How to survive exams

Imagine this; final exams are coming up and it’s assessment time. You try your hardest to study but no matter what you do, you can’t get on top of things. Or maybe you don’t need to imagine it, maybe you’re living it. Here is my how to survive exams guide. I hope you can find it helpful and might pick up a few tips.

  1. Break things down into bite-size, manageable chunks that you can do one at a time. Maybe write a to-do list and then cross off tasks as you go. This way you can avoid getting overwhelmed by all the content
  2. Start early. The earliest you start to revise, the better place you’ll be when it comes to exam time. Your brain works better at memorising information the more you can go over it, so starting early means you can thoroughly encode the information into your long-term memory.
  3. Work in chunks and take regular breaks. Often it’s recommended to study for 45mins to an hour and then take a 10-minute break. The break is necessary to stop all the information getting jumbled up in your head.
  4. Get enough sleep! The average amount of sleep needed for an adult is 8 hours but this varies between individuals, so do what you know works for you. Revising right before bed is also a good way to make sure the information is consolidated.
  5. Start a new hobby or begin watching a new tv show. It’s good to have something to look forward to between study breaks.

 

Good luck and I’m sure you’ll smash them! Always remember to be kind to yourself; you’re doing the best you can

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A History of Psychiatry: Hero or Villain?

My favourite subject at university by far was the history of minds and madness, so I thought I’d share my essay with you all. Enjoy!


The notion of madness has long been acknowledged, but advancements have altered the way the mentally ill person is conceived, and there remains significant diversity in the accounts of treatments throughout history[1]. Science routinely attempts to legitimise itself by highlighting its roots, but recollection of the history of the psych sciences (i.e psychiatry and proto-psychiatry) is complicated by sporadic progress and diverse origins[2]. Furthermore, competing biological, social and psychological schools have repeatedly rewritten the past as they have risen to the forefront[3]. In this essay, I put forth that the Whiggish perspective of a linear progression[4] is too simplistic, and reflection is required to frame the changing epistemology and content of the psych sciences into wider social and ideological contexts. While there has been significant advancement in effective treatments, I argue that psychiatry needs to be humble in acknowledging that these have originated from its past, and refrain from ‘recasting its heroes as villains’[5], as events have only come to be seen as abuses in hindsight. Furthermore, I aim to highlight the present decline in progress of conceptualising and understanding mental illness. In order to do this, I will expand on the themes of; humoralism, confinement and moral therapy, shock therapy, the emerging pharmaceutical industry, and the classification system of the third Diagnostic and Statistical Manual of Mental Disorders (DSM-III)[6].

The emergence of humoralism caused a departure from the long held tradition of attributing madness to supernatural and divine causes[7]. Hippocrates medicalised illness through his proposition that wellbeing was contingent on the balance of four humours (blood, phlegm, yellow bile, and black bile)[8]. It was believed that physical and mental health were equivalent, and therefore mental ailments could be treated through physical methods such as cupping, bloodletting and induced vomiting which would restore the humours to optimal balance[9]. This notion of physical qualities provided a naturalistic conception of madness that remained popular for much of the 17th Century[10], and the concept of balance[11] which recent disease specificity has lost. Robert Burton endorsed humouralism in his Anatomy of Melancholy[12], whose namesake references the theory of melancholia; significant sadness and anxiety thought to be caused by an excess of black bile[13]. On the other hand, mania was described as the possession of ideas that differed from the truth[14]. In 1886, Wundt regarded these as two different dimensions[15], and thus established an early dimensional model. The notion of physical origin later became associated with reason (or lack of) through Cartesian dualism, but this was challenged by Locke’s tabula rasa which was significant as it proposed methods of retraining the brain[16]. Thus hile it was eventually invalidated, the long endurance of humoralism can be attributed to its relatively sophisticated structure in a time of few alternatives.

Following humoralism came the mad doctors and institutionalisation of the 17th-18th Centuries, and the subsequent moral therapy[17]. The early beginnings of ‘the great confinement’, as Foucault refers to it, can be traced back to the foundation of the Hôpital-Général in Paris in 1656[18]. For a long time, madness was seen as an individual issue but greater awareness, population growth and ideological changes saw it ‘transform[ed]… into a social problem’[19]. These first hospitals were the attempt to deal with the impoverished, incompetent and society’s outcasts[20]. These were not state-led as sometimes argued[21], and highlights that the conception of the psychiatric inpatient predated medical psychiatry[22]. Mad-doctors like Monro continued to use humoralism inspired methods,[23] and patients were often managed like animals. Foucault reasons that this went beyond physical restraint by removing the fascination and ‘voice’ of madness[24], thereby reducing it to an absence of humanity. Such was the case for James Norris, who was chained leash-like for 12 years at Monro’s Bethlehem Hospital[25]. Yet, many argue that contrary to Foucault’s previously mentioned claim, there was nothing ‘great’ or large-scale about confinement in the 17th century, as many favoured private asylums, and outside France institutionalisation rates were low[26]. Furthermore, despite the common interpretation that ‘the 18th century…was a disaster for the insane’[27], massive rehabilitation of institutions occurred through the Mad House Act (1828), and alongside the legends of Tuke and Pinel, through Battie[28] and Conolly[29], and emerging moral therapy[30]. Moral therapy was based on the premise that routine and compassion could treat madness which was an illness[31], and asylums were restructured and built to be places of ‘calmness… hope… [and] satisfaction…where humanity…shall reign supreme’[32] . Nevertheless, this movement failed due to their increasingly chronic and aging population[33], and an inability to maintain high physician-patient-ratios in public institutions[34]. Asylums were not where psychiatry was practiced, but where it was developed to treat and manage patients, and the location where theories were put into practice[35]. While to Foucault, asylums remained repressive[36]; it was here, that humoralism was shown to be ineffective and psychosurgery to be rarely useful; it was here, that optimism and early intervention were born [37]. Hence, though the asylums are considered inhumane, moral therapy conveyed a level of care not previously available.

Before moving on to the biological movement, it seems necessary to define psychiatry and recognise other schools of thought. The term psychiaterie, meaning soul and mind physician, was introduced as a medical discipline in 1808 by Johann Reil who advocated for humane treatment, de-stigmatisation and argued that, ‘we will never find pure mental, pure chemical or mechanical diseases’[38]. This idea of interrelatedness contrasts with the pure biological view of psychiatry, and the psychoanalytic period that Shorter describes as a ‘blip’ in psychiatry’s history[39]. Influenced by Charcot’s inability to find a biological cause for hysteria, Freud’s popular 20th century paradigm focused on talk therapy and argued that mental illness was caused by conflict and repression in the unconscious[40]. To the psychiatrists who wanted to legitimise their field as evidence based, it was a disaster; but from those that viewed psychiatry as pseudo-medical[41], it was ‘the most sophisticated sector’[42]; and from a psychological view, it was the foundation for psychotherapy. Psychoanalysis occurred parallel to significant medical discoveries[43].

The ‘second’ biological movement of the 19th Century, the first involving phrenology and lobotomy, believed madness was caused by a malfunction of the brain and treatments were designed to shock it into correcting itself[44]. The medical term shock refers to states of hypotension and hypothermia[45], and attempts to produce this were done through deep sleep therapy, and insulin comas (1933)[46], which were originally thought would induce seizures[47]. This was founded on Meduna’s observations that epilepsy was uncommon in schizophrenics, and of contrasting changes in the brains of epileptics and schizophrenics, all which suggested that schizophrenia was an antagonist of epilepsy[48]. Subsequently, drugs like Camphor became used to induce seizures, but while arguably effective at reducing psychosis they also caused residual seizures[49]. These side effects motivated the development of the Bini-Cerletti ECT machine in 1938 and the method of using electricity to treat Schizophrenia[50]. The original experiment suggested a decline in symptoms, but is criticised for being vague and likely doctored, especially as it is not popularly known that the first patient Enrico X later relapsed[51]. New methods have highlighted that the prevalence of epilepsy in schizophrenia was actually higher (1.5%) than early studies had suggested (0.13%) and support for biological antagonism declined[52]. A search for a new basis of ECT found that it was more useful for depression than schizophrenia (1940s)[53]. As is a common theme in psychiatry, ECT became a treatment for a disease that it was not intended for which questions the basis and legitimacy of the original experiment. However, it is now thought to be one of the most successful treatments for both severe mood disorders and psychosis and schizophrenia[54]. Highlighting again, that much of the underlying mechanisms is unknown.

Additionally, the growth in biological psychiatry demanded the development of psychopharmacology. Shorter claims that psychiatrists have a tendency to abandon a treatment once there appears to be a better one, and ECT was for a time largely discarded in preference for medications[55]. The beginnings of psychopharmacology were marked by the discovery of lithium (1940s), and Chlorpromazine (1951), the first antipsychotic[56]. In a time where psychoanalysis’ influence was apparent, chlorpromazine was beneficial, as it appeared to cause sedation while allowing capacity for therapy[57]. Psychopharmacology began by using drugs whose mechanisms were not understood, to treat illnesses that were not yet defined[58], however the results of those that worked allowed investigation into the mechanisms behind mental illness[59]. Thus, chlorpromazine made it possible to explore a neural basis of Schizophrenia, and in 1963, was found to increase the metabolism of dopamine[60], which led to the dopamine hypothesis (1966), that Schizophrenics may have overactive dopamine pathways[61]. Thus changing the understanding from electrical impulses to ‘chemically mediated’ signals and leading to the discovery of more neurotransmitters[62]. This allowed breakthroughs into the mechanisms of other illnesses, other antipsychotics, and ultimately to antidepressants[63]. However, it is argued that the search to discover treatments has changed to ‘medicalizing aspects of the human condition’[64] and therefore in trying to progress, psychiatry has distanced itself from essential social and cultural discoveries of the past[65]. Furthermore, the knowledge about pathology has often been overplayed, i.e. the psychiatry’s miracle drug chlorpromazine has been labelled by antipsychiatry as a ‘chemical straitjacket’[66], and research by Kirsch questions the foundations of the neural theories whose results he attributed to the placebo effect[67]. Though there is increasing evidence in favour of the benefits of medication[68]. Regardless, psychiatry has been beneficial insofar as individuals have become to be seen as suffering from a disease ‘in the same sense that cancer or high blood pressure are diseases’[69], and thus it is a step towards de-stigmatising mental illness. In summary, to evaluate the utility of medication it remains necessary to understand the influences involved in its creation, and how perceptions have changed[70].

Moreover, the line between mental illness and normality has still not been clearly described. As put by the Journal of Mental Science, ‘our knowledge of the mental functions of the brain is still comparatively obscure’[71]. Early attempts at taxonomy were made by Kraepelin who abandoned the psychoanalytic focus on aetiology, and the idea of a continuum between normality and madness, in favour of descriptive pathology and categorisation of distinct biological diseases.[72] This was replicated in the creation of the DSM-III (APA, 1980)[73], a manual commonly used to diagnose mental health disorders. The DSM, now up to it’s 5th edition, has undergone many revisions through its attempts to please the current popular movements. These definitions indirectly influence society’s notion of mental illness through the inclusion of symptoms that subsequently, if not already, become perceived as abnormal and hence, the DSM has arguably created many illnesses[74]. Furthermore, despite intending to provide clear definitions to be used by trained professionals, it has regularly failed to do so and there is subjectivity within the medical field. It is possible that this has been caused by the extrapolation of the diagnosing role to professionals other than psychiatrists. Nevertheless, to classify a disorder necessitates that it be understood, but time again history has highlighted the lack of knowledge around aetiology and thus the categories are likely to be incongruent with the structure of mental illness[75]. Furthermore, the DSM was highly influenced by prestige, race, politics, culture and gender prejudices[76], and what makes something a disorder should instead depend on science and the level of disability it has on an individual[77]. There is some argument that the DSM has also been shaped by drug use; occasionally responses to a psychoactive drug have led to distinctions between disorders or perceived boundary change[78]. Additionally, the purely descriptive approach has impaired the development of valid diagnostic categories due to the absence of a testable system[79]. While it may have been progressive in it’s time, the DSM highlights the lack of scientific progress that has occurred since the conception of the DSM-III.

In conclusion, retracing the past may appear to contrast with the linear progression aligning with biological psychiatry, yet progression is not usually undeviating, and it is necessary to understand how psychiatric methods and ideas become recognised as acceptable despite their many risks[80]. I argue that the use and abuse of psychiatry, from humoralism to the asylums and more recent times, was often the result of limited knowledge and thus in the future, modern methods may be criticised for being ‘blinded by biology’[81]. Psychiatry has made considerable advancements in treatments for mental illness, but it is necessary to remain humble about the past and recognise that what is perceived as moral, varies depending on the context. Furthermore, I contend that psychiatry’s conception of mental illness has scarcely progressed at all and this remains a significant problem when treatments are based on classifications provided by the DSM. Future classifications should critique the early theories that led to the DSM, and attempt to provide a measure that aligns with the true nature of mental illness.

 


[1] Eric J. Engstrom, “Cultural and Social History of Psychiatry,” Current Opinion in Psychiatry 21, no. 6 (November 2008): 585, doi: 10.1097/YCO.0b013e328312674f.

[2] Mark S. Micale and Roy Porter, Discovering the History of Psychiatry (Oxford University Press, 1994), 4.

[3] Micale and Porter, 5.

[4] Edwin R Wallace and John Gach, eds., History of Psychiatry and Medical Psychology (Boston: Springer, 2008), xxiii.

[5] Roy Porter, Madness: A Brief History (Oxford: Oxford University Press, 2002), 12.

[6] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (Washington: APA, 1980).

[7] George Androutsos et al., “Health and Disease in Ancient Greek Medicine,” International Journal of Health Science 1, no. 2 (2008): 32.

[8] Lois Hague, “The Four Elements, Four Qualities, Four Humours, Four Seasons, and Four Ages of Man,” Wellcome Library (London: Wellcome Library, 1991).

[9] Androutsos et al., “Health and Disease in Ancient Greek Medicine.”

[10] Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (London: Tavistock, 1967), 197.

[11] Androutsos et al., “Health and Disease in Ancient Greek Medicine,” 35–36.

[12] Robert Burton, Anatomy of Melancholy: What It Is, with All the Kinds, Causes, Symptomes, Prognostickes & Severall Cures of It : In Three Partitions, with Their Severall Sections, Members & Subsections Philosophically, Medicinally, Historically, Opened & Cut Up, 4th ed. (Oxford, 1632)

[13] Hague, “The Four Elements, Four Qualities, Four Humours, Four Seasons, and Four Ages of Man.”

[14] Foucault, Madness and Civilization, 125.

[15] Robert M Stelmack and Anastasios Stalikas, “Galen and the Humour Theory of Temperament,” Personality and Individual Differences 12, no. 3 (1991): 261, doi: 10.1016/0191-8869(91)90111-N.

[16] Porter, Madness: A Brief History, 35–36.

[17] Porter, 53–54.

[18] Foucault, Madness and Civilization, 39.

[19] Gerald N. Grob, “The Transformation of American Psychiatry,” in History of Psychiatry and Medical Psychology (Boston: Springer, 2008), 533, doi: 10.1007/978-0-387-34708-0_18.

[20] Foucault, Madness and Civilization, 40.

[21] Porter, Madness: A Brief History, 53.

[22] Grob, “Transformation of American Psychiatry,” 534.

[23] Andrew Scull, The Insanity of Place / The Place of Insanity: Essays on the History of Psychiatry (Oxford: Routledge, 2006), 56.

[24] Foucault, Madness and Civilization, 38.

[25] Foucault, 72.

[26] Porter, Madness: A Brief History, 53.

[27] Scull, The Insanity of Place, 42.

[28] Porter, Madness: A Brief History, 56.

[29] Scull, The Insanity of Place, 21.

[30] Porter, Madness: A Brief History, 58.

[31] Aaron Rosenblatt, “Concepts of the Asylum in the Care of the Mentally Ill,” Psychiatric Services 35, no. 3 (1984): 244.

[32] John Conolly, On the Construction and Government of Lunatic Asylumd (London: Churchill, 1849), 143.

[33] Grob, “Transformation of American Psychiatry,” 540.

[34] Porter, Madness: A Brief History, 64.

[35] Porter, 55.

[36] Foucault, Madness and Civilization, 266.

[37] Porter, Madness: A Brief History, 56–57.

[38] Andreas Marneros, “Psychiatry’s 200th Birthday,” The British Journal of Psychiatry 193, no. 1 (July 1, 2008): 1–2, doi: 10.1192/bjp.bp.108.051367.

[39] Edward Shorter, A History of Psychiatry: From the Era of the Asylum to the Age of Prozac (New York: John Wiley & Sons, 1997).

[40] Porter, Madness: A Brief History, 94.

[41] David Cooper, “Introduction,” in Madness and Civilization: A History of Insanity in the Age of Reason (London: Tavistock, 1967), viii.

[42] Cooper, ix.

[43] Porter, Madness: A Brief History, 98.

[44] Edward Shorter and David Healy, Shock Therapy : A History of Electroconvulsive Treatment in Mental Illness (New Jersey: Rutgers University Press, 2007), 6.

[45] Shorter and Healy, 9.

[46] Nancy A Piotrowski and Frank Guerra, “Shock Therapy,” Magill’s Medical Guide (Online Edition) (Salem Press, 2016).

[47] Shorter and Healy, Shock Therapy, 17.

[48] Shorter and Healy, 24.

[49] Shorter and Healy, 39.

[50] Piotrowski and Guerra, “Shock Therapy.”

[51] German E Berrios, “The Scientific Origins of Electroconvulsive Therapy: A Conceptual History,” History of Psychiatry 8, no. 29 (1997): 110.

[52] Berrios, 108.

[53] Berrios, 109.

[54] Piotrowski and Guerra, “Shock Therapy.”

[55] Shorter and Healy, Shock Therapy, 164.

[56] Thomas A Ban, “Fifty Years Chlorpromazine: A Historical Perspective,” Neuropsychiatric Disease and Treatment 3, no. 4 (2007): 495–500.

[57] Shorter and Healy, Shock Therapy, 165.

[58] Samuel H. Barondes, “The Biological Approach to Psychiatry: History and Prospects,” The Journal of Neuroscience 10, no. 6 (1990): 1708.

[59] Shorter and Healy, Shock Therapy, 170.

[60] Bertha K. Madras, “History of the Discovery of the Antipsychotic Dopamine D2 Receptor: A Basis for the Dopamine Hypothesis of Schizophrenia,” Journal of the History of the Neurosciences, 22 (2013): 63, doi: 10.1080/0964704X.2012.678199.

[61] Madras, 64.

[62] Ban, “Fifty Years Chlorpromazine: A Historical Perspective,” 497.

[63] Ban, 497.

[64] David Healy, Creation of Psychopharmacology (Harvard University Press, 2002), 2.

[65] Andrew Scull, “Madness and Meaning,” The Paris Review, 2015, https://www.theparisreview.org/blog/2015/04/22/madness-and-meaning/.

[66] Healy, Creation of Psychopharmacology, 4.

[67] Irving Kirsch, “Antidepressants and the Placebo Effect,” Zeitschrift Fur Psychologie 222, no. 3 (2014): 128, doi: 10.1027/2151-2604/a000176.

[68] F Hieronymus et al., “Efficacy of Selective Serotonin Reuptake Inhibitors in the Absence of Side Effects: A Mega-Analysis of Citalopram and Paroxetine in Adult Depression,” Molecular Psychiatry 00 (2017): 1, doi: 10.1038/mp.2017.147.

[69] Nancy C Andreasen, The Broken Brain : The Biological Revolution in Psychiatry (New York: Harper & Row, 1984), 18.

[70] Andrea Tone, “Listening to the Past: History, Psychiatry, and Anxiety,” The Canadian Journal of Psychiatry 50, no. 7 (June 1, 2005): 377, doi: 10.1177/070674370505000702.

[71] Porter, Madness: A Brief History, 105.

[72] Jonathon Y Tsou, “Natural Kinds, Psychiatric Classification and the History of the DSM,” History of Psychiatry 27, no. 4 (2016): 412–13, doi: 10.1177/0957154X16656580.

[73] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders.

[74] Rachel Cooper, Classifying Madness : A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorder (New York: Springer, 2005), 1.

[75] Cooper, 4.

[76] Porter, Madness: A Brief History, 103.

[77] Cooper, Classifying Madness : A Philosophical Examination of the Diagnostic and Statistical Manual of Mental Disorder, 2–4.

[78] Cooper, 126.

[79] Tsou, “Natural Kinds,” 407.

[80] Tone, “Listening to the Past,” 375.

[81] Scull, The Insanity of Place, 85.

On Completing University Part-time

At the beginning of my degree, if I’d been asked if I would ever go part-time with my course, I would have certainly said ‘no’. Yet, that’s not how things occurred and after my first year, I did drop a subject (still considered full-time) and then later took a leave of absence for a year. Unsurprisingly, my views about going part-time have changed.

University can be full on and I found myself drowning in coursework and exams, and for a while forgot who I was as a person. It’s important to have a balance between studying, work, and things that you find enjoyable. My problem was that I was too focused on grades and living up to my peers, and therefore wasn’t enjoying it.

The best thing I ever did was take time off. The notion of completing an undergrad in three years is changing and I’ve come across a lot of people who are choosing to do it over four or even five! You are not weak or abnormal for choosing to take that little bit longer during your studies and you may actually be better off. Spending more time on fewer subjects means you will have a better chance at getting those HDs and be able to enjoy university life more.

If you need to take longer than usual to finish your studies, that is okay. It is perfectly normal. You are not worth less than your peers. You are not doing anything wrong. You are not expected to complete them in a set time. I wish someone had told me when I first started because I may have been able to have had a better quality of life during the beginning of my studies.

How I Write My Notes Now

  1. I used to organise my notes on the computer as seen here, but found that it was difficult for me to remember them and I am the type of learner who needs to physically write my notes out.Screen Shot 2018-02-24 at 12.59.38 pm.png
  2. The method that works best for me now involves printing off the lecture slides, writing on them during lectures and then organising them in folders. I tend to have one folder for two subjects so two folders per semester. This has changed a lot to how I previously took my notes, which you’ll see was primarily computer-based. I also take a plastic document folder to all my classes for loose pieces of paper which go into my folder when at home. Then during SWOTVAC, I rewrite my notes into a spiral notebook and/or cue cards and mindmaps.img_22851.jpg

It’s taken me a long time and a lot of trial and error to work out what works for me but now I have and it’s become almost automatic. You need to find a method that works for you and for the subject you are studying because everyone learns differently.

A History of Psychiatry in 5 Objects

  1. 400-500 BC: Humorism

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Figure 1: Humorism

Humorism was an early theory for the mechanisms of the body. Hippocrates (400-500BC) stated that illness was caused by an imbalance of four humours; blood, phlegm, yellow bile, and black bile (Stelmack and Stalikas 1991, 257), an idea that reigned until the 17th Century (Bos 2009, 29). Galen (Hague 1991) later linked blood to a sanguine disposition (hopeful); yellow bile to a choleric one (easily angered), phlegm to a phlegmatic one (calm, neutral); and black bile to melancholia (sadness). It was understood that imbalances could be adjusted with physical treatments, such as bloodletting and emetics that would remove a humour that was in excess (Androutsos et al 2008, 32), and bleeding and vomiting were evidence that the imbalance was rectified.

Humorism provided a holistic view of wellness that acknowledged the importance of both physical and environmental factors, such as diet and exercise (Telles-Correia and Marques 2015). It was predominately a departure from supernatural ideology and the role of the gods, in favour of the concept that physical and mental health were intrinsically linked (Bos 2009, 31). Bos (2009, 29) believes the decline is linked to a parting from a focus on character in favour of alternative theories. Nevertheless, the idea of balance remains prevalent.

2. From the 17th C: The Asylum

1

Figure 2: Bethlehem Hospital 1714

The concept of locking up the insane began in the late 17th Century (Porter 2002, 51-52). The Asylum was an institution based on moral therapy; the premise that psychology and compassion could be used to treat severe mental illness (Rosenblatt 1984). Prior to this, individuals were largely kept in the community (Porter 2002). One of the earliest hospitals was Tuke’s York Retreat (1796) (Rosenblatt 1984, 246), which echoed the theory of Pinel breaking patient chains (Porter 2002, 58). Both advocated for routines, pleasant surrounds and to abolish restraint.

The asylums were self-contained yet isolated, with architecture that was part of the treatment (Porter 2002, 62). Early on, conditions varied greatly and following outrage at abuse of patients like William Norris at the Bethlehem Hospital (1814), a move was made towards regulation through the Mad House Act of 1828 (Wiles 2016). However, due to overpopulation, patient care declined and by the 1890s more were leaving dead than cured, influencing consequent deinstitutionalisation (Wiles 2016, Porter 2002, 64).

Originating as a place of refuge, asylums were a sign and place of progress (Porter 2002, 65). While it is argued that moving the focus from the body to the mind merely meant switching repression type (Foucault, 1988, 266), this does not warrant overlooking the introduction of compassion, hope and a person-central approach (Shorter, 1997, 4).

3. 1939: Electro-Convulsive Therapy

2Figure 3: Australian ECT Machine (Melbourne Museum 2017)

Electro-convulsive therapy (ECT) is arguably the greatest discovery of psychiatry, and the most effective and empirical treatment (Shorter and Healy 2007, 2).

Replacing chemical alternatives such as metrazol and insulin, both dangerous and less successful, it is a form of shock therapy (1935; Shorter and Healy 2007, 6) which was based on Meduna’s idea that schizophrenia was an antagonist of epilepsy. The concept was to treat symptoms by disrupting brain activity through seizures, coma or loss of consciousness (Piotrowski and Guerra 2016). The development of the Bini-Cerletti ECT machine was motivated by the desire to find a safer treatment.

4. 1951: The First Antipsychotic (Chlorpromazine)

Laborit’s and Rhone-Poulence’s discovery of Chlorpromazine (1951), the first antipsychotic, was a precursor to the rapid development of the psychopharmacology industry (Ban 2007).

3

It was initially used with general anaesthesia to sedate and prevent shock(Carpenter and Davis 2012, 1168) and when trialled on patient Jacques Lh. undergoing ECT, an improvement of psychiatric symptoms was observed (Ban 2007). This was replicated by Deniker and Delay, who announced in Luxemburg that Chlorpromazine reduced psychosis symptoms(Carpenter and Davis 2012). Following this, Chlorpromazine saw the wards of asylums grow calm as noisy schizophrenic patients became quieter and more docile (Elkes and Elkes, 1954, 560), thus reducing violence and the number of hospitalised patients. Hence, despite some side effects like tardive dyskinesia, it became regarded as a miracle drug (Ban 2007, Carpenter and Davis 2012)

4

Following moral therapy’s failure, antipsychotics offered the possibility of a scientific and medical approach that shifted the location of clinical care(Carpenter and Davis 2012, 1168). It wasn’t long before advertisements began marketing Chlorpromazine at not only schizophrenia, but also emotional instability, hiccups and cancer (APA 1956, 2; APA 1958), highlighting the lack of understanding of the mechanisms of the drug. Over time the uses became more specific and psychopharmacology grew rapidly and chlorpromazine prompted the development of the dopamine hypothesis (Carpenter and Davis 2012, 1170).

5. 980- The Diagnostic and Statistical Manual of Mental Disorders-III

5Figure 6: DSM-III

The third edition (1980) of the APA’s DSM (Diagnostic and Statistical Manual of Mental Disorders), was revolutionary for the diagnosis and treatment of mental illness (Decker 2013, xvii).

The DSM-III influenced psychiatry’s shift from an aetiological and psychoanalytic focus, towards descriptive classification (Decker 2003, xvi). Neo-Kraepelinian in nature, (Tsou 2016), it emphasised symptoms and course and aimed to provide clear and valid definitions (APA 2017). This was influenced by the 5-axis system implemented by Spitzer, who advocated for biological ideas (Decker 2013, 315-317). The manual was larger than it’s predecessors and involved the caveats that the criteria were not completely discrete, and should only be used by psychiatrists (APA 1980), for whom it became convenient shorthand.

The DSM-IIIs flaws can be seen through attempts of subsequent editions to rectify mistakes, such as homosexuality’s removal in 1973 (Cooper 2004, 6) and some argue that it has not managed to progress beyond description (Tsou 2016). The criteria were not as clear or evidence based as intended, and symptom thresholds excluded many people from diagnosis (Cooper 2004, 5-22). Nevertheless, the DSM-III was a milestone document due to its descriptive diagnostic categories and the support for which it gave to the disease model (Decker 2013). It was the first DSM to become widely used by professionals and provide a uniform method of diagnosis (Tsou 2016).

The results of electrically induced seizures in a patient called Enrico X, were presented at the 3rd International Neurological Congress (1939), with a reported significant reduction of symptoms (Shorter and Healey 2007, 43), from which ECT rose to popularity in the 1940s. Early on, seizures would result in physical harm and this led to the development of muscle relaxants and use of anaesthetics (Piotrowski and Guerra 2016).

Despite initial popularity, in the 1980s antipsychiatry and politics resulted in rapid decline in the use and reputation of ECT, damage that is still being reversed today (Shorter and Healey 2007, 145). ECT’s development is significant as it is an empirical treatment that can produce rapid responses to acute symptoms of psychosis and depression (Shorter 1997, 3).

 

The Power of Self Compassion

Being compassionate towards others is one thing, but how about directing it towards yourself? Many people find this difficult but allow me to explain why it is important.

Phrases such as ‘ I am enough’ and ‘I am deserving’, hold huge amounts of power. It would not feel significant saying them to yourself, but over time it makes a difference.

I don’t believe in ‘should’ve, could’ve, would’ve’, as we are continuously growing. Every day we are working on ourselves and progressing. Both the good and bad time help to shape us into the person who we are and that’s a journey that we go on throughout our whole lives.

The simple fact is, that changes in behaviour start with changes in mindset and this can be as simple as noticing when you are criticising yourself and being your own bully and acknowledging what you are doing. You could also try reminding yourself that you are multifaceted and have both good and bad parts. One wouldn’t exist without the other.

Change starts with you at the forefront, you can hear all this and not take anything in or you can choose to think about it and find what works for you. There is no one right way to think or do things as we are all individuals, but there may be a right way for you.

So next time you notice you are criticising yourself, acknowledge it. Tell yourself that it’s okay to not be perfect. It’s okay to not always have the answer or do things the way you want to. It’s okay because you are human and humans are imperfect. You are deserving of health and happiness and compassion. You do your best every day and that’s all anyone can do. Be nice to yourself, someone needs to be and there’s no reason why that can’t be you.

Cheers to 21 Years

Today I did something that for a long time I wasn’t sure I would; I turned twenty-one. I wasn’t sure that I would make it this far, but I have.

This feels like the year that I should start feeling like an adult. Turning twenty didn’t feel much different to being a teenager, and now it’s getting real. Guess this means I should start getting my life in order.

Good job me, you made it this far and the world didn’t end. Things will be okay. Just wait and see. You’ll be okay, I promise.

A Guide to Practicing Self Care

Self Care is an important tool for maintaining mental and physical wellbeing. It’s something that’s often passed off as too difficult to fit into our schedules or something we think works for other people and not ourselves. I’m here to tell you that it doesn’t have to be complicated. Sometimes it’s just allowing ourselves to take a break and stop and simply exist. Below is my guide to simple and achievable self-care.

Take Breaks to Recharge

Whether it be from work to study, taking a break from day to day life to do something that makes you feel good can be extremely beneficial. Listening to music, taking a long luxurious bath, painting your nails, sipping herbal tea, watching Netflix or whatever it may be, take time out for yourself to recover.

Find a hobby

This may sound self-explanatory but having a hobby is a good way to destress or unwind and it gives you something to do during the times when you don’t have much to keep you occupied.  Some hobbies include; knitting, crochet, sewing, drawing, running, sport or journalling

Congratulate Yourself for Your Achievements

We are often so busy comparing our lives to that of others’, that we seldom find time to recognise our own achievements. Life is hard. It’s feel of challenges, bumps and hardships that we have to overcome and sometimes even the simple things can be hard. Congratulate yourself for making your bed, for eating breakfast, for not arguing with your family although you wanted to. Whatever it is, you’re doing your best and that’s enough. You don’t have to be perfect, you just have to be you.

Going into my final year of study

This year will be my fourth year completing my undergraduate degree. I started it straight out of high school and have now completed two full years of study. It’s difficult knowing that many of my classmates have graduated and sometimes that makes me feel left behind, but other times it doesn’t bother me too much. I may have taken longer but I needed to due to my health and I believe that my grades have been much higher than what they would otherwise be. So in some ways, my peers have surpassed me but in other ways, they have not. Slow and steady wins the race as they say but this is my personal experience and what works for me might not work for others.

This year I am completing two full-time semesters and one winter subject that I need to make up. I am majoring in psychology and this means that I have two core subjects plus some elective psych subjects to do. I am excited because this means that I finally get to go more in-depth in clinical psych and neuroscience, areas which I deeply enjoy. However, I am also scared about what this means because at the end of this year my degree will be finished. Then I have to choose where I want to go from there. Will I continue with honours? Will I complete my masters? And in what and where? I’m anxious even thinking about it. I am just as uncertain about my future as I was when I had just finished high school.

I hope that this year I can do well with my grades and get into something that makes me happy and that I’m passionate about. I want to do well but I also want to stay mentally and physically well. I think I am finally learning to balance and manage my illnesses with other commitments. It’s taken me a long time but I’m heading in the right direction and that gives me hope.

Navigating University With a Mental Health Condition

Being independent is difficult and even more so, when you are balancing a mental health condition. If the media is correct, then going off to university is meant to be the peak of a young person’s life; it’s the border between being a teenager and becoming an adult. Yet, for many young people it can be the source of disappointment or uncertainty. Below are some tips for how to make the most of university and the resources available.

Register for the disability service

Most unis have a service dedicated to supporting students with an illness, including mental illness. They can provide important information about special consideration, help with applying for extensions, offer alternative assessment rearrangements and check in to see how you’re doing.

Utilise course planning services and student advisors

You can often feel like your identity has been reduced to just one number among many so making appointments with advisors can help you to engage with university staff and feel like you are being listened to. There is staff dedicated to helping you plan your degree, sort out accommodation and financial aid and navigate other services.

Get Organised

Diaries are an extremely important and simple way to keep track of assignments and dates and getting stationary together before classes start can help you to feel on top of things. You can also carry around your class timetable in case you ever need to check it.

Download the Lost on Campus app

The lost on campus app provides a map and direction system that can be used to find classrooms and lecture theatres. If you ever get lost then all you need to do is open the app up on your phone and put in where you want to go and it will direct you.

Seek outside support

Whether this is through a GP or psychologist (most unis have a service too but you won’t want to have an outside one), or through Centrelink having extra support can be crucial to reaching your potential.

Talk to staff

Your tutors are there to help you so talk to them if any issues come up and you’re not sure what to do. There also there to help you learn so make sure to ask questions about the content and assessments and are not a stranger to the teaching staff. The best way to learn is by asking questions.

Look after yourself

Self-care is an essential part of staying well. Find other things that you enjoy and that aren’t related to study, to give yourself a break. This could be through university clubs, learning an instrument or language, work, volunteering, art groups or reading. Whatever it is, make sure you have something that breaks up the study so that your life is enriched and you don’t burn out. Grades are important but there is also more to life than studying.