Historical Perspective

Question 0

Hippocrates (460-377 bc)

Answer 0

• natural causes: brain pathology, heredity/predisposition, head injuries
• imbalance between body fluids/forces
  - shaped personality
• recommended humane treatments

Question 1

Prehistoric times

Answer 1

• mental illness are caused by good or bad spirits
• trepanation: hole in skull to release demons, person usually died
• good spirit: awe and respect
• bad spirit: magic, potions, fear

Question 2

Hippocrates: bodily fluids

Answer 2

• they shaped and classified personality
• 4 humors
  1. Melancholic: black bile, earth, cold and dry, sorrowful
  2. Choleric: yellow bile, fire, hot and dry, egocentric
  3. Sanguine: blood, air, hot and wet, lively
  4. Phlegmatic: phlegm, water, cold and wet, private

Question 3

Hippocrates: treatments

Answer 3

• humane
• regular peaceful life
• sobriety and refraining from excess and extremes
• vegetarianism and celibacy
• exercise
• bleeding

Question 4

Plato (429-347 BC)

Answer 4

• not responsible for acts, shouldn’t be punished

- care in community and specialty hospitals

Question 5

Aristotle (384-322 BC)

Answer 5

-changed in ways of thinking could be curative

Question 6

Later greek and roman thought

Answer 6

• pleasant surroundings
• constant activities –> stimulation, not constant rest
• pleasant physical therapies

Question 7

Early chinese thought

Answer 7

• natural, not supernatural causes
• restore balance: yin and yang
• stress can contribute
• drugs and regaining emotional balance

Question 8

Middle ages

Answer 8

• russia, arabia, muslim empire
  - deserve humane treatment
  - first psychiatric hospital in baghdad
• europe
  - superstition, supernatural phenomenon
  - lots of plagues –> at the mercy of uncontrollable events
  - mass madness –> group behaviors, ex large group dancing and not stopping

Question 9

16th to 18th centuries

Answer 9

• disease rather than demonic possession
• asylums were established –> effort to provide sanctuary
  
  • became more like warehouses
• Bedlem “madhouse” in London charged admissions for spectators
• less severely ill were beggars
• severe treatments designed to intimidate patients into choosing rationality over insanity

Question 10

End of 18th century, europe

Answer 10

• humanitarian reform
  
  • phillipe pinel in France and william tuke in england
• changes in attitudes, treatments, leaderships, laws
  - patients were fed and clothed better

Question 11

End of 18th century, america

Answer 11

• Moral treatment movement

- mental hygiene movement

Question 12

Moral treatment movement

Answer 12

-End of 18th century, america
benjamin rush –> humane care and morality
-focus on moral strength –> build up someones moral strength so they can recover –> this is flawed bc it blames people too much
-had issues with upper vs lower class and moral spirituality

Question 14

Mental hygiene movement

Answer 14

• end of 18th century, america

- dorthea dix: clean asylums, raise money for new asylums, better heating and warm showers

Question 15

19th Century

Answer 15

• the “great confinement”/ “asylum era”
• expansion in the number and size of psychiatric institutions
• giant asylums: look like mansions, hold a ton of people, very large buildings
• began with moral treatment in mind, but became too large and imprisonable
• heavy drugging, purging
• docs became administrators and didn’t treat
• untrained laypersons administered treatment

Question 16

20th Century

Answer 16

• deinstitutionalization: community mental health
  - increase in them until 1960, then rapid decline
• hospitalization was prevented by
  
  • antipsychotic meds became more widespread: treat so don’t need hospital, or treat to get out quicker
  • counseling and social work seen as legit profession
• but led to revolving door: shorter but more frequent hospital stays, get out of hospital before you are ready

Question 17

21st century

Answer 17

• greater public acceptance of talk therapy but decreasing use as first line treatment
  
  • HMOs, drugs as quick fix
• mental illness as a “brain disease”
  
  • diseases treated with meds, not with talking
• treatment moving to primary care settings, ex depression, anxiety
• New Research

Question 18

New Research, 21st century

Answer 18

• new biological treatments
  
  • DBS: deep brain stimulation
  • TMS
• identification of genetic/biological risk
• mHealth and teleHealth - over the phone help
• RDoc - NIH focused on finding underlying factors instead of causes of specific diseases
• shift in language: “clients” or “consumers” instead of “patient” because patient was seen as pejorative, “client” made it a more equal relationship