The American Osteopathic Board of Neurology and Psychiatry (AOBNP) is an organisation that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) and non-osteopathic (MD and equivalent) physicians who specialise in disorders of the nervous system (neurologists) and to qualified Doctors of Osteopathic Medicine and physicians who specialise in the diagnosis and treatment of mental disorders (psychiatrists).
The board is one of 16 medical specialty certifying boards of the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) of the American Osteopathic Association (AOA). Established in 1941, the AOBNP is responsible for examining physicians who have completed an ACGME-accredited residency in neurology and/or psychiatry. Since its inception, over 630 physicians have achieved primary certification in psychiatry and 400 in neurology, along with physicians holding subspecialty certifications.
The AOBNP is one of two certifying boards for neurologists and psychiatrists in the United States. The other certifying authority is the American Board of Psychiatry and Neurology, Inc. (ABPN), a member board of the American Board of Medical Specialties.
Organisation
There are eight elected members of the AOBNP. Each member is an AOA board-certified physician, certified through the AOBNP. Membership includes a representatives from each area of neurology (4) and psychiatry (4), as well as representation from the subspecialties of the board and a representative from each of the time divisions of the United States whenever possible.
Board Certification
Initial certification is available to osteopathic and other neurologists and psychiatrists who have successfully completed an ACGME-accredited residency in neurology or psychiatry and successful completion of the written exam.
Board certified neurologists and psychiatrists (diplomates of the AOBNP) must participate in Osteopathic Continuous Certification on an ongoing basis to avoid expiration of their board certified status.
Effective 01 June 2019, all AOA specialty certifying boards implemented an updated continuous certification process for osteopathic physicians, called “(OCC)”, and are required to publish the requirements for OCC in their basic documents. The following components comprise the updated OCC process:
Component 1: Licensure. AOA board-certified physicians must hold a valid, active license to practice medicine in one of the 50 states or Canada.
Component 2: Lifelong Learning/Continuing Medical Education. A minimum of 75 CME credits in the specialty area of certification during each 3-year cycle. Of these 75 specialty CME credits, 18 must be AOA Category 1-A. The remaining 57 hours will have broad acceptance of specialty CME.
Component 3: Cognitive Assessment: AOBA board-certified physicians must complete the online cognitive assessment annually after entry into the Longitudinal Assessment process to maintain compliance with OCC.
Component 4: Practice Performance Assessment and Improvement. Attestation of participation in quality improvement activities. Physicians may view the Attestation Form by logging in with their AOA credentials to the AOA Physician Portal on the AOA website.
Diplomates of the AOBNP may also receive Subspecialty Certification or Certification of Special Qualifications in the following areas:
Addiction Medicine
Neurophysiology
Geriatric Psychiatry
Hospice and Palliative Medicine
Sleep Medicine
Effective 01 July 2020, allopathic (MD) physicians may apply for certification by the AOBNP.
The American Psychiatric Association (APA) is the main professional organisation of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organiaation in the world. It has more than 38,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders.
The organisation has its headquarters in Washington, D.C.
Brief History
At a meeting in 1844 in Philadelphia, thirteen superintendents and organisers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). The group included Thomas Kirkbride, creator of the asylum model which was used throughout the United States. The group was chartered to focus “primarily on the administration of hospitals and how that affected the care of patients”, as opposed to conducting research or promoting the profession.
In 1893, the organisation changed its name to the American Medico-Psychological Association. In 1921, the association changed that name to the present American Psychiatric Association. The association was incorporated in 1927.
The cover of the publication Semi-Centennial Proceedings of the American Medical Psychological Association, which the association distributed in 1894 at its 50th annual meeting in Philadelphia, contained the first depiction of the association’s official seal. The seal has undergone several changes since that time.
The present seal is a round medallion with a purported likeness of Benjamin Rush’s profile and 13 stars over his head to represent the 13 founders of the organisation. The outer ring contains the words “American Psychiatric Association 1844.” Rush’s name and an MD are below the picture.
An association history of the seal states:
The choice of Rush (1746–1813) for the seal reflects his place in history. …. Rush’s practice of psychiatry was based on bleeding, purging, and the use of the tranquilizer chair and gyrator. By 1844 these practices were considered erroneous and abandoned. Rush, however, was the first American to study mental disorder in a systematic manner, and he is considered the father of American Psychiatry.
In 2015, the association adopted a new logo that depicts the serpent-entwined Rod of Asclepius superimposed over the image of two hemispheres of a human brain. The logo appears next to the words “American Psychiatric Association”, with the word “Psychiatric” in bold type; the tagline “Medical leadership for mind, brain and body” appears below the logo. The association will continue to use the seal bearing Rush’s profile for ceremonial purposes and for some internal documents.
Organisation and Membership
APA is led by the President of the American Psychiatric Association and a board of trustees with an executive committee.
APA reports that its membership is primarily medical specialists who are qualified, or in the process of becoming qualified, as psychiatrists. The basic eligibility requirement is completion of a residency programme in psychiatry accredited by the Residency Review Committee for Psychiatry of the Accreditation Council for Graduate Medical Education (ACGME), the Royal College of Physicians and Surgeons of Canada (RCPS[C]), or the American Osteopathic Association (AOA). Applicants for membership must also hold a valid medical license (with the exception of medical students and residents) and provide one reference who is an APA member.
APA holds an annual conference attended by an American and international audience.
APA is made up of some 76 district associations throughout the country.
Foundation
APA operates a non-profit subsidiary called the American Psychiatric Association Foundation (APAF), offering community-based programs and research initiatives intended to better understand and support issues of mental health. Its strategic partners include the Council of State Governments (CSG) Justice Centre, Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Association of Counties (NACo).
Corporate Alliance
APAF partners with industry organisations to collaborate on mental health research and development through its Corporate Alliance. Current and recent members of the alliance include:
AbbVie
Acadia Pharmaceuticals
Alkermes
Allergan
Bausch Health
Boehringer Ingelheim
Eisai
Indivior
Janssen Pharmaceuticals
Jazz Pharmaceuticals
Lundbeck
Myriad Genetics
Neurocrine Biosciences
Otsuka Pharmaceutical
Pfizer
Sunovion
Takeda Pharmaceutical Company
Donors to the foundation in 2019 include the Austen Riggs Centre, BB&T, Cenveo, McLean Hospital, Menninger Foundation, NeuroStar, Newport Academy, NewYork-Presbyterian Hospital, Sheppard Pratt, and Silver Hill Hospital.
Publications and Campaigns
APA position statements, clinical practice guidelines, and descriptions of its core diagnostic manual (the DSM) are published.
APA publishes several journals focused on different areas of psychiatry, for example, academic, clinical practice, or news.
Top Five Choosing Wisely Recommendations
In coordination with the American Board of Internal Medicine, the APA proposes five recommendations for physicians and patients. The list was compiled by members of the Council on Research and Quality Care. The APA places a primary focus on antipsychotic medications due to a rapid increase in sales, from $9.6 billion in 2004 to $18.5 billion in 2011.
Do not prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.
Do not routinely prescribe 2 or more antipsychotic medications concurrently.
Do not prescribe antipsychotic medications as a first-line intervention to treat behavioural and psychological symptoms of dementia.
Do not routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.
Do not routinely prescribe antipsychotic medications as a first-line intervention for children or adolescents for any diagnosis other than psychotic disorders.
Notable Figures
Donald Cameron, was president of the American Psychiatric Association in 1952-1953. He conducted coercive experiments widely denounced as unethical, including involuntary electroshock therapy, drug administration, and prolonged confinement and sensory deprivation funded as part of the Central Intelligence Agency Project MKUltra.
Enoch Callaway, psychiatrist, pioneer in biological psychiatry.
Adolf Meyer, former psychiatrist-in-chief at the Johns Hopkins Hospital, was the president of the American Psychiatric Association from 1927 to 1928 and was one of the most influential figures in psychiatry in the first half of the twentieth century.
Mark Ragins: American psychiatrist in the recovery movement, founding member of the Village ISA. He won the 1995 van Ameringen Award for his outstanding contribution to the field of psychiatric rehabilitation and was named a Distinguished Fellow of the American Psychiatric Association in 2006.
Herb Pardes past president and noted figure in American psychiatry.
Robert Spitzer was the chair of the task force of the third edition of the DSM.
Drug Company Ties
In his book Anatomy of an Epidemic (2010), Robert Whitaker described the partnership that has developed between the APA and pharmaceutical companies since the 1980s. APA has come to depend on pharmaceutical money. The drug companies endowed continuing education and psychiatric “grand rounds” at hospitals. They funded a political action committee in 1982 to lobby Congress. The industry helped to pay for the APA’s media training workshops. It was able to turn psychiatrists at top schools into speakers, and although the doctors felt they were independents, they rehearsed their speeches and likely would not be invited back if they discussed drug side effects. “Thought leaders” became the experts quoted in the media. As Marcia Angell wrote in The New England Journal of Medicine (2000), “thought leaders” could agree to be listed as an author of ghostwritten articles, and she cites Thomas Bodenheimer and David Rothman who describe the extent of the drug industry’s involvement with doctors. The New York Times published a summary about antipsychotic medications in October 2010.
In 2008, for the first time, Senator Charles Grassley asked the APA to disclose how much of its annual budget came from drug industry funds. The APA said that industry contributed 28 percent of its budget ($14 million at that time), mainly through paid advertising in APA journals and funds for continuing medical education.
The APA receives additional funding from the pharmaceutical industry through its American Psychiatric Association Foundation (APAF), including Boehringer Ingelheim, Janssen Pharmaceuticals, and Takeda Pharmaceutical Company, among others.
Controversies
In the 1964 election, Fact magazine polled American Psychiatric Association members on whether Barry Goldwater was fit to be president and published “The Unconscious of a Conservative: A Special Issue on the Mind of Barry Goldwater”. This led to a ban on the diagnosis of a public figure by psychiatrists who have not performed an examination or been authorised to release information by the patient. This became the Goldwater rule.
Supported by various funding sources, the APA and its members have played major roles in examining points of contention in the field and addressing uncertainties about psychiatric illness and its treatment, as well as the relationship of individual mental health concerns to those of the community. Controversies have related to anti-psychiatry and disability rights campaigners, who regularly protest at American Psychiatric Association offices or meetings. In 1970, members of the Gay Liberation Front organisation protested the APA conference in San Francisco. In 2003 activists from MindFreedom International staged a 21-day hunger strike, protesting at a perceived unjustified biomedical focus and challenging APA to provide evidence of the widespread claim that mental disorders are due to chemical imbalances in the brain. APA published a position statement in response and the two organisations exchanged views on the evidence.
The APA’s DSM came under criticism from autism specialists Tony Attwood and Simon Baron-Cohen for proposing the elimination of Asperger’s syndrome as a disorder and replacing it with an autism spectrum severity scale. Roy Richard Grinker wrote a controversial editorial for The New York Times expressing support for the proposal.
The APA president in 2005, Steven Sharfstein, praised the pharmaceutical industry but argued that American psychiatry had “allowed the biopsychosocial model to become the bio-bio-bio model” and accepted “kickbacks and bribes” from pharmaceutical companies leading to the over-use of medication and neglect of other approaches.
In 2008 APA was the focus of congressional investigations on how pharmaceutical industry money shapes the practices of non-profit organisations that purport to be independent. The drug industry accounted in 2006 for about 30 percent of the association’s $62.5 million in financing, half through drug advertisements in its journals and meeting exhibits, and the other half sponsoring fellowships, conferences and industry symposiums at its annual meeting. The APA came under increasing scrutiny and questions about conflicts of interest.
The APA president in 2009–10, Alan Schatzberg, was identified as the principal investigator on a federal study into the drug mifepristone for use as an antidepressant being developed by Corcept Therapeutics, a company Schatzberg had created and in which he had several million dollars’ equity.
In 2021, the APA issued an apology for its historical role in perpetuating racism.
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Ted Chabasinski (20 March 1937 to Present) is an American psychiatric survivor, human rights activist and attorney who lives in Berkeley, California. At the age of six, he was taken from his foster family’s home and committed to a New York psychiatric facility. Diagnosed with childhood schizophrenia, he underwent intensive electroshock therapy (now termed electroconvulsive therapy or ECT) and remained an inmate in a state psychiatric hospital until the age of seventeen. He subsequently trained as a lawyer and became active in the psychiatric survivors movement. In 1982, he was a leader in an initially successful campaign seeking to ban the use of electroshock in Berkeley, California.
Early Life
Chabasinski was born in New York to a Polish-born immigrant woman. His father was of Russian descent. In the period just before and after Chabasinski’s birth, his birth-mother, who was poor, unmarried and had been given a diagnosis of schizophrenia, was committed to a psychiatric facility. He was subsequently placed in the care of a foster family in the Bronx, New York. While an intelligent child, his social worker from the Foundling Hospital, a Miss Callaghan, thought him withdrawn and suspected that he was exhibiting the initial signs of an incipient schizophrenia. Chabasinski himself attributes this diagnosis to the then widespread opinion that mental illness was hereditary and thus, he contends, the social worker supervising his foster home placement was “looking for symptoms”.
In 1944, at six years of age, Chabasinski, then a shy and withdrawn child, was taken from his foster family and committed to the children’s ward of the psychiatric division of the Bellevue Hospital in Manhattan, New York. While in this ward, known as Unit PQ6, he was brought under the care of the celebrated child psychiatrist Lauretta Bender, now deceased, who is the clinician commonly credited with founding the study of childhood schizophrenia in the United States. She formally diagnosed Chabasinski as suffering from schizophrenia. He was one of the first children ever to receive ECT, which was then given in its unmodified form without either anaesthetic or muscle relaxant. Despite the strenuous protests of his foster parents against the treatment, he underwent ECT under a regressive and experimental protocol where the treatment was given at a more intensive frequency than was the norm for shock therapy. Chabasinski received ECT daily for a period of about three weeks, comprising approximately twenty sessions of the procedure.
Recalling the experience, Chabasinski stated:
I was one of 300 children involved in an experimental program … I remember being dragged down a hallway, thrown on a table and having a handkerchief stuffed in my mouth.
It made me want to die … I remember that they would stick a rag in my mouth so I wouldn’t bite through my tongue and that it took three attendants to hold me down. I knew that in the mornings that I didn’t get any breakfast that I was going to get shock treatment.
I wanted to die but I didn’t really know what death was. I knew that it was something terrible. Maybe I’ll be so tired after the next shock treatment I won’t get up, I won’t ever get up, and I’ll be dead. But I always got up. Something in me beyond my wishes made me put myself together again. I memorized my name, I taught myself to say my name. Teddy, Teddy, I’m Teddy … I’m here, I’m here, in this room, in this hospital. And my mommy’s gone … I would cry and realize how dizzy I was. The world was spinning around me and coming back to it hurt too much. I want to go down, I want to go where the shock treatment is sending me. I want to stop fighting and die…and something made me live, and go on living. I had to remember never to let anyone near me again.
In 1947, Bender published on 98 children aged between four and eleven years old who had been treated in the previous five years with intensive courses of ECT. These children received ECT daily for a typical course of approximately twenty treatments. This formed part of an experimental trend amongst a cadre of psychiatrists to explore the therapeutic impact of intensive regimes of ECT, which is also known as either regressive ECT or annihilation therapy. In the 1950s Bender abandoned ECT as a therapeutic practice for the treatment of children. In the same decade the results of her published work on the use of ECT in children was discredited after a study showing that the condition of the children so treated had either not improved or deteriorated.
Commenting on his experience as part of Bender’s therapeutic program Chabasinski said that, “It really made a mess of me … I went from being a shy kid who read a lot to a terrified kid who cried all the time.” Following his treatment, he spent ten years as an inmate of Rockland State Hospital, a psychiatric facility now known as the Rockland Psychiatric Centre.
Chabasinski was discharged from the Rockland State Hospital at the age of seventeen. He eventually went to college where he qualified as a lawyer.
Activism
Chabasinski has been active in the psychiatric survivors movement since 1971.
The Berkeley Ban
Chabasinski was Chairman of the Coalition to Stop Electroshock which in 1982 qualified an initiative measure, titled Initiative T., for municipal ballot to make the application of electroconvulsive therapy a misdemeanour in Berkeley, California, punishable with a $500 fine or up to six months imprisonment. Chabasinski was the author of the ballot question and, along with fellow psychiatric survivor Leonard Roy Frank, he was a leader in the campaign. The campaign group, supported by human rights organisations such as the Berkeley-based ex-patient group Network Against Psychiatric Assault, consisted of some 250 people approximately half of whom were former psychiatric patients with the majority of the remainder consisting of students from Berkeley and individual doctors who were opposed to ECT. The coalition’s entire campaign fund was in the region of $1,000. The American Psychiatric Association provided funds of $15,000 to campaign against the initiative. 2,500 people petitioned in support of the initiative exceeding the 1,400 signatures required to put the motion on the ballot.
At the time Chabasinski argued that the enforcement of the law governing consent to ECT in psychiatric facilities in the state of California was so lax that a total ban on the procedure was required. He and his fellow campaigners also claimed that ECT was a dangerous and barbaric treatment that could cause either long or short term memory loss, brain damage and that the procedure could even result in death. They also charged that when resident in a psychiatric institution the very concept of informed consent is meaningless.
During the campaign dozens of ex-psychiatric patients gave testimony against electroshock at a Berkeley City Council hearing. Protests were also held outside the Herrick Hospital, then the only facility in Berkeley where ECT was provided. In 1981 that facility administered ECT to 45 individuals. In order to collect and exceed the requisite number of signatures required to place Initiative T. on the ballot paper, members of the coalition campaigned outside supermarkets and went from door to door soliciting support.
The ballot was held on Tuesday 02 November 1982 and the measure passed with 25,380 voters, or 61.7%, supporting the ballot calling for a ban on ECT while 15,756 residents, or 38.2%, voted against the measure. Giving his perspective on why the measure had passed so resoundingly, Chabasinski stated that: “I think it’s a very sympathetic issue … Basically, they’re going ahead and causing brain damage just to subdue people.” Speculating on the possibility of extending the ban across the state of California and alluding to the wider aims behind the campaign he also said: “To be honest, this is one way of having a referendum on mental patients’ rights and the way they are treated”.
In response to the passage of the initiative the American Psychiatric Association asserted that plebiscite was not an appropriate means to arrive at a medical judgement on a complex issue. A spokesman for the association stated: “The voters have passed a law we believe is unnecessary, probably unconstitutional and … dangerous … We hope it will be overturned before doing harm by denying a seriously ill person access in Berkeley to treatment that could be lifesaving,” One of the two doctors who administered ECT at Herrick Hospital, Dr. Martin Rubinstein, contended that the vote to ban the procedure reflected “pathological consumerism” and constituted “another case of the inmates trying to run the asylum”. He further epitomised the ballot result as stemming from “an uninformed electorate [deliberating] on esoteric matters.”
In June 1983 Donald McCullom, an Alameda County Superior Court Judge, issued an injunction on the implementation of the ban on ECT. Initiative T. was overturned shortly thereafter following a successful legal challenge initiated by the American Psychiatric Association, on the constitutionality of the measure.
Other Roles
Chabasinski is the former directing attorney for Mental Health Consumer Concerns, (MHCC), and a former president of the board of Support Coalition International (SCI). He was also a board member of the successor organisation to the SCI, MindFreedom International and for which he acted as an attorney.
Eli Lilly and Zyprexa
In January 2007 Chabasinski acted as the attorney for the late psychiatric survivor activist and author Judi Chamberlin, the medical journalist and author of Mad in America and Anatomy of an Epidemic, Robert Whitaker, and the director of MindFreedom International David Oaks in opposing a motion by Eli Lilly to extend an injunction to conceal documents that revealed that the company had known for the previous decade of the potentially lethal effects of Zyprexa and had engaged in an illegal off-label marketing campaign.
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The Critical Psychiatry Network (CPN) is a psychiatric organisation based in the United Kingdom. It was created by a group of British psychiatrists who met in Bradford, England in January 1999 in response to proposals by the British government to amend the Mental Health Act 1983. They expressed concern about the implications of the proposed changes for human rights and the civil liberties of people with mental health illness. Most people associated with the group are practicing consultant psychiatrists in the United Kingdom’s National Health Service (NHS), among them Dr Joanna Moncrieff. A number of non-consultant grade and trainee psychiatrists are also involved in the network.
Participants in the Critical Psychiatry Network share concerns about psychiatric practice where and when it is heavily dependent upon diagnostic classification and the use of psychopharmacology. These concerns reflect their recognition of poor construct validity amongst psychiatric diagnoses and scepticism about the efficacy of anti-depressants, mood stabilisers and anti-psychotic agents. According to them, these concerns have ramifications in the area of the use of psychiatric diagnosis to justify civil detention and the role of scientific knowledge in psychiatry, and an interest in promoting the study of interpersonal phenomena such as relationship, meaning and narrative in pursuit of better understanding and improved treatment.
CPN has similarities and contrasts with earlier criticisms of conventional psychiatric practice, for example those associated with David Cooper, R.D. Laing and Thomas Szasz. Features of CPN are pragmatism and full acknowledgment of the suffering commonly associated with mental health difficulties. As a result, it functions primarily as a forum within which practitioners can share experiences of practice, and provide support and encouragement in developing improvements in mainstream NHS practice where most participants are employed.
CPN maintains close links with service user or survivor led organisations such as the Hearing Voices Network, Intervoice and the Soteria Network, and with like-minded psychiatrists in other countries. It maintains its own website. The network is open to any sympathetic psychiatrist, and members meet in person, in the UK, twice a year. It is primarily intended for psychiatrists and psychiatric trainees and full participation is not available to other groups.
Coercion and Social Control
The other involved the introduction of community treatment orders (CTOs) to make it possible to treat people against their wishes in the community. CPN submitted evidence to the Scoping Group set up by the government under Professor Genevra Richardson. This set out ethical and practical objections to CTOs, and ethical and human rights objections to the idea of reviewable detention. It was also critical of the concept of personality disorder as a diagnosis in psychiatry. In addition, CPN’s evidence called for the use of advance statements, crisis cards and a statutory right to independent advocacy as ways of helping to sustain autonomy at times of crisis. CPN also responded to government consultation on the proposed amendment, and the white paper.
The concern about these proposals caused a number of organisations to come together under the umbrella of the Mental Health Alliance to campaign in support of the protection of patients’ and carers’ rights, and to minimise coercion. CPN joined the Alliance’s campaign, but resigned in 2005 when it became clear that the Alliance would accept those aspects of the House of Commons Scrutiny Committee’s report that would result in the introduction of CTOs. Psychiatrists not identified with CPN shared the Network’s concern about the more coercive aspects of the government’s proposals, so CPN carried out a questionnaire survey of over two and a half thousand (2,500) consultant psychiatrists working in England seeking their views of the proposed changes. The responses (a response rate of 46%) indicated widespread concern in the profession about reviewable detention and CTOs.
The CPN was paid attention by Thomas Szasz who wrote: “Members of the CPN, like their American counterparts, criticise the proliferation of psychiatric diagnoses and ‘excessive’ use of psychotropic drugs, but embrace psychiatric coercions.”
The Role of Scientific Knowledge in Psychiatry
There is a strong view by CPN that contemporary psychiatry relies too much on the medical model, and attaches too much importance to a narrow biomedical view of diagnosis. This can, in part, be understood as the response of an earlier generation of psychiatrists to the challenge of what has been called ‘anti-psychiatry’. Psychiatrists such as David Cooper, R.D. Laing and Thomas Szasz (although the latter two rejected the term) were identified as part of a movement against psychiatry in the 1960s and 1970s. Stung by these attacks, as well as accusations that in any case psychiatrists could not even agree who was and who was not mentally ill, academic psychiatrists responded by stressing the biological and scientific basis of psychiatry through strenuous efforts to improve the reliability of psychiatric diagnosis based in a return to the traditions of one of the founding fathers of the profession, Emil Kraepelin.
The use of standardised diagnostic criteria and checklists may have improved the reliability of psychiatric diagnosis, but the problem of its validity remains. The investment of huge sums of money in Britain, America and Europe over the last half-century has failed to reveal a single, replicable difference between a person with a diagnosis of schizophrenia and someone who does not have the diagnosis. The case for the biological basis of common psychiatric disorders such as depression has also been greatly over-stated. This has a number of consequences:
First, the aggrandisement of biological research creates a false impression both inside and outside the profession of the credibility of the evidence used to justify drug treatments for disorders such as depression and schizophrenia. Reading clinical practice guidelines for the treatment of depression, for example, such as that produced for the UK National Health Service by the National Institute for Health and Clinical Excellence (NICE), one might be fooled into believing that the evidence for the efficacy of selective serotonin reuptake inhibitors (SSRIs) is established beyond question. In reality this is not the case, as re-examinations of drug trial data in meta-analyses, especially where unpublished data are included (publication bias means that researchers and drug companies do not publish negative findings for obvious commercial reasons), have revealed that most of the benefits seen in active treatment groups are also seen in the placebo groups.
As far as schizophrenia is concerned, neuroleptic drugs may have some short-term effects, but it is not the case that these drugs possess specific ‘anti-psychotic’ properties, and it is impossible to assess whether or not they confer advantages in long-term management of psychoses because of the severe disturbances that occur when people on long-term active treatment are withdrawn to placebos. These disturbances are traditionally interpreted as a ‘relapse’ of schizophrenia when in fact there are several possible interpretations for the phenomenon.
Another consequence of the domination of psychiatry by biological science is that the importance of contexts in understanding distress and madness is played down. This has a number of consequences. First, it obscures the true nature of what in fact are extremely complex problems. For example, if we consider depression to be a biological disorder remediable through the use of antidepressant tablets, then we may be excused from having to delve into the tragic circumstances that so often lie at the heart the experience. This is so in adults and children.
Meaning and Experience in Psychiatry
There is a common theme, here, with the work of David Ingleby whose chapter in Critical Psychiatry: The Politics of Mental Health sets out a detailed critique of positivism (the view that epistemology, or knowledge about the world is best served by empiricism and the scientific method rather than metaphysics). A common theme running through Laingian antipsychiatry, Ingleby’s critical psychiatry, contemporary critical psychiatry and postpsychiatry is the view that social, political and cultural realities play a vital role in helping us to understand the suffering and experience of madness. Like Laing, Ingleby stressed the importance of hermeneutics and interpretation in inquiries about the meaning of experience in psychiatry, and (like Laing) he drew on psychoanalysis as an interpretative aid, but his work was also heavily influenced by the critical theory of the Frankfurt School.
The most forceful critic of this view was R.D. Laing, who famously attacked the approach enshrined by Jaspers’ and Kraepelin’s work in chapter two of The Divided Self, proposing instead an existential-phenomenological basis for understanding psychosis. Laing always insisted that schizophrenia is more understandable than is commonly supposed. Mainstream psychiatry has never accepted Laing’s ideas, but many in CPN regard The Divided Self as central to twentieth century psychiatry. Laing’s influence continued in America through the work of the late Loren Mosher, who worked at the Tavistock Clinic in the mid-1960s, when he also spent time in Kingsley Hall witnessing Laing’s work. Shortly after his return to the US, Loren Mosher was appointed Director of Schizophrenia Research at the National Institute of Mental Health, and also the founding editor of the journal Schizophrenia Bulletin.
One of his most notable contributions to this area was setting up and evaluating the first Soteria House, an environment modelled on Kingsley Hall in which people experiencing acute psychoses could be helped with minimal drug use and a form of interpersonal phenomenology influenced by Heidegger. He also conducted evaluation studies of the effectiveness of Soteria. A recent systematic review of the Soteria model found that it achieved as good, and in some areas, better, clinical outcomes with much lower levels of medication (Soteria House was not anti-medication) than conventional approaches to drug treatment.
Efficacy
One comparison study showed 34% of patients of a ‘medical model’ team were still being treated after two years, compared with only 9% of patients of a team using a ‘non-diagnostic’ approach (less medication, little diagnosis, individual treatment plans tailored to the person’s unique needs). However the study comments that cases may have left the system in the ‘non-diagnostic’ approach, not because treatment had worked, but because (1) multi-agency involvement meant long-term work may have been continued by a different agency, (2) the starting question of ‘Do we think our service can make a positive difference to this young person’s life?’ rather than ‘What is wrong with this young person?’ may have led to treatment not being continued, and (3) the attitude of viewing a case as problematic when no improvement has occurred after five sessions may have led to treatment not being continued (rather than the case ‘drifting’ on in the system).
Critical Psychiatry and Postpsychiatry
Peter Campbell first used the term ‘postpsychiatry’ in the anthology Speaking Our Minds, which imagines what would happen in a world after psychiatry. Independently, Patrick Bracken and Philip Thomas coined the word later and used it as the title of a series of articles written for Openmind. This was followed by a key paper in the British Medical Journal and a book of the same name. This culminated with the publication by Bradley Lewis, a psychiatrist based in New York, of Moving Beyond Prozac, DSM, and the New Psychiatry: The Birth of Postpsychiatry.
According to Bracken, progress in the field of mental health is presented in terms of ‘breakthrough drugs’, ‘wonders of neuroscience’, ‘the Decade of the Brain’ and ‘molecular genetics’. These developments suited the interests of a relatively small number of academic psychiatrists, many of whom have interests in the pharmaceutical industry, although so far the promised insights into psychosis and madness were yet to be realized. Some psychiatrists have turned to another form of technology, Cognitive Behavioural Therapy, although this does draw attention to the person’s relationship with their experiences (such as voices or unusual beliefs), and focuses on helping them to find different ways of coping, it however, it is based on a particular set of assumptions about the nature of the self, the nature of thought, and how reality is constructed. The pros and cons of this have been explored in some detail in a recent publication.
Framing mental health problems as ‘technical’ in nature involves prioritising technology and expertise over values, relationships and meanings, the very things that emerge as important for service users, both in their narratives, and in service user-led research. For many service users these issues are of primary importance. Recent meta-analyses into the effectiveness of antidepressants and cognitive therapy in depression confirm that non-specific, non-technical factors (such as the quality of the therapeutic relationship as seen by the patient, and the placebo effect in medication) are more important than the specific factors.
Postpsychiatry tries to move beyond the view that we can only help people through technologies and expertise. Instead, it prioritises values, meanings and relationships and sees progress in terms of engaging creatively with the service user movement, and communities. This is especially important given the considerable evidence that in Britain, Black and Minority Ethnic (BME) communities are particularly poorly served by mental health services. For this reason an important practical aspect of postpsychiatry is the use of community development in order to engage with these communities. The community development project Sharing Voices Bradford is an excellent example of such an approach.
There are many commonalities between critical psychiatry and postpsychiatry, but it is probably fair to say that whereas postpsychiatry would broadly endorse most aspects of the work of critical psychiatry, the obverse does not necessarily hold. In identifying the modernist privileging of technical responses to madness and distress as a primary problem, postpsychiatry has looked to postmodernist thought for insights. Its conceptual critique of traditional psychiatry draws on ideas from philosophers such as Heidegger, Merleau-Ponty, Foucault and Wittgenstein.
Anti-Psychiatry and Critical Psychiatry
The word anti-psychiatry is associated with the South African psychiatrist David Cooper, who used it to refer to the ending of the ‘game’ the psychiatrist plays with his or her victim (patient). It has been widely used to refer to the writings and activities of a small group of psychiatrists, most notably R.D. Laing, Aaron Esterson, Cooper, and Thomas Szasz (although he rejects the use of the label in relation to his own work, as did Laing and Esterson), and sociologists (Thomas Scheff). Szasz discards even more what he calls the quackery of ‘antipsychiatry’ than the quackery of psychiatry.
Anti-psychiatry can best be understood against the counter-cultural context in which it arose. The decade of the 1960s was a potent mix of student rebellion, anti-establishment sentiment and anti-war (Vietnam) demonstrations. It saw the rise to prominence of feminism and the American civil rights movement and the Northern Ireland civil rights movement. Across the world, formerly colonised peoples were throwing off the shackles of colonialism. Some of these themes emerged in the Dialectics of Liberation, a conference organised by Laing and others in the Round House in London in 1968.
Critical Psychiatry Network – Activities
CPN is involved in four main areas of work, writing and the publication of academic and other papers, organising and participating in conferences, activism and support. A glance at the members’ publication page on the CPN website reveals in excess of a hundred papers, books and other articles published by people associated with the network over the last twelve years or so. These cover a wide range of topics, from child psychiatry, psychotherapy, the role of diagnosis in psychiatry, critical psychiatry, philosophy and postpsychiatry, to globalisation and psychiatry. CPN has also organised a number of conferences in the past, and continues to do so in collaboration with other groups and bodies. It has run workshops for psychiatrists and offers peer supervision face to face and via videolink. It also supports service user and survivor activists who campaign against the role of the pharmaceutical industry in psychiatry, and the campaign for the abolition of the schizophrenia label. The CPN has published a statement in support.
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The Shrink Next Door is a podcast by Wondery that tells the story of Isaac Herschkopf, a psychiatrist who abused his relationship with his patients to exploit them for personal gain. The podcast was written and hosted by Joe Nocera. The podcast premiered on 21 May 2019, and consists of 14 episodes.
On 23 April 2020, it was announced that Apple Inc. had given a straight-to-series order for an 8-episode limited series based on The Shrink Next Door for Apple TV+, and it began airing on 12 November 2021. The adaptation is written by Emmy winning writer Georgia Pritchett and directed by Michael Showalter. Dr. Isaac Herschkopf is played by Paul Rudd, and Martin Markowitz is played by Will Ferrell.
Episodes
Episode
Title
Date
1
Welcome to the Neighbourhood
21 May 2019
2
Sibling Rivalry
21 May 2019
3
Easy Mark Markowitz
23 May 2019
4
The Familia
28 May 2019
5
The Last Straw
04 June 2019
6
What Did I Do To You?
11 June 2019
7
Update
18 June 2019
8
Charged
07 August 2019
9
My Dinner With Ike
14 July 2020
10
The Decision
22 April 2021
11
Interview with Will Ferrell and Paul Rudd
12 November 2021
12
Interview with Kathryn Hahn and Casey Wilson
19 November 2021
13
How Michael Showalter Translated the Podcast to the TV Screen
03 December 2021
14
How Georgia Pritchett Filled in the Blanks
17 December 2021
Release
The series aired between 12 November 2021 and 17 December 2021.
The Shrink Next Door was the number one podcast for three weeks straight on Apple’s podcast charts. It won the 2020 Webby Award for Documentary in the category Podcasts.
Miniseries
The Shrink Next Door is an American psychological black comedy-drama miniseries developed by Georgia Pritchett based on the podcast of the same title by Joe Nocera. The miniseries premiered on Apple TV+ on 12 November 2021. The podcast and TV series are both based on the real life story of psychologist Isaac Herschkopf, who in 2021 was determined by New York’s Department of Health to have violated “minimal acceptable standards of care in the psychotherapeutic relationship”.
Outline
Psychiatrist Dr. Ike Herschkopf inserts himself into the life of one of his patients, Marty Markowitz.
Cast
Main:
Will Ferrell as Martin “Marty” Markowitz
Paul Rudd as Dr. Isaac “Ike” Herschkopf
Kathryn Hahn as Phyllis Shapiro
Casey Wilson as Bonnie Herschkopf
Cornell Womack as Bruce
Recurring:
Sarayu Blue as Miriam
Robin Bartlett as Cathy
Gable Swanlund as Nancy
Richard Aaron Anderson as Joel
Allan Wasserman as Rabbi Sherman
Christina Vidal as Hannah
Guest:
Lindsey Kraft as Deborah
Lisa Rinna as herself
Carlos Lacámara as Benny
Annie Korzen as Esther
Mindy Sterling as Mrs. Zicherman
Episodes
Number 01: The Consultation
In 1982, Martin “Marty” Markowitz visits Dr. Isaac “Ike” Herschkopf under the advice of his sister, Phyllis Shapiro, in order to help with his anxiety attacks and grief after their parents’ recent deaths. Ike’s unconventional method manages to help Marty as he takes him outside to play basketball and eat lunch, and he helps Marty with a problem concerning his recently broken-up girlfriend. Satisfied with his first session, Marty decides to return while also forming a bond with Ike. In 2010, Ike hosts a party at a large house, while later in the night, the caretaker vandalises the backyard in anger and frustration. The caretaker is revealed to be Marty.
Number 02: The Ceremony
Nearing Marty’s 40th birthday, Ike suggests he have a second bar mitzvah as Marty had not enjoyed his first due to anxiety and stomach problems. Phyllis, however, is against the idea, believing it will dishonour the memories of their parents. Marty and Ike go ahead with it anyway and Phyllis complains to her rabbi, causing him to lodge a complaint to Ike’s rabbi, who, in turn, warns him about it. Marty later berates Phyllis and they have an argument. On his birthday, Marty proceeds with the second bar mitzvah, though most of the people who show up are Ike’s wife and friends. Meanwhile, Phyllis, believing Marty will abandon the idea, prepares his birthday celebration with her kids, only to be left in tears when Marty doesn’t show.
Number 03: The Treatment
Phyllis asks Marty to open the family’s trust fund so she can hire a better lawyer during her divorce. Ike gives Marty a business opportunity when a Broadway show requires his help to make a large curtain for the stage. The curtain ends up costing too much, and Marty’s staff are unenthusiastic at solving the problem. Marty brings Ike to the company to motivate them, and they manage to solve the issue. Alarmed at the increasing closeness between the two, Phyllis visits Ike for a session, which ends badly. Marty later gets into another argument with her and refuses to unlock the trust. While Marty is out with Ike, Phyllis visits his apartment but becomes angered at seeing how close her brother is to Ike. She then robs their parents’ jewels from his vault. Returning home and reading Phyllis’ message, Marty calls Ike and asks for help, in the process revealing his large inheritance. Realising the extent of Marty’s wealth, Ike inserts himself into Marty’s life even further.
Number 04: The Foundation
Marty cuts Phyllis out of his life and hires Ike as a consultant at the fabric company, annoying the company staff. Ike becomes a father to twin girls, but refuses to hire help even as his wife, Bonnie, becomes overwhelmed. This prompts her to hire the help anyway using her own money. Under Ike’s influence, Marty starts a foundation with him, mostly using Marty’s money. Marty later scores a date with Hannah, a girl who works at a frame shop that he and Ike often visit. Ike suggests taking her out to an expensive charity gala on a date. During the gala, both Hannah and Marty become uncomfortable at Ike’s blatant claims and his irresponsible use of Marty’s money. The night ends with Marty having a heart attack and being hospitalised after Ike spends $20,000 of Marty’s money during an auction. Ike later warns Hannah that she should let go of Marty for the good of his recovery.
Number 05: The Family Tree
In 1990, Ike’s father passes away. Marty is invited to the funeral and offers Ike’s family to stay in his Hamptons house for the weekend. Ike begins taking over the house, convincing Marty to redecorate, having him sleep in the guest house instead of the master bedroom, and extending his stay in the house indefinitely as he plans on writing his novel, while making Marty type it on his own. Disliking a large tree in the backyard, Ike tries to have Marty chop it down, but he refuses as it was a tree that his parents planted when they bought the house. Ike becomes angered and threatens to leave, forcing Marty to chop down the tree later in the night in order to salvage his relationship with him. One year later, under Ike’s advice, Marty buys the property next door and combines it with the house.
Number 06: The Party
Ike begins throwing a series of parties at Marty’s Hamptons house, while making Marty serve his guests. In 1997, Marty witnesses Bonnie break down during one of the parties, saying that she does not recognise her husband anymore. In 2007, during another party, Marty meets with Miriam, another of Ike’s patients. She tells him about how Ike previously convinced her to cut off her relationship with her own mother, which she deeply regrets as she missed her death. While in town, Marty meets with a neighbour who talks about Phyllis’ current life, making him realise how much he missed over the last few years. He attempts to run away from Ike but can’t bring himself to do so. While heading back to the city, Miriam’s bus suddenly breaks down; however, it is revealed to be a ploy by Ike to strand Miriam at a nearby gas station while he cuts her off, stating that she is a toxic person.
Number 07: The Breakthrough
In 2010, Ike angrily refuses a plan to move the foundation to New Jersey to keep it from going under. Marty is diagnosed with a hernia and undergoes surgery. Ike never visits him during his recovery. Marty escapes the hospital after four days and confronts Ike, finding out that he was hosting another party at the Hamptons house. Ike attempts to convince Marty that he did everything he could to help him, but when Marty finds out one of his koi fish has died as a result of Ike’s neglect, he breaks down in front of Bonnie, saying he can’t do it anymore. Later that night, Marty begins vandalising the backyard as seen in the first episode. When Marty misses his next therapy session, Ike tries to contact him, only to find that he has moved the foundation to New Jersey without his knowledge. Ike confronts him but is fired from the foundation by Marty as a result.
Number 08: The Verdict
Marty returns to therapy with Ike, wanting to give him another chance. Ike continues with his old ways by having Marty as his best man at the renewal of his wedding vows, even though he and Bonnie have been separated for years. Marty tries to reconnect with Phyllis through her daughter, Nancy, but she angrily rebuffs him. When Marty finds out that the reason Hannah never called him back was because of Ike, he cuts off contact with him for good. Phyllis later confronts Marty approaching Nancy, but she ends up reconciling with him. Ike shows up while Marty and Phyllis are burning his stuff from the house, attempting to convince him again about Phyllis’ toxicity. Marty finally stands up for himself and tells him to leave. One year later, Marty has fully reconnected with Phyllis and her family. He has also sued Ike in an attempt to get his license revoked. Ike tries to insert himself back into Marty’s life one last time, but Marty, now immune to him, says he feels absolutely nothing. The textual epilogue shows that Ike’s license was eventually revoked in 2021, and that Marty has never returned to therapy.
Production
It was announced in February 2020 that a television adaptation of the podcast The Shrink Next Door was in development, in which Will Ferrell and Paul Rudd would star. The series was greenlit and ordered by Apple TV+ in April. Kathryn Hahn and Casey Wilson were added as leads in November, with Sarayu Blue cast in a recurring role in February 2021.
Filming began in November 2020, in Los Angeles and finished in March 2021.
David Graham Cooper (1931 in Cape Town, South Africa – 29 July 1986 in Paris, France) was a South African-born psychiatrist and theorist who was prominent in the anti-psychiatry movement.
Cooper graduated from the University of Cape Town in 1955. R.D. Laing claimed that Cooper underwent Soviet training to prepare him as an Anti Apartheid communist revolutionary, but after completing his course he never returned to South Africa out of fear that B.O.S.S. would eliminate him. He moved to London, where he worked at several hospitals. From 1961 to 1965 he ran an experimental unit for young people with schizophrenia called Villa 21, which he saw as a revolutionary ‘anti-hospital’ and a prototype for the later Kingsley Hall Community. In 1965, he was involved with Laing and others in establishing the Philadelphia Association. An “existential Marxist” he left the Philadelphia Association in the 1970s in a disagreement over its lack of political orientation. Cooper coined the term “anti-psychiatry” in 1967, and wrote the book Psychiatry and Anti-psychiatry in 1971.
Leading Concepts
Cooper believed that madness and psychosis are the manifestation of a disparity between one’s own ‘true’ identity and our social identity (the identity others give us and we internalise). Cooper’s ultimate solution was through revolution. To this end, Cooper travelled to Argentina as he felt the country was rife with revolutionary potential. He later returned to England before moving to France where he spent the last years of his life.
Cooper coined the term anti-psychiatry (see below) to describe opposition and opposing methods to the orthodox psychiatry of the time, although the term could easily describe the anti-psychiatrists’ view of orthodox psychiatry, i.e., anti-psychic healing.
He coordinated the Congress on the Dialectics of Liberation, held in London at The Roundhouse in Chalk Farm from 15 July to 30 July 1967. Participants included R. D. Laing, Paul Goodman, Allen Ginsberg, Herbert Marcuse and the Black Panthers’ Stokely Carmichael. Jean-Paul Sartre was scheduled to appear but cancelled at the last moment. The term “anti-psychiatry” was first used by David Cooper in 1967.
He was a founding member of the Philadelphia Association, London.
Family and The Death of the Family
Cooper describes how ‘during the end of the writing of this book against the family, I went through a profound spiritual and bodily crisis….The people who sat with me and tended to me with immense kindliness and concern during the worst of this crisis were my brother Peter and sister-in-law Carol…a true family’.
He had earlier described the need to break free from ‘one’s whole family past…in a way that is more personally effective than a simple aggressive rupture or crude acts of geographical separation’; as well as the kind of false autonomy which occurs when ‘people are still very much in the net of the internal family (and often the external family too) and compulsively search for rather less restricting replica family systems’.
The book may thus be seen as a self-reflexive attempt ‘to illustrate the power of the internal family, the family that one can separate from over thousands of miles and yet still remain in its clutches and be strangled by those clutches’.
The Language of Madness
In 1967, ‘David Cooper provided an introduction to Foucault’s Madness and Civilization which began “Madness has in our age become some sort of lost truth”‘ – a statement not atypical of ‘a time which posterity now readily regards as half-crazed’. Continuing the same line of thought, by the end of the following decade, ‘he elevated madness to the status of a liberatory force’ in his last publication. Here are a few typical utterances from The Language of Madness (Cooper 1980): “Madness is permanent revolution in the life of a person…a deconstitution of oneself with the implicit promise of return to a more fully realized world”‘.
This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/David_Cooper_(psychiatrist) >; 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.
Camille Laurin (06 May 1922 to 11 March 1999) was a psychiatrist and Parti Québécois (PQ) politician in the Canadian province of Quebec. A MNA member for the riding of Bourget, he is considered the father of Quebec’s language law known informally as “Bill 101”.
Biography
Born in Charlemagne, Quebec, Laurin obtained a degree in psychiatry from the Université de Montréal where he came under the influence of the Roman Catholic priest, Lionel Groulx. After earning his degree, Laurin went to Boston, Massachusetts, in the United States, where he worked at the Psychopathic Department of Boston State Hospital. Following a stint in Paris in 1957, he returned to practice in Quebec. In 1961, he authored the preface of the book Les fous crient au secours, which described the conditions of psychiatric hospitals of the time.
He was one of the early founders of the Quebec sovereignty movement. As a senior cabinet minister in the first PQ government elected in the 1976 Quebec election, he was the guiding force behind Bill 101, the legislation that placed restrictions on the use of English on public signs and in the workplace of large companies, and strengthened the position of French as the only official language in Quebec.
Laurin resigned from his cabinet position on 26 November 1984 because of a disagreement with Lévesque on the future of the sovereignty movement. He resigned from his seat in the National Assembly on 25 January 1985. He was elected once again to the Assembly on 12 September 1994 but did not run in the 1998 election for health reasons.
He died in 1999 after a long battle with cancer.
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Bénédict Augustin Morel (22 November 1809 to 30 March 1873) was a French psychiatrist born in Vienna, Austria. He was an influential figure in the field of degeneration theory during the mid-19th century.
Biography
Morel was born in Vienna, Austria in 1809, of French parents. In the aftermath of the War of the Sixth Coalition Morel was abandoned by his parents, and left with the Luxembourgish Abbé Dupont and his servant Marianne, who raised him.
Morel received his education in Paris, and while a student, supplemented his income by teaching English and German classes. In 1839 he earned his medical doctorate, and two years later became an assistant to psychiatrist Jean-Pierre Falret (1794–1870) at the Salpêtrière in Paris.
Morel’s interest in psychiatry was further enhanced in the mid-1840s when he visited several mental institutions throughout Europe. In 1848 he was appointed director of the Asile d’Aliénés de Maréville at Nancy. Here he introduced reforms towards the welfare of the mentally ill, in particular liberalization of restraining practices. At the Maréville asylum he studied people with mental disabilities, researching their family histories and investigating aspects such as poverty and childhood physical illnesses. In 1856 he was appointed director of the mental asylum at Saint-Yon in Rouen.
Morel, influenced by various pre-Darwinian theories of evolution, particularly those that attributed a powerful role to acclimation, saw mental deficiency as the end stage of a process of mental deterioration. In the 1850s, he developed a theory of “degeneration” in regards to mental problems that take place from early life to adulthood. In 1857 he published Traité des dégénérescences physiques, intellectuelles et morales de l’espèce humaine et des causes qui produisent ces variétés maladives, a treatise in which he explains the nature, causes, and indications of human degeneration. Morel looked for answers to mental illness in heredity, although later on he believed that alcohol and drug usage could also be important factors in the course of mental decline.
Démence Précoce
In the first volume of his Études cliniques (1852) Morel used the term démence précoce in passing to describe the characteristics of a subset of young patients, and he employed the phrase more frequently in his textbook Traité des maladies mentales which was published in 1860. Morel used the term in a descriptive sense and not to define a specific and novel diagnostic category. It was applied as a means of setting apart a group of young men and women who had “stupor.” As such their condition was characterised by a certain torpor, enervation, and disorder of the will and was related to the diagnostic category of melancholia. His understanding of dementia was a traditional and distinctly non-modern one in the sense that he did not conceptualise it as irreversible state.
While some have sought to interpret, if in a qualified fashion, Morel’s reference to démence précoce as amounting to the “discovery” of schizophrenia, others have argued convincingly that Morel’s descriptive use of the term should not be considered in any sense as a precursor to the German psychiatrist Emil Kraepelin’s dementia praecox disease concept. This is due to the fact that their concepts of dementia differed significantly from each other, with Kraepelin employing the more modern sense of the word, and also that Morel was not describing a diagnostic category. Indeed, until the advent of Arnold Pick and Kraepelin, Morel’s term had vanished without a trace and there is little evidence to suggest that either Pick or indeed Kraepelin were even aware of Morel’s use of the term until long after they had published their own disease concepts bearing the same name. As Eugène Minkowski succinctly stated, ‘An abyss separates Morel’s démence précoce from that of Kraepelin.’
Degeneration Theory
Morel is known for creating degeneration theory in the 1850s. He began to develop his theory while he was the director of the mental asylum at Saint-Yon in northern France. In 19th century France, there was an increase in crime, sickness, and mental disorders, which interested Morel. He was determined to identify the underlying causes of this increase. Morel’s Catholic and radical political background greatly shaped his process. Morel noticed that the patients in the mental asylum with intellectual disability also had physical abnormalities like goiters. He was able to expand this idea when he noticed most people in the asylum had unusual physical characteristics. Morel’s degeneration theory was based on the idea that psychological disorders and other behavioural abnormalities were caused by an abnormal constitution. This also meant that he believed that there was a perfect type of human that degenerations altered. He believed that these abnormalities could be inherited and that there was a progressive worsening of the degeneration by generation. These traits were not specified pathologies, but rather an overall abnormality like a highly susceptible nervous system to disturbances from excessive toxins. The first generation started with neurosis, then, in the next generation, mental alienation. After the second generation, the mental alienation led to imbecility. Finally, the fourth generation was destined to be sterile.
In Morel’s theory, degeneration was synonymous with anything that was different from the natural or normal state. These abnormalities were caused by environmental influences like diet, disease, and moral depravities or traits that were passed from generation to generation like alcoholism and living in the slums. Due to the law of progressivity, these degenerations would get worse in each generation to produce more criminals and neurotics with worse degenerations. Over time, the degenerations would progress until later generations (specifically the fourth generation) were so idiotic that they were essentially sterile and the abnormal family would die out. This theory explained why there was an increase in mental disorders and also allowed Morel to relate very different diseases as caused by previous generations because they had become more variable over time. Since there was an increase in mental disorders, Morel believed that society was approaching extinction of the imbeciles. He believed that the most degenerative illness was insanity. Morel was able to categorise degenerations into four main categories:
Hysteria;
Moral insanity;
Imbeciles; and
Idiots.
In 1857, Morel published his degeneration theory in Traité des dégénérescences physiques, intellectuelles et morales de l’espèce humaine et des causes qui produisent ces variétés maladives. In his work, he included images of twelve patients that demonstrated the physical, mental, and moral traits that were evidence of degeneration. Some of these characteristics included altered ear shape, asymmetrical faces, extra digits, and high-domed palates that had psychological representations as well. Morel’s work was well received. It connected psychiatric medicine to general medicine to provide a complete and well-researched cause for a large social problem. It became dominant because it grounded moral treatment, which was questionable in this time period, in science. Morel’s theory also allowed psychiatrists who were unable to help their patients explain why they had not been successful. Degeneration theory meant that there were some psychological disorders that were genetic and could not be cured by a psychiatrist. It also explained all psychological disorders. If a psychiatrist could not find a physical cause of the disease, they could blame it on the individual’s constitution. It quickly spread throughout Europe with key figures spreading the information and using it to explain criminal psychology, personality disorders, and nervous disorders. Wilhem Griesinger introduced Morel’s theory to Germany, Valentin Magnan helped his ideas spread in France, and Cesare Lambroso brought Morel’s theory to Italy. In the 1880s, Morel’s degeneration theory was very important in French psychiatry and the majority of diagnostic certificates in French mental hospitals involved the words mental degeneracy.
Legacy
Morel is regarded as the father of dementia praecox and the degeneration theory. Both of these ideas helped understand mental illness as it was on the rise in 19th and 20th century France. Morel’s degeneration theory gained quick popularity across Europe, which allowed it to shape further scientific developments. It was used as the basis of body typology and disposition theories as well as Lombroso’s theory of anthropological criminology. His theory was highly ideological and provided a scientific rationale for the eugenics programmes used by the Nazis. He is also known for generating research programs to understand the effects of paternal drinking on children. Morel’s degeneration theory is a key influence on Émile Zola’s Les Rougon-Macquart about the environmental influences of violence, prostitution, and other immoral activities on two branches of a family during the Industrial Revolution. In Britain, the degeneration theory bolstered the eugenics and Social Darwinism movement. Karl Pearson and Sidney Webb justified selective breeding and immigration in Britain by trying to prevent the degeneration of the British race. Not all theorists accepted Morel’s work. Sigmund Freud, Karl Jaspers, Adolf Meyer, and Oswald Bumke rejected his ideas. Overall, while Morel’s degeneration theory is considered outdated by modern psychiatrists, Morel is credited with creating the modern biological approach to understanding psychiatric disorders.
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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.
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