Medico-Psychological Association Research Articles

All Voices Must Be Heard and Respected

All Voices Must Be Heard and Respected

Efforts to Describe Mental Illnesses Continue to Make Progress

Efforts to Describe Mental Illnesses Continue to Make Progress

The brief existence of the Indian section of the royal medico-psychological association: A historical note.

Specialists in psychiatry, in the Indian sub-continent, were trained in the UK in the early 20th century. Just before Independence, an Indian branch of the Royal Medical Psychological Association was established. Many issues of contemporary concern were discussed, as also plans for the further development of psychiatry in the region. Soon after the Second World War, and the Independence of India, the association was disbanded. However, a large number of psychiatrists from south Asia now live and work in the UK, and the Indian Psychiatric society and the Royal College continue to have close links.

James Foulis Duncan - psychiatry in history.

James Foulis Duncan was the last of the Duncan family to own Farnham House, a private asylum in Finglas, County Dublin, Ireland. He served as president of the King and Queen's College of Physicians in Ireland (1873–1875) and of the Medico-Psychological Association (MPA) in 1875. Duncan's mother

Snowy Campbell, Australian Pioneer Investigator of the Brain by Malcolm Macmillan

Health & History Ɣ 19/1 Ɣ 2017 127 Malcolm Macmillan, Snowy Campbell, Australian Pioneer Investigator of the Brain (Melbourne: Australian Scholarly Publishing, 2016). ISBN 978-1-925333-74-9 (PB) B&W and colour illustrations, xi + 390 pp. PioneeringAustralian neurologist, neuropathologist, and psychiatrist, Alfred Walter (‘Snowy’) Campbell, was notoriously reticent—as well as somewhat playful—about his medical achievements. When asked what he did during a period in England in the 1890s and early 1900s when he conducted a bevy of gifted research studies, he responded that when he wasn’t playing cricket he was shooting grouse! In this commendable biography by psychologist, Malcolm Macmillan, we learn that his modesty was matched by tenacity in grasping the opportunities that came his way. Campbell (1868–1937) was the sports-loving son of an innovative NSW farm manager of Scottish, Danish, and French extraction and a plucky mother who stood up to a band of bushrangers in an 1863 attack on the family home. She died after childbirth in 1870, leaving three young children including two-year-old ‘Snowy’. In adolescence he attended Oaklands School in Mittagong, NSW, which provided a classical education for boys ‘from families of more considerable means’. After achieving ‘decidedly inauspicious’ results in the senior public examinations held by the University of Sydney, he gained entry to Edinburgh University where he studied medicine from 1885 to 1889, his results improving over the years but not, according to Macmillan, to the stellar levels sometimes claimed for him. Soon after qualifying in medicine and surgery in Edinburgh, Campbell passed the Certi¿cate of Experience in Psychological Medicine, a credential offered by the Medico-Psychological Association for Great Britain and Ireland. It enabled him to work in several English county mental asylums, where he found himself attracted to the scienti¿c side of the work. A year in Vienna and Prague followed, with Campbell catapulted into several new and developing ¿elds, combining histology, pathology and bacteriology. The boy from country NSW intended ‘to take of¿ce in one of the few large institutions then affording collateral facilities for general administrative experience and special scienti¿c study’, but his aspirations expanded in line with the laboratories he sampled. At ¿rst he worked as a voluntary assistant in the pathology laboratory of Professor Heinrich Obersteiner, from the Neurological 128 BOOK REVIEWS Institute in Vienna, who had just published a major work on the structure of the central nervous system. He then gained experience in the laboratories of Professor Richard von Krafft-Ebing, head of Psychiatry at the University of Vienna, and those of Professors Arnold Pick and Hans Chiari in Prague. It was an exciting time to be in Europe with ongoing progress in identifying clinical phases of mental diseases and pathological changes in the brain, and in devising new techniques for postmortem examinations at a time when germ theory was challenging old notions of pathology and disease causation. At the very least, Campbell greatly expanded his histopathological methods while abroad and, after returning to Edinburgh in 1892, wrote his MD (Doctor of Medicine) thesis. It focussed on the nervous system changes associated with ‘alcoholic neuritis’, a painful condition of the hands, feet, and limbs. The following year, and still only in his mid-twenties, he joined the Lancaster County Asylum, called Rainhill, near Liverpool where he quickly rose from assistant medical of¿cer to mental hospital pathologist. During the next twelve years, he completed some trailblazing studies, resulting in more than forty publications. The topics were diverse and resulted in a wealth of papers on topics including the histopathology of shingles (herpes zoster) in collaboration with up-and-coming English neurologist, Henry Head, and on the bacterial causes of colitis (asylum dysentery), which was almost endemic in many mental hospitals. He also carried out a study on the then quite controversial topic of the rib strength of asylum patients and their proneness to fracture. This may sound like a humdrum subject, but Macmillan brings it to life, explaining that Campbell’s study method and conclusions served to debunk a treasured theory of some senior colleagues while also raising the possibility of nefarious staff practices that might explain some of the bone breakages in asylums. In the years...

The transformation of American psychiatric nosology at the dawn of the twentieth century.

Between 1896, when Kraepelin published his first formulation of dementia praecox (DP), and 1917, when the American Medico-Psychological Association issued the first official American psychiatric nosology that contained DP and manic-depressive insanity (MDI)--Kraepelin's key categories--psychiatric nosology in the United States underwent a transformation. I describe and contextualize historically this process using Thomas Clouston, a Scottish Psychiatrist and widely-read textbook author, as a representative pre-Kraepelinian diagnostician. Clouston used three major diagnostic categories based on symptomatic presentation--mania, melancholia and paranoia--all derived from the beginnings of modern psychiatry in the early nineteenth century. He observed that these categories contained good-outcome cases and those progressing to 'secondary dementia'. Kraepelin designed his categories of DP and MDI to reflect putative distinct disease processes reflected in their course and outcome. Although Clouston and Kraepelin each saw similar patients, their nosologies started from different first principles: symptomatic presentation versus presumed etiology. Driven largely by social forces with American psychiatry, Kraepelin's system spread throughout the United States in the succeeding decades replacing older diagnostic approaches typified by Clouston's. In 1896, American psychiatry was demoralized as the idyllic asylums had become overcrowded, isolated scientific backwaters. Kraepelin's nosology was derived from and was championed by individuals working in high-status research-based university psychiatric clinics. It brought excitement, the promise of subsequent research breakthroughs and the high prestige then associated with German biomedicine. Scientific research comparing the older and Kraepelinian diagnostic systems played little role in this transition. Using empirical methods to guide changes in our diagnostic system is a recent development in the history of psychiatry.

Asylum Doctor Extraordinaire: Dr. Thomas Drapes (1847-1919).

Dr. Thomas Drapes (1847-1919) was resident medical superintendent of Enniscorthy District Asylum in County Wexford, Ireland from 1883 to 1919, and one of the leading figures in Irish asylum medicine for several decades. Drapes' career was as complex as it was remarkable. Drapes was elected president of the Medico-Psychological Association for the term 1911-12 but had to decline on health grounds. In 1912, however, he was unanimously elected as co-editor of the Journal of Mental Science, to which he devoted his considerable energies and intellect. Drapes published widely, opposing Emil Kraepelin's proposed division of "functional" psychosis into manic-depressive illness and dementia praecox; openly examining the use of "punitive measures" in asylums (Enniscorthy had notably low rates of restraint and seclusion); and publicly bemoaning the folly of "psychophysical parallelism", or the spurious division between mental and physical symptoms in medicine. Although not immune to passing trends in medical thought (e.g. regarding sterilisation of the mentally ill to prevent further mental disorder), Drapes was generally independent-minded, insightful and incisive, and his legacy was to help shape Irish mental health care for many decades.

The enigmatic figure of Dr Henry Maudsley (1835-1918).

In spite of his contribution to psychiatry in 19th century Britain, Henry Maudsley remains a mysterious figure, a man mostly known for his donation to the London County Council for the building of the Maudsley Hospital and for The Maudsley Annual Lecture created in honour of his benevolence. Besides Sir Aubrey Lewis' article in 1951 and Michael Collie's attempt in 1988 to construct a biographical study on Maudsley, there does not seem to be any current endeavour to tell the story of his life, whereas Trevor Turner's contribution to the 2004 Oxford Dictionary of National Biography gives a somewhat scathing but unattributed account of Maudsley's personality. This essay attempts to explore his contributions to the Medico-Psychological Association (MPA), the current Royal College of Psychiatrists, his editorship of the Journal of Mental Health (currently named the British Journal of Psychiatry), his literary contributions and his vision for a psychiatric hospital. This essay is an attempt to demystify his figure and to explore some of the rumours and criticisms surrounding his name and the reasons why so little has been written about him. It is also a venture to unravel his complex personality and his intricate philosophy.

Eleonora Fleury captured – extra

In the history of the Medico-Psychological Association (MPA), precursor to the Royal College of Psychiatrists, the admission of the first female member in 1894 was surely one of the landmark events. It is surprising therefore that so little is known about Dr Eleonora Fleury and that the College has

Diagnostic and statistical manual of mental disorders 5: A quick glance

Byline: Vihang. Vahia Dr. Dilip Jeste, the then President of the American Psychiatric Association, released the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) [sup][1] on May 18, 2013 at the 166 [sup]th Annual Meeting of the APA at San Francisco. This was a landmark achievement for the APA. Indian psychiatrists should take additional pride in the fact that Dr. Dilip V. Jeste is actually one of us. He used to be an Overseas Member of the Indian Psychiatric Society (IPS). History of the DSM Earliest documented efforts to gather epidemiological data on mental illness commenced in the USA in the year 1840. Mental illnesses were then classified under a single category of idiocy/insanity. Inaccurately defined categories of mental illness like mania, melancholia, monomania, general paralysis of the insane, dementia, and dipsomania were included in the US Census of 1880. In 1918, the American Medico-Psychological Association published a manual of classification of mental illnesses that listed 22 categories. The manual was designed for the use of Institutions for the Insane. The American Medico-Psychological Association was later renamed APA in 1921. During World War II, the US army prepared a manual of medical illnesses called the ' Medical 203 '. The US Navy revised the Medical 203 to formulate the Classified Nomenclature of Disease or the Standard. Office of the US Surgeon General adopted the Standard to classify illnesses on the battle grounds and among veterans returning from the war. The Veterans Administration adopted the Standard with few modifications. After the war, psychiatrist with experience of using the Standard during the Second World War continued to use it in civilian practice. The World Health Organization (WHO) included a chapter on Mental Disorders in its International classification of Diseases (ICD) 6 (1949). It resembled the Standard . In the year 1950, the APA set up a committee on nomenclature and statistics. This committee published the first DSM in the year 1952. [sup][2],[3],[4],[5],[6] The first edition of DSM (1952) was titled 'Diagnostic and Statistical Manual of Mental Disorders'. It did not carry any number attached to its title. Authors of the manual had perhaps not envisaged that the manual would be revised periodically. The second edition (1968) was titled Diagnostic and Statistical Manual of Mental Disorders, Second Edition. The trend of fixing a roman suffix to the newer editions of the DSM commenced with the third edition which was titled DSM III (1980). DSM III also pioneered the multiaxial system of evaluation and classification of mental disorders. A revised version was christened DSM III R (1987). The trend continued while publishing the DSM IV (1994) and its text revised edition the DSM IV TR (2000). [sup][2],[3],[4],[5],[6] The most recent edition of the DSM was initially labeled DSM V. As the process of developing the manual progressed, the Roman numerical 'V' was replaced by the alpha numerical '5'. This would facilitate subsequent revisions being numbered as 5.1, 5.2 and so forth. While facilitating the numbering, it is also a tacit acceptance that the DSM 5 is not the ultimate manual of classification of mental disorders. It is a document that reflects current consensus of the leading academicians, clinicians, and researchers in the field of mental health. [sup][5],[6],[7] Methodology By the year 1999, even as the DSM IV TR was being published, clinicians and researchers had noticed several flaws in the DSM IV. The DSM IV TR (2000) did not propose any substantial modifications to the doctrine of DSM IV (1994). The diagnostic criteria continued to result in rather frequent diagnosis of comorbidity. Heterogeneity within the diagnostic groups was unacceptable to the researchers and it contaminated treatment outcome. The erratic thresholds for inclusion and exclusion could not differentiate the normal from abnormal or syndromal from subsyndromal disorders. …

The Role of the Irish Division of the Royal Medico-PsychologicalAssociation in the Development of Intellectual Disability Nursing in Ireland

The development of a specialist intellectual disability workforce in independent Ireland by the Royal Medico-Psychological Association was influenced by nursing regulatory bodies and Catholic religious orders, the latter of which provided lay residential education to people with intellectual disabilities. Although the RMPA shaped curriculum and examinations, practice scope, clinical assessment and practical skills were weighted more heavily towards bedside nursing, psychology and education due to the input of the religious orders and nursing board.

Roadmap to Indian psychiatry.

Byline: E. Mohandas Introduction We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions; so we have to know how to act . - Swami Vivekananda With all its alluring contrasts and remarkable features, India has a grand heritage of 34,000 years. Down the traditional lane, it has evolved into a pluralistic, multilingual, and multiethnic society. It is quite striking that while India is the second-most populous country, it has the largest democracy in the world. The second fastest growing economy and the third largest military force are also her golden quills. Seventy-four per cent of the 1.14 billion population of India live in rural areas. India has 28 states, seven union territories, 612 districts, and 6, 38,365 villages. The fact that there are 22 official languages in a single country is ample evidence for the heterogeneous nature of the society it represents. Having a literacy rate of about 64.8%, India has 80 million internet users. With all this, I do not mean to say that India is not without its lacunae. Even while India is the world's twelfth largest economy, we cannot close our eyes to the grim truth that 22% of the population exists below the poverty line.[sup] [1],[2],[3] With regard to the academic scene, India is proud to have 289 institutions providing undergraduate medical training (196 MCI recognized, 77 MCI permitted, and 16 in the danger zone). The postgraduate training in psychiatry includes Doctor of Medicine (MD) (83 centers, 159 seats), Diploma in Psychological Medicine (DPM) (46 centers, 107 seats), and Diplomate of National Board (22 centers, 36 seats). Strikingly, 25% of the medical colleges in India do not have a Psychiatry Department.[sup] [4],[5],[6] Apparently, there are only around 4000 psychiatrists in India to serve the five crore mentally ill population currently. Mental Health Scenario in India Obviously, in a vast country like India, the threat posed by the psychiatric and behavioral disorders is just inexplicable. A meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000. Another meta-analysis of 15 epidemiological studies reported a total morbidity of 73 per 1000.The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group. The existing facilities in the country fall short of the required norms, which makes the situation still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population. The major share of psychiatric facilities lies with the government sector (especially mental hospitals), which is centered on certain areas of particular states. The psychiatric services have not yet been integrated into the primary health care system and this leaves large populations in dire need of such facilities, with no hope of effective treatment. Therefore, they seek help from the private sector and there are no clear policies regarding treatment of the mentally ill in the private sector. A significant population in India cannot afford private hospital care and the insurance system in the country is in its infancy. The rehabilitation of psychiatric patients is also given little importance in the existing mental health framework. The integration of psychiatric services to primary care needs a public-private partnership to enable comprehensive mental health care.[sup] [7],[8],[9],[10] Indian Psychiatric Society Evolution Our society sprouted from the Indian Association for mental hygiene founded in 1929 by Berkeley Hill. In 1935, the Indian division of the Royal Medico-Psychological Association (RM-PA) was formed, due to the efforts of Dr. …

Institute of mental health and hospital, Agra: Evolution in 150 years

Byline: Sudhir. Kumar, Rakesh. Kumar Introduction Lunatic asylums were established by the British in India based on the fact that the care of the insane was the responsibility of the Crown.[sup] [1] The first asylum was established in 1745 in Bombay, followed by Calcutta in 1784.[sup] [2] There were a few asylums until 1857, which mostly existed in the major cities of Calcutta, Bombay, and Madras. The growth of lunatic asylums was facilitated by the enactment of the Indian Lunatic Asylum Act, 1858.[sup] [3] The Act set up guidelines for the establishment of lunatic asylums as well as the procedures for the admission of lunatics. The Agra Asylum came into existence in 1859.[sup] [4],[5] The circumstances of its establishment were created by the lunacy of the Lt. Governor of Agra Mr. J. R. Colvin who became a lunatic in 1857. In the year of its establishment, the first admitted patient was Aniga, a female beggar who was loitering in the cantonment area. She was admitted on 9[sup] th September 1859. In that year, 39 patients were admitted, out of which 25 died, 6 were cured, 7 improved and were declared fit for discharge, and 1 escaped. The administration of the asylum was being managed by the Inspector General of Prisons. Mostly custodial care was provided to inmates in mud houses. The wards and living conditions of inmates were very poor and unhygienic. Lice were seen even on the walls. Many patients died because of diarrhoea. A Movement Towards Growth of Psychiatric Services : 1904-1956 The Lunatic Asylum in Lucknow was abolished in 1904 and the patients with their case records were transferred to the asylum in Agra. This asylum was granted Provincial Status.[sup] [6] The administrative management of the Inspector General of Prisons came to an end in 1905 when Col. A. Cochrane was appointed as the first Medical Superintendent of the asylum [Figure 1]. This marked the beginning of the medical and psychiatric growth of this asylum. The leadership of the Asylum came into the hands of a leading academician Lt. Col. A.W. Overbeck-Wright in 1911. Apart from his regular services as Medical Superintendent, he served as a visiting lecturer on Mental Diseases to King George's Medical College, Lucknow and Medical School, Agra. He was a member of the Medico-Psychological Association of Great Britain and Ireland. He authored two excellent books in psychiatry: 1) Mental Derangement in India and 2) Lunacy in India. Like other hospitals, this asylum was renamed as a Mental Hospital, Agra in 1925.[sup] [6] Lt. Col. Banarsi Das was appointed as the Medical Superintendent of the hospital in 1934 and served up to 1943 [Figure 2]. His notable contribution was his first real attempt to form an association of psychiatrists in India. He wrote personal letters to the Superintendents of principal mental hospitals throughout the country on June 24, 1935 suggesting that a conference of Indian psychiatrists be held to serve as a 'forum for the exchange of ideas and act as a clearing house of administrative experience'. He received an encouraging response.[sup] [7] However, his attempt was not fruitful until 4 years later, when a meeting actually took place under the auspices of the Indian Division of the Royal Medico-Psychological Association (RMPA) on June 24, 1939. This meeting was attended by 20 psychiatrists under the chairmanship of Lodge-Patch. The second meeting was held in 1941 under the chairmanship of Dr. Banarsi Das. No meetings could be subsequently held during World War II. The Indian Division of the Royal Medico-Psychological Association is considered to be the predecessor of the Indian Psychiatric Society formed in January 1947.[sup] [8] Another highly significant event in the history of this hospital was the commencement of the M.D. course in Psychological Medicine with the initiative of Dr. R.S. Lal who served this hospital from 1943 to 1955 as the Medical Superintendent. …

Holding Environment as Home

Holding Environment as Home

Asylums Attacked as Jails

Back to table of contents Previous article Next article Letters to the EditorFull AccessAsylums Attacked as JailsThomas Szasz, M.D.Thomas SzaszSearch for more papers by this author, M.D.Published Online:20 Jul 2007https://doi.org/10.1176/pn.42.14.0028bThe “History Notes” article by Lucy Ozarin, M.D., in the June 1 issue was too brief to completely convey relations between American neurologists and psychiatrists toward the end of the 19th century. One item she did not discuss was the moral issue that divided Weir Mitchell from his psychiatric colleagues—the prison function of the mental hospital. Books on the history of psychiatry regularly omit the following passage from Mitchell's lecture to the “asylum doctors” (as psychiatrists were then called):“You quietly submit to having hospitals called asylums; you are labeled as medical superintendents.... You should urge in every report the stupid folly of this. You.. .conduct a huge boarding house—what has been called a monastery of the mad... .I presume that you have, through habit, lost the sense of jail and jailor which troubles me when I walk behind one of you and he unlocks door after door.... You have for too long maintained the fiction that there is some mysterious therapeutic influence to be found behind your walls and locked doors. We hold the reverse opinion... .Your hospitals are not our hospitals; your ways are not our ways.”The above is quoted from Mitchell's “Address Before the Fiftieth Annual Meeting of the American Medico-Psychological Association, held in Philadelphia, May 16th, 1894,” which was published in the July 1894 Journal of Nervous and Mental Disease. For a full account, see my book, Coercion as Cure: A Critical History of Psychiatry (Transaction Publishers, July 2007).Syracuse, N.Y. ISSUES NewArchived

Physical sciences and psychological medicine: the legacy of Prof John Dunne.

Fifty years ago, on July 13, 1955, Professor John Dunne delivered his presidential address to the annual meeting of the Royal Medico-Psychological Association in Dublin, focussing on the contributions of 'the physical sciences to psychological medicine.' In his address, Professor Dunne discussed (a) the principle of conditioning, and the work of Hans Selye, especially in relation to 'General Adaptation Syndrome' and the role of stress in producing psychosomatic symptoms; (b) cybernetics and the generation of partial models of cerebral functioning, such as Grey Walter's Conditioned Reflex Analogue and the Electronic Delayed Storage Automatic Computer of Cambridge and (c) the development of integrated, holistic models of cerebral functioning, that took account of advances in both physical medicine and psychoanalytic thought. Professor Dunne placed particular emphasis on the importance of basic scientific research and the development of broadly based models of psychiatric care, both of which were to play critical roles in the development of more scientifically-based, bio-psycho-social models of service provision in the decades to follow.

The Case of the Vanishing Diagnosis

Back to table of contents Previous article Next article History NotesFull AccessThe Case of the Vanishing DiagnosisLucy Ozarin, M.D., M.P.H.Lucy OzarinSearch for more papers by this author, M.D., M.P.H.Published Online:21 Jan 2005https://doi.org/10.1176/pn.40.2.00400028As revisions to APA's Diagnostic and Statistical Manual (DSM) have reflected, our understanding of psychiatric disorders has evolved over time. For example, consider the diagnosis of pellagra—it has virtually vanished.Pellagra, with its triad of dermatitis, dementia, and diarrhea, is rarely seen today, but less than a hundred years ago it was a major reason for admission to mental hospitals in the United States, particularly in the southern states.As late as 1930-32, the state hospital in Goldsboro, N.C., for example, reported that pellagra was responsible for 19 percent of all admissions.In 1863 John Gray, M.D., editor of the American Journal of Insanity (AJI), published a report in the journal of a case of pellagra with psychosis at his hospital in Utica, N.Y. In 1906 Reuben Searcy reported an epidemic of 88 cases at his psychiatric hospital in Alabama. In 1908 the staff of South Carolina's state hospital published a literature review and a review of pellagra-related cases in the AJI, and in 1912 another report from that hospital stated that 28 percent of admissions were due to psychosis with pellagra. Case reports were published from other parts of the country, including Connecticut and Maine.Pellagra had been known in Europe since the 18th century, but its presence in the United States was often denied by physicians and others. Osler's 1906 textbook, Practice of Medicine, said it did not occur in this country. The disease was thought to be due to spoiled maize (corn), but other suggested causes were infectious agents, toxins, and insect bites.The discovery of the cause of pellagra rivals the story of Dr. John Snow, who ended an epidemic of cholera in 1854 simply by removing the handle of the Broad Street pump in London.In 1914 Joseph Goldberger, a physician in the U.S. Public Health Service, was assigned to work on the problem of pellagra, which was reaching epidemic proportions. His observations in a Mississippi orphanage led to controlled studies in a Mississippi prison and at the state hospital in Milledgeville, Ga. He determined that pellagra was due to a nutritional deficiency curable by a diet containing milk and meat. By 1937, the chemistry of the disease was elucidated—tryptophan in the diet is a precursor of nicotinic acid (niacin), which is a necessary co-enzyme in cell metabolism.During this period, the American Medico-Psychological Association (now APA) was concerned with the need for a classification of mental diseases. The first such classification was developed and adopted in 1917. It included the diagnosis of psychosis with pellagra. The rubric was retained in the 1934 revision and in 1942 was placed under “psychoses due to disturbances in metabolisms.”The 1952 revision of DSM changed the rubric to “chronic brain syndrome associated with other disturbances of metabolism” and specifically included pellagra. The 1968 revision placed pellagra under“ psychoses with other physical conditions” and the subheading“ psychoses with other metabolic or nutritional disorders (including pellagra).”The 1980 DSM-III, with its atheoretical and descriptive approach, makes no mention of pellagra, although it does mention toxic and metabolic disturbances as etiologic factors. DSM-III-R, published in 1987, changed the classification to “organic mental disorder of known etiology,” with mention of metabolic disorder but no reference to pellagra.In 1994 DSM-IV used the term “dementia due to (indicate general medical condition)” and mentions vitamin B-12 but not pellagra. An appendix to that volume showing ICD-9-CM codes for selected medical conditions lists pellagra (niacin deficiency) under “nutritional diseases.”Most recently, DSM-IV-TR notes in the chapter “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” that the etiology of these disorders is either a general medical condition or due to the effects of a substance.The story of pellagra is a classic example of how psychiatry has progressed as new knowledge unfolds. ▪ ISSUES NewArchived

'Caught in the middle'? Mental nurse training in England 1919-51.

The early history of mental health nurse training is one that has only been partially researched. While some writers have discussed the content and impact of training on the development of mental health nursing, little has been written on the professional and institutional factors that influenced this development. The medical profession, psychiatry, was to play an important role in the development of training and regulation of nursing staff in the large Victorian asylums and was an important influence on the knowledge base of mental health nursing. Their professional organization, the Medico-Psychological Association (the Royal Medico-Psychological Association after 1926 when they acquired a royal prefix) produced the first textbook for asylum nurses in 1885 and established a national training scheme for them 4 years later. However, in 1919 the Nurses Registration Act established the General Nursing Council for England and Wales and this body was given statutory responsibility for the training and registration of nurses, including 'mental' nurses. They were soon to be in conflict with the Medico-Psychological Association. The two organizations continued to run their own rival training schemes for mental health nurses for over 30 years, the Royal Medico-Psychological Association finally relinquishing their role in 1951. The Royal Medico-Psychological Association scheme proved far more popular than the General Nursing Councils, with significantly more nurses participating in it. This paper discusses these organizational influences on the development of 'mental nurse' training and discusses the possible impact that they have had on the knowledge base of mental health nursing.

Bernard Sachs: 50-Year APA Member

Back to table of contents Previous article Next article History NotesFull AccessBernard Sachs: 50-Year APA MemberLucy Ozarin, M.D.Lucy OzarinSearch for more papers by this author, M.D.Published Online:17 Jan 2003https://doi.org/10.1176/pn.38.2.0048Tay-Sachs disease is a fatal, inherited, metabolic condition. A British ophthalmologist, Warren Tay, M.D., gave the first description of the disorder’s effects on the eyes in 1881, and in 1887 a New York neurologist, Bernard Sachs, M.D., described the clinical picture of Amaurotic familial idiocy.Sachs, known as the dean of American neurology in the first part of the 20th century, was twice elected to the presidency of the American Neurological Association, first at age 36 and again at age 74, and sought to ally psychiatry and neurology.Sachs was born in 1858. He attended Harvard University, where he was influenced by the psychologist William James. After graduating in 1878, he went to Europe and studied with, among others, Adolf Kussmaul and Friedrich Leopold Goltz. After graduating from the University of Vienna in 1882, he spent two years with Theodor Hermann Meynert in Vienna, Jean-Martin Charcot in Paris, and John Hughlings Jackson in London.In 1886 he opened a private practice in New York to treat “mental and nervous diseases.” He later established the first neurologic service in a voluntary hospital at Mount Sinai in New York, which he headed for many years, and was a professor of clinical neurology at Columbia University.In 1897 the American Medico-Psychological Association (forerunner of APA) invited Sachs to give the address at the annual meeting. This was three years after the scathing attack of S. Weir Mitchell, M.D., who had told the members, almost all of whom worked in mental hospitals, that they were isolated from medicine. In contrast, Sachs adopted a conciliatory tone in his speech and talked about the mind as an organ of the brain.Sachs was opposed to psychoanalysis as a treatment method. He had sat with Sigmund Freud in Meynert’s laboratory, and they continued a correspondence for many years. Sachs said analysis was illogical, unsubstantiated in science, and possibly dangerous when used with children.Sachs had 194 publications to his credit, including the first American text on Nervous Diseases of Children (1895), Nervous and Mental Disorders From Birth to Adolescence (1926), and the Normal Child (1926; second edition, 1936). This last book contained a long chapter on “the evils of psychoanalysis.” He remained a strong advocate of bringing psychiatry and neurology together in a neuroscience. ▪ ISSUES NewArchived

The British reaction to dementia praecox 1893-1913. Part 2.

Part 1 of this study described the backdrop to the development of Kraepelin's ideas on dementia praecox and examined the response to the concept in the British psychiatric textbooks and journals of the period. Part 2 now explores the reaction to the concept in the professional meetings of the period, held by the British Medical Association (BMA) and the Medico-Psychological Association (MPA) during the years 1893 to 1913. In addition, it examines and evaluates the main issues and conclusions arising from the debate.