- •Psychiatry
- •Isbn 0–19–280727–7 978–0–19–280727–4
- •Contents
- •Preface
- •List of illustrations
- •Chapter 1 What is psychiatry?
- •All the ‘psychs’: psychology, psychotherapy, psychoanalysis, and psychiatry
- •Psychology
- •Psychoanalysis
- •Psychotherapy
- •What is psychiatry?
- •What is a mental illness?
- •The subjectivity of diagnosis
- •Imposing categories on dimensions
- •The scope of psychiatry – psychoses, neuroses, and personality problems
- •Schizophrenia
- •Manic depressive disorder (bipolar disorder)
- •Treatment of psychotic disorders
- •Compulsory treatment
- •Depression and neurotic disorders
- •Depression
- •Anxiety
- •Obsessive compulsive disorder
- •Hysterical disorders
- •Personality disorders
- •Addictions
- •Suicide
- •Why is psychiatry a medical activity?
- •A consultation with a psychiatrist
- •Chapter 2 Asylums and the origins of psychiatry
- •The York retreat
- •The asylum movement
- •1. Narrenturm (‘Fools’ Tower’) situated alongside the Vienna General Hospital, the first modern general hospital in Europe, built by Emperor Joseph II in 1787
- •2. Georgia state sanatorium at Milledgeville: the largest state mental hospital in the usa. At its height in 1950 it housed over 10,000 patients
- •Psychiatry as a profession
- •‘Germany’ – psychiatry’s birthplace
- •4. Eugen Bleuler (1857–1939): first used the term ‘schizophrenia’, in 1911 Eugen Bleuler (1857–1939)
- •Sigmund Freud (1856–1939)
- •5. Freud (1856–1939): the father of psychoanalysis
- •The first medical model
- •Julius Wagner-Jauregg (1857–1940) and malaria treatment
- •Electro-convulsive therapy
- •Mental health legislation
- •Chapter 3 The move into the community
- •Deinstitutionalization
- •The revolution in social attitudes The Second World War
- •Therapeutic communities
- •‘Institutional neurosis’ and ‘total institutions’
- •Erving Goffman and total institutions
- •The rights and abuse of the mentally ill
- •7. One Flew Over the Cuckoo’s Nest: Jack Nicholson as the rebellious Randle McMurphy in Milos Forman’s 1975 film depicting a repressive mental hospital
- •‘Transinstitutionalization’ and ‘reinstitutionalization’
- •Care in the community
- •District general hospital units and day hospitals
- •Community mental health teams (cmhTs) and community mental health centres (cmhCs)
- •Day hospitals
- •Stigma and social integration
- •Social consensus and the post-modern society
- •Chapter 4 Psychoanalysis and psychotherapy
- •How is psychotherapy different from normal kindness?
- •Sigmund Freud and the origins of psychoanalysis
- •The unconscious and free association
- •8. Freud’s consulting room in Vienna c.1910 with his famous couch. The room is packed with evidence of Freud’s preoccupation with ancient Egypt and mythology Ego, id, and superego
- •Defence mechanisms
- •Psychodynamic psychotherapy
- •Existential and experimental psychotherapies
- •The newer psychotherapies and counselling
- •Family and systems therapies and crisis intervention
- •Behaviour therapy
- •Cognitive behavioural therapy
- •Self-help
- •Chapter 5 Psychiatry under attack – inside and out
- •Mind–body dualism
- •Nature versus nurture: do families cause mental illness?
- •The origins of schizophrenia
- •The ‘schizophrenogenic mother’
- •The ‘double-bind’
- •Social and peer-group pressure
- •Evolutionary psychology
- •Why do families blame themselves?
- •The anti-psychiatry movement
- •9. Michel Foucault (1926–84): French philosopher who criticized psychiatry as a repressive social force legitimizing the abuse of power
- •10. R. D. Laing (1927–1989): the most influential and iconic of the antipsychiatrists of the 1960s and 1970s
- •11. The remains of the psychiatry department in Tokyo – students burnt it down after r. D. Laing’s lecture in 1969
- •Anti-psychiatry in the 21st century
- •Chapter 6 Open to abuse Controversies in psychiatric practice
- •Old sins
- •12. Whirling chair: one of the many devices developed to ‘calm’ overexcited patients by exhausting them
- •13. William Norris chained in Bedlam, in 1814 The Hawthorn effect
- •Electro convulsive therapy and brain surgery
- •Political abuse in psychiatry
- •Psychiatry unlimited: a diagnosis for everything
- •The patient
- •‘Big Pharma’
- •Reliability versus validity
- •Psychiatric gullibility
- •Personality problems and addictions
- •Coercion in psychiatry
- •Severe personality disorders
- •Drug and alcohol abuse
- •The insanity defence
- •Psychiatry: a controversial practice
- •Chapter 7 Into the 21st century New technologies and old dilemmas
- •Improvements in brain science
- •14. Mri scanner: the first really detailed visualization of the brain’s structure
- •15. A series of brain pictures from a single mri scan. Each picture is a ‘slice’ through the brain structure, from which a 3d image can be constructed
- •The human genome and genetic research
- •Early identification
- •Brainwashing and thought control
- •Old dilemmas in new forms
- •Will psychiatry survive the 21st century?
- •Further reading
- •Chapter 1
- •Chapters 2 and 3
- •Chapter 4
- •Chapter 5
- •Chapter 6
List of illustrations
1 Narrenturm (‘Fools’ Tower’) situated alongside the Vienna General Hospital Narrenturm (‘Fools’ Tower’) situated alongside the Vienna General HospitalNarrenturm (‘Fools’ Tower’) situated alongside the Vienna General Hospital
© Hulton Archive/Getty Images
2 Georgia state sanatorium at Milledgeville
Courtesy of the Central State Hospital, Georgia
3 Emil Kraepelin (1856–1926)
Courtesy of the US National Library of Medicine
4 Eugen Bleuler (1857–1939)
Courtesy of the US National Library of Medicine
5 Sigmund Freud (1856–1939)
Courtesy of the US National Library of Medicine
6 A ‘bag lady’: a homeless, mentally ill woman with her few possessions
© Douglas Kirkland/Corbis
7 One Flew Over the Cuckoo’s Nest
© United Artists/Fantasy Films/The Kobal Collection
8 Freud’s consulting room in Vienna c.1910 with his famous couch
© Hulton Archive/Getty Images
9 Michael Foucault (1926–84)
© Photos12.com/.Carlos Freire
10 R. D. Laing (1927–89)
© J. Haynes/Lebrecht
11 The remains of the psychiatry department in Tokyo after students burnt it down after R. D. Laing’s lecture in 1969
© Hiroshi Hamaya/Magnum Photos
12 Whirling chair
Courtesy of the US National Library of Medicine
13 William Norris chained in Bedlam in 1814
© Fotomas/2006 TopFoto.co.uk
14 MRI scanner
© Corbis/Punchstock
15 A series of brain pictures from a single MRI scan
© Simon Fraser/Science Photo Library
The publisher and the author apologize for any errors or omissions in the above list. If contacted they will be pleased to rectify these at the earliest opportunity.
Chapter 1 What is psychiatry?
The only normal people are the ones you don’t know very well.
All of us know someone who has been troubled (anxious, depressed, or confused). Most of us have felt that way ourselves sometimes (adolescence is often a particular time of self-doubt and unhappiness). At these times our emotions may be overwhelming, unpredictable, and impossible to control and our thoughts strange and bizarre.
Does this mean that we have been mentally ill or need to see a psychiatrist? Luckily the answer for most of us is no. Yet when we read about psychiatry what we find described are experiences remarkably similar to these. Psychiatry is fascinating because it deals with consciousness, choice, motivation, free will, relationships – indeed everything that makes us human. While it is often cloaked in forbidding jargon (‘affect’ instead of mood, ‘anxiety’ instead of worry, ‘phobia’ rather than fear, ‘cognition’ instead of thinking) the conditions described are still instantly recognizable.
This is one of the persisting paradoxes about psychiatry that will recur throughout this book – that its subject is simultaneously firmly rooted in common human experience and yet is somehow ‘that bit different’. We recognize similar experiences to our own in what the patient describes. They are immediately familiar to us, yet these familiar experiences are used to diagnose disorders quite outside our experience. Hopefully by the end of this book you will understand this dilemma better but I can’t promise to resolve it for you. It’s been argued about since psychiatry came into being and the argument still goes on. However, it may be best to start by defining what psychiatry is (and what it is not) before returning to the philosophical and political controversies that attend it.