Transcript Unit 1 History of Psychiatric Treatmeants ppt

The History of Psychiatric Treatments
One of the oldest “treatments” was
trepanning or making holes in the
skulls for the spirits to escape
These are some examples of trpanning tools)
The patient would literally have a
hole drilled in his head. While this
may relieve pressure for patients
with brain injury, mental illness is
rarely cured by a hole in one’s
head.
Look at this skull. The hole is from
trepanning but more interesting is the
fact that there is evidence of healing
around the hole. Yep, you guessed
it…the patient lived after the surgery
long enough to heal.
In the early 16th century the witch
trials started in Europe and spread to
America.
Many people who were mentally ill were
thought to be witches and dunked in cold
water (if they were “witch” they would float
and thus be burned at the stake if they sunk
they were innocent but probably dead).
Several water treatments, usually
involving cold water, were used
through the years to shock the patient
into mental health
Cold water was meant to “snap” the
patient out of “it” and warm water
was meant to relax them
Doctors in the Elizabethan time believed in
the Four Humors and believed these must
be balanced to be healthy.
Humour
Sanguine
Choleric
Phlegmatic
Melancholic
Body
substance
blood
yellow bile
phlegm
black bile
produced by
liver
spleen
lungs
gall bladder
Element
air
Qualities
hot and moist
fire
hot and dry
water
cold and
moist
earth
cold and dry
Complexion
and Body type
Personality
red-cheeked,
and obese
amorous,
happy,
generous,
optimistic,
irresponsible
red-haired,
thin
violent,
vengeful,
shorttempered,
ambitious
Obese
Sluggish,
pallid,
cowardly
sallow, thin
Introspective,
sentimental,
gluttonous
Doctors then tried what is called
phlebotomy or blood letting to rid the
body of an overflow of one of the
humors.
Phlebotomy tools used in history
included a pan for the blood and
instruments to make different size
holes
They then moved on to what
amounted to torture
These devices spun the
patient to redistribute
the humors
Some treatments were meant to make
them tired
This is the “Gerbil Wheel” which was purposely spun to
make the patient run inside until “calm”.
• Benjamin Rush believed that mental diseases
were caused by irritation of the blood vessels
in the brain.
• His treatment methods included bleeding,
purging, hot and cold baths, and mercury, and
he invented a tranquilizer chair (pictured
below) and a gyrator for psychiatric patients.
He published many medical papers and gave
medical lectures to physicians and students.
• Dorothea Lynde Dix(1802-1887),
• the foremost advocate for the humane care of
the mentally ill during the 19th century.
• Her efforts are credited with the
establishment of 32 state mental hospitals
throughout the United States.
The Question of Patient Restraint
• From the beginning, doctors believed that
mechanical restraint was necessary in their
hospitals
• It was to be employed at a minimum and
never as punishment.
• But early on Dr. Amariah Brigham employed a cagelike “crib bed” at Utica designed after a European
model, and thereafter restraint of one sort or
another was used in American institutions well into
the 20th century.
These are “Bird Cages”
Later these were made from metal
These confine the
patients until they
tire out, calm
down, and can be
handled, some
staff abused this
and left the
patients in them
for days.
The Case of Mrs. Packard and
Legal Commitment
• In 1860, Elizabeth Packard, who differed with the theology of her
clergyman husband, was forcibly placed in an Illinois state hospital. She
remained there for 3 years.
• At that time, Illinois law stated that "married" women could be
hospitalized at a husband's request without the evidence required in
other cases.
• Mrs. Packard was able to obtain a release by an action of the hospital,
but on her return home, she was locked up by her husband who planned
for her admission to an asylum in her native Massachusetts.
• She eventually gained her freedom in 1863 through a habeas
corpus hearing in a local court.
• Mrs. Packard then embarked on a vigorous campaign to protect women's
rights. She published three books on her asylum experience and that of
other women, including The Prisoner’s Hidden Life (Chicago, 1868)
and Modern Persecution, or Insane Asylums Unveiled (Hartford, 1873).
Straight Jackets were popularized in
the late 1800’s and are still used today
Straight Jackets keep the patient from
hurting themselves or others and are
made from cotton ticking so they are
strong but still soft on the skin
Lobotomies were introduced at the
beginning of the 20th century.
Originally introduced in
Europe, the first
lobotomies made slices
through the frontal part
of the brain. In the
United States we
streamlined the process
and using the natural
opening of the eye
socket to hammer a
metal stylus into the
frontal lobe. Essentially
lobotomies did calm the
patient but it was due to
the brain damage
inflicted. These went out
of style when
pharmaceuticals were
introduced in the 1950’s.
As we entered the 20th Century
new treatments were used
As we became enamored with
machines Steam Therapy was
used but was short lived.
Hydrotherapy is actually based on
the scientific fact that warm water
relaxes the body
The canvas covering was for privacy and restraint- notice it is
tied on. Also indoor plumbing allowed for the water to be
drained and refilled. Some hospital staff abused this ability and
kept the patients in there for many hours and sometimes days.
One of the more recent was, however,
Electric Shock or Electroconvulsive
Therapy
Electrodes are
placed against
the temples
with gel that
helps conduct
the electricity.
Then electricity
is passed
through the
brain to
stimulate it.
Later more humane therapies were
introduced that treated the patients
like human beings.
Music therapy was introduced
The newest art therapy includes
adult coloring books to relieve
stress
The future seems to be in medications
but we have many issues today as
well…
The biggest questions
currently debated are:
 How young do we start to
medicate those with mental
health issues?
 Should we be able to force
the mentally ill to take
medications?
 How can we better fund
facilities and the growing use
of meds?
 How do we get the general
population to see the mentally
ill as human being without a
stigma attached?