HISTORY OF DIAGNOSIS
Diagnosis were made on the basis of presumed etiology, as when Hippocrates rooted the illnesses he diagnosed in various imbalances of black bile, yellow bile, blood, and phlegm. an influential Greek anatomist who lived more than 500 years later, took much the same view in his descriptions of both normal and abnormal sensations and perceptions as products of a spirit or vapor he called pneuma psychikon. Basing diagnostic assessments on such etiologic conceits changed only when the Swiss physician and natural philosopher Paracelsus developed the concept of syndromal diagnosis. Paracelsus defined the syndrome as a group of signs and symptoms that co-occur in a common pattern and thereby, presumably, characterize a particular abnormality or disease state, but for which etiology is unknown, perhaps even unknowable. Syndromal diagnosis is epitomized today in the DSM, which continues its focus on the signs and symptoms of diseases, rather than their presumed etiologies, which are unnecessary for diagnostic purposes.
Typically, psychiatric illnesses are organized hierarchically, by the principles of descriptive similarity or shared symptom pictures. Thus, following Paracelsus Thomas Sydenham an English physician for whom a childhood chorea is named, and a bit later by the French physician Franc¸ois de Sauvages. Shortly afterward, famed French hospital reformer Phillippe Pinel (1745–1826), pictured in almost every abnormal psychology textbook breaking the chains of the insane in Paris’s Biceˆtre and Salpeˆtrie`re hospitals, proposed a system that included melancholia, mania, mania with delirium, dementia, and idiotism. The appearance of this nomenclature coincided with the development of asylums for the insane, for which Pinel was partly responsible, and certainly contributed to both their humanity and their success. Building on this advance, both Pinel’s system and the new availability of large numbers of diagnostically differentiated patients in asylums paved the way for the marked increase in efforts to categorize psychopathology during the nineteenth century. The victims of serious, chronic psychopathology—what are today understood as organic mental disorders, severe developmental disabilities, dementia, schizophrenia, and bipolar disorder were permanent residents of these asylums for the mentally ill. the German psychiatrist Karl Kahlbaum) discovered that understanding the premorbid course of dementia praecox (which today we call schizophrenia), and the factors that conferred risk for it, helped predict its outcome. The roots of modern syndromal classification, including the Diagnostic and Statistical Manual of Mental Disorders, can be traced to Kahlbaum and to fellow German taxonomists Griesinger and Hecker. But no figure in descriptive psychopathology stands taller than Emil Kraepelin successive textbook editions at the end of the nineteenth and beginning of the twentieth centuries anticipated much of what modern-day diagnosticians would find familiar, including detailed medical and psychiatric histories ofpatients, mental status examination, emphasis on careful observation of signs and symptoms to establish diagnoses, and understanding the psychoses as largely diseases of the brain. Kraepelin’s taxonomy of mental illness has a strikingly contemporary feel and includes many of the terms used today. In the twentieth century, more and more mental health practice took place outside the mental asylums, to encompass the military services, private clinics and office practice, company-supported mental health and substance abuse services, and educational institutions at all levels. This was both fortunate and necessary, unexpectedly, most psychological casualties resulted from nonpsychotic, acute disorders like substance abuse, depression, and the anxiety disorders, with extraordinarily high base rates among combat personnel. Clearly, the impact of these conditions on the war effort required development of a nomenclature that provided substantially greater coverage of these conditions so that they could be accurately identified, treated, and their sufferers returned to service
Diagnosis were made on the basis of presumed etiology, as when Hippocrates rooted the illnesses he diagnosed in various imbalances of black bile, yellow bile, blood, and phlegm. an influential Greek anatomist who lived more than 500 years later, took much the same view in his descriptions of both normal and abnormal sensations and perceptions as products of a spirit or vapor he called pneuma psychikon. Basing diagnostic assessments on such etiologic conceits changed only when the Swiss physician and natural philosopher Paracelsus developed the concept of syndromal diagnosis. Paracelsus defined the syndrome as a group of signs and symptoms that co-occur in a common pattern and thereby, presumably, characterize a particular abnormality or disease state, but for which etiology is unknown, perhaps even unknowable. Syndromal diagnosis is epitomized today in the DSM, which continues its focus on the signs and symptoms of diseases, rather than their presumed etiologies, which are unnecessary for diagnostic purposes.
Typically, psychiatric illnesses are organized hierarchically, by the principles of descriptive similarity or shared symptom pictures. Thus, following Paracelsus Thomas Sydenham an English physician for whom a childhood chorea is named, and a bit later by the French physician Franc¸ois de Sauvages. Shortly afterward, famed French hospital reformer Phillippe Pinel (1745–1826), pictured in almost every abnormal psychology textbook breaking the chains of the insane in Paris’s Biceˆtre and Salpeˆtrie`re hospitals, proposed a system that included melancholia, mania, mania with delirium, dementia, and idiotism. The appearance of this nomenclature coincided with the development of asylums for the insane, for which Pinel was partly responsible, and certainly contributed to both their humanity and their success. Building on this advance, both Pinel’s system and the new availability of large numbers of diagnostically differentiated patients in asylums paved the way for the marked increase in efforts to categorize psychopathology during the nineteenth century. The victims of serious, chronic psychopathology—what are today understood as organic mental disorders, severe developmental disabilities, dementia, schizophrenia, and bipolar disorder were permanent residents of these asylums for the mentally ill. the German psychiatrist Karl Kahlbaum) discovered that understanding the premorbid course of dementia praecox (which today we call schizophrenia), and the factors that conferred risk for it, helped predict its outcome. The roots of modern syndromal classification, including the Diagnostic and Statistical Manual of Mental Disorders, can be traced to Kahlbaum and to fellow German taxonomists Griesinger and Hecker. But no figure in descriptive psychopathology stands taller than Emil Kraepelin successive textbook editions at the end of the nineteenth and beginning of the twentieth centuries anticipated much of what modern-day diagnosticians would find familiar, including detailed medical and psychiatric histories ofpatients, mental status examination, emphasis on careful observation of signs and symptoms to establish diagnoses, and understanding the psychoses as largely diseases of the brain. Kraepelin’s taxonomy of mental illness has a strikingly contemporary feel and includes many of the terms used today. In the twentieth century, more and more mental health practice took place outside the mental asylums, to encompass the military services, private clinics and office practice, company-supported mental health and substance abuse services, and educational institutions at all levels. This was both fortunate and necessary, unexpectedly, most psychological casualties resulted from nonpsychotic, acute disorders like substance abuse, depression, and the anxiety disorders, with extraordinarily high base rates among combat personnel. Clearly, the impact of these conditions on the war effort required development of a nomenclature that provided substantially greater coverage of these conditions so that they could be accurately identified, treated, and their sufferers returned to service
No comments:
Post a Comment