Because of this, our new-age friend in psychiatry might need some help if it's to keep up with the sheer weight of information that it needs to compute. Of course, separating psychiatry as a discipline with some sort of life of its own from living psychiatrists who practice their trade, is a deliberate misnomer, or an artificial separation that we will just have to use for now.
The discipline or general study of psychiatry raises seemingly impossible questions of boundaries in knowledge as it's held to be now and as it's remade each day. A simple idea of psychiatry as medical biology with a specialism in neurology (the human nervous system to you and I) would grossly simplify the work that existing psychiatrists do now and put pressure on their craft to live up to potentially impossible future goals such as linking internal human biology with external events as they unfold.
These events, no matter how personal or how general in scope, will occur sometimes in new ways unknown to both observer and observed, or historical participant and.. historical participant.
The Royal College of Psychiatrists have produced a short introductory video which contains the phrase that psychiatry crosses both science and art. 'It' does more than this to most of the rest of us - 'it' plays a critical role in the real lives of countless millions amongst the living, the dead and the still to be born.
From the academic British Journal of Psychiatry Andreas Marneros marked the passing of 200 years of formal use of the term 'psychiatry' in 2008, after Johann Christian Reil's considrered introduction of the new word aimed to draw in only the best physicians, who like he, were to have studied medicine.
The view commences formal discussion of the concept of 'mental illness' as the main domain of psychiatry, which for Reil was very different to other arguments rooted in philosophical psychology. Where the recent author Marneros summarises, it's in saying that advances in biology, genetics and psychology are highly important. Whether for us they can outweigh real world events in history, or as measured by sociology and explored by linguistics is not something we can conclude just yet.
The onset of psychiatry seems heavily linked with the establishment and development of institutions within which 'patients' can reside. Not only were German universities a place where new doctors trained and educated but their role, as in other areas of the continent, was also in admitting people to asylums.
There are still of course historical debates surrounding the nature of the altered processes by which circumstances dramatically changed for most people as modernity took hold. It seems also fair to say that the simultaneous developments (both elsewhere and in the UK) of the; American Civil War, French Revolution, industrial revolution and expansive quests overseas beyond mercantile venture, are hotly debated too.
When the 19th century dawned, records from 1801 indicate less than a thousand asylum inhabitants in Britain and France combined. By 1900, this figure reaches over 100,000.
We know that families and 'poorhouses' were able to care less and less for those who were deemed 'unwell'. Asylums were often built away from centres of population and Rogers & Pilgrim note a move towards segregation between the able-bodied poor in workhouses and those unable to labour being put elsewhere.
The view of Michel Foucault from his seminal work 'Madness and Civilization' is along the lines of a challenge to conventional narrative tales of nineteenth century treatments liberating the 'mad' from brutal circumstance in previous times which in turn was seen as being based on the ignorance of backward ages. For Foucault, certain moral hyprocrises play a role, as he views the movement towards the modern era's confinement of people as congruent, or intimately linked with, the theoretical viewing of those confined subjects in a place where new generations of medical doctor begin to treat them as belonging.
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| Michel Foucault |
"The constitution of madness as mental illness... bears witness to a rupture in dialogue, gives the separation as already enacted, and expels from the memory all those imperfect worlds, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out."
This is where psychiatry develops for Foucault, in the space left when perhaps what we may view as smaller communities of close communicative dependence are transformed.
From the historical canon too, the view of Eric Hobsbawm in his work Industry and Empire, sees old ways of life as being majorly transformed from the late eighteenth century onwards. The stark differences between the majority who engage in pre-industrial labour based around peasant holdings (and perhaps craft workshops) and the new rigidly monotonous routines of factory, clock and wage- increasingly within cities, take hold.
When previous ways of life are toppled, the quandry that "pre-industrial experience, tradition, wisdom and morality provided no adequate guide for the kind of behaviour which a capitalist economy required" is central to Hobsbawm's view, and of use to us here. Where previously people may have viewed for themselves either the right to earn a living or be assisted within a community, the dictates of market practice and taking 'whatever one can get' raise new uncertainties in matters of life and death.
Simultaneoulsy as some would see it, mood-instabilities enter the psychiatric vocabulary as new conditions to be incorporated and to diagnose. Joan Busfield notes in her work 'Men, Women and Madness', that the mid-nineteenth century is a form of golden era for psychiatry, with encroachment by neurology and the on-going establishement of three types of institution: private madhouses, voluntary or charitably run asylums and public asylums, providing real locations where practice could flourish.
When the twentieth century dawned, positivist approaches such as those of Emil Kraeplin are worth a mention. Disease classification was important to him and this view is also said to have later influenced the 1980 Diagnostic and Statistical Manual III. Kraeplin's view of genetic and biological problems also led into the theory and practice of eugenics, whereby the security of the German people or Volk was seen as being under threat from "idiots, epileptics, psychopaths, criminals, prostitutes, and tramps who descend from alcoholic and syphilitc parents and who transfer their inferiority to their offspring."
Nazi commentators worried over the collapse of the whole social and moral system, and Hitler himself, spoke of the economic costs of illness as justification for mass sterilisation and extermination (not confined to Germany alone).
Notions of historical narrative also need to include the popularity of psychoanalysis for some time after Sigmund Freud's work and formulations in part sustained by a reaction against Nazi ideology after the second world war. Despite this, the purely biological based views of those such as Kraeplin are said to dominate certain circles once more.
Elsewhere, Joanna Moncrieff has informed us of the physical treatments used in asylums from around 1920 onwards. Examples such as neurological syphillis and malarial treatments moved onto insulin coma treatment and electroconvulsive therapy after the 1930s.
If ecclecticism is present in twentieth century psychiatry, psychiatrists own preference for physical treatments is cited by several commentators. The development of powerful sedatives and stimulants as viewed just before 1950 give way for Moncrieff to the new views that the same substances are somehow able to pinpoint and treat exact causes of assorted malaise in what she refers to as a 'disease centred' model. Her view is that a 'drug centred' model is more accurate to proceed from.
Knowing that the medications are drugs and knowing about the effects seem very sound principles to incorporate. Of the main school of thought which adopts this view the 1960s current of 'anti-psychiatry' has been described by current Exeter Ph-D candidate Sarah Smith (paper available by request) as:
"A radical view of psychiatry [that] might be described as a movement which challenges conventional modern approaches to defining 'mental illness', the role of psychiatric staff in treatment, and traditional ideas about the most appropriate site for psychaitric intervention, opposing the methods of coercion and compulsory hosptial treatment of traditional psychiatry."
Looking at thinkers such as Gregory Bateson and R D Laing, Smith points out the relative merits of both, raising Bateson's emphasis on the symmetry that should be aimed for between sufferer and psychiatrist. With double-binds of contradictory interactions leaving no room for any suitable response, family and micro-sociologcial circumstance are acknowledged as vital.
And of Glaswegian R D Laing, his view is that remaining 'normal' is a less healthy and human response to certain life circumstances than behaving in ways that may attract a dianosis of mental 'illness'. His exampe of schizophrenia located the concept, as opposed to Kraeplin, in wider notions of society and not in individuals. The unity of mind and body is raised in a discussion of his existential approach.
Treating just a brain or mind could also give way to an acknowledgment of alternative sites for treating the distressed. Theraputic communities such as those founded by Laing do still exist in various forms, whereby conflict can be explored through co-presence with others. Details of one such current example is found here: http://www.philadelphia-association.org.uk/ with other prior examples cited by Sarah Smith as follows: Kingsley Hall, Archway and The Arbours Association.
In a very recent paper 'Psychiatry Beyond the Current Paradigm' in the British Journal of Psychiatry, the various authors concur that relationships, meanings and values are seen as subervient or secondary within the current technological way of viewing things by the mainstream discipline of psychiatry.
The (positivist) technological view that the brain is the same as other organs is challenged, just as the view that the medicalisation of everyday life links in with the expansion of markets for psychotropics is mentioned too. Where a new paradigm may emerge they say, will involve amongst other things greater engagement with the real experts of the 'service-user' movment. Where cultural diversity is viewed as important, the non-Western lived examples of other routes to recovery are included. So too is a statement that psychiatry is not and should-not be just neurology, which may ignore social, cultural and psychological dimensions.
A closing quote from them surmises that "All forms of suffering involve layers of personal history, embedded in a nexus of meaningful relationships that are, in turn, embedded in cultural and political systems."
For what it's worth, Bracken et al in their 'new-paradigm' approach stop slightly short of what might also have been useful, an explicit broadening of psychiatry's location in the larger historical scheme of things. Where useful non-western examples were cited, we could pick up on the theme by mentioning a recent BBC news article on Chad's only psychiatrist, Dr Egip Bolsane.
A view from Chad is that mental health issues are not talked about much and the concept of demonic posession, for better or worse, is said to prevail. Where war, civil war, rebellion and coup alongside torture, imprisonment and employment of child soldiers are common; schizophrenia and other conditions are described as having quite frequent rates of occurence.
It's more than likely that the major flaws in this brief initial contextualisation of psychiatry are the omission of a prior inclusion of gendered differences and those which stem from past views of race: as both are viewed by some as being still firmly embedded within the reproduction of social relations in general terms and will be present at each level of psychiatry; as discipline and practice.
By way of introduction to just some of the themes contained in psychiatry over the years, this post has been quite descriptive in nature. It may be possible to extend some of the themes in the following post's dicussion of the social and medical models for distress or 'illness'. That psychiatry is touching on something which is of real importance seems without question to all. Whether the forms of what they see each day can still be explained more fully from outside their discipline, rather than from within, is an open question.
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