History of Psychiatry

History of Psychiatryد.وليد عزيز العميدي
المرحله الخامسه
In the first civilizations in Egypt and the Near East, mental illness was attributed to the magical forces of malevolent deities, and the main therapists were priests who used religious and magical rites to counter those forces.
In the civilizations of ancient Greece and Rome, psychiatry was a province of religious cults for healing illnesses and of schools of philosophy and medicine (often part of philosophy), which viewed mental illness as mainly psychological, mainly somatic, or a mixture of both psyche and soma; thus, the three enduring psychiatric viewpoints were established.
Hippocrates: (460–370 BC) propounded the view that the human body contains four essential humors—phlegm, yellow bile, black bile, and blood—which are secreted by different organs, possess different qualities, and vary with the seasons. The brain was considered the seat of life, and its normal functioning required a balance between the humors. Large excesses of phlegm caused a form of dementia, yellow bile caused manic rage, and black bile caused melancholia. It was the first attempt to explain differences in temperaments and personalities.
The Hippocratic authors were the first to rationally describe and classify such diseases as epilepsy, mania, paranoia, organic toxic delirium, postpartum psychosis, phobias, and hysteria, which they named and believed to be confined to women and to be caused by a wandering uterus.
Plato and Aristotle: The philosopher Plato (427–347 BC) divided the soul into three parts: rational, appetitive (lusts and greed), and spirited-affective. Madness occurred when the appetitive soul lost the influence of the rational soul or when a divine disturbance of the soul produced either inspired or destructive behavior. For treating disease, Plato advocated a verbal dialectic between a patient and a philosopher or a physician, a question-and-answer dialogue that enabled the patient to alleviate an illness by developing a state of philosophical knowledge.
Plato s pupil Aristotle (384–322 BC) believed that mental illness occurred when the soul was subjected to changes in temperature, black bile, and the emotions. He was the first to describe accurately the affections of desire, anger, fear, courage, envy, joy, hatred, and pity.
Neither Greece nor Rome took social responsibility for treating the insane. Most of the seriously insane were kept under restraint at home by their families.

Hospitals and Asylums
Since Islam held that society is responsible for the kindly care of the insane, the Arabs built hospitals with psychiatric divisions in Baghdad (750) and Cairo (873); they also built special insane asylums in Damascus (800).
Christian attitudes toward the insane fluctuated between rejection and toleration, they were incarcerated in madmen s towers and were periodically expelled from towns.
Historians have usually recorded that the first Christian western European asylum caring exclusively for the insane was in Valencia Spain in 1409, and that this was followed by other Spanish asylums that were built under the influence of Islam.
For most of the eighteenth century, the insane inmates in public mental asylums were often regarded as having incurable diseases and were subjected to physical restraints, beatings, and constant fear (in some private asylums treatment was more lenient). Toward the end of the century that harsh treatment was changed by reforms that abolished most restraints and created an asylum regimen in which the mental patient was respected as a person.

Theory of Degeneration
A theory of mental illness, propounded by two French psychiatrists, Benedict-Augustin Morel (1809–1873) and Valentin Magnan (1835–1916), held that a variety of mental illnesses ranging from insanity to obsessions and compulsions could be congenitally inherited from parents who were afflicted by similar diseases and that the predisposition could slowly become activated into a disease by repeated transmission from parent to child or it could suddenly be activated by the effects of such external events as social traumas, alcoholism, syphilis, and other infections.

Kraepelin : When Emil Kraepelin (1856–1926) was a professor of psychiatry, he studied the objective symptoms and clinical life histories of thousands of psychotic patients. In 1899, Kraepelin classified the major psychoses into two groups. Manic-depressive psychosis (formerly called circular insanity) patients usually recovered; dementia precox, which deteriorated to dementia and which consisted of three subgroups—hebephrenia and catatonia, described by Ewald Hecker (1843–1909) and Karl Kahlbaum (1828–1899) in 1871 and 1874, and dementia paranoia, described by Kraepelin and separated from paranoia and paraphrenia., although Kraepelin later conceded that some patients with dementia precox recovered.
Bleuler : The Swiss psychiatrist Eugen Bleuler (1857–1939) Like Emil Kraepelin, he argued that dementia praecox, or "the schizophrenias," was fundamentally a physical disease process characterized by exacerbations and remissions. Bleuler was concerned less with prognosis and more with the mechanisms of symptom formation. Unlike Kraepelin, he believed that the overall prognosis was not uniformly grim. Bleuler introduced the term "schizophrenia" to the world.

Shock Treatments
In the 1920s and 1930s convulsions produced by metrazol given by the Hungarian psychiatrist Ladislas Meduna (1896–1964) and by insulin used by the Viennese physician Manfred Sakel (1900–1957) resulted in remissions in the symptoms of schizophrenic patients. In April 1938 two Italian psychiatrists, Ugo Cerletti (1877–1963) and Lucio Bini (1908–1964), produced convulsions by means of electroshock.
Sigmund Freud (1856–1939) In the 1890s he began diagnosing patients as suffering from separate clinical illnesses which he called "anxieties," "phobias," and "obsessions"; terms that would subsequently influence the diagnosis and classification of neuroses.
At first Freud, along with his physician friend Joseph Breuer (1841–1925), treated these patients with hypnosis. Then by himself he originated a new method that consisted of free thought association and interpretation of dreams, which in 1896 he first called "psychoanalysis." Using this method, he was able to show that neurotic patients suffer from memories of past traumatic events that they repressed into the unconscious parts of their mind and that when those memories were brought into consciousness by psychoanalysis and re experienced with the support of the psychoanalyst, the neurotic symptoms were alleviated. The method revealed that the illnesses of these patients (their hysterical symptoms, anxieties, phobias, and obsessions) were caused by unconscious memories of past illicit sexual encounters. The concept of the unconscious had been known to philosophers since the seventeenth century; however, no one had thought that it could be used to investigate and treat psychiatric illnesses.
In 1900 The Interpretation of Dreams was published. It was Freud s most insightful work, and it revolutionized psychiatric thought and practice as well as other areas of thought. In it Freud showed how processes of condensation, distortion, disguise, and secondary elaboration transform unconscious latent dream content into conscious manifest content. His analysis of his own dreams, which was part of his self-analysis, was one of the most revealing psychological introspections ever recorded.
Lobotomies
During the late 1940s and early 1950s, under the influence of two neurologists—Egas Moniz (1874–1955) and Walter Freeman (1895–1972)—many intractable psychotic and obsessive-compulsive patients were treated by lobotomies, the destruction of the white matter of the frontal lobes of the brain. Some patients improved, but others suffered severe and irreversible personality deterioration. With the advent of the psychotropic drugs, the use of lobotomies declined markedly. In 1949 Moniz along with the Swiss neurophysiologist Walter Hess was awarded the Nobel Prize in Physiology and Medicine.