Psychiatry and Psychology are as old as human existence itself. We know for a fact since the early beginnings of time even before recorded human history early hominid life was characterized by medicine, herbs and yes, even the characterization of insanity.
That characterization included seeing unexplained behavior as anything from godlike to demonic leading to a containment of abhorrent behavior as something outside of normal and the exception. In doing so, hominids were able to secure themselves into a sane rather than strange behavior with explanations of what they saw having it’s own characteristics.
The earliest civilizations, the Egyptians who coined math, science and astrology had explanations for insanity. The Greeks which were among the first ‘thinkers’ came to realize there were maladies of the brain which resulted in permanent and altered behavior. The Romans were among the civilization that saw insanity as a godlike quality of the Gods that ruled the underworld.
The Greeks sought to ‘treat’ insanity with herbal drugs of one kind or another altering body chemistry to enhance accepted behaviors. Altered body chemistry (not brain chemistry) which can be measured today with a simple blood test, tends to change behavior in one fashion or another. Example: Low sodium levels (Na+) causes confusion. Always accompanying the science of psychiatry was the practice of psychology but in many instances that was in the area of spiritual practices and not formal medicine.
The earliest organization of modern day psychiatry began somewhere in the 1700s. But, even then doctors like Franz G. Alexander and Sheldon T. Selesnick stated the treatment of the mentally deranged was beyond the ‘methods of medicine. There was just no acceptable treatment of people and they were frequently locked away from society rather than included in it.
General hospitals were first declared an issue for society in France. Louis XIII in 1676 set aside space for the infirmed. Mind you, being hospitalized until the later 1900’s usually dictated death. The treatment of even common physical illnesses was crude and mostly inhumane with practices like blood letting. IV therapy began with access to veins with metal and/or glass rods and vials that instilled fluid that usually resulted in worsening conditions. People were different centuries ago, they were physically strong and rarely were they depleted so the crude treatment of illness by these methods including early surgeries sometimes worked. Caesarian Section, named after the birth of Caesar’s first born son, for the birth of breached infants was around much earlier than the Roman Empire and was practiced first in Egypt. When ‘interventionary’ medicine worked it spurred the further investigation of scientific study leading to medicine so it all wasn’t so bad. There had to be enough of a survival rate all along the chain of exploration to continue to believe all should not be left up to the gods.
But, with hospitals also came the confinement of the insane including those ordered by a court somewhere in the land for law breakers that were too deranged to contain elsewhere. Custodial institutions, asylums, were the earliest of institutionalized care of the insane but there was no medication or treatment except for very crude methods such as placing those admitted in serpent filled holes to shock them out of their insanity. This is where the name ‘Snake Pit’ was derived referring to the early institutions to contain the insane.
Asylums were ‘convenient’ for society and became a legitimate place to house the insane. Psychiatrists were therefore needed to care medically for these people and for hundreds of years practiced methods that were mostly cruel and not therapeutic but demonstrated ‘logical’ treatment as sane people were to understand it and approve of their treatment of the insane. Asylums were more or less a political institution with little regard for the reality of purposeful treatment.
It wasn’t until the later 1800s that Rudolf Virchow released his Cellular Pathology as Based upon Physiological and Pathological Histology, hence, the beginnings of molecular understanding of the processes of the body and the birth of modern day medicine. That step into the reality of molecular medicine brought with it the fashionable thinking of psychiatry bringing now and finally experimental treatment modalities rather than social confinement and logical explanations. Psychiatry was going to become controversial and indulgent. Indulgence of the insane was a new venue for society who isolated themselves from the strange they were now faced with confronting the mysticism of the mind.
Some of the earliest treatments were still very cruel such as ‘whipping’ but also came the concept of body massage leading to body work and in far away places like the orient practices such as ‘acupuncture’ were still unknown to Western style medicine. Opium would come to be realized as a very early treatment of behavioral disorders.
For some time and not until medicine was more sophisticated, the treatment of the insane remained focused on body work and manipulation and how the mind reacted to that treatment. The methods remained cruel in many ways but at least society was beginning to deal with the fact ‘the mind’ had it’s own illnesses and made a commitment to address them.
As always what coexisted with psychiatry was the success being found in places of psychology and the development of true mental illness not traceable to any physical malady. The late 1800s found itself with a gifted man by the name of Sigmund Freud who wrote a book on hysteria. Hysteria was the first ‘diagnosable’ malady of the mind whereby there was no physical condition but only traumatic experience related to a person’s understanding of life which lead to psychosomatic illness. This book was based on an experience Freud had with a woman who had gradually over time lost use of her body as a form of hysteria related to caring for a man that would eventually die. The illness was psychosomatic and without any interventionary medicine Freud treated the hysteria with patient psychotherapy to reverse the understanding of the trauma and allow the body to stop it’s sympathy with the mind. The treatment was legitimate and Freud coined it in analogy to ‘lancing a boil.’
Freud would come to be respected in some circles demonstrating his ability to captivate society with an understanding of ‘developmental’ psychology based in sexual development of people. First Freud realized the physical needs of the body were satisfied through orifices and hence named his developmental stages as oral, anal and sexual. He divided the mind’s development into Id, Superego and ‘the ego.’ It was the healthy ego society sought to capture.
The trend of psychotherapy spread like wildfire throughout Europe and eventually lead medicine down a path to treat the physical aspects of psychiatric disease as all illnesses of the mind were not satisfied by psychotherapy alone. Some physicians did not see all mental illness as metaphysical as Freud and his followers and detractors did.
In the 1920s and 1930s it was usually some type of shock to the body that was the methodology of treatment including the horrors of Metrozol shock, insulin shock, electroshock and psychosurgery. It wasn’t until the 1950s and 1960s did we realize psychotropic medicines were effective. These medications were originally developed for treatment of physical ailments but side effects were showing control of behavior as well.
One of the earliest discoveries resulted from a chemical used to treat shock in post surgical patients. The patients undergoing surgery were experiencing shock due to anesthesia. A talented French surgeon by the name of Henri Laborit attempted administrations of large amounts antihistamines to reduce swelling and wake people sooner from anesthesia improving their outcomes from surgery. He found a drug by the name of chlorpromazine had an effect on his patients and decided to encourage the use of it in psychiatry. These were the early beginning of psychopharmaceuticals and were discovered to be effective quite by accident. The early drugs psychiatrists used were never developed for psychiatry. It was after this that brain biopsies of cadavers and live patients at times allowed microscopic understanding of what is know today as chemical brain balance. The chemistry of the brain has been come to be called appropriately neurotransmitters. It is a grossly boring subject of which would take a great deal of time to begin to explain and I will not go into it here.
The physical attributes of the brain are quite interesting in the defense mechanisms that exist to protect it. The brain tissue never truly comes in contact with the blood and therefore brain chemistry is not measurable in blood tests. There are intricate mechanisms of specialized cells that compose the brain-blood barrier which protect and nourish brain tissue. Our thoughts are dominated by chemistry. There really is nothing mystical about it, except to say it is an amazing quality of our lives we need to appreciate and hold in esteem. The ‘workings’ of the mind that conducts thoughts is still somewhat distant in understanding but we know through modern diagnostic tools there are ways of looking at ‘normal’ functioning vs. what we as a society call ‘dysfunction.’
Needless to say it wasn’t until journalist got involved did the treatment of the insane take on a humane character. Through film journalism such as Geraldo Rivera’s expose’ on Willowbrook disclosure of cruel and inhumane treatment of society’s discarded people came to light never to remain the same.
Today, psychiatry has honed itself into a specific discipline that still has large avenues of perfection to pursue and one of the most areas of the practice of psychiatry with little emphasis is in the area of women’s disorders known as the Baby Blues, Post Partum Depression and Post Partum Psychosis. Even in the year 2005 these disorders of women are grossly unemphasized by American society and ostracized into prisonable and or institutionalized offenses by women with little regard for the depth of understanding needed in an empathetic society whereby supposedly family and children are the primary focus.
A very healthy discussion regarding the treatment of women experiencing post partum mental illness has begun in the USA and it has it’s basis in the sound understanding of grossly neglected treatment of hormone (steroid) imbalance after parturition. I suggest we return to a venture into understanding the potency of uniquely ‘female’ hormones and their effect on the psychi as well as recognition of the lack of adequate pre-natal preparedness for the event that could easily destroy a family as well as build one.
