Tag: Psychiatrist

The Consultant (2022)

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Introduction

The Consultant is a thriller TV series by director Ignacio Maiso.

Outline

A psychiatrist relives all of his past fears with the arrival of three new patients.

Cast

  • John-Christian Bateman … David
  • Rebecca Calienda … Sharon
  • Katie Dalton … Kate
  • Gareth Lawrence … Mike
  • Alex Reece … John
  • David Stock … John
  • Sindri Swan … Delivery guy

Production & Filming Details

  • Director(s):
    • Ignacio Maiso
  • Producer(s):
    • Agustin Maiso … executive producer
    • Ignacio Maiso … executive producer
    • Danny Mounsey … producer
    • David Stock … associate producer
  • Writer(s):
    • Ignacio Maiso
  • Music:
    • Ben Cook
  • Cinematography:
    • Milos Moore
  • Editor(s):
    • Chiraag Patel
  • Production:
    • Tractorni Productions
  • Distributor(s):
  • Release Date: 26 October 2022 (Internet).
  • Running Time: 97 minutes.
  • Rating: Unknown.
  • Country: UK.
  • Language: English.

Currently unavailable.

Who was Karl Williams?

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Introduction

Franz Karl Heinrich Wilmanns (27 July 1873 to 23 August 1945) was a Mexican-born German psychiatrist who founded the Heidelberg school of psychopathology.

In 1933, Wilmanns was fired from Heidelberg University for political reasons.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Karl_Wilmanns >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Biological Psychiatry?

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Introduction

Biological psychiatry or biopsychiatry is an approach to psychiatry that aims to understand mental disorder in terms of the biological function of the nervous system. It is interdisciplinary in its approach and draws on sciences such as neuroscience, psychopharmacology, biochemistry, genetics, epigenetics and physiology to investigate the biological bases of behaviour and psychopathology. Biopsychiatry is the branch of medicine which deals with the study of the biological function of the nervous system in mental disorders.

There is some overlap with neurology, which focuses on disorders where gross or visible pathology of the nervous system is apparent, such as epilepsy, cerebral palsy, encephalitis, neuritis, Parkinson’s disease and multiple sclerosis. There is also some overlap with neuropsychiatry, which typically deals with behavioural disturbances in the context of apparent brain disorder. In contrast biological psychiatry describes the basic principles and then delves deeper into various disorders. It is structured to follow the organisation of the DSM-IV, psychiatry’s primary diagnostic and classification guide. The contributions of this field explore functional neuroanatomy, imaging, and neuropsychology and pharmacotherapeutic possibilities for depression, anxiety and mood disorders, substance abuse and eating disorders, schizophrenia and psychotic disorders, and cognitive and personality disorders.

Biological psychiatry and other approaches to mental illness are not mutually exclusive, but may simply attempt to deal with the phenomena at different levels of explanation. Because of the focus on the biological function of the nervous system, however, biological psychiatry has been particularly important in developing and prescribing drug-based treatments for mental disorders.

In practice, however, psychiatrists may advocate both medication and psychological therapies when treating mental illness. The therapy is more likely to be conducted by clinical psychologists, psychotherapists, occupational therapists or other mental health workers who are more specialised and trained in non-drug approaches.

The history of the field extends back to the ancient Greek physician Hippocrates, but the phrase biological psychiatry was first used in peer-reviewed scientific literature in 1953. The phrase is more commonly used in the United States than in some other countries such as the UK. However the term “biological psychiatry” is sometimes used as a phrase of disparagement in controversial dispute.

Brief History

Early 20th Century

Sigmund Freud was originally focused on the biological causes of mental illness. Freud’s professor and mentor, Ernst Wilhelm von Brücke, strongly believed that thought and behaviour were determined by purely biological factors. Freud initially accepted this and was convinced that certain drugs (particularly cocaine) functioned as antidepressants. He spent many years trying to “reduce” personality to neurology, a cause he later gave up on before developing his now well-known psychoanalytic theories.

Nearly 100 years ago, Harvey Cushing, the father of neurosurgery, noted that pituitary gland problems often cause mental health disorders. He wondered whether the depression and anxiety he observed in patients with pituitary disorders were caused by hormonal abnormalities, the physical tumour itself, or both.

Mid 20th Century

An important point in modern history of biological psychiatry was the discovery of modern antipsychotic and antidepressant drugs. Chlorpromazine (also known as Thorazine), an antipsychotic, was first synthesized in 1950. In 1952, iproniazid, a drug being trialled against tuberculosis, was serendipitously discovered to have anti-depressant effects, leading to the development of MAOIs as the first class of antidepressants. In 1959 imipramine, the first tricyclic antidepressant, was developed. Research into the action of these drugs led to the first modern biological theory of mental health disorders called the catecholamine theory, later broadened to the monoamine theory, which included serotonin. These were popularly called the “chemical imbalance” theory of mental health disorders.

Late 20th Century

Starting with fluoxetine (marketed as Prozac) in 1988, a series of monoamine-based antidepressant medications belonging to the class of selective serotonin reuptake inhibitors were approved. These were no more effective than earlier antidepressants, but generally had fewer side effects. Most operate on the same principle, which is modulation of monoamines (neurotransmitters) in the neuronal synapse. Some drugs modulate a single neurotransmitter (typically serotonin). Others affect multiple neurotransmitters, called dual action or multiple action drugs. They are no more effective clinically than single action versions. That most antidepressants invoke the same biochemical method of action may explain why they are each similarly effective in rough terms. Recent research indicates antidepressants often work but are less effective than previously thought.

Problems with Catecholamine/Monoamine Hypotheses

The monoamine hypothesis was compelling, especially based on apparently successful clinical results with early antidepressant drugs, but even at the time there were discrepant findings. Only a minority of patients given the serotonin-depleting drug reserpine became depressed; in fact reserpine even acted as an antidepressant in many cases. This was inconsistent with the initial monoamine theory which said depression was caused by neurotransmitter deficiency.

Another problem was the time lag between antidepressant biological action and therapeutic benefit. Studies showed the neurotransmitter changes occurred within hours, yet therapeutic benefit took weeks.

To explain these behaviours, more recent modifications of the monoamine theory describe a synaptic adaptation process which takes place over several weeks. Yet this alone does not appear to explain all of the therapeutic effects.

Scope and Detailed Definition

Biological psychiatry is a branch of psychiatry where the focus is chiefly on researching and understanding the biological basis of major mental disorders such as unipolar and bipolar affective (mood) disorders, schizophrenia and organic mental disorders such as Alzheimer’s disease. This knowledge has been gained using imaging techniques, psychopharmacology, neuroimmunochemistry and so on. Discovering the detailed interplay between neurotransmitters and the understanding of the neurotransmitter fingerprint of psychiatric drugs such as clozapine has been a helpful result of the research.

On a research level, it includes all possible biological bases of behaviour – biochemical, genetic, physiological, neurological and anatomical. On a clinical level, it includes various therapies, such as drugs, diet, avoidance of environmental contaminants, exercise, and alleviation of the adverse effects of life stress, all of which can cause measurable biochemical changes. The biological psychiatrist views all of these as possible aetiologies of or remedies for mental health disorders.

However, the biological psychiatrist typically does not discount talk therapies. Medical psychiatric training generally includes psychotherapy and biological approaches. Accordingly, psychiatrists are usually comfortable with a dual approach:

“psychotherapeutic methods […] are as indispensable as psychopharmacotherapy in a modern psychiatric clinic”.

Basis for Biological Psychiatry

Sigmund Freud developed psychotherapy in the early 1900s, and through the 1950s this technique was prominent in treating mental health disorders.

However, in the late 1950s, the first modern antipsychotic and antidepressant drugs were developed: chlorpromazine (also known as Thorazine), the first widely used antipsychotic, was synthesized in 1950, and iproniazid, one of the first antidepressants, was first synthesized in 1957. In 1959 imipramine, the first tricyclic antidepressant, was developed.

Based significantly on clinical observations of the above drug results, in 1965 the seminal paper “The catecholamine hypothesis of affective disorders” was published. It articulated the “chemical imbalance” hypothesis of mental health disorders, especially depression. It formed much of the conceptual basis for the modern era in biological psychiatry.

The hypothesis has been extensively revised since its advent in 1965. More recent research points to deeper underlying biological mechanisms as the possible basis for several mental health disorders.

Modern brain imaging techniques allow non-invasive examination of neural function in patients with mental health disorders, however this is currently experimental. With some disorders it appears the proper imaging equipment can reliably detect certain neurobiological problems associated with a specific disorder. If further studies corroborate these experimental results, future diagnosis of certain mental health disorders could be expedited using such methods.

Another source of data indicating a significant biological aspect of some mental health disorders is twin studies. Identical twins have the same nuclear DNA, so carefully constructed studies may indicate the relative importance of environmental and genetic factors on the development of a particular mental health disorder.

The results from this research and the associated hypotheses form the basis for biological psychiatry and the treatment approaches in a clinical setting.

Scope of Clinical Biological Psychiatric Treatment

Since various biological factors can affect mood and behaviour, psychiatrists often evaluate these before initiating further treatment. For example, dysfunction of the thyroid gland may mimic a major depressive episode, or hypoglycaemia (low blood sugar) may mimic psychosis.

While pharmacological treatments are used to treat many mental disorders, other non-drug biological treatments are used as well, ranging from changes in diet and exercise to transcranial magnetic stimulation and electroconvulsive therapy. Types of non-biological treatments such as cognitive therapy, behavioural therapy, and psychodynamic psychotherapy are often used in conjunction with biological therapies. Biopsychosocial models of mental illness are widely in use, and psychological and social factors play a large role in mental disorders, even those with an organic basis such as schizophrenia.

Diagnostic Process

Correct diagnosis is important for mental health disorders, otherwise the condition could worsen, resulting in a negative impact on both the patient and the healthcare system. Another problem with misdiagnosis is that a treatment for one condition might exacerbate other conditions. In other cases apparent mental health disorders could be a side effect of a serious biological problem such as concussion, brain tumour, or hormonal abnormality, which could require medical or surgical intervention.

Examples of Biologic Treatments

Latest Biological Hypotheses of Mental Health Disorders

New research indicates different biological mechanisms may underlie some mental health disorders, only indirectly related to neurotransmitters and the monoamine chemical imbalance hypothesis.

Recent research indicates a biological “final common pathway” may exist which both electroconvulsive therapy and most current antidepressant drugs have in common. These investigations show recurrent depression may be a neurodegenerative disorder, disrupting the structure and function of brain cells, destroying nerve cell connections, even killing certain brain cells, and precipitating a decline in overall cognitive function.

In this new biological psychiatry viewpoint, neuronal plasticity is a key element. Increasing evidence points to various mental health disorders as a neurophysiological problem which inhibits neuronal plasticity.

This is called the neurogenic hypothesis of depression. It promises to explain pharmacological antidepressant action, including the time lag from taking the drug to therapeutic onset, why downregulation (not just upregulation) of neurotransmitters can help depression, why stress often precipitates mood disorders, and why selective modulation of different neurotransmitters can help depression. It may also explain the neurobiological mechanism of other non-drug effects on mood, including exercise, diet and metabolism. By identifying the neurobiological “final common pathway” into which most antidepressants funnel, it may allow rational design of new medications which target only that pathway. This could yield drugs which have fewer side effects, are more effective and have quicker therapeutic onset.

There is significant evidence that oxidative stress plays a role in schizophrenia.

Criticism

Refer to Biopsychiatry Controversy.

A number of patients, activists, and psychiatrists dispute biological psychiatry as a scientific concept or as having a proper empirical basis, for example arguing that there are no known biomarkers for recognized psychiatric conditions. This position has been represented in academic journals such as The Journal of Mind and Behaviour and Ethical Human Psychology and Psychiatry, which publishes material specifically countering “the idea that emotional distress is due to an underlying organic disease.” Alternative theories and models instead view mental disorders as non-biomedical and might explain it in terms of, for example, emotional reactions to negative life circumstances or to acute trauma.

Fields such as social psychiatry, clinical psychology, and sociology may offer non-biomedical accounts of mental distress and disorder for certain ailments and are sometimes critical of biopsychiatry. Social critics believe biopsychiatry fails to satisfy the scientific method because they believe there is no testable biological evidence of mental disorders. Thus, these critics view biological psychiatry as a pseudoscience attempting to portray psychiatry as a biological science.

R.D. Laing argued that attributing mental disorders to biophysical factors was often flawed due to the diagnostic procedure. The “complaint” is often made by a family member, not the patient, the “history” provided by someone other than patient, and the “examination” consists of observing strange, incomprehensible behaviour. Ancillary tests (EEG, PET) are often done after diagnosis, when treatment has begun, which makes the tests non-blind and incurs possible confirmation bias. The psychiatrist Thomas Szasz commented frequently on the limitations of the medical approach to psychiatry and argued that mental illnesses are medicalized problems in living.

Silvano Arieti, while approving of the use of medication in some cases of schizophrenia, preferred intensive psychotherapy without medication if possible. He was also known for approving the use of electroconvulsive therapy on those with disorganised schizophrenia in order to make them reachable by psychotherapy. The views he expressed in Interpretation of Schizophrenia are nowadays known as the trauma model of mental disorders, an alternative to the biopsychiatric model.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Biological_psychiatry >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 26 February [2023]

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People (Births)

People (Deaths)

  • 1969 – Karl Jaspers, German-Swiss psychiatrist and philosopher (b. 1883)

Emile Coue

Émile Coué de la Châtaigneraie (26 February 1857 to 02 July 1926) was a French psychologist and pharmacist who introduced a popular method of psychotherapy and self-improvement based on optimistic autosuggestion.

Considered by Charles Baudouin to represent a second Nancy School, Coué treated many patients in groups and free of charge.

Sandie Shaw

Sandie Shaw, MBE (born Sandra Ann Goodrich; 26 February 1947) is a retired English singer. One of the most successful British female singers of the 1960s, she had three UK number one singles with “(There’s) Always Something There to Remind Me” (1964), “Long Live Love” (1965) and “Puppet on a String” (1967). With the latter, she became the first British entry to win the Eurovision Song Contest. She returned to the UK Top 40, for the first time in 15 years, with her 1984 cover of the Smiths song “Hand in Glove”. Shaw retired from the music industry in 2013.

Concentrating on a new career as a psychotherapist, Shaw opened the Arts Clinic in 1997 with her husband, to provide psychological healthcare and creative development to those in the creative industries.[6]: 387  The clinic is now styled Barefoot Therapy: The Arts Clinic and continues to provide psychological support for those in the fields of entertainment, media and sports. In 1998 she was invited to join the Royal Society of Musicians as an Honorary Professor of Music.

Karl Jaspers

Karl Theodor Jaspers (23 February 1883 to 26 February 1969) was a German-Swiss psychiatrist and philosopher who had a strong influence on modern theology, psychiatry, and philosophy. After being trained in and practicing psychiatry, Jaspers turned to philosophical inquiry and attempted to discover an innovative philosophical system. He was often viewed as a major exponent of existentialism in Germany, though he did not accept the label.

On This Day … 21 February [2023]

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Events

People (Births)

  • 1892 – Harry Stack Sullivan, American psychiatrist and psychoanalyst (d. 1949)
  • 1914 – Jean Tatlock, American psychiatrist and physician (d. 1944)
  • 1961 – Elliot Hirshman, American psychologist and academic

Harry Stack Sullivan

Herbert “Harry” Stack Sullivan (21 February 1892 to 14 January 1949, Paris, France) was an American Neo-Freudian psychiatrist and psychoanalyst who held that “personality can never be isolated from the complex interpersonal relationships in which [a] person lives” and that “[t]he field of psychiatry is the field of interpersonal relations under any and all circumstances in which [such] relations exist”. Having studied therapists Sigmund Freud, Adolf Meyer, and William Alanson White, he devoted years of clinical and research work to helping people with psychotic illness.

Jean Tatlock

Jean Frances Tatlock (21 February 1914 to 04 January 1944) was an American psychiatrist and physician. She was a member of the Communist Party of the United States of America and was a reporter and writer for the party’s publication Western Worker. She is also known for her romantic relationship with J. Robert Oppenheimer, the director of the Manhattan Project’s Los Alamos Laboratory during World War II.

The daughter of John Strong Perry Tatlock, a prominent Old English philologist and an expert on Geoffrey Chaucer, Tatlock was a graduate of Vassar College and the Stanford Medical School, where she studied to become a psychiatrist. Tatlock began seeing Oppenheimer in 1936, when she was a graduate student at Stanford and Oppenheimer was a professor of physics at the University of California, Berkeley. As a result of their relationship and her membership of the Communist Party, she was placed under surveillance by the FBI and her phone was tapped.

She suffered from clinical depression and died by suicide on 04 January 1944.

Elliot Hirshman

Elliot Lee Hirshman (born 21 February 1961) is an American psychologist and academic who is the president of Stevenson University in Owings Mills, Maryland since 03 July 2017. Prior to Stevenson University he served as president at San Diego State University and served as the provost and senior vice president of the University of Maryland, Baltimore County.

What is Social Psychiatry?

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Introduction

Social psychiatry is a branch of psychiatry that focuses on the interpersonal and cultural context of mental disorder and mental wellbeing.

It involves a sometimes disparate set of theories and approaches, with work stretching from epidemiological survey research on the one hand, to an indistinct boundary with individual or group psychotherapy on the other. Social psychiatry combines a medical training and perspective with fields such as social anthropology, social psychology, cultural psychiatry, sociology and other disciplines relating to mental distress and disorder. Social psychiatry has been particularly associated with the development of therapeutic communities, and to highlighting the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, with the latter focused on genetics, brain neurochemistry and medication. Social psychiatry was the dominant form of psychiatry for periods of the 20th century but is currently less visible than biopsychiatry.

After reviewing the history and activities of social psychiatry, Vincenzo Di Nicola reviews three major questions for social psychiatry and concludes with a manifesto for a 21st-century social psychiatry:

  1. What is social about psychiatry? This addresses definitional problems that arise, such as binary thinking, and the need for a common language.
  2. What are the theory and practice of social psychiatry? Issues include social psychiatry’s core principles, values, and operational criteria; the social determinants of health and the Global Mental Health (GMH) Movement; and the need for translational research. This part of the review establishes the minimal criteria for a coherent theory of social psychiatry and the view of persons that emerges from such a theory, the social self.
  3. Why the time has come for a manifesto for social psychiatry. This manifesto outlines the parameters for a theory of social psychiatry, based on both the social self and the social determinants of health, to offer an inclusive social definition of health, concluding with a call for action.

Brief History

The events of the first half of the 20th century brought the issue of the relationship between the individual and the community to the fore. Psychiatrists who showed a willingness to confront these issues at home, after the war, called themselves social psychiatrists. Psychoanalytic psychotherapy and all its offshoots were grounded in an approach to the patient that focused almost exclusively on the individual – the relational aspects of therapy were implicit in the relationship between therapist and patient, but the main source of problem and motivation for change was seen as being intrapsychic (within the individual). The social and political contexts were largely disregarded. Sarason observed in 1981, that:

“it is as though society does not exist for the psychologist. Society is a vague, amorphous background that can be disregarded in one’s efforts to fathom the laws of behavior” (Sarason 1981).

Early landmarks in social psychiatry included: Karen Horney, MD, who wrote about personality as it interacts with other people (1937); Erik Erikson, who discussed the influence of society on development (1950); Harry Stack Sullivan’s (1953) integration of sociological and psychodynamic concepts, and his work on the role of early interpersonal interactions in the development of the self; Cornell University’s Midtown Manhattan Study, which looked at the prevalence of mental illness in Manhattan; August Hollingshead, PhD, and Frederick Redlich, MD, looked at the influence of social class on psychiatric conditions (1958); Alexander H. Leighton, MD, looked at the relationship between social disintegration and mental illness (1959); Burrow was an early pioneer of the social causes of mental disorder and suggested “Sociatry” as the name for this new discipline.

Over the years many sociologists have contributed theories and research which has enlightened psychiatry in this area (e.g. Avison and Robins); The relationship between social factors and mental illness was demonstrated by the early work of Hollingshead and Readlich in Chicago in the 1930s, who found a high concentration of individuals diagnosed with schizophrenia in deprived areas of the city has been replicated numerous times throughout the world, although controversy still exists as to the extent of drift of vulnerable individuals to these areas or of a higher incidence of the disorder in the socially disadvantaged; the Midtown Manhattan Study conducted in the 1950s by Cornell University hinted at widespread psychopathology among the general population of New York City (Srole, Sanger, Michael, Opler, and Rennie, 1962); the Three Hospitals Study (Wing, J.K. and Brown, G.W. (1967) Social Treatments of Chronic Schizophrenia: a comparative survey of three mental hospitals. Journal of Mental Science. 107, pp.847-861) was a very influential work that has been replicated, that demonstrated forcefully that the poverty of the environment in poor mental hospitals lead to greater handicaps in the patients.

Social psychiatry was instrumental in the development of therapeutic communities. Under the influence of Maxwell Jones, Main, Wilmer and others (Caudill, 1958; Rapoport, 1960), combined with the publications of critiques of the existing mental health system (Greenblatt et al., 1957, Stanton and Schwartz, 1954) and the sociopolitical influences that permeated the psychiatric world, the concept of the therapeutic community and its attenuated form – the therapeutic milieu – caught on and dominated the field of inpatient psychiatry throughout the 1960s. The aim of therapeutic communities was a more democratic, user-led form of therapeutic environment, avoiding the authoritarian and demeaning practices of many psychiatric establishments of the time. The central philosophy is that clients are active participants in their own and each other’s mental health treatment and that responsibility for the daily running of the community is shared among the clients and the staff. “TCs” have often eschewed or limited medication in favour of psychoanalytically derived group-based insight therapies.

Current Work

Social psychiatry can be most effectively applied in helping to develop mental health promotion and prevent certain mental illnesses by educating individuals, families, and societies.

Social psychiatry has been important in developing the concept of major “life events” as precipitants of mental ill health, including, for example, bereavement, promotion, moving house, or having a child.

Originally inpatient centres, many therapeutic communities now operate as day centres, often focused on borderline personality disorder and run by psychotherapists or art therapists rather than psychiatrists.

Social psychiatrists help test the cross-cultural use of psychiatric diagnoses and assessments of need or disadvantage, showing particular links between mental illness and unemployment, overcrowding and single parent families.

Social psychiatrists also work to link concepts such as self-esteem and self-efficacy to mental health, and in turn to socioeconomic factors.

Social psychiatrists work on social firms in regard to people with mental health problems. These are regular businesses in the market that employ a significant number of people with disabilities, who are paid regular wages and work on the basis of regular work contracts. There are approximately 2,000 social firms in Europe and a large percentage of people with disabilities who work in social firms have a psychiatric disability. Some are specifically for people with psychiatric disabilities. (Schwarz, G., & Higgins, G, (1999) Marienthal the social firms network Supporting the Development of Social Firms in Europe, UK).

Social psychiatrists often focus on rehabilitation in a social context, rather than “treatment” per se. A related approach is community psychiatry.

Facilitating the social inclusion of people with mental health problems is a major focus of modern social psychiatry.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Social_psychiatry >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

On This Day … 15 February [2023]

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People (Births)

  • 1856 – Emil Kraepelin, German psychiatrist and academic (d. 1926)

Emil Kraepelin

Emil Wilhelm Georg Magnus Kraepelin (15 February 1856 to 07 October 1926) was a German psychiatrist.

H.J. Eysenck’s Encyclopaedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century’s end. While he proclaimed his own high clinical standards of gathering information “by means of expert analysis of individual cases”, he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviours from patients with a specific diagnosis. He has been described as “a scientific manager” and “a political operator”, who developed “a large-scale, clinically oriented, epidemiological research programme”.

On This Day … 08 February [2023]

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People (Deaths)

  • 1964 – Ernst Kretschmer, German psychiatrist and author (b. 1888)
  • 2007 – Ian Stevenson, Canadian-American psychiatrist and academic (b. 1918)

Ernst Kretschmer

Ernst Kretschmer (08 October 1888 to 08 February 1964) was a German psychiatrist who researched the human constitution and established a typology.

In 1926 he became the director of the psychiatric clinic at Marburg University.

Kretschmer was a founding member of the International General Medical Society for Psychotherapy (AÄGP) which was founded on 12 January 1927. He was the president of AÄGP from 1929. In 1933 he resigned from the AÄGP for political reasons.

After he resigned from the AÄGP, he started to support the SS and signed the “Vow of allegiance of the professors of the German universities and high-schools to Adolf Hitler and the National Socialistic state.” (German: “Bekenntnis der Professoren an den deutschen Universitäten und Hochschulen zu Adolf Hitler und dem nationalsozialistischen Staat”).

From 1946 until 1959, Kretschmer was the director of the psychiatric clinic of the University of Tübingen. He died, aged 75, in Tübingen.

Ian Stevenson

Ian Pretyman Stevenson (31 October 1918 to 08 February 2007) was a Canadian-born American psychiatrist, the founder and director of the Division of Perceptual Studies at the University of Virginia School of Medicine.

He was a professor at the University of Virginia School of Medicine for fifty years. He was chair of their department of psychiatry from 1957 to 1967, Carlson Professor of Psychiatry from 1967 to 2001, and Research Professor of Psychiatry from 2002 until his death in 2007.

As founder and director of the University of Virginia School of Medicine’s Division of Perceptual Studies (originally named “Division of Personality Studies”), which investigates the paranormal, Stevenson became known for his research into cases he considered suggestive of reincarnation – the idea that emotions, memories, and even physical bodily features can be passed on from one incarnation to another. In the course of his forty years doing international fieldwork, he researched three thousand cases of children who claimed to remember past lives. His position was that certain phobias, philias, unusual abilities and illnesses could not be fully explained by genetics or the environment. He believed that, in addition to genetics and the environment, reincarnation might possibly provide a third, contributing factor.

Stevenson helped to found the Society for Scientific Exploration in 1982,[8] and was the author of around three hundred papers and fourteen books on reincarnation, including Twenty Cases Suggestive of Reincarnation (1966), Cases of the Reincarnation Type (four volumes, 1975-1983) and European Cases of the Reincarnation Type (2003). His 1997 work Reincarnation and Biology: A Contribution to the Etiology of Birthmarks and Birth Defects reported two hundred cases in which birthmarks and birth defects seemed to correspond in some way to a wound on the deceased person whose life the child recalled. He wrote a shorter version of the same research for the general reader, Where Reincarnation and Biology Intersect (1997).

Reaction to his work was mixed. In an obituary for Stevenson in The New York Times, Margalit Fox wrote that Stevenson’s supporters saw him as a misunderstood genius, that his detractors regarded him as earnest but gullible, but that most scientists had simply ignored his research. His life and work became the subject of the supportive books Old Souls: The Scientific Search for Proof of Past Lives (1999) by Tom Shroder (a Washington Post journalist), Life Before Life (2005) by Jim B. Tucker (a psychiatrist and colleague at the University of Virginia who now heads the division Stevenson founded), and Science, the Self, and Survival after Death (2012), by Emily Williams Kelly. Critics, particularly the philosophers C.T.K. Chari (1909-1993) and Paul Edwards (1923-2004), raised a number of issues, including instances where the children or parents interviewed by Stevenson had deceived him, instances of Stevenson asking leading questions in his interviews, and problems with working through translators who credulously believed what the interviewees were saying at face value. Stevenson’s critics contend that ultimately his conclusions are undermined by confirmation bias, where cases not supportive of his hypothesis were not presented as counting against it, and motivated reasoning since Stevenson had always maintained a personal belief in reincarnation as a fact of reality rather than also considering the possibility that it may not happen at all.

Who was Thomas Forrest Main?

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Introduction

Thomas Forrest Main (1911-1990) was a psychiatrist and psychoanalyst who coined the term ‘therapeutic community’. He is particularly remembered for his often cited paper, The Ailment (1957).

Refer to British Journal of Medical Psychology for The Ailment.

Life

Thomas Main was born on 25 February 1911 in Johannesburg, where his father was a mine manager who had emigrated there from England. At the start of World War I his mother returned to England with Thomas and his two sisters Isabella and Mary, while his father joined the South African Army. Main was educated at the Royal Grammar School, Newcastle-upon-Tyne before studying medicine at Durham University, graduating in 1933 and becoming a doctor in 1938. Specialising in psychiatry, he gained a Diploma in Psychological Medicine from Dublin in 1936. In 1937 he married Agnes Mary (Molly) McHaffie who also graduated in medicine at Durham University and who also became a psychoanalyst. They had three daughters and a son, Jennifer (Johns), Deborah (Hutchinson), Ursula (Kretzschmar) and Andrew.

Main worked as superintendent at Gateshead Mental Hospital. During the Second World War he joined the Royal Army Medical Corps as an adviser in psychiatry, attaining the rank of lieutenant colonel and working at the Northfield Army Hospital (aka Hollymoor Hospital) for the treatment of war neuroses. The work conducted at Northfield is considered by many psychiatrists to have been the first example of an intentional therapeutic community. The principles developed at Northfield were also developed and adapted at Civil Resettlement Units established at the end of the war to help returning prisoners of war to adapt back to civilian society and for civilians to adapt to having these men back amongst them.

The term “therapeutic community” was coined by Main in his 1946 paper, “The hospital as a therapeutic institution”, and subsequently developed by others including Maxwell Jones, R.D. Laing at the Philadelphia Association, David Cooper, and by Joshua Bierer.

After the war Main joined the Cassel Hospital, as medical director in 1946 and continued working there for the next thirty years.

Training as a psychoanalyst under Michael Balint, he was supervised by Anna Freud, Melanie Klein and Paula Heimann. In 1974 he co-founded with Michael Balint the charitable Institute of Psychosexual Medicine in London. He served as its Life President. He also served as vice-president of the Royal College of Psychiatrists, and was a co-editor of the British Journal of Medical Psychology. He died in Barnes, London on 29 May 1990, aged 79.

His papers are held in the Archive of the British Psychoanalytic Society, whose member he was for many years.

Works

  • The hospital as a therapeutic institution.
  • The Ailment and other Psycho-Analytical Essays, ed. Jennifer Johns, London: Free Association Books, 1989. ISBN 1-85343-105-2. The noted essay, The Ailment, is a report of Main’s detailed study of the feelings aroused in a team of nurses caring for a group of psychiatric patients with low potential for recovery. He found that a sedative would be used in the management of a patient “only at the moment when the nurse had reached the limit of her human resources and was no longer able to stand the patient’s problems without anxiety, impatience, guilt, anger or despair”.
  • Mothers with children on a psychiatric unit.
  • A fragment on mothering.
  • Meanings of madness: psychiatry comes of age.

Reference

Main, T.F. (1957) The Ailment. British Journal of Medical Psychology. 30(3), pp.129-145. https://bpspsychub.onlinelibrary.wiley.com/doi/10.1111/j.2044-8341.1957.tb01193.x.

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