Term
| WHY SHOULD WE CARE ABOUT HISTORY? |
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Definition
• Intrinsically interesting
• Helps avoid mistakes of the past?
• “To understand the present, one must begin in the past” (Ann Johnson)
• Helps to predict the future? |
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Term
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Definition
• The writing of history
• The study of the methods of history and historical writing |
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Term
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Definition
- Practitioner vs academic historians
- Internalism vs externalism
- Synchronic (“cross-sectional”) vs diachronical (“longitudnal”)
- Presentism |
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Term
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Definition
| practice a non-historical discipline (like science of mental illness) and then develop an interest in the history of their field |
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Term
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Definition
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Term
| Tensions between Academic and Practitioner Historians |
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Definition
○ Academic historians criticize practitioner historians because they are not trained in history
○ Practitioner historians see problems with academic historians because academic historians are not trained in the fields they are studying (like science of mental illness); they don’t truly understand the deeper complex more technical issues; academic historians are not interested in science |
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Term
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Definition
- highly focused on the events immediately surrounding the subject matter
○ Ex: in the early 1950's Thorzine was introduced into psychology; step by step description of how Thorzine was introduced |
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Term
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Definition
| step back and look at the broader concepts surrounding a subject matter (social, cultural concepts) |
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Term
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Definition
- tends to view historical change as “progress”, also emphasizes personalistic perspective
○ Longitudinal approach to writing about history; focuses on personalities responsible for the developments
○ Personalistic perspective: historical events are a product of the actions of men
Ex: evolution was discovered because of Darwin |
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Term
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Definition
- tends toward externalism, emphasizes the naturalistic perspective (Zeitgeist)
○ Cross-sectional; relates the event of interest to everything else that is going on at the time
○ Naturalistic perspective: historical events are a product of their time
Ex: if Darwin had not discovered evolution, someone else would have |
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Term
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Definition
• Bad – judging past by today’s standards
○ Ex: Water Freeman (did lobotomies) is guilty of medical malpractice
§ This is taken out of context; in the 1930's this made sense
• Good – using present to understand the past
• Good – using past to understand the present
• (presentism is usually critical; not thought of as a good thing by historians)
• Instead of blindly judging, ask: "Were those things reasonable in the context they were developed?" |
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Term
| HISTORY AND SCIENCE DIFFERENCES |
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Definition
• Historical events are unique
• Ex: WWII only happened once, never happened before and will never happen again
• Science often deals with repeatable events
• Scientific experiments deal with trying to manipulate variables in order to create repeatable events
• In science the causal variable can be isolated and manipulated
• Science yields laws
Relationships between variables that hold true through time |
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Term
| HISTORY AND SCIENCE SIMILARITIES |
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Definition
• History is (or should be) evidence based
• Both strive for truth
• Knowledge is cumulative
• Historical conclusions are subject to refutation
• As many people would say about science
• Some sciences deal with non-repeatable events, e.g., evolutionary biology, geology, cosmology
• History is, arguably, lawful |
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Term
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Definition
• “Those who cannot remember the past are condemned to repeat it.” (Law of Repetitive Consequences, George Santayana)
• The prevalence of a mental disorder is directly proportional to the availability of treatment for that disorder |
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Term
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Definition
| Description of events (what happened), including a chronology (dimension of time), and explication of cause and effect based on evidence |
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Term
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Definition
- Science relies on inductive reasoning
- Popperain model of science
- • All experience (evidence) is interpreted |
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Term
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Definition
○ Going from particular events to a generalization
○ Ex: see a sample of crows that are all black; conclude that the entire population of crows are black. This is invalid! |
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Term
| Popperain model of science |
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Definition
- Conjecture
- Refutation (a hallmark of a scientific statement)
- If a statement is put into a form that it can not be refuted then it is not considered a scientific statement
- Science doesn't proceed by proving things, rather it proceeds by disproving things |
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Term
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Definition
• Everything we see and experience is what our brain interprets it to be
• Everything we know about the external world is coded
• How can we be sure that our nervous systems are coding everything accurately?
○ We can't know with absolute certainty that what our senses tell us is accurate
- Therefore all knowledge is a social construction |
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Term
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Definition
• Wrote a history of mental illness
• Said mental illness does not exist; it is a social construction |
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Term
| Foucault’s Social Construction of Reality |
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Definition
| “Each society has its regime of truth, its ‘general politics’ of truth: that is, the types of discourse which it accepts and makes function as true; the mechanisms and instances which enable one to distinguish true and false statements, the means by which each is sanctioned; the techniques and procedures accorded value in acquisition of truth; the status of those who are charged with saying what counts as true.” |
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Term
| The New Historicism/Postmodernism |
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Definition
• Social construction of reality
• We can have no objective knowledge of the external world
• All knowledge is uncertain
• Knowledge is, therefore, a social construction
• **extreme view but contains a kernel of truth**
• Implications
• Relative truth (and morality)
• No distinction between fact and fiction
• No distinction between history and literature
• The “New Historicism”, “Postmodernism”
• Literature
• History
• Cultural studies
○ Aversion to saying one culture is better than another
○ So each culture has its own "legitimate truth"
• Social Science |
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Term
| THOMAS KUHNTHE STRUCTURE OF SCIENTIFIC REVOLUTIONS |
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Definition
• He elaborates the social aspects of science
• Said science cycles between normal science and scientific revolution |
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Term
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Definition
| set of beliefs that is generally held by a particular scientific community |
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Term
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Definition
○ Paradigm driven
- Defines fundamental nature of the thing studied
□ Ex. Mental illness is defined as biological
- Defines questions that are legitimate to ask
□ In mental illness would ask questions related to biology (physical symptoms)
- Defines methods
○ Aimed at confirming and extending paradigm
- Not necessarily searching for the truth- only want to confirm paradigm
○ Cumulative growth of knowledge
○ Continuity of knowledge and concepts
- All ideas, explanations, concepts should be consistent with paradigm
○ Troublesome anomalies are ignored or explained away
- Anomalies: ideas that are not consistent with paradigm
- Anomalies build up until you can ignore them
□ Then someone will propose a new paradigm
□ Leads to paradigm shift |
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Term
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Definition
○ Paradigm shift
§ When new paradigm is adopted that is qualitatively different than the one that was previously in place
○ Discontinuous growth of knowledge |
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Term
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Definition
- Madness is an archaic term
- Etymology
- Philosophy |
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Term
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Definition
• Madness – from Gothic Mod, meaning anger or rage
• Modnesse – Old English, additional meaning folly or foolishness |
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Term
| MADNESS CAME TO BE A GENERIC TERM FOR SEVERE MENTAL ILLNESS |
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Definition
• Delusions
• Hallucinations
• Disorganized Thinking
• Bizarre Behavior
• Severe Mood Swings |
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Term
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Definition
• Mania – from Greek mainesthai, meaning to rage
• Insane – from Latin insanus, meaning unsound mind
• Delirium – from Latin de lira, meaning out of the track
• Crazy – from French encrase, meaning crushed or broken
• Lunacy – from Latin lunaticus, meaning moonstruck
• Psychosis- correct synonym to use today |
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Term
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Definition
• Term coined in 1845 by von Feuchtersleben (do not have to know name)
• Disturbance of mind involving
• Passions (emotion, particularly instinctual drives like sex, anger, aggression)
• Judgment
• Hallucinations (Seeing something that is not there (no stimulus). Different from an illusion where there is a stimulus that is just distorted)
○ Most common in mental illness is auditory- hearing voices
• Delusions
○ False beliefs
○ Religious delusions are common (i.e. belief that they are Jesus)
• Term (psychosis) comes into general use in early 20th century
• Organic vs Functional Psychoses |
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Term
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Definition
• Demonstrable neuropathology (“organicity”)
• Something wrong with the brain
• Infectious diseases (e.g., syphilis - GPI)
• Syphilis plays central role in history of psychology
• GPI: General Paresis of the Insane
○ Happens when syphilis has entered the brain
○ Before 1940 about 20% of people in mental institutions had this!
• Toxins (e.g., alcohol, mercury, drugs)
• Drug induced psychosis is most strongly associated with amphetamines
• Neurological diseases (e.g., epilepsy, Alzheimer’s, tumors, head injury)
• Metabolic disorders (Pellagra, hyperthyroidism)
• In 20 century organic psychoses becomes the domain of neurology |
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Term
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Definition
• Functional implies organiscity, but organicity is not demonstrable
• Oragnicity presumed, but not demonstrable
• Schizophrenia, manic-depressive disorder
• We really don’t know what causes these
• Can't call it organic because we don’t know what the problem is
• Has always been domain of main-stream psychiatry |
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Term
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Definition
- Are not a defining characteristic of psychosis
- Were considered a separate category
- Melancholia – from Greek melas, meaning black and chole, meaning bile
• Used to mean depression
- For Most of History Mental Disorders had a Dichotomous Classification
○ Madness
○ Melancholia |
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Term
| ICD: International Classification of Disease |
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Definition
| Entire world uses it except the US |
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Term
| The Diagnostic and Statistical Manual of Mental Disorders (DSM – IV) |
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Definition
○ Approximately 200 categories of mental disorder
- (Went from 2 to 200)
○ Heterogeneous symptoms within categories and overlap of symptoms between categories
- In one disorder- symptoms can be very different; between disorders- there is a lot of overlap
- This makes diagnoses very difficult
• DSM V to be published in 2013
○ New disorders (e.g., hypersexual disorder; temper dysregulation disorder)
○ Asperger's syndrome will be eliminated and put in ASD
○ Dimensional representation, particularly for personality disorders |
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Term
| Most problems that patients present to psychologists and psychiatrists are: |
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Definition
1st person subjective experiences
○ Disturbances of thought
○ Disturbances of perception
○ Disturbances of emotion |
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Term
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Definition
• Body
○ Material
○ Has mass and form
○ Has location in time and space
○ Is about nothing
• Mind
○ Not material
○ Has no mass or form
○ Has no location in space, may or may not be temporally limited
○ Mental activity is about something |
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Term
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Definition
• Mind and matter are fundamentally different entities
• Popularized by Rene Descartes
• Proposed two-way interactionism
○ Mind could influence body; body could influence mind
• Problem with theory: No one has been able to explain how two fundamentally different entities could interact with each other |
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Term
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Definition
• Mind and matter are not fundamentally different
• Idealism: it’s all mind, no matter
○ George (Bishop) Berkely (“to be is to be perceived”)
○ Material does not exists except for in mentation
○ If you were in a room by yourself, you would cease to exist
His solution was you were held in existence by the mind of God |
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Term
| Materialism (Physicalism, Naturalism) |
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Definition
- type of monism
- it’s all matter, no mind
○ Physicalism: more broad; basic forces of nature
○ Naturalism: usually used in a theological context; they don’t believe in the supernatural
○ Most scientists would be materialist
○ Mind and body are both made out of material |
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Term
| Different types of materialism |
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Definition
- Logical Behaviorism
- Neurophysiological Identity Theory |
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Term
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Definition
□ A monistic materialistic theory
□ Did not believe that mental activity exists or that it can't be explained, so there is no point to study it
□ How do you explain thirst?
- A mental state like thirst is no more than a predisposition to behave in a certain way
- Thirst is the high probability that when presented with water, you with drink it |
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Term
| Neurophysiological Identity Theory |
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Definition
□ Another monistic materialistic theory
□ Mind IS brain processes
Ignores reality of our subjective experiences |
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Term
| Materialistic monism - issues |
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Definition
• How does matter become “conscious”?
○ What is consciousness?
- Awareness of internal and external environment
- Awareness of self ; What is the thing referred to by “I”?
□ How do you explain ability to think about thinking; ability of the mind to be aware of different parts of the mind
○ How do you explain “qualia” "The 'what it is like' character of mental states”; Can “qualia” be explained by physical processes?; the Mary problem
• Materialism strongly implies Determinism
• Materialism also implies Reductionism |
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Term
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Definition
○ The future is fixed by the past; The present is the effect of the past and the cause of the future
○ There is no “free will”
- Everything you do and feel is beyond your control
○ Can be construed to negate personal responsibility
○ The universe works by an unbroken chain of cause and effect starting with the big bang.
○ Can be used to negate personal responsibility
- If everything is determined, how can we say anyone is responsible for anything they do? |
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Term
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Definition
-properties of a complex phenomenon can be understood in terms of its parts
• Everything is made up of atoms; cells; tissues; organs, etc.
• If that is true, we should be able to start at the top and look at one level below and explain it |
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Term
| Problems of Physical Reductionism |
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Definition
• The idea may be fundamentally wrong
○ Emergence (the whole is more than the sum of the parts)
- As we move from one level of complexity to a higher level, new physical laws emerge
□ Because new laws emerge you can't explain the higher phenomenon completely by the lower phenomenon
- Many scientists would reject the idea of emergence
• Although it may be right in principle
○ We are not close to being able to reduce mental phenomena to biological
○ It is impractical |
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Term
| A Modern Materialistic theory of Mind |
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Definition
• The functional /Computational / Information Processing theory of mind
• Mind is totally dependent on a neuroanatomical substrate and neurophysiological processes
• Brain is a biological information processing device (i.e., it is a biologic computer)
• The mind is somehow a product of complex information processing
• A central issues is are conscious mental states causative
• The “feeling” that we are in control of our actions may be an illusion
• An interesting implication of this theory is that minds can, in theory, exist on non-biologic substrates |
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Term
| Information Processing Perspective on Etiology (cause) of Madness |
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Definition
• Mental disorders are disorders of information processing
• Two possible loci of defects in information processing
○ Wetware (like hardware)
○ Software |
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Term
| Two possible causes of wetware and software problems |
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Definition
○ Genetic (nature)
- Can effect wetware
- Can effect software – Blank slate is a myth
- Theory of Mind: we all have the ability to understand (to some degree) other peoples' minds
□ Physi |
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Term
| Two broad approaches to treatment of mental disorders |
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Definition
• Two sources of impaired information processing (i.e., mental disorder): Problems in 1) wetware 2) software
• Correct defect in the software of the mind
○ Psychotherapy
○ Counseling
○ Education
○ Behavior modification
• Correct defect in wetware
○ Drugs
○ Psychosurgery
○ Coma and convulsive therapies
○ Etc. |
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Term
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Definition
○ One of first forms of mental illness
○ Only occurred in women
○ Believed this was caused by a wandering uterus
○ Was it really conceived of as a mental disorder?
□ If it was caused by wandering uterus, then that would be purely physical |
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Term
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Definition
- father of modern medicine
• Emphasized naturalism and observation (empiricism)
Believed illness was caused by natural causes |
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Term
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Definition
○ 26 treatises
○ More than 50 subjects
○ Written by various physicians
○ No single work that refers to mental illness, but one work comes close: "On the Sacred Disease" |
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Term
| Hippocratic theory of medicine |
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Definition
○ Also called humoral theory
○ Humor refers to fluids
Believed illness was imbalance of body fluids |
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Term
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Definition
- Sanguine
- Phlegmatic
- Melancholic
- Choleric |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
• “the patient loses his speech, and chokes, and foam issues by the mouth, the teeth are fixed, the hands are contracted, the eyes distorted, he become insensible, and in some cases the bowels are evacuated”
- Referring to epilepsy
○ Was considered to be a mental illness
• “it appears to me to be nowise more divine nor more sacred than other diseases”
- Ancient people were afraid of epileptics (thought they were possessed), but these physicians say this is an illness and it has a natural cause
• “it occurs in those who are of a phlegmatic constitution, but does not attack the bilious”
• “the brain is the cause of this affection”
- Placed the seat of epilepsy in the brain (they got this right)
• “from nothing else but the brain come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentation…And by this same organ we become mad” |
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Term
| Ancient treatments for mental illness |
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Definition
• Opium
○ Pain suppression, sedative, mood lifting
• Purges (hellebore- most famous drug used for this purpose)
○ Complete emptying out of the GI track
○ Used from 400 BC right up to modern times
• Bleeding
○ Actually does the opposite of promoting health
• Fire Cupping
○ Also practiced right up to modern times
• Poultice
○ A solution that was rubbed all over the body
• Relaxation
○ Listen to music, go to quiet place, read a book
○ Sensible
• Diet
○ Sensible
• Because of relaxation and diet: number 1 rule of medicine- "Do no harm" |
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Term
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Definition
• Methodist (not Hippocratic)
○ Solidism
□ Believed it was the solid part of the body, not the liquids, that caused illness
○ Atomism
□ Believed body was made up of atoms and that the holes between atoms could contract and expand and the contraction and expansion between atoms was responsible for illness
• Wrote “On Acute and Chronic Diseases”
○ Contained chapters devoted to Mania and Melancholia
○ Characteristics Mania
□ Impairment of reason
□ Sudden emotional change
□ Delusions
○ Characteristics of Melancholia
□ “Downcast”, rarely cheerful
□ Mental anguish
□ Longing for death |
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Term
| ARETAEUS (1st century AD) |
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Definition
• Eclectic (does not belong to any particular theory)
• Wrote “Causes and Symptoms of Chronic Disease”
○ Contained separate chapters on Mania and Melancholia
• Thought melancholia was “the commencement and part of mania”
○ Thought melancholia was the precursor to mania
○ Described mental illness with alternating forms of depression and mania
• Often credited as first person to recognize bipolar disorder |
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Term
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Definition
• Probably most important of the Greek people we've talked about
• Founder of experimental physiology
○ Arteries contain blood
○ Traced 7 cranial nerves
○ Distinguished between sensory and motor nerves
○ Said that nerves relay impulses to and from brain and spinal cord
• Promoted Hippocratic doctrine
• Codified and disseminated primitive medical theory to Medieval world and beyond
• Dominated western medicine of 1500 years
○ Because of the books he wrote |
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Term
| Medicine in the Middle ages |
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Definition
• Medicine in general, and hospitals in particular, have always been strongly linked to religion
• First hospitals appear in far east ca 400BC
• When Christianity became official religion of Roman empire (ca 400 AD) there was a rapid proliferation of hospitals
• Most of these hospitals were associated with the Church
• These hospitals maintained medical libraries and many adopted a teaching mission
• Formal practice and teaching of medicine was Hippocratic and based on works of Galen
• Many (if not most) formally trained physicians in the Middle ages were priests
• So “academic” medicine in the Middle ages certainly had a spiritual dimension,
• But since “academic” medicine was Hippocratic it was also naturalistic and empirical
• Religious institutions were often sources of compassion for the mentally ill
• Inquisition aimed at heretics not mentally ill
• Torture of mentally ill for witch craft was probably rare
• Obsession with demonology and persecution of the mentally ill occurred during the Renaissance and after |
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Term
| Development of psychiatry is directly related to evolution of mental hospitals |
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Definition
• The idea of a therapeutic mental hospital got psychiatry started
• Institutions for mentally ill appear in 15th century
• Mission was custodial, not therapeutic
○ Protect society from individual
○ Protect and care for individual?
○ Not really, people were very mistreated
• Resembled jails more than hospitals
○ Had no therapeutic mission
○ Mental illness was seen as an incurable disease
○ Put into cells, shackled to walls
• Some were even “tourist” attractions
○ St. Mary’s of Bethlehem (Bedlam)
○ Lunatic’s Tower Vienna
• About 1750 the idea emerged that hospitalization could be curative
• The rise of modern psychiatry is directly related to a shift in mission of mental hospitals from “custodial” to “therapeutic” |
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Term
| Why the shift from custodial to therapeutic mission? |
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Definition
• “Personalistic” or “Great Man” theories – progress and change are due to the influences of individual men and women
○ “The history of the world is but the biography of great men.” Thomas Carlyle
• “Naturalistic” theory of history – change and progress are related to the “intellectual spirit of the times” or the Zeitgeist
• Rise of therapeutic hospitals is the product of both |
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Term
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Definition
○ 18th intellectual movement away from authority (particularly religious) toward science and reason
○ Extended into social realm and medicine
○ Enlightenment thinking gives rise to new therapeutic optimism
• Mental illness is curable
• Hospitalization is essential part of treatment |
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Term
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Definition
• Term “psychiatry” coined in 1808 by Reil
• From Gk. psykhe- "mind“ + iatreia "healing, care"
• For most of the 19th century they were called “alineists” - one who treats mental alienation
• Most of the first psychiatrists were superintendents of mental hospitals
• Original name of the American Psychiatric Association was “Association of Medical Superintendents of American Institutions for the Insane” |
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Term
| William Battie (1703-1776) |
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Definition
| “Repeated experience has convinced me that confinement alone is often times sufficient, but always so necessary, that without it every method hitherto devised for the cure of Madness would be ineffectual.” |
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Term
|
Definition
• Term “psychiatry” coined in 1808 by Reil
• From Gk. psykhe- "mind“ + iatreia "healing, care"
• For most of the 19th century they were called “alineists” - one who treats mental alienation
• Most of the first psychiatrists were superintendents of mental hospitals
• Original name of the American Psychiatric Association was “Association of Medical Superintendents of American Institutions for the Insane” |
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Term
| Vincenzio Chiarugi (1759-1820) |
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Definition
• Wrote a book on how to run a mental hospital
• Very explicit and detailed about the routine of running a therapeutic hospital
• First to experiment with moral (mental) therapy
○ Early form of psychotherapy or counseling
○ Being nice to patients, giving encouragement, etc.
• Humane treatment starts to evolve |
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Term
| Philippe Pinel (1745-1826) |
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Definition
• Also wrote a book- much more influential than Chiarugi
• He ordered that shackles be removed from patients and that they should be treated humanely |
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Term
| Benjamin Rush (1745-1813) |
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Definition
- Father of American Psychiatry
- Believer in biological cause of mental illness
- credited with inventing the tranquilizer (a chair that patient was strapped to and wooded box lowered over their head)
- Another therapy he developed was the 'spinning chair'
- Patient would be spun in order to get rid of the blood in the brain |
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Term
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Definition
- Rich British Quaker
○ Not a doctor
- Made a hospital called the York Retreat
- His son and grandson followed in his footsteps |
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Term
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Definition
- wrote a book on moral therapy
- A layperson's view of how to treat the mentally ill in a hospital |
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Term
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Definition
○ Model of what a mental hospital should be
○ Small, had entertainment (like plays, concerts), had well-kept gardens |
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Term
| Therapeutic Hospitals ca 1800-1850 |
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Definition
• Small – dozens to a few hundred patients
• Mix of public and private hospitals (differed from country to country)
• Not enough hospitals to care for all the mentally ill
• Belief that mental illness was increasing
○ Growing perception that mental illness was becoming an epidemic disease
• Growing humanitarian concern
• Leads to pressure to build more and larger hospitals
○ Very quickly lost the therapeutic role |
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Term
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Definition
- Influential early advocate for the mentally ill
- Pressed for construction of state mental hospitals
- Was a school teacher
- Very religious woman
- Did bible studies for women
- Traveled the country side finding horrible conditions for mentally ill people
- Advocated for construction of public hospitals |
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Term
| Why did hospital populations increase unrelentingly for 150 years? |
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Definition
• Conspiracy theory
• The nosocomial argument
• Increase in mental illness |
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Term
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Definition
• Mental illness is a social construction
• Invented by capitalists in conspiracy with the central state and psychiatrists to control unfit, deviant, and unproductive members of society
• Problems with Foucault
○ In some countries (e.g., England) most early hospitals were private
○ Hospital population grew in non-capitalist countries (e.g., Italy)
○ Until the 20th century the number of hospitalized patients was relatively small – no “grand confinement” |
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Term
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Definition
• According to the nosocomial view increased hospital population was due to factors (other than an increase in mental illness) that influenced hospitalization
• Among the nosocomial factors are:
○ Redistribution of the mentally ill from the general population to hospitals
○ More accurate case identification
○ Broadening of the concept of mental illness
○ Increasing positive attitudes of public toward hospitals |
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Term
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Definition
• When “asylum era” began there was a huge “extra-hospital” population of mentally ill
• As hospital beds were added, they were filled by the extra hospital population |
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Term
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Definition
| percent of the population that has mental illness |
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Term
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Definition
| Number of new cases of mental illness in a period of time |
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Term
| Things that affect prevalence |
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Definition
• How long a disease lasts
• Things that affect how long a disease last
○ Death rates
○ Recovery rates |
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Term
| Factors that increase first admissions |
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Definition
○ Increased incidence
○ Redistribution
○ Changes in diagnosis
○ Increased public acceptance of hospitalization |
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Term
| Factors that can decrease first admissions |
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Definition
○ No beds (overcrowding)
○ Decreased public acceptance of hospitalization
○ Changes in admission practices |
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Term
| If mental illness was increasing what diseases may account for this? |
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Definition
• Syphilis (general paresis of the insane, GPI)
• Mental illness related to senility
○ Psychoneuroses
- Relatively minor mental disorders that were "invented" by Freudian psychologists
- Reflects growing influence of Freudian thought |
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Term
| The Recency Hypothesis of schizophrenia |
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Definition
• In about 1750 schizophrenia or a variant of schizophrenia began to increase
• Some symptoms of schizophrenia have been recorded since antiquity
• But, many disorders other than schizophrenia have these symptoms, e.g.,
○ Fever
○ Chronic alcoholism
○ Metabolic disorders |
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Term
| Descriptions of “classic” schizophrenia increase dramatically in the 19th century |
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Definition
• First unambiguous description of schizophrenia made by Haslam in 1809
• Among children admitted to the Bethlem Royal Hospital, recording of hallucinations and delusions, respectively, rose from 4% to 73% and 49% to 89% between 1830 and 1899, Wilkins
• By the end of the 19th century psychosis in youth had become so common that Thomas Clouston said “Adolescent insanity ending in secondary dementia may be regarded as the typical form of mental illness.” |
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Term
| Factors correlated with in increase in schizophrenia |
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Definition
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Term
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Definition
○ Founded National Committee for Mental Hygiene
○ Became mentally ill (probably had schizophrenia), went to a state mental institution, experienced abuse, neglect, etc
○ Eventually recovered well enough to be released
○ Wrote a book about his experience in the mental hospital: "A Mind that Found Itself"
• Eugenics practices spread
○ Wanted to prevent the mentally ill from reproducing |
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Term
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Definition
- First proposed deinstitutionalizaion in 1934
○ Report he wrote was so critical, the government wouldn’t publish it
○ Said the hospitals needed to be closed because conditions were terrible |
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Term
| Mechanisms of deinstitutionalization |
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Definition
○ Parole- return them to their families (if they'll take them)
○ Foster care- families would agree to take a mentally ill person into their house for a fee
○ Outpatient clinics |
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Term
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Definition
The Shame of the States
Traveled to hospitals and took pictures |
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Term
| Things to Look for in “The Snake Pit” |
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Definition
• Depiction of institutions and the ward system
○ Different wards for different disabilities
○ e.g. ward 1 might be nice, ward 30 might be the incontinence ward
○ As Virginia gets worse, she moves to worse and worse wards
• Depiction of mental illness
○ Probably had schizophrenia (auditory hallucinations)
• Medical treatments
○ Electroconvulsive therapy (ECT)
○ Narcoanalysis
○ Narco=drug; Analysis= psychoanalysis
○ Sedate and then talk to patient about early childhood experiences
○ Psychoanalysis was not an effective treatment for someone who is schizophrenic
○ Hydrotherapy
• Cause of Virginia’s illness
○ Her mother was not sufficiently warm and loving
○ Central theme of psychoanalytic theory- cold mother syndrome
• How Virginia is ultimately cured
○ Psychoanalysits were portrayed as the good guys |
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Term
| Drugs and Deinstitutionalization |
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Definition
• Decline in population of mental hospitals is often attribute to the therapeutic effect of modern drugs
• However, the drugs did NOT cure mental illness
• At best, and in theory, the drugs enable the mentally ill to live in less restrictive environments
• But, even with drugs, the mentally ill needed community support to function
• Adequate community support never provided |
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Term
| Driving Forces of Deinstitutionalization |
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Definition
• Economics
• Social movement
• Advent of modern psychotherapeutic drugs
• Entitlement programs, Medicaid, SSI
• Legal movement, patient rights
○ A 'right to treatment' was established through litigation- but institutions did not provide that so were shut down |
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Term
| LEGACIES OF DEINSTITUTIONALIZATION |
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Definition
• Homelessness
• Repeated re-institutionalization
• Inadequate treatment
• 2nd great redistribution – from hospitals to prisons
○ 20% of prison population is mentally ill
○ (about 500,000 people)
○ ***This is the same number of people who were institutionalized in 1950's |
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Term
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Definition
- Mental illness is a social construction
- Growth of mental hospitals was due to redistribution
- People were drawn to hospitals by increasing positive attitudes
- Boundaries of mental illness expanded
- Any real increase in prevalence was caused by an increased duration of mental illness due to: 1) an increase in chronic forms,
2) an increase life expectancy,
3) a decrease in recovery rates |
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Term
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Definition
| The Joint Commission received a mandate from Congress in 1955 to survey the resources and to make recommendations for combating mental illness in the United States. A central theme of the final report was that treatment be shifted from long-term care in state mental hospital to intense acute care in the community. The report explicitly advocated closing of long-term care state hospitals as rapidly as possible. As can be seen, it is only after the issuance of this report that first admissions and readmissions begin to decline. So social policy, not drugs was responsible for the rapid decline in the population of mental health hospitals. |
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