Psychiatry
From ancient times mental health problems were often thought to have supernatural or spiritual causes and mentally ill people were considered to be in some way possessed by bad spirits. Treatments were often made using magic or sorcery and exorcism was a commonly considered ‘cure’.
Hospitals for those with mental health problems are thought to have been established in medieval Islamic society in Baghdad. In 1247 the first mental institution was opened in Europe – the Bethlehem Royal Hospital, later shortened to ‘Bedlam’. There were no real treatments for people who were admitted to these institutions.
The word ‘psychiatry’ has its roots in the Greek words psyche, meaning soul or mind, and iatros, meaning physician. It was not until 1808 that the term was coined by the physician Johann Christian Reil. Mental health institutions developed more humane treatment methods in the nineteenth century (for example, William Tuke, a Quaker who founded the York Retreat in 1796) and psychiatry was then considered to be a recognized, specialized discipline.
As psychiatry continued to evolve, in the 1930s specialized drugs were developed. Electroconvulsive therapy (ECT) started being widely used from 1938. Drugs such as lithium, which was used for treating mania, were developed in 1948 and antipsychotic drugs were introduced from 1951.
In the 1960s leading writers such as Laing, Szasz, Lacan and Michael Foucault offered critiques of psychiatry. This led to the anti-psychiatry movement which, in essence, was a criticism of certain practices rather than opposing all that psychiatry did. In the UK, the 1959 Mental Health Act encouraged a change towards community care. In the 1970s the development of selective serotonin reuptake inhibitors (SSRIs), typically used in the treatment of depression and anxiety disorders, further facilitated possibilities of community care. Drugs with lesser side-effects, such as Prozac, were developed in the late 1980s.
In the UK in the late 1980s and the 1990s legislation for community care set out the basis for psychiatric support in the community. The large psychiatric asylums closed down and more patients started to live in less institutionalized settings.
The twentieth century brought with it further understanding of the biology behind many mental disorders and the development of new drugs for the treatment of many psychiatric conditions. In current psychiatry, the focus is on a medicalized approach, with referral for psychological treatments or talking therapies where government guidelines recommend.
In this section we detail the development of the talking therapies from medical practice, psychiatry and psychology. The field of counselling and psychotherapy mushroomed in growth in the twentieth century. With roots going back through hundreds of years in philosophy and religion, it was in the twentieth century that the professions were founded. Counselling and psychotherapy are therefore very new professions
Practitioner Clip 1.1 Bars on the windows of the mind
I (Steve) was told by the Senior Nursing Officer of a mental hospital in the north of England in 1975 that with the advent of drug treatments ‘We have taken the bars off the windows of the mental hospitals and put them in the minds of the patients’.
Psychology
Psychology also has its roots in the great civilizations of Egypt, Greece, China and India. The first psychological therapy was performed by Islamic physicians on those with mental illness in a psychiatric hospital built in Fez, Morocco, in the eighth century CE.
Ahmed ibn Sahl al-Balkhi (850–934) proposed that ‘if the nafs (psyche) gets sick, the body may also find no joy in life and may eventually develop a physical illness’. He stated that the body and the soul can be healthy or sick, or ‘balanced or imbalanced’, and that imbalance of the body can result in fever, headaches and bodily illnesses, while imbalance of the soul can result in anger, anxiety and sadness, which could be treated psychologically (Deuraseh and Talib, 2005).
Psychology was considered a branch of philosophy until the mid-nineteenth century when it was developed as a scientific discipline in Germany and then, in the USA, with the focus on the structure of mind. Wundt (1896) wrote the first textbook on the subject and his perspective was from empirical experimentation. The development of psychology as a natural science was in some way counterbalanced by the work of Freud, who has remained influential into the twenty-first century. In the twentieth century, the development of behaviourism and cognitivism were central to mainstream psychology and its empirical focus. Psychology as a new human science flourished.
Freud is regarded as the founder of psychoanalysis, the precursor to psychotherapy. Freud’s original work was with the ‘unconscious’ and working with ‘hysterical’ patients. Traditionally, the therapist analysed the client and there was little emphasis on the interpersonal relationship.
His ideas greatly influenced the work of Jung, Adler, Assagioli, Rank and a host of others who went on to form diverse schools of therapy. Parsons (1909) coined the term ‘counselling’ in relation to vocational guidance, but it was Carl Rogers who developed counselling as a disciplined therapeutic practice, as distinct from psychotherapy. This was primarily because the practice of psychotherapy was restricted to physicians.
Table 1.1 outlines a brief history of psychiatry, psychology and counselling and psychotherapy. The information here can be followed up with further reading.
The talking therapies are historically a relatively new phenomenon. Until the Freudian era, working with mental health had been the domain of doctors, who applied a medical approach. The development of psychology in the nineteenth century led to an objective approach to understanding the structure and functions of the human mind. From the early work of Freud, four forces or traditions which aim to work psychotherapeutically with human distress have developed.
