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“Maeva-Asma-Charlotte-Noémie


History of psychiatry

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We are going to present the history of Psychiatry or its origins.

Small questions will be asked at the end of each part so that the part seems clearer to you.
Finally, we will offer you a little quiz at the end of the presentation to see who understood it the best!


Antiquity

- It was referred to as Alienism and mental medicine for a long time.


- Etymology: medicine of the soul (iatros and psukhê), a soul that was treated by the psychotherapist, and whose science (logos) comes under psychology.

- In the Greek and Roman world, health is defined by the balance of moods and psychic pathology.





- The therapies rely essentially on certain types of diets to restore humoral balance, associated with drugs including a specific, ellébore.
- There are three major orders of mental illness:
Phrenitis (febrile acute delirium), Mania (restlessness without fever) and Melancholia (chronic disorder without restlessness and without fever).


Melancholia (melancholia, Greek melancholia, black bile or black mood) are great diseases, without agitation or fever, usually marked by sadness.


Mania (from Latin and Greek mania, and its synonyms furor and insania) are great psychic diseases, marked by fever-free delirium with fury and loss of reason.

Before the word psychiatry was invented, what did we talked about ?

Question

=> Alienism and mental medicine.

Answer

Middle Ages

- The prevailing idea in society remains that madness is a manifestation of sin, a divine punishment, when it is not a sign of demonic possession.

- Three major conceptions are opposed:
The naturalist school
The "psychodynamist" movement with Saint Augustine
and the organic approach applied to the mental illnesses of Arab doctors, notably Maimonides and Avicenna, a Persian poet philosopher







- Hysteria = supernatural disease
- In the Middle Ages, under Roman law, justice could pronounce the incapacity of a subject due to madness.
But no place was reserved for the reception of madmen, except for the furious, locked up in dungeons arranged in towers or the walls of the city walls.
As for the foreign madmen who wandered, they were expelled from one city to another. The hotels-Dieu, institutions of charity and assistance, had for their part no suitable premises.

Middle Ages

- The creation of these charitable institutions allowed humanitarian treatment

Among them are the institutions of the great Islamic civilization:

The refuges of Fez
The moristans of Cairo and Edirne
The Almeraphtan of Baghdad
The Byzantine morotrophia




- At the very end of the following century, around 1398-1400, the Bethlem Royal Hospital, installed in a priory founded in 1217 and better known as Bedlam, was opened to the insane, the London hospital for lunatics known as St Mary of Bethlehem becoming in 1547 a Royal Foundation, while keeping the same destination.

Middle Ages




• no right to marry.
• no right to baptism (possible if necessary for “madmen” born)
• the property is managed by a guardian chosen by the judge from among the members of the immediate family and has no possibility of disposing of it by will.
• Confinement of madmen deemed dangerous is advocated by law (which gives them extenuating circumstances) to prevent them from harming the community (preventive confinement for agitated madmen and imprisonment in the event of a serious incident).
• Suicide is condemned by the Church.
• Only God decides life or death.


But it was in Spain that the first establishments that really foreshadowed

asylums developed, reserved for the sick of the spirit.

Restrictions imposed by canon and civil law:

What did society think a mental illness was the manifestation of ?

Question

=> A sin or a divine punishment.

Answer

The nineteenth century :

Medico-philosophical treatise (late 1801 for the first edition, 1809 for the second edition) on the insanity or mania of the year X


- madness = morbid entity. The madman is no longer a «fool»





- Pinel regards mental alienation as an illness in the sense of organic diseases, a disorder of intellectual functions, that is, of the superior functions of the nervous system. He classifies it in the class of neuroses, that is to say diseases of the nervous system «without inflammation or structural lesion»,


The nineteenth century:

Law 1838:
The asylum must be treated but also sequestered. It is quite difficult to determine whether institutions should be considered hospices or detention centres. 1) locking up individuals who can harm society and 2) providing healing opportunities for sick individuals.

The law was criticized because it makes it possible to encumber asylums and compromise, according to some individuals, the therapeutic vocation. The buildings were outdated, and the cells were defective. It was also attacked on the guarantee of the person and the risk of arbitrary internment, the poor quality of supervisory staff, the numerical insufficiency of medical supervision, ...






From the beginning of the century, the medicalization of the management and treatment of the insane, led by the alienist, expanded and became widespread. Asylums were built in most departments before and especially since the Law of the 30th of June 1838.
The 1810 penal code includes in its article 64 the principle of the irresponsibility of the criminal in a state of dementia at the time of the act.
The law of the 30th of June 1838, which was not reformed until 1990, was the first law of general and specific assistance and security, inspired by the ideas of Pinel, Esquirol, Ferrus and Falret on isolation.

The nineteenth century:

This was the beginning of the true "great withdrawal": the number of insane persons hospitalized in Paris over the course of sixty years was multiplied by more than five.

- The English system of no-restraint began to be applied in France, notably by Magnan in Sainte-Anne (Paris). Family settlements were created following the example of Gheel, Ainay-le-Château and Dun-sur-Auron.

- This century is also the century of nosology and psychiatric clinics. A rich and complex evolution of concepts leads French psychiatry from Pinel’s nosography to classifications inspired by the German work of Kraepelin.





Organogenesis undergoes a great development following the thesis of Antoine-Laurent Bayle, which links lesions, symptoms and evolution, and makes General Paralysis a model.
Asylums were gradually opening. The insane asylum became in 1937 a psychiatric hospital, dependent on the General Council, and later Specialized Hospital Centre (C.H.S.).
Although not provided for by the law of 1838, the first free services opened their doors in the 1920s (Édouard Toulouse created the Henri-Rousselle hospital in 1922), a few years after the opening of psychiatric services at Assistance Publique in Paris (Gilbert Ballet at the Hôtel-Dieu in 1904).


The asylum must treat but also sequester. Why was that law criticized ?

Question

It will encumber asylums and compromise the therapeutic vocation (if too many people).

Answer

Psychiatry these days :

Psychiatry "outside the walls" was created with the opening of the first dispensaries, and care in private practice, following a real demographic boom.
In 1880, in the whole of France, there were still only 120 alienists for 37 million inhabitants, all in hospitals or nursing homes. At the beginning of 1923, there were 233 French specialists in psychiatry: doctors from public or insane asylums, hospice districts, private mental health homes, professors, and mental medicine associates. In 1967, their number had risen to about 2,000, and to 6,000 in 1983...
At the same time, Freudian psychoanalysis or analysis was experiencing a great development.






- The notion (and the term) of schizophrenia, invented by the Swiss Eugene Bleuler in 1926, quickly became established in France.
- Mental illnesses were replaced by large psychopathological structures.

The Manuel Statistique et Diagnostic ("D.S.M. "), created for the purposes of drug experimentations, was established at the end of the century as a reference to the classification and definition of psychiatric disorders, parallel to the rise of neuroscience and biological psychiatry.


Psychiatry these days :

The questioning of the system of concentration camps and the aspirations born in the Liberation led to the elaboration of a new policy of care


- The circular of 15 March 1960 (confirmed by the law of 31 December 1985) establishes the principle of sectorisation





- Antipsychiatry, which constitutes the radical criticism of the European psychiatric system, has a rather limited resonance in France..
- After a period dominated by psychoanalysis, where notably Françoise Dolto and Jacques Lacan (1901-1981) are born, other modalities of psychotherapy treatment (cognitive and behavioural therapies, systemic therapies).



The law of the 3rd of January 1968 (Protection of incapacitated persons of full age under civil law) dissociates civil capacity from hospitalization (before 1838, there was the principle of prior prohibition. Under the 1838 law, interned patients were automatically protected throughout their stay by the appointment of a provisional administrator).


The law of the 27th of June 1990, reforming the law of 1838, aimed to better protect the rights and freedom of the sick, and established various principles, including prevention, ambulatory management and free hospitalization as a rule.

Psychiatry these days :

The new penal code of 1992 replaced article 64 by article 122.1, with the notion of abolition or alteration of discernment (judgment and control of acts).
The law of the 5th of July 2011 replaced the 1990 law.
Among the most important developments ::







- the concept of care without consent replaces that of hospitalization under duress
- the possibility of initiating care without consent in a general care facility and being continued there for 48 hours, before possible transfer to a psychiatric setting.
- the introduction of a restraining order issued by the director of the host institution, on a medical certificate but without a third party, in the event of “imminent danger”.
- after admission into care without consent, a medical certificate is drawn up within the first 24 hours (without change), then within 72 hours, then between the first 6th and 8th days (the "eight days", which replaces the "fortnight" of the laws of 1838 and 1990).
- the control of justice becomes systematic: the Judge of Freedoms and Detention meets the person concerned before the 15th day of full hospitalization in care without consent and may decide to put an end to it by his own authority.
- In case of disagreement between the treating psychiatrist, who requests the lifting of an SPDRE measure, and the prefect, the opinion of another psychiatrist of the establishment is binding on the representative of the State.



What was the Diagnostic and Statistical Manual ("D.S.M. ") created for ?

Question

=> For the purposes of drug experimentation.

Answer

Conclusion

We can observe that over time, there is a recognition of psychiatric illnesses, and treatment adapted according to the illnesses and this continues to evolve over the years.

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