HLTH AGE 2G03 Lecture 2: Lecture 2 A Brief history of Mental Illness and Psychiatry

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But - how does this come about?
Where have this idea of abnormal behaviour/decency, we called it madness but now we call it mental illness
Madness -> Mental illness
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It has become progressively more common
Mental illness on the rise - why?
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Treatment/conception of mentally ill does not necessarily fit simply story of medical progress
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And we cannot determine how they are and what they are distinctly brought on by
How old are disorders? Are historical symptoms the same as historical diseases?
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KEY THEMES
Earliest recordings from 2nd c. BCE, potentially mania, depression and delusions
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We don’t have clear records of them being present but descriptions of things that sound like these illnesses
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We don’t have them making these diagnoses - just someone writing descriptions of some people
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Hippocrates and Galen -> situated madness in brain
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He places it also in the brain but accounts for a spiritual explanation as well
Rome falls, medicine declines. Revived by Islamic scholars (Al-Razin, Ibn Sina), treatment wards for mad found
across Muslim World
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PRE-INSTITUTIONAL HISTORY 1
The church had a lot of power at this time
In Christian Europe some citied spiritual basis for madness, other argued for imbalance of humours (biological)
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Happened in the France in the early 16th century
A woman starts dancing in the street and doesn’t stop for 24 hours
At one point there was about 400 people would be dancing
Considered a psychological phenomenon; few people died from it
Dancing plague
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"treatment" in monasteries, some witches and madmen (especially dangerous) burnt at stake, etc. .. Other treated
through prayed, bloodletting, whipping, purging etc. .. Yet most stayed with family
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PRE-INSTUTIONAL HISTORY 2
Practice continued in some places until the nineteenth century (and beyond)
Would drill inside someone's skulls -- to relive pressure in the brain and to remove/release demons
TREPANATION
Established of Bethlehem Hospital in 14th century
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Henry VIII later assigned it primarily for madness, already going by the name Bedlam
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Bedlam; disorganized chaos
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Becomes first to specialize in madness
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BETHLEM HOSPTIAL
Marks rising interest in madness, literary trope by 16TH c. becomes oft-used topic of ballads and songs
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Its descriptions like this that create negative connotations to mental illness
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BETHLEM IN POPULAR CULTURE
From a story that by Hogarths
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A rake is a term to describe someone who drinks a lot, gambles and pays for sex-workers
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Gets a lot of money from his parents -- moves to London, gambles his money away
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At the result he ends up in Bethlehem
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There is all sorts of figures to represent the illnesses that people have
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Payed to get into the hospital to go in and look at mental people
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HOGARTHS 18TH C. "A RAKES PROGRESS"
Swarms of people came to see the 'freak show', in which the inmate was regarded as a beast or monster
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Inmates tormented, teased, filled with drink
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Thye had to take special precautions to 'prevent sexual contact between visit and women patients'
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By mid-18th century, 17000 a year visted -- by 1700 vistors were banned from entering (HOWEVER not for moral
reasons)
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BEDLAM AS A ZOO
Beginning to see consumer capitalism; one of the of things that ppl were paying for was to place people in
these asylums and keep them there
Rise of private madhouses and small charity asylums, although care in the home is still the dominant model
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Still no such things as psychiatrists -- it did not exist at this point
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EIGHTEENTH CENTURY
Someone who is not a murder but is associated with criminality
They move and shift and are hard to keep track
What is vagrant?
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We see a classification b/t criminality and mental illness
Before this they were all seen as the same
Differentiated "pauper lunatics" from "vagrants, sturdy beggars, rouges"
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First time government takes action
Confinement funded by parish
Lunatics, unlike normal poor, not to be whipped
No requirement for treatment however
First time state begins to forcibly confine lunatic on account of predicted dangerousness
Charged JPS with apprehending individuals who "by lunacy, or otherwise are furiously Mad, and dangerous to be
permitted to go Abroad (meaning to be about), and to see that such individual were "kept safely locked up in such
secure place within the county" and if necessary "to be there chained"
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VAGRANCY ACT 1714
Lecture 2; A Brief history of Mental Illness and Psychiatry
January 18, 2016
7:06 PM
Lectures Page 1
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"trade lunancy" develops during 18th c. open to anyone
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Government would pay people who owned property to keep mad people in their houses
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Profit driven in new service economy
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A problem with this is that you are you going to need a lot of lunatics
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Another issue is being locked against their will -- people were afraid of this
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They were storage cases -- they were not facilities just kept them alive
Places of custodial care rather than treatment
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RISE OF PRIVATE MADHOUSES
Anyone could do literally anything or nothing to these people
Was really bad quality of life
Because the amount of mad houses were increases something interesting happen; a publishment of what people
what were doing were come about
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*this is important because with this law we link madness with medicine*
Law required inspection and licensing of madhouses by the Royal College of Physicians
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Involuntary confinement possible only after physican and JP had reviewed case
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There should be some type of measures these mad places should be kept
Beginning of state control of lunacy broadly (not simply madness)
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1774 Act for regulating Madhouses
Advances in science -- couldn’t madness be explained
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Much of the modern world comes from this time where all of these changes happen
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Madness was seen as something that can be fixed and cured
Improvability, changeability, curability
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Science was very pro+ in this era;
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Anything could be changed as long as you applied change + reason
Asylum could be purpose designed, not simply custodial
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Transformation of madness into mental illness, madhouse into therapeutic facility
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THE AGE OF ENLIGHTENMENT
Founded a facility
Founded by Quakers (religious minority), 1796. Lay facility
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They were preachers -- had this idea that ppl with mental illness needed support and kindness
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They wanted the retreat would be self-sustainable
Instead of locking them up they were allowed to work on the land
Mad free to work land
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A benefit of talking to people as human beings instead of beasts
Kindness, rather than harsh regimen, the guide to treatment
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Leading model of moral treatment
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TUKES AND THE YORK RETREAT
Appointed to head French mental hospitals in 1793
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Believed he could improve reasoning ability of mentally ill
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If treated with dignity, patient more likely to recover
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"Therapeutic conversation"
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The first signs of psycho-therapy
If we actually talk to someone we can help them
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He removed the chains off of people
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MORAL TREATMENT - PHILIPPE PINEL
Physicians w/ physical training needed to treatment mentally ill, first classes on "Maladies Mentales"
First classes we see that can be considered psychiatric
That hospitals can be redesigned in a way to improve the patients
Special curative institutions necessary -- further medicalization of madness
Rationality was considered the ultimate quality
They began to plan peoples days; they were hyper-structured
Their days get broken up in parts when you have to move to one part to the next
Regimen is therapeutic
There was this belief that they needed to the removed from other society
That the society had created their madness thus they needed to be removed
Or that it was contagious;
Because either:
Isolation form environment that has "caused" madness
Jean-Etiennne Esquirol (early 19th c.)
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RISE OF THE TREATMENT ASYLUM
Kindness and control, understanding and discipline
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Active role in own treatment
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Calm-setting, large ground, farmland, self sufficiency
Architecture important (I.e. rational, no bars, bright, airy, segregation of patients by gender/disorder)
Discipline (self-control) and routine (to combat impulsiveness)
Idea of making them use reason by placing all the same buttons together
Example; button sorting
Using straight-jackets
Restraint to use sparingly, not to incite terror or pain
This is also following the idea of kindness
Stress on doctor-patient relationship
Orderly life is restorative -- don’t want them to be idle
Purpose-built asylum
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MORAL TREATMENT - BASIC TENETS
1800s to mid-1900s from last resorts to first resort?
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They become very common
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From few (private) small hospitals to many state institutions, explosion of pop.
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Significant -- large proportions of the populations were diagnosed with mental illness
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ASYLUM BULDING ERA
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The rates of abnormal behaviour jump dramatically
Significant -- large proportions of the populations were diagnosed with mental illness
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Also known as psychiatrist
The alienist -- first specialized professional for mental illness
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"Good intentions gone bad"
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New medical profession
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They estimated small proportions but ended up being way larger
Over time they became overcrowded
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Therapy gives way to custodianship
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People who are in charge of these institutions but they do not conduct any kind of therapy
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But People in these places are not necessarily getting better in these institutions
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There is some questions of whether these people actually stayed there forever
Notions of patients, once in the asylum, remained there until their death. Accurate?
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By 1900, asylums full, psychiatrists looked down upon by fellow medical professional, little active therapy
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Hard time to get people who want to get into this practice
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LEGACY OF ASYLUMS
Social control or social rise?
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One result is that society is getting sicker
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Other explanation is that there is some type of re-framing of society
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WHAT CAUSED MASSIC INCREASE IN MENTALLY ILL?
According to him once government becomes more dominant in people's lives mental illness increases
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Mad were those who did not accept new logic of society, victims of social rationalization
That if you did not fit into this category you would be placed in these categories
Growing state authoritarianism
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Due to the changes in society like industrialization there was this presence of structure -- some people refused
thus were sent to these asylums
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Not confined for humanitarian or medical reasons but for control. An attempt to silence/remove the mad
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Link b/t enlightenment and the confinement of the insane -- an attempt to impose reason on the 'unreasonable'
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FOUCAULT - THE GREAT CONFINEMENT
Asylums as 'dumping grounds'
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Took all the people that were undesirable and difficult to deal with, created problems with families
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19th c. witnessed mad being segregated from other deviant by bureaucratic capitalist state machine due to
economic productivity
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Madness transformed into mental illness
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If you create an asylum and its massive you have to fill it -- or you'll just have a big old building
They need people to put into it thus places harsher descriptions of what is considered mentally ill
Existence of asylum accounts for rise in the mentally ill, rather than vice versa
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Examples of things that were controlled; Masturbation, nymphomania (women having sex w/ men that
weren't their husbands)
Upper middle class trying to impose order and control on lower classes (sexual norms, dipsomania (alcoholism))
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Growing numbers of patients reflects widespread labelling of undesirable behaviour as mental illness
Lumber room thesis
Development of psychiatric profession an attempt to establish hegemony over madness to boost own authority
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SOCIAL CONTROL (Focault)
There was court jesters
That were celebrating mad people but now due to authoritarianism we see it being crushed --- this isn't
very convincing however to historians
FOUCALT's Golden Age of Madness" a myth
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Not the state nor profession, but families at forefront of confinement
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Asylums not "dumping ground" but on again, off-again institutions
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People simply being diverted from other institutions, like poorhouse, prison
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Not all mentally ill treated in asylums
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If this was the case why weren't there more people in asylums?
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CRITICISM OF FOUCAULT/SOCIAL CONTROL
Tertiary syphilis; a stage of syphilis that has likeliness to mental illness
Industrialization and urbanization responsible for increasing severity of some mental diseases (i.e. alcohol, tertiary
syphilis) and creating other entirely new categories?
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Seen as a new disease in the 19th century
Recency hypothesis
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Maybe perhaps due to the social differences b/t those coming and those that were here -- that there
cultural/social differences that make it look like they were mentally ill
Immigration left to new social stresses, poor sanitary conditions, exposure to new viruses, etc.
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REAL RISE?
Mental health's greatest moment?
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Or a fatal blow?
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FREUD - A TRUE REVOLUTION
Mental disorder result conflicts b/t id, superego and ego
Aggressive self-satisfying, little self-restraint = id
That reason that you feel guilty for doing things that you know don’t go by the book
Super-ego; part of a person's personality - behaves by the book
Ego; in the middle of these two
Conflicts began in the childhood when ego overburdened by demands of the id and superego (anxiety) it utilizes
defence mechanism (repression, denial)
It is all about bringing up these hidden conflicts
These processes unconscious in nature
Talking can help!
He did not interact with a lot of mental illnesses
The extent to which of his theories are applicable is iffy
Basic theory of Freud
Watch a movie and argue that either the film
promotes stigma or doesn’t promote stigma
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Doesn’t have to be an academic essay
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Can use first person
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Doesn’t need extra sources
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*Have an essay question on this *
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