historical perspectives of psychiatry and mental health care

clinical aspects of psychiatric care

  • BC - Hippocrates 4 personality types - choleric, melancholic, sanguine, & phlegmatic
  • 1792 French physician Philippe Pinel introduced humane treatment approaches to those suffering from mental disorders
  • 1800 - At the turn of the 19th century, England and France combined only had a few hundred individuals in asylums. By the late 1890s and early 1900s, this number skyrocketed to the hundreds of thousands
  • 1838 - France enacted a law to regulate both the admissions into asylums and asylum services across the country
  • 1843 - Victoria's Lunacy Act
  • 1863- Kalhlbaum and Hecker were among the first to describe and categorize syndromes of the mentally ill. They used descriptive terms such as dysthymia, cyclothymia, catatonia, paranoia and hebephrenia in their analyses.
  • 1874 - Kalhlbaum publishes his book on catatonia
  • 1890 - asylums worldwide had become overcrowded, partly due to transfer of care from families and poor houses, and the optimism of treating the mental ill wained as asylums increasingly became custodial institutions which adversely impacted the reputation of psychiatry.
  • 1890 - Burckhardt performs 1st frontal lobe lobotomies
  • 1893 - Kraepelin divided psychosis into manic depression (now seen as comprising a range of mood disorders such as major depression and bipolar disorder), and dementia praecox (what we now call schizophrenia)
  • 1900-02 - Sigmund Freud publishes his books which spurred the psychoanalytic approach
  • 1903 - barbital (Veronal) is the 1st barbiturate to find clinical use
  • 1906 - Alzheimer publishes pathology of Alzheimer's disease
  • 1908 - Bleuler coins the term schizophrenia (“split” or “shattered” mind)
  • 1912 - phenobarbital (Luminal, phenobarbitone) introduced
  • 1920 - Sigmund Freud in his essay Beyond The Pleasure Principle proposes the psyche can be divided into ego, super-ego and id and that humans are driven by two central conflicting desires - life drive (libido) and death drive (Thanatos)
  • 1924 - development of behavioural therapies starting with Mary Cover Jones' work on the unlearning of fears in children
  • 1927 - Pavlov's experiments 1st translated into English and inspired behaviourist learning theory
  • 1930's - lobotomies and ECT Rx introduced & gained widespread use in the 1940's and 1950's after Moniz successfully performed prefrontal leucotomies in 1935
  • 1936 - Anna Freud stresses the importance of the ego and proposes the concept of defense mechanisms.
  • 1943 - Maslow's hierarchy of needs
  • 1946 - Freeman first performed a transorbital lobotomy on a live patient.
  • 1947 - Eysenck proposed E-N model of personality
  • 1948 - Melbourne psychiatrist Dr Cade's discovery of lithium carbonate as Rx of bipolar disorders
  • 1950 - USSR and other nations ban use of lobotomy (its use in other countries declined in the early 1970's and few were being done in the mid-1980's in UK and USA - the two main countries where it was performed.
  • 1950's - Anna Freud instrumental in development of child psychoanalysis and child development psychology.
  • 1950's - Maslow becomes leader of the humanistic school of psychology which gave rise to several different therapies, all guided by the idea that people possess the inner resources for growth and healing and that the point of therapy is to help remove obstacles to individuals' achieving this. The most famous of these was client-centered therapy developed by Carl Rogers.
  • 1952 - chlorpromazine (Largactil) revolutionises the Rx of schizophrenia
  • 1955 - meprobamate marketed & became popular in the late 1950's as “Happy Pills”
  • late 1950's - tricyclic antidepressants 1st discovered (imipramine)
  • 1960 - the 1st of the benzodiazepines, chlordiazepoxide (Librium) marketed
  • 1961 - the popular MAOI, iproniazid withdrawn as cases of fatal hepatotoxicity
  • 1962 - Kesey's novel One flew over the cuckoo's nest published (later made into a film in 1975)
  • 1963 - diazepam (Valium) 1st marketed
  • 1960's - the development of cognitive therapy
  • 1960's - Janov creates Primal Therapy to re-live and express repressed feelings
  • 1967 - haloperidol approved by FDA
  • 1970's - use of psychoanalytic theory in psychiatry becomes marginalised and deinstitutionalisation commences in USA
  • 1980's and 90's - cognitive therapies merge with behavioural to form cognitive behavioural therapy (CBT) following the work of Lazarus in the 1970's.
  • 1988 - fluoxetine (Prozac) approved by FDA became the 1st blockbuster SSRI
  • 1992 - deinstitutionalisation commences in Australia
  • 1993 - risperidone approved by FDA for Rx of schizophrenia
  • 1995 - genes associated with schizophrenia (chromosome 6) and BPD (chromosomes 18 and 21)
  • 1996 - olanzapine approved by FDA for Rx of schizophrenia
  • 1997 - quetiapine (Seroquel) approved by FDA for Rx of schizophrenia

mental health in Victoria

  • 1843 - Lunacy Act
  • 1867 - asylums built at the goldfields (Ararat (Aradale) and Beechworth) to replace the infamous Yarra Bend Asylum in Melbourne
  • 1872 - Kew asylum (Wiilsmere Hospital) built
  • 1916 - Royal Park Receiving House
  • 1946 - Mont Park Receiving House
  • 1971 - average LOS in acute care = 90 days
  • 1973 - Melville Clinic commences
  • 1986 - Mental Health Act 1986
  • 1986 - Office of Psychiatric Services established
  • 1988 - Decommissioning of Willsmere Hospital
  • 1990 - National Human Rights Commission Inquiry into rights of the mentally ill
  • 1991 - Building Better Cities Program commenced
  • 1991 - average LOS in acute care 23 days
  • 1991 - Psychiatric Services commenced integration and mainstreaming with the public health system
  • 1991 - Reviews conducted into the practices at Lakeside (Ballarat) and Aradale (Ararat) hospitals
  • 1992-3 - decommissioning of institutionalised care facilities such as Aradale, Lakeside, Beechworth
  • 1995 - implementation of new Victorian Area Mental Health System
  • 1998 - last ward at Aradale closes - the Forensic Psychiatry Centre which still held 12 clients and employed 45 staff.
  • 2006 - acute psychiatric bed access block an increasing problem with long stays in public emergency departments
  • 2008 - private ECT Rx in Australia increase 300% since 2003 with a puzzling increase in children under 12yrs (even some younger than 4yrs) prompting WA to ban ECT Rx for those under 12 yrs.

assumptions made in moving patients from institutional care to the community in 1993-1998

  • psychotropic drugs will control psychotic symptoms and allow return to normal life in community and with families
  • with treatment, patients will gain insight into their illness and adhere to Rx guidelines
  • intensive case management will only be needed for short periods
  • as a result of insights gained on effect of substance abuse on their mental illness, patients will modulate their intake, even in communities where availability and acceptability of substance use is increasing
  • community will demonstrate increasing acceptance and tolerance of the presence of significant numbers of mentally ill in their midst, accepting that their human rights will be honored
  • the justice system will be more tolerant and supportive when individuals trying to assimiliate transgress community or legal norms
  • adequate safe accommodation options will be provided for those no longer living in long stay institutions, but who do not require acute hospitalisation
  • moving the care of mentally ill patients will reduce stigma on them from the general health sector which will acknowledge and meet their needs.
  • provision of effective community service will reduce the need for acute mental health beds, and virtually eliminate the need for long term beds, except for the aged who will need psychogeriatric nursing homes.
  • cost of the community services will be constrained by limiting services to only the severely mentally ill (eg. acute psychosis) with the majority of other conditions being treated by private psychiatrists and GPs.

other resources

Aradale mental hospital / Ararat Asylum

h_psychiatry.txt · Last modified: 2022/02/10 12:43 by gary1

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