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Medical Model of Madness

Medical Model of Madness. The Emergence of Mental Illness Nick Klenda , Brittney Perez, Dominique Staats, and Dyland Walker. Ancient Palestine. In Hebrew the verb “to behave like a prophet” also meant to rave or “to act like one beside oneself”. Classical Greek and Roman.

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Medical Model of Madness

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  1. Medical Model of Madness The Emergence of Mental Illness Nick Klenda, Brittney Perez, Dominique Staats, and Dyland Walker

  2. Ancient Palestine In Hebrew the verb “to behave like a prophet” also meant to rave or “to act like one beside oneself”

  3. Classical Greek and Roman • Two explanations for madness • 1. Cosmological-supernatural explanation- madness was caused by the Gods or inflicted by the spirit underworld • 2. Huromal Theory- The existence is four humors • Blood, phlegm, black vile, yellow vile

  4. Treatments • Limited diet • Gentle massage • Bleeding and cupping • Other treatments in cases with no improvement included • Purges • Vomitives • Hot and cold baths • Sunbathing

  5. Severe Case Treatments • Physical restraint • Violent purges • Excessive bleeding • Dunking patient into cold water • Whipping and beating • Eels placed on head

  6. Madness in Graeco-Roman Era • Madness considered a family problem • By Roman law the mad could not marry, acquire property, or witness a will • Most wondered the country side

  7. The Middle Ages • Believed human imbalances caused maniacs to imitate wolves • Treatments were similar to Greeks with added remedies of poppies and lettuces • Byzantine physicians- made incisions to skull • Church retained a lot of power in the Middle Ages and considered madness a punishment for sin

  8. 17th Century • Before the 17th century, harmless and mad people were free to roam the country-sides and towns. • Sometimes abused and driven from towns. • Responsibility was with the family or community. Narranschiff (Ship of Fools) Madness and folly was not hidden from society. Michel Foucault 1965

  9. The Great Confinement Mid 17th Century • Absolutist & Capitalist order was emerging. • 1656 the Hospital General opened in Paris by royal decree. Not a hospital, no medical treatment or medical involvement. • Prison, to those who were considered socially useless. More than just mad people were held here • More institutions were appearing in European countries. Confinement was a new way to deal with deviants. Labor soon became a big part of these institutions and how they would start to operate.

  10. Able-Bodied vs. Lunatics • Importance of labor force increased, so it was necessary to then separate those who could work from those who couldn’t. • Lunatics separated not for special treatment, but a means to keep able-bodied workers working. • Special institutions were now in place for lunatic or mad people (18th Century).

  11. Introducing the Physician • 18thcentury, physicians played a small role in the confinement and little treatment was given to mad people. • In 1774 England made a physician’s certificate required in order to receive commitment to a madhouse. • Treatments that emerged in the 18th century were those that involved physical punishment. Darwin Chair.. • Philippe Pinel, the great humanitarian. Physical bondage was no longer needed(1794). Wrote Psychiatry in 1801.

  12. Unitary Concept • John Weyer & the humoral physicians • Medical Historians, Ackerknecht (1968) Alexander & Selesnick (1966) • Theodore Sarbin 1969 • Comas Enfermas – a sick state of being • Legitimacy of mental illness concept • Psychiatric Profession • Thomas Kuhn… Politics

  13. 19th Century America Experience • Pennsylvania Hospital 1756 • Founded by the Quakers • Mad people confined to the cellar • Williamsburg Lunatic Asylum 1773 • Keep the peace and constrain the insane • 3 Principle Sources • “police power” • Parenspatriae • State’s power over indigent members of pauper community

  14. Asylums • Biological disease of the brain that was “socially caused” • Believed insanity was curable • Try to make a Utopian World • “Cult of curability” • Need for special skills and knowledge to treat these mental illnesses • Became more of a medical matter

  15. Science of Mental Disease • Took more of a somatic approach • Continually added and expanded on the medical model • Freud and psychoanalysis-talking cure • Neurotic disorders-hysteria, obsessions, compulsions, and phobias • Immergence of new treatments • “Shock shops” and lobotomy • Families of madmen

  16. Third revolution in mental health • Early 1950’s psychiatry was characterized by a “psychotherapeutic ideology. Based on Freudian principles. • Majority of patients in institutions were left untreated and cared for in “back wards” this all began to change by the 1955.

  17. Psychotropic Medication • Psychotropic drugs: chemicals that exert their principal effect on a persons mind. • Ex. Thorazine, and resperpine • Thorazine within a year estimated 2million people were on thorazine. • Many patients that were previously inaccessible could now be reached, and treated for their diseases.

  18. Psychotropic Medication • Critics of the drugs called them “chemical straightjackets” and argued that the chemicals only masked the symptoms and did not treat or cure. • This started the psychopharmacological revolution and psychiatrists felt they could now act like “real physicians.

  19. Decline in mental hospital populations. • Factors that led to decreased hospital populations • Introduction of drugs • Research on the negative effects of institutionalization • Economic reasons

  20. Sociological research • Research focused on three subjects: the mental hospital, social epidemiology, and identifying mental illness. • Research found mental hospitals to be total institutions that were over run and had a sharp divide between patient and staff. • Patients were institutionalized to the hospital and learned little of how to better themselves for the outside world.

  21. Sociological research cont. • Social Epidemiology: patterns of incidence and prevalence of mental illness in a population are described. • These patterns are then correlated with social factors (ex. Social class, residence, race, sex) that appear to affect the likelihood of mental illness.

  22. Sociological research cont. • Identifying mental illness • shift from patient to the defining social audiences. • Mental symptoms are “residual deviance” for which we have no appropriate labels, that arise from a variety of sources. • Patients’ behaviors are interpreted on the assumption that they are mentally ill.

  23. Psychiatric Critique Thomas Szasz: R. D. Laing • mental illness is a myth. People should be able to act as they please • Hospitalization deprives people of liberty • People have problem in living • Psychotherapy needs to be a “moral dialogue” and is not a treatment for a sick mind. • Madness does not reside within the person, but is a response to the life situation that they find themselves in. • Family communication system is the cause of madness. • Mad person is a victim of poor family communication system • Help people go through experiences and grow from them

  24. Community Mental Health:A Bold New Approach • Larger governmental concern for mental health of the public • In 1955 Congress enacted the 1955 Mental Health Study Act. This act had appropriation of more than $1,000,000 and established the Joint Commission on Mental Health and Illness.

  25. Federal action and professional growth • Action for Mental Health(1961) • Expanded treatment programs • Prevention emphasis • Increase in mental health expenditures • No mental hospital should have more than 1000 beds • One community mental health clinic should be established for every 50,000 persons in a population.

  26. Community Psychiatry • Professional arm of the bold new approach • This was an attempt to turn psychiatric knowledge and techniques to community problems. • Goal of preventing and minimizing mental disorder. • Three levels of prevention • Primary- eliminating the causes of mental illness in the community • Secondary-early identification of and intervention against mental problems • Tertiary prevention was treatment and rehabilitation efforts that attempted to prevent long-term, incapacities

  27. Medical Models of Madness in the 1970’s • Brought a new concern for the individual • Renewed emphasis on biological and organic models of madness. • Genetics and biochemistry • Increased interest in technology • Intensified emphasis on the medical model of madness.

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