History of Diagnostic Categories: Mental Illness Through The Ages PDF

Changes in diagnostic categories throughout the ages Sydney B. Miller Tonje J. Persson Jiahong Sun Rachael Neal Jessica Yott Introduction  Foucault and Szasz (The Myth of Mental Illness) argued that mental illness must...

Changes in diagnostic categories throughout the ages Sydney B. Miller Tonje J. Persson Jiahong Sun Rachael Neal Jessica Yott Introduction  Foucault and Szasz (The Myth of Mental Illness) argued that mental illness must be understood not as a natural fact but as a cultural construct.  Others (e.g., Sir Martin Roth (The reality of mental illness) and Jerome Kroll) have argued that the stability of psychiatric symptoms over time shows that mental illness is a real psychopathological entity.  Evolution of psychiatry is related to evolution of civilization. Prehistoric period  Little evidence due to lack of written records.  Archeologists have found trepanned skulls dating back to at least 5000 BC.  “Those whom the gods destroy, they first make mad.” (Euripides).  Madness as fate or punishment. Witch doctors.  Mental and physical suffering were not separated. Medicine, magic, and religion not separated.  Ancient civilizations Egyptian and Mesopotamian - Mental affliction attributed to demonic possession. - Incantation (charm or spell). Dominated by magic and religion to reconcile suffering person with the transcendental world. Indian -Angry demons inhabit the body. -Imbalance of bodily fluids. -Animistic and exorcistic practices. Ancient civilizations Hebrew and Israelite - One God – caused by problems in the relationship between man and God. - Cure of disease as an attribute of the Divine. Ancient Times  An example: epilepsy  Babylonians  Demons attacking person  Hindu  Goddess Graphi  Greece  Visions brought by the Gods  Demonic possession Der Lange(image creator). (2005). Spike-waves [image/png], Retrieved 09/18/2012 from: http://commons.wikimedia.org/wiki/File:Spike- waves.png The classical era Greek and Roman - Elemental conflicts (Homer, Sophocles, Euripides). - Imbalance in four humours of the body The playwrights  Person driven to insanity by the gods, crushed by destiny, or driven to madness by self- infliction (shame, pride, guilt).  Agony could lead to wisdom. Hippocrates (460 BC - 370 BC)  Gods not held responsible – Naturalized medicine.  “ The sacred disease [epilepsy] appears to me to be no more divine nor more sacred than other diseases, but has a natural cause from which it originates like other afflictions. Men regard its nature and cause as divine from ignorance and wonder, because it is not like other diseases.” Humoralism - Black bile – melancholia (spleen) - Yellow bile – choleric (easily angered, bad tempered) (liver) - Blood – unstable mood shifts (heart) - Phlegm – phlegmatic (calm, unemotional) (brain) Hippocrates  Imbalance of 4 humours caused mental illness.  Appropriate treatment depended on which bodily fluid or humour had caused the problem.  Cure disease by using elements opposite to the four fundamental qualities (heat, dryness, moisture, and cold).  Offered the first classification of mental diseases. The influence of Hippocrates  Hippocratic physicians recognized a number of mental illnesses that still exist (or are similar to modern conditions)  First classification of mental illnesses  Mania  Melancholy  (Paranoia)  Epilepsy Humoralism – the opposites  Opposites  Healthiness in equilibrium – sickness in extremes – mania and melancholia.  “Bipolar” became ingrained in the minds of educated people. Plato & Aristotle  Plato: Two types of mental illness: 1. divinely inspired that gives the person prophetic powers; 2. Caused by physical disease.  Aristotle: abandoned the divine explanation of mental illness – caused by physical problems. Return of the Supernatural  4th C BC: Emperor Constantine officially sanctioned Christianity in Roman Empire  legitimized supernatural beliefs  faith, love of -and belief in- the will of God, belief in divine will > reason  Holy madness vs. mental illness  Implications for treatments  Religious houses Galen (129-200AD)  Brain as the site of the rational soul.  Severe emotional disturbance might indicate a lesion in the brain.  Adopted a single symptom approach rather than broad diagnostic categories.  Sought an integrating force to link mind and body.  Personality types based on humours. Aretaeus of Cappadocia  Contemporary of Galen – credited with identifying what was later called bipolar disorder.  “ Some patients after being melancholic have fits of mania so that mania is like a variety of melancholia. “  In summary: Classical period = Madness rationalized. Middle ages (5th to 15th century) Muslim world:  Mental disorder thought to be related to a loss of reason.  Mentally disordered worthy of humane treatment.  First psychiatric hospital founded in Baghdad in 705. Christian Europe:  Demons came back. Diabolic possession.  Exorcism as treatment.  Purges, bloodletting, and whipping. Renaissance (14th to 17th century)  Humanistic movement – revival of Greek learning.  The individuality of man – intellect served the strivings of man.  Rejection of witchcraft. Realism  On the Illusions of the Demons and on Spells and Poisons (1563), Johann Weyer.  Weyer criticized Christian witch hunting – investigated cases of “witchcraft,” which became psychiatric descriptions of different mental disorders. Modern period (17th to 19th century)  Emphasis on the role of reason.  In 1602, 1st medical textbook on Psychiatry (Felix Platter’s Praxix Medica) was published.  Classification of mental symptoms throughout the 18th century.  Number of mental hospitals skyrocketed in Europe in 19 th century. Modern period (17th to 19th century)  Moral treatment movement developed towards the end of the 18th century  William Tuke (England) (1732-1822) - Hannah Mills (1790) -> York Retreat Pioneered humane treatment.  Benjamin Rush (United States) (1745-1813) – disease of the brain – moral therapy Modern period (17th to 19th century)  Chiarugi (Italy) (1759-1820) – held that bodily states influenced the mind via the activities of the senses and the nervous system at large.  The mentally ill should be respected as people. Mental conditions were acquired and not inherited. Cure not by medical means but through humane management. Modern period (17th to 19th century)  Pinel (France) (1745-1826) - Categories of mental illness – madness as a breakdown of internal, rational discipline  4 types of insanity: melancholia, mania, dementia, idiocy  "I cannot but give enthusiastic witness to their moral qualities.”  In 1798 Pinel published an authoritative classification of diseases (Nosographie philosophique ou méthode de l'analyse appliquée à la médecine). Modern period (17th to 19th century)  Charcot – (1825 – 1893) (France) “founder of modern neurology”  Clinical Professor of the Nervous System at the Salpêtrière – hysteria and hypnosis - hysteria was a neurological disorder caused by hereditary problems in the nervous system. Late 19th to 20th century  Dorothy Dix (1802-1887) – mental hygiene movement – funded 32 state hospitals (United States) – 1st generation of American mental asylums.  Emil Kraepelin (1855-1926) (Germany) – first classification based on symptomatology – 15 categories of disorder - causes organic - manic- depressive psychosis (good prognosis) versus dementia praecox (incurable).  Sigmund Freud (1856-1939) (Austria) – psychoanalytic model – causes of non-psychotic disorders. Late 19th to 20th century  In 1918, first standardized psychiatric classification system: Statistical Manual for the Use of Institutions for the Insane (United States). History  Reasons for the DSM:  The need for an official classification system  Aid the collection of statistical information (American Psychiatric Association, 2000) History  1952: DSM-I  American Psychiatric Association Committee on Nomenclature and Statistics  Descriptions of diagnostic categories  Clinical utility  Reflected psychoanalytical theories  Unclear diagnostic categories  1968: DSM-II  Very similar to DSM-I (American Psychiatric Association, 2000) History:  1980: DSM-III  Explicit diagnostic categories  Multiaxial system  Theoretically neutral  Inconsistencies or ambiguities  1987: DSM-III-R  Changes in categories  Inconsistencies resolved (American Psychiatric Association, 2000) History  1994: DSM-IV  Three stage empirical process  Literature reviews  Reanalysis of data  Extensive issue-focused field trials  Criteria for change  Threshold for changes set higher  Criteria sets simplified (American Psychiatric Association, 2000) History  DSM-IV-TR  Gap between editions  Risk of being out-dated  Goals:  Correct errors  Ensure information is up-to-date  Make necessary changes (American Psychiatric Association, 2000) History  DSM 5  The 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  Not greatly different from DSM IV  Various authorities have criticized the fifth edition