The Psychiatry (in German and mental healing ) is the medical discipline that deals with the prevention , diagnosis and treatment of mental disorders busy. It developed as an independent discipline from neurology, which earlier also covered the field of today's neurology .
The term psychiatry was coined in 1808 by the doctor Johann Christian Reil , who worked in Halle , who understood it to mean the “therapeutic functionalization of psychological effects”. Originally (as Reil first used in 1808) the word psychiatry was used , which was later converted to psychiatry and is composed of the ancient Greek words ψυχὴ psyche , German 'soul' and ἰατρός iatrós , German 'doctor' .
In the course of medical progress, many special subjects have developed within psychiatry that deserve their own mention. It should be emphasized that the essence of psychiatry lies primarily in the knowledge of the interaction of biological, developmental and psychosocial factors on the patient's psychopathological findings . It is therefore not surprising that, in addition to the psychological sub-disciplines, there are also many sub-areas with a biological and scientific orientation within psychiatry:
|Psychopathology||Is concerned with recording the various forms of pathologically changed experience and behavior. For this purpose, symptoms with disease value are described on a psychological level, which in their complexity are then named as manifestations of mental illness.|
|General Psychiatry||Clinical part of the subject that deals with mental illnesses and disorders of adulthood.|
|Acute psychiatry||Handles psychiatric emergencies.|
|Addiction medicine||Treats patients with substance-related (alcohol, nicotine, cannabis , heroin, etc.) or substance-free (gambling addiction, etc.) abuse or addiction behavior.|
|Gerontopsychiatry||Is generally understood as a psychiatry for people of older age, whereby the age (60 years) is only an approximate benchmark. This concerns on the one hand people who are mentally ill at a young age and whose treatment must be continued taking into account age-related peculiarities, and on the other hand people of older age whose mental illness results from aging itself.|
|Forensic psychiatry||Deals with the treatment and assessment of mentally ill and addicts lawbreakers (see also the penal system ).|
|Psychosomatic medicine||Originally emerged from psychiatry, it is now a specialty of its own and can be understood as a link between internal medicine and psychiatry. It deals with psychosomatoses, with somatoform disorders and somatopsychic adjustment disorders, diseases in which interactions between psychological and physical factors ( psychosomatics ) play a central role. Psychotherapeutic methods for relief or healing are in the foreground.|
|Biological psychiatry||Collective term for psychiatric research approaches based on biological methods. These include neuroanatomical , neuropathological , neurophysiological , biochemical and genetic approaches.|
|Child and Adolescent Psychiatry||Independent medical specialty, deals with the mental illnesses of children and adolescents up to the age of 21.|
|Military psychiatry||Deals with mental disorders within military constellations with the aim of ensuring the health of as many military personnel as possible as well as with the treatment of military personnel who are considered unfit as a result of mental illness.|
|Transcultural Psychiatry||Deals with the cultural aspects of the development , frequency and type of mental disorders and with the so-called culture- related syndromes .|
|Neuropsychiatry||The neuropsychiatry deals with neurological factors of mental disorders. As organic influences are being discovered for more and more mental disorders, it is a branch of science that is gaining in importance. For example, illnesses such as obsessive-compulsive disorder , Tourette's syndrome and schizophrenia were primarily explained psychoanalytically and psychologically up until the 1970s, but today there is well-founded knowledge about neurological influencing factors.|
|Social psychiatry||The term social and community psychiatry describes the concept of so-called community-based psychiatric care. The aim is that people with mental illnesses - just like people with physical illnesses - can be treated in the vicinity of their place of residence.|
Modern psychiatric treatment approaches are characterized by "multimodal" concepts . According to this, all areas of the patient's life should be considered in one treatment and different therapeutic approaches should be combined with one another. The most important principles of modern psychiatric treatment are accordingly:
- Freedom is more important than health. First and foremost, this means that patients have the right to refuse treatment.
- Equality for the mentally and physically ill. This principle is important in the care structures because it creates sufficient funds for care.
- Community care: Patients have the right to be treated in clinics and facilities that are close to where they live; In Germany this has led to the establishment of small psychiatric departments at general hospitals and to the closure of many state hospitals.
- The aim of psychiatric treatment is not only to cure, but also to improve the quality of life , ie living with the disease.
- Therapists from all professional groups in psychiatry support the anti-stigma initiatives of those affected by promoting the integration of patients with mental illnesses into society in a variety of ways (outpatient treatment, sheltered living, sheltered work).
The psychotherapy is available as a generic term for the professional treatment of mental disorders by psychological means. It includes all verbal and non-verbal psychological procedures aimed at treating mental and psychosomatic illnesses , states of suffering or behavioral disorders .
- In behavioral therapy , the focus is on helping the patient to help himself, in order to provide him with methods with which he can cope better in the future after understanding the causes and history of his problems. For example, cognitive behavioral therapy tries to make the person concerned understand his thoughts and assessments, correct them if necessary and translate them into new behaviors.
- In depth psychology (e.g. psychoanalysis ) and in depth psychology-based psychotherapy, there is a confrontation with unconscious motivations and conflicts that are anchored in the life story, mostly in childhood. The aim is to clarify the unconscious background and causes of current ailments or conflicts that recur in the history of life and to dissolve or weaken them through awareness.
The psychopharmacology and psychopharmacotherapy deal with the influence of the soul and state of mind by medication. Since the 1960s, psychotropic drugs have made up the vast majority of the “physical” - that is, non-psychotherapeutic - treatment methods in psychiatry.
→ Main article: Forced treatment
Forced treatment is the sum of therapies and custodial measures used in psychiatry that is carried out independently of the patient's will. It is used in situations that are dangerous to oneself or others and is subject to judicial control. Methods of external coercion can also restrict self-determination. The focus here is on legitimacy in both therapeutic and legal terms.
The demarcation of psychiatry from other medical disciplines is such. B. in the consulting and liaison psychiatry (K&L) partly fluent. In the psychosomatic medicine patients are treated primarily in which mental disorders seriously affect the physical condition have (z. B. eating disorders ). The boundaries between the domains of neurology and psychiatry are fluid, for example in the case of organic brain psychosyndromas and dementias, as well as in view of the recent increasing knowledge that many mental disorders can also have neurobiological causes.
In child and adolescent psychiatry , patients under the age of 21 with mental illnesses are treated. There are also age-specialized clinics for this group of patients. The doctor for psychotherapy and psychiatry for children and adolescents, the child and adolescent psychiatrist, has been an independent specialist group since 1993, some of which completed their training in pediatric and psychiatric clinics, but mostly in specialist child and adolescent psychiatric clinics. Adolescent patients with mental disorders should and are therefore treated by child and adolescent psychiatrists on an outpatient basis and, if necessary, in child and adolescent psychiatric hospitals, especially if the symptoms are very severe or occur suddenly.
The psychology is an independent empirical science , while psychiatry is a branch of medicine. Psychology describes and explains the experience and behavior of people, their development in the course of life and all relevant internal and external causes and conditions. Graduated psychologists work as employees in psychiatry and take on tasks there in the field of diagnostics and therapy for mental disorders. Psychological psychotherapists with a license to practice practice work independently in the therapy of mental disorders. In contrast to medical psychotherapists, psychological psychotherapists only have psychotherapeutic methods at their disposal.
The specialist in psychiatry and psychotherapy has replaced the previous specialist titles "specialist in psychiatry" and "neurologist" (as a combined specialist training from psychiatry and neurology). In 1994 psychotherapy was made compulsory in specialist training.
For psychiatric (and some neurological diseases) (in contrast to the then still widespread magical-religious ideas), “natural” causes were assumed for the first time in the Corpus Hippocraticum , at the time based on concepts of humoral pathology .
The doctor Johann Weyer , who worked in the 16th century, saw mentally ill or feeble-minded patients who were not punished but instead should be treated medically in women who were described or defamed as witches .
The main features of modern psychiatry can be traced back to just a few concepts. In the middle of the 19th century Wilhelm Griesinger formulated the most important basis of modern psychiatry with the thesis that mental illnesses are diseases of the brain. Emil Kraepelin provided a usable nosological reference system for the first time in the history of psychiatry . Karl Jaspers ' work on general psychopathology from the 1920s is fundamental to the methodology of modern psychopathological thinking. The basis of the concept of illness in modern psychiatry until the 1990s is the so-called triadic system according to Kurt Schneider , which was published in 1931. With the introduction of the ICD-10 in 1992, a globally standardized classification system, psychiatry's understanding of illness changed again.
In Germany, more than 100,000 people who were declared mentally ill were killed in the context of the national socialist murders (e.g. Aktion T4 and Aktion Brandt ) by 1945. This was only possible with the approval of numerous doctors and clinics. These crimes have been played down and suppressed for decades. It was not until the early 1980s that critical research into the role of psychiatry during the Nazi era began. In 2010, the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) set up an independent commission to review its history, headed by the medical historian Volker Roelcke from Giessen . As part of a two-year research contract, the historical commission examined the period from 1933 to 1945, during which, among other things, the centrally planned homicides took place, which were organized from Tiergartenstrasse 4 in Berlin (Action T4). Furthermore, on November 26, 2010, a commemorative event "Psychiatry under National Socialism - Remembrance and Responsibility" took place in Berlin, at which the then DGPPN President Frank Schneider, on behalf of the psychiatric society, spoke to the victims and their relatives for the injustice and suffering they suffered excused.
Reform of psychiatry
The introduction of neuroleptics and the implementation of catamnesis studies in Germany in the 1950s, especially by the Bonn psychiatrist Gerd Huber , helped to end the long-standing therapeutic nihilism of psychiatrists, especially in the case of schizophrenia . After the psychiatry reform in the 1960s and 1970s and the development of modern social psychiatry , mentally ill people were largely emancipated from paternalism in most western countries.
Modern psychiatry is therefore essentially based on the findings of biological psychiatry and the reform efforts of social psychiatry. Overall, a bio-psycho-social understanding of illness is currently assumed, i.e. an interplay of biological, psychological and social influences is considered to be the cause of the development of psychological disorders. This also results in a multimodal approach in treatment that includes biological (especially psychopharmacological), psychotherapeutic and social aspects.
Criticism of psychiatry
The psychiatrists Thomas Szasz (1920–2012) and Ronald D. Laing , like the sociologist Michel Foucault , hold the view that concepts such as madness (psychosis) and psychological normality are not objective diagnoses but rather subjective judgments with social and political effects. According to Foucault, the demarcation between normality and madness is used for social control. Clinical psychiatry is no longer just a medical facility, but serves as a norm-setting authority.
- List of psychotherapeutic specialist and professional associations
- German Society for Psychiatry, Psychotherapy and Neurology (DGPPN)
- German Society for Social Psychiatry (DGSP)
- Royal College of Psychiatrists
- Federal Association of Experienced Psychiatrists
- Federal Association of Relatives of Mentally Ill People (BApK)
- BASTA - The Alliance for Mentally Ill People
- Erwin Heinz Ackerknecht: Brief history of psychiatry. 3. Edition. Enke, Stuttgart 1985, ISBN 3-432-80043-6 .
- Mathias Berger (Ed.): Mental illnesses. Clinic and Therapy. 2nd Edition. Urban and Fischer, Munich 2004, ISBN 3-437-22480-8 .
- Thomas Bock, Hildegard Weigand (Hrsg.): Handwerksbuch Psychiatrie. Textbook. 5th edition. Psychiatrie-Verlag, Bonn 2002, ISBN 3-88414-120-1 .
- Klaus Dörner : To err is human . 3. revised Edition. 2006, ISBN 3-88414-440-5 ( review by Annemarie Jost. In: socialnet reviews from July 2, 2002)
- Gerd Huber: Psychiatry. Textbook for study and further education. Schattauer, Stuttgart / New York 1974, ISBN 3-7945-0404-6 , 7th edition 2005, ISBN 3-7945-2214-1
- Andreas Marneros , F. Pillmann: The word psychiatry was born in Halle. From the beginnings of German psychiatry. Schattauer Verlag, Stuttgart 2005, ISBN 3-7945-2413-6 .
- Hans-Jürgen Möller , Gerd Laux, Arno Deister : Psychiatry and psychotherapy. 4th edition. Thieme, Stuttgart 2009, ISBN 978-3-13-128544-7 .
- Christian Müller (Ed.): Lexicon of Psychiatry. Collected treatises of the most common psychopathological terms. Springer, Berlin / Heidelberg / New York 1973; newer edition ibid 1986, ISBN 3-540-16643-2 .
- Ewald Rahn, Angela Mahnkopf: Textbook Psychiatry for Study and Work. 3. Edition. Psychiatrie-Verlag, Bonn 2005, ISBN 3-88414-378-6 .
- Frank Schneider , Peter Falkai, Wolfgang Maier: Psychiatry 2020 plus: Perspectives, opportunities and challenges. Springer, Berlin / Heidelberg 2012, ISBN 978-3-642-28221-8 . (Full text, PDF; 3.3 MB)
- Frank Schneider (Ed.): Specialist knowledge of psychiatry and psychotherapy . Springer, Berlin 2012, ISBN 978-3-642-17191-8 .
- Frank Schneider (Ed.): Psychiatry in National Socialism - Remembrance and Responsibility. Psychiatry in National Socialism. Remembrance and responsibility . Springer, Berlin 2011, ISBN 978-3-642-20468-5 .
- Heinz Schott , Rainer Tölle : History of Psychiatry. Disease teachings, wrong turns, forms of treatment . Beck, Munich 2006, ISBN 3-406-53555-0 .
- German Society for Psychiatry, Psychotherapy and Neurology (DGPPN)
- Psychiatry network (information offered by several socio-psychiatric associations and publishers)
- Mechler: The word psychiatry. In: The neurologist. Volume 34, 1963, pp. 405 f.
- Bernhard D. Haage, Wolfgang Wegner: Medicine in the Greek and Roman antiquity. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 915-920; here: p. 918 (quoted).
- Biographical archive of psychiatry: Reil, Johann Christian .
- SC Yudofsky, EH Hales: Neuropsychiatry and the Future of Psychiatry and Neurology. In: American Journal of Psychiatry. 159 (8), 2002, pp. 1261-1264.
- JB Martin: The integration of neurology, psychiatry, and neuroscience in the 21st century. In: American Journal of Psychiatry. 159 (5), 2002, pp. 695-704. doi: 10.1176 / appi.ajp.159.5.695 . PMID 11986119
- P. Gamazo-Garrán, CA Soutullo, F. Ortuño: Obsessive-compulsive disorder secondary to brain dysgerminoma in an adolescent boy: a positron emission tomography case report. In: Journal of child and adolescent psychopharmacology. Volume 12, number 3, 2002, pp. 259-263, doi : 10.1089 / 104454602760386950 , PMID 12427300 .
- N. Ozaki, D. Goldman, WH Kaye, K. Plotnicov, BD Greenberg, J. Lappalainen, G. Rudnick, DL Murphy: Serotonin transporter missense mutation associated with a complex neuropsychiatric phenotype. In: Molecular Psychiatry. Volume 8 (2003), pp. 933-936.
- W. Goodman: What Causes Obsessive-Compulsive Disorder (OCD)? 2006, In: Psych Central. Retrieved November 4, 2011 from http://psychcentral.com/lib/2006/what-causes-obsessive-compulsive-disorder-ocd/
- CA Ross, RL Margolis, SA Reading et al: Neurobiology of schizophrenia. In: Neuron. 2006 Oct 5; 52 (1), pp. 139-153.
- Christopher Smith: A Tourette syndrome primer for therapists. 2008, ISBN 978-0-549-72050-8 .
- Mary M. Robertson: Gilles de la Tourette syndrome: the complexities of phenotype and treatment. (PDF; 303 kB), In: British Journal of Hospital Medicine. February 2011, Vol 72, No 2.
- Keyword psychotherapy in DORSCH (Encyclopedia for Psychology)
- Hans Bangen: History of the drug therapy of schizophrenia. Berlin 1992, ISBN 3-927408-82-4 .
- CA Ross, RL Margolis, SA Reading et al: Neurobiology of schizophrenia. In: Neuron. 2006 Oct 5; 52 (1), pp. 139-153.
- Helmut Siefert : Psychiatry. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 1190-1193; here: p. 1190 f. ( Antiquity ).
- Gerhardt Nissen : Early contributions from Würzburg on the development of child and adolescent psychiatry. In: Peter Baumgart (Ed.): Four hundred years of the University of Würzburg. A commemorative publication. Degener & Co. (Gerhard Gessner), Neustadt an der Aisch 1982 (= sources and contributions to the history of the University of Würzburg. Volume 6), ISBN 3-7686-9062-8 , pp. 935–949; here: p. 937.
- Thomas S. Szasz: Mental Illness - A Modern Myth? Outline of a theory of personal behavior. Olten / Freiburg i. Br. 1972, p. 11 ff. (Orig .: The Myth of Mental Illness. Foundations of a Theory of Personal Conduct. New York 1961.)
- Michel Foucault: Madness and Society. A story of madness in the age of reason. Frankfurt am Main 1993, pp. 15-21. (Orig .: Histoire de la folie à l'âge classique - Folie et déraison. 1961)