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The Story of Psychiatry (Part I)
Uddip Talukdar
Senior Resident of Psychiatry, Himalayan Institute of Medical Sciences, Jolly-Grant, Dehradun
When I recall my medical undergraduate days, where inbetween all the big and vast subjects, there was one small subject – hardly ever read well, hardly been able to understand anything and always felt like reading a story book – complete with odd, fancy theories, pretty daring comments about sex, and everything else. It was called Psychiatry. We feared to go to the ward which was at one of the corners of the hospital that some patient might turn up with a knife and run after us. Even the teachers seemed odd. One thing looked quite sure: there is somethingsomething mystical about this subject. On hindsight I find that that mystical feeling about this subject made me pursue it in my post-graduation. As I forayed into the subject I found that things are not as I saw them, not as I felt, more importantly, not as I wanted. Nonetheless, psychiatry was interesting. I know, till date that most who are not directly related to this field, harbours the same mystical feeling about this subject. Sometimes, I find this mysticism amusing. But the problem is: this mystery, this vagueness is neither healthy for psychiatry nor for other medical branches. Probably, it’s high time to bridge this gap to give the highest benefit to the patients. So, to come to this article – I first started with the topic ‘history of psychiatry’. But as I went through different books I found that the word history very annoying; psychiatry does not have a his-story, neither is her-story, their-story, psychiatry is most importantly our story, a story of all mankind.
I presume you would not like to read story, but to read some scientific discussion. But science also has a story, until and unless you know the heroes, villains, side characters of any science, you cannot feel the subject, you cannot love the subject. So, I would like to tell you this story. I hope you will find it interesting as like a pot-boiler hindi movie, this story has all: emotions, drama, violence and sex. So, let’s begin the story…
Once upon a time…
And that time is about two thousand years back. The first written account of a psychiatric illness was found. A king of Babylon named Nabuchadnazar was described to have periods of insanity and aggression and sometimes of melancholy. This probably points to a diagnosis of Bipolar Mood Disorder. Nothing much is known about the psychiatry of those periods except brief mentions of King’s going insane, but another reason about this lull in information can be the various accounts of possession by God or Devil, a right way to think about psychiatric illness in those days.
But, Hippocrates the great healer of all times, have touched upon mental disorders and described ‘melancholia’: something so close to depression that even today there is a subtype called melancholic depression. Hippocrates also did something very bold, he said that mental disorders are not demonic possessions or weakness of the mind, rather they occur because of deficiencies of bile system. Now, please do not confuse Hippocrates’ bile to our very own and familiar gall bladder bile. Hippocrates opined that presence of excessive black bile causes ‘melancholia’, the word means exactly so. So, that was his view about the cause of mental illness. I wish that was so simple. It seems idiotic in today’s terms. But, Hippocrates should be given his due credit just for his ability to question the commonly held belief about mental illness and describing it as illness. Just for this daringness he is the most important of all healers till date. Even today we fear to go against the crowd, which is the biggest hindrance for the progression of science.
No doubt Hippocrates ignited a very necessary spark. But then came the Christianity, flooded the whole Europe and gave a blow to logic and reasoning, and brought in the concept of omnipotent God, who takes care of everything that happens in this world. The darkness of the Dark Age engulfed all scientific lights for longer than a thousand years. Anything that went against socially acceptable norms was considered Satanic influence. As a result many psychiatric patients were burnt alive or incarcerated in the asylums to have mercy of God, tortured severely to drive away the possessing Demon.
However, there is one silver lining in that Dark. For those patients who showed minimal symptoms were shown empathy and were given counseling in the name of God, and for those types of patients brought in certain hope that God will set everything right.
The Renaissance We all know that dark middle age was put to side-ways when the sunlight of Renaissance came in. The explosion of new thinking in all fields brought in some great thinkers who began to delve into something as complex as human mind. But, human brain being one of the most complex machines was not understandable to them. And one philosopher ultimately said, do not mix up body and mind. These two are independent. Body is just a place where the mind resides. The philosopher was Rene Descarte and this concept was known as “Mind-Body dualism”. It made things easier for them to understand, but actually hampered the progression of medical science (I want to differ myself here a bit, some authors feel Mind-Body Dualism to be fore-runner of current biological psychiatry, but the way I understood it, it seems the opposite. May be I am totally wrong. I shall be very glad if someone can clear my concept, please add an article to this magazine about Descarte’s Dualism).
But there were some remarkable achievements in psychiatry in those days.
In 1793, Philippe Pinel ordered all inmates of the asylum of Bicetre, Paris to be unchained as soon as he was appointed the director of the asylum. People, political parties, all were against him, and he was hurled at by Paris mob, one of the inmates he unchained saved him. Pinel’s observation that many patients in the asylum were improved by itself and that very few of them are actually dangerous brought in many thinkers to ponder about the mental illness. Their studies made one thing clear that mental illnesses and the mind itself could not be studied by the procedures available till then. As a result a different approach grew, of studying the symptoms and then understanding the problem. This approach give a remarkable shape to the mind, that is the mind has no shape. Mind thus became a system, not a thing or a bodily organ. A concept considered still valid and agreed upon.
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