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• Mental illness must be understood as a cultural construct, not a natural fact, according to Foucault and Szasz.
• Sir Martin Roth and Jerome Kroll have argued that the long-term stability of psychiatric symptoms indicates mental illness is a real psychopathological entity.
• The evolution of psychiatry is related to the evolution of civilization.

Prehistoric Period

• Little evidence exists from this time due to a lack of written records.
• Archeologists have discovered trepanned skulls dating back to at least 5000 BC.
• Madness was considered a matter of fate or punishment, dealt with by witch doctors.
• Mental and physical suffering were not distinguished, and medicine, magic, and religion were intertwined.

Ancient Civilizations

• Egyptian and Mesopotamian views attributed mental affliction to demonic possession.
• Incantation was used as treatment, dominated by magic and religion, aiming to reconcile the suffering with the transcendental world.
• In ancient India, angry demons were thought to inhabit the body, causing mental illness.
• Imbalances of bodily fluids were seen as a cause, treated with animistic and exorcistic practices.
• Hebrew and Israelite beliefs connected One God with mental illness, stemming from problems in the relationship between man and God.
• Curing disease was considered an attribute of the Divine.

Ancient Times

• Epilepsy was viewed as an example of mental illness in ancient civilizations.
• Babylonians considered demons attacking the person as the cause.
• Hindu cultures associated the goddess Graphi.
• Greece regarded visions as brought by the Gods and demonic possession as a cause.

The Classical Era

• Elemental conflicts caused mental illness according authors like Homer, Sophocles and Euripides.
• An imbalance in the four humors of the body were also a considered a cause.

The Playwrights

• People driven to insanity by the gods, crushed by destiny, or driven to madness by self-infliction.
• Agony could lead to wisdom.

Hippocrates (460 BC - 370 BC)

• Gods were not held responsible, and medicine was naturalized.
• Epilepsy was not more divine or sacred than other diseases, but had a natural cause.

Humoralism

• Black bile was associated with melancholia, located in the spleen.
• Yellow bile was connected to a choleric temperament, causing one to be easily angered, located in the liver.
• Blood was associated with unstable mood shifts, located in the heart.
• Phlegm was linked to a phlegmatic disposition, associated with being calm, located in the brain.

Hippocrates

• Mental illness comes from an imbalance of the four humours.
• Appropriate treatment depended on which bodily fluid or humour had caused the problem.
• Disease can be cured by using elements opposite to the four fundamental qualities: heat, dryness, moisture, and cold.
• Hippocrates developed the first classification for mental illnesses

The Influence of Hippocrates

• Hippocratic physicians recognized a number of mental illnesses that still exist or are similar to modern conditions
• One of the conditions were classified as mania, melancholy, paranoia, and epilepsy.

Humoralism

• Healthiness is defined by equilibrium. Sickness is defined by the extremes of mania and melancholia.
• Bipolar was a concept ingrained in the minds of educated people.

Plato & Aristotle

• Plato believed their were 2 types of mental illness: One type divinely inspired which gives the person prophetic powers. The other type caused by physical disease.
• Aristotle abandoned the divine explanation of mental illness, attributing it to physical problems..

Return of the Supernatural

• Emperor Constantine officially sanctioned Christianity in the Roman Empire in the 4th C BC..
• This legitimized supernatural beliefs and promoted faith and love and belief in the will of God over reason.
• Holy madness was distinguished from mental illness.
• This had implications for treatments, including religious houses.

Galen (129-200AD)

• The site of the rational soul is the brain.
• Sever emotional disturbance might indicate a lesion in the brain.
• Adopting a single symptom approach rather than broad diagnostic categories.
• Seeking an intergrating force to link mind and body.
• Personality types are based on humours.

Aretaeus of Cappadocia

• Contempary of Galen, Aretaeus is credited with identifying what would later be bipolar disorder.
• Classical period = Madness was rationalized.

Middle Ages (5th to 15th century)

• In the Muslim world, mental disorder was thought be related to a loss of reason.
• People who were mentally disordered were thought of as worthy of humane treatment
• The first psychiatric hospital was founded in Baghdad in 705.
• In Christian Europe, demons came back and diabolic possession.
• Exorcism was treatment for this, including purges, bloodletting, and whipping.

Renaissance (14th to 17th century)

• During this time there was a large humanistic movement, which included the revival of Greek learning.
• The individuality of man served the strivings of man through intellect.
• There was a rejection of withcraft and a push for realism.
• Johann Weyer wrote "On the Illusions of the Demons and on Spells and Poisons" in (1563)
• Weyer criticized Christian witch hurthing and investigated cases of "witchcraft" which became psychiatric descriptions of different mental disorders.

Modern Period (17th to 19th century)

• Reason was emphasized
• The first medical textbook on psychiatry (Felix Platter's Praxix Medica) was published in 1602.
• In the 18th century there was greater classification of mental symptoms.
• There was a skyrocketing of numbers of mental hospitals in Europe in the 19th century.
• The moral treatment movement developed towards the end of the 18th century
• William Tuke (England) (1732-1822) and Hannah Mills (1790) pioneered humane treatment by creating the York Retreat.
• Benjamin Rush (United States) (1745-1813) linked disease to moral therapy.
• Chiarugi (Italy) (1759-1820) said bodily stated influenced the mind via the activites of the senses and the nervous system at large.
• He was known as someone who beieved the mentally ill should be respected as people.
• Pinel (France) (1745-1826) categorized mental illnesses as madness which was a breakdown of internal, rational discipline.
• In 1978 he published an authoritative calssification of diseases called "Nosographie philosophique ou méthode de l'analyse appliquée à la médecine”.

Charcot

• Charcot (1825 – 1893) France was the founder of modern neurology.
• Charcot was a clinical proffesor of the nervous system at the Salpetriere.
• Charcot said that Hysteria was a neurological disorder caused by hereditary problems in the nervious system.

Late 19th to 20th Century

• Dorothy Dix (1802-1887), started the mental of hygene movement which funded 32 state hospitals.
• This was also the 1st generation of American mental asylums.
• Emil Kraepelin (1855-1926) was known for classifying based on symptomatology, which lead to 15 catagories disorder
• This caused organic manic-depressive psychosis (good prognosis) versus dementia praecox (incurable).
• Sigmaud Frued (185--1939), creates a psychoanalytical model which causes non-psychotic disorders.

History of the DSM

• In 1918, the first standardized psychiatric calssification system was created: Statistical Manual fot the use of Institutions for the insane in the US.
• This was needed for an official calssification sustem.
• This also aided the cllection of statistical information.

DSM-I

• DSM-I was released int 1952.
• It was part of the American Physchiatric Association Committee on Nomenclature and Statistics.
• This created descriptions of disgnosistic categories and clinical utility.
• This also reflected psychoanalytical theories.
• There was unclear diagnostic catagories.

DSM-II

• DSM-II was released in 1968.
• It was very similiar to DSM-1

DSM-III

• DSM-III was released in 1980
• It was known for its explicet diagnostice catagories, multiaxial system, and theoretically netual
• It had inconsistencitsand ambiguities.
• 1987: DSM-III-R changed catagories and resolved inconsistencies.

DSM-IV

• DSM-IV was released in 1994.
• It had a three stage emperical process, which had literature reviews, reanalysis of data
• It was simplified by extensive issue-focused field trials

Goals

• All the versions aimed to correct errors
• Ensure information is up-to-date
• Make necessary changes

DSM 5

• DSM-5 was published on May 18, 2013.
• The development of the new edition began with a conference in 1999
• A task force was formed in 2007 which developed and field tested new classifications
• It was not greatly different from DSM IV
• Various authorities have criticized the fifthd edition