HISTORY OF ABNORMAL BEHAVIOR

The Early Years

Stone Age Early human skulls Early Egyptian writings Demonological or supernatural model Spiritual possession of some kind controlled the body and the mind Trephining-releasing the demon Exorcism-purging the evil spirit through magic, prayer, starvation Frontal lobotomies/frontal lobe damage-led to dramatic personality change

Golden Age of Greece

Ancient Greece and origins of the medical model: more biological/scientific view Hysteria found in young women, a result of the uterus dislodging E.g., uterus landed at the heart anxiety Somatic symptoms, extreme emotionality, anxiety Treatment? Marriage, of course If no other choice, bring the uterus home Use of sweet-smelling flowers

Hippocrates

Father of modern medicine First to describe psychopathology as a disease, biological explanations Theory of humors (around 400 BC) imbalance of bodily humors creates abnormal beh; temperament depends on which one predominates Four: Phlegm Black Bile Blood Yellow Bile Temperament still used First personality-psychopathology connection

Middle Ages

Medieval return to the demonological/supernatural model (late 400s 1800s) fall of Rome/rise of Christianity rejection of more scientific ways of thinking; with rise of Christianity, religion strongly influenced thinking In many parts of Europe, clergy were responsible for dealing with mentally ill

Middle Ages cont. (1400s to 1600s)

Witchcraft

Malleus Maleficarum The Witches Hammer

Witch-hunting manual written by two Dominican Monks Many mentally ill were identified as witches and inhumanely punished Mostly women This is controversial

Middle Ages cont. (1400s to 1600s)

Animalism The mentally ill were like animals Lack of self-control Capable of violence Ability to live in miserable conditions Thus, should be treated like animals Put into asylums Brutal conditions

Early Asylums
16th century on Development of asylums to house mentally ill Began as a way to remove them from society Often described as no more than residences or storage

Age of reason and enlightenment (1700s to 1800s)

advances in medicine and psychiatry Greisinger (1817-1868): suggested roots of abnormal behavior in the brain Kraepelin (1856 1926): classification of mental disorders Applied medical model to psychopathology dementia praecox, manic-depressive psychosis discovery of cause of syphilis Caused by bacterial microorganism Symptoms: delusions, bizzare behavior

Philippe Pinel 1745 - 1826

Father of modern psychiatry Removed the chain of mentally ill person Some started running to see sunset People started beating Pinel. Insane person came back and saved Pinel, since then humanity era started. People realized that mentally ill are not always abnormal, rather most of the times they are better than the normal people

20th century
developments in psychological theory, treatments, understanding of neuroscience, assessment, classification including two major theoretical movements: Psychoanalysis (Freud), Behaviorism Advanced our approach to understanding psychopathology

20th century cont.

Psychoanalysis: established importance of psychological factors in etiology Emphasis on unconscious motives in understanding behavior Behaviorism: established psychological research tradition Role of learning in human behavior Importance of environment

An Integrative Approach

What about now? Many psychological disorders appear to have a number of causes and influences Genetic Neurological Behavioral Emotional Cultural, Social, and Interpersonal Developmental Human behavior is complex

History of psychiatry in India.

Ayurveda

Mental disorders are mentioned in various types of literature. The aetio-genesis: because of provoked humours like vatonmad, Pittonmad & Kaphonmand. Exogenously the causes were sudden fear or association with ill influence of certain mythological gods or demon, Charak Samhita designated Psychiatry as Bhuta Vidya

HISTORY OF PSYCHIATRY

5000 BC Ayurveda - Bhoot vidya

Endogenous factor Hereditary Constitution Personality

Exogenous factors
Demons God Stress Fear

Treatment

Sympathy Rituals Prayers Aversion therapy for minor mental illness scalding whipping If severely psychotic, hearing voices and hitting others - killed If insane person says he could do the best for the society & have a power then people used to worship him.

AYURVEDA

The description of personality: sathvik- intellectual & moral Rajasik - emotional & passionatic & impulsive Tamasik- more or less near mental subnormality or angry. Treatment of mental disorders mainly included psychotherapy, physiotherapy, shock, drug treatment, hypnotism & religious discourses by Sages.

Unani System
Najabuddin Unhammad (1222 A. D), an indian physician, described seven types of mental disorders viz. :-Sauda-a- Tabee(Schizophrenia); Muree Sauda (depression); Ishk ( delusion of love); Nisyan (Organic mental disorder); Haziyan (paranoid state); Malikholia-a-maraki (delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine

Siddha System
Siddhi means achievement and Siddhas are men who have achieved results in medicine, as well as yoga and tapas. The great saga Agastya, one of the 18 Siddhas has contributed greatly to the Siddha system of medicine of the South. He formulated a treatise on mental diseases called as Agastiyar kirigai Nool , in which 18 psychiatric disorders with appropriate treatment methods is described.

History continued

During the reigns of King Ashoka, many hospitals were established for mentally ill. A temple of Lord Venkateswara at Tirumukkudal, Chingleput District, Tamil Nadu, contains inscription on the walls belonging to Chola period. A hospital named as Sri Veera Cholaeswara hospital and contained 15 beds.

History continued

Maulana Fazulur-Lah Hakim, an indian physician was in charge of the first Indian mental asylum, i. e. Mandu Hospital opened by Mahmood Khilji (14361469) at Dhar, M. P. First lunatic Asylum, Bombay Asylum, was built in modern India in approximately 1750 A. D. at the cost of 125/-, no traces of it is present today. In 1794, a private lunatic asylum was opened at Kilpauk, Madras. The central mental hospital, Yerwada, Pune was opened in 1889.

History continued

Maxell Jones in 1953 introduced the concept of Therapeutic community resulting in the improvement in the Mental Hospital conditions. Subsequently other facilities such as Occupational Therapy, Recreational facilities, Outdoor games and Picnics were started in Mental Hospitals . Lt. Col. Berkley Hill Was the pioneer in starting Occupational Therapy at the European Mental Hospital, Kanke, Ranchi, in 1935. However inspite of all these facilities, the adjustment of the mentally ill patients was poor in these hospitals.

NIMHANS

On the recommendation of Bhore committee (in 1946), All India Institute Mental Health was set up in 1954, which became the National Institute of Mental Health And NeuroSciences in 1974 at Bangalore. First community Mental Health unit (CMHU) was started with the Dept. of Psychiatry at NIMHANS in 1975

NIMHANS

Various training programs for psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Psychiatric nurses and Primary Care doctors are conducted at NINHANS. NMHP was launched in 1982 . The specific vulnerable population, children, disaster population, tribal population, the elderly population, and homeless mentally ill, is included for mental health care planning.

GHPU
The first GHPU(General hospital psychiatry units) was started in R. G. Kar Medical College & hospital, Calcutta in 1933 & GMC R. J. J. group of Hospital Bombay in 1938. The number has gradually increased since then. Gradually GHPU started the PG training centres .

Voluntary Health Sector (VHS) in Mental Health

The major effort of VHS is evident in the area of suicide & Deaddiction where various kind of activities are being carried out to help people in crisis. Oganization like SCARF (Chennai), Richmond fellowship foundation (Banglore), Cadbum are also helping people in rehabilitation and integrating them in the society

Indian Journal of Psychiatry

It was started in 1949 as Indian Journal Of Neurology and Psychiatry, was edited by Dr. Nagendra nath De. After 6 issues publication was stopped in 1954. It was renamed as Indian Journal of Psychiatry in 1958

Indian Psychiatric Society (IPS)

Indian Psychiatric Society was inaugurated at Delhi on 7th January 1947.

Present scenerio of psychiatric services in india

National Mental Health Programme was implemented to provide services to rural as well as urban population. However even today 80% of the rural population do not get these services. Multidisciplinary approach for the treatment of mentally ill is confined to only few institutions.

Present scenario

Importance is attached to treat the mentally ill patients & not much thought is given to prevent mental illness & promote mental health. More importance is given to biological psychiatry and psychopharmacology, and psychology and social psychiatry are not given due importance.