Historical Overview

Although human interest in the nature of the mind and its passions surely goes back to a time long before the beginning of recorded history, the systematic scientific search for the causes of psychological disorders did not begin in earnest until the latter part of the 19th century. Prior to that, the practice of psychiatry was characterized more by superstition and punishment, punctuated by occasional humane concerns. Although there were several sustained periods of enlightened care of the emotionally distraught, as in the ritual purification (i.e., "incubation" or rest therapy) approaches of the Grecian period, it is likely that one of the main functions of those whole-body, whole-mind efforts—which included athletics, baths, music, dance, and ritualized sexual encounters—was the alleviation of everyday stress and sexual inadequacy. The holistic cures of those healing temples, organized symbolically under the aegis of Asclepius, the god of health, thrived for well over a millennium, but surely the stigmatization and brutalization of serious mental ailments also remained abundant yet uncelebrated. While a humanistic tradition was sustained in many middle eastern countries, Europe succumbed to the flea-ridden plagues and narrow-mindedness of the Dark Ages for an extended period, in which harsh punishments and the demonizing of nonstandard human souls prevailed [for a more detailed historical coverage, see Andreasen (2001), Mora (1985) and Stone (1997)].

Most biological approaches to treating mental ailments during the past several thousand years have been based on unsubstantiated beliefs and wild logic rather than scientific substance. Beatings, bleedings, starvation, hot and cold water shock treatments, and restraints have all been time-tested therapeutic failures, at least in the long-term. However, various socially sustained and often effective placebo approaches have often flourished, including witch-doctoring, shamanism, and occasional trepanations of skulls to release evil spirits. Apparently our social brains respond quite well to the sympathetic concerns of others, which may be the foundation of all pervasive placebo effects in psychiatry (Harrington 1999; Moerman 2002; Shapiro and Shapiro 2001). Of course, we now know that placebo effects have real effects on the brain (Mayberg et al., 2002), perhaps brain opioid mediated (Petrovic et al., 2002), and the intervening prosocial feelings may be mediated, in part, by endogenous opi-oids (Panksepp, 1998).

A few revolutionaries also made substantive biomedical advances. Paracelsus (1493-1541) enthusiastically promoted one of the few effective medicines available in his time (e.g., opioids), and in Diseases Which Deprive Man of His Reason (1567), he described many alchemical concoctions, some of which contained heavy metals such as mercury. We now know that some of these toxic agents can help purge the body of certain psychopathological vectors, one of which was recognized as Treponema pallidum in 1906—the agent responsible for causing syphilis and its resulting schizophreniform mental deteriorations. Unfortunately, the safety margin between the effective doses and lethal doses was not auspicious. The eventual discovery that induction of fevers could sometimes halt syphilis-induced mental deterioration was honored with Nobel recognition (Laureate Julius Wagner-Jauregg, 1927) for the "discovery of the therapeutic value of malaria inoculation in the treatment of dementia paralytica" (Jasper, 1983).

With the emergence of the scientific tradition in the physical sciences, enlightened thinkers sought to approach human psychological problems with a new sensitivity. Benjamin Rush (1745-1813) in America, along with Phillipe Pinel (1745-1826) in France, and Vincenzo Chiarugi (1759-1820) in Italy, set in motion the "moral treatment" of the insane, even though some also advocated somatic treatments: Benjamin Rush promoted bloodletting, emetics, purges, special diets, and his agitation-constraining, straight-jacket "tranquilizing chair," while Benjamin Franklin promoted electrical therapy for various ailments. These revolutionaries helped establish havens for the mentally ill in small humanistic hospitals where they sought to create therapeutic environments that aimed to facilitate the reestablishment of emotional homeostasis. The movement was sustained and amplified by social activists such as Dorothea Dix (1802-1887). Sadly, by the end of the 19th century this model had devolved in America into the massive warehousing of cognitively and emotionally impaired individuals in large state-run institutions.

Meanwhile, with the growth of scientific physiology and biochemistry throughout the latter half of the 19th century, especially in German universities, neuropsychiatry became integrated into the standard biologically oriented medical curriculum. Indeed, modern psychiatry emerged from the successes of neurology, and the hybrid subdiscipline of neuropsychiatry still thrives (Yudofsky and Hales, 1997). However, a clear division of duties also developed—classical neurologists came to focus on standard brain abilities (i.e., sensations, perceptions, actions, and only more recently cognitive activities) while psychiatrists occupied themselves more with how people feel and how they impulsively react and choose to behave on the basis of their internal passions and other affectively experienced value systems.

Thus, the two sister disciplines, neurology and psychiatry, also commonly deal with different parts of the nervous system, the former with the somatic components and the other more with the visceral components. Theodore Meynert's 1884 textbook Psychiatry: A Clinical Treatise on the Diseases of the Forebrain was prescient in this regard. Since then, it has become increasingly clear that emotional regulation and psychiatric diseases are related more to frontal-limbic executive functions than to posterior cortico-thalamic, sensory-intellectual functions. Parenthetically, Meynert was one of Freud's esteemed teachers, and even after he abandoned brain approaches, Freud continued to acknowledge that his wide-ranging psychoanalytic theories eventually needed to be linked to neuroscience. He recognized that what might eventually grow from that potentially fertile hybridization could be spectacular. As Freud noted in Beyond the Pleasure Principle (1920, p. 60): "Biology is truly a land of unlimited possibilities. We may expect it to give us the most surprising information, and we cannot guess what answers it will return in a few dozen years____They may be of a kind which will blow away the whole of our artificial structure of hypotheses." And by the end of the 20th century, his premonitions had come true to such a degree that his own conceptual ideas also seemed to be blown away, or so it seemed to many who had become disenchanted with the possibility of scientifically understanding the "mental apparatus." However, there are recent indications of resurgent interest in the relations between brain and depth psychological issues in the newly emerging neuropsychoan-alytic movement (Solms and Turnbull, 2002), which seeks to build substantively on past and present discoveries.

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