History of Psychopathology in world and importance

History of psychopathology

1. PsychopathologyPsychopathology
DefinitionDefinition
Science and study of psychological and
psychiatric symptoms
Clinical psychopathology: study in the clinical
context in which psychiatrists make diagnostic
assessments and deliver mental health services

Casey P, Kelly B. Fish's clinical psychopathology. 3rd ed.
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2. OverviewOverview
Ancient beliefs
Supernatural phenomenon
Contribution of thinkers
The Dark age
The Renaissance
Asylums
The Humane approach
Reformers of Psychopathology
 Jaspersian-Schneiderian Approach
Psychoanalysis: Sigmund Freud
Modern Psychiatry
Objectives of Psychopathology
Future Insights
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3. ANCIENT BELIEFSANCIENT BELIEFS
Abnormal behaviours are caused by some
supernatural magic, evil spirits, demons, moon and
the stars
Scholars, theologians & philosophers believed that
a troubled mind was a result of displeased gods or
possession
https://psycnet.apa.org/record/2008-17157-001
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4. SUPERNATURAL PHENOMENONSUPERNATURAL PHENOMENON
Barlow D. H. ,Durand V. M. , Belmont CA: Abnormal Psychology:
An Integrative Approach (4th ed) 2005. 4

5. CONTRIBUTION OF GREAT CONTRIBUTION OF GREAT
THINKERSTHINKERS
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6. HIPPOCRATES(460-377BC)HIPPOCRATES(460-377BC)
Early Greek thinker
Father of modern medicine
Natural causation of mental diseases
Brain pathology- Maladaptive behavior
Classification:
- Mania
- Melancholia
- Phrenitis
Hendrick I. , Hart B: Psychopathology. Its Development and Its Place in Medicine. American Journal
of Psychiatry. 1928;84(5):858-861. 6

7. GALEN(447-398BC)GALEN(447-398BC)
Roman physician; adopted Hippocratic theory
Advocated that four fluids (humors) relate to
the Greek environmental concepts:
i.Heat (blood),
ii.Dryness (black bile)
iii.Moisture ( yellow bile)
iv.Cold (phlegm)
Hendrick I. , Hart B: Psychopathology. Its Development and Its Place in Medicine. American
Journal of Psychiatry. 1928;84(5):858-861.
TEMPERAMENTS
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8. PLATO(429-347BC)PLATO(429-347BC)
Mentally ill: not
responsible for
criminal acts
Hospital care to be
provided for mentally ill
The Divine Causation
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Hendrick I. , Hart B: Psychopathology. Its Development and Its Place in Medicine. American
Journal of Psychiatry. 1928;84(5):858-861.

9. ARISTOTLE(384-322 BC)ARISTOTLE(384-322 BC)
Central concept: Balance
Followed the view of Hippocrates
Believed in relationship between science & philosophy
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Hendrick I. , Hart B: Psychopathology. Its Development and Its Place in Medicine. American
Journal of Psychiatry. 1928;84(5):858-861.

10. The Dark Age: A Big Step BackThe Dark Age: A Big Step Back
Fall of classical civilisation of Greece & Rome
Hippocrates’ biological approach vanished in Europe
Catholic church dominated
Return to the supernatural beliefs
-Mass madness
-Exorcism
Barlow D. H.,Durand V. M., Belmont CA: Abnormal
Psychology: An Integrative Approach (4th ed) 2005.
10

11. Witchcraft & Exorcism Witchcraft & Exorcism
(13(13
thth
-14-14
thth
century) century)
Mental illness: possession
by evil spirit
Treated by exorcism
Malleus Maleficarum
(Hammer of Witches)
 -documented beliefs and
ways to identify, convict &
execute witches
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https://www.thoughtco.com/malleus-maleficarum-witch-document-3530785

12. While in the middle East…While in the middle East…
Islamic countries continued the scientific approach
of Greek thinkers
BAGDAD: First mental hospital in 792 AD
Avicenna of Arabia; Prince of physicians wrote
the book- ‘Canon of Medicine’
Hendrick I. , Hart B: Psychopathology. Its Development and Its Place in Medicine. American Journal of
Psychiatry. 1928;84(5):858-861. 12

13. The Renaissance(14The Renaissance(14
thth
-17 -17
thth
century) century)
Scientific questioning re-emerged
Mental hygiene movement started with the
concept of moral therapy; advocated
humane approach
Barlow D. H.,Durand V. M., Belmont CA: Abnormal Psychology: An Integrative Approach (4th ed)
2005.
13

14. Traditional understanding…Traditional understanding…
Barlow D. H.,Durand V. M., Belmont CA: Abnormal Psychology: An Integrative Approach
(4th ed) 2005. 14

15. Asylums(16Asylums(16
thth
century) century)
With Leprosy on decline, plenty of rooms left
vacant
Taken over as places to refuge mentally ill
St. Mary’s of Bethlehem a/k/a Bedlam
https://psychcentral.com/blog/the-birth-of-the-mental-asylum/
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16. Ancient Vedic IndiaAncient Vedic India
Ayurveda, Charak sanghita, Shushrut sanghita
Atharvaveda: mental illness may result from
divine curses
Gupta SP. Psychopathology in Indian Medicine - Ayurveda. 1 
st
 ed. Aligarh: Ajay Publishers; 1977. p. 223
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17.   
NavarasaNavarasa
Nava: nine; Rasa: Emotions
Verma LP. Psychiatry in ayurveda. Indian J Psychiatry 1965;7:292
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18.   AyurvedaAyurveda
Five elements: space, air, earth, fire,water
Come together to create three different
constitutional types or doshas:
-Vata
-Pitta
-Kapha
Gupta SP. Psychopathology in Indian Medicine - Ayurveda. 1 
st
 ed. Aligarh: Ajay Publishers; 1977. p. 223
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19. Pioneers of the Humane approachPioneers of the Humane approach
Barlow D. H.,Durand V. M., Belmont CA: Abnormal Psychology: An Integrative Approach
(4th ed) 2005.

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20. Pioneers of the Humane approachPioneers of the Humane approach
Barlow D. H.,Durand V. M., Belmont CA: Abnormal Psychology: An Integrative Approach
(4th ed) 2005.
20

21. Reformers of PsychopathologyReformers of Psychopathology
21

22. Emil KraepelinEmil Kraepelin
(1856-1926) (1856-1926)
German psychiatrist
Diagnosis and classification of Psychological
Disorders
Connection of pathogenesis and manifestation of
psychiatric disorders

22
Möhler H: Emil Kraepelin un Neurowissenschaft heute.Vortrag anlässlich der Verleihung der Kraepelin.
Max-Planck-Institut für Psychiatrie in München. 26 November 2003.

23. Emil Kraepelin: The DichotomyEmil Kraepelin: The Dichotomy
1898: Discovered:-
- Dementia precox
- Manic-Depressive Insanity
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Möhler H: Emil Kraepelin un Neurowissenschaft heute.Vortrag anlässlich der Verleihung der Kraepelin.
Max-Planck-Institut für Psychiatrie in München. 26 November 2003.

24. Eugen BleulerEugen Bleuler
(1857-1939)(1857-1939)
Swiss psychiatrist 
April 24, 1908: Coined the term
“Schizophrenia” at a meeting of the German
Psychiatric Association in Berlin
Greek verb: schizein, indicating splitting
Greek word: phren,denoting to ‘soul, spirit, mind’
Fusar-Poli P, Politi P. Paul: Eugen Bleuler and the Birth of Schizophrenia.(1908) Am J
Psychiatry. 2008;165:1407.
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25. Bleuler & SchizophreniaBleuler & Schizophrenia
“I call dementia precox schizophrenia because, the
splitting of the different psychic functions is
one of its most important features. In each case there
is a more or less clear splitting of the psychological
functions: as the disease becomes distinct, the
personality loses its unity”
-Bleuler, 1911

 Bleuler:Dementia Praecox: Or the Group of Schizophrenias. New York: International Universities
Press; 1911. 25

26. Bleuler & SchizophreniaBleuler & Schizophrenia
Concept of primary and secondary schizophrenic
symptoms
 Kuhn R. :Eugen Bleuler's concepts of psychopathology. Hist Psychiatry. 2004;15:361–6.
26

27. Karl Jaspers Karl Jaspers
(1883-1969)(1883-1969)
German-Swiss psychiatrist and philosopher
Imported phenomenology into descriptive
psychopathology
1945: Used “existential” to describe his philosophy
1946: “General Psychopathology”
Jaspers K. :Allgemeine Psychopathologie. Ein Leitfaden für Studierende, Ante und Psychologen. Berlin,
Germany: Julius Springer. 1913:45, 47.
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28. PhenomenologyPhenomenology
Greek stems:
-phainomenon (to appear)
- logia (discourse, science)
Method of choice for obtaining empathic, detailed
& neutral descriptions of mental states
Objective: capturing of “experiential essence” to
reconstruct reality on firmer basis
Berrios GE: Phenomenology, psychopathology and Jaspers: a conceptual history. History of Psychiatry, 3,
303–27 (1992).
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29. Karl Jaspers: Works & ThoughtsKarl Jaspers: Works & Thoughts
29
Klerman GL, Kerr A, McClelland H:An American perspective on the conceptual approaches to
psychopathology. Gaskell. 1991:74–83.

30. Jasper’s Philosophical SearchJasper’s Philosophical Search
3 stages: -Discovery of the world
-Clarification of existence
-Attempt to transcend the world of objects
Klerman GL, Kerr A, McClelland H:An American perspective on the conceptual approaches to
psychopathology. Gaskell. 1991:74–83.
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31. Kurt SchneiderKurt Schneider
(1887-1967)(1887-1967)
German psychiatrist
1931: Director of German Psychiatric Research
Institute, founded by Emil Kraepelin
Diagnosis and understanding of :
-Schizophrenia: First rank symptoms
-Personality disorders (Psychopathic personalities)
Developed “Clinical Psychopathology”
Schneider, K. :Clinical Psychopathology. New York: Grune and Stratton. 1959.
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32. First Rank Symptoms: ConceptFirst Rank Symptoms: Concept
Deals with delusions &
hallucinations: Primary
symptoms
“Presence of delusional
perception excludes a
reactive experience and
always indicates a true
psychosis, which in
practical terms is a
schizophrenic illness”
32
Taylor MA: Schneiderian first-rank symptoms and clinical prognostic features in
schizophrenia. Arch Gen Psychiatry. 1972;26:64–67.

33. First Rank SymptomsFirst Rank Symptoms
33
Schineider (1959), Wing et al (1974).

34. Jaspersian- Schneiderian ApproachJaspersian- Schneiderian Approach
34
Huber G: The psychopathology of K. Jaspers and K. Schneider as a fundamental method for
psychiatry. World J Biol Psychiatry. 2002 Jan;3(1):50-7.

35. Sigmund FreudSigmund Freud
(1856-1939) (1856-1939)
Austrian neurologist
Pioneer of Psychoanalysis
Experimented with different procedures of hypnosis
Encouraged his patients to talk freely
Discovered the unconscious mind and its influence in
psychopathology
Emphasised on internal mental processes and
childhood experiences
Carson, R. C., Butcher, J. N., & Mineka, S:Clinical assessment and treatment. In Fundamentals of
Abnormal Psychology and Modern Life. New York (2002).
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36. Core elements of PsychoanalysisCore elements of Psychoanalysis
36
Carson, R. C., Butcher, J. N., & Mineka, S:Clinical assessment and treatment. In Fundamentals of
Abnormal Psychology and Modern Life. New York (2002).

37. Psychopathology: In Modern Psychopathology: In Modern
PsychiatryPsychiatry
Gestalt for psychiatric disorders
Guided clinical and scientific progress
Marginalized by neurobiological, genetic and
neuro-psychological research
Schultze LF, Schmidt SJ: Psychopathology-A Precision Tool in Need of Re-sharpening. Frontier
Psychiatry, 19 Sept 2018.
37

38. Objectives of Psychopathology: 21Objectives of Psychopathology: 21
stst

centurycentury
Musalek M, Larach-Walters V, Lepine JP, Millet B, Gaebel W on behalf of the WSFSBP Task Force
on Nosology and Psychopathology. Psychopathology in the 21st century. World J Biol
Psychiatry (2010).
38

39. Descriptive PsychopathologyDescriptive Psychopathology
39
Schultze LF, Schmidt SJ: Psychopathology—a Precision Tool in Need of Re-sharpening.
Frontier Psychiatry, 19 Sept 2018.

40. Descriptive PsychopathologyDescriptive Psychopathology
Defines the “abnormal” by standard deviations from the mean or similar
measures
Eg: -Severity  assessment of symptoms of psychosis introduced in DSM-5
-Development of criteria-based operational diagnoses in DSM and ICD
 Stanghelli G. The meanings of psychopathology. 
Curr Opin Psychiatry (2009) 22:559–64.
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41. 41
https://www.who.int/classifications/icd/en/

42. Research Domain Criteria (RDoC) Research Domain Criteria (RDoC)
Research
framework for
new approaches
to investigating
mental disorders
42
Cuthbert BN:Translating intermediate phenotypes into psychopathology:
the NIMH research domain criteria. Psychophysiology(2014)51:1205–6.

43. Clinical PsychopathologyClinical Psychopathology
Musalek M, Larach-Walters V, Lepine JP, Millet B, Gaebel W on behalf of the WSFSBP Task Force on
Nosology and Psychopathology. Psychopathology in the 21st century. World J Biol
Psychiatry (2010)11:844–51.
43

44. Dimensional nosology :Recent Dimensional nosology :Recent
approachesapproaches
Hierarchical Taxonomy Of Psychopathology (HiTOP)
Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR: The Hierarchical Taxonomy of Psychopathology (HiTOP): a
dimensional alternative to traditional nosologies. (2017) 126:454–77.   
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45. Theoretical PsychopathologyTheoretical Psychopathology
Study of etiology or pathogenesis
Strongly links psychopathology to neuroscience
fMRI
Musalek M, Larach-Walters V, Lepine JP, Millet B, Gaebel W on behalf of the WSFSBP Task Force on
Nosology and Psychopathology. Psychopathology in the 21st century. World J Biol
Psychiatry(2010)11:844–51.
45

46. Psychopathology: Psychopathology:
Future InsightsFuture Insights
Psychiatry & psychopathological research: continuum
between (natural) facts and (human) constructs
Re-integration of Neuroscientists and philosophers
i.e., “brain” &“mind”
Widening of diagnostic structures to the full range of
patients' self-experiences in descriptive
psychopathology and reassessed in
clinical psychopathology
Stanghelli G, Broome MR: Psychopathology as the basic science of psychiatry. Br J Psychiatry(2014)205:169–70.
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47. To look forward to…To look forward to…
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1.) Heckers S, Bull S:Future in psychopathology research.(2014) 40(Suppl. 2):S147–51.
2.) Torres-Correia D, Sampaio D:Historical roots of psychopathology. Front Psychol. (2016) 7:905.

48. 48
•Diagnosis and classification of psychological
disorders
•Four As of schizophrenia
•Phenomenology in psychopathology
•Schneiderian first rank symptoms
•Genetic & neurobiological research
•Newly defined nosological constructs
•Etiological psychopathology
•Novel diagnostic tools

49. Take Home MessageTake Home Message
Understanding the history of psychopathology,
its forward steps and mis-steps alike, helps us
to understand the emergence of modern
concepts of Psychiatry
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50. ThankyouThankyou
50
“The world of psychiatry stands on the
grounds which had been dug and built, only
to be dug again and rebuilt”
-Anonymous