This week is Mental Illness Awareness Week. Okay, let’s get aware. Following is a random traverse through history:
790,000 BC, give or take a few years - Discovery of fire. Anyone crazy enough to take a burning tree into their cave and find a practical application had to have been dealing with bipolar. So, you nonbipolars out there, listen up: We give you the gift of civilization, and how do you thank us? That’s right. You marginalize us. (By the way, sorry we couldn’t get fire to you sooner.)
2000 BC - Ancient Egyptians view mental illness symptoms as physical, caused by disorders of the heart.
400 BC - Hippocrates and fellow ancient Greeks explain physical and mental illness in terms of “the four humors.” Melancholia literally means “black bile,” a condition Aristotle assigns to Socrates. Later, Galen refines the humors into “temperaments.” Bottom line: Mental illness is considered biological.
Second century AD - Aretaeus of Cappadocia links mania to melancholia, thus effectively identifying bipolar.
410 AD - Alaric and his Visigoths sack Rome. Dark Ages officially begin. Christian belief interprets mental illness as a sign of divine punishment or Satanic possession. This “fault principle” permeates treatment of the mentally ill to this very day.
Middle Ages - One of the treatments for mental illness includes drilling holes in the skull to allow evil spirits to escape.
1242 - The Order of Mary of Bethlehem establishes a shelter for the insane in London, referred to as “Bedlam.”
1492 - Christopher Columbus has a crazy idea and sails to the New World. To nonbipolars: We introduce to you to the concept of America, and how do you thank us? Yeh, right. (Sorry we couldn’t find it for you sooner.)
1512 - After four years, Michelangelo finishes the ceiling to the Sistine Chapel. To nonbipolars: We bring you the arts and how do you thank us? (Sorry he didn’t get the job done faster.)
1687 - Isaac Newton publishes “The Principia.” To nonbipolars: We bring you modern science and how do you thank us? (Sorry you were weren’t smart enough to come up with gravity on your own.)
1750-early 1800s - Enlightenment beliefs include the novel idea that we can better our own condition, morally, socially, spiritually, and materially - that we do not necessarily have to die in the same state that we were born.
1840s - Dorothea Dix agitates for better treatment of the mentally ill in the US. The asylums of the day are beautiful buildings in pastoral settings with farms attached, and are based on the enlightened principle of placing patients in a nurturing environment and treating them with dignity. Only later do these same asylums become chambers of horrors.
1844 - Establishment of the American Psychiatric Association, an outgrowth of the enlightened ethos of the day.
1854 - French physician Jean Pierre Falret describes “folie circular,” characterized by cycles from depression to mania.
1856 - Birth of Sigmund Freud, Austrian founder of the psychoanalytic school of psychiatry, and Emil Kraepelin, German pioneer of diagnostic psychiatry. These two men and their followers would set the tone of psychiatric debate throughout the twentieth century and into today.
1859 - Charles Darwin publishes “On the Origin of Species.” The work influences literally every aspect of human inquiry, psychiatry included.
1890 - American philosopher and psychologist William James publishes his seminal “Principles of Psychology.” Later works include “The Will to Believe” and “The Varieties of Religious Experience.”
1893 - Kraepelin publishes his first edition of “Compendium der Psychiatrie” (the final version appeared in 1927), which lays the foundation for the modern classification of mental illness. It was Kraepelin who coined the term manic-depression and separated it out from schizophrenia (which he called “dementia praecox”), thereby giving psychiatry a basic navigating system. For many decades, Kraepelin’s influence was eclipsed by Freud, but he has since returned with a vengeance.
1899 - Freud publishes “The Interpretation of Dreams.” The “unconscious” is hardly a new idea, but under Freud we learn that we are in dominion of our minds a lot less often than we think. Freud’s development of psychoanalytic principles, with its focus on rooting out underlying causes to human behavior, becomes the dominant theme to psychiatric practice throughout most of the twentieth century.
Early twentieth century - Between 1907 and 1939 more than 30,000 individuals in 29 states are sterilized, many without knowledge or against their will, while incarcerated in prisons or mental institutions.
1934 - Hitler begins forced sterilization of 300,000-400,000 individuals deemed “feeble-minded” or mentally ill. Between 1939 and 1945, a quarter million physically and mentally handicapped individuals are euthanized.
1930s - Italian psychiatrist Ugo Celetti develops ECT. Portrayed as an instrument of torture in the 1975 film, “One Flew Over the Cuckoo’s Nest,” ECT is today regarded as a first option for suicidal depression and where other options have failed.
1949 - The most embarrassing moment in Nobel Prize history (other than the 1973 Peace Prize to Henry Kissinger): Portuguese physician António Egas Moniz is awarded the Nobel Prize in Medicine for developing the prefrontal lobotomy. About 40,000 lobotomies were performed in the US.
1949 - Australian psychiatrist John Cade discovers the therapeutic use of the common salt lithium in the treatment of manic-depression, but it is not until 1970, following definitive studies by Danish psychiatrist Mogens Schou, that this treatment is embraced by psychiatry.
1952 - The American Psychiatric Society publishes the first edition of the “Diagnostic and Statistical Manual” (DSM-I), which is a homage to the Freudian mindset of the day. Schizophrenia, manic-depression, and depression and other conditions are deemed “reactions” to underlying psychosis or neurosis or behavioral traits. Mental illness is viewed as a nonbiological adaptive failure on the part of the individual to dealing with life. According to the dogma of the day, diagnosing and treating say, depression, is secondary to rooting out the underlying neurosis that is supposed to be causing the depression.
1953 - “Nature” publishes Watson and Crick’s, “The Molecular Structure of Nucleic Acids: A Structure for Deoxyribose Nucleic Acid,” ushering in a new age of genetic science.
1957 - The FDA approves chlorpromazine (Thorazine) for the treatment of schizophrenia, thereby setting the scene for a new era of biological psychiatry. Thorazine (which is still in service) is one of the first of the “typical” antipsychotics, and becomes the prototype for the later generation (atypical) antipsychotics.
1950s and 1960s - Other first generation psychiatric meds include the MAO-Is (such as Nardil) and tricyclic class of antidepressants (such as nortriptyline) - often used as second and third options - and benzodiazepines (such as Valium) for sleep and anxiety (still used as first options).
1967 - Aaron Beck outlines cognitive-behavioral therapy for depression. CBT and related therapies are short-term, manual-based, and designed to help patients manage specific problems in dealing with life (such as in learning to recognize one’s destructive automatic thoughts). Subsequent studies find CBT and related therapies highly beneficial in treating depression and other conditions.
1968 - The APA publishes the DSM-II, which is largely a re-run of the DSM-I.
1970s - Psychiatry comes under attack from a variety of fronts: The antipsychiatry/civil liberties movement rebels against forced institutionalization and other abuses; gays protest medicalizing homosexuality as an illness; insurance companies question paying out for long-term talking therapies with no proven benefit; reform-minded psychiatrists speak out against Freudian dogma. In addition, psychoanalysts are rapidly losing business to psychologists and social workers.
1970s - With the closing of mental institutions, patients are released into the streets, often without supporting community services. Further cuts in housing and other services throughout the 80s results in a new population of homeless individuals in the US.
1980 - Inspired by Kraepelin, Robert Spitzer leads the development of the revolutionary DSM-III, which provides a rational basis for diagnostics worldwide and encourages research and treatment into discrete mental illnesses, such as anxiety, depression, bipolar, and schizophrenia. The DSM-III is further expanded and refined in the 1987 DSM-III-R. Under the Spitzer era, “new” illnesses include ADD, PTSD, and borderline personality disorder. The DSM-III heralds the end of the reign of Freud and gives psychiatry a new lease on life.
1987 - The FDA approves fluoxetine (Prozac) for the treatment of depression. Prozac is by no means the first SSRI on the market, but its impact on both psychiatry and the popular culture is immediate and lasting. Other SSRIs to hit the market include Paxil, Celexa, and Zoloft. The success of these meds help break down stigma and encourage people to seek treatment. Psychiatric practice is now firmly established in prescribing meds.
1989 - The FDA approves the first “atypical” antipsychotic, clozapine (Clozaril), for the treatment of schizophrenia. The med has safety issues that severely restrict its use, but its perceived advantages inspire the development of other drugs in this category, including Zyprexa, Risperdal, Seroquel, and others. Atypicals are also later approved for treating both mania and bipolar depression.
Early 1990s - The success of Prozac sets off a predictable reaction in the form of Peter Breggin’s “Talking Back to Prozac,” plus various academic criticisms of drug industry practices from Martin Teicher and David Healy and others. Over the years, the debate will heat up.
1994 - The APA publishes the DSM-IV, which amounts to a fairly minor revision of the DSM-III-R. By now, the DSM is the new dogma. The DSM-IV-TR of 2000 is a mere technical update. Essentially, in 2009 we are basing diagnosis and treatment on what (little) we knew back in 1980.
Mid-1990s - The development of the internet empowers patients and loved ones to research their illness, and to find supportive communities.
2000 - Eric Kandel, Arvid Carlsson, and Paul Greengard share the Nobel Prize in medicine for their work into how neurons communicate. Over the past several decades, researchers have painstakingly mapped out various brain pathways and gained insight into their influence on behavior. That progress is about to become greatly accelerated through the development of gene chip, imaging, and other technologies.
2000 - An economic recession results in a severe curtailment of mental health services, a trend that will grow worse throughout the decade. Ironically, as treatments and therapies improve and science leaps ahead, the long-term prospects for many patients continue to grow more bleak.
2000s - The evidence increasingly builds that the drug industry, with an acquiescent psychiatric profession, has overstated the benefits of meds and downplayed their side effects. Despite vastly more people taking psychiatric meds, mental illness is running rampant and appears to be increasing. One result is a “recovery movement” that relegates meds to a much smaller role in the entire wellness equation.
2000s - Pharma proves to be as dumb as Detroit. Patent protection runs out on blockbuster meds, with virtually no immediate replacements in the development pipeline. With little financial stake in influencing psychiatry, by 2009 Pharma has virtually withdrawn from the game. In the face of huge revenue losses, they may lack the resources to ever get back in it.
2000s - A large body of brain science, genetic, and longitudinal population studies provide convincing evidence that genes and the environment interact in highly complex ways. In one sense, our genes influence how we react to whatever life throws our way. In another, we can alter our environment in ways to let sleeping genes lie. And yet again, we can influence how our own brains continue to develop. These studies promise to radically alter our whole concept of how we view mental illness and treat it.
The future - Stay tuned ...
Published On: October 08, 2009
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