{"title":"Puzzles of Mental Illness","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0001","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0001","url":null,"abstract":"This chapter considers the extensive array of answers various groups have provided to questions about the nature of mental illness and its boundaries with sanity. While all societies recognize a class of behaviors they call “madness,” they vary considerably in the content of this category and how it differs from normality. What distinguishes mental illnesses from other sorts of devalued conditions? Should medical, religious, psychological, legal, or no authority at all respond to the mentally ill? Why do some people become mad? What treatments might help them recover? The various responses that diverse societies have provided to these issues are both widely divergent and surprisingly similar to current understandings.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131094895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Past and Future of Mental Illness","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0010","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0010","url":null,"abstract":"The puzzles that mental illnesses present have perennially beguiled both professional and lay observers. Throughout history they have asked questions regarding what qualities of madness distinguish it from sanity, the extent to which mental and physical pathologies are similar or different, the kinds of factors that lead people to become mentally ill, and the sorts of treatments that might restore their sanity. Across time, knowledge about these issues does not show any steady growth or, arguably, much progress. The immense recent technological advances in brain science have not yet led to corresponding improvements in understandings of and treatments for mental illnesses. These perplexing phenomena remain almost as mysterious now as they were millennia ago.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127849168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Decline and Fall of Dynamic Psychiatry","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0006","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0006","url":null,"abstract":"After psychiatry’s ascendancy during the two decades after World War II ended, the profession entered its most troubled period. From the emergence of the anti-psychiatry movement in the mid-1960s through the resurrection of a biomedical model in the DSM-III in 1980, the field endured a time of continual crisis. The general culture shed its earlier infatuation with analytic ideas and turned sharply against the discipline. The medical profession, biologically oriented psychiatrists, and third-party insurers, too, came to reject psychodynamic approaches. The National Institute of Mental Health as well discarded its initial psychosocial emphasis in favor of a strong biological focus. Another government agency, the Food and Drug Administration, forced drug companies to stop advertising their products as remedies for general distress and mandated that they show efficacy in treating specific diseases. The high pedestal that dynamic psychiatry rested on in the postwar period swiftly crumbled.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123331424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Freud’s Transformation of Normality","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0004","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0004","url":null,"abstract":"From the beginning of the 20th century onward, Freud’s writings concentrated on elucidating the common processes—repression, the unconscious, childhood sexuality, and the libido—that gave rise to both normal and neurotic phenomena. World War I then turned his attention to external traumas and the role of the ego in mediating between the conflicting demands of the id on one side and the superego and civilization on the other. Freud’s lasting contribution to thinking about mental illness was to successfully expand the range of disorders well beyond conditions thought to have an organic basis or the psychoses. Neuroses resulted from interactions between individuals and their human environments: no physical defect needed to be present. Psychiatrists came to have legitimate claims to treat distressing states that had previously been viewed as purely psychogenic in nature and therefore outside of the medical or neurological realm. Moreover, his blurring of the boundaries between the neuroses and normality created a zone of ambiguity that mental health professionals came to exploit. They came to treat a vast expanse of common occurrences including interpersonal conflicts, the psychic results of traumas, and everyday problems of living.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117280492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Successes and Failures of the DSM Revolution","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0009","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0009","url":null,"abstract":"Forty years after the DSM-III diagnostic revolution, the fundamental dilemmas that have perennially confronted psychiatry (and other mental health professions) remain unresolved. Neuroscientific and epidemiologic findings show that the current DSM system poorly characterizes the nature of mental disorder. Contrary to the intentions of the researchers who developed the DSM-III, its conditions have tremendous internal heterogeneity, artificial comorbidity, and an inability to separate contextually appropriate from dysfunctional symptoms. These inadequacies led the DSM-5 Task Force to propose fundamental changes in the categorical system that was at the heart of these problems. Yet, the pathway they choose to remedy the situation—the introduction of dimensions—would have made these problems even worse. The American Psychiatric Association assembly and board of trustees rejected this premature upheaval in psychiatric diagnosis. The DSM-5, however, did implement other changes, in particular, the abolition of the bereavement exclusion to the diagnosis of major depression, which exacerbated the confusion between normality and pathology. Despite the intentions of its developers, the DSM-5 did not improve understandings of mental disorder.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133291717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mental Illness Becomes Ubiquitous","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0005","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0005","url":null,"abstract":"The quarter century that ran roughly from Freud’s death in 1939 through the mid-1960s featured a growing number of conditions seen as indicating mental illness and needing professional mental health care. A variety of factors contributed to this expansion of pathology. Some of these involved developments within psychiatry, whose mandate enlarged to the extent that, as a president of the New York Psychoanalytic Institute reflected: “Scarcely any human problem admits of solution other than psychoanalysis.” Another source of the growing range of disorders was the radical reshaping of concepts of normality and abnormality that emerged from the experiences of military psychiatrists during World War II. After the war, a newly activist federal government turned its attention to the mental health of entire populations, not just identified patients. At the same time, the transformation of the primary locus of psychiatric treatment from inpatient institutions to outpatient practices mandated a sweeping revision of psychiatry’s system of classifying mental illnesses to encompass many more conditions. Psychoactive drug treatments, too, expanded to attract a huge proportion of Americans; the current templates for anxiolytic, antidepressant, and antipsychotic drugs all arose in the 1950s.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132822002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Biological Century","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0003","url":null,"abstract":"At the outset of the 19th century, mental illnesses were few in number, loosely defined, explained through many diverse and often competing theories, and treated by a wide variety of healers. As the century progressed, theological views faded as understandings coalesced around a medical model that understood mental disturbances as comparable to organic diseases. They were brain malfunctions that were often transmitted through hereditarian processes and that should be specified and distinguished from each other through their etiology, course, and outcome. The most seriously ill often entered mental institutions that were run by superintendents affiliated with the new medical specialty of psychiatry. The more numerous classes of nervous patients came to seek help from somatically oriented doctors. Although explanations of mental disturbances still encompassed both internal and external factors, the balance had tilted sharply toward the former.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122959020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Biology Re-Emerges","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0008","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0008","url":null,"abstract":"The DSM-III did not dictate any particular cause of mental disorder. It classified each diagnosis through its symptoms, not by what factors led symptoms to emerge. Indeed, the manual’s theoretical neutrality was a key reason why the diverse factions within psychiatry and other mental health professions accepted it. The next transformation in views of mental illness involved yoking the DSM-III’s symptom-based diagnoses to the view that mental disorders were brain diseases produced by malfunctioning neurochemical systems and problematic genes. Since 1980, psychiatry has replaced the biopsychosocial model with a bio-bio-bio model that emphasizes brains, genes, and medications. A single-minded focus on psychopharmacology has supplanted the pluralist combination of psychotherapy, psychosocial interventions, and drug treatments that characterized the field during the postwar period. Over a short time period, the biological study of mental illness evolved from a marginal and discredited enterprise to become the dominant model in not just psychiatry but also popular culture.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125764324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Before Psychiatry","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0002","url":null,"abstract":"This chapter explores the three major conceptions of mental illness—supernatural, biological, and psychological—that developed among the ancient Greeks and that formed the major templates for madness that have continually resurfaced in Western thought through the present. During the long period between the fall of the Roman Empire and the European Renaissance and Reformation, physicians became subordinate to theologians and medical thought itself languished. Nevertheless, the Hippocratic psychiatric corpus remained virtually undisturbed. The chapter then considers views of madness that developed in the 16th century in the works of Robert Burton, Richard Napier, and William Shakespeare. Finally, it turns to how mental illness became increasingly likely to be viewed within medical, as opposed to spiritual or moral, frameworks over the course of the 17th and 18th centuries. Within medicine, the influence of humoral pathology, which had dominated medical thinking since ancient times, gradually waned as mechanistic notions grounded in nerves, fibers, and organs arose.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"291 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116515812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostic Psychiatry","authors":"A. Horwitz","doi":"10.1093/med/9780190907860.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190907860.003.0007","url":null,"abstract":"Psychiatry faced a major predicament as it entered the 1970s: it lacked the disease conditions that would provide the field with medical legitimacy. The publication of the DSM-III by the American Psychiatric Association in 1980 marked a thoroughgoing change in thinking about mental illness. In one stroke, psychiatry discarded one intellectual paradigm that had little concern with diagnosis and adopted an entirely new system of classification that imported a model from medicine where diagnosis is “the keystone of medical practice and clinical research.” The promulgators of the DSM-III overthrew the broad, vague, and often etiologically oriented concepts that were embodied in the DSM-I and DSM-II, reclaiming the diagnostic tradition that dominated 19th-century psychiatry. The fundamental principle of the new manual was to define distinct mental disorders through using observable clusters of symptoms without reference to their causes. The DSM-III created a powerful standardized system of diagnoses that reigned virtually unchallenged for the following three decades. It allowed psychiatry to reorganize itself from a discipline where diagnosis played a marginal role to one where it was the basis of the specialty. The DSM-III revolutionized conceptions of mental disorder through transforming conditions that had been thought to be distinctively psychosocial into ones that were disease-like states.","PeriodicalId":434335,"journal":{"name":"Between Sanity and Madness","volume":"422 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129911517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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