2 Prehistoric Period:Had you been mentally ill at a time during the prehistoric period, a time believed to be dominated by mystical viewpoints, your symptoms may have been interpreted as signs of possession by a demon or other malevolent spirit. Displays of abnormal behavior may easily be seen as proof of the control the supernatural entity had over you. Frightened by you, society may have sent you to a shaman who would carry out an exorcism or perform other spells to remove the demon’s control over you.
3 10000 B.C. – 3,000 B.C. --- Prehistoric Times As far as historians can ascertain, Paleolithic people saw no distinction between medicine, magic, and religion.Archeologists have uncovered skulls with holes drilled in them dating back as far as 8,000 B.C.Researchers have determined that, for some, bone healed near these holes indicating that the procedure may have been surgical and that the person survived. Many theories have been developed as a means to explain the purpose behind this surgery, called trephining.Some anthropologists theorize that the holes may have been drilled into the skull as a means of releasing “evil spirits” that were trapped inside the head causing abnormal behavior.Other anthropologists believe that trephining was used to treat medical problems (e.g., removal of a tumor).However, the true purpose for trephining during the Stone Age remains unknown.Trephining continues to be practiced today among certain African tribes for the relief of head wounds. For an idea of how you might have been treated if you had a mental illness in the Stone Age
4 B.C. MesopotaminaIt seems likely that if you had a mental illness in Mesopotamina during the 1700’s B.C. you would have been sent to see a physician called an Ashipu (“sorceror”) or an Asu (“physician”).If you were seen by the Ashipu he would first attempt to diagnosis which spirit or sin you had committed to cause the illness.He would then perform and use a variety of spells to drive the spirit out of your body.The Asu may have more been more likely to use herbal remedies to treat you.In addition, it is possible that the Asu may haveused a knife to “scrape the skull of the patient,” based on two cuneiform tablets titled “Prescriptions for Diseases of the Head.”Payment for the services would most likely depend on your social status in the society, where the physician himself may be punished for failure to cure you if you were of high social status.
5 1800 B.C. – 1700 B.C. -- CODE OF HAMMURABI In Mesopotamia, between B.C., Hammurabi, King of Babylon, issued a structured code of laws, known as the Code of Hammurabi. The Code of Hammurabi was preserved on Cuneiform, a system of writing developed by the Sumerians, which consisted of writing onto wet clay with a wedge and then drying those clay tablets.This code is the first-known example an orderly body of laws created by a ruler. The code of laws includes legal procedures for physicians in the treatment of a variety of physical ailments such as payment for successful services rendered as well as punishment for a failed service to his patient (e.g., loss of the physician’s hands).Mesopotamian diseases were viewed from a primarily mystical perspective and were blamed on spirits: gods, ghosts, etc.Each spirit was believed to cause a disease in any one part of the body.Some diseases were referred to as “Hand of …” signifying a divine cause whereas others were simply identified by names (e.g., bennu). For an idea of how you might have been treated in Mesopotamia during the 1700's B.C
6 800 B.C. -Greek and Roman Civilization If you had a mental illness during the 800’s B.C., you may have been sent to relax and sleep in a serene and peaceful locations such as anatural, warm spring.You may have been given drugs to help you sleep.During your sleep, Asclepius would come into your dreams and cure you.In addition to this “sleep therapy,” you may be placed onto a diet and encouraged to exercise.
7 400 B.C. -Greek and Roman Civilization If you had a psychological disorder in Greek or Roman civilization during Hippocrates life, you would most likely undergo a variety of different treatments depending on the particular mental illness that you were suffering from.If you were found to be “melancholic” you may be given a laxative or emetic (nausea-producing substance) and also placed onto a diet rich in fruits and vegetables.Someone who was choleric may be encouraged to drink lots of fluids and may be given a diuretic as well as a proper diet.A person that was phlegmatic may be treated through purging and possibly bleeding.Finally, those individuals who were seen as having “sanguine” would likely receive bleeding as the preferred treatment.If you were particularly difficult to treat, you may have been incarcerated.There were humanitarian treatments as well as more spiritual treatments in Greek and Roman civilization, but the views of Hippocrates were dominant.
8 The Middle (DARK) AgesIf you suffered from a psychological disorder (particularly the more severe forms, such as schizophrenia) during the early periods of the Middle Ages and were treated by a physician or priest you would likely be treated according to the variety of mystical beliefs or to theories related to an excess of certain bodily fluids. Most likely, if you sought treatment or were forced into treatment, you would see a priest and be given an exorcism.Exorcism during the Middle Ages may not correspond to the current perceptions of exorcism we have today. Exorcism would be viewed more like torture today and basically consisted of beatings, starvings, forced eating of substances (foul-tasting, blood, sheep dung) agitating the spirit and causing it to flee the body. Otherwise, you may have seen a physician and be subject to the variety of treatments recommended by Hippocrates such as bloodletting. You may have also been subject to a trephining procedure to “remove the stones. ”If you were seen as threatening or burdensome to the community, you may have been executed or ostracized from the community. You may have been left to wander the countryside seeking help from wherever you could find it, receiving much ridicule and derision.
9 Treatment at the Bedlam If you were to have a serious mental illness during the later half of the Middle Ages during the ’s you may have been sent to an asylum, much like the Hospital of St. Mary of Bethlehem in London.In the asylum, especially after the 1400’s you would find yourself in the absolute worst conditions.You may have been referred to as an inmate and be placed into a cell, devoid of fresh air, light, and given very little nutrition.It is possible that you would have been chained to the wall or to your bed and had to lie in your own excrement and that of the other “inmates.”You may have shared a mattress on the floor with 5 or more “inmates,” some of whom were criminally ill, and others who were suffering from a variety of other mental disorders.Later in the asylums years, you may have become a tourist attraction where local citizens could come through and view you and all the other “lunatics.”If you became unruly you would be subject to beatings as a means of controlling your behavior.In many cases you would be all but forgotten by society and left in the asylum to die.However, there were those, such as the artist William Hogarth who spent time in the asylum and were able to leave.
10 14th and 15th CenturyDuring the 14th and 15 centuries in Europe, if you were suffering from a mental illness (especially more severe forms of mental illness) you may have been labeled a witch by the church.Once labeled as a witch, there was virtually no escape.There were a variety of “tests” to determine who was and was not a witch.However, often you proved you were not a witch by your death (e.g., drowning) during the test. Had you been a witch, it was believed your powers/demons would have protected you.If they determined that you were a witch, you may have been given an exorcism or burned at the stake.If you were lucky, you may have fallen under the care of more humanitarian beliefs which began to become more predominant in the 16th and 17th centuries.
11 17th, 18th, and 19th CenturiesMesmer conducted most of his work cloaked in mystery. In a group setting, many people would encircle a tub filled with chemicals that had iron rods protruding from the mysterious liquid. Mesmer would use one of the soaked rods and rub it on the patients afflicted area. In some cases, Mesmer could even have his subjects swallow iron tablets to increase the magnetism between himself and the afflicted.Rush used some crude devices to treat the mentally ill; none of which were very effective. The circulating swing (top left) was used to spin depressed patients at high speeds. The tranquilizer chair (top right) was used to calm people suffering from mania. The crib (bottom) was widely used to restrain violent patients. Rush also felt that frightening the patient was beneficial. Some subjects were told repeatedly of their impending death, and then placed in a casket with holes that was submerged in water for several minutes. Rush’s favorite treatment was bleeding. He felt that many mental disorders were caused by a buildup of blood in the brain.
12 6000 yıl önce Sümerle cennette şunu bildirdiler: The sick eyed says not I am sick eyed. The sick headed (says) not I am sick headed (Gözleri hasta olan, gözlerim hasta değil demektedir. Kafası hasta olan ise kafam hasta değil..)MÖ 3500:Eber papiruslarında ”Courtesan of Pharoah” mahkemesi ile ilgili bir vak’ada kişi “ başının yarısında hastalıklı” olarak tanımlanmıştır
14 Prehistorik PeriodDünyada uygulanan en eski beyin ameliyatının (trepanasyon), yaşlarında bir kadın hasta üzerinde Aşıklı Höyük’te olduğunu işaret etmektedir.Hittite Dönemi (MÖ )Kafkasya yolu ile Avrupa’dan gelen insanlar, MÖ 1200 yılları civarındaKapadokya çevresine yerleşmişler ve bu bölgedeki yerleşik halk ilebirleşerek bir İmparatorluk kurmuşlardır. Dilleri ise Indo-Avrupa kökenlidir
16 DIABETES MELLITUSMÖ 1552: 3. Hükümdarlık periyodunda Dr. Hesy-Ra ilk defa diyabeti tanımlamış ve semptom olarak poliüreden bahsetmiştir.MS 1. yüzyılda Arateus diyabeti “yağ ve bacakların eriyerek idrara karışması” olarak tarif etmiştir.
17 Diabetes mellitusAşagıdakiler Kapadokyalı Areteus tarafından, MS 2. veya 3. yüzyılda yazılmıştır.Diabet, erkekler arasında pek sık görülmeyen ve et ile uzuvların eriyip idrara akmasına neden olan bir durumdur. Sebebi soğuk ve nemli doğadır.Seyri ise genellikle bellidir; böbrekler ve mesane hiç bir zaman idrar yapmayı bırakmaz, ancak akış, sanki orifisler açık kalmış gibi süreklidir.Bundan sonra hastalık kronik bir seyir izler ve oluşması uzun süre alır. Hastalık tam olarak kendini ortaya koyduğunda ise hastanın ömrü kısadır, erime çok hızlı gelişir ve ölüm çabukturHasta idrar yapmaktan kurtulamaz.
18 Diabetes mellitusSusamayı tedavi edecek ilaçlar gereklidir, cünkü kesinlikle önüne geçilemeyen bir susuzluk söz konusudur, dolayısı ile bu susuzluğu geçirecek kadar su içmek mümkün değildir. Bu nedenle mutlaka mideyi güçlendirmemiz gerekmektedir, çünkü burası susuzluğun merkezidir..İçelecek su, sonbahar meyvaları ile kaynatılmalıdır. Yiyecek olarak süt ile beraber nişasta, buğday ve yulaf yenmelidir. Buruk şaraplar mideye tonus kazandırır. Çok tuzlu yenmemelidir, çünkü bu suzusluğu artırır.
19 HippocratesBC:Hippocrates distinguished different types of headaches in his Aphorism, and was the first state that this was a true disorder and not a visitation from the gods.He was the first to describe several well-known features of migraine, vizuel aura, the onset of headache after the aura, the headache becoming generalized and its relief by vomiting
20 The Greek word, hemicrania, was changed by the Romans to the Latin, hemicranium, and then corruted into low Latin as hemicraia, them emigranea, migranea and migrana.In English, it appeard as mygraine (1398), myegrym (1460), migrien (1579), and megrim (1713). Migraine appeard in English (from the French) in Megrim has neen spelled in 33 different ways
21 MS 30-90 : Kapadokyalı Arateus Arateus of Cappococia: Migrenli birçok doktor gibi Kapadokyalı Arateus ta kendi migrenine önem verdi ve klinik tanımını yaptı. Vizüel auranın detaylı tanımını yaptı: “..ağrıdan önde mor-siyah ışık çakmaları görülür..”İlk defa fotofobi ve fonofobiyi tanımladı
22 Kendi başağrısı....ağrı. Başın yarısında kalır. Buna heterokania denir. Hafif başlasa bile kesinlikle hafif bir hastalık değildir...Akut olarak başlar, bazen hoş olmayan, korkunç semptomlar görülür..bezdirici bulantı, safra kusma, başta ağırlık, anksiyete görülür...karanlık hastalığı örter..
23 Celsus (25 BC to 50 AD) ilk defa migrenin hayat boyu süren, öldürücü olmayan fakat tetikleyici faktörleri olan bir hastalık olarak tanımladıEfesli Soranus ( AD) skotomayı tanımladıGalen ( AD) HEMICRANIA terimini kullandı
24 30-90 AD: Arateus of Cappococia: 3 Değişik tip baş ağrısı tanımlamıştırCephalalgia: hafif, seyrek olarak gelen, bir kaç gün süren, gerilim başagrısı olması muhtemel ağrıCephalea: daha uzun süren, daha şiddetli, tedavisi zor, muhtemelen yapısal bir probleme bağlıHeterocrania: Heterokrania: gözlerin önünde kararmalar olan, tek taraflı başağrısı, bulantı, kusma, fotofobi ve osmofobi (MİGREN)Eğer gün doğuşunda başlarlarsa, ertesi gün, öglen vaktinde sona ererler; ve eğer gün ortasında başlarlarsa, gün batarken sonlanırlar. “Bir atağın daha uzun süremesi nadirdir”. Ataklar 6 ile 24 saat arasında sürerler. Başağrısı başın iki yanından birinde veya frontal, vertikal olabileceği gibi aynı gün içinde de değişlikler gösterebilir. Ağrı lokalize olduğunda heterokrania adı verilir.
25 ARATEUS…those affected with melancholy are not every one of them affected according to one particular form but they are suspicious of poisoning or flee to the desert from misanthropy (insanlardan kaçan, nefret eden) or turn superstitious or contract a hatred (düşmanlık, kin) of life.The patients are dull or stern (katı), dejected (kederli) or unreasonably torpid (uyuşuk, durgun)……they also become peevish (huysuz), dispirited (neşesiz, keyfsiz) and start up from a disturbed sleep
26 DEVELOPMENT OF PSYCHIATRY Eski çağlarda: Zihinsel hastalıklar alternatif gerçek olarak kabul edilmiştir. Tedavi topluluğun saygı gören bir üyesi tarafından uygulanmaktaydı. Holistic yaklaşım sıktır.Mısır, MS 2850: Uyku terapisi. Nil gezintileri, müzik, dans, resim.Mezopotamya, MÖ 2000: Mental ve fiziksel hastalıkların tedavisi için farklı gruplar, holistic yaklaşım, psikoterapinin başlangıcıPrehistorik: Mental ilness regarded as alternate reality; treatment administered by respected member of community. Holistic approach is common.Egypt, 2850 B.C.: Sleep therapy. Nile excursions, music, dancing, painting.Mesopotamia, 2000 B.C.: Division of labor betwen treatment of physical and mental ailments, holistic approach, beginning of psychotherapy.
27 DEVELOPMENT OF PSYCHIATRY MÖ 5. Yüzyıl:Hippocrat birçok mental hastalığı dökümante etti. Beyni, düşünce ve duyguların merkezi olarak belirledi.Plato, Freud’un ego, süperego ve id teorisinin öncü teorisini ortaya koyarMÖ 4. Yüzyıl:Aristo hareketleri, duyguları ve düşünceleri bir bütün olarak kabul eder ve mental hastalıklarda genetik yatkınlık bulunduğunu tarifler. Arzular ve mantık ile ilgili çalışır. Aristofanes, Freud teoreminin erken şekillerini içeren oyunlar yazar.
28 Eski insanlar, psikiyatrik hastalıkları, doğa üstü güçler tarafından ele geçirilmek olarak açıklamaktaydılar.Üzerlerinde geniş delikler açılmış olan eski kafastasları bulunmuştur. Buna trepanasyon adı verilmektedir. Amaç kötü ruhları serbest bırakmaktır.Koslu Doktor Hipokrat (MÖ 450) üzüntü, apati ve kendine güvenin kaybı ile seyreden tabloya, siyah safradan kaynaklandığını düşünerek, melankoli adını vermiştir (melanos: siyah cholle: safra)Bu terim daha sonra Arateus (MS ) ve Galeno (MS ) gibi doktorlar tarafından da kullanılmıştır.
29 Arateus...melankoli tarafından etkilenenler her zaman aynı şekilde davranmamaktadır: zehirlenmekten süphe duymaktadırlar, veya insanlardan kaçıp çöle yerleşirler, veya fazlası ile batıl inançlı hale gelirler, ya da hayattan nefret ederler.Hastalar sıkıcı veya acımasız, kederli veya anlaşılmaz şekilde hareketli olabilirler...aynı zamanda huysuz, ruhsuz hale gelirler, uyku problemleri vardır.
30 DEVELOPMENT OF PSYCHIATRY A.C.: Arateus writes an accurate description of bipolar illness; views normal and abnormal behavior as a continuum9th-10th Century A.C: Rhazes operates hospital in Baghdad with a separate psychiatric ward, where patients are humanely treated.
31 Trigeminal Neuralgia: Arateus, MS 1. yüzyılda ilk defa “trigeminal nevralji” veya diğer adı ile Tic douloreux’u (Fransızca’da Acılı Tik) tarif etmiştir.1677’de, John Locke, bu durumu tarif eden ilk doktordur.Nicolaus Andre 1756 da ayri b’r kl’n’k ant’te olarak TN tanimladi.TN en sık gözlenen fasial nevraljidir ve hastaların yaşayabileceği en ağrılı durumlardan biri olarak kabul edilmektedir.
32 EPILEPSY2. yüzyılda, Greko-romen Pneumatic Tıp Okulunda, Kapadokyalı Arateus auralı epilepsiyi tanımlamıştır.Galenos zamanında ( AC) epilepsi ataklarının ayın (lunar) hareketleri ile ilişkili olduğu düşünüldüğü için bu kişilere lunatik adı verilmiştir.Orta çağ Avrupasında epilepsinin sihirli veya dinsel güçlerle ilişkili olduğu düşünülmüştür.XVI. Yüzyılda ( ), Paracelsus epilepsiyi histeri ile ilişkilendirdi ve bulaşıcı bir hastalık olduğunu iddia etti.In century II, Arateus of the Capadócia described the aura of the epileptic crisis in the Pneumatic School of Greco-roman Medicine.At the time of Galenos ( AC) the popular belief started to associate the epiletic attack with lunar alterations and the patients were called lunatics, persisting this idea until century XVII.In the medieval Europe, the cause of the epilepsy was attributed to the magical or religious factorsIt started to appear the practical one of exorcisms (witches had blunted). In that occasion it had a mixture and confusion between: religion, misticism, witchcraft and histeria.In century XVI ( ), the Paracelsus associated the epilepsy with histeria and described the epilepsy as contagious disease.
33 Arateus, bütün mental hastalıkların orijininin saptanamyacağını öne süren ilk bilgindir. Mental hastalıkların kafadan veya abdomenden kaynaklanabileceğini ve diğer organın ikincil olarak etkilenebileceğini belirtmiştir.Aynı zamanda premorbid kişilikler hakkında çalışmış ve manik olan kişilerin daha öncesinde de labil yapılı, kolaylıkla alınan, kızan veya mutlu olan insanlar olduğunu ileri sürmüştür. Melankolik olan kişiler ise daha sonraki hayatkarında depresyona daha yatkındırlar.Emosyonel bozukluklar, mevcut karakteristik özelliklerin uzantısı veya ekzajerasyonu olarak kabul görmüştür. Ayrıca, mani ve depresyonun aynı kişide görülebildiğini öne sürmüş ve bu Kraeplin’in çalışmalarının temelini oluşturmuştur.
34 Arateus and Galen (30-90 AC) SoulsLocationFunctionRationalBrainControls internal and external functionsInternal: imagination, judgement, memory, apperception, movementExternal: 5 sensesIrrationalHeart and LiverControls all emotions
35 Kapadokyalı Arateus, MS 2 Kapadokyalı Arateus, MS 2. yüzyılda, “Mısırlı Hastalığı” veya “Suriyeli Ülseri” olarak bilinen tonsillerin ülserasyonu, burundan yemek gelmesi ve nefes alamamak ile seyreden hastalığı tarif etmiştir.
36 SPECULUMThe first evidence that a speculum was used in antiquity is found in the Talmud about 1300B.C.,This speculum was a cylinder made initially of bamboo or the stem of a gourd and later of metal.The present name of speculum was adopted in the Roman era, and it was Galen (AD ) who made the first record of a speculum. In 1818 in the excavation of Pompeii two specula were found which were estimated to have been buried in AD 79. These were bronze dilators; one with three and the other with four blades which diverged when a centrally located screw is turned and they were used in the time of Galen and Celsus (27 BC to A.D.50) and very likely in the Middle Ages.At about the second century, speculum was described in several medical books of the time. Soranus of Ephesus, Arateus, Archingenes, Aspasia and Leonido, are few of the physicians who recognised the association of speculum with anorectal and gynaecological examination.
37 Ancient Greek Solar System. CELLARIUS, A Ancient Greek Solar System. CELLARIUS, A. [Amsterdam, 1660] Saturn was the outermost planet in ancient cosmology, as it is the furthest planet visible with the naked eye. The planets are represented by fine medallions of the ancient gods and goddesses after whom they are named. Groups of astronomers in the lower corners are seen conversing around globes. Knowledge of the ancient Greek solar system derived from an epic poem by Arateus, referred to in the chart's title, which was written in the third century B.C.