Approach to mental disorders down the ages

by Nagalingam Kumarakuruparan

The recent massacre at New-town, Connecticut USA, where 20 children and six adults in an elementary school were killed by a youth with an assault rifle had shocked the world. Was this person suffering from any mental disorders? Was he a neurotic? And if so, then what is the essential difference between a neurotic person and a normal person? Is this condition a disease? Is it curable? Can modern day psychiatry answer the questions? What is the responsibility of a psychiatrist?

The task which concerns the psychiatrist today is one whose roots are spread more widely than the foundations of medicine or even pure science; yet from the time of Hippocrates onwards it has been the combination of scientific and objective study with a sincere interest in human beings as a whole which has led to the greatest advances and the most sure methods in the practice of psychological medicine or psychiatry.

The concept of normality is in fact fundamental to any study of the abnormal; and yet when we examine the concept we see that there are more ways than one of forming a judgement of what is normal in any field which we agree to survey.

Our field here is the study of human personality and the scientific basis for this. The theory and application of the science of human behaviour and experience is called normal psychology. It bears the same relationship to psychiatry as physiology bears to general medicine and surgery.

Greek civilisation

Even before the blossoming of Greek civilisation, with its medical tradition which has survived to this day, there is abundant evidence of attempts to understand and treat mental illness the medical system of ancient India, whose records are to be found in the literary heritage of the Vedas as well as in other well-known treatises, included not only the belief in demoniacal possession as a basic cause of mental disturbance, but also the views of Susruta which even today remain in advance of much of contemporary medical thought.

About a hundred years later in another and seemingly separate civilisation, the ideas were to appear in the writings of Hippocrates. Some strikingly similar to the more mystical speculation of the Indian philosophers although not including the conception of the transmigration of souls, characterised the later works of Plato and his pupil Aristotle.

But while Plato and Aristotle were philosophers and their interest in psychology was traditional and scholastic, Hippocrates was essentially a physician and a practising clinician at that.

History of medicine

If we look into the history of medicine, in contrast to the relatively smooth and sure development of medicine in the sphere of tangible physical disorder, the story of affliction of the mind and personality is indeed appalling charred with countless burning at the stake, chequered with violence, cruelty and remorseless persecution and dark not only with the gloom of ignorance and superstition, but also with the despair of unlit solitary cell, stocks, bars, chains and brands and all the sickening paraphernalia of torture.

Why should this be so? There is an echo of this attitude to mental illness in the heart of everyone of us.

However, little we may care or be able to acknowledge it, but before we can understand it better we shall need to examine as honestly and objectively as possible something of the problem of mental illness itself. Words are important here.

We object to the very terms 'mental illness' or mentally ill people, preferring the more robust and traditional 'madness,' 'lunacy,' 'madmen' and 'lunatics.' For these older words carry with them strong and in some ways more satisfying emotional charge of contempt or horror or derision or at least condescension, according to the way they are used.

They have acquired this emotional flavour from the time when such a constellation of feelings was almost universal among some people towards those less fortunate than themselves.

Attitude

Our attitude towards insanity is fundamentally one of contempt of rejection of the lunatic as someone essentially separated from us, with whom we desire as little contact and for whom we acknowledge as little responsibility as possible or whether we can accept his plight as an illness and him as a sickman with a claim upon our sympathies. The basis of the distinction is, therefore, an emotional one; and this in turn will govern our choice of words. But this does not end with the choice of words.

The subject we have to examine includes the whole range of disturbance of human emotion, judgement, action and personality.

Mental illness

Whenever this disturbance is sufficiently profound to be considered abnormal, this range will extend from excessive anxiety, tension, unhappiness, fear or confusion without apparent cause at one end to the most bizzare forms of insanity.

At the other, somewhere along it must be found a place for simple failure of mental development, failure to meet the requirements of society, sheer personal inadequacy and the various short lived but violent disturbances known as deliria; It must also include some other disturbances of consciousness and memory whether due to structural disease or damage to the brain or not. This aspect of human suffering in all its manifestations we shall call mental illness.

It is with all this that the psychiatrist of today is concerned.

We must now turn back for a moment and remind ourselves that our first object in examining the study of mental illness and its treatment was to gain an understanding of its history in which, violence has played so tragic a part, while the more decent and humane aspects of medicine have been all too often eclipsed despite the isolated efforts of outstanding individuals throughout the centuries.

Hippocrates recognised the importance of the brain as an organ of mind, he sought a physiological explanation of the various temperaments, moods and emotional disorders he encountered in his patients and he attacked vigorously the conception of divinely ordained and therefore unalterable illness.

Hippocrates

Hippocrates, the physician and founder of objective and empirical medical thought was far from being a materialist in the modern sense of the word.

Many hundred years later, before the dark ages closed on medicine there was to be one final torch blazing against the deepening shadows.

This was the contribution of the physician galen. Modern medical historian Gregory Zil Boorg sums up the achievement of Galen by saying that while he contributed nothing new to either the therapy or the clinical description of mental diseases his total contribution was monumental. His remarks that whereas political historians divide ancient history from the medieval period by emphasising the decisive invasion of Rome by the Barbarians in the latter part of the fifth century, the dark ages in medical history began with the death of Galen in 200AD.

In the history of medical psychology during the period which lasted roughly from AD200 until the latter part of the 18th century in Europe thousands were put to death because of the wrong understanding of insanity.

The blame for it was placed at the doorstep of the universal Church of Rome. It was blamed for a great deal of the cruelty, intolerance, persecution and terror of the times. Indeed there were no shortage of teachers and scholars who could quote the scriptures in support of many of the terrible things which were done. To seek out and kill mentally abnormal people in the belief that they were witches or inhabited by devils came to be regarded as a religious duty.

The intolerance and persecutory fervour which gripped the Middle Ages was consistent not truly with religion but with the recurring pattern of a totalitarian orthodoxy which bears the same sickening and horrifying characteristics whenever it is seen throughout history, and whatever the creed around which it is constructed. There are always the sincere fanatics who elevate absolute conformity above individual worth or dignity of man; and for their henchmen, willing bullies and torturers are never found wanting.

The first formal execution of a witch took place in Europe somewhere about AD430. How many hundreds of thousands were to follow will never be known. Before the reformation period the principal authority for the entire practice of the persecution of the insane or neurotic was a treatise by two monks, Henry Kramer and James Sprenger entitled 'Molleus Maleficarum' - the witches hammer.

They had been entrusted by Pope Innocent VIII with the duty of preparing this treatise so that the believers' kingdom might be purged of a tremendous invasion by demons, witches and the like. The Pope had issued a bull on December 9, 1484 appointing them supreme inquisitors, empowered both to inspect the existing arrangements for controlling heresy and witchcraft and to advise upon the improvement. The Malleus has been described by latter day historians as so insane, so raw and cruel and leading to such terrible conclusions, that never before or since did such a combination of horrible characteristics flow from human pen.

Johann Weyer was the greatest contributor to psychiatry in the renaissance period. He took great pains to describe the various types of delusion and disturbances of behaviour which he had seen among patients.

A return to the Hippocratic objectivity led to further attempts to find empirical means of treating mental illness. This laid the foundation for the modern psychiatry the world has come to know. The up-to-date knowledge of the problems of mental illness and abnormality their causes and treatment.

Will the UN make a difference in Haiti?

by Kevin Edmonds

On December 11, the United Nations announced a long overdue initiative to end the cholera epidemic which has devastated Haiti for more than two years - taking over 7,750 lives and infecting 600,000 more. While the announcement by the Secretary General Ban Ki moon is a welcome and much needed step, the ten-year plan is not without controversy.

Perhaps most practically, the Initiative for the Elimination of Cholera in the Island of Hispaniola remains largely unfunded. Of the $2.2 billion price tag, only $238.5 million has been committed.

The initiative seeks to implement clean water and sanitation infrastructure in addition to public education and capacity building programs throughout both Haiti and the Dominican Republic. When pressed about the lack of funding, Nigel Fisher, the UN Resident and Humanitarian Coordinator for Haiti could only state that "I'm confident that more resources will come".

Given that the only half of the $12 billion in pledges for the 2010 earthquake reconstruction effort have materialised or that a $30 million emergency request made earlier in the year only raised one-third of the intended amount, Fisher's words do not inspire a great deal of confidence that more money is on the way.

Of the funds that did make it to Haiti after the earthquake, only 10 percent was directed towards government programs and public infrastructure.

Mark Weisbrot, Co-Director of the Centre for Economic and Policy Research, stated that "It is unclear where the money for this is going to come from, and whether the international community, which has chronically underfunded responses to disasters in Haiti, will treat this any differently, and actually put up the cash to stop needless deaths."

In addition, Weisbrot put forward a practical solution in order to fund the initiative - by redirecting the money away from the highly controversial and unnecessary United Nations Stabilisation Mission in Haiti (MINUSTAH).

While the Secretary General made no mention of this, negligent screening protocols and sanitation practices introduced the cholera outbreak into Haiti.

This has been proven through various independent scientific studies, the Center for Disease Control, and numerous high level UN staff such as Bill Clinton, and Dr. Danielle Lantagne, top U.S. cholera expert hired by the UN In October, Dr. Lantagne said "We can now say that the most likely source of the introduction of cholera into Haiti was someone infected with the Nepal strain of cholera and associated with the United Nations Mirabalais camp."

Weisbrot added that "There is no conflict there. The Mission's $676 million budget should be spent instead on eliminating cholera."

This view has also been widely echoed in Haiti. MINUSTAH is widely considered to be a destabilising occupying force, and given their consistent human rights violations, they are not popular with either the Haitian people or the politicians.

A February Security Council Report argued that Haitian "Parliamentarians shared frank and mostly critical views on MINUSTAH. They called for the mission to compensate cholera victims and to swiftly punish those within MINUSTAH responsible for incidents of sexual exploitation and abuse of Haitians."

A January survey revealed that a large percentage of respondents believed that MINUSTAH troops are or have been engaged in criminal activities such as violence, theft and rape.

At his last address to the United Nations Security Council in April 2011, former President Rene Preval said that the dangers of violent confrontation in Haiti were over and that "peacekeeping operations did not quickly enough adapt to the new situation" - and as such, tanks should be replaced by bulldozers.

-Third World Network Features

Motivation, study habits determine growth in maths achievement

It's not how smart students are but how motivated they are and how they study that determines their growth in mathematics achievement. That's the main finding of a new study that appears in the journal Child Development.

"While intelligence as assessed by IQ tests is important in the early stages of developing mathematical competence, motivation and study skills play a more important role in students' subsequent growth," according to Kou Murayama, post-doctoral researcher of psychology at the University of California, Los Angeles (who was at the University of Munich when he led the study).

Murayama and colleagues looked at six annual waves of data from a German longitudinal study assessing math ability in 3,520 students in grades 5 to 10. They investigated how students' motivation, study skills, and intelligence jointly predicted long-term growth in their mathematics achievement over five years.

Intelligence was strongly linked to students' mathematics achievement, but only in the initial development of competence in the subject.

Motivation and study skills turned out to be more important factors in terms of students' growth (their learning curve or ability to learn) in mathematics. Students who felt competent; were intrinsically motivated; used skills like summarising, explaining, and making connections to other materials; and avoided rote learning showed more growth in mathematics achievement than those who didn't. In contrast, students' intelligence had no relation to growth in mathematics achievement.

- MNT

Toddlers' language skills predict less anger by preschool

Toddlers with more developed language skills are better able to manage frustration and less likely to express anger by the time they're in preschool. That's the conclusion of a new longitudinal study from researchers that appears in the journal Child Development.

"This is the first longitudinal evidence of early language abilities predicting later aspects of anger regulation," according to Pamela M. Cole, liberal arts research professor of psychology at Pennsylvania State University, who was the principal investigator of the study.

Angry outbursts such as temper tantrums are common among toddlers, but by the time children enter school, they're expected to have more self-control. To help them acquire this skill, they're taught to use language skills like "using your words." This study sought to determine whether developing language skills relates to developing anger control. Does developing language ability reduce anger between ages 2 and 4?

Researchers looked at 120 predominantly White children from families above poverty but below middle income from the time they were 18 months to 48 months. Through home and lab visits, they measured children's language and their ability to cope with tasks that might elicit frustration.

In one lab-based task, children were asked to wait 8 minutes before opening a gift while their mothers finished "work" (a series of questions about how the child usually coped with waiting).

- MNT