The Development of Psychiatry

Christian Gambino

Mr. Alburger

English III Honors

2 February 2018
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Christian Gambino

Mr. Alburger

English III Honors

2 February 2018

The Development of Psychiatry

Psychiatry modernizes the practice of administering medicine. This branch of medicine

calls for the treatment of mental, emotional, or behavioural disorders. Psychiatry provides aid to

those with mental disorders or conditions through counseling, medical assessment procedures,

and prescription medicine.

Common mental disorders include: Attention Deficit Hyperactivity Disorder (ADHD),

Clinical Depression, Social Anxiety Disorder (SAD), and Anorexia and Bulimia Nervosa. In

order to treat these conditions, a college student must acquire a minimum of a bachelor’s degree

and achieve a medical degree, and after four years of residency training, they would then apply

for a medical license to lastly become Board Certified.

ADHD causes consistent inattention that interferes with normal functioning or

development (​National Institute of Mental Health​). Symptoms for an adolescent with ADHD

would include: careless mistakes or overlooking small details on schoolwork, having trouble

remaining attentive for long periods of time, having trouble organizing, and avoiding and

disliking tasks that require a sustainable mental effort. Typical treatment for a patient with

ADHD would entail prescribed amphetamines, behavioural treatments at both home and school,

or a combination of the two.

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Clinical Depression causes a consistent depressed mood including a loss of interest in

activities, which causes distress. Persistent distress or sadness can cause changes in sleep,

appetite, concentration and self-esteem. Depression can also lead to thoughts of suicide or

self-harm. Any person either experiencing the symptoms mentioned above or aware of someone

who does experience them should seek medical attention for the sake of that individual's

personal safety (​National Institute of Mental Health)​. Common medication for depression

include antidepressants such as Adapin, Celexa, Desyrel, Lexapro and Prozac (​Griffin, R.

Morgan)​. Antidepressants affect the brain’s neurotransmitters by re-adjusting its sleep cycle and

improving the patient's mood, increasing their appetite and concentration (​Goldberg, Joseph)​.

Social Anxiety Disorder causes irrational anxiety, fear, and self-consciousness of one’s

self. This disorder acts as a phobia for its implications in a social environment. Fear usually

occurs when the individual worries about potential embarrassment, humiliation, or highly

concerned about offending someone. Individuals with social anxiety will most likely avoid social

situations that involve participating in starting conversations or dating and risking personal

relationships (​May Foundation for Medical Education and Research)​. Common physical

symptoms include blushing, sweating, uneasy breathing, dizziness and most commonly a lost

train of thought (​A., Barkley R)​. If left untreated, anxiety can interfere with work or school and

potentially lower self-esteem and cause social isolation with little to no social relationships.

Anorexia Nervosa causes an irrational fear of an overweight body figure. Typically,

anorexia begins directly after a major stress-inducing event which causes a distorted body image

and attempts to maintain a below-normal weight through starvation, excessive exercise, or

abusive the usage of laxatives to produce weight loss. Long-term effects may include
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osteoporosis, infertility, heart damage, and women will often stop postpone their menstrual

periods. Anorexia has a plethora of cultural factors that involve the high value of thinness in

modeling, athletics, dancing or other forms of exercise. The main treatment procedure for

anorexia involves restoring a moderate Body-Mass Index (BMI), maintaining a healthy weight

and reestablishing a comfortable personal perspective of one’s self. Bulimia Nervosa actually

shares many qualities with Anorexia but has only one major difference. Bulimic patients

typically maintain a healthy body weight but also involve a cycle of binge-eating and purging.

Diagnosis of anorexia typically categorize as a below-average BMI and self-starvation, while

diagnosis of bulimia describes the frequency of binge-eating and self-induced vomiting.

Diagnosing a treating mental disorders have not always involved prescription medicine or

counseling, but rather a started in a more primitive studying technique. In the 1890’s,

well-recognized Australian psychologist Sigmund Freud founded a psychological process known

as psychoanalysis. (​McLeod, Saul)​ Psychoanalysis therapy attempts to relieve the suppression of

someone’s inner emotions and experiences by bringing the unconscious mind into conscious

awareness, and Freud believed that this insight would allow someone to better understand their

own mental processes. This eventually led to the institutionalization for psychiatric patients and

providers for those with mental health issues.

During the development of psychiatric institutions in the nineteenth century, many grew

concern for the lack of effort it required to gain admission but the severe difficulty and length it

took to release a patient. Psychologist David Rosenhan wanted to conduct an experiment that

would test the validity of the psychiatric institutions diagnoses of each patient (​The Rosenhan

Experiment​)​. This experiment involved eight mentally-stable associates (also known as

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pseudopatients) including Rosenhan himself. Each pseudopatient would gain entry to each

institution by claiming to falsely hear voices and other symptoms of schizophrenia. Once

admitted each researcher would act normally and not show any symptoms that would have

associated the pseudopatient with their falsely self-proclaimed mental illness. They also kept

track how long it took for administrators to recognize that they actually had adequate mental

health. Conclusively, the pseudopatients spent an average of 19 days of treatment before release,

but for one researcher, it took 51 days for his release.

In 1887, reporter Nellie Bly decided she wanted to experience the harsh conditions of the

asylum in order to then later help improve conditions in mental institutions across New York

City (​Demain, Bill.)​. Her words about these asylums indirectly shadowed David Rosenhan’s

experiment, “The insane asylum on Blackwell’s Island is a human rat-trap. It is easy to get in,

but once there it is impossible to get out.” By the late 1880’s, New York newspapers had a

plethora of stories about nurse brutality and patient abuse. Nellie had started her study by

working on a few routines she deemed necessary to make her behaviour look convincingly

enough like someone with poor mental health. In order to gain admission she posed as Nellie

Moreno, a Cuban immigrant persona. She also practiced a crazy-eyed manner, quit brushing her

teeth, stopped bathing, and she would look into the mirror and practice her dazed look of crazed

lunatic. Twenty-four hours had passed when she had checked herself into a temporary boarding

house for women.

Nellie portrayed her hostile rants, and within hours, had every other resident fearing their

lives. Police hauled her off to the courthouse soon after where she had received a professional

diagnosis as undoubtedly insane and shipped off the Blackwell’s Island. Nellie’s experience in
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this “madhouse” surpassed her worst expectations. She witnessed careless doctors and other

employees choking, beating and harassing other patients. Each patient received old, stale food,

given dirty clothes to wear, deprived of warm water and given constant ice-showers that

portrayed the same feelings as would someone getting waterboarded. Subjectively speaking,

Nellie Bly claims the enforced isolation to each patient revealed itself as the toughest obstacle in

her entire experience. According to Nellie, each patient sat from 6am to 8pm without speaking,

no distraction, no activities, given bad food and forced to additionally endure the harsh treatment

for the remainder of the day. She suggests that two months of this alone would turn her, a

perfectly sane and healthy woman, into a complete mental and physical wreck. In correlation to

Rosenhan’s experiment, Bly had dropped her persona and acted normally in order to test the

separate diagnoses of each patient. Horrifically, this had the complete opposite effect as

intended. The more mentally sane she acted, the more the nurses believed they underestimated

her mental insanity and dangerousness.

When her attorney finally requested her release, the psychiatric doctors quickly

apologized, gave excuses and quick defenses for their actions, and disregarded how they had

treated her and all the other patients. Although, despite the negative circumstances, there mainly

a positive outlook. Her story reached across the country and she donated over one million dollars

of revenue to increase the budget for asylums in order to greatly increase the quality of care

given to the mentally ill. When she made a return to the island a few years later, the tyrannical

nurses had all received termination, the food and water conditions significantly improved, and

sanitation had gotten unbelievably better in comparison to her previous visits.

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As the need for change grew, the United States government established the Health and

Human Resources Department in 1953 (​ASPA)​ . This department had then went on to Congress

and guarantees basic human rights to each patient, confidentiality rules and setting priorities of

the patients first over the needs of the employees that work there. Unfortunately, after all the

publicization of poor treatment and containment of the mentally ill, society still enacts a stigma

towards individuals with mental disorders as if they had mentally crippling or sub-human

disabilities. The stigmatization to individuals with mental illnesses or disorders overwhelm any

individual with pre-existing disorders or those that want to seek help for a disorder in the future

(Pershing, Abigail). The varying beliefs opinions on such illnesses that derive from family

tradition, culture, religious teachings, have further polarized these people and imposed heavy

discrimination against them. This polarization motivates many activists to combat issues such as

itself, and provide a safe, sanctuarial, environment to those affected and treat these individuals

with the medical care they need.

The new psychiatric treatment implemented now reflects more of a one-on-one

interaction between a patient and their therapist. Common first impressions of therapy include:

devaluing the severity their own issue, believing that it must have the severity of a crisis in order

to get considered for an appointment, and the initial fear of opening up and talking to a therapist.

In an interview of Rochelle Craig, she had elaborated on her own personal experiences as

a psychotherapist for eating disorders. During first appointments, her clients come in with much

to say. Some patients know what they want to talk about and instantly open up into conversation

while others remain nervous because they do not know what to say or how to respond to their

eating disorder. When they do talk, they wallow in emotional pain; they describe every aspect of
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their personal history. This usually takes multiple session before some sort of connection

establishes between the story and how negatively it had affected an individual’s present-day life.

Although a typical patient does not open up initially. Those sessions that get spent making

connections between important life events and disorders would then rather get spent as more of a

conversation. People with eating disorders often jumbled on their words or get baffled easily

because they have never had someone genuinely listen to their words. Rochelle Craig does not

agree with initial trust. Her patients do not know what trust means. Often in the past, people with

eating disorders trusted untrustworthy people and now expect the worst. These people feel

suspicion and do not trust anyone. Some patients who trust too easily and open up too fast feel

uncomfortably vulnerable and demand an easy solution. They either trust too quickly or do not

trust at all.

They voice their fears and past disappointments. They then pour out their hearts hoping

they stay in their safe place and can survive this emotional leap of faith. They take on their

courage and take risks. They also draw on the courage and determination to remain in therapy. In

fact, ​many patients almost cancel an appointment last minute simply out of fear. The first few

sessions remain the most crucial because of the emotional risks the patient takes for their

recovery and typically will only maintain a schedule of appointments once they discover that

they can now bear this experience along with the therapist.

People with an eating disorder often remain successful in ignoring many of their feelings.

The primary function of an eating disorder does involve emotional numbing. This serves as a

safety precaution to block any fear or anxiety. Unfortunately, these people often trust others very

prematurely and make these same dangerous decisions throughout their lives. The causation and
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involvement of food remains a common belief among eating disorders. Each binge, starvation,

compulsive meal, or purge session may actually serve as a way of self-medicating. Because they

cannot bear the emotional experience in life derived from the disorder, they eat to the point of

emotional numbness. They fill themselves up to the point of actual physical pain and then

dispose of the binge through purging just to fight off this terrible despair. When a client feels

more pain than they can bear they may look towards suicide as a reasonable option, but as soon

as client grows emotionally stronger they develop confidence in their self and this urge goes

away. They can now bear the experience and make decisions that provide the most beneficial

outcome. Once the eating disorder behavior subsides, the most dangerous and challenging

psychological event has yet to come. If a patient realizes they do not have their familiar numbing

methods, they panic and struggle for a solution. This individual sees a whole new world full of

challenges, threats, and opportunities, but all of these new emotions and perceptions seem way

too overwhelming or even strange. The client gets hit by a harsh reality once they grow aware of

the consequences for their previous actions. They have little life experience to learn from, which

makes confrontation with others a sensitive part of this new reality. There comes a slight chance

that this conversation may bring back the symptoms of the disorder and poorly impact the

individual. Although, without their traditional methods of healing, they have made an attempt to

trust their own capability to make decisions and extend personal responsibility upon themselves.

Overeating, purging, and starving will eventually no longer compares to the newly found trust

and freedom made for themselves. Eventually, a recovering client will incorporate aspects of

their relationship with the therapist into establishing themselves as their own caregiver. They

now have to confidence to know what they feel and how to describe it to themselves. An eating
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disorder can waste time and uselessly compare itself to the trustworthiness and new-found

responsibility of an individual.

Ultimately, the need for evaluations of mental disorders have remained relevant

throughout history. From the mental institutions in the 1800’s to the use of psychotherapy that

has actively participated in today’s society, psychiatry has also evolved to fit the needs of its

patients. Whether some decide to study each disease or treat these on an individual basis, patients

can rest in comfortable safety knowing they will get cared for.
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Bibliography

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Department of Health and Human Services,
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Assistant Secretary for Public Affairs (ASPA). “Laws & Regulations.” ​HHS.gov​, 18 Mar. 2016,
www.hhs.gov/regulations/index.html

A., Barkley R. “Treatments for ADHD.” ​My ADHD,​ My ADHD, 2000,

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Craig, Rochelle. “Personal Interview.” 20 Feb. 2018.

Demain, Bill. “Ten Days in a Madhouse: The Woman Who Got Herself Committed.” ​Mental
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“The Rosenhan Experiment.” ​Frontier Psychiatrist «,​ 27 July 2004,

frontierpsychiatrist.co.uk/the-rosenhan-experiment-examined/.

Goldberg, Joseph. “Depression Medications (Antidepressants).” ​WebMD,​ WebMD, 7 Feb. 2017,

www.webmd.com/depression/guide/depression-medications-antidepressants.

Griffin, R. Morgan. “10 Natural Depression Treatments.” ​WebMD​, WebMD, 2005,

www.webmd.com/depression/features/natural-treatments.

McLeod, Saul. “Psychoanalysis.” ​The Unconscious Mind,​ Simply Psychology, 1 Jan. 1970,
www.simplypsychology.org/psychoanalysis.html.

Pershing, Abigail. “Cultural Perspectives on Mental Health.” ​Unite For Sight​, Unite For Sight,
17 Dec. 2017, www.uniteforsight.org/mental-health/module7.
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“Social Anxiety Disorder (Social Phobia).” ​May Clinic,​ May Foundation for Medical Education
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