972: 276,000 patients in state mental hospitals Imprecise slashing of the frontal lobe of the brain History of Psychopathology History of Psychopathology 35 History of Psychopathology 36 6 26.01.2012 Genetics Psychological Approaches Rise of the idea that mental illness can be inherited Franz Anton Mesmer (1734-1815) (early 20th century) Treated hysterical patients with “animal magnetism” Behavioralgenetics Early practitioner of hypnosis Extent to which behavioral differences are due to Josef Breuer (1842-1925) genetics Used hypnosis to facilitate catharsis Catharsis - Release of emotional tension triggered by Eugenics Promotion of enforced sterilization to eliminate reliving and talking about event undesirable characteristics from the population Many state laws required mentally ill to be sterilized History of Psychopathology 37 History of Psychopathology 38 The Rise of Anti-Psychiatry Psychoanalytic Theory Sigmund Freud (1856-1939) 1946 – 1963: Changing views of mental health services Most influental psychologist and physican of the 20th Mary Jane Ward published The Snake Pit (1946) DSM-I published (1952) Erving Goffman published Asylums (1961) century Hospitals similar to “total institution” Breuer and Freud (1895/1896) “Studies on Hysteria” including the case of Anna O. History of Psychopathology Thomas Szasz (1961)The Myth of mental Illness Patients suffer from problems of living in a stressful world 39 40 CLASSIFICATION SYSTEMS Deinstitutionalization Forces that initiated/shaped the movement History of Psychopathology International List of Causes of Death (ICD) Developed by World Health Organization (WHO) Now in its 11th edition (ICD-11) Miracle drugs Reconceptualization of Mental Illness Recognition of Institutional Hazards Economic Incentives Diagnostic & Statistical Manual (DSM) Developed by American Psychiatric Association (APA) Now in edition DSM-V Chinese Classification of Mental Disorders Psychodynamic Diagnostic Manual History of Psychopathology 41 History of Psychopathology 42 7 26.01.2012 ICD DSM www.who.en The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability: Chapter V: Mental and behavioural disorders (F00-F99) History of Psychopathology 43 History of Psychopathology 44 The Dimensions of Classification in DSM AXIS I Clinical Disorders (e.g. anxiety disorders, mood disorders, schizophrenia) Magill, Frank (Ed.) (1996). International Encyclopedia of Psychology Volume I and II. Fitzroy Dearborn Publishers: London, Chicago. Mahrer, Winifred B. & Mahrer, Brendan A. (2003) Abnormal Psychology. In: Weiner, Irving B. & Freedheim, Donald K. (ed.): Handbook of Psychology. History of Psychology, 1, 15, 303-336. Hoboken, New Jersey: John Wiley & Sons. Millon, Theodore & Simonsen, Erik (2010) A Précis of Psychopathological History. In: Millon, Theodore, Krueger, Robert F., Simonsen Erik (ed.): Contemporary Directions in Psychopathology. Scientific Foundations of the DSM-V and ICD-11, 1, 3-52, New York, London: The Guilford Press. AXIS II Personality Disorders, Mental Retardation AXIS III General Medical Conditions (e.g. infectious diseases, etc.) AXIS IV Psychosocial & Environmental Problems (e.g. educational problems, economic problems) AXIS V Global Assessment of Functioning History of Psychopathology 45 History of Psychopathology 46 8