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The rise of the lunatic asylum and its gradual transformation into, and eventual replacement by, the modern psychiatric hospital, explains the rise of organized, institutional psychiatry. While there were earlier institutions that housed the 'insane,' the arrival at the answer of institutionalisation as the correct solution to the problem of madness was very much an event of the nineteenth century. To illustrate this with one regional example, in England at the beginning of the nineteenth century there were, perhaps, a few thousand "lunatics" housed in a variety of disparate institutions but by 1900 that figure had grown to about 100,000. That this growth should coincide with the growth of alienism, now known as psychiatry, as a medical specialism is not coincidental.


Beginning stages

In 1632 it was recorded that the old house of Bethlem had "below stairs a parlor, a kitchen, two larders, a long entry throughout the house, and 21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in".[1]Inmates who were deemed dangerous or disturbing were chained-up or shut-up but Bethlem was an otherwise open building for its inhabitants to roam around its confines and possibly throughout the general neighborhood in which the hospital was situated.[2]

Humanitarian Reform

Europe

Franz Mesmer

hypnotism . His theory was that the magnetism of iron affected a magnetic fluid in the body and with this theory he treated patients with ranges of physiological symptoms including paralysis, blindness and chronic pain.[3]
Mesmer's clinic introduced the idea of psychotherapy as theater.

Mesmer's theory was that disease was the result of "obstacles" in the flow of the fluid through out the body, and the obstacles could only be broken by what he called a crises. Crises were trance states that often ended in delirium or convulsion. [4]


Philippe Pinel


"In all public asylums as well as in prisons and hospitals, the surest, and, perhaps, the only method of securing health, good order, and good manners, is to carry into decided and habitual execution the natural law of bodily labour, so contributive and essential to human happiness." - A Treatise on Insanity, Section 1. Translated by D. D. Davis.


Philippe Pinel was a French physician who was responsible for a widespread reform in French asylums and is credited as being one of the founders of psychiatry.[5] Also an author, Pinel's book A Treatise on Insanity gave an improved and simple classification system for mental disorders.

Pinel arrived to the hospital of

Bicêtre in 1792. Before his arrival, inmates were chained in cramped cell like rooms where there was poor ventilation and filth. Pinel requested that the French government allow him to implement a new treatment plan for the inmates. Pinel's new treatment consisted of allowing the inmates to have more freedom,physical exercise, and teaching them to make logical choices that were followed up with reasonable punishment if needed.[6]

Due to more humane treatment, patients began to reform their behavior and Pinel was able to slowly liberate fifty patients. Pinel was also able to petition the Revolutionary Committee to discontinue bloodletting and purging as customary medical treatments. [7]

He advocated against the idea that mental illness was cause of demoniacal possession but instead the result of excessive exposure to social and psychological stresses of heredity and physiological damage.[8]


Jean-Marc Itard

Jean-Marc Itard was a French teacher of the deaf who made an accidental discovery in the area of mental deficiency. Itard's work started when a young boy was found by hunters. The boy was unable to talk and was diagnosed by Pinel as an "incurable idiot". While Itard worked with the boy for two years, he was not able to speak but made progress and became affectionate. Itard work suggests what could happen on a bigger stage with children and mental retardation.[9]

Edouard Seguin

Edouard Seguin was a Frenchmen who developed a systematic approach for training individuals with mental deficient.[10] In 1839,Séguin opened the first school for the severely retarded and developed a method of treatment based on that the mentally deficient did not have a disease or an abnormal brain. Seguin later on moved to the United States and created schools for retarded children as well as opening up his own practice. He also became the founding president of the Association of Medical Officers of American Institutions for Idiotic and Feebleminded Persons in 1876.[11]

America

i) Rush

Benjamin Rush of Philadelphia also promoted humane treatment of the insane outside dungeons and without iron restraints, as well as sought their reintegration into society. In 1792 Rush successfully campaigned for a separate ward for the insane at the Pennsylvania Hospital. His talk-based approach led to modern occupational therapy and addiction medicine, although most of his physical approaches have long been discredited, such as bleeding and purging (unlike Pinel), hot and cold baths, mercury pills, a "tranquilizing chair" and gyroscope. In Italy, Vincenzo Chiarugi may also have banned chains before this time. Johann Jakob Guggenbühl in 1840 started in Interlaken the first retreat for mentally disabled children.[citation needed]

ii) Trends

iii) Dix

Physical therapies

A series of radical physical therapies were developed in central and continental Europe in the late 1910s, the 1920s and, most particularly, the 1930s. Among these we may note the Austrian psychiatrist

Walter Freeman and James W. Watts in what is known as Freeman-Watts procedure or the standard prefrontal lobotomy. From 1946, Freeman developed the transorbital lobotomy, using a device akin to an ice-pick. This was an "office" procedure which did not have to be performed in a surgical theatre and took as little as fifteen minutes to complete. Freeman is credited with the popularisation of the technique in the United States. In 1949, 5074 lobotomies were carried out in the United States and by 1951, 18,608 people had undergone the controversial procedure in that country.[16]

In modern times, insulin shock therapy and lobotomies are viewed as being almost as barbaric as the Bedlam "treatments", although the insulin shock therapy was still seen as the only option which produced any noticeable effect on patients. ECT is still used in the West, but it is seen as a last resort for treatment of mood disorders, and is administered much more safely than in the past.[17] Elsewhere, particularly in India, use of ECT is reportedly increasing, as a cost-effective alternative to drug treatment. The effect of a shock on an overly excitable patient often allowed these patients to be discharged to their homes, which was seen by administrators (and often guardians) as a preferable solution to institutionalization. Lobotomies were performed in the hundreds from the 1930s to the 1950s, and were ultimately replaced with modern psychotropic drugs

Drugs

The twentieth century saw the development of the first effective

psychiatric drugs
.

The first

neuroleptics (antipsychotics) in 1955 a series of psychiatric studies were presented by, among others, Hans Hoff (Vienna), Aksel[who?] (Istanbul), Felix Labarth (Basle), Linford Rees (London), Sarro[who?] (Barcelona), Manfred Bleuler (Zurich), William Mayer-Gross (Birmingham), Winford[who?] (Washington) and Denber[who?] (New York) attesting to the effective and concordant action of the new drugs in the treatment of psychosis.[citation needed
]

The new antipsychotics had an immense impact on the lives of psychiatrists and patients. For instance,

muscle relaxants allowed ECT to be used in a modified form for the treatment of severe depression and a few other disorders.[19] Fluoxetine hydrochloride (fluoxetine) was developed in 1973 by Bryan Molly, David Wong and Roy Fuller of the Eli Lilly corporation and is today sold under the brand name Prozac.[20]

The discovery of the

mood stabilizing effect of lithium carbonate by John Cade in 1948 would eventually revolutionize the treatment of bipolar disorder, although its use was banned in the United States until the 1970s.[citation needed
]

The use of

which?][citation needed] New treatments led to reductions in the number of patients in mental hospitals.[citation needed
]

Present Day (1900-2000)

Europe

United States

i) United States: Reform in the 1940s

ii) Psychiatric internment as a political device

iii) Deinstitutionalization

Other places

i) South America

ii) Asia

iii) New Zealand

iv) Africa

See also

References

  1. ^ Allderidge 1979a, p. 145
  2. ^ Andrews et al. 1997, p. 51
  3. ^ King.A History of Psychology.p.203.ISBN-13: 9780205512133
  4. ^ http://www.britannica.com/EBchecked/topic/376668/Franz-Anton-Mesmer
  5. ^ http://www.pinelschool.org/pp.htm
  6. ^ http://www.pinelschool.org/pp.htm
  7. ^ <a href="http://psychology.jrank.org/pages/494/Philippe-Pinel.html">Philippe Pinel</a>
  8. ^ http://www.pinelschool.org/pp.htm
  9. ^ King.A History of Psychology.p.214.ISBN-13: 9780205512133
  10. ^ King.A History of Psychology.p.214.ISBN-13: 9780205512133
  11. ^ http://www.britannica.com/EBchecked/topic/532753/Edouard-Seguin
  12. doi:10.1177/0957154X0001104403
    .
  13. ^ Ugo Cerletti, for instance, described psychiatry during the interwar period as a "funereal science". Quoted in Shorter, Edward (1997). A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley: p. 218
  14. ^ Hoenig J (1995). "Schizophrenia. In Berrios, German and Porter, Roy (Eds.), A History of Clinical Psychiatry. Athlone: p. 337; Meduna, L.J. (1985). Autobiography of L.J. Meduna". Convulsive Therapy. 1 (1): 53.
  15. ^ Shorter, Edward (1997). A History of Psychiatry. Wiley: pp. 190–225.
  16. ^ Shorter, Edward (1997).A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Wiley: pp. 226–229.
  17. ISBN 978-0-8166-4940-2
    .
  18. ISBN 1-85317-886-1
  19. ^ http://studymore.org.uk/mhhtim.htm
  20. ^ http://www-personal.umich.edu/~kruger/hon7.html

Further reading

http://www.uniteforsight.org/mental-health/module2

http://www.tiki-toki.com/timeline/entry/37146/A-History-of-Mental-Institutions-in-the-United-States/

http://www.english-heritage.org.uk/discover/people-and-places/disability-history/1485-1660/mental-illness-in-the-16th-and-17th-centuries/

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