Essay Question for history of disease and medicine?

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Report Thread starter 5 years ago
Hi, I have been assigned the essay question: "Why has it been so difficult for psychiatrists to treat mental illness? " in my history of medicine and disease class at university.
Does anybody have any thoughts on what to look at for this question?
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Report 5 years ago
This is a very big question, but here are some avenues that come to mind.

- Psychiatry is very young compared to physical medicine. Because mental illness was conceptualised in a religious context for so long it means that progress fell behind compared to physical medicine. So it's very much playing catch up and simply hasn't had time to make progress. Organic medicine has been around for thousands of years. Psychiatry only really took of in the 1800s.

- Medicine assumes that an organic (biological) pathophysiology underlies all disease. You work out what is wrong biologically and then treat that biologically with medicines. Psychiatric pathophysiology is far more complex, involving biological, social and psychological factors. Using medicines to treat things heavily influenced by social and psychological factors means the outcomes are always going to be difficult as you aren't addressing all the factors causing and perpetuating an illness. Using psychological techniques as a treatment is also difficult as behaviours are hard to learn and even harder to unlearn.

- Classification is a problem in psychiatry. What do we define as normal behaviour? what do we define as abnormal behaviour? why is one behaviour normal in one culture but abnormal in another? Are mental illnesses discovered or created? It is difficult to treat something that has diagnostic uncertainty attached to it. Some authors (Thomas Szasz, R.D Laing and other anti-psychiatrists) argue that mental illness doesn't exist and is a man made creation. In terms of your question it raises the question of how can you effectively treat something that doesn't exist.

- Excluding the organic conditions that can give psychiatric symptoms (tumours, syphilis, Parkinson's, Huntington's, hypothyroidism, steroid use etc etc) most mental illness has no physical marker. You do blood tests and you find nothing. You do brain scans and you find nothing. This makes diagnosis and treatment very difficult as you cannot identify a clear target to treat.

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