Scull+++psychiatric+revolution++Lancet++2010

Scull psychiatric - Perspectives The art of medicine A psychiatric revolution As I reach nearer the end than the beginning of my career it still

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Perspectives 1246 www.thelancet.com Vol 375 April 10, 2010 The art of medicine A psychiatric revolution As I reach nearer the end than the beginning of my career, it still comes as something of a shock to realise that I have been at work on the history of psychiatry for some four decades now. I never intended that my early infatuation with disorders of the mind should turn into a life-long obsession. I began my explorations at a time when the museums of madness that were the Victorian age’s response to Unreason still loomed large in our collective conscience. The massive, ramshackle piles retained their hold, not just on our imaginations, but upon thousands and thousands of people with mental illness, still confined in what had once been proclaimed as a therapeutic isolation. It is hard to forget the sense of constriction and confinement that oppressed one’s spirit on crossing the threshold of one of these establishments. Above all, perhaps, I remember the smell, the fetid odour of decaying bodies and minds, of wards impregnated with decades of stale urine and faecal matter, of the slop served up for generations as food, the unsavoury mixture clinging like some foul miasma to the physical fabric of the buildings. My first encounter with the sights, the smells, the sense of despair that enveloped these total institutions, ought to have perhaps been enough to put me off any lingering attachment to research in such settings. Yet I remain as fascinated as ever with trying to understand the elaborate social institutions we have devised to grapple with, manage, and dispose of the “mad”, and with the intellectual puzzle that mental illness itself represents. To be sure, I have long since strayed outside the confines of the 19th century: initially into the Georgian age where the madhouse first came to the fore and mad-doctors began to develop their claims to expertise; then into the therapeutic enthusiasms and uncontrolled experimentation on the bodies of patients in the first half of the 20th century; and, most recently, into the realm of hysteria from its origins in ancient Greece through the height of its fame in Charcot’s hysterical circus, its overt sexualisation by Sigmund Freud and his followers, and its official demise at the hands of the neo-Kraepelinians, who banned it from their Bible, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders . It is a history that has its charms as well as its horrors. But while I was busy in the archives, the contemporary psychiatric enterprise was undergoing a transformation as dramatic and fundamental as can readily be imagined. When I began to explore its past, psychiatry, at least in its American guise, was dominated by psychoanalysis. The Freudian movement had first risen to prominence during World War II, in the treatment of “war neurosis”. Through the 1960s,
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This note was uploaded on 11/29/2010 for the course PSYCH SY BEH 102 taught by Professor Raymondw.novaco during the Spring '10 term at UC Irvine.

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Scull psychiatric - Perspectives The art of medicine A psychiatric revolution As I reach nearer the end than the beginning of my career it still

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