psychiatry(redirected from geriatric psychiatry)
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psychiatry (səkīˈətrē, sī–), branch of medicine that concerns the diagnosis and treatment of mental, emotional, and behavioral disorders, including major depression, schizophrenia, and anxiety. Although the Greeks recognized the significance of emotions in mental disorders, medieval thought emphasized demonic influence. From the Middle Ages until the time of the French physician Philippe Pinel (1745–1826), who instituted humanitarian reforms in the care of the mentally ill, there was no organized attempt to study or treat mental abnormalities or to provide decent institutional conditions for the mentally ill. Such 19th-century reformers as Dorothea Dix fought for improved conditions in asylums. The early 20th cent. saw the organization of the mental hygiene movement, dedicated to the prevention of mental disease through guidance clinics and education. Scientists of the period sought underlying causes of mental and nervous disorders. The German psychiatrist Emil Kraepelin was the first to divide psychosis into the two general classifications of manic-depressive psychosis (see bipolar disorder) and schizophrenia. Gradually, some psychiatrists, led by Sigmund Freud, turned to the behavior and emotional history of the patient as clues to the nature of psychoneurosis and psychosis.
Today, a wide variety of treatment strategies are used in psychiatry, to combat many different psychological disorders. Psychiatry may involve physiological or psychological treatment, or a combination of the two. Physiological treatment generally involves the use of drugs influencing neurotransmitter functions in the brain, or electroconvulsive treatment (see electroconvulsive therapy). Psychiatrists are licensed physicians, specially trained to treat patients with mental disorders and to prescribe drugs. In recent years, psychological difficulties have lost much of the stigma they once had, and many people have sought psychiatric help who might have been reluctant to do so in the past. Psychiatric diagnoses have been misused by authoritarian governments to punish and forcibly confine dissidents, most notably in the former Soviet Union, but also in Russia under Putin and some other post-Soviet nations.
See C. M. McGovern, Masters of Madness: Social Origins of the American Psychiatric Profession (1985); C. Thompson, ed., The Origins of Modern Psychiatry (1987); L. Robins and D. Regier, ed., Psychiatric Disorders in America (1991); R. Michaels, ed., Psychiatry (1992); H. Kaplan and B. Sadock, Comprehensive Textbook of Psychiatry (2 vol., rev. ed. 1993); T. M. Luhrmann, Of Two Minds: The Growing Disorder in American Psychiatry (2000).
psychiatrythe treatment of the mentally ill by medically trained practitioners. Psychiatry is a branch of general medicine, using drug treatment as a clinical resource, but also other physical methods such as surgery and ECT (electroconvulsive therapy). Thus, on the orthodox medical model, the patient is seen as having a specific dysfunction, and specific physical intervention is used to effect improvement. However, though physical intervention may be a first resort, the influence of PSYCHOANALYSIS, BEHAVIOUR THERAPY, and COUNSELLING and other nonphysical approaches to treating mental illness have considerably ameliorated this interventionist approach. Though the management of the PSYCHOSES is still very dependent on drug treatment, a variety of other techniques which emphasize the importance of the patient's perception and experience and the patient's role in their own treatment are used, and the appropriateness of behavioural techniques for changing behaviour is widely acknowledged in the profession. These methods are accepted as being of particular value for the neurotic patient (see NEUROSIS), and this, together with the evidence for severe problems of addiction arising from the prolonged use of tranquillizers, led to a swing from drug treatment to these 'softer’ methods for the neurotic patient in the 1980s. See also PSYCHOTHERAPY, ANTIPSYCHIATRY, PHENOMENOLOGICAL PSYCHOLOGY.
a medical discipline that studies the causes, character, symptoms, and course of mental diseases; methods of treatment and prevention; and organization of care for mental patients. Clinical observation is the principal method in psychiatry, but neurophysiological, biochemical, immunological, genetic, psychological, epidemiological, and other methods are also used.
General psychiatry (general psychopathology), which investigates the basic general patterns of mental disorders, is distinguished from special psychiatry, which deals with specific mental disorders. The psychiatry of “minor” or borderline disorders is a branch of special psychiatry that studies psychopathies, neuroses, and reactive states. Among the independent branches of psychiatry are pediatric psychiatry; gerontological psychiatry; and forensic psychiatry, which deals with the question of responsibility and fitness for work of mental patients. Independent associations and journals of social and biological psychiatry have been established in the USA, Great Britain, and the Federal Republic of Germany (FRG). Among the more recently established branches of the discipline are military psychiatry and narcology, which studies narcomania.
Medical descriptions of mental disorders are found in the works of the ancient Greek physician Hippocrates and in the works of the ancient Roman physicians Aretaeus, Soranus, Celsus, and Galen. Mystical views of the character of mental diseases prevailed in Western Europe during the Middle Ages. Some Oriental physicians sought the natural causes of mental diseases. For example, Avicenna attributed them to disturbances in the body fluids. With the growth of cities, it became increasingly urgent to isolate and care for mental patients. At first, these functions were performed by monasteries (”charitable homes”) and even by prisons. Specialized institutions were established in the 13th through 16th centuries (for example, Olmütz [Olomouc] in Czechoslavakia and Bedlam [Bethlehem Hospital] in London). In Russia the Stoglav (Hundred Chapters) Synod (1551) drew up special regulations for the monastery care of those suffering from mental disorders.
The development of psychiatry as an independent discipline (late 18th and early 19th centuries) is associated with a number of physicians, including the Italian V. Chiarugi. P. Pinel reformed psychiatric care in France and advocated the humane treatment of patients, who were customarily kept in chains. His student J. Esquirol was the founder of psychiatric research. W. Griesinger substantiated the interpretation of mental disorders as brain diseases and founded the German school of psychiatry, which overcame the influence of the “psychicists” and the “somaticists,” adherents of the argument that the immortal soul cannot get sick. The English psychiatrist H. Maudsley developed the evolutionary approach in psychiatry and was a pioneer in pediatric and forensic psychiatry.
In Russia psychiatric clinics were organized in the second half of the 19th century at the St. Petersburg Academy of Medicine and Surgery (I. M. Balinskii), Moscow University (S. S. Korsakov), and the University of Kazan (A. U. Freze). At these clinics the main schools of Russian psychiatry took shape. (I. P. Merzheevskii, V. M. Bekhterev, V. P. Serbskii, P. B. Gannushkin, and N. N. Bazhenov were among the most distinguished members of these schools.) Zemstvo medicine (care funded by district and provincial assemblies in prerevolutionary Russia) played a major role in the development of psychiatric treatment. (Among the doctors associated with zemstvo medicine were V. I. Iakovenko, P. P. Kashchenko, and L. A. Prozorov.) The first society of physicians for the insane was organized in St. Petersburg in 1861. Congresses of Russian psychiatrists were held periodically from 1887. Problems in psychiatry were also discussed at the Pirogov congresses.
In psychiatry the end of the 19th century was marked by the development of a nosologic classification of psychoses by the German psychiatrist E. Kraepelin, whose work was anticipated by that of K. Kahlbaum in Germany and V. Kh. Kandinskii and S. S. Korsakov in Russia. The late 19th century also saw the development of the psychiatry of minor or borderline disorders and the elaboration of a theory of neuroses and psychopathies (the French physician J.-M. Charcot). Psychiatry abandoned the “theory of madness” and became a scientific discipline concerned with morbid changes in the human psyche.
In the 20th century two approaches developed in psychiatry: the materialist and idealist approaches. The materialist approach, which is responsible for advances in the field, concentrates on the character of psychoses, relying on progress made in biology, neurophysiology, and morphology. The idealist approach, which consists of many trends, including Freudianism, phenomenology, and personalism, is characterized by K. Jaspers’ view that there is an “impassable desert” between the physical and the mental. Antipsychiatry, a peculiar variety of the idealist approach, is based on the thinking of the 20th-century French philosopher M. Foucault.
Progress in psychiatry was promoted by increased knowledge of the clinical manifestations of schizophrenia (E. Bleuler and many others) and other mental disorders and by genetic analysis. In addition, there were advances associated with new methods of treatment, including the biological method of treating general paresis (proposed by the Austrian psychiatrist J. Wagner von Jauregg in 1917 and anticipated by studies by the Russian physician A. S. Rozenblium in 1876), as well as insulin shock therapy and electroshock therapy for schizophrenia. Most of the progress in psychiatry in the second half of the 20th century is attributable to the development and use of psychotropic agents.
An important feature of the development of psychiatry in the USSR was the establishment of psychiatric dispensaries—a new type of service that provided outpatient treatment for most mental patients, arranged jobs for them, and helped prevent the exacerbation of mental illness. In the middle of the 20th century, outpatient care became widely available in other socialist countries and later in the USA, Great Britain, the Netherlands, France, and elsewhere.
The emphasis on prevention broadened the opportunities for the study of incipient and borderline forms of mental illness, for genetic research, and for the treatment and rehabilitation of patients. This emphasis, along with the nosologic approach and a theoretical foundation (the doctrine of higher nervous activity), are characteristic of Soviet psychiatry. There are many psychiatric research centers in the Soviet Union, including the institutes of psychiatry of the Academy of Medical Sciences of the USSR and the Ministry of Public Health of the RSFSR, the V. P. Serbskii Institute of Forensic Psychiatry in Moscow, the V. M. Bekhterev Institute of Psychoneurology in Leningrad, the Institute of Psychoneurology in Kharkov, the M. M. Asatiani Institute of Psychiatry in Tbilisi, psychiatry divisions in a number of institutes, and about 100 psychiatry subdepartments at medical institutes and at institutes for advanced medical studies. Among the major foreign research centers are the national Mental Health Association in Washington, D.C., and institutes of psychiatry in New York and London. Research at the principal Soviet and foreign centers is multidisciplinary, covering the clinical, social, epidemiological, psychological, neurophysiological, pathophysiological, and pathomorphological aspects of various problems. There are institutes for psychiatric research in many countries, including Poland, Czechoslovakia, Hungary, Bulgaria, the FRG, France, Japan, and India.
In 1973, approximately 15,000 Soviet psychiatrists were members of the All-Union Society of Neuropathologists and Psychiatrists (founded in 1927). Since 1968 the society has been a member of the World Psychiatric Association (founded in 1961), which includes 74 national societies. International congresses of psychiatrists have been held since 1950. The Mental Health Unit of the World Health Organization plays an important role in organizing international psychiatric research.
The problems of psychiatry are discussed in the Soviet journal Zhurnal nevropatologii i psikhiatrii im. S. S. Korsakova (S. S. Korsakov Journal of Neuropathology and Psychiatry, since 1901) and in foreign journals such as Archiv für Psychiatrie und Nervenkrankheiten (Berlin, since 1868), Fortschritte der Neurologie, Psychiatrie und ihrer Grenzgebiete (Stuttgart, since 1929), Les Annates Medico-Psychologiques (Paris, since 1843), L’Evolution Psychiatrique (Paris, since 1925), the American Journal of Psychiatry (Washington, D.C., since 1844), and the British Journal of Psychiatry (London, since 1855).
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