Today the 18th-century lunatic asylum does not exist. Most of the asylums were closed in the late 1900s because of the invention of antipsychotic medicines. Today, there are psychiatric hospitals for people with mental illness. This includes Broadmoor Hospital, which houses some of Britain's the most dangerous criminals with mental illnesses.
In the 1800s, Dorothea Dix fought against the bad treatment of patients in mental asylums. She started a "mental hygiene" group to encourage politicians to change the treatment of mental patients in the United States. When people became aware of the wrongdoing in mental asylums, money was raised to improve the treatment of patients and the asylums. Dix is thought to have helped to create 32 mental hospitals. By 1940 there were more than 400,000 patients living in mental asylums.
Most treatments were still cruel to patients and were not effective. The asylums were quickly becoming overcrowded. Mary Jane Ward wrote a book in 1946 called "The Snake Pit" that raised awareness of the inhumane treatment of mental patients.
The National Institute of Mental Health was created the same year. The organisation provided training and support for mental patients and workers that cared for them. The Hill-Burton Act was passed to give money to the mental health hospitals.
Later, the Community Health Services Act of 1963 was passed. This law which created outpatient buildings for patients to live at home rather than in hospitals. Rehabilitation and community care centers were also built under this act.
During the late 1900s, mental asylums were less accepted. The cruel treatment of patients and the overcrowding and ways of living were seen as not needed. Less money was being given to asylums. So many closed all around the world. The closing down of mental hospitals became known as deinstitutionalization. The movement from asylum to community was meant to help patients' development and recovery. The lack of good support programs meant that patients felt abandoned and found it hard to fit into normal life. This led to many becoming homeless.
In the past there were three ways to explain abnormal behaviour. These were supernatural, biological, and psychological explanations. Western medicine no longer uses supernatural explanations. Instead we use biological and psychological explanations. Biological explanations use genetics and neuroscience to explain abnormal behaviours. The biological explanation is based on how the brain works and how genes change the way it works. Psychological explanations use how the mind works to explain abnormal behaviours.
Early cultures believed that abnormal behaviour was from demons, spirits and astrology. Trepanation was when a hole was drilled in a person's head. This was done to let the spirits or demons out of the person's head.
Exorcism was practiced mainly by the Catholic Church. Exorcism was believed to ward the spirits out of the person that they possessed.
These practices were normal during the Middle Ages. This was when abnormal behaviour was thought to be a religious issue rather than a psychological one. Some abnormal behaviour was thought to be witchcraft. People accused of witchcraft were almost always punished for the acts. In many cases, the punishment was to be murdered.
The Biological approach to explaining abnormal behaviour assumes that the behaviour can be explained by physical factors. Hippocrates was a man who lived during the 5th century and is thought by many to be the father of modern medicine. He did not accept that evil spirits or astronomy were the causes of psychological disorders. Hippocrates believed that there were natural causes for the disorders and appropriate treatments could be found. He focused on the "four humors" of the brain. He believed that the four humours must be balanced for healthy mental states and when one humour was stronger, various disorders would appear. To balance the humors, Hippocrates would tell patients to change their lifestyles. There are now new ideas when talking about the biological explanations of psychological disorders. But, Hippocrates' focus on mental processes and clinical practice was a revolutionary concept.
Another Greek physician called Galen also took a scientific approach to the causes of psychological disorders. He divided them into physical and mental categories. Among Galen's causes were head injuries, alcohol abuse, and life experiences. During the 18th century, Galen's concepts influenced the medical industry. Galen's focus was on the biological causes for mental disorders.
Psychological explanations for abnormal behavior sometimes take a behavioral approach in which the positive behaviors are reinforced and negative ones are not. This approach is more focused on changing the actual behavior of a person than the true cause of it.
Sigmund Freud was one of the most popular psychological theorists of the 20th century. The method he used to study and treat patients was known as psychoanalysis. Methods of hypnosis by were used by Freud, but also by Franz Mesmer and physicians in the Nancy School. However, Freud attempted to have his patients confess their deepest, truest emotions, which was referred to as a catharsis. He would have his patients speak freely about themselves, in free association. Also he would conduct dream analysis where patients would record and discuss their dreams. Freud's work led to other great psychoanalytic theorists such as Carl Jung, Alfred Adler, and Harry Stack Sullivan. Wilhelm Wundt and William James were credited for opening up the first experimental psychology laboratories. This led to many studies and psychological methods, such as classical conditioning led by Ivan Pavlov and John B. Skinner, while Edward Thorndike and B. F. Skinner were the leaders of the study of operant conditioning.
The North American reference book used by psychiatrists and psychologists to diagnose and treat psychological disorders is known as the Diagnostic and Statistical Manual of Mental Disorders (DSM). It is produced by the American Psychiatric Association (APA). The most recent version was released in May of 2013 and is known as the DSM-5. The DSM is relied upon by clinicians, health insurance companies, medicine companies, and the legal system as a reference for understanding and identifying mental disorders. The DSM divides mental disorders into groups and provides descriptive signs and symptoms that define each disorder. In addition, it lists statistics for each disorder ranging from its frequency in the general population to the most effective form of treatment.
Before diagnosing an individual with a "specific" mental disorder, a professional must first determine whether that individual does in fact suffer from a mental disorder. The DSM defines a mental disorder as a condition that:
When using the DSM, a complete psychiatric diagnosis is split up into five dimensions, called "axes", that relate to different characteristics of disability or disorder:
The separate axes of the DSM are often linked together in the development of mental disorders.
The International Statistical Classification of Diseases and Related Health Problems (ICD) was created by the World Health Organization (WHO) and is the universal diagnostic system for mental disorders. The ICD is approved by health officials from 193 WHO member countries, and is available for free on the internet. Its purpose is to help countries reduce the problems associated with mental disorders. The coding system used in the DSM is designed to be compatible with the system used in the ICD; however, some codes may not match because the two publications get revised at different times. The ICD-10 was made public in 1994; its most recent update occurred in 2010. Chapter 5 of the ICD-10 covers over 300 mental and behavioral disorders which are divided into the following categories:
"The Online ICD-10 can be found in its entirety here"