History of Norwegian psychiatry

Psychiatry as a professional and scientific enterprise developed in Norway in the middle of the 19th century. During the last part of this century, four state asylums were erected, followed by several county asylums during the first part of the 20th century. From the 1870 s, institutions for private care were established, usually in the vicinity of the asylums. During the middle of the 19th century, psychiatry in Norway was influenced by "moral treatment", but during the end of the century somatic ideas prevailed. After the Second World War, Norwegian psychiatry was influenced by Dutch and British social psychiatry, followed by American psychoanalytic-oriented psychiatry during the 1960-70s. Since the 1980s, the climate changed, with more emphasis on classification and drug therapy. The new American DSM-III also influenced Norwegian psychiatry, and cognitive-behavioral therapies became more prevalent. Norwegian psychiatric research has during the last few decades been characterized by epidemiological studies, clinical follow-ups and twin research.     

Karl Wilmanns (1873-1945)--a biobibliographic view of a psychiatric era

The Heidelberg University school of psychiatry was mainly shaped by the personality of Emil Kraepelin (1876-1926) who won world-wide recognition at the end of the 19th century during the discussions on "dementia praecox". It was his personality that made Heidelberg a fulcrum of a growing new scientific self-assurance that had no precedent in clinical psychiatry which no longer needed the disciplines of neuropathology and neurophysiology as pillars of support to gain recognition among the experts. Although the scientific achievements of Wilmanns cannot be rated as highly as those of E. Kraepelin and K. Jaspers, it is a fact that the period between 1918 and 1933 during which the Department of Psychiatry of the University of Heidelberg as represented by the University Hospital of Psychiatry, was headed by Karl Wilmanns, was the most fruitful period of the "Heidelberg School". 1933 was not only a political but also a psychiatric turning-point. Karl Wilmanns was one of the first of the well-known university teachers who was dismissed from office for political reasons. With his exit the Heidelberg School came to an end, and with it the discipline of psychopathology as a fundamental part of psychiatry- which had been the true progeny of that school. The references outline the influence of biological though on the "zeitgeist" of psychiatry. The contradictions, inhumanity and seduction of this line of thinking were not sufficiently recognised in all their aspects and consequences even by critical minds such as that of K. Wilmanns.     

Madhouse, asylum, retreat, specialist hospital - on the genesis and history of names for psychiatric institutions in Germany until the beginning of the 20th century

This paper analyses the history of names for psychiatric institutions in the German language. When scientific, medical psychiatry came into being in the late 18 (th) century, names with negative connotations such as "Narrenhaus" or "Tollhaus" (approximating to the English word "madhouse") were substituted by the then neutral "Irrenhaus" and later in the 19 (th) century by "Irrenanstalt". Soon, however, this new term became associated with negative connotations, making it unsuitable as a reflection of the many improvements made both in the treatment and the public image of psychiatric service users. Changes in word form such as "Heilanstalt", "Pflegeanstalt" and "Heil- und Pflegeanstalt" better reflect the character of the institutions. Objections to the word "Anstalt" (institution) were not acknowledged until the 20 (th) century when the term "Fachkrankenhaus" ("specialist hospital") was introduced. Before then the German word "Klinik" was reserved for university hospitals, the first of which was founded in 1878. The history of names for psychiatric institutions reflects both changes in the treatment of the mentally ill and the attempts made above all by psychiatrists to face and overcome stigmatisation of their clients.     

Turning points in American psychiatry of the 20th century

Sabshin describes three turning points in twentieth century American psychiatry. Following "the time of the Thirteen", the time of the founders of modern American psychiatry, the first turning point was marked by the rise of Meyerian psychobiology and had its peak impact during the second quarter of the twentieth century. In the post World War II years diverging therapeutic ideologies became dominant, including the important impact of psychoanalysis. But competing ideologies (e.g. in social and biological psychiatry) were of importance also. The most recent turning point was marked by the current surge of neuro-science and psychopharmacology along with empiricism and logical positivsm. It is predicted to peak in the middle of the current decade. Following the preceding demedicalization a remedicalization of psychiatry was the result. For the turn of the 21st century, as Sabshin predicts, a re-emergence of analogues of Meyerian psychobiology will take center stage, particularly concentrating on questions of coping and adaptability, on how the human being keeps himself healthy and sane during subsequent developmental stages as well as in the face of stressful life events.     

On the history of taking up the word "irre" and its derived forms into the nomenclature of German psychiatry

At the threshold from the 18th to the 19th century, the development of the psychiatry in Germany - as a subject of science and as a health service - made it necessary to find adequate terms for the new perception of mental illness and people suffering from it. At that time, some more or less discriminating expressions with origins in the medieval or early modern German, some words derived from the Latin language of scientists, and some new terms used in contemporary theories on the explanation of psychic disorder, constituted "eine verwirrende Vielfalt der Gattungsnamen für psychische Krankheit" (a confusing multiplicity of names for mental illness) - (F. Nasse 1818). To make an end to this multiplicity, in the last decade of the 18th century some experts proposed to use terms derived from the word "irre" as standard expressions for illness, symptoms and patients in psychiatry as well as for the new elements of the emerging psychiatric health sector. The word "irre" with the meaning "geistig gest?rt" (mentally disordered) was part of the German vocabulary since the end of the Middle Ages. According to its advocates, it seemed to be suitable as new standard term, because it was not linked to discriminating prejudices with respect to its origin and to the understanding of that time. Therefore it met the contemporary demand for a more humanitarian behaviour towards ill people. But it took 20 years of discussion and clarification until this nomenclature was accepted in the new subject psychiatry and rested well established for nearly the next 100 years.     

A century of Dutch neurology

The Netherlands Society of Neurology evolved from the Society of Psychiatry founded in 1871. The name was changed into Netherlands Society of Psychiatry and Neurology (NSPN) in 1897. In the same year, the word neurology was also added to the name of the journal. The Society steadily blossomed, but in 1909 the first signs of dissatisfaction occurred: the Amsterdam Neurologists Society was founded. A few split-offs would follow. The number of members of the NSPN increased from 205 in 1920 to 585 in 1960. In the early 1960s, the Society was reorganised and would consist of two sections, one for psychiatry and one for neurology. However, this would not last, as a full separation was established in 1974. For several reasons, the name of the journal was changed four times until it assumed its present name in 1974. The 100th volume of CNN was not published, as expected, in 1996, but in 1998, because of two skipped publication years, one during WWII and another in the 1970s. During the last decades of the nineteenth century, teaching of neurology was mostly given within the frame of psychiatry, following the German tradition of ‘brainpsychiatry’ (organic or biologic psychiatry). The first official chair of psychiatry was founded at Utrecht, 1893 (Winkler). In Amsterdam, private teachers such as Delprat taught ‘electro-therapy and nervous diseases’ since the 1880s. The first extraordinary chair of neurology and electrotherapy was founded for his successor, Wertheim Salomonson in 1899. The first university clinic for psychiatry and neurology started at the Amsterdam Municipal University, when Winkler became professor of psychiatry and neurology in Amsterdam in 1896. Around the turn of the century, chairs of psychiatry and neurology were also founded in Groningen and Leiden. Separate chairs for neurology and psychiatry appeared in Amsterdam in 1923 and in Utrecht in 1936. Following an initiative of Brouwer, the first neurological university clinic opened its doors in Amsterdam in 1929. In the 20th century, a number specialised peripheral neurological clinics and epilepsy institutes were founded. In 1909, the the Central Institute for Brain Research was established in Amsterdam.     

Epilepsy, psychiatry, and neurology

This article reviews the relationship between the psychiatry and neurology of epilepsy, especially in the last 100 years. Throughout most of its recorded history of 3 to 4 millennia epilepsy has been viewed as a supernatural or mental disorder. Although first suggested by Hippocrates in the 5th century B.C., the concept of epilepsy as a brain disorder only began to take root in the 17th and 18th centuries. The discipline of neurology emerged from "nervous disorders" or neuropsychiatry in the late 19th century, when vascular theories of epilepsy predominated. By the turn of the 19th century psychiatry and neurology were diverging and epilepsy remained to some extent in both disciplines. It was only in the middle of the 20th century with the development of electromagnetic theories of epilepsy that the concept of epilepsy per se as a neurological disorder was finally adopted in international classifications of disease. This was associated with a refined definition of the ictal, pre-, post-, and interictal psychological disorders of epilepsy, which have contributed to a renaissance of neuropsychiatry. At the beginning of the 21st century and the centenary of the ILAE psychiatry and neurology have been converging again, led in some respects by epilepsy, which has provided several useful models of mental illness and a bridge between the two disciplines.     

Community Psychiatry Tracks for Residents: A Review of Four Programs

Many psychiatry residency graduates end up practicing at least in part in community settings. However, declining funding and other issues prevent many residency programs from offering robust community psychiatry training to all of their residents. Accordingly, some residency programs have developed Community Psychiatry Tracks, with the goal of developing future leaders in public sector psychiatry. We cataloged US psychiatry residency programs offering Community Psychiatry Tracks by reviewing the literature and surveying training directors and members of the American Association of Community Psychiatrists. Authors from each of the four programs found to be actively offering such tracks describe their track curricula, from which we elucidated common and variable elements as well as strengths and weaknesses and then make recommendations for other programs wishing to start a track. A Community Psychiatry Track preliminarily appears to be a well-received way to offer enhanced Community Psychiatry training to interested residents, to recruit medical students to residency programs, to offer opportunities for collaboration between residents and faculty members, and to expand opportunities for scholarly work by residents.     

Introduction : gouverner et soigner

French psychiatry was born in a particular political context: that of the revolutionary and post-revolutionary period. From its beginning, at the end of the 18th century, it was linked to the political realm. We will start with a pre-revolutionary text: The 1785 Colombier and Doublet memorandum containing a genuine program of organization and of care originating from the philanthropic ideas of the Enlightenment philosophy. This program contained the seeds of the very possibility of the birth of a new discipline, the medicine of the insane linked to the curability of madness, a medical version of the notion of degeneracy the 18th century philanthropic current was fond of. Later, the imbrication of politics and psychiatry may be studied by way of the parallel evolutions of psychiatry and of the successive political regimes of the 19th century, and also through some expressions of clinical psychiatry itself, as may be seen by the presence of the political in the mental representations found in some forms of delusion. The study of links between the political and psychiatry leads us to consider the secularization of discourse and of psychiatric institutions, and to examine the origin and consequences of the 1838 law as well as the criticisms rapidly leveled at it. The political stakes of classifying illnesses, the relations of psychiatry with justice and the eventual repressive uses of psychiatry should also be considered. Finally, the organization of care and the design of the architectural environment and more generally of the therapeutic environment are also related de facto to political choices.     

Student career choice in psychiatry: Findings from 18 UK medical schools

Abstract

Psychiatry recruitment continues to be a problem in the UK and large-scale studies are required to understand the factors surrounding this. A quantitative, cross-sectional online survey, incorporating demographics, career choices, teaching exposure, attitudes to psychiatry and personality factors, was administered to final-year UK medical students. A total of 484 students from 18 medical schools responded (66% women). Sixteen (16%) had chosen psychiatry at medical school entry. By final year, 15 respondents (3%) had decided to pursue a career in psychiatry, while another 78 (17%) were seriously considering it. There was little difference in the quality ratings of lectures and small group teaching between those interested in psychiatry and those not. Experience of ‘enrichment activities’ (psychiatry special study modules or components, psychiatric research, university psychiatry clubs, and psychiatry electives) were significantly more likely to take up psychiatry. Causality cannot, however, be determined in this study. The study identified several distinct groups of UK students: those deciding on psychiatry before medical school and maintaining that career choice, those deciding on psychiatry during medical school, and those interested in other fields. Addressing psychiatry teaching and exposure may improve recruitment into the speciality.     

Past, present and future of biological psychiatry.

These excerpts from the Presidential Address at the 7th World Congress of Biological Psychiatry, Berlin, 2001 attempt to define the term "biological psychiatry", the principle relevance of diagnostic systems for biological psychiatry and the relevance of biological psychiatry in the past and future for the development of psychiatry in general. They also cover the problem of misuse of biological psychiatry and the need for the rigorous observation of ethical standards.     

Some resolutions in difficulties of postgraduate psychiatric education in Japan]

1. Board Certification System of Psychiatry There was a heated debate about "Postgraduate Psychiatric Education and Board Certification of Psychiatry" in the annual meeting for the Japanese Society of Psychiatry and Neurology held in Nagasaki in 1968 and in Kanazawa in 1969. The oppositions of young psychiatrists were as follows; 1) Issues of low cost of medical expense as government politics, social protect politics from psychiatric patients, and improper management of patients in mental hospitals should be dealt before making Board Certification System of Psychiatry. 2) Management of the Society of Psychiatry and Neurology dissatisfies many psychiatrists. Board Certification Systems started in many medical societies from 1969 to 1987. Main nine departments except psychiatry started the system. In 1987, the Japan Association of Chairmen of Department of Psychiatry of Medical Colleges (JACDPM) proposed a program for a postgraduate course. The Japanese Society of Psychiatry and Neurology (JSPN) formed the Committee on Psychiatric Education in 1987 and Working Group on Accreditation Program (WGAP) in 1991 under the Committee of Psychiatric Education. After intensive discussions on the Board certification, the WGAP reported a summary of their discussions in 1994. The essence of the WGAP recommended model for the Board of Association was as follows: Minimal Requirements Outline Training Period--three years psychiatric training after two years primary care experience by rotation through other departments. Field of Training--WGAP recommended that post-graduate training should be given at different kinds of institutes such as the department of psychiatry in medical schools, mental hospitals, out-patient mental clinics, community experiences in rehabilitation, day care, social clubs and health centers. Assessment--both oral examination and case reports are requested for evaluation and board certification. Re-evaluation every five years is required. However, there have been the following opinions and the Board Certification System has not been realized. 1) Making improvement in mental hospital is more important than starting Post-graduate Training and Organization for Board Certification of Psychiatry System (PTOBCP). 2) Starting PTOBCP makes professors in department of psychiatry in medical colleges give great power to suppress the right of personal management. 3) Financial support for postgraduate trainee and trainer is insufficient. Medical and psychiatric situations have changed from 2001 to 2002. 1) A neutral organization instead of academic societies will make Board Certification System in each department in the future. 2) Postgraduate educational rotation system (two years) will start in 2004. 3) Advertisement of being certificated by the Board has been possible. In recent situation, necessity for making of PTOBCP is increasing and many members of JSPN long to make it. In the 98th annual meeting, 2002 it was decided to make PTOBCP. 2. Post-graduate mandatory education system including psychiatry Recently, it was legally decided that post-graduate education for two years should be mandatory for every medical doctor who has passed a national board from 2004. Furthermore, psychiatric training should be mandatory for every rotating resident. The period of psychiatric training is one, two or three months, which depends upon each teaching hospital. It is epoch-making that every resident should receive psychiatric training, however, in other words, it means that psychiatric education in Japan will be re-evaluated through such a new training system.     

Nosographie et classifications des maladies mentales dans l’histoire de la psychiatrie

Objective

Retrace the history regarding the classification of diseases, notably mental diseases, from the birth of psychiatry at the beginning of the 19th century and up to the 10th revision of the International Classification of diseases published by the WHO (in 1993).

Method

Study the classifications proposed successively by the nosographists during this period.

Results

In the 18th century, physicians classified diseases in the same way as animal and vegetal species (Carl von Linné). In the 19th century, following several attempts in France and Germany to classify mental diseases according to known or suspected aetiological and pathogenic factors (B.-A. Morel, Griesinger), psychiatrists classified psychosis and neurosis according to their clinical symptomatology and their development over time, from their onset up to the terminal stage. In 1893, J. Bertillon proposed a “Nomenclature of diseases” during the International Congress of Statistics in Chicago that permitted their classification, so as to classify-collect statistical epidemiological data on international level. Revisions were made between the two world wars by the Office of Health of the Society of Nations (Geneva). Following the foundation in 1948 of the WHO, it was the latter that continued the revisions of the International classification of diseases (ICD), Chapter V (F) of which is dedicated to disorders.

Discussion

The debate on the question of classifications in psychiatry has always taken place during the World Congress on Psychiatry since its initiation in Paris in 1951. In 1976, during the sixth congress in Honolulu, a resolution was adopted requesting the national psychiatric societies that had a classification of mental diseases to revise the latter so that they tallied with Chapter V(F) of the ICD. The American Psychiatric Association revised its Diagnosis and Statistical Manuel of mental disorders (DSM) and published the DSM III. In France, a group of pedopsychiatrists published a French classification of Mental disorders in children and adolescents (Classification Française des Troubles Mentaux de l’Enfant et de l’Adolescent- CFTMEA), the last revision of which was published in 2012 (CFTMEA R 2012).

Conclusion

This study shows that it is not possible to propose a classification of mental diseases, in particular according to the development of psychiatry at the time it is drawn up; it can only be of value within the cultural context of the country in which it is to be used.     

Karl Ludwig Kahlbaum (1828-1899)--a protagonist in modern psychiatry

Kahlbaum was one of the most influencial psychiatrists of the 19th century. He paved the way for Kraepelin and inspired the development of 20th century clinical psychiatry. With his work he contributed to new ideas in general psychopathology and in psychiatric nosology. He described "clinical state-course-entities" and developed the concept of "exogenous reaction types", which would later be known as the "Bonhoeffer-paradigm". Kahlbaum was also the first to differentiate between centripetal, intracentral and centrifugal psychic functions, which was later transformed into the "psychic reflex circuit" by Wernicke. The concept of organic versus non-organic psychoses proved to be a heuristically fruitful classification system even for modern psychiatry. Kahlbaum was the first German psychiatrist to describe several disorders and syndromes and to coin new psychiatric terminology for them, including paraphrenia, hebephrenia, catatonia and cyclothymia. These terms and their originally associated meaning are still in use today. Kahlbaum's ambitious scientific aim was to develop specific therapeutic strategies which were based on a methodologically and etiologically sound classification system.     

Kraepelin and degeneration theory

Emil Kraepelin’s contribution to the clinical and scientific field of psychiatry is recognized world-wide. In recent years, however, there have been a number of critical remarks on his acceptance of degeneration theory in particular and on his political opinion in general, which was said to have carried “overtones of proto-fascism” by Michael Shepherd [28]. The present paper discusses the theoretical cornerstones of Kraepelinian psychiatry with regard to their relevance for Kraepelin’s attitude towards degeneration theory. This theory had gained wide influence not only in scientific, but also in philosophical and political circles in the last decades of the nineteenth century. There is no doubt that Kraepelin, on the one hand, accepted and implemented degeneration theory into the debate on etiology and pathogenesis of mental disorders. On the other hand, it is not appropriate to draw a simple and direct line from early versions of degeneration theory to the crimes of psychiatrists and politicians during the rule of national socialism. What we need, is a differentiated view, since this will be the only scientific one. Much research needs to be done here in the future, and such research will surely have a significant impact not only on the historical field, but also on the continuous debate about psychiatry, neuroscience and neurophilosophy.

     

Changing care for the mentally ill in the "house of the poor insane in Lübeck" from the 17th to the early 19th century

Until quite recently the history of the "House of the Poor Insane" in the Hanseatic City of Lübeck has only been studied selectively. Our study comprises an overall view of the comprehensive historical documents concerning this institution during the 17th and 18th century; the period of the following 40 years in another new constructed house is outlined likewise. Not only the journal, into which the principals of the institution wrote down the minutes, but foremost the cassa-books without omissions were used to describe the social history as well as the range of activities. Thus historical windows into the daily routine of the inmates are opened. - During the greater part of 17th century, the institution rather resembled a prison for the mentally ill, though in the end of the 17th and during the 18th century an important early phase of reform is to be recognized, followed, however, by a period of repression and "containment" towards the end of the century and in the beginning of the 19th century. Then again, this time initiated by the medical profession, the reform was revived. - The Lübeck findings are not only compared with the historical development of inpatient treatment in institutions elsewhere, but it is also discussed, which influences were the decisive factors for the public care in the city of Lübeck.     

The position of biological psychiatry among the psychiatric disciplines

Psychiatry rests on three models: the psychological/psycho-dynamic, the social/sociological and the medical/neurobiological model. Biological psychiatry is that branch of psychiatry that concerns itself with the last mentioned model. Its precepts and objectives are discussed. So far in this century, abiological trends—phenomenological, anthropological, psychodynamic and sociological—have had the upper hand in psychiatry. This paper points out the great importance of restoring the tripartite character of psychiatry; in other words, the great importance of giving biological psychiatry a position of equality beside psychodynamic and social psychiatry. A well-balanced distribution of attention to the three fields would seem to be to the advantage of psychiatric training, practice and progress.     

Academic psychiatry and the pharmaceutical industry

In the second half of the 19th century new drugs introduced by the pharmaceutical industry helped lead to the establishment of academic departments in psychiatry. Causal treatment of cerebral pellagra by nicotinic acid and cerebral syphilis by penicillin in the first half of the 20th century led to major changes in the diagnostic distribution of psychiatric patients. In the second half of the 20th century with the introduction of a rapidly growing number of psychotropic drugs, pharmacotherapy became the primary form of treatment in mental illness. Psychiatrists today perceive neuropharmacology as one of the basic sciences of psychiatry and psychopharmacology as the bridge between the mode of action and the clinical indications of psychotropic drugs. Pharmacotherapy with psychotropic drugs focused attention on the differential responsiveness to the same drug within the same diagnostic category. Yet, instead of re-evaluating psychiatric nosology and conducting research in psychopathology, a statistical methodology was adopted for the demonstration of therapeutic effectiveness in pharmacologically heterogeneous populations. Employment of consensus-based classifications and psychiatric rating scales in the clinical development of psychotropic drugs led to semi-finished products, which are prescribed indiscriminately. Replacement of single-center clinical trials by multi-center centrally coordinated clinical investigations led to the control of education in pharmacotherapy by the pharmaceutical industry. To separate education from marketing, the identification of the treatment-responsive forms of illness and the delineation of the therapeutic profile of psychotropic drugs are proposed with the employment of a new methodology, the "Composite Diagnostic Evaluation System." It is postulated that development of a pharmacologically valid psychiatric nosology with the employment of a "nosologic matrix" would provide the pharmaceutical industry with the necessary feedback to develop clinically selective drugs in mental illness and to break the impasse of progress in "translational research" in psychiatry.     

Nosography and classification of mental diseases in the history of psychiatry

ObjectiveRetrace the history regarding the classification of diseases, notably mental diseases, from the birth of psychiatry at the beginning of the 19th century and up to the 10th revision of the International Classification of diseases published by the WHO (in 1993).MethodStudy the classifications proposed successively by the nosographists during this period.ResultsIn the 18th century, physicians classified diseases in the same way as animal and vegetal species (Carl von Linné). In the 19th century, following several attempts in France and Germany to classify mental diseases according to known or suspected aetiological and pathogenic factors (B.-A. Morel, Griesinger), psychiatrists classified psychosis and neurosis according to their clinical symptomatology and their development over time, from their onset up to the terminal stage. In 1893, J. Bertillon proposed a “Nomenclature of diseases” during the International Congress of Statistics in Chicago that permitted their classification, so as to classify-collect statistical epidemiological data on international level. Revisions were made between the two world wars by the Office of Health of the Society of Nations (Geneva). Following the foundation in 1948 of the WHO, it was the latter that continued the revisions of the International classification of diseases (ICD), Chapter V (F) of which is dedicated to disorders.DiscussionThe debate on the question of classifications in psychiatry has always taken place during the World Congress on Psychiatry since its initiation in Paris in 1951. In 1976, during the sixth congress in Honolulu, a resolution was adopted requesting the national psychiatric societies that had a classification of mental diseases to revise the latter so that they tallied with Chapter V(F) of the ICD. The American Psychiatric Association revised its Diagnosis and Statistical Manuel of mental disorders (DSM) and published the DSM III. In France, a group of pedopsychiatrists published a French classification of Mental disorders in children and adolescents (Classification Française des Troubles Mentaux de l’Enfant et de l’Adolescent [CFTMEA]), the last revision of which was published in 2012 (CFTMEA R 2012).ConclusionThis study shows that it is not possible to propose a classification of mental diseases, in particular according to the development of psychiatry at the time it is drawn up; it can only be of value within the cultural context of the country in which it is to be used.