Missouri Institute of Mental Health

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Missouri Institute of Mental Health
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Dr. John Harvey Kellogg Sex is the sewer drain
of a healthy body, sir! Any use of the sexual act
other than procreation is a waste of vital
energy! Wasted seeds are wasted lives!
The Road to Wellville
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5400 Arsenal Street
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Fulton State Hospital
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Saint Louis State Hospital opened in 1869 as the
Saint Louis County Lunatic Asylum. It later
became the Saint Louis Insane Asylum. It was a
Kirkbride Hospital. The first mental hospital in
Missouri (in fact, the first west of the
Mississippi), was Fulton State Hospital.
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Abraham Lincoln was still in office (1861 1865)
when the Saint Louis Lunatic Asylum began
construction in 1863.
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TrepanationThe Archeology of Madness

• Skulls at archeological digs routinely show
  evidence of surgical approaches to the
  extirpation of demons and voices.

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Recovery Occurred

• The smooth edges found on many skulls
  indicate that the patients survived the surgery
  and lived for many years and for long enough
  for the skull to continue to grow.

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The Frontal Lobes

• The fact that trepanation often involved the
  frontal lobes and the right side suggests a
  certain level of neurological sophistication by
  the persons performing the procedure.

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Odysseus could not have been mad if his reason
and memory were intact

• When Odysseus wants to feign insanity to avoid
  the expedition to Troy, he sows salt into his
  fields, until Palamedes, the Greeks messenger,
  tosses baby Telemachus before the plow.

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The three sirens seek to lure Odysseus and his
companions to their death with their melodious
voices. However Odysseus has had himself securely
bound to the mast of his ship while his
companions row on with their ears stopped with
bees-wax, thus unable to hear the sirens' song.
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Hippocrates (circa 410 BC)

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Caligula of Rome

• Probably schizophrenic
• Cruel and vicious
• Epilepsy
• Made his horse a Senator
• Incestuous relationships with his 3 sisters
• Declared himself a God

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St. Dymphna, Patron Saint of Mental Illness
Here us, O God, Our Saviour, as we honor St.
Dymphna, patron of those afflicted with mental
and emotional illness. Help us to be inspired by
her example and comforted by her merciful help.
Amen.

Feast Day May 15th
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Bosch Depicts Trepanation in the painting
Extraction of the Stone of Madness
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William Blakes Nebuchadnezzar
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Medieval manuscripts frequently portrayed the
Devil as actively engaged in human affairs.
Typically, the Devil would be portrayed as a
demon with wings, entering or exiting the body
through the mouth.
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The Urine Flask Became an Iconographic Emblem for
Medicine

• Urinalysis was used to assess a patients
  humoral condition, and medieval physicians would
  examine the urine for color, consistency,
  deposits and taste in order to make a diagnosis.
  (The distinction between between diabetes
  mellitus and diabetes insipidus was not made
  until 1674.)

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Humors and Personality

• The man at the pump typifies the melancholic
  humor (and may be a portrait of Dürer himself).
  The man with the flower represents the sanguine
  temperament, whereas the choleric type is seen in
  the man with the scraper. Finally, the phlegmatic
  personality is represented by the man with the
  stein of beer.

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Vesalius (1514-1564) published the first textbook
of human anatomy
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The Practice of Physick Two Discourses
Concerning the Soul of Brutes (1684)

• The mentally ill are wild animals that must be
  dominated and broken by the physician.
• Bleeding
• Purges
• Near Drowning
• Bath of Surprise.

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Bedlam Hospital was founded in London in 1247.
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A sight of Bedlam might be recommended as a
peculiarly effective deterrent to the wayward
inclinations of children.
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Locke differentiated natural fools from insane
persons the latter do not appear to me to have
lost the faculty of reasoning, but having joined
together some ideas very wrongly, they mistake
them for truths and they err as men do that
argue right from wrong principles.
John Locke, Essay Concerning Human Understanding,
1690.
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Cogito Ergo Sum (1596 1650)
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Philippe Pinel (1745 1826)

• Pinel discarded the long-popular equation of
  mental illness with demoniacal possession,
  regarding mental illness as the result of
  excessive exposure to social and psychological
  stresses, and in some measure, of heredity and
  physiological damage.

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William Tuke and Moral Treatment
York Retreat, Founded 1792
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Principles of Moral Treatment
Self-control - patients were rewarded if
successful in controlling themselves.
Resocialization Harmonious environment - a
building that would lift the spirits, surrounded
by natural beauty Physical nourishment Useful
occupation Staff as role models
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King George III
Acute intermittent porphyria First symptoms in
1765 Mania, delusions, hallucinations and violent
outbursts Attacks in 1801, 1804, 1810, each
lasting several months Final attack in 1820 at
age 72 ended in senility, blindness and deafness.
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DR. BENJAMIN RUSH'S "TRANQUILIZER CHAIR" (1811)
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Van Gogh's short period of artistic co-operation
with Gauguin ended with van Gogh's symbolic act
of self-mutilation he cut off an earlobe.
Although van Gogh spent most of his last months
under psychiatric treatment, paintings from this
period brought him the greatest fame.
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Dorothea Dix (1802-1887)
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The Functions of the Frontal Lobes Were Not Well
Understood in 1848
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1848
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Executive Functions

• "He is . . . irreverent, indulging at times in
  the grossest profanity (which was not previously
  his custom), manifesting but little deference for
  his fellows, impatient of restraint or advice
  when it conflicts with his desires . . .
  obstinate, yet capricious and vacillating,
  devising many plans of future operation, which
  are no sooner arranged than they are abandoned in
  turn for others. . . "

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Sigmund Freud(1856 1939)

1900
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A Taste of History
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Psychology vs. BiologyA False Dichotomy?

• Psychotherapy refers to a collection of
  undefined techniques applied to unspecified cases
  with unpredictable results.

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Is it naïve to assume that words alone can ease
human suffering?
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The Organic Basis for Aberrant Behavior Began to
be Appreciated after the Industrial Revolution

• People in the felt-hat industry sometimes
  showed signs of mercury poisoning and came down
  with "Mad-Hatter" syndrome. This was the basis
  for the "Mad Hatter" character in Lewis Carroll's
  book Alice in Wonderland.

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Phrenology

• I thought I could detect in his physiognomy a
  mind owning better qualities than his father ever
  possessed. . . .Emily Bronte, Wuthering Heights

Circa 1800
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Gall and Spurzheim published their Atlas of the
Brain in 1812

• I never knew I had an inventive talent until
  Phrenology told me so. I was a stranger to myself
  until then! Thomas Alva Edison

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physiognomy 1 the art of discovering
temperament and character from outward
appearance2 the facial features held to show
qualities of mind or character by their
configuration or expression3 external aspect
also inner character or quality revealed
outwardly
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If the impression takes root that these tests
really measure intelligence, that they constitute
a sort of last judgment on the child's capacity,
that they reveal "scientifically" his predestined
ability, then it would be a thousand times better
if all the intelligence testers and all their
questionnaires were sunk in the Sargasso Sea.
Walter Lippmann

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Restraint Devices

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Surgeon Henri Laborit discovered chlorpromazine
in his Paris laboratory in 1952. He uses it to
calm his pre-operative patients. It later became
the worlds first antipsychotic drug.
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Thorazine first became widely used as a
neuroleptic in 1955

• Thorazine is an anti-histamine and is
  chemically similar to many over-the-counter
  allergy medicines.

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Indeed, the warnings section of the Valium
package insert admitting to the occurrence of
withdrawal symptoms leads one to believe that
addiction can only occur should the usual doses
be exceeded or the user be an alcoholic, drug
addict, or "addiction-prone", a state further
undefined.
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• PET and MRI Scanning have revolutionized
  neurodiagnostics

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3 Pounds 10 Billion Neurons 100 Billion Glial
Cells 100 Trillion Connections
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Mind, Molecules, and Mental Illness in the 21st
Century The Golden Age of Neuroscience
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Contact Information

• Danny Wedding, PhD, MPH
• Missouri Institute of Mental Health
• 5400 Arsenal Street
• Saint Louis, MO 63139
• (314) 877-MIMH (6464)
• danny.wedding_at_mimh.edu