Medical Model of Madness

1. Medical Model of Madness The Emergence of Mental Illness Nick Klenda, Brittney Perez, Dominique Staats, and Dyland Walker

2. Ancient Palestine In Hebrew the verb “to behave like a prophet” also meant to rave or “to act like one beside oneself”

3. Classical Greek and Roman • Two explanations for madness • 1. Cosmological-supernatural explanation- madness was caused by the Gods or inflicted by the spirit underworld • 2. Huromal Theory- The existence is four humors • Blood, phlegm, black vile, yellow vile

4. Treatments • Limited diet • Gentle massage • Bleeding and cupping • Other treatments in cases with no improvement included • Purges • Vomitives • Hot and cold baths • Sunbathing

5. Severe Case Treatments • Physical restraint • Violent purges • Excessive bleeding • Dunking patient into cold water • Whipping and beating • Eels placed on head

6. Madness in Graeco-Roman Era • Madness considered a family problem • By Roman law the mad could not marry, acquire property, or witness a will • Most wondered the country side

7. The Middle Ages • Believed human imbalances caused maniacs to imitate wolves • Treatments were similar to Greeks with added remedies of poppies and lettuces • Byzantine physicians- made incisions to skull • Church retained a lot of power in the Middle Ages and considered madness a punishment for sin

8. 17th Century • Before the 17th century, harmless and mad people were free to roam the country-sides and towns. • Sometimes abused and driven from towns. • Responsibility was with the family or community. Narranschiff (Ship of Fools) Madness and folly was not hidden from society. Michel Foucault 1965

9. The Great Confinement Mid 17th Century • Absolutist & Capitalist order was emerging. • 1656 the Hospital General opened in Paris by royal decree. Not a hospital, no medical treatment or medical involvement. • Prison, to those who were considered socially useless. More than just mad people were held here • More institutions were appearing in European countries. Confinement was a new way to deal with deviants. Labor soon became a big part of these institutions and how they would start to operate.

10. Able-Bodied vs. Lunatics • Importance of labor force increased, so it was necessary to then separate those who could work from those who couldn’t. • Lunatics separated not for special treatment, but a means to keep able-bodied workers working. • Special institutions were now in place for lunatic or mad people (18th Century).

11. Introducing the Physician • 18thcentury, physicians played a small role in the confinement and little treatment was given to mad people. • In 1774 England made a physician’s certificate required in order to receive commitment to a madhouse. • Treatments that emerged in the 18th century were those that involved physical punishment. Darwin Chair.. • Philippe Pinel, the great humanitarian. Physical bondage was no longer needed(1794). Wrote Psychiatry in 1801.

12. Unitary Concept • John Weyer & the humoral physicians • Medical Historians, Ackerknecht (1968) Alexander & Selesnick (1966) • Theodore Sarbin 1969 • Comas Enfermas – a sick state of being • Legitimacy of mental illness concept • Psychiatric Profession • Thomas Kuhn… Politics

13. 19th Century America Experience • Pennsylvania Hospital 1756 • Founded by the Quakers • Mad people confined to the cellar • Williamsburg Lunatic Asylum 1773 • Keep the peace and constrain the insane • 3 Principle Sources • “police power” • Parenspatriae • State’s power over indigent members of pauper community

14. Asylums • Biological disease of the brain that was “socially caused” • Believed insanity was curable • Try to make a Utopian World • “Cult of curability” • Need for special skills and knowledge to treat these mental illnesses • Became more of a medical matter

15. Science of Mental Disease • Took more of a somatic approach • Continually added and expanded on the medical model • Freud and psychoanalysis-talking cure • Neurotic disorders-hysteria, obsessions, compulsions, and phobias • Immergence of new treatments • “Shock shops” and lobotomy • Families of madmen

16. Third revolution in mental health • Early 1950’s psychiatry was characterized by a “psychotherapeutic ideology. Based on Freudian principles. • Majority of patients in institutions were left untreated and cared for in “back wards” this all began to change by the 1955.

17. Psychotropic Medication • Psychotropic drugs: chemicals that exert their principal effect on a persons mind. • Ex. Thorazine, and resperpine • Thorazine within a year estimated 2million people were on thorazine. • Many patients that were previously inaccessible could now be reached, and treated for their diseases.

18. Psychotropic Medication • Critics of the drugs called them “chemical straightjackets” and argued that the chemicals only masked the symptoms and did not treat or cure. • This started the psychopharmacological revolution and psychiatrists felt they could now act like “real physicians.

19. Decline in mental hospital populations. • Factors that led to decreased hospital populations • Introduction of drugs • Research on the negative effects of institutionalization • Economic reasons

20. Sociological research • Research focused on three subjects: the mental hospital, social epidemiology, and identifying mental illness. • Research found mental hospitals to be total institutions that were over run and had a sharp divide between patient and staff. • Patients were institutionalized to the hospital and learned little of how to better themselves for the outside world.

21. Sociological research cont. • Social Epidemiology: patterns of incidence and prevalence of mental illness in a population are described. • These patterns are then correlated with social factors (ex. Social class, residence, race, sex) that appear to affect the likelihood of mental illness.

22. Sociological research cont. • Identifying mental illness • shift from patient to the defining social audiences. • Mental symptoms are “residual deviance” for which we have no appropriate labels, that arise from a variety of sources. • Patients’ behaviors are interpreted on the assumption that they are mentally ill.

23. Psychiatric Critique Thomas Szasz: R. D. Laing • mental illness is a myth. People should be able to act as they please • Hospitalization deprives people of liberty • People have problem in living • Psychotherapy needs to be a “moral dialogue” and is not a treatment for a sick mind. • Madness does not reside within the person, but is a response to the life situation that they find themselves in. • Family communication system is the cause of madness. • Mad person is a victim of poor family communication system • Help people go through experiences and grow from them

24. Community Mental Health:A Bold New Approach • Larger governmental concern for mental health of the public • In 1955 Congress enacted the 1955 Mental Health Study Act. This act had appropriation of more than $1,000,000 and established the Joint Commission on Mental Health and Illness.

25. Federal action and professional growth • Action for Mental Health(1961) • Expanded treatment programs • Prevention emphasis • Increase in mental health expenditures • No mental hospital should have more than 1000 beds • One community mental health clinic should be established for every 50,000 persons in a population.

26. Community Psychiatry • Professional arm of the bold new approach • This was an attempt to turn psychiatric knowledge and techniques to community problems. • Goal of preventing and minimizing mental disorder. • Three levels of prevention • Primary- eliminating the causes of mental illness in the community • Secondary-early identification of and intervention against mental problems • Tertiary prevention was treatment and rehabilitation efforts that attempted to prevent long-term, incapacities

27. Medical Models of Madness in the 1970’s • Brought a new concern for the individual • Renewed emphasis on biological and organic models of madness. • Genetics and biochemistry • Increased interest in technology • Intensified emphasis on the medical model of madness.