Introduction and Context

Introduction and Context--first a question

Thomas Szazs in the forward to his book "The Myth of Mental Illness" wrote:

I became interested in writing this book approximately ten years ago when, having become established as a psychiatrist, I became increasingly impressed by the vauge, capricious, and generally unsatisfactory character of the widely used concept of mental illness and its corollaries, diagnosis, prognosis, and treatment. It seemed to me that although the notion of mental illness made good historical sense--stemming as it does from the historical identity of medicine and psychiatry--it made no rational sense. Although mental illness might have been a useful concept in the nineteenth century, today it is scientifically worthless and socially harmful.
Although dissatisfaction with the medical basis and conceptual framework of psychiatry is not of recent origin, little has been done to make the problem explicit, and even less to remedy it. In psychiatric circles it is almost indelicate to ask: "What is mental illness?" In nonpsychiatric circles mental illness all too often is considered to be whatever psychiatrists say it is. The answer to the queston, "Who is mentally ill?" thus becomes: "Those who are confined in mental hospitals or who consult psychiatrists in their private offices."
Perhaps these answers sound silly. If they do, it is because they are silly. However, it is not easy to give better answers without going to a good deal of trouble, first by asking other questions, such as "Is mental illness an illness?" and second, by resetting one's goals from our understanding mental illness to understanding human beings.
The need to re-examine the problem of mental illness is both timely and pressing. There is confusion, dissatisfaction, and tension in our society concerning psychiatric, psychological, and social issues. Mental illness is said to be the nation's number one health problem. The statistics marshaled to prove this contention are impressive: more than a half-million hosptial beds for mental patients, and 17 million persons allegedly suffering from some degree of mental illness.
The concept of mental illness is freely used in all the major news media--the newspapers, radio, and television. Sometimes famous persons are said to be mentally ill--for example, Adolf Hitler... At other times the label is attached to the most lowly and unfortunate members of society, especially if they are accused of a crime.

...The question "What is mental illness" is shown to be inextricably tied to the question "What do psychiatrists do?"

What is mental illness? and what do psychiatrists do?"

We will begin this course on Psychopharmacology by taking a look back into time in hopes of finding at least a preliminary answer to Szasz's question. Three basic trends can be identified in the history of psychiatry down through the ages:

The Magical Approach

The Psychological Approach

The Organic Approach

This will help us to see how disease is a social construct.

dis ease -- is a socially defined condition

The definition

varies with tools of measurement of individuals
varies with the values of those whom society selects to define disease
varies with the society's ability to accept deviation from the norm whic it considers healthy

The second part of our discussion will be about the "ultimate molecule".



                       FDA
                    /       \
                     ______    ____ABA
                PMA         AMA
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                                  InCo

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