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Developments in Ideas about Psychiatric Disorders

In the beginning of the twentieth century ideas on psychiatric disorders were largely dominated by the conviction that there must be a bodily cause for these diseases. The discovery of the syphilitic infection of the central nervous system as a cause for dementia paralytica powerfully reinforced this thinking. At the time dementia paralytica was a fairly common disease. It was assumed that it was just a matter of time before organic lesions and bodily causes for the other psychoses would be found. In the thirties, several therapies with a bodily angle were introduced, among them insulin shock in 1933, psychosurgery in 1935, and electroshock in 1938. It is notable that all of these treatments, whether intending to cause shock or whether intending to cause lesions in the nervous system, insofar as they have not been abandoned, are heavily criticized on humanitarian grounds, in particular by patients’ movements.

The idea that mental illness could be explained by psychogenic causes gained ground after 1910. In this view psychiatric disorders were thought to originate from psychological factors rather than organic ones. In the United States the dominating psychogenic school of thought was psychoanalytical, although at the same time Adolf Meyer’s psychobiology and Bleuler’s work in Zurich should not be forgotten. In the forties and early fifties of the twentieth century this school of thought determined the face of psychiatry.

In the fifties, the pendulum swung back in the direction of organic psychiatry, mainly owing to the discovery and use of psychoactive drugs. These drugs deeply affected the treatment of psychiatric patients and conditions in the institutions. The institutions became less locked. The idea of the therapeutic community arrived from England (Maxwell Jones) and made a hit. It was the beginning of social psychiatry. In those days there was an atmosphere of hope and optimism. There is complex mutual influence among ideas on psychiatric disorders, therapeutic discoveries, and social events, to which this brief sketch cannot do justice, but it should be mentioned.

It is worth noting that the benefits of practically every newly introduced psychiatric theory and therapy were heavily overestimated. Ridenour mentions as examples the focal infection, thought to cause psychoses, and the avitaminosis theory, which were extremely popular in the nineteen-twenties. But great expectations were also pinned on shock therapy, psychoactive drugs, and psychotherapy when they were introduced, which later disappointed. It seems that there is a propaganda element in both schools of thought, prompting the pendulum to swing farther in the directions of both organic and psychosocial theories and therapies than could be justified by new facts and findings.
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