- Classification is concerned with the categorization of the signs and symptoms of mental distress into meaningful groups or Unlike traditional diagnoses in clinical medicine, however, present classifications in psychopathology do not invariably bear a relationship to etiology.
- Psychodynamics is concerned essentially with the functional significance of the emotional and the motivational aspects of behaviour, including both conscious and unconscious A symptom is thus considered to be and expression of or the resultant of a constellation of forces presently operating within the person. A basic assumption of psychodynamics is that behaviour is goaldirected and motivated by impulses, needs, and forced of which the person is often not consciously aware.
- Psychogenesis is concerned with the origin or the beginnings of the disorder, rather than with its present As developed in the context
of this volume, psychogenesis refers essentially to those life experiences which probably established the motivational patterns described under psychodynamics.
Psychopathology is the branch of psychology which deals with the recognition, treatment and prevention of mental abnormalities and disorders. It deals with illnesses which predominantly affect a person’s mental life and behaviour, i.e. his feelings, his thinking, his behaviour and, social relationships. The field of psychology is diverse and extensive. There are special branches dealing with children and old age (psycho geriatrics). Forensic pathology deals with medico-legal aspects. Social psychopathology includes all environmental factors, including epidemiology.
The clinical psychologist Forms an integral part of the psychiatric team which comprises psychiatrist, psychologist, psychiatric social worker, nurses etc.
A psychiatrist is a physician who has been trained and has had experience in the diagnosis and treatment of psychiatric illness. Post-graduate training extends over 5-8 years, during which time higher qualifications in general medicine as well as specialist qualifications in psychiatry are usually obtained.
A psychotherapist is a person with special training in psychotherapy. A psychoanalyst is a psychotherapist who is trained in the method of Freud. Clinical Psychologist is concerned with the study of mental life and behaviour. It stands in relationship to psychiatry is very much the same way as physiology does to general medicine. A psychologist is not medically qualified and has a degree in psychology.
M.A. Part-II Psychology (class notes) Counselling Psychology (Group-B- 4)
Questions:-Write the explanation of concept of Counselling Psychology Ans:
The point of view presented in earlier indicates that the author does not consider guidance to be the concern of the counselor only. Collective efforts of the administrator, librarian, English teacher, and school nurse, among others, are needed if students are to be provided with a comprehensive, effective guidance program.
Counseling is the component of guidance for which the school counselor takes primary responsibility. Others assist him in gathering the data that comprise the individual inventory and maintaining community contacts so that a placement service may be effective. The task of assisting students to examine conflicting values that are the root of a personal problem or to weigh information as they make plans about schooling and work is one which requires specific education, supervised practice, and experience. Students may find genuine benefit in talking with friends and teachers. If the conversation is to be beneficial for the student, it should have a number of characteristics, such as the establishment of objectives or goals toward which the conversation might point, the quality of opening up the area of concern rather than glossing it over, effective use of the
decision process by formulating alternatives and projecting consequences of each, and terminal structure that allows the student to review critically what has taken place and makes provision For future meetings if they are needed. Social conversation may or may not be marked by any of these characteristics, depending upon the people involved and the nature of their relationship. Counselors, because of their specialized training, can develop relationships with students that contain all of these characteristics. Further, they can use accumulated information, test results, and knowledge of community resources as they help the student to understand himself, his environment, and the process of change.
Two traditions that have their roots in the early years of this century are represented within the field of counseling. The first grew initially out of a need to assist immigrants and those living in slums to become employed. This humanitarian purpose was increasingly supported by tools of assessment that were developed within the growing field of measurement and evaluation.
Frank Parson’s founding of the Vocational Bureau in Boston in 1908 is frequently cited as the birth of this tradition. Vocational guidance, with its broad interest in social reform and specific skills to help workers obtain employment, gradually blossomed into counseling psychology, with attention given to the normal individual’s development in personal and social, as well as vocational and educational, areas.
The second tradition also had its beginnings in 1908 with the publication of Clifford Beers’ book, A Mind That found Itself. This led to the establishment of the National Committee for Mental Health in 1909. The
National Committee first championed adequate living conditions and humane regard forthose who had succumbed to serious mental disorders. Later it turned public attention to those with less severe disorders and persuaded educators to become more cognizant of developmental problems such as self-doubt and alienation tendencies among their students.
Each tradition has influenced the other during the sixty years since their beginnings in 1908. Vocational guidance early demonstrated tendencies toward orderliness and quantification through development of a scientific approach to extensive occupational classification systems, vocational surveys, research methods, and assessment instruments. Mental health programs placed stress upon assisting the individual to develop, change, and cope.
Gradually, as vocational guidance developed into counseling psychology, it was shaken From its authoritarian approach to individuals and became aware of the person as well as his problem. Stress, as never before, was placed upon counseling processes and techniques. At the same time, greater emphasis upon research and publications caused those within the mental health tradition to become more involved in research of the counseling process and assessment of outcomes.
Each tradition is being now advanced by new proponents. Many of the original distinguishing features have been blurred as each has taken on
some characteristics of the other. But differences exist. Current interest in environmental manipulation, computerized counseling, and systems approaches to the process may be traced to vocational guidance origins,
while those who focus upon the counseling relationship and the personal qualities of the counselor more nearly follow the mental-health tradition.
Orientation of Students to Counseling
School counselors could spend a considerable portion of their available time in orienting students to the counseling process unless they organized some formal system or plan. To introduce each student to counseling through the experience of the interview alone not only is an inefficient use of the counselor’s time, but also may prevent students who need to see the counselor from knowing of his availability and cause anxieties on the part of students who do see him and are unfamiliar with the process. The counselor’s attempts to be seen as one who treats students as his equal and is willing to meet with them whenever they have a concern, a doubt, or a decision to consider may be seriously harmed by the paternalistic act of calling in a student at the counselor’s convenience, according to a checklist, and without regard to the need of the student.
The problem, therefore, is one of allowing students to visit the counselors office as they desire and yet having them familiar with the counseling service in order that they might avail themselves of it. A number of practices have been developed to make the nature of counseling services known to students, parents, teachers, and administrators. First, the counselor may present programs at school assemblies, before parent groups, or in faculty meetings. In addition to verbal explanation, slides that indicate the various aspects of the counseling service, role-playing interviews, and the playing of model tapes may be used.
Students, however, need to become acquainted with the person, not a figure standing before them in an auditorium or a sequence of slides that
show a smiling face and no action. An interim step is to have teachers send small groups of students to see the counseior for a “get acquainted” visit of a few minutes’ duration, if the counselor is new to the school, this may be done with all students. The experienced counselor may use this as an ongoing practice of orientation for the class of students just entering the school each fall and students who transfer from other schools during the academic year.
The counselor introduces himself to the students, lets each student introduce himself to the group, and makes certain that they understand the purpose of the visit. Conversation is focused upon the purposes of counseling, why students might wish to visit the counselor, how the counselor might assist them, and what resources he has at his disposal. Although the interaction is not counseling, the counselor attempts to enter fully and openly into the discussion. To give them the “feel” of the counseling relationship, he may ask one of them to role-play a student who is concerned about English or wondering about his future, The informal nature of the meeting and the security of having peers at his side helps the student to remain calm until he becomes familiar with the counselor’s manner and the physical surroundings. As a terminal exercise, the counselor shows students how they may sign up for interviews and asks them to visit him when they feel he may be of assistance.
Most students will be receptive to this introduction and visit the counselor at a later date. Some, however, may express interest in knowing more about the process. The counselor may then wish to meet at greater length with the student or’ provide an audio-tape of an interview that can he played publicly, in order that the student may gain further insight.
The Counseling Process
Counseling, as a process, has been defined variously by authors and professors for nearly fifty years. While no single definition has stood the test of time, most contain some reference to difference in role of the student (who is to be assisted or helped) and the counselor (who is more experienced, frequently older, and has as his function to help). Also, mention is genealIy made of the objective or goal in terms of improved adjustment, higher functioning, and greater happiness. Finally, focus is usually placed upon the process involved, the learning that occurs, and the assistance that is given.
Four basic assumptions must be accepted if counseling is to be successful. First, it is assumed that the student is willing to participate in the process. He may have a concern, a wonderment about the world around him, or curiosity about what he is experiencing. While the process may be unfamiliar to him and he may display resistance at moments, counseling will not be successful unless he participates fully.
Second, the counselor must possess appropriate training, experience, and personal attitudes to function effectively. He must be able to relate easily with the student, assist him in establishing objectives and goals, and employ any ethical means that will assist the student to change or learn behaviors necessary to cope with his environment and work toward the objectives they mutually have established. Third, an appropriate environment is necessary. Depending upon the nature of the interview, this environment must provide assurance of confidentiality, a mood of contemplation, and or adequate information resources.
KOLHAN UNIVERSITY CHAIBASA
M.A. Previous Psychology Class Notes of Dr. J.P. Mishra
University Head, Deptt. of Psychology
Paper –V (Philosophy of Psychology)
(Dr. J.P. Mishra)
Questions:- Distinction between Schools of Psychology).
Ans:- We can define and explain the schools about psychology as given under:-
Psychoanalysis and Related Schools
The historical development of psychological methods of treatment up to the discoveries of Freud was briefly outlined.
Sigmund Freud, born in 1856, studied physiology after qualifying as a doctor and later devoted his attention to neurology. Tn 1885 Freud went to Paris to work under Charcot, who had impressed him greatly with the use of hypnosis as a method of treating hysteria.
Freud, however, found hypnotic suggestion, by itself, to be of limited value. In collaboration with J oseph Breuer who, incidentally, had also started his career as a physiologist, he developed a method of treating patients in which they were allowed to talk out their emotional difficulties during hypnosis.
Under hypnosis the patient was able to remember past experiences more clearly and to release emotions associated with forgotten experiences. Breuerand Freud were Impressed by the curative effect of talking out difficulties and referred to the process as mental catharsis. The term abreaction was used to denote the liberation of emotion whilst talking about emotional problems and experiences.
Both Breuer and Freud found that, during treatment by these methods, some female patients appeared to fall in love with them. This alarmed Breuer but Freud soon realised that it was not his own personality that was attractive but merely that he was serving as a substitute for the original person they loved. The love was transferred to the physician and this process was referred to as ‘transference’ which Freud dealt with by maintaining an impersonal attitude and, in fact, utilised the transference reaction in the resolution of problems and promoting recovery.
Freud discontinued hypnosis and instead instructed patients to relax in a reclining position and to talk freely about their problems. This method was referred to as free association and patients were encouraged to tell everything that came into their minds, even if t appeared embarrassing, ridiculous, irrelevant or unimportant.
In order to facilitate and expedite progress achieved by free associa-tion, Freud also used interpretation of the patient’s dreams, again using free association. He found that there were many suppressed desires and complexes and that these were often of a sexual nature. Sex desires when in conflict with the requirements of society were repressed.
Freud found that exploring by free association deeper and further back into the patient’s history was more effective in treating his patients. Many patients recalled traumatic emotional experiences in childhood, often of a sexual nature, and related sexual assaults by relatives of these accounts were fantasy ratherthan fact.
TOPOGRAPHY OF THE MIND
Freud divided the mind into three regions: the unconscious, the preconscious and the conscious, each of which has unique characteristics.
The Unconscious is the repository of mstinctive drives together with repressed material from experience. The contents of the unconscious are not accessible to consciousness and can only reach the conscious via the preconscious, which excludes them by censorship or repression. Repressed ideas may, however, reach consciousness when the censor is evaded as in dreams, or in psychiatric symptoms, or by slips of the tongue and other errors of everyday life.
The Preanscious develops during childhood m parallel with the development of the ego. The preconscious can be reached by both the conscious and the unconscious. Contents of the unconscious can only gain access to consciousness by being linked with words and via the preconscious.
Dynamic Aspect of The Mind
The Conscious is involved with awareness and attention whereby the individual becomes aware of stimuli from the outside world.
- The The term id is the term applied to basic drives, instinctive drives such as those concerned with survival, sex and aggression. The id. demands immediate satisfaction and ruled by the pleasure-pain principle and is illogical. It is non-verbal and does not enter consciousness.
- The ego is conscious, and attempts to be the mediator between the drives from the id and derived from the id and the outer It is influenced by the super-ego.
- The super-ego arises out of the ego by a process of learning from experience to deal with the needs of It is mainly unconscious. The super-ego is composed of the conscience, the ego ideal and is derived from primitive conditioning.
The ego is concerned with reality testing, discrimination, integration, adaptation, learning, consciousness, reason, intellect, memory, judgement and will power.
Libido Theory and Psychosexual Development
The term libido is used to describe sexual drives in the widest sense and includes pleasurable sensations relating to bodily functions. The libido can be attached to a variety of objects and undergoes development through different phases.
Freud described the following stages of psychosexual development:
- The oral phase which starts at birth and continues for about eighteen It is divided into a receptive phase followed later by a sadistic phase when the child acquires teeth and becomes more aggressive.
- The anal phase develops during the first year and continues until approximately the age of three The anal phase has been divided into a destructive expulsive component and a mastering retaining aspect.
- The genital erotic phase begins during the third year of life and continues until the end of the fifth year
The Oedipus situation evolves during the third to the fifth, years in children of both sexes. In the Oedipus situation the child’s libido becomes directed towards the parent of the opposite sex. The other parent is seen as a rival and feelings of hostility are engendered. The child anticipates retaliation because of its own aggressive feelings and in boys this takes the form of a castration complex.
Freud regarded the Oedipus situation as being prepotent for the development of later neurosis and symptom formation, and also in the development of character and personality.
n the development of obsessional symptoms, sex drives may be dealt with by displacement into washing activities acting as a purification.
Projection is the process whereby some attribute of the self or some quality or property of the self is attributed to the environment. It is a common mental mechanism as well as an important pathological process. It is well known that what is perceived is, in part, a function of the motivational structure of the personality. This forms the basis of projective tests.
In experiments it has been found that the frequency with which food is mentioned in speculations about the missing parts of incomplete pictures correlates positively with the degree of hunger.
As a psychopathological mechanism, projection may be a defence mechanism against anxiety and it has been found experimentally that
individuals who possess more than an average amount of a particular trait tend to attribute that trait to others, providing that insight is lacking. People with a strong tendency to dishonesty will suspect others of being dishonest.
Various symptoms of schizophrenia and other mental disorders may he produced by the projection of dissociated complexes; for example, hallucinations, delusions of persecution and grandeur.
This is an attempt to make understandable and logical, feelings or actions or attitudes which are emotionally influenced and irrational.
This is the excessive use of intellectual processes to avoid unpleasant emotional experience or expression.
Denial is the refusal to admit or acknowledge the presence or existence of something, usually unpleasant reality. This occurs frequently as a normal phenomenon as well as in pathological conditions. Denial may operate in any unpleasant experience including the possibility of illness.
Introjection is the process of assimilating or internalising into the subject’s ego qualities of the loved object.
When a person incorporates within himself a mental picture of a person and then feels, thinks. Id acts as he conceives that person to think, l and
act, this is Identification and is largely ri unconscious process. Identification with the oved object plays an important part in ego Jevelopment. It may play an important role as a defence mechanism against anxiety or distress accompany separation from, or the loss of object, whether this is real, as in bereavement, Ernest ones describes the major principles & Freudian doctrine as follows:
- psychic determinism, and goal motivated
- emotional processes have a certain autonomy, and can be detached and
Question No-2 :- Write the classification of Analytical Psychology and Individual Psychology
Carl Jung of Zurich, born in 1875, was originally a follower of Freud but later developed his own school of psychotherapy and psychopathology.
In treatment, Jung also used the technique of free association and dream analysis but started with the study of the patient’s present problem and sought to discover the elements of weakness in his manner of dealing with it. J ungian analysis gives the patient an understanding of his present state as well as of his infantile past.
The concept of libido to Jung is of a general life force. It is the total vital energy seeking the goal of growth as well as of activity and reproduction.
Jung, if anything, makes more of the concept of the unconscious; be distinguishes between the personal unconscious and the collective or racial unconscious. The personal unconscious is formed partly by repression from the conscious and other material that has been acquired unconsciously. The collective unconscious or racial unconscious is inherited and consists of instincts and primordial ideas or archetypes. The instincts are primitive ways of acting and the archetypes are primitive ways of thinking.
Dream interpretation to Freud is carried out in terms of causality and determinism but, to
Jung, dreams are symbolised accounts of what has happened but also provide symbolic guidance for the present and the future.
AlfredAdler, born in Vienna in 1870, also broke away from Freud because of disagreement over the importance of infantile sexuality and the validity of the libido theory of Freud.
Adler placed much greater emphasis on the ego as against the libido and placed more emphasis on the influence of the social environment and, as each person was unique in his psychology, he termed his school that of’ individual psychology’.
The following are some of Adler’s concepts:
- inferiority feelings are fundamental in the development of
- the study and analysis of the individual patient is designed to discover his pattern of life, or Life Style as Adie calls it and in particular the goal of superiority which he has set himself and which he still follows in some form or
Adleremphasised that individuals tended to cope with inferiority feelings by elaborating compensatory attitudes and patterns of behaviour. He laid great emphasis on the will to power, characterised by striving for power, dominance and superiority.
HORNEY’S DYNAMIC CULTURAL SCHOOL
Karen Homey developed a theory which differs from the classical Freudian theory in many respects. She did not accept the libido theory and the derivatives there from such as the stages of psychosexual
development, the Oedipus complex, infantile fixation and regression. While acknowledging the importance of sexual drives, she considered cultural-social influences and disturbances in interpersonal and intrapsychic development to be more important in neurosis in general.
She accepted the Freudian concept of psychic determinism and unconscious motivation. However, her concept of the unconscious was broader than that of classical psychoanalytic teaching. Homey represented one of the two main branches within the dynamic cultural school of psychoanalysis, the other being the school of Harry Stack Sullivan.
Sullivan emphasised social, cultural and environmental factors rather than biological events as being important in the development Sullivan’s therapy was based on his conviction that psychotherapy is the study of interpersonal processes in which the psychiatrist acts as a participant observer.
RADO’S SYSTEM OF ADAPTATIONAL PSYCHODYNAMICS
of neuroses. He considered present day interpersonal relationships rather than past experience as being most relevant and important.
Sandor Rado, having worked with Freud, felt the need to reformulate classical psychoanalytic theory on lines of biological science and scientific methodology. He used evolutionary principles in which adaptation to the environment was deemed to be of paramount importance. He interpreted the role of pleasure and pain, emotions and
thought, desire and executive action in terms of adaptation to the environment based on concepts of evolution.
He divided his methods of psychotherapy into two groups:
- reconstructive using the adaptational technique of psychoanalytic
- reparative which is less ambitious and with limited goals, and usually of shorter
ADOLF MEYER’S SCHOOL OF PSYCHOBIOLOGY
Meyer paid particular attention to types of reaction manifested by the total individual in terms of his total life experience. Psychobiology is the genetic, dynamic science which studies personality development in the light of environmental setting and longitudinal growth. His central theme is the mind in action and he stresses the relationship between the conscious drives and the environment. He considered that ideal mental health was the optimum ability to get on with people without the interference of internal conflict or external frictions, this resulting in full mutual satisfaction based on a constant give and take relationship.
The system of treatment, based on Meyer’s teachings, is referred to as distributive analysis and synthesis and attempts to adapt the patient to his surroundings both by working with him and, indirectly, via environmental manipulation.
THE SCHOOL OF MELANIE KLEIN
The Kleinian or English School of Psychoanalysis differs from the classical Psychoanalytic School in the following respects:
Klein maintains that the primitive super-ego develops doing the first and second years at the stage of Infantile anxiety and aggressiveness, in contrast to orthodox theory which postulates the development of the Super-ego during the fourth year of life. Klein also believes that aggressive rather than sexual drives are pre eminent during the earlier stages of development. She considers that the presence of aggressive and sadistic impulses and the fear of retaliation are mainly responsible for the development of the primitive super-ego.
Using special methods such as play, storytelling, dreams etc., Klein maintained that children of two years of age could be treated analytically.
Klein also differed from the orthodox school in that she considered that the answer to the Oedipus situation could be traced to the earliest months of life, and also in her concept of a depressive condition during childhood which she considered of paramount importance in the child’s development and its later capacity for love. The child introjects both good and bad objects. The introjection of bad objects is considered to be dangerous to the ego.
She considers that a paranoid condition develops at the age of about two to three months. Projection is employed as a defence and in the earlier stages the aggressive fantasies are turned towards the mother during the later oral phase.
Klein believes that the child develops anxiety lest the loved object be lost due to its own destructiveness. Whenever the mother makes the child angry the good internal object is threatened with destruction. This conflict is the basis of the depressive condition in which guilt forms the precursor of conscience.
A Short History of Psychotherapy by N. Walker. Routledge & Kegan Paul, London (1957).
CurrentApproaches to Psychoanalysis by P. R Hoch,J . Zubin (Eds.) Grune and Stratton Inc., NewYork and London (1960).
General Psychopathology by K. J aspers, translated byj . Hoenig and M.
- Hamilton, Manchester University Press (1963).
M.A. Part-I (Psychology) Paper- III
Question No-1 :- Throw light the definition of personality in your onwards.
The term personality is frequently used to refer to certain qualities possessed by some people which influence or impress others. This notion of personality is incomplete and superficial.
In psychology the term personality has a wider meaning and refers to the sum total of a person’s psychological and physical characteristics which make him a unique person. The term embraces his behavioural tendencies, his intellectual qualities and his emotional disposition.
The term character refers to an evaluation of personality, according to some standard whether moral, ethical, religious, social, etc. In describing the person as good, dishonest or wicked we are describing his character.
The term temperament refers to the emotional aspects of personality, namely the person’s enduring emotional disposition. For example, a person may be anxious, pessimistic or cheerful in temperament.
Two fundamental concepts have operated in the description of personality in the past, namely concepts of types and concepts of traits. Atrait of personality is defined as the observed constellation of individual action tendencies. A type may be defined as a group of correlated traits.
Throughout the ages man has tended to classify his fellow beings into types. In the time of Hippocrates and Galen four temperaments were described corresponding to the four humours— blood, black bile, yellow bile and phlegm—and we still use terms derived from this concept, e.g. sanguine, phlegmatic, etc.
Very many classifications of personality type have been proposed in modern times, e.g. Introvert and Extravert types of jung and the Schizothymic and Cyclothymic types of Kretschmer.
Whichever typological classification is used, we find no evidence of separate and disparate personality types. Instead there is a continuous gradation from one extreme to its antithesis at the other extreme distributed along the normal frequency curve. For example, with regard to introversion and extraversion the majority of persons are midway between the two extreme types.
As Pope succinctly put it ... ‘Virtuous and vicious all men must be, few in the extreme but all/n a degree’.
Question No-2:- Write the Determinants Of Personality.
Personality is the product of the interaction of genetic constitutional (intrinsic) factors and the environmental (extrinsic) factors.
Among the intrinsic factors are:
(1) genotype. (2) genotypic milieu.
- constitution comprising physical, physiological and biochemical
- endocrine (5) growth and maturation processes.
DEVELOPMENT OF SCHOOLS & MODERN PSYCHOLOGY
The interest of some people in human nature is motivated only by curiosity. They want to know just for the sake of knowing. In exactly the same way that some people want to understand rocks or stars, others want to understand human beings. They agree with the poet Alexander Pope that ‘the proper study of mankind is man’. effect, they want to know what it means to be a human being.
Ancient medicine, both Egyptian and Greek, considered all disease to be caused by evil spirits or demons and similar concepts continued in Europe with regard to mental disorders throughout the middle ages. (Hippocrates (460-377 BC) replaced demoniacal concepts of disease by a theory and practice of medicine based on observation and natural causes. Hippocrates regarded mental illnesses in much the same light as he did physical illnesses. He considered that mentally ill patients needed to be investigated to discover the causes of the illness in order that these should be dealt with as effectively as possible. The theories of disease causation of Hippocrates and Gaien regarded disease to be due to a disturbance in the body of the distribution of the four humours--black bile, yellow bile, blood and phlegm. We still pay reference to these humoral theories by the everyday use of the terms melancholia, choleric, sanguine, and phlegmatic.
Despite the enlightened teachings of Hippocrates and Galen, beliefs that mental illnesses were due to possession by demons persisted throughout the middle ages and were responsible for cruelty to the mentally ill, who were flogged and ill-treated in order to drive out demons and evil spirits. Witch hunting occurred on a large scale in the fifteenth century and many
supposed witches were put to death because they were believed to be possessed by evil spirits.
Three bright lights shone in the darkness of this period. One was a hospital which existed in the sixth century at Mount Cassino in Italy, which provided humane care for mentally ill patients and later other hospitals which, similarly, treated mentally ill patients with understanding and humane care were founded in Lyons in the sixth century and Paris in the seventh century.
Question-3:- Explain the Modern Trends In Psychopathology & Psychology in Hospital Setup.
It will be convenient to consider the development of modem trends in psychiatric care under the following headings:
- hospital care, including social and legal
- the development of psychological methods of
- the development of the organic or biological approach to psychiatric
- the development of drug treatment in
1. Hospital Care, Social and Legal Aspects of Psychiatric Care
One of the most important dates in the history of psychopathology is 1795, which marks the inauguration of the humane treatment of the mentally ill by Pine! in Paris.
Pine/ gave patients increased liberty and provided them with work and activities in the hospital. Previously, they had been restrained and
sometimes chained and were noisy, destructive and disturbed in behaviour but, when freed and given work to do, their behaviour dramatically improved and an air of tranquillity prevailed throughout the hospital.
This important social reform was continued by Rush in America and by Connollyand Tukein England and these pioneers are the real founders of modern social psychiatry.
The work of Tuke in York and Connolly in Harwell, Middlesex, not only started the movement for more humane treatment forthe mentally ill in this country but also influenced public opinion to regard mentally ill people as being ill and not criminals or possessed by devils, and that society had a duty to provide medical treatment as well as providing humane care.
In Britain a large number of mental hospitals were built during the nineteenth century. In 1890 the Lunacy Act was passed, which imposed on local authorities the duty of providing mental hospital accommodation. The Act made Certification and a J udicial Order a prerequisite for admission to public mental hospitals.
The effect of this was that persons with early or mild degrees of mental illness were excluded from treatment, as Certification was only invoked when the behaviour or the medical condition of the person made admission to hospital imperative.
The Maudsley Hospital, by a special Act of Parliament, was allowed to admit patients on a voluntary basis in the early nineteen- twenties. Subsequently, in 1930 the Mental TreatmentAct enabled all mental hospitals to take voluntary patients.
This Act had far-reaching consequences patients now sought admission at a much earlier stage of the illness, with the result that recovery and discharge rates improved. There was also a rapid development of out- patient clinic services to enable patients to be seen prior to admission and to be followed up after discharge.
The most striking change in social and legal provisions for psychi-atric illness in this country is the Mental Health Act of 1959 which, in. many ways, constituted. a revolutionary change in psychiatric care.
The Act abolished Certification and also did away with the distinction, from the legal viewpoint, between mental and general hospitals. Patients can now be admitted informally to psychiatric hospitals, just as they can to general hospitals. Compulsory admission, when necessary for observation or treatment, is not a judicial procedure but based on medical recommendations. The Act lays much greater emphasis on the care of a patient in the community, with increased opportunities for treatment of psychiatric illnesses at out-patient clinics, day hospitals and in the patient’s home.
The Department of Health and Social Security in its long term plans, proposes closing down many of the older mental hospitals and establishing large psychiatric units at general hospitals which will serve specific catchment areas.
2. The Development of Psychological Methods and Treatment
Paracelsus, in the fifteenth century, put forward the view that health and illness were controlled by astral bodies such as the stars and the moon. The term lunacy is a relic of these theories which allege that mentally ill people are affected by the moon.
From this developed the concept of animal magnetism and Mesmer believed that ill health was due to a disturbance in the body of a fluid which was called animal magnetism.
Patients treated on the basis of the animal magnetism theory often went into a trance-like state, which was in fact identical with what we now know to be hypnosis. Hypnosis was later used by Charcot and others therapeutically. Charcot believed that hypnosis and suggestion were the keys to psychiatric treatment.
Freud started using hypnosis to treat psychiatric patients but later dispensed with it, as he found it was unnecessary and often created undesirable dependence on the part of the patient. He replaced it by his method of free association. This became the foundation of psycho- analysis, which proved to have far-reaching influences on thinking and attitudes as well as providing a method of treatment for certain psychiatric disorders and laid the basis of modern dynamic psychiatry.
3 The Organic or Biological Approach
The organic or biological trend paid due attention to physical factors in mental illness and initiated somatic treatment methods, starting in the eighteenth century with Morgagril who held the view that mental illness was an organic disease. This concept was refined by various other neuropsychiatrists, laying the foundation for a biological, constitutional and organic type of psychiatry.
This led to a number of important treatments; in 1917 Wagner vonjaureggintroduced malarial therapy for general paresis and, later, Klaesi !ntroduced prolonged narcosis therapy, Sake! introduced insulin coma therapy and Meduna cardiazol convulsive therapy. Moniz
introduced prefrontal lobotomy in 1936 and in 1938 Cerletti and BM introduced electroconvulsive therapy.
4. The Development of Drug Treatment
Herbal remedies and concoctions were used for the treatment of mental disorder by Hippocrates and were described by Burton in his
Anatomy of Melancholy. Chloral hydrate was introduced into medicine in 1869 and Fisher synthesised the first barbiturate in 1903.
The drug treatment of mental illness has developed with remarkable rapidity during the past decade or so. New drugs with potent actions on the higher functions of the central nervous system (Psychotropic Drugs) have been discovered, which have transformed psychiatric treatment.
The field of study of these drugs is termed Psychopharmacology, which is one of the most rapidly developing areas of psychiatry.