History of madness

From primitive communities to the Middle Ages

The concept of “madness” was not familiar to primitive people, but they had great respect for the world of spirits, which sometimes allegedly interacted with them. A shaman, sorcerer or priest was responsible for contact with the spirits in the tribe. And if something strange happened to someone, for example, a person heard voices, he was helped either to communicate with spirits or drive them away.

In ancient times, it was believed that madness was the curse of harsh gods. It remained only to put up with this punishment or try to propitiate God by making a sacrifice. At the same time, in Antiquity, the school of Hippocrates appeared, whose members put forward the idea that madness is not at all divine in nature, it’s just that it’s still unknown what happens to a person.

As a result, two approaches to mental illness have emerged:

1. Special states arise when there is contact with the supernatural world.

2. There is a connection between these states and the body, but the lack of knowledge, skills and tools makes it difficult to understand the mechanism of interaction.

In the Middle Ages, the role of the church increased and what was written in the sacred texts began to be considered the norm. The “special conditions” of people were explained by the fact that they deviated from the laws of God or they were seduced by the devil. It was also believed that the devil puts a “stone of madness” in the brain. The doctor could open the skull and get out the “stone”, but in most cases, patients simply died.

How leper colonies became madhouses

In the Middle Ages, in connection with regular epidemics of leprosy (leprosy), leper colonies began to be built.

The epidemic subsided, the leper colonies remained. They began to resettle the most diverse contingent: patients with syphilis, criminals and those who, according to relatives, mismanage property. It was within the walls of leper colonies among people who simply did not fit into society that psychiatry developed. Until the XNUMXth century, living conditions in these shelters could hardly be called humane.

Everything changed after the French Revolution, which brought the ideas of freedom, equality, and fraternity. A new chief physician, Philippe Pinel, has arrived at the La Bicetre asylum in Paris. He introduced the norms of personal space, forbade beatings, chains, shackles, steel collars, helmets, introducing soft clamps instead. That’s when the straitjacket appeared. Pinel obliged doctors to come to patients, talk with them, carry out medical procedures, and introduced occupational therapy.

Three months after Pinel’s reform, some of the patients began to recover and were released from shelters. It turned out that if you remove the chains from people, start feeding, stop beating and depriving them of sleep, they stop behaving aggressively.

What’s with Freud?

Freud saw in the symptoms of diseases not only a medical, but also a psychological component that had to be deciphered. In one of his first research papers, he divides paralysis (restriction of movement of the limbs) into two types: the first is caused by damage to the spinal cord, and the second has no apparent cause. Freud also noticed that there are special paralyzes that sometimes disappear, but then return again, he called them psychogenic.

In addition, Freud was the first to speak loudly about the unconscious and its manifestation through bodily symptoms. He believed that it is necessary to realize the content of the unconscious, and then it will lose its power. How to do it?

1. Method of free associations. The man came about 3-4 times a week for two hours and talked about everything. After a while, he was already talking about what worries him.

2. Analysis of bodily symptoms. Suppose a man planned to make a marriage proposal to his beloved, but his side ached and his hand stopped moving. Freud believed that such a symptom could indicate that he did not want to make an offer.

3. Dream analysis. In a dream, censorship falls and images from the unconscious come to us in a distorted form.

4. Analysis of the psychopathology of everyday life. The method was based on the theory that when we get tired, the unconscious breaks through in speech, in action, or in what we hear.

So in the XNUMXth century, a new idea appeared: deviations from the norm can be associated with the psychology of the individual.

Norma today

To determine what is normal and what is pathology, several approaches are used today.

1. Statistical approach. It is based on the fact that any feature is subject to the law of normal distribution: the most common is considered normal.

This approach is used in tests to measure the level of IQ, in which diagnoses depend on the number of points scored. For example, if the result is less than 20, the diagnosis is imbecile, if the IQ level falls in the range from 20 to 40 – debility, etc. But the difference between 19 and 20 points is small, and the diagnoses are different. The question arises: where and how to draw the line? There is no exact answer, so today the statistical approach is used only for reporting data, but not for diagnostics.

2. Adaptive approach. The norm is what helps to adapt to certain conditions. Our ancestors were anxious and fearful, and this is what allowed them to survive and leave offspring. But in the modern world, these states do not help survival: people prone to anxiety and panic attacks find it difficult to ride the subway, speak in public, and call strangers.

The adaptive pathology of today is perfectionism. Living with him is hard, but society is comfortable with perfectionists who strive to work very, even too well.

3. Idealistic approach. The norm is the “ideal state” of a person. Ideal people are beautiful, young, efficient, don’t procrastinate, get up early, exercise, drink smoothies, and don’t eat gluten.

The problem is that no one will ever be completely normal. He only strives for the ideal, but never reaches it, and this makes him feel that he does not live up to expectations and is not the right one.

4. Cultural approach. The idea of ​​the norm also depends on the culture.

In Japan, for example, there is a mysterious disease Taijin kefuse – fear of interpersonal relationships. In Japanese society, there are strict rules about how to behave depending on the position on the social ladder. Because of this, young people have a fear of making a mistake, offending another with their behavior. They are afraid to enter into any relationship with others and even go out into the street. There are more and more people with this diagnosis in Japanese psychiatric clinics, while this is not the case in any other culture.

5. Clinical approach. The ratio of symptoms and diagnoses is prescribed in the guidelines: the International Classification of Diseases (ICD – 10) and the American Diagnostic Handbook DSM – V. They are constantly reviewed and supplemented, but scientists still manage to come to a certain consensus.

When making a diagnosis, not only the presence of symptoms is taken into account, but also social maladaptation. For example, in the USA they organized a community of people who hear voices and believe that this is not a disease, but a feature. They do not want to be treated, and some of them lead quite normal lives.

That is, if you hear voices and do not suffer from this, do not go to the doctor, you should not be treated. According to article 29 of the Law of the Russian Federation “On psychiatric care and guarantees of the rights of citizens in its provision”, hospitalization is only voluntary. Involuntary hospitalization is possible only in three cases: if a person poses a threat to himself and others, is in a state of helplessness, and if there is a threat of deterioration or the threat of death.

How are mental disorders treated today?

All causes of mental disorders are divided into three clusters: biological, psychological and social. Depending on the causes, the doctor chooses a method of treatment.

Pharmacotherapy. It is impossible to predict whether a particular drug will help a patient or not. It should be prescribed only by a doctor who will take into account age, gender, individual reactions. And you can’t cancel, just stopping taking it. This should be done gradually and under the supervision of a doctor.

Electroconvulsive therapy (ECT). An effective method surrounded by many myths. The procedure looks rather intimidating: the patient is injected with muscle relaxants (drugs that reduce the tone of skeletal muscles. – Approx. Ed.) And light anesthesia, whiskey is treated with alcohol, electrodes are installed, and a discharge is passed. After that, short-term memory disappears. But soon she returns, and the symptoms go away. It’s like rebooting a computer: a big electric shock restarts the brain. As a rule, it is difficult for the patient to agree to ECT. Most often it is prescribed in cases where the pills no longer help.

Psychotherapy. Psychotherapy deals with the psychological and social causes of illness. It is needed to accept the diagnosis and get rid of the myths that surround him, to adapt to ordinary life.

It is most effective to combine pharmacotherapy and psychotherapy. Just taking pills is pointless: it is important to change the lifestyle, relationships with others. If this is not done, there is a great risk that the patient will again end up in a hospital bed, because he has not learned to respond to stress properly.