According to the World Health Organization (WHO), the concept of mental illness is defined as any deviation from mental, spiritual, and emotional well-being. Such deviations may include various human behavioral abnormalities, addictions, as well as disorders that disrupt mental health, such as the different forms of schizophrenic psychoses, the wide range of affective psychoses (such as endogenous depression and involutional melancholia), anxiety disorders (panic or anxiety attacks), mood disorders (bipolar or cyclothymic disorder), dissociative identity disorders, as well as a large variety of mental syndromes and illnesses.
The vast majority of the aforementioned mental syndromes can be effectively treated with the assistance of a psychiatrist—a medical specialty which, by virtue of the specialized academic and clinical training it requires, contributes both preventively and therapeutically to the diagnosis, study, and treatment of mental conditions, aiming to ensure the greatest possible functionality for individuals suffering from mental illness. The main difference between a psychiatrist and a psychologist lies largely in the severity of the cases they manage, since, as is commonly the case, a psychiatrist handles the most serious conditions, which, naturally, require pharmaceutical treatment.
But how did the specialty of psychiatry come into existence, and how did it develop and evolve over the centuries?
Psychiatrists in Antiquity
The aforementioned conditions deviating from normal behavior had been studied and classified as mental disorders since ancient times. In most cases, however, the early forms of psychiatrists encountered in various societies of the ancient world approached such conditions primarily through a religious framework—medieval Europe being a characteristic example. Mental disorders, nonetheless, had been the subject of extensive study even in Ancient Athens, as we know from ancient texts and references by Hippocrates, Asclepius, Galen, and Aristotle. Various archaeological findings, such as skulls showing evidence of trepanation, testify not only to the existence of ancient practitioners resembling psychiatrists but also to early attempts to cure different mental illnesses.
Psychiatrists in the Byzantine Empire
In the Byzantine Empire, we encounter the earliest organized efforts to address various mental illnesses. During this period, there is a clear departure from the widespread belief—dominant in the Middle Ages—that mental disorders were primarily the result of supernatural causes. At that time, asylums operated under the authority of the Church, and members of the clergy often undertook duties which, under normal circumstances, would belong to a psychiatrist. The notion that mental illness was caused by divine or demonic forces possessing the souls of the afflicted gradually weakened, eventually giving way to a more structured system of mental-health care. These emerging institutions placed greater emphasis not only on psychiatry as such but also on occupational therapy, with the goal of restoring each patient’s mental functionality.
Psychiatrists in the 18th Century
For many years, the belief that mental illnesses were incurable, along with the relatively diminished status of psychiatrists at the time, prevented any real progress in the treatment of mental disorders. On the contrary, psychiatrists were largely confined to diagnosing mental illnesses, and as a result, patients housed in numerous asylums around the world were treated with great disdain and often subjected to extensive use of force.
The 18th century, however, became a landmark era for psychiatrists. The strong humanitarian movement that emerged from the Enlightenment led not only to the defense of the human rights of the mentally ill but also to the triumphant establishment of psychiatry as a scientific and safe therapeutic practice. Thus, the specialty of psychiatry began to develop steadily, albeit gradually.
Psychiatrists Through the Lens of the First World War
Throughout the duration of the First World War, as well as after its end, individuals who had been exposed to the battlefield soon began to exhibit a wide range of new types of mental disorders, such as paralytic attacks, physical and psychological exhaustion, total disorientation, and hysterical blindness. These new clinical observations created new global needs in the field of mental health, as outdated methods previously used by psychiatrists (such as cold showers, electroshock, and near-drowning therapy) were gradually replaced by innovative methods of psychological rehabilitation that began to appear in psychiatric institutions worldwide.
From that point onward, psychiatrists began to focus not only on suppressing but also on preventing the various mental illnesses that had until then afflicted populations across the globe, with the most significant innovation being the adoption of psychoanalysis. The end of World War I marked the gradual weakening of psychiatric asylums as centers of confinement for the mentally ill and a strong shift toward advancing the role of psychiatrists as key specialists responsible for the therapeutic treatment of mental disorders.
Psychiatrists After the Second World War
Another war—this time even more devastating—struck the world. Along with the Second World War came a remarkable advancement in the field of psychiatry, for in addition to the establishment of psychoanalysis as a primary method for treating mental illness, we encounter for the first time in history the presence of psychiatrists on the battlefield.
The realization of the negligible effectiveness of psychiatric asylums, combined with the strong mobilization of the human rights movement and the growing opposition to the inadequate care provided by psychiatrists and the harsh living conditions within these institutions, led to more rigorous scientific training for psychiatrists, a partial reduction of the stigma surrounding mental illness, and further development in the structure and operation of mental health services worldwide.
The 19th century is renowned, among other things, for its major innovations in psychiatry. Some of these include the establishment of numerous mental health centers around the world under the leadership of well-trained psychiatrists, the discovery of chlorpromazine—the first effective antipsychotic treatment in history—the adoption of national action plans and reforms for combating mental disorders by many countries, the development of a wide range of psychotropic medications, and the performance of the first prefrontal lobotomy in history.
Medicine
This article was published on ELARISAblog.
