HISTORY OF ABNORMAL BEHAVIOR

The Early Years Stone AgeStone Age Early human skullsEarly human skulls Early Egyptian writingsEarly Egyptian writings Demonological or supernatural modelDemonological or supernatural model Spiritual possession of some kind Spiritual possession of some kind

controlled the body and the mindcontrolled the body and the mind Trephining-releasing the demonTrephining-releasing the demon Exorcism-purging the evil spirit through Exorcism-purging the evil spirit through

magic, prayer, starvationmagic, prayer, starvation Frontal lobotomies/frontal lobe damage-Frontal lobotomies/frontal lobe damage-

led to dramatic personality changeled to dramatic personality change

Golden Age of Greece

Ancient Greece and origins of the medical Ancient Greece and origins of the medical model: more biological/scientific viewmodel: more biological/scientific view

HysteriaHysteria found in young women, a result of the uterus found in young women, a result of the uterus

dislodgingdislodging E.g., uterus landed at the heart à anxietyE.g., uterus landed at the heart à anxiety

Somatic symptoms, extreme emotionality, Somatic symptoms, extreme emotionality, anxietyanxiety

Treatment?Treatment? Marriage, of courseMarriage, of course If no other choice, bring the uterus homeIf no other choice, bring the uterus home Use of sweet-smelling flowersUse of sweet-smelling flowers

Hippocrates

Father of modern medicineFather of modern medicine First to describe psychopathology as a “disease,” First to describe psychopathology as a “disease,”

biological explanationsbiological explanations Theory of humors (around 400 BC)Theory of humors (around 400 BC) imbalance of bodily humors creates abnormal imbalance of bodily humors creates abnormal

beh; temperament depends on which one beh; temperament depends on which one predominatespredominates

Four: Four: PhlegmPhlegm

Black BileBlack Bile BloodBlood Yellow BileYellow Bile

““Temperament” still usedTemperament” still used First personality-psychopathology connectionFirst personality-psychopathology connection

Middle Ages

Medieval return to the Medieval return to the demonological/supernatural model demonological/supernatural model (late 400s - 1800s)(late 400s - 1800s)

fall of Rome/rise of Christianityfall of Rome/rise of Christianity rejection of more scientific ways of rejection of more scientific ways of

thinking; with rise of Christianity, thinking; with rise of Christianity, religion strongly influenced thinkingreligion strongly influenced thinking

In many parts of Europe, clergy In many parts of Europe, clergy were responsible for dealing with were responsible for dealing with mentally illmentally ill

Middle Ages cont. (1400s to 1600s)

WitchcraftWitchcraft Malleus MaleficarumMalleus Maleficarum – “The – “The

Witches’ Hammer”Witches’ Hammer” Witch-hunting manual written by Witch-hunting manual written by

two Dominican Monkstwo Dominican Monks Many mentally ill were identified as Many mentally ill were identified as

witches and inhumanely punishedwitches and inhumanely punished Mostly womenMostly women This is controversialThis is controversial

Middle Ages cont. (1400s to 1600s)

AnimalismAnimalism The mentally ill were like animalsThe mentally ill were like animals Lack of self-controlLack of self-control Capable of violenceCapable of violence Ability to live in miserable conditionsAbility to live in miserable conditions Thus, should be treated like animalsThus, should be treated like animals Put into asylumsPut into asylums Brutal conditionsBrutal conditions

Early Asylums

16th century on16th century on Development of asylums to Development of asylums to

house mentally illhouse mentally ill Began as a way to remove Began as a way to remove

them from societythem from society Often described as no more Often described as no more

than residences or “storage”than residences or “storage”

Age of reason and enlightenment (1700s to 1800s) advances in medicine and psychiatryadvances in medicine and psychiatry Greisinger (1817-1868): suggested roots of Greisinger (1817-1868): suggested roots of

abnormal behavior in the brainabnormal behavior in the brain Kraepelin (1856 –1926): classification of Kraepelin (1856 –1926): classification of

mental disordersmental disorders Applied medical model to psychopathologyApplied medical model to psychopathology dementia praecox, manic-depressive dementia praecox, manic-depressive

psychosispsychosis discovery of cause of syphilis discovery of cause of syphilis

Caused by bacterial microorganismCaused by bacterial microorganism Symptoms: delusions, bizzare behaviorSymptoms: delusions, bizzare behavior

Philippe Pinel 1745 - 1826 Father of modern psychiatryFather of modern psychiatry Removed the chain of mentally ill personRemoved the chain of mentally ill person Some started running to see sunset Some started running to see sunset People started beating Pinel. People started beating Pinel. Insane person came back and saved Pinel, Insane person came back and saved Pinel,

since then humanity era started.since then humanity era started. People realized that mentally ill are not People realized that mentally ill are not

always abnormal, rather most of the times always abnormal, rather most of the times they are better than the normal peoplethey are better than the normal people

20th century

developments in psychological developments in psychological theory, treatments, theory, treatments, understanding of neuroscience, understanding of neuroscience, assessment, classificationassessment, classification

including two major theoretical including two major theoretical movements: Psychoanalysis movements: Psychoanalysis (Freud), Behaviorism(Freud), Behaviorism

Advanced our approach to Advanced our approach to understanding psychopathologyunderstanding psychopathology

20th century cont.

Psychoanalysis: established Psychoanalysis: established importance of psychological importance of psychological factors in etiologyfactors in etiology

Emphasis on unconscious motives Emphasis on unconscious motives in understanding behaviorin understanding behavior

Behaviorism: established Behaviorism: established psychological research tradition psychological research tradition

Role of learning in human behaviorRole of learning in human behavior Importance of environmentImportance of environment

An Integrative Approach

What about now?What about now? Many psychological disorders appear to Many psychological disorders appear to

have a number of causes and influenceshave a number of causes and influences Genetic Genetic NeurologicalNeurological BehavioralBehavioral EmotionalEmotional Cultural, Social, and InterpersonalCultural, Social, and Interpersonal DevelopmentalDevelopmental Human behavior is complexHuman behavior is complex

History of psychiatry in India. AyurvedaAyurveda

Mental disorders are mentioned in various Mental disorders are mentioned in various types of literature. types of literature.

The aetio-genesis: because of provoked The aetio-genesis: because of provoked humours like vatonmad, Pittonmad & humours like vatonmad, Pittonmad & Kaphonmand. Kaphonmand.

Exogenously the causes were sudden fear or Exogenously the causes were sudden fear or association with ill influence of certain association with ill influence of certain mythological gods or demon, Charak Samhita mythological gods or demon, Charak Samhita designated Psychiatry as ‘Bhuta Vidya’ designated Psychiatry as ‘Bhuta Vidya’

HISTORY OF PSYCHIATRY

5000 BC Ayurveda - Bhoot vidya5000 BC Ayurveda - Bhoot vidya

Endogenous factorEndogenous factor HereditaryHereditary ConstitutionConstitution PersonalityPersonality

Exogenous factors

DemonsDemons GodGod StressStress FearFear

Treatment SympathySympathy RitualsRituals PrayersPrayers Aversion therapy for minor mental illness Aversion therapy for minor mental illness scalding scalding whippingwhipping If severely psychotic, hearing voices and If severely psychotic, hearing voices and

hitting others - killed hitting others - killed If insane person says he could do the best for If insane person says he could do the best for

the society & have a power – then people used the society & have a power – then people used to worship him.to worship him.

AYURVEDA

The description of personality:The description of personality: sathvik- intellectual & moralsathvik- intellectual & moral Rajasik - emotional & passionatic & Rajasik - emotional & passionatic &

impulsiveimpulsive Tamasik- more or less near mental Tamasik- more or less near mental

subnormality or angry.subnormality or angry. Treatment of mental disorders mainly Treatment of mental disorders mainly

included psychotherapy, physiotherapy, included psychotherapy, physiotherapy, shock, drug treatment, hypnotism & shock, drug treatment, hypnotism & religious discourses by Sages. religious discourses by Sages.

Unani System

Najabuddin Unhammad (1222 A. D), an Najabuddin Unhammad (1222 A. D), an indian physician, described seven types of indian physician, described seven types of mental disorders viz. :-Sauda-a- mental disorders viz. :-Sauda-a- Tabee(Schizophrenia); Muree Sauda Tabee(Schizophrenia); Muree Sauda (depression); Ishk ( delusion of love); (depression); Ishk ( delusion of love); Nisyan (Organic mental disorder); Haziyan Nisyan (Organic mental disorder); Haziyan (paranoid state); Malikholia-a-maraki (paranoid state); Malikholia-a-maraki (delirium). Psychotherapy was known as (delirium). Psychotherapy was known as Ilaj-I-Nafsani in Unani Medicine Ilaj-I-Nafsani in Unani Medicine

Siddha System

‘‘Siddhi’ means achievement and Siddhas are Siddhi’ means achievement and Siddhas are men who have achieved results in medicine, men who have achieved results in medicine, as well as yoga and tapas. as well as yoga and tapas.

The great saga ‘Agastya’, one of the 18 The great saga ‘Agastya’, one of the 18 Siddhas has contributed greatly to the Siddha Siddhas has contributed greatly to the Siddha system of medicine of the South.system of medicine of the South.

He formulated a treatise on mental diseases He formulated a treatise on mental diseases called as ‘Agastiyar kirigai Nool ‘, in which 18 called as ‘Agastiyar kirigai Nool ‘, in which 18 psychiatric disorders with appropriate psychiatric disorders with appropriate treatment methods is described. treatment methods is described.

History continued During the reigns of King Ashoka, many During the reigns of King Ashoka, many

hospitals were established for mentally ill.hospitals were established for mentally ill. A temple of Lord Venkateswara at A temple of Lord Venkateswara at

Tirumukkudal, Chingleput District, Tamil Tirumukkudal, Chingleput District, Tamil Nadu, contains inscription on the walls Nadu, contains inscription on the walls belonging to Chola period.belonging to Chola period.

A hospital named as Sri Veera Cholaeswara A hospital named as Sri Veera Cholaeswara hospital and contained 15 beds. hospital and contained 15 beds.

History continued Maulana Fazulur-Lah Hakim, an indian Maulana Fazulur-Lah Hakim, an indian

physician was in charge of the first Indian physician was in charge of the first Indian mental asylum, i. e. Mandu Hospital opened by mental asylum, i. e. Mandu Hospital opened by Mahmood Khilji (1436-1469) at Dhar, M. P.Mahmood Khilji (1436-1469) at Dhar, M. P.

First lunatic Asylum, Bombay Asylum, was First lunatic Asylum, Bombay Asylum, was built in modern India in approximately 1750 A. built in modern India in approximately 1750 A. D. at the cost of 125/-, no traces of it is D. at the cost of 125/-, no traces of it is present today.present today.

In 1794, a private lunatic asylum was opened In 1794, a private lunatic asylum was opened at Kilpauk, Madras. The central mental at Kilpauk, Madras. The central mental hospital, Yerwada, Pune was opened in 1889. hospital, Yerwada, Pune was opened in 1889.

History continued Maxell Jones in 1953 introduced the concept of Maxell Jones in 1953 introduced the concept of

Therapeutic community resulting in the improvement in Therapeutic community resulting in the improvement in the Mental Hospital conditions.the Mental Hospital conditions.

Subsequently other facilities such as Occupational Subsequently other facilities such as Occupational Therapy, Recreational facilities, Outdoor games and Therapy, Recreational facilities, Outdoor games and Picnics were started in Mental Hospitals .Picnics were started in Mental Hospitals .

Lt. Col. Berkley Hill Was the pioneer in starting Lt. Col. Berkley Hill Was the pioneer in starting Occupational Therapy at the European Mental Hospital, Occupational Therapy at the European Mental Hospital, Kanke, Ranchi, in 1935. However inspite of all these Kanke, Ranchi, in 1935. However inspite of all these facilities, the adjustment of the mentally ill patients was facilities, the adjustment of the mentally ill patients was poor in these hospitals. poor in these hospitals.

NIMHANS

On the recommendation of Bhore On the recommendation of Bhore committee (in 1946), All India Institute committee (in 1946), All India Institute Mental Health was set up in 1954, which Mental Health was set up in 1954, which became the National Institute of Mental became the National Institute of Mental Health And NeuroSciences in 1974 at Health And NeuroSciences in 1974 at Bangalore. Bangalore.

First community Mental Health unit First community Mental Health unit (CMHU) was started with the Dept. of (CMHU) was started with the Dept. of Psychiatry at NIMHANS in 1975 Psychiatry at NIMHANS in 1975

NIMHANS Various training programs for psychiatrists, Various training programs for psychiatrists,

Clinical Psychologists, Psychiatric Social Clinical Psychologists, Psychiatric Social Workers, Psychiatric nurses and Primary Workers, Psychiatric nurses and Primary Care doctors are conducted at NINHANS.Care doctors are conducted at NINHANS.

NMHP was launched in 1982 .NMHP was launched in 1982 . The specific vulnerable population, The specific vulnerable population,

children, disaster population, tribal children, disaster population, tribal population, the elderly population, and population, the elderly population, and homeless mentally ill, is included for homeless mentally ill, is included for mental health care planning. mental health care planning.

GHPU

The first GHPU(General hospital The first GHPU(General hospital psychiatry psychiatry units) units) was started in R. G. Kar Medical College was started in R. G. Kar Medical College & hospital, Calcutta in 1933 & GMC R. J. & hospital, Calcutta in 1933 & GMC R. J. J. group of Hospital Bombay in 1938.J. group of Hospital Bombay in 1938.

The number has gradually increased The number has gradually increased since then. Gradually GHPU started the since then. Gradually GHPU started the PG training centres . PG training centres .

Voluntary Health Sector (VHS) in Mental Health The major effort of VHS is evident in the The major effort of VHS is evident in the

area of suicide & Deaddiction where area of suicide & Deaddiction where various kind of activities are being various kind of activities are being carried out to help people in crisis.carried out to help people in crisis.

Oganization like SCARF (Chennai), Oganization like SCARF (Chennai), Richmond fellowship foundation Richmond fellowship foundation (Banglore), Cadbum are also helping (Banglore), Cadbum are also helping people in rehabilitation and integrating people in rehabilitation and integrating them in the societythem in the society

Indian Journal of Psychiatry It was started in 1949 as Indian It was started in 1949 as Indian

Journal Of Neurology and Journal Of Neurology and Psychiatry, was edited by Dr. Psychiatry, was edited by Dr. Nagendra nath De.Nagendra nath De.

After 6 issues publication was After 6 issues publication was stopped in 1954. It was renamed stopped in 1954. It was renamed as Indian Journal of Psychiatry in as Indian Journal of Psychiatry in 1958 1958

Indian Psychiatric Society (IPS) Indian Psychiatric Society was Indian Psychiatric Society was

inaugurated at Delhi on 7th inaugurated at Delhi on 7th January 1947. January 1947.

   Present scenerio of psychiatric services in india 

    National Mental Health Programme National Mental Health Programme was implemented to provide services was implemented to provide services to rural as well as urban population.to rural as well as urban population.

However even today 80% of the However even today 80% of the rural population do not get these rural population do not get these services.services.

Multidisciplinary approach for the Multidisciplinary approach for the treatment of mentally ill is confined treatment of mentally ill is confined to only few institutions.to only few institutions.

Present scenario

Importance is attached to treat the Importance is attached to treat the mentally ill patients & not much thought mentally ill patients & not much thought is given to prevent mental illness & is given to prevent mental illness & promote mental health.promote mental health.

More importance is given to biological More importance is given to biological psychiatry and psychopharmacology, and psychiatry and psychopharmacology, and psychology and social psychiatry are not psychology and social psychiatry are not given due importance.given due importance.