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UNIT II HISTORY OF PSYCHIATRY - ANCIENT TIMES (4000 BC – 1000AD )

UNIT II HISTORY OF PSYCHIATRY - ANCIENT TIMES (4000 BC – 1000AD ). MSc Nursing 2nd year. HISTORY PSYCHIATRY : (Text Book of postgraduate psychiatry) IMPORTANT VIEWS. Ayurveda (4000 BC) Indian system of scientific medicine and positive health

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UNIT II HISTORY OF PSYCHIATRY - ANCIENT TIMES (4000 BC – 1000AD )

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  1. UNIT II HISTORY OF PSYCHIATRY - ANCIENT TIMES (4000 BC – 1000AD) MSc Nursing 2nd year

  2. HISTORY PSYCHIATRY : (Text Book of postgraduate psychiatry) IMPORTANT VIEWS

  3. Ayurveda (4000 BC) • Indian system of scientific medicine and positive health • Psychiatry was labeled asbhut – vidya, (demonology, Charak Samhita, “Neither gods.. Nor demons)

  4. Heriditory – causation of mental disorders • Psychiatry patient- treated with the sympathy and kindness. • Intractable disease were treated by brutal treatment with scalding ( hot water, iron or oil) whipping, tying with soft bandages and confinement. • Sushruta believed that passions an d strong emotions could not only cause mental disorders but also physical disorders that may require surgical intervention. • 2. SAGE AGASTRA (7th CENTURY BC) • Indian sage, practitioner of siddha system of medicine • Described 18 types of mental disorders, with treatment consisting giving bhasam (ash) • Wrote a treatise of mental disorders called as Agastiyar Kirigai Nool.

  5. 3. ALCMAEON ( 6th century BC) • A Greek physician priest; a student of pythagoras. • Related sensation to brain processes, and concluded that defects in reasoning must result from brain pathology and not from abstract spiritual phenomena. • 4. JIVAK (5th Century BC) • Indian physician • Practiced neurosurgery and performed that several operations on brain • 5. BHAGAVAD GITA ( 4th Century BC) • Psychotherapy and counseling • Guru Chela relationship (Dr- Patient)

  6. 6. HIPPOCRATES (460- 377BC) • Greek physician • Temperaments were believed to be caused by mixture of 4 bodily humors (blood, phlegm, yellow bile and black bile) and were called as Sanguine phlegma tic, choleric and melancholic. • Disease- imbalance of these bodily humors • Attempted to classify mental disorders into categories recognizable as melancholia, post partum psychosis, phobias , delirium, dementia and hysteria • Hysteria- wandering uterus ( treatment marriage and sexual intercourse ) • epilepsy was a sacred disease and believed natural causes to be responsible for the malady. • Stressed the importance of doctor – patients relationship

  7. 7. SOCRETES (469- 399 BC) • Greek philospher • Developed a unique method of teaching • 8. Plato ( 427-347BC) • Greek philosopher and rationalist • believed that the mental world consists of self exist ideas which are wholly independent of one’s life experience • Divided the soul of psyche into 3 parts (appetite, impulses and reason) located respectively abdomen, chest and head • Earlier he described 2 kinds of madness • The appetitive soul loses the domination of the rational soul. • The gods inspire the madness (divine madness)

  8. Later, in phaedrus’, he described 4 kinds of madness • Prophetic madness • Telestic or Ritual Madness • Portic madness • Erotic madness • In the ‘Laws’, Definite norms of handling a ‘mental’ patient are given, e.g. confinement at home, exile, and even punishment by death (in extreme cases)

  9. 9.ARISTOTLE (384- 322 BC) • Greek physician; plato’s most influential student • Insisted that theories should be derived from observable data; thus believed in empiricism as opposed to plato’s rationalism. • Described ‘heart’ as the seat of all mental functions and therefore, the major agent of causation of mental disorders. • Described the various emotions or affections’ (eg., desire, joy, courage, anger, fear , hatred, and pity) in De Anima (a collection of 8 books, containing his views and theories on psychology. • Discussed ‘catharsis’ as a natural outlet for disturbing passions. Advocated that passions must be purged consistently to avoid violence.

  10. 10. Herophilus (335- 280 BC) • Greek physician • Known as the ‘father of Anatomy.’ • Refuted the theory of body humors and believed anatomic defects within the brain to be responsible for mental disorders. • 11. KING ASHOKA (27 4- 235 BC ) • Indian King; a great warrior who later embraced Buddhism. • His regime saw establishment of many hospitals. Mentally ill were humanely cared for, along with the physically ill, in these hospitals.

  11. 12. ASCELEPIADES (C 150 BC) • Roman (originally from Asia Minor) Philosopher- physician • Rejected the doctrine of bodily humors • Differentiated illusions from delusions • Subdivided the diseases into acute and chronic. • Advocated psychological modes of treatment and stressed the importance of environmental influences. • His teachings led to the cult of Asclepias (O: Asclepiades ), the god of healing. The Asclepian priest: used dream interpretation to suggest healing measures.

  12. 13. CICERO (106- 43BC) • Roman physician • Provided the 1st detailed description of passions, the strongest of which was ‘libido’ (violent passion). • 1st to use the term ‘libido’ in a psychological sense. • 14. AURELIUS CORNELIUS CELSUS (25BC – 5 0 AD) • Non – medical, Roman encyclopedist. • Described 6 types of insanity in his classic medical text book, ‘De Re Medica’. • Phrenitis, Melancholia ,Delirium,Lethargus (stupor),Epilepsy,Schizophrenia • Advocated ‘shocking harshaly’ as a method of treatment for the mentally ill. • This ‘shock treatment’ provided a rationale for the brutal treatment of the insane for centuries to come.

  13. 15. ARETAEUS (50- 130 AD) • Physician in Cappadocia, in Eastern Asia Minor (a part of the Roman Empire). • Believed mental disorders to be exaggerated normal processes • 1st to describe mania and depression as two phases of the same disorder, occuring in the same person • Also described paranoid syndromes. • Studied pre- morbid personalities of the mentally ill and conducted detailed follow up studies • Proposed an ‘eclectic’ approach in treatment.

  14. 16. SORANUS (93- 138) • Roman physician • Provided many accurate description of mental disorders (especially delusions of grandiosity, states of stupor). • 17. GALEN (130 – 200) • Physician in Asia (Now Turkey) of the Roman Empire. • Instrumental in the ‘rebirth’ and propagation of the humoral theory • Defined hysteria as a complex, in curable disease with an known physical cause. He located the seat of the disorder in cerebellum, calling it the site of ‘carnal love’. • His views had widespread acceptance and hindered the development of knowledge regarding mental disorders for many centuries.

  15. 18. ST. AUGUSTINE (354- 430) • Aurelius Augustinus, later known as St. Augustine, was born in Tagaste (Numidia,. North Africa). • Wrote the 1st book, ‘Confessions’, on psychological introspection based on self – analysis, though tinged with religious overtones. • 1st to describe vidibly, and in detail, his subjective emotional experiences without any reservations. Believed to be the forerunner of existentialism, phenomenology and psychoanalysis. • His views had tremendous influence on the Western intellectual world for at least the next 10 centuries

  16. 19. BAGHDAD MENTAL ASYLUM (C 705 ) • 1st asylum for the mentally ill (exclusively) at Baghdad. • Provided humane treatment for the insane • RHAZES OR AL RAZI (865- 925) • Persian physician in the city of Baghdad. • known as the ‘Persian Galen’. • Believed mental disorders to have ‘organic’ ca uses • Proponent of psychological modes of treatment • Was the physician – in – child of the Baghdad hospital. • Wrote more than 200 volumes on subjects ranging from medicine and religion, to philosophy and astronomy.

  17. PRIMITIVE AGES ( Demonology gods, and Magic) Primitive people believed that the mentally ill were possessed by demons, who invaded the human body as a form of punishment for the sins which the afflicted person had committed. This theory was enlarged to such an extent that a demon was assigned to each of 36 parts of the body. Many of the so –called possessed individuals were abandoned. As misfits or worthless, to the forests where they were devoured by animals; others were burned at the stake. This practice appeared to be prompted by the belief that mentally ill were allied with the devil and capable of casting spells. (Margareta)

  18. Five Different belief models shaped the reactions to mental illness of earl y humans and their primitive descendants. • The person’s soul has fled the body; and the wandering needed to be convinced to return. • A foreign body with magical powers entered the body; the cure required that it be extracted and neutralized. • Evil spirits had entered the body; these had to be exorcised before the victim could have relief. • The person had infringed on a taboo; the person and situation required ritualistic purification. • The person had sinned (Hebraic and other traditions attributed mental illness to sin). Requiring confession in the hope that sins could be expiated (Jeffrey and Hedlund).

  19. Primitive era – treatment (Magic) • Primitive medicine or psychiatry was believed to cure if the client accepted and belived in the treatment. the effectiveness of healing was attributed to magic. • Ellenberger identified five key elements in the success of primitive medical haling (1970): • The healer occupied a central role in the society • Confidence was in the healer, not in the medication • Healers were learned people, as defined by culture • Psychological methods of healing were more important • The healing is almost always a public affair.

  20. TREATMENT IN ANCIENT TIMES FOCUSED ON 1. EXORCISM : Prayer, noise – making and preparation of purgatives prepared from sheep dung and wine to be drunk by the patient.

  21. 2. OPERATION / TREPHENING: It is a circular opening made on the skull with crude stone instrument for the evil spirit to escape from the brain( K. Lalitha).

  22. DEMONOLOGICAL THEORY AND HEALERS • Priest • Physician • Psychologist • Magician

  23. METHODS OF TREATMENT • Mystic rites • Incantation • Temples of healing • Shaman – wooden statue • Wearing talisman • A trephened skull • Exorcism

  24. Rosenblatt records community response during the ancient times Assistance : The least restrictive approach, provided food and money and often enables family to maintain as a unit Banishment : Led to wandering lunatics living no one cared how and dying no one cared where. Confinement : Most restrictive method of copying with the mentally ill. Who were often chained.

  25. Age of rationalism (BC 500- 580) Hyppocrates (460 – 357BC) Charaka and Susruta (100AD) (Ayurvedic physician placed the mind in the heart ) Galen ( 130-200 AD)

  26. The dark ages (500- 1000AD) Demonology and witchcraft

  27. An asylum – Baghdad(705 AD) Rhazes ( 900 AD)

  28. Pre- christian Development ( 580 – 510 BC) ( Age of rationalism) Pythagoras Hippocrate Plato Aristotle Herophilus Asclepiads Early christian period of 25BC – 1000 AD Augustine , Aurelius, Cornelius Celsus, Aretaeus of Cappadocia, Galen, Soranus, Caelius Aurelinus

  29. HISTORY OF PSYCHIATRY (midieval period)

  30. The following categories of periods are identifiedThe period of persecution (1552BC-1400AD)The period of segregation(1545AD-1800AD)The humanitarian period (1745-1826AD)Beginning of scietific attitude(1796-1878)The period of prevention(1885-1960)

  31. Avicenna or Abu Alibn Sina(980-1037) • Persian physician • Recognised that emotional upsets can cause certain physical and mental disorders • Used physiological methods of treatment

  32. Constantius Africamus(1020-1087) • A resident of carthage • Provided aa detailed description of melancholia • Believed melan cholia to be caused byan excess of black bile • Opined that prognosns better in acute,reactive conditions • Was instrumental in spreading Galenic views on depression

  33. Naja buddin Unhammad ( c 1222) • Indian physician • Described 7 types of mental disorders • 1. Sauda-a-Tabee 2. MureeSauda • 3. Malikholia-a-Maraki 4. Haziyan • 5. Ishk 6. Nisyan • 7. Janoon Methods of treatment – Bleeding and purging, nutritious food, massage, change of climate, avoidance of fear and irritation etc

  34. Moses Maimonides (1135-1204) • Arab scholar • Provided a detailed description of depression • Believed in mental hygiene program St.Thomas Aquinas (1225-1274) • Believes soul being divine in origin, cannot commit any sin • Mental diseases sprang from organic factors • Attributed mental disorders to deficient use of reasons

  35. Bartholomaes Anglicus (13th century • French Monk • First attempts to localize brain functions Valencia Mental Asylum (1409) • First European mental hospital • Founded by Fr. Gilabert Jofre • Advocate humane treatment for the mentally ill • Separate unit for the mentally ill children

  36. Maulana Fazulure-Lah Hakim (1450) • Indian physician • In charge of the Indian mental asylum opened by Mohammed Khilji at Dhar Malleus Maleficarum (1487) • A book, title of which means “Witches Hammer” • Authorised by Heinrich Kraemer and Johann Sprenger

  37. Phillipus Aureolus Paracelsus (1493-1541) • Austrian physician • Later latinized his name to Paracelsus • Provided a new classification of diseases in his book, “On diseases which deprive Man of Reason: • Vesamia 2. Lunacy 3. Insanity • Believed mental disorders to be natural diseases and not caused by demons. • Believed in bodily `magnetism’ and lunar phenomenon. • Advocated treatment with chemicals • There was complete absence of psychotherapy

  38. Juan Louis Vives(1492-1540) • Spanish Philosopher • Wrote the first model text book of psychology • Forerunner of Freud in emphazing the importance of psychological associations in forming emotions • Believed that painful, long forgotten memories can be recalled through reflective association • Popular for his humanitarian stance towards mental ill

  39. Teresa of Avila • Spanish nun • Suggested that a mind can be ill just as a body can be ill. Johann Wayer (1552-1586) • Dutch physician • Regarded by some as the father of psychiatry • His book “De Praestigis Daemonum” vigorously attacked ‘Malleus’ refuting that the demons are the cause of mental disorders • Practiced psychotherapy

  40. Francis Bacon (1521-1626) • Introduced the inductive method Bethlehem Hospital (1547) • Introduced the inductive method • Founded as a priory of St. Mary of Bethlehem, London in 1247. • Henry VIII gave it a charter as a hospital for the cure of lunatics in 1547. • Name was later corrupted to Bedlam

  41. Timothy Bright (1551-1615) • English physician • Wrote the first treatise on mental illness by an English physician • Classified melancholia into two • 1.Caused by humeral imbalance which can treated by diet and physical means • 2.Caused by psychological factors which can be treated by psychological treatment

  42. Felix Plater(1536-1614) • Swiss physician • Classified mental disorders on the basis of symptoms • 1Coernatio mentis • Mentis alienato • Mentis defatigatio • Imbecillitas mentis • Emphasize the importance of clinical observation • Believed brain damage to be the chief cause of mental disorders • First physician to separate medicine from philosophy

  43. Reginald Scot (1538-1599) • English physician • Opponent of demonology • His book discovery of witch craft Gockel (1547-1628) • German Philosopher • Coined the word psychology in 1590 • Emphasized the importance of mind body relationship

  44. Robert Burton (1577-1640) • Oxford Dean of Divinity • Provided a comprehensive description of melancholy in his book “The Anatomy of Melancholy” Rane Descartes (1596-1650) • A deductive rationalist • Introduced the concept of reflex arc to explain all animal and much human behaviour • Believed that man had a thinking substance, the soul, which did not interact with the body, thus creating a misleading mind body dichotomy

  45. Paulozacchia (1584-1659) • Italian physician and lawyer • First forensic psychiatrist • Suggested that a physician rather than a priest or lawyer should evaluate a patient’s responsibility for abnormal behaviour Thomas Sydenhan (1624-1689) • English physician • Provided a comprehensive of the symptomatology of hysteria • Believed hysteria to be caused by disturbed animal spirits • First to draw attention to the symptom of neurosis

  46. Baruch Spinoza (1632-1677) • Portuguese philosopher • Challenged Descarte’s mind-body dualism and replaced it with a concept of psychophysiological parallelism Thomas Willis (1622-1675) • English physician • Classified mental disorders into two groups 1. Caused by gross brain disease 2. Caused by disturbed animal spirits • Described clinical features of major mental disorders • First to describe the Circle of Willis in brain and first ot use the term reflex action

  47. George Ernst Stahl (1660-1734) • German physician • First to make distinction between functional and organic illnesses • Propounded his theory of animism • Mental disorders were believed to be caused by inhibitions of `anima’ for bodily illnesses

  48. George Cheyne (1671-1743) • English physician • Described depression as the “English Malady” and that there is nothing shameful about abnormal behaviour Francois Brossier De Sarwages (1706-1767) • French Physician and Botanist • Arranged mental disorders overt symptoms in a manner similar to natural scientist who systematised plans and animals

  49. Bombay Asylum (1745) • First lunatic asylum to be built in modern India

  50. Pennsylvania Hospital (1751) • First hospital in USA to accept mentally ill Simon Andre Tissot (1728-1797) • Swiss physician • Emphasized the pathological effects of excessive masturbation

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