Dr Emmanuel Onyekwelu Guest Editors: Contributing Editors: Medical Scientific Historical and Academic medical Associates. - презентация

1 Dr Emmanuel Onyekwelu Guest Editors: Contributing Editors: Medical Scientific Historical and Academic medical Associates.

2 May 2014 Volume 1 Supplement 1 Classics and Revisits in Scientific Psychiatry. Childhood, Adolescent and Adulthood Psychiatry. Original Article The Historical perspective of Scientific Psychiatry and the origin of therapeutic interventions and concepts in psychiatry. Emmanuel Onyekwelu Historical Perspectives Etymology: The word psyche is derived from the ancient Greek word for soul or butterfly, which forms a symbolic logo for most psychiatric institutions. Psychiatry is the medical specialty devoted to the study, diagnosis, treatment and prevention of mental disorders, among which are affective, behavioural, cognitive and perceptual disorders or abnormalities. The term psychiatry was first coined by the German physician Johann Christian Reil in 1808 and literally means the medical treatment of the soul. [psych=soul from Ancient Greek psyche –soul –iatry-medical treatment from Gkiatrikos, medical from iasthai to heal] A medical doctor who has specialized in psychiatry is known as a psychiatrist. Ancient History of Psychiatry: The Ebers papyrus one of the most significant medical papyri of ancient Egypt briefly mentioned clinical depression by 1550 BC [Silverberg, Robert [1967].The dawn of Medicine.Putman. In a page from the Ebers Papyrus of the 6 th century 600 BC, it was revealed that many cities in ancient Greece had temples devoted to Asklepios known as Asklepieion who provided cures for psychosomatic illnesses. [Scholl, Reinhold [2002], Der Papyrus Ebers.Die groBte Buchrolle zuw Heilkunde Altagyptens.Leipzig ] Commencing from the 5 th century BCE, mental disorders, especially those with psychotic traits, were considered supernatural in origin, a view which existed throughout ancient Greek and Rome. This conception and mindset encouraged the frequent referral of these patients to the high priests and traditional healers who profferred healings through divination,astrology,offering of incarntations,pouring libetions and making of sparring ovations to the gods.

3 Historical Perspectives The beginning of Psychiatry as a medical specialty is dated to the middle of the nineteenth century, although one may trace its conception and germination to the late eighteenth century. Early manuals about mental disorders were created by the Greeks. In the 4 th century BCE Hippocrates theorized that physiological abnormalities may be the root of mental disorders. In the 4 th and 5 th Century B.C.Greece. Hippocrates wrote that he visited Democritus and found him in his garden cutting animals open. Democritus explained that he was attempting to discover the cause of madness and melancholy Hippocrates praised his work. Democritus had with him a book on madness and melancholy. Religious leaders often turned to versions of exorcism to treat mental often utilizing cruel and barbaric methods. As early as 705 AD Specialist hospitals were already built in Baghdad, followed by Fes in the early 8 th century, and Cairo in 800 AD and Damascus in [Shorter.E (1997) Physicians who wrote on mental disorders and their treatment in the Medieval Islamic period included Muhammad ibn Zakariya Razi [Rhazes] In the middle east,the Arab physician Najab ud-din Muhammad and Abu Ali al-Hussain ibn Abdallah ibn Sina, known in the West as Avicenna an 11the century Persian physician discovered and described physiological psychology in the treatment of illnesses involving emotions, and developed a system for associating changes in the pulse rate with the internal feelings. Specialist hospitals were built in Medieval Europe from the 13 th century to treat mental disorders but were utilized only as custodial institutions and did not provide any type of treatment as such.

4 Historical Perspectives Early Modern Period: In the 13 th century, in 1247, the Bethlem Royal Hospital in Bishops gate outside the wall of London was founded, it is one of the oldest and most famous, early public Lunatic asylums for the mentally ill, and was inaugurated as a priory of the order of St.Mary of Bethlem to collect alms for Crusaders; after the English government secularized,it started admitting mental patients by ,becoming known as Bedlam Hospital,in 1547,it was acquired by the city of London, operating until 1948,it is now part of the British NHS Foundation Trust. Several privately run asylums for the insane began to proliferate and expand in size and had more spacious accommodations for the poor distracted people and their servants.

5 Historical Perspectives The violent or noisy inmates usually had their hands and legs chained, The Bethel hospital was an otherwise open building for its inhabitants to be able to stroll around its premises, and possibly the neighborhood in which the hospital was situated. In 1676 Bethlem expanded into newly built premises at Moorfields with a capacity for over one hundred inmates. The Bethel Hospital Norwich was opened in 1713, as the first purpose –built asylum in England, founded by Mary Chapman. In 1621, Oxford University mathematician, astrologer, and scholar Robert Burton published one of the earliest treatises on mental illness: The Anatomy of Melancholy.What is it: With all the Kinds, Causes, Symptoms, Prognostickes, and Several Cures of it. In Three Maine Partitions with their several Sections. Members and Subsections. Philosophically, Medicinally, Historically, Opened and Cut Up. Burton thought that there was no greater cause of melancholy than idleness, no better cure than business. Unlike the English Philosopher of Science Francis Bacon. Burton argued that knowledge of the mind, not natural science, is human kinds greatest need. King Louis XIV of France in 1656 created a public system of hospitals for those suffering from mental disorders, and founded Pitie-Salpetriere Hospital in Paris for the destitutes and the mentally insane. Thereafter the English Physician Thomas Willis published the anatomical treatise De Anima Brutorum, describing psychology in terms of brain function.

6 Historical Perspectives Humanitarian Reform and Moral Therapy During the enlightenment attitudes towards the mentally ill began to change. It came to be viewed as a disorder that required compassionate intervention and management that would aid in the rehabilitation of the victim. After being plagued with guilt over the Salem Witch Trials, in 1724, influential New England Puritan minister Cotton Mather broke with astrology and superstition by advancing physical explanations for mental illness over demonic explanations.[British Journal of Psychiatry:Psychiatry,s 200 th birthday.] In 1758, the English physician William Battie wrote and published his treatise on Madness on the management of mental disorder. It was a critique aimed particularly at the Bethlem Hospital where a conservative regime continued to use barbaric custodial therapeutic interventions. Battie argued for a tailored management approach and strategy of patients for the rich and poor mental patients alike in the asylums, entailing cleanliness, good food, fresh air, and distraction from friends and family, in this way psychiatry became a respectable profession. He argued that mental disorder originated from dysfunction of the material brain rather than the internal workings of the mind. In 1788.the then ruling monarch in England George III was known to be suffering from a mental disorder. Following the Kings remission in 1789, mental illness came to be seen as something that could be treated and cured.

7 The Introduction of Moral Therapy in Psychiatry: The introduction of moral therapeutic interventions was initiated independently by the French doctor Philippe Pinel and the English Quaker William Tuke. In 1792, Parisian Physician Phillipe Pinel was appointed and became the chief physician at the Bicetre Hospital South of Paris.In 1797, Pussin first freed patients of their chains and banned physical punishment, although strait jackets could be used instead. Lunatic patients were allowed to move freely about the hospital grounds, and eventually dark dungeons were replaced with sunny, well ventilated rooms.Pussin and Pinels approach was seen as remarkably successful and they later brought similar reforms to mental hospitals in Paris for female patients.La Salpetriere, and this was the beginning of moral treatment for psychiatric patients. In 1809, Phillipe Pinel published the first description of dementia praecox [schizophrenia] Pinels student and successor, Jean Esquirol [ ] went on to establish ten new mental hospitals that operated on the same principles. There was an emphasis on the selection and supervision of attendants in order to establish a suitable setting to facilitate psychological work, and particularly on the employment of ex-patients as they were thought most likely to be more empathic and refrain from inhumane treatment while being able to manage events of pleading, menaces or complaining. William Tuke led the development of a radical new type of institution in Northern England, following the death of a fellow Quaker in a local asylum in 1790.

8 The Introduction of Moral Therapy in Psychiatry: In 1796, with the assistance of fellow Quakers and others, the York retreat was founded, where eventually about thirty patients lived as part of a small community in a quiet country house and engaged in a combination of respite care,rest, talk, and manual work. Rejecting medical theories and techniques, the efforts of the York retreat centered on minimizing restraints and cultivating rationality and moral strength. Thereafter, the entire Tuke family became known as founders of moral treatment. William Tukes grandson, Samuel Tuke, published an influential work in the early 19 th century on the methods of the retreat; Pinels Treatise On Insanity had then been published and Samuel Tuke translated his term as moral treatment. Tukes Retreat became a model throughout the world for humane and moral treatment of patients suffering from mental disorders. The York retreat inspired similar institutions in the United States, most notably the Brattleboro Retreat and the Hartford Retreat,now referred to as the Institute of Living. Although Tuke, Pinel and others had tried to do away with physical restraint, it remained widespread into the 19 th century. At the Lincoln Asylum in England, Robert Gardner Hill with the support of Edward Parker Charlesworth, pioneered a mode of treatment that suited all types of patients, so that mechanical restraints and coercion could be dispensed with-a situation he finally achieved in In 1839 Sergeant John Adams and Dr.John Conolly were impressed by the work of Hill, and introduced the method into their Hanwell Asylum, by then the largest in the country. Hills system was adapted, since Conolly was unable to supervise each attendant as closely as Hill had done. By September 1839, mechanical restrain was no longer required for any patient.

9 The Science of Phrenology: William A.F Browne was an influential reformer of the lunatic asylum in the mid-19 th century, and an advocate of the new science of phrenology. Scotlands Edinburgh medical school of the eighteenth century developed an interest in mental illness, with influential teachers including William Cullen [ ] and Robert Whytt [ ] emphasizing the clinical importance of psychiatric disorders. The American Physician Benjamin Rush in 1812, became one of the earliest advocates of humane treatment for the mentally ill, with the publication of Medical Inquiries and Observations upon Diseases of the Mind, which was the first American Textbook for Psychiatry.[The British Journal of Psychiatry,Psychiatrys 200 th birthday.] The element Lithium was first isolated in 1821 from Lithium oxide, and described by the English chemist William Thomas Brande, Lithium salts latter had a footing in Scientific Psychiatry for the treatment of Bipolar disorders. In 1816, the phrenologist Johann Spurzheim [ ] visited Edinburgh and lectured on his craniological and phrenological concepts; the central concepts of the system were that the brain is the organ of the mind and that human behaviour can be usefully understood in neurological rather than philosophical or religious terms. Phrenologists also laid stress on the modularity of the mind. Some of the medical students, including William A.F.Browne [ ], responded very positively to this materialist conception of the nervous system, and by implication, of mental disorder. George Combe an Edinburgh [ ], an Edinburgh solicitor, became an unraveled exponent of phrenological thinking, and his brother. Andrew Combe [ ], who was latter appointed a physician to the Queen Victoria, wrote a phrenological treatise entitled Observations on Mental Derangement [1831].They found the Edinburgh Phrenological Society in The modern era of institutionalized provision for the care of the mentally ill, began in the early 19 th century with a large state-led effort.

10 The Science of Phrenology: Public mental asylums were established in Britain after the passing of the 1808 County Asylums Act. This Act empowered magistrates to build rate supported asylums in every county to house the many pauper lunatics. Nine counties first applied, and the first public asylum opened in 1812 in Nottinghamshire.Parliamentary Committees were established to investigate abuses at private mad houses like Bethlem Hospital, its officers were eventually dismissed and national attention was focused on the routine use of bars, chains and handcuffs and the filthy conditions that the inmates lived in.However,it was not until 1828,that the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. In 1835 an organization known as Alcoholics Anonymous was founded, and was dedicated to the control of alcoholism by mutual support, group therapy and self help. Lord Shaftesbury was a vigorous campaigner for the reform of lunacy law in England and the Head of the Lunacy Commission for 40 years. The Lunacy Act of 1845 was an important landmark in the treatment of the mentally ill, as it explicitly changed the status of mentally ill people to patients who required treatment. The Act created the Lunacy Commission headed by Lord Shaftesbury, to focus on lunacy legislation reform. The commission was made up of eleven metropolitan commissioners who were required to undertake the provisions of the act, the compulsory construction of asylums in every country, with regular inspections on behalf of the Home secretary.All asylums were required to have written regulations and to have a qualified resident physician. A national body of asylum superintendents –the Medico-Psychological Association –was established in 1866 under the Presidency of William A.F Browne, although the body appeared in an earlier form in In 1838, France enacted a law to regulate both the admission into asylums and asylum services across the country. Edouard Seguin developed a systematic approach for training individuals with mental deficiencies and in 1839, he opened the first school for the severely retarded. His method of treatment was based on the assumption that the mentally deficient did not suffer from disease. The Association of Medical Officers of Asylums and Hospitals for the Insane was founded in 1841, receiving the Royal Charter in 1926, and becoming the Royal College of Psychiatry thereafter. In the United States the erection of state asylums began with the first law for the creation of one in New York, passed in The Association of Medical Superintendents of American Institutions for the Insane [AMSAII], the forerunner of the American Psychiatric Association [APA], was founded in Philadelphia, Pennsylvania.USA, The Lunacy act was passed in 1845, and the county Asylums Act in 1845 were passed in England and Wales, leading to the setting up of the Lunacy Commission.

11 Other Early hallmark publications in Psychiatry : The Parisian Physician Benedict Augustin Morel in 1852 published the Traite des Maladies Mentales [2 volumes]; the 2 nd ed. [1860] and coined the word, dementia praecox,[demence precoce] for patients suffering from,stupor [melancholia] The further publications of Benedict Augustin Morel include [Traite des Degenerescences-promoting the understanding of mental illness based upon the theory of degeneration,which became one of the most influential concepts in psychiatry for the rest of the century, which was published in [Traite Clinique et Therapeutique de L, Hysterie] was published in 1859, by Josef Breuer. The Utica State Hospital was opened approximately in 1850.The creation of this hospital as many others was largely the work of Dorothea Lynde Dix,whose philanthropic efforts extended over many states, and in Europe as far as Constantinople. Many state hospitals in the United States were built in the 1850s and the 1860s on the Kirkbride plan, an architectural style meant to have curative effect. At the turn of the century, England and France combined had only a few hundred individual asylums. By the late 1890s and early 1900s, this number had risen to the hundreds of thousands.However.the idea that mental illness could be ameliorated through institutionalization was soon disappointed. Psychiatrists were pressured by an ever increasing patient population. The average number of patients in asylums kept on growing. Asylums were quickly becoming almost indistinguishable from custodial institutions, and the reputation of psychiatry in the medical world had hit an extreme low,

12 Scientific Advances in Psychiatry. Emil Kraepelin studied and promoted ideas of disease classification for mental disorders. In the early 1800s psychiatry made advances in the diagnosis of mental illness by broadening the category of mental disease to include mood disorders in addition to disease level delusion or irrationality. The term psychiatry [Greek psychiatrike] which comes from the Greek word [psyche which means the soul or the mind] and iatros; meaning the healer] was coined by Johann Christian Reil in 1808.JeanEtienne Dominique Esquirol a student of Pinel, defined lypemania as an affective monomania [meaning excessive attention to a single thing] This was an early diagnosis of depression. Jacob Mendes Da Costa [ ] was an American surgeon who described the Da Costa syndrome which is a neurotic conviction that one is suffering from a heart disease. The syndrome features palpitations,chest pain, a rapid pulse and fatigue and is essentially an anxiety state centered on the heart. Also known as neurocirculatory asthenia. Alfred Binet [ ] was a Parisian French psychologist whilst an academic at the University of Stanford in California developed the Stanford - Binet test which is a type of intelligence test on which many current tests are based called the Stanford-Binet Test. Alfred Adler [ ] was a German Psychiatrist and an Austrian psychologist [ ] who developed the school of psychological thought which maintains that much of our behaviour is a response to subconscious efforts to compensate for inferiority, he suggested that in some people, a superiority complex is a response to feelings of inferiority.

13 Scientific Advances in Psychiatry. The German Psychiatrist Emil Kraepelin clinically defined dementia praecox, which was latter reformulated as Schizophrenia The 20 th century introduced a new psychiatry into the world. Different perspectives of looking at mental disorders began to be introduced. The career of Emil Kraepelin reflects the convergence of different disciplines in psychiatry and his work in a university psychiatric clinic, Kraepelins interest in pure psychology began to fade and he introduced a plan for a more comprehensive psychiatry. Kraepelin began to study and promote the ideas of disease classification for mental disorders, an idea introduced by Karl Ludwig Kalbaum. The initial ideas behind biological psychiatry stating that the different mental disorders were all biological in nature, evolved into a new concept of nerves and psychiatry became a rough approximation of neurology and neuropsychiatry, However, Kraepelin was criticized for considering schizophrenia as a biological illness in the absence of any detectable Histologic or anatomic abnormalities. While Kraepelin tried to find organic causes of mental illness, he adopted many theses of positivist medicine, but he favoured the precision of nosological classification over the in definitiveness of etiological causation as his basic mode of psychiatric explanation. The Kraepelian dichotomy between affective psychosis and dementia praecox [schizophrenia] was introduced in the 6 th edition of Emil Kraepelins famous Lehrbuch in 1899.

14 Significant Literary Contributions and Publications in Psychiatry. Sigmund Freud and Josef Breuer of Vienna Austria published The Studies on Hysteria based on the case of Bertha Pappenheim [known as Anna O], developing the Talking Cure; Freud and Breuer latter split over Freuds obsession with sex. In 4 th November 1899, Sigmund Freud published the interpretation OF Dreams [Die Tramdeutung] Following Sigmund Freuds pioneering work, ideas stemming from psychoanalytic theory also began to take root in psychiatry. Sigmund Freud published The Psychopathology of Everyday life in Sigmund Freud visited USA in 1909 and went to the Clark University, winning over the U.S. Psychiatric establishment. Sigmund Freud founded the International Psychoanalytical Association [IPA] in 1910, with Carl Jung as the first President and Otto Rank as the first secretary. Sigmund Freud in 1914 published On Narcissism: An introduction. In 1917, Sigmund Freud published the Introduction to Psychoanalysis and Mourning and Melancholia. Sigmund Freud in 1921 published the Group Psychology and the Analysis of Ego. Micheal Lesch [Born 1939] American Cardiologist and William Leo Nyan [Born 1926] American Paediatrician. Lesch-Nyan syndrome is a rare X-linked recessive disease of male children In which a severe over-production of uric acid causes gout, cerebral palsy mental retardation, chorea and compulsive self-mutilating biting. The disease is due to a deficiency of the enzyme hypoxanthine-guanine phosphoribosyl transferase. Mary Jane Ward published the novel The Snake Pit in 1946, which was filmed in 1948, causing reforms in the US state psychiatric hospitals. The Societe Psychanalytique de Paris was founded in 1926, with the endorsement of Sigmund Freud. The first Diagnostic and Statistical Manual of Mental Disorders [DSM] was published in 1952, by the American Psychiatric Association [APA] and was subsequently revised in 1968, 1980,1987,1994,2000 and In the year 1948, the first large scale studies of human sexual behaviour known as the Kinsey reports on the sexual behaviour in the human male was undertaken by Alfred C.Kinsey, Wardell B, Pomeroy and Clyde E Martin, also in 1953, another study in the sexual behaviour of the human female was undertaken by the same authors in addition to Paul.H.Gebbard,these studies had a profound impact on public and private attitudes to sexuality and assisted to overcome repressive taboos about frank discussions on the subject. Relevant Institutions societies and organizations in Psychiatry: The Indian Psychiatric Society was established in In 1942, the controversial discussions between Sigmund Freuds daughter Anna Freud and Melanie Klein founder of Object Relations Theory caused the British Psychoanalytical Society to permanently split into three camps. The American Neuropsychiatry Association was founded in 1990.

15 The early 20 th century psychiatry : Psychopharmacology, Drug History and Pharmacotherapeutic Advancements: Ritalin [Methylphenidate] a drug latter used for the management of attention deficit hyperactivity state was synthesized in Lithium Carbonates ability to stabilize the mood both highs and lows was demonstrated by Australian Psychiatrist John Cade, becoming the first effective medicine for the treatment of mental illness. The first Monoamine oxidase inhibitor [MAOI] antidepressant Iproniazid was discovered in Parisian Psychiatrist Jacques Lacan founded the Societe Francaise de Psychanalyse in James Olds and Peter Milner of McGill University discovered the brain reward system in Roger Sperry of Caltech began split-brain research in The first published clinical trial of chlorpromazine which is the first antipsychotic which was invented by Henri Laborit, Jean Delay and Pierre Deniker was conducted at fr: Centre hospitalier Sainte-Anne in Paris. The first tricyclic antidepressant Imipramine was discovered from the Pineal gland in Aaron T Beck developed cognitive therapy in The first benzodiazepam, chlordiazepoxide under the trade name Librium was introduced in The US Food and Drug Administration [FDA] approved Lithium for the treatment of acute mania in The first selective serotonin reuptake inhibitor [SSRI] an antidepressant Fluoxetine [trade name Prozac] was released in 1988, and was commonly recommended y practicing physicians. The US Controlled Substances Act was passed, putting LSD, DMT, Psilocybin, Mescaline and Marijuana on Schedule 1[no accepted medical use] in The American psychologist David Rosenhan published the Rosenhan experiment, a study challenging the validity of psychiatric diagnoses. The ICD-9 was published by the WHO in Psychopathies and Accentuations of Character of Teenagers was published by Andrey Lichko in 1982.

16 The early 20 th century psychiatry: Nobel Prizes in Physiology or Medicine relevant to Psychiatry: The Portuguese Neurologist Antonio Moniz won the Nobel Prize in Physiology or Medicine for his work on Lobotomy in The worlds Psychiatric Association was founded in The German Psychiatrist Alois Alzheimer identified the first case of what latter became known as the Alzheimers disease in The Austrian Physician Julius Wagner-Jauregg in 1917 initiated and invented the malaria therapy as a treatment for neurosyphilis or general paralysis of the insane for which he won the Nobel Prize in Physiology or Medicine. Manfred Sakel an Austrian Psychiatrist in 1927, developed insulin shock therapy as a treatment for psychosis. The Indian Association for Mental Hygiene was formed in Sandor Ferenezi, a Hungarian psychiatrist an ally of Sigmund Freud published a paper on the psychological explanations for the early childhood sexual challenges. Swiss-born psychiatrist Adolf Meyer became director of the New York Psychiatric Institute, influencing American Psychiatry with his common sense approach which included keeping detailed patient records, he coined the term mental hygiene. Dr.Banarasi Das pioneered the establishment the Indian division of the Royal Medico-Psychological Association in The psychoanalytic theory became popular among psychiatrists because it allowed the patients to be treated in private practices, instead of the warehoused in asylums. By the 1970s the psychoanalytic school of thought had become marginalized within the field. The insulin shock therapy for psychosis was discontinued in 1970s. The French Psychologists Alfred Binet and Theodore Simon created the Binet - Simon scale to assess the intellectual capability, marking the beginning of a standardized psychological and psychometric testing. The Russian Physician Pavlov published the first conditioning studies in The term Schizophrenia was coined by the Swiss psychiatrist Paul Eugen Bleuler in Boris Sidis opened the Sidis Psychotherapeutic Institute [a private hospital] at Maplewood Farms in Portsmouth, NH for the treatment of nervous patients using the latest scientific methods. The Swiss psychiatrist Herman Rorschach developed the Rorschach Inkblot Test in The All India Institute of Mental Health was founded in 1946, following the recommendation of the Bhore Committee, this institution latter became the National Institute of Mental Health and Neurosciences[NIMHANS] in 1974 at Bangalore.

17 The European Psychiatric Association was founded in 1983, The National Mental Health programme was launched in India in The Indian Mental Act was drafted by the parliament, but it came into effect in all the states and union territories of India in April This act replaced the Indian Lunacy Act of 1912,which earlier replaced the Indian Lunatic Asylum of Gregory Bateson, John Weakland, Donald deAvila Jackson and Jay Haley proposed the double bind theory of schizophrenia in 1956,with regards to it as stemming from situations where a person receives different or contradictory messages. The English translation of The Standard Edition of the Complete Psychological Works of Sigmund Freud was published between 1956 to 1974 in 24 volumes. The United States president John Kennedy in 1963, introduced legislation delegating the National Institute of Mental Health to administer community mental health centres for those being discharged from state psychiatric hospitals. Ronald David Laing published Sanity, Madness and the Family, claiming that the roots of schizophrenia lie in the family nexus where people play dark games with each other. Biological psychiatry reemerged during this time.Psychpharmacology became an integral part of psychiatry starting with Otto Loewis a German discovery of the neuromodulatory properties of acetylcholine, thus identifying it as the first–known neurotransmitter. Otto Loewis work led to the identification of the first neurotransmitter, acetylcholine. He co- discovered the neurotransmitter Acetylcholine with with the English Neuroscientist Sir Henry Dale, which earned them the 1936 Nobel Prize in Physiology or Medicine.

18 The European Psychiatric Association was founded in 1983, The Italian neurologist Ugo Cerletti and the Italian Psychiatrist Dr.Lucio Bini discovered Electroconvulsive Therapy in The Swiss Psychiatrist Ludwig Binswanger in 1942 founded Existential Therapy. Neuroimaging was first utilized as a tool for psychiatry in the 1980s. Alfred Adler in 1911, left Freuds Psychoanalytic Group to form his own school of thought, accusing Freud of overemphasizing sexuality and basing his theory on his own childhood. The American Psychoanalytic Association [APsaA] was founded in The British Psychoanalytic Society was founded by Ernest Jones in 1913, who became the Freuds biographer. The German Neuropsychiatrist Otto Rank published the Trauma of Birth, coining the term the pre Oedipal causing Freud to break with him. The discovery of chlorpromazines effectiveness in treating schizophrenia in 1952 revolutionized the treatment of the disease, as did lithium carbonates ability to stabilize mood highs and lows in bipolar disorders in 1948.Citing Freuds inability to acknowledge religion and spirituality,Carl Jung split and developed his own theories, his new school of thought became known as the Analytic Psychology. Jacob.L.Moreno pioneered Group Psychotherapy methods in Vienna, which emphasized spontaneity and interaction; they became latter known as Psychodrama and Sociometry. Psychotherapy was still utilized, but as a treatment for psychological issues. In the 1920s and 1930s, most asylum and academic psychiatrists in Europe believed that manic depressive disorder and schizophrenia were inherited, but in the decades after World War II, the conflation of genetics with Nazi racist ideology thoroughly discredited genetics. Now genetics were once again thought to play a role in mental illness. Molecular biology opened the door for specific genes to mental disorders to be identified.

19 Deinstitutionalization: Asylum Essays on the Social Situation of Mental Patients and Other Lunatics was written by the sociologist Erving Goffman examined the social situation of mental patients in the hospital. Based on his participant observation field work, the book developed the theory of the total institution and the process by which it takes efforts to maintain predictable and regular behaviour on the part of both guard and Captor. The book suggested that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role in other words of institutionalization them Asylums was a key in the development of deinstitutionalization In 1963, US president John.F.Kennedy introduced legislation delegating the National Institute of Mental Health to administer Community Mental Health Centres for those being discharged from the state psychiatric hospitals Later though the community Mental Health Centres focus shifted to providing psychotherapy for those suffering from acute but less serious mental disorders. Ultimately, there were no arrangements made for actively following and treating severely mentally ill patients who were discharged from hospitals. Some of those suffering from mental disorders drifted into homelessness or ended up in prisons and jails. Studies found that 33% of the homeless population and 14% of inmates in prisons and jails were already diagnosed with a mental illness.

20 David Rosenhan a psychologist in 1973 published the Rosenhan experiment, a study with results that led to questions about the validity of psychiatric diagnosis. Critics such as Robert Spitzer placed doubt on the validity and credibility of the study, but did not concede that the consistency of psychiatric diagnosis needed improvement. Psychiatry, like most medical specialties has a continuing, significant need for research into its diseases, classifications and treatments. Psychiatry adopts biologys fundamental belief that disease and health are different elements of an individuals adaptation to an environment. But psychiatry also recognizes that the environment of the human species is complex and includes physical, cultural and interpersonal elements. In addition to external factors, the human brain must contain and organize an individuals hopes, fears, desires, fantasies and feelings. Psychiatrys difficult task is to bridge the understanding of these factors so that they can be studied both clinically and physiologically.

21 Controversy&Mental illness myth: Viennas Narrenturm-German for fools tower–was one of the earliest buildings specifically designed as a mad house. It was built in Since the 1960s there have been many challenges to the concept of mental illness itself. Thomas Szasz wrote The Myth of Mental Illness [1980] which said that mental illnesses are not real in the sense that cancers are real. Except for a few identifiable brain diseases, such as Alzheimers disease, there are neither biological or chemical tests nor biopsy or necropsy findings for verifying or falsifying psychiatric diagnoses. There are no objective methods for detecting the presence or absence of mental disease.Szasz argued that mental illness was a myth used to disguise moral conflicts. He has said serious persons ought not to take psychiatry seriously-except as a threat to reason, responsibility and liberty.

22 Controversy&Mental illness myth: Sociologists such as Erving Goffman and Thomas Scheff said that mental illness was merely another example of how society labels and controls non-conformists ;behavioural psychologists challenged psychiatrys fundamental reliance on unobservable phenomena; and gay rights activists criticized the APAs listing of homosexuality as a mental disorder. A widely-publicised study by Rosenhan in Science was viewed as an attack on the efficacy of psychiatric diagnosis. These critiques targeted the heart of psychiatry: They suggested that psychiatrys core concepts were myths that psychiatrys relationship to medical science had only historical connections, that psychiatry was more aptly characterized as a vast system of coercive social management, and that its paradigmatic practice methods [the talking cure and psychiatric confinement] were ineffective or worse.

23 Medicalisation of Normality: For many years, some psychiatrists [such as Peter Breggin, Paula Caplan, Thomas Szasz] and outside critiques [such as Stuart.A.Kirk] have been accusing psychiatry of engaging in the systematic medicalisation of normality. More recently these concerns have come from insiders who have worked for or promoted APA [Robert Spitzer, Allen Frances] Allen Frances said that psychiatrists diagnosis still relies exclusively on fallible subjective judgments rather than objective biological tests. For many years some psychiatrists [such as Peter Breggin, Paula Caplan, Thomas Szasz] and outside critics [such as Stuart.A.Kirk] have been accusing psychiatry of engaging in the systematic medicalisation of normality. More recently these concerns have come from insiders who have worked for and promoted the APA [Robert Spitzer, Allen Frances] in 2013, Allen Frances said that psychiatric still relies exclusively on fallible subjective judgments rather than objective biological tests.

24 Medicalisation of Deviance: Medicalisation of deviance: The concept of medicalisation is created by sociologists and used for explaining how medical knowledge is applied to a series of behaviours, over which medicine exerts control, although those behaviours are not self-evidently medical or biological.According to Kittrie, a number of phenomena considered deviant, such as alcoholism, drug addiction and mental illness, were originally considered as moral, then legal, and now medical modes of social control. Similarly, Conrad and Schneider concluded their review of the medicalisation of deviances by supposing that three major paradigms may be identified that have reigned over deviance designations in different historical periods deviance as sin; deviance as crime and deviance as sickness. According to Franco Basaglia and his followers, whose approach pointed out the role of psychiatric institutions in the control and medicalisation of deviant behaviours and social problems, psychiatry is used as the provider of scientific support for social control to the existing establishment, and the ensuing standards of deviance and normality brought about repressive views of discrete social groups. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances

25 Political Abuse of Psychiatry Psychiatrists have been involved in human rights abuses in states across the world when the definitions of mental disease were expanded to include political disobedience. As scholars have long argued, governmental and medical institutions code menaces to authority as mental diseases during political disturbances, Nowadays, in many countries, political prisoners are sometimes confined and abused in mental institutions. Psychiatric confinement of sane people is a particularly pernicious form of repression. Psychiatry possesses a built-in capacity for abuse that is greater than in other areas of medicine. The diagnosis of mental disease allows the state to hold persons against their will and insist upon therapy in their interest and in the broader interests of the society. In addition, receiving a psychiatric diagnosis can itself be regarded as oppressive. In a monolithic state, psychiatry can be used to bypass standard legal procedures for establishing guilt or innocence and allow political incarceration without the ordinary odium attaching to such political trials. The use of hospitals instead of jails prevents the victims from receiving legal aid before courts, makes indefinite incarceration possible, and discredits the individuals and their ideas. In that manner, whenever open trials are undesirable, they are avoided. Examples of political abuse of the power, entrusted in physicians particularly psychiatrists are abundant in history and seen during the Nazi and the Soviet rule when political dissenters were labeled as mentally ill and subjected to inhumane treatments. In the period from 1960s up to 1986, abuse of psychiatry for political reasons was reported to be systematic in the Soviet Union, and occasionally in other Eastern European countries such as Romania, Hungary,Czechoslovakia and Yugoslavia. The practice of incarceration of political dissidents in mental hospitals in Eastern Europe and the former USSR damaged the credibility of psychiatric practice in these states and entailed strong condemnation from the international community. Political abuse of psychiatry also takes place in the Peoples Republic of China. Psychiatric diagnoses such as the diagnosis of sluggish schizophrenia in political dissidents in the USSR were used for political purposes.

26 Electroconvulsive Therapy: Electroconvulsive therapy [ECT] was one treatment that the anti-psychiatry movement wanted eliminated. Their arguments were that ECT damages the brain and were used as a punishment or a threat to keep the patients in line, since then ECT has improved considerably and is performed under general anaesthesia in a medically supervised environment. There is currently no consensus on the effectiveness of ECT.A meta-analysis done in 2003 concluded that ECT is an effective short term treatment for depression,and is probably more effective than drug therapy. Other studies say that ECT is an effective tool for certain illnesses at certain stages, and some physicians claim that ECT can save lives. On the other hand, a 2010 literature review concluded that ECT had minimal benefits for people with depression and schizophrenia. The authors said given the strong evidence of persistent and for some permanent brain dysfunction, primarily evidenced in the form of retrograde and antegrade amnesia, and the evidence of a slight but significant increased risk of death, the cost benefit analysis for ECT is so poor that its use cannot be scientifically justified. The most common side effects include headache, muscle soreness, confusion and temporary loss of recent memory.

27 Deinstitutionalization: The prevalence of psychiatric medication helped initiate deinstitutionalization, the process of discharging patients from psychiatric hospitals to the community. The pressure from the anti-psychiatry movements and the ideology of community treatment from the medical arena helped sustain deinstitutionalization. Thirty-three years after deinstitutionalization started in most settings, only about 19% of the patients in state owned hospitals remained. Mental health professionals envisioned a process wherein patients would be discharged into communities where they could participate in a normal life while living in a therapeutic atmosphere. Psychiatrists were criticized, however for failing to develop community- based support and treatment. Community based facilities were not available because of the political infighting between in-patient and community based social services, and an unwillingness by social services to dispense funding to provide adequately for patients to be discharged into community-based facilities.

28 Pharmaceutical Industry Associations: Psychiatry has greatly benefited by advances in pharmacotherapy. However, the close relationship between those prescribing psychiatric medications and pharmaceutical companies and the risk of a conflict interest, is also a source of concern. The costs of developing new drugs are immense, and it not surprising that the marketing of these drugs is ruthless. For example, pharmaceutical company funds have contributed more than moneys worth to the annual meeting and conferences of the American Psychiatric Association. This marketing by the pharmaceutical industry has a profound influence on practicing psychiatrists, which has an impact on prescription.Child psychiatry is one of the areas in which prescription has grown massively. In the past it was rare, but nowadays child psychiatrists on a regular basis prescribe psychotropic drugs for children, for instance Ritalin. Several prominent academic psychiatrists have refused to disclose financial conflicts of interest, which further undermines public trust in psychiatry.Charles Grassley led a 2008 Congressional Investigation which found that well-known university psychiatrists[such as Joseph Bierderman,Charles Nemeroff,and Alan Schwartzberg],who has promoted psychoactive drugs, had violated federal and university regulations by secretly receiving large sums of money from the pharmaceutical companies which made the drugs. In an effort to reduce the potential for hidden conflicts of interest between researchers and pharmaceutical companies, the US Government issued a mandate in 2012 requiring that drug manufacturers receiving funds under Medicare and Medicaid programs collect data, and make public, all gifts of doctors or hospitals.

29 Prisoner experimentations: Experimentation on Prisoners: Prisoner experimentations: Experimentation on Prisoners: Prisoners in psychiatric hospitals have been the subjects of experiments involving new medications. Vladimir exposed of the USSR was an individual exposed to such treatment in the 1980s. However, the involuntary treatment of prisoners by the use of psychiatric drugs has not been limited to Khailo, nor the USSR.

30 Antipsychiatry Controversy has often surrounded psychiatry, and the anti-psychiatry message is the psychiatric treatments are ultimately more damaging than helping patients, Psychiatry is often thought to be a bening medical specialty practice, but at times is seen by some as a coercive instrument of oppression. Psychiatry is seen to involve an unequal power relationship between doctor and patient and advocates of anti-psychiatry claim a subjective diagnostic process, leaving much room for opinions and interpretations. Every society, including liberal Western society, permits compulsory treatment of mental illness and patients. The WHO recognizes that poor quality services and human rights violations in mental health and social care facilities are still an everyday occurrence in many places, but has recently taken steps to improve the situation globally. Psychiatrys history involves what some view as dangerous treatments. Electroconvulsive therapy is one of these which was used widely between the 1930s and the 1960s and is still in use today. The brain surgery procedure lobotomy is another practice that was ultimately seen as too invasive and brutal. In the US between 1939 and 1951, over 50,000 lobotomies operations were performed in mental hospitals. Valium and other sedatives have arguably been over-prescribed, leading to a claimed epidemic of dependence. Concerns also exist for the significant increase in prescription of psychiatric drugs to children.

31 Antipsychiatry Three authors have come to personify the movement against psychiatry,of which two are or have been practicing psychiatrists.The most influential was R.D,Laing,who wrote a series of best selling books, including ;The Divided Self. Thomas Szasz rose to fame with the book The Myth of Mental Illness.Micheal Foucault challenged the very basis of psychiatric practice and cast it as repressive and controlling The term anti-psychiatry itself was coined by David Cooper in Divergence with psychiatry generated the anti-psychiatry movement in the 1960s and the 1970s, and is still present. Issues remaining relevant in contemporary psychiatry are questions of freedom versus coercion, mind versus brain, nature versus nurture, and the right to be different.

32 Psychiatric Survivors movement: Outline of the psychiatric survivors movement : The psychiatric survivors movement arose out of the civil rights ferment of the late 1960s and early 1970s and the personal histories of psychiatric abuse experienced by some ex-patients rather than the intradisciplinary discourse of antipsychiatry. The key text in the intellectual development of the survivor movement, at least in the American continent was Judi Chamberlins 1978 text. On our own patient controlled Alternatives to the Mental Health System. Chamberlin was an ex-patient and co-founder of the Mental Patients Liberation front. Coalescing around the ex-patient newsletter Dendron. In the late 1988 leaders from several of the main national and grassroots psychiatric survivor groups felt that an independent human rights coalition focused on problems in the mental health system was needed. That year the support coalition International[SCI] was formed, SCIs first public action was to stage a counter conference and protest in New York city,in May 1990,at the same time as[and directly outside of] the American Psychiatric Associations annual meeting. In 2005, the SCI changed its name to Mind Freedom International with David W Oaks as its director. The US signed the Mental Health Act in 1996, requiring psychiatric conditions to be considered equal to any other medical or surgical illness by health insurance providers. It equally signed an amended version in The No free Lunch Organization was founded in 2000 by Dr.Bob Goodman, an internist from New York.USA.