PSYCHIATRY


PSYCHIATRY
-The Biblical Period References to states of mental disturbance are frequently found in the Bible. Deuteronomy 28:28, 34 views madness as punishment for disobeying the commandments. The tragedy of Saul's last years is ascribed to an evil spirit that troubled Saul when the Lord departed from him. Saul's paranoidal fears and jealousy of David could not be assuaged by David's attempts to help and reassure him by playing the harp (I Sam. 16:14–23; 18:10ff.; 19:9–10). Later, David himself, in order to escape from Achish, simulated insanity, "scribbling on the doors of the gate and letting his spittle fall upon his beard" (21:11–16). The Bible does not speak of treatment of mental illness or recognize insanity as illness. On the contrary, it was enjoined that the person who was seen to be possessed by spirits should be stoned to death (Lev. 20:27); yet the Bible abounds in counsel for mental health, usually with an ethical intention. In Proverbs it is held that understanding is "a wellspring of life" (16:22) and that "a merry heart doeth good like medicine" (17:22). -In the Talmud In the Talmud mention of mental illness is generally of a legal nature. The episodic nature of mental illness is taken into account on several occasions and there are references to periods when the person is of lucid or of unsound mind. There are also suggestions of a possible classification of mental illness such as a mental defect, confusion, acute and cyclical psychoses, and those which result from physical illness. The Talmud recognizes mental illness and is chary of accepting popular definitions such as: "he who goes out alone at night, who sleeps in the cemetery and tears his clothes" (Tosef., Ter. 1:3, and cf. Ḥag 3b). The word shoteh which contains the idea of walking to and fro without purpose is used to describe the mentally ill. The legal and social implications of insanity are frequently referred to in the Talmud. The mentally ill are not responsible for the damage they cause and those who injure them must bear the responsibility; the insane are not responsible for the shame they cause. They may not marry but, contrary to Greek concepts, in periods of lucidity the individual is considered healthy and capable from every other point of view. The Talmud sets very little store by magical medicines and cures for mental illness which were then current among the nations and were frequently found among Jews in the Middle Ages. It prefers to admit frankly the lack of effective treatment. -The Medieval Period In the Middle Ages Jewish physicians no less than others were dependent on the humoral theories of Greek and Roman medicine (Hippocrates and Galen). Some Jewish physicians made original discoveries and contributions. asaph , the earliest Jewish physician known by name who lived apparently in the sixth or seventh century, felt that the heart is the seat of the soul and vital spirit. In his work, The Book of Medicines, he refers to the disturbed behavior of epileptics and to psychosis–phreneticus. shabbetai donnolo , who lived in the tenth century, wrote in one of his medical books an analysis of the psychiatric conditions of melancholia and of nightmare. His description of mania contains a complex of conditions and undoubtedly included schizophrenia. Donnolo's psychiatric views while avoiding the magical element are derivative from the humoral theory of the Greeks. Nevertheless, though some of his explanations could be termed psychological his treatment was almost purely medicinal. maimonides in the 12th century added to the genius of exegetical and philosophic work the brilliant practice of medicine and the exposition of it. His work Pirkei Moshe ("The Aphorisms of Moses") distinguishes clearly between motor and sensory nerves and voluntary and automatic activity. This book also deals with the anatomy of the brain and organic conditions such as epilepsy, weakness, contractions, and tremor. Maimonides' view of the influence of emotion on bodily function, in producing illness and retarding cure, was unique in his time. He was thus the father of psychosomatic medicine. In Hanhagat ha-Beri'ut ("The Regimen of Health") he sets out these views and instructions for attention to and the mitigation of the emotional state of the patient. He does, however, recognize the limitations of psychiatric care. Sefer ha-Nimẓa, which deals with mental illness, is questionably attributed   to him. The "Sefer Madda" in Maimonides' Code sets out clearly his views on the promotion of individual mental health. His orientation to it is, of course, profoundly ethical, yet he relates mental health no less to the pragmatic functioning of the body and its appetites and effects. In essence this view recommends the middle road between indulgence and asceticism. He abjures all magical procedures. The medieval flowering of Jewish medicine was followed by a prolonged period of folk medicine practiced by peripatetic healers. They acquired a reputation for healing as wonder-workers through incantations, amulets , etc. They treated mental patients as if they were afflicted by spirits, devils, and impure influences. The founder of the ḥasidic movement israel ben eliezer , in the 18th century, acquired his medical reputation by a rapid cure of a mental case. After him there ensued a further period of decadence in which the healers encouraged and exploited superstition. -The Modern Period The reconstruction of psychiatry as a moral practice and a rational system after medieval times was accomplished in Europe only after a prolonged struggle against the demonological beliefs of the Church and the people. Phillipe Pinel's work in France after the Revolution was a turning point. The 19th century saw the progressive definition and classification of mental illness, of the psychoses and the neuroses, and the humanization of treatment in hospital. The first Jewish medical psychologist to join this European movement was cesare lombroso who in 1864 published his Genius and Insanity. He described the delinquent personality carefully and related it to anatomical phenomena and genetic causes rather than moral factors. He thus became a pioneer in human and rational corrective measures for criminal behavior. His work also contributed much to the promotion of scientific thought and methods in psychiatry. hippolyte bernheim 's name is linked with the investigation of the neuroses which took precedence in the last two decades of the century. Although a careful observer, his interest was not in theory but in the cure of the patient. He was the first psychologist to advocate the principle of the "irresistible impulse" in legal medicine. In 1889 sigmund freud was a spectator of Bernheim's astonishing experiments in the treatment by hypnosis of mental hospital patients. Freud decided to use hypnosis in the treatment of neurotic patients and was associated in this task with josef breuer , a practitioner in Vienna. In 1895 their epoch-making book, Studien ueber Hysterie, appeared. This work embodied the discovery of the unconscious. Freud soon found that he could dispense with hypnosis by letting the patient talk at random and obtained better therapeutic results. This new method Freud called free association. With the publication in 1900 of his Interpretation of Dreams, Freud invaded the field of normal psychology, and the borderland between abnormal and normal psychology began to disappear. Freud's theory and technique of psychoanalysis, after much resistance, not only revolutionized psychiatric therapy but was the final and decisive medium in which education, child care, and the treatment of criminals was humanized and made rational. alfred adler challenged the validity of Freud's concepts of basic sexual drives and repression as prerequisites for neurotic symptom formation. In 1912 he coined the term "individual psychology." He reduced the significance of childhood sexual factors to a minimum. For the school which developed around Adler, neurosis stems from childhood experience of over-protection or neglect or a mixture of both. This leads to a neurotic striving for superiority. His intuitive thinking may have been confirmed by thinkers subsequently who have defined the interaction between the goals of the individual and his social group and environment. sandor ferenczi made a singular contribution to psychoanalysis which has been considered second only to that of Freud with whom he was associated. He attempted to correlate biological and psychological phenomena in his scientific method – bioanalysis. karl abraham , one of the founders of psychoanalysis, contributed greatly through his researches to the clinical understanding of the neuroses and the psychoses especially of manic-depressive insanity. A.A. Brill was responsible for the introduction of psychoanalysis into the United States and into the practice of psychiatry there. max eitingon founded the first psychoanalytic training institute and polyclinic in Berlin in 1920. This became the model for all psychoanalytic training. He settled in Palestine in 1933 where he founded the psychoanalytic society and institute. Freud's inner circle or "Committee" by 1919 comprised Ferenczi, Abraham, Eitingon, otto rank , hans sachs , and the only non-Jew among them, Ernest Jones. Jones has commented on the effect of Freud's Jewishness on the evolution of his ideas and work; he attributed the firmness with which Freud maintained his convictions, undeterred by the prevailing opposition to them, to the "inherited" capacity of Jews to stand their ground in the face of opposition and hostility. That also held true for his mostly Jewish followers. Freud believed that the opposition to the inevitably startling discoveries of psychoanalysis was considerably aggravated by antisemitism. Early signs of antisemitism appeared in the Swiss analytic group. Freud felt that it was easier for Abraham to follow his thought than for Jung, because Jung as a Christian and the son of a pastor could only find his way to Freud through great inner resistance. Hans Sachs joined Freud in 1909. He abandoned law for the practice of psychoanalysis. Sachs was an editor and trained analyst whose main work was in the application of psychoanalysis to understanding the creative personality. There were several other Jewish psychiatrists and lay psychoanalysts associated with the earlier phases of the development of psychoanalysis. Among them was paul federn who met Freud in 1902 and was the fourth physician to become an analyst. theodor reik was associated with Freud from 1910. Probably his major theoretical contribution was in the field of masochism. helene deutsch as a psychiatrist and analyst made the pioneer exploration of the emotional life of women and constructed a comprehensive psychology of their life cycle.   melanie klein and anna freud , both lay analysts, were originators of the psychoanalytical treatment of children, which they carried from the Continent to England. In the United States, erik homberger erikson developed concepts of the development of the identity of the individual and his effort to maintain its continuity while seeking solidarity with group ideals and group identity. margaret mahler added to the understanding of normal development in earliest infancy, describing the separation process from the mother. Perhaps the greatest contribution to child psychiatry was made in the United States by leo kanner who, in 1943, first described and named the infantile psychosis, "early infantile autism." Lauretta bender believed that genetic factors determine the infants' vulnerability to a schizophrenic type of disorder and further related the onset of the psychosis to a biological crisis. Her visual Motor Gestalt Test was widely used to reveal organically based problems. moritz tramer , the Swiss child psychiatrist, maintained that childhood schizophrenia exists as a hereditary entity in childhood and runs its course into the adult form. The psychoanalyst paul schilder 's dynamic concept of the "body image" contributed much to psychological thinking in the study of schizophrenia, especially in children. Beata Rank, while stressing the hereditary and constitutional factors in atypical emotional development, in therapy treated the early parent-child relationship. rene spitz , a psychoanalyst, made important contributions in his studies of emotionally deprived infants and those separated from their mothers. Many Jewish psychoanalysts, psychiatrists, and psychologists have been involved in the further development of child psychiatry and therapy especially in the United States. These include phyllis greenacre , herman nunberg , Ruth Eissler, Edith Buxbaum (c. 1895–1982), Bertha Bornstein (c. 1890– ), Marianne R. Kris, William Goldfarb (1915–1995), David Levy (1892–1977), Stella Chess (1914– ), Augusta Alpert, S.R. Slavson , Peter B. Neubauer (1913– ), Reginald Lourie, fritz redl , and Martin Deutsch (1923– ). The effect of analytic theory and practice on psychiatry in the United States received an historic impulse after the Nazi accession and the transplantation of the psychoanalytic centers and practitioners from Europe. franz alexander from Berlin had already added much to ego psychology and that of the criminal before developing, in his Chicago School, concepts of psychosomatic medicine and modifications of psychoanalytic treatment methods. sander rado , who had studied drug addiction and developed "ego analysis" in New York, developed his modifications of it in "adaptational psychodynamics." heinz hartman laid the foundations for the theoretical understanding of the interaction of the ego with personal, biological, and social reality. With ernst kris and rudolph loewenstein he explored the ways in which cultural differences produced variations of behavior. Géza Roheim applied psychoanalytic principles to anthropological research. otto fenichel is remembered as a teacher of psychoanalysis. Ernst Simmel was noted for his contribution on war neuroses and on antisemitism. wilhelm reich made a basic contribution in his analysis of character before his defection from psychoanalysis. Sander Lorand is noted for his teaching in technique. kurt lewin made a notable contribution to the understanding of personality within its psychological environment; erich fromm to the appreciation of the passions and behavior of men as determined by the creativity and frustrations of society; kurt goldstein 's studies have applied principles of perception and reaction of Gestalt psychology. Among the U.S. psychiatrists and others who have contributed much to psychiatry the following should be mentioned here: F.J. Kallmann, for his genetic studies; jules masserman , for his "biodynamic" methods; david rapaport , in his psychological researches; Melitta Schmideberg, for her treatment of major criminals; manfred sakel who discovered insulin therapy; roy grinker , for his integrative approach; and nathan ackerman , for his family therapy. Other notable practitioners, teachers, and researchers were Eduardo Weiss, Milton Greenblatt (1914– ), Paul Lemkau (1909– ), felix deutsch , Greta L. Bibring (1899–1977), Melvin Sabshin (1925– ), lewis wolberg , theresa benedek , Lawrence S. Kubie (1896–1973), Leon Salzman (1915– ), David A. Hamburger (1925– ), David Shakow (1901–1981), abraham kardiner , frieda fromm-reichman , Theodore Lidz (1910–2001), thomas szasz , Samuel Beck (1896– ), bruno bettelheim , David Wechsler (1896–1981), J.S. Kasanin (1897–1946), Samuel Ritvo, Ralph Greenson (1911–1979), Rudolf Ekstein (1912–2005), Milton Rosenbaum (1910–2003), Eugen Brody (1921– ), Eric D. Wittkower (1899–1983), Iago Galdston (1895– ), M. Ralph Kaufman (1900–1977), Howard P. Rome (1910–1992), J.R. Linton (1899– ), Frederick Redlich (1910–2004), and J.L. Moreno who developed psychodrama. Social scientists who contributed to mental health were Marvin and morris opler , Melford Spiro (1920– ), Leo Srole (1908–1993), Morris and Charleen Schwartz, Bert Kaplan (1919– ), and Daniel Lerner (1917–1980). In England the psychoanalytic approach was represented by michael balint , kate friedlander , willie hoffer , susan isaacs , August Bonnard, Joseph J. Sandler (1927– ), W.G. Joffe, and Liselotte Frankl. Erwin Stengel (1902–1973) made remarkable contributions on suicide and M.D. Eder , an early member of the movement, was also a devoted Zionist. Jews in psychiatry are ably represented by sir aubrey lewis , W. Mayer-Gross, emanuel miller (1894–1970), and H.J. Eysenck (1916–1997), who represents the school of "behavior therapy" and psychology. In South Africa, Wulf Sachs (1893–1949) pioneered psychoanalysis and analyzed the first African subject. In France, eugene minkowski was a pioneer in psychiatry and existentialist psychotherapy. In the Soviet Union L.M. Rozenshteyn developed preventive methods in neuropsychiatry. M.O. Gurevich (1906– ) shared the writing of a well-known textbook of psychiatry. The noted Soviet psychiatrist T.I. Yudin wrote an outline of the history of Russian psychiatry. O.B. Feltsman tried to popularize psychoanalysis through a psychotherapy journal and Moshe Woolf attempted this through his activities. The psychologist L. Vygotski and his coworker Luria   contributed fundamentally to the understanding of disturbed thought processes. Psychoanalysis was brought to Palestine by Eitingon Moshe Woolf and Ilya Shalit d. Its influence was extended into the practice of psychiatry by Henri Winnik, Ruth Jaffe, Eric Gumbel (1908– ), and Shmuel Nagler (1914– ). The establishment of the State of Israel led to a rapid expansion of psychiatric facilities, initially in the army and later in communities. Notable contributions were made in this respect and in others by Yeshayahu Baumatz (1897–1964), erich neumann , Shmuel Golan (1901–1966), Janus Schossberger (1914– ), Shlomo Kulcar (1901– ), Abraham Weinberg (1891–1972), Julius Zellermayer (1910– ), F.S. Rothschild , Franz Bruell (1904– ), Ludwig Tramer (1923– ), Miriam Gay (1917– ), Phyllis Palgi (1917– ), and Nehama Barzilai (1918– ). The impact of Jews in modern Western psychiatry probably relates to their personal analytic gifts fostered by their own historic culture. Two events of the 19th century contributed to their entry into psychiatry in the 20th century: the political emancipation of Jews in Europe which permitted their entry into the universities and into the valued profession of medicine in which they had been involved in medieval times; and the freeing of psychiatry from its cloak of irrationality and prejudice, speeded by the discoveries of Freud. Ernest Jones has remarked that historically psychoanalysis was not a particularly Jewish movement in England. Neither psychoanalysis nor psychiatry in England are so even today. Psychoanalysis was not essentially attractive to Jews in the United States until the displacement to the U.S. of the largely Jewish Viennese and German schools and their attraction of Jews there to the profession. In psychiatry in Western countries, Jews were on the whole under-represented but they are especially today well represented in the U.S. -BIBLIOGRAPHY: J.M. Leibowitz, in: Harofe Haivri, 1 (1961), 167–75; D. Margalit, Ḥakhmei Yisrael ke-Rofe'im (1962); G. Zilboorg, History of Medical Psychology (1941), 484–570. (Louis Miller)

Encyclopedia Judaica. 1971.

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