A Historical Perspective on Psychological Disorders
As humanity, we approach everything we do not know and cannot understand with suspicion. In fact, this is typical animal behavior. However, this is where a feature that distinguishes us from most other animals comes into play: Curiosity to learn the unknown. This curiosity takes us forward; develops science, art, religion, politics, philosophy and many concepts; In short, it ensures the formation and development of civilization. Yes, the result is mostly beautiful; but the process is full of painful experiences.
History of Psychopathology
After the evolution of religions and beliefs, people began to think that every good or bad event that happened to them was caused by a divine intervention. As humanity, our effort to name and justify everything stems from the search for meaning mentioned above. In this way, we think that, for example, an earthquake is sent by the gods who are angry with people for some reason to warn or punish them. Why else would the earth shake and make our houses collapse on our heads? If we believe that this is caused by a god "for the purpose of punishment", this answer, whether true or false, provides a justification, an explanation, and therefore a meaning for the phenomenon we observe. In essence, this is how science was born: From the moment someone tried to question how true these beliefs were, to prove the opposite of those that were wrong, and to reveal only the answers that we could be sure were correct, science began to develop.
Early Demonological Period
The doctrine that an evil spirit or entity can live inside a person and control his body and mind is called demonology. Examples of demonological thoughts are found in every society and it is a doctrine still maintained by some religious groups. For example, today people believe that the spots on their hands are caused by imaginary creatures called "genies" (although the cause of the spots is fungi). Another example is in the Gospel of Mark 5:8, where Jesus drives out the devil from a man who was possessed by the devil and could no longer be restrained even by chains.[3] In other words, according to the followers of demonological teachings, people with strange behavior that did not comply with the general opinion of the society were believed to be possessed by an "evil spirit", and some "treatments" were applied to make this person's body an uninhabitable place for the devil. People who were thought to be influenced by the devil were not given food, were made to drink incredibly bad-tasting mixtures, and were even whipped to make the devil leave the body.
Hippocratic Period
Hippocrates, who is considered the father of modern medicine, tried to distance medicine from supernatural approaches. He rejected the view that gods send diseases to punish, and instead argued that mental illnesses, like other diseases, have a biological cause and therefore can be treated. Moreover, he was one of the first people to think that mental illnesses developed as a result of a problem in the brain. He claimed that joy, pleasure, laughter, joke, sadness, grief, sadness and crying are reactions coming from the brain. Plato, following Hippocrates, accepted the brain as the center of psychological activities.
We learn detailed information about the Suyuk doctrine from Galen (Galenos), another giant of Ancient Greek medicine, rather than from Hippocrates. Galen took his existing anatomy knowledge further with his animal dissections and combined it with the sukuk teaching.
Dark Ages and Demonology
The death of Galen, considered the last great physician of ancient Greek medicine, is considered the beginning of the Dark Age of medicine in Western Europe. During this period, the church gained influence and declared its independence from the papacy and the state. At this point, churches began to replace doctors, thanks to their increasing authority. Priests, people with mental disorders; They tried to cure them by praying, touching holy relics and drinking potions. During this period, the idea that mental disorders were caused by supernatural causes became stronger again.
"Witches" are to blame for everything!
At the beginning of the 13th century, people in Europe again turned to demonology to explain the epidemics and social unrest they were experiencing. With the influence of the church, people began to accuse people of different appearances, who did not comply with society's value judgments, and most of whom had mental disorders, as "witches" and to persecute them with pleasure. The book Malleus Maleficarum (The Witch's Hammer), written by the Dominican Order priest Heinrich Kramer in 1486, was an official guide for the witch hunt. In this book, it was explained that sudden loss of mind was a sign of demonic possession and that the recommended method to exorcise the devil was to burn the person. Based on this, the masses massacred those they believed to be "witches" not only by burning, but also by brutal methods such as hanging, strangulation, and impalement. Demonology was not as popular in other countries as it was in Europe. For example, the Islamic geography continued the teachings of Greek medicine. In fact, this reversal did not last long in Europe either. As European cities grew, urban authorities began to strengthen. Urban authorities sometimes supported the church and sometimes took over some of the church's duties. One of these duties was to care for patients with mental illness. British law allowed people with mental illnesses to be hospitalized.
Era of Mental Hospitals
Era of Mental Hospitals According to records, Bethlehem's St. Mary's Monastery hosted 6 men with mental illness in 1403. In 1547, it became a hospital where only patients with mental disorders were confined. The conditions in the hospital were deplorable, and the term "madhouse" used for this hospital would find terrible reactions in society. People were literally lining up to watch the patients here. Bethlehem had become one of England's biggest tourist attractions. At the end of the 19th century, watching patients was considered a pastime. So much so that in the Lunatics Tower, built in Vienna in 1784, patients were locked in rooms where they could be monitored from the outside. The treatments in this hospital were also quite brutal. Benjamin Rush, considered the father of American psychiatry, believed that mental disorders occurred due to excess blood accumulating in the brain; Therefore, his most common treatment was to draw large amounts of blood from the patient. Pinel Reforms During this period, when patients were tied to the walls, not allowed to move, kept in dark and neglected rooms, malnourished and mocked, Philippe Pinel, who started working at La Bicetre Hospital in Paris, realized that patients could not recover under these conditions. Deciding to fix this situation, he began to investigate what more effective solutions might be.
Pinel Reforms
During this period, when patients were tied to the walls, not allowed to move, kept in dark and neglected rooms, malnourished and mocked, Philippe Pinel, who started working at La Bicetre Hospital in Paris, realized that patients could not recover under these conditions. Deciding to fix this situation, he began to investigate what more effective solutions might be.
Hospitals established in Europe and America were now mostly providing humane treatments. Depending on this view, known as moral treatment, patients were kept in more suitable conditions, could read books, and were encouraged to communicate with each other and with doctors. Moreover, there were no more than 250 patients in the hospitals.
Population Increase in Mental Hospitals
Towards the end of the 19th century, 32 more public hospitals were opened thanks to the efforts of Dorothea Dix, who worked as a school teacher in Boston. Thanks to the opening of public hospitals, patients who could not stay in private hospitals began to receive treatment here. However, the increasing number of patients brought some problems. First of all, the individual approach, which is the basis of moral treatment, could not be provided due to lack of personnel; this reduced the effectiveness of moral treatment. Moreover, the opened hospitals became the home of doctors who researched the biological and physical characteristics of diseases. Thanks to this development, today's psychiatry began to sit on more solid ground.
New "Treatment" Methods
The increase in population in mental hospitals and the increasing curiosity of doctors led to the emergence of quite radical "treatment" methods. These new methods developed caused many innocent patients to lose their lives. Although most of these treatment methods are not used today, some treatment methods that have proven useful and are still used were developed during this period.
Lobotomy and Psychosurgery
Lobotomy is one of the psychosurgery methods used to treat diseases such as mood disorders or schizophrenia. In general, it is the process of opening a hole in the skull and severing the connections in the prefrontal cortex of the brain, which performs important tasks such as thinking, decision-making and personality formation. Even when lobotomy was popular, it was not considered experimental, that is, its usefulness was not definitely accepted. After most lobotomy procedures, patients either experienced irreversible side effects or died. One of the most popular examples of failed lobotomy is the lobotomy performed on John F. Kennedy's sister, Rosamery Kennedy. Rosamery Kennedy, who had a lobotomy in 1941 to treat her increasing seizures and extreme mood swings, lost her ability to speak and walk after the procedure, and obvious changes occurred in her personality. With the development of antipsychotic drugs, the lobotomy procedure lost its popularity and was removed from practice all over the world by the 1980s. However, this does not mean that psychosurgery does not exist today. Some patients who do not show improvement with medication and therapy can benefit from psychosurgery methods that have proven useful.
Insulin Coma Treatment
In 1927, while Manfred J. Sakel was trying to calm morphine addicts experiencing withdrawal crises by injecting insulin, he accidentally injected an overdose of insulin into one of his patients, causing the patient to fall into a coma. After the patient recovered from the overdose, Sakel observed an improvement in the patient's mental state. In order to establish this observation on more solid grounds, he began to put patients into comas by injecting excessive doses of insulin into schizophrenic patients.[5] After his first studies, he observed some improvements, especially in patients with new onset schizophrenia. Based on these results, it soon became clear that the treatment, whose use had become widespread with courage, was not actually very useful. Some of the patients who were put into a coma were in a prolonged coma, and unfortunately, some of them died. Moreover, the rate of significant recovery in patients who survived the coma was not satisfactory. By the 1960s, it was gradually replaced by electroconvulsive therapy.
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is one of the methods used in the treatment of disorders such as schizophrenia, depression and bipolar disorder by triggering seizures in the brain, just like insulin coma treatment.
It was invented in Italy in the late 930s. During this period, psychiatrists discovered that causing seizures could relieve the symptoms of diseases. Before ECT, seizures were managed with a drug called Metrazol. However, this drug caused patients to feel a deep sense of fear before a seizure, causing them to harm both themselves and their surroundings. Ironically, due to these effects of Metrazol, doctors brought ECT to the agenda. ECT is a treatment method with a bad reputation, just like lobotomy. One of the main reasons for this stigma is that ECT is frequently portrayed as a threat and torture method in movies and TV series. One of the most cult examples of this is the 1975 movie "Cuckoo's Nest". Of course, we cannot accept everything in the movies as true. However, many reports from the 1950s and 1960s also confirm that ECT was used as a threat. Of course, it would be a great injustice to put today's ECT practice on the same level as the ECT practice of those times. Today, in order to protect against the side effects and physiological harms of seizures, the procedure is performed under anesthesia and patients are given muscle relaxants.
Despite all this stigma, ECT is one of the most preferred treatment methods today. However, this does not mean that criticism against ECT is over. The number one issue being discussed with ECT is memory loss. It is known that ECT causes short-term memory loss in patients after therapy, and this is considered a temporary process. However, the possibility that ECT may cause permanent memory loss raises concerns. Many clinicians think that these cases are very rare and that they are a risk that can be taken along with the rewards.
Psychiatry is a very complex field and it is almost impossible to reach a consensus on some issues. Therefore, with each new day, we discuss how true the things we knew yesterday were. How diseases occur, how comprehensive the criteria for diagnosis are, what normal and abnormal are, how effective treatments are, and many other issues are still being discussed. And these discussions will never end. What is important and what will take us further is that we take a rational and ethical stance towards the problems we face.
