A contribution to the study of psychoses in young people with special reference to prognosis

This thesis is concerned with the occurrence of acute psychotic reactions in adolescents and young adults. The study of the causation, the symptoms, and the course of these reactions, furnishes a series of problems of importance and interest. The thesis depends on the examination of the psychoses as reactions brought on by an interplay of the social environment and the individual endowment.The fundamental problem that is discussed is the problem of prognosis. The question that we will address ourselves to is the question of what the prognosis depends on in these reactions. There are various subsidiary questions, each in itself a method of approach to the main problem. For example, the factors which conduce to a recovery are fully discussed and the factors which constitute a basis of malignancy in the reactions are considered. The problems are approached by an examination of the evidence manifested in the endowment of character and personality, in the environmental circumstances, and in the psychotic reaction itself. The points suggestive of the reaction being of a more easily recoverable nature are evaluated along with those which might indicate that the final and satisfactory social adjustment is more difficult of achievement.The problem of the relation to prognosis of the character and personality, the environmental circumstances, and the psychiatric symptomatology may be approached in many ways. What are the best methods of approach? In what way, for example, should the pre -psychotic personality be assessed? To what extent in the majority of cases is it possible to arrive at a satisfactory estimate of the type of pre- psychotic personality or the adequacy of the pre -psychotic character? To what extent is it the case that the better the pre -psychotic adjustment, the better the prognosis? Can the pre-psychotic history be regarded as a reliable guide to prognosis? To what extent can mental illness or eccentricity in the parents or ancestry be taken as a guide to the unsoundness of the individual endowment?The study of the environmental circumstances similarly raises many points. Can abnormality in the reactions of the parents be considered also in this connection? Can the reactions in some such cases indicate an understandable reaction in the circumstances, or is the parental abnormality more suggestive of the likelihood of a bad endowment in the offspring and of the probability that an illness occurring in early life is likely to be malignant in proportion to the eccentricity of the parents? If patients come from a part of the country where there is a greater tendency to psychotic reactions, is it likely that the majority will not recover on account of their coming from a bad stock, or is it likely that the factors that in other people would 'lead to adolescent emotional difficulties of a minor nature, lead, in such people, to a frank psychotic reaction and that this reaction is therefore a temporary upset. In the case of patients who have espoused strange beliefs, or have been interested in strange sects, can it be assumed that there has been an insidious tendency to abnormal thinking indicative of a progressively asocial type of reaction? Or does the fact that a patient has for long been involved in, say, spiritualistic beliefs indicate that the psychosis is not so bad as it looks, that the patient is not so ill, having regard to his usual standard of mental health, and that as he has been associated with others in the abnormal trend of beliefs, so he may be influenced by others towards a recovery?With regard to the study of the patient in the psychosis, there are also many factors to consider. Is an acute onset always of good prognosis, or sufficiently so to serve as a useful guide? If regression is not a true indication of a bad prognosis, is it any guide at all? How should a stupor reaction be assessed in terms of prognosis? Is apparent absence of affect a bad sign? Is preservation of affect always a good sign? Can the extent to which affect is present always be assessed with any degree of confidence? Can any of the features of the psychosis be regarded with any degree of confidence as of good or bad prognosis? Is the acute recoverable schizophrenia of young people a true condition?Do cases of chronic depression occur, beginning in youth? Is it legitimate to divide all cases of psychosis occurring before the age of thirty between the manic depressive group and the schizophrenic group? Is it to be recommended that these names should carry as much prognostic significance as they are accustomed being acceded? Is it possible to continue the use of these terms without such impli- cations having regard to the tenacity with which the diagnosis and course have clung together in spite of all efforts at separation?It is generally appreciated that a prognostic classification has more disadvantages and advantages and that diagnosis by outcome is wholly unsatisfact- ory. The disadvantages of a prognostic classification have been a constant subject of dissension for the past thirty years, and diagnosis by outcome has been held up to ridicule. At the same time the present methods are but modifications of the methods of classifying by prognosis and diagnosing by outcome. The current practice is somewhat as follows:If the examiner's bias is in favour of basing a prognosis on the features of the psychosis, he first assesses the relative prominence of manic - depressive and schizophrenic features and then makes a diagnosis which bears great prognostic significance since the manic depressive elements are equivalent to the more favourable prognostic signs and the schizophrenic to the less favourable. If the manic depressive patient recovers and the schizophrenic patient dements, then the diagnosis is supported by the course. If, on the other hand, the manic depressive patient proceeds to dementia, the diagnosis requires to be changed although the schizophrenic patient may be allowed to recover without the necessity of change of diagnosis.If the examiner's bias is in favour of basing prognosis mainly on the pre -psychotic history, he first arrives at an estimate of the comparative adequacy of the adaptation, assesses the prognosis on this estimate, and calls the patient "manicdepressive" or "schizophrenic" according to the prognosis already arrived at.There is sufficient truth in this account of present methods of diagnosis and prognosis to make it clear that the criticisms of the more rigid type of prognostic classification have not had the desired effect.If the term "schizophrenia" is to be robbed of much of its prognostic importance, then an assessment of the prognosis on the basis of the psychosis, or the pre -psychosis, being so much schizophrenic and so much manic -depressive psychosis will no longer be valid. Are the essentially schizophrenic and the essentially malignant the same? If not, then the term "schizophrenia" can embrace recoverable conditions. How wide should the net be cast? Are all cases of malignant psychosis occurring in young people cases of schizophrenia? If so, is it reasonable to hammer away at the necessity of separating diagnosis from prognosis? If cases other than schizophrenia occur in youth and run a malignant course, can the division remain, or must a new search be made for the essential and fundamental characters of the psychosis?If there is so much misgiving with regard to diagnosis, is prognosis in a better position? Are the prognostic principles of the past thirty years justified? Is a prognosis based on the psyd2 osis and the pre -psychotic history sufficiently accurate to permit us to be satisfied with the present methods, or are such studies as the present merely indicative of an awareness of the limitation of present methods and of an admission that the secant of reversibility in the psychoses must await the development of psycho pathology, or of the methods of psychometry, biophysics and biochemistry?In the present contribution, the psychosis is considered in relation to the life situation. This relationship is studied with a view to finding indications of importance for prognosis. It should be made clear that in the selection of case material, the less malignant rather than the more malignant have been chosen. The approach to the study of the prognosis can be made in two ways. One way is to attempt to establish the essential signs of malignancy, to search for what are assumed to be the essentially malignant features, and to assess the prognosis on their relative prominence. This is best done in association with a report of cases which are running a chronic course. In the present contribution, the other method is chosen; namely, an attempt is made to estimate the value of what may be considered to be favourable signs in the pre -psychotic history, the onset of illness, and the features of the psychosis. Reports are given of groups of cases where such favourable signs can be noted. By means of brief historical surveys, the development of the present -day methods of approach to the problem of prognosis is studied. It is hoped that if this thesis were read by anyone unfamiliar with twentieth century methods in psychiatry, it would prove sufficiently comprehensive for the value of the approach to mental illness in terms of the life situation and the psychobiological reaction to be appreciated. If present -day methods have their limitations, it is surely because the deeper implications in the psychobiological approach have yet to be realised.It is my belief that an examination of the psychosis in its relation to the environmental circumstances and the development of the individual from childhood is as important in the study of mental illness as i8 the examination of the symptoms and physical signs in relation to gross pathology in the study of physical diseases. On this basis an attempt is made to indicate the possibilities of prognostic forecasts.An examination of the psychosis in relation to the development of the individual in early childhood may prove' more analogous to the study of sickness in relation to the finer pathology of disease, and may reveal methods of surer guidance in prognosis. This thesis is not concerned with any such study

A family asylum: a history of the private madhouse at Ticehurst in Sussex, 1792-1917.

Despite a recent burgeoning of interest in the history of psychiatry and institutions for the insane, there has been no full-length study of the history of a private asylum in England. The archives of Ticehurst Asylum, which was run by four generations of the Newington family between 1792 and 1917, offer a rich source for such a study. This thesis locates the asylum in both its social and medical contexts. Initially founded as a small private madhouse, it took a wide range of clientele, including some paupers. The published medical writings of Thomas Mayo (1790-1871), who was visiting physician to Ticehurst from 1817-36, and a published account by John Perceval of his stay at Ticehurst in 1832 mean that there Is substantial evidence to place Ticehurst in the 1820s and 1830s within broader trends of social change, especially the influence of Evangelicalism on manners and morals, and the development of a diagnosis of 'moral insanity'. By the l840s, Ticehurst had become an elite asylum for predominantly upper-class patients. Increased documentation required by the 1845 Lunacy Act means that a fuller profile can be drawn of medical and moral treatment at the asylum, and it is argued that emphasis by historians on the importance of moral treatment has led to insufficient emphasis being paid to the influence of psycho-physiology on asylum doctors'practice, and Victorian medical therapeutics for mental disorders. Finally, the professional career of Herbert Francis Hayes Newington (1847-1917), who was president of the Medico-Psychological Association in 1889-90, provides the basis for a discussion of Ticehurst's location within the profession of psychiatry. This includes the conflict over the proposed closure, and eventual stricter regulation, of private asylums; and the difficulties faced by psychiatry in the absence of significant therapeutic advances in a period of rapid scientific development in other areas of medicine

Themes in Scottish asylum culture : the hospitalisation of the Scottish asylum 1880-1914

Having embarked on a vast journey of asylum construction from the 1860s, Scottish mental health care faced uncertainty as to the appropriate role of the asylum by the 1880s. Whereas the mid century was dominated by official efforts to lessen the asylum's custodial image, late Victorian asylum culture encompassed both traditional and new themes in the treatment and care of patients. These themes included hospitalisation, traditional moral approaches, and wider social influences such as the poor law, philanthropy, endemic disease and Victorian ethics. In an age of medical advance, Scottish asylum doctors and administrators introduced hospitalisation in a bid to enhance the status of asylum culture. The hospitalisation of the asylum was attempted through architectural change, transitions in mental nursing and the pursuit of laboratory research. Yet as a movement, hospitalisation was largely ornamental. Although hospitalisation paved the way for impressive new buildings, there was little additional funding to improve asylum infrastructure by raising nursing standards or to conduct laboratory research work. While the Commissioners in Lunacy proclaimed `hospitalisation' to be a distinctive part of the Scottish approach of mental health care, the policy's origins lay not with the policy makers but with individual medical superintendents. Although hospitalisation became an official approach by the General Board of Lunacy, like any other theme in asylum culture, the extent of hospitalisation's implementation relied on the support of individual doctors and local circumstance. Despite this attempt to emulate modern medicine, moral management rather than hospitalisation methods continued as the fundamental approach of treatment and control in most institutions. The main components of moral management were work and a system of rewards (implemented through liberties and accommodation privileges). The process of mental recovery continued to be linked to industriousness and behaviour. The thesis acknowledges the impact of local forces and wider society upon attitudes towards mental health care, such as the economically driven district lunacy boards and to a lessening extent the parochial boards and philanthropy. In viewing the asylum within the wider context of Scottish society, the asylum shared some characteristics with other Victorian institutions. Finally, although the patient's autonomy within the system should not be overplayed, the asylum doctor was also affected by the patients' co-operation with treatment and the involvement of family and friends in admission

Changing public representations of mental illness in Britain 1870-1970

This thesis uses Habermas' arguments concerning the public sphere and Nancy Fraser's concept of counter-public spheres as a framework to explore how changes in the representation of mental illness occurred between 1870 and 1970. Within this period, the nineteenth-century polarisation of sanity and madness that had led to the segregation of the mentally ill within the asylum gave way to the belief that mental health and illness formed a continuum. Psychiatry extended beyond the walls of the asylum into the community, expanding its scope to incorporate the nominally healthy. These developments, which culminated in the creation of community mental health services and the closure of the asylums, suggest that mental disturbance was no longer seen solely as the problem of sick individuals but of the public at large, and points to a potential destigmatisation of mental illness. To examine if the representation of mental illness matched these developments in practice and to explain why, this thesis studies how groups directly connected to the mentally ill, conceptualised as sub-public groups, sought to represent mental illness. The groups studied are the Medico-Psychological Association in Chapter One, the National Asylum Workers' Union in Chapter Two, The Association of Psychiatric Social Workers in Chapter Three and a charity, the Mental After Care Association, in Chapter Four. The fifth chapter explores patients and the representation of mental illness. It is argued that such sub-public groups helped initiate a debate about mental illness and enabled a broader spectrum of people to participate in the debate. However, it is suggested that private and professional motivations impinged upon how groups chose to represent the mentally ill. The thesis argues that the difficulties groups experienced balancing the representation of their own interests with those of the mentally ill, combined with the negative perceptions some sub-public groups held regarding the general public's capacity to participate in a debate on mental illness, obstructed their efforts to communicate with the public and to represent the interests of the mentally ill. Finally, the thesis uses the case study of the BBC to explore the factors that influenced the media to cover the issue of mental health and illness. This final chapter illustrates the interactions that occurred between media organisations and sub-public groups

Changing public representations of mental illness in Britain, 1870-1970

This thesis uses Habermas' arguments concerning the public sphere and Nancy Fraser's concept of counter-public spheres as a framework to explore how changes in the representation of mental illness occurred between 1870 and 1970. Within this period, the nineteenth-century polarisation of sanity and madness that had led to the segregation of the mentally ill within the asylum gave way to the belief that mental health and illness formed a continuum. Psychiatry extended beyond the walls of the asylum into the community, expanding its scope to incorporate the nominally healthy. These developments, which culminated in the creation of community mental health services and the closure of the asylums, suggest that mental disturbance was no longer seen solely as the problem of sick individuals but of the public at large, and points to a potential destigmatisation of mental illness. To examine if the representation of mental illness matched these developments in practice and to explain why, this thesis studies how groups directly connected to the mentally ill, conceptualised as sub-public groups, sought to represent mental illness. The groups studied are the Medico-Psychological Association in Chapter One, the National Asylum Workers' Union in Chapter Two, The Association of Psychiatric Social Workers in Chapter Three and a charity, the Mental After Care Association, in Chapter Four. The fifth chapter explores patients and the representation of mental illness. It is argued that such sub-public groups helped initiate a debate about mental illness and enabled a broader spectrum of people to participate in the debate. However, it is suggested that private and professional motivations impinged upon how groups chose to represent the mentally ill. The thesis argues that the difficulties groups experienced balancing the representation of their own interests with those of the mentally ill, combined with the negative perceptions some sub-public groups held regarding the general public's capacity to participate in a debate on mental illness, obstructed their efforts to communicate with the public and to represent the interests of the mentally ill. Finally, the thesis uses the case study of the BBC to explore the factors that influenced the media to cover the issue of mental health and illness. This final chapter illustrates the interactions that occurred between media organisations and sub-public groups.EThOS - Electronic Theses Online ServiceUniversity of Warwick (UoW)GBUnited Kingdo

Rheumatism

Obviously it is beyond the scope of this essay to enter into a full and critical account of all the above various conditions to which the term rheumatism has been in one sense or other applied. Such being,then, both unnecessary and inadvisable, I shall restrict my efforts to the consideration of such common forms of the disease as acute articular rheumatism(including the subacute variety and the affection in children), chronic rheumatism,muscular rheumatism,and gonorrhoeal rheumatism,as well as arthritis deformans

Albuquerque Morning Journal, 06-17-1911

https://digitalrepository.unm.edu/abq_mj_news/3056/thumbnail.jp

The construction of scientific knowledge regarding female 'sexual inversion': Italian and British sexology compared, c. 1870-1920

PhDThis thesis uses medical and psychiatric records to explore how physicians analysed `female sexual inversion' in Italy and Britain, c. 1870 to 1920. It investigates why sexology emerged when it did and considers the role national, political and cultural debates played in shaping sexological research. I argue that sexology both upheld and challenged national cultural norms and sought to address various broader problems that shadowed social and political debate in these societies. For Italy, detailed case histories of female inverts are presented. In Britain, however, female homosexuality was observed within other medical concerns because physicians were reluctant to study sexual inversion until at least the late 1890s. In each national context close attention is paid to `typical' locations of female homosexuality, for example asylums, brothels and schools, and to particular figures and relationships; the `tribade-prostitute', the 'fiamma', and the so-called nymphomaniac. Italian and British sexologists had different approaches to the study of these women-only environments, in which female homosexuality was supposedly widespread. By comparing the debates around female sexual inversion it is possible to chart important and illuminating differences of language, status and politics. I will highlight the proliferation of these studies in Italy and the relatively marginal status of British sexologists. Moreover, in Italy criminal anthropology was critical in shaping sexological studies, while in Britain, political motivations linked to laws against `sodomy' were crucial. In the central chapters, the works of Cesare Lombroso and Pasquale Penta in Italy, and Henry Havelock Ellis and William Blair Bell in Britain, are crucial. Alongside texts explicitly discussing `female sexual inversion' as a psychiatric disease, the thesis also examines other medical concerns related to female sexuality. Questions of sexuality and homosexuality were important to wider discussions about women's role in society, female education, prostitution, and broader debates about progress, civilisation and national well-being