Hey. I appreciate your contribution too. I'm always happy when people post their thoughts on this kind of stuff because it gets me thinking :-) I'm not sure where I contradict myself... Though it is of course possible that I do :-)

I found Roy Porter's 'The Greatest Benefit to Mankind: A Medical History of Humanity From Antiquity to The Present' at a book stall the other day:

http://www.amazon.com/Greatest-Benef.../dp/0393319806

Part of the reason why I was inspired to get it was because of your post :-) I also made a blog entry on the theme:

http://analysis.psychcentral.net/2007/08/

Someone asked me this question several months ago: 'How is it that doctors got involved with mental disorders anyway?'

I didn't know what to say in response to that. I've read Edward Shorter's 'A History of Psychiatry: From the Era of the Asylum to the Age of Prozac':

http://www.amazon.com/History-Psychi.../dp/0471245313

But the answer to the question was still unclear to me. Porter offers many examples of how what are now commonly regarded as psychiatric symptoms (e.g., hysteria, melencholia (depression) etc) have always been part of the subject of medical understanding. While it might be wrong to consider there to be 'doctors' in the time of ancient greece etc the people who were interested in helping people with broken legs, battle wounds, fever etc were also interested in helping people with delusions, hysteria, melencholia etc. So... mental (or psychiatric) symptoms have been of interest to medical people for as long as non-mental (or more paradigmatically medical) symptoms have been of interest to medical people.

Porter tells a story where there didn't use to be a divide between 'mental' and 'physical' in the sense that supernatural causes and physical causes were intermingled in understanding and treatment. Remidies included prayers, aumulets, herbs, etc. Materialism (as we know it today) is a fairly recent invention and I'm not really up to that part of the book yet (still in the enlightenment).

I guess a fairly major advance was appreciating that the brain is the physical organ responsible for functions like emotion and perception and reason etc. Hard to understand the physical basis of mental disorder without knowing that. That being said medicine used to be a whole heap more holistic than it is at present. A very old idea indeed is the idea that one should practice 'moderation' with respect to food, drink, sleep, exercise etc. That a moderate person was a healthy person (in the physical/mental sense). There was more focus on (and appreciation of) environmental or situational causes of physical/mental disorder than there is at present. Nowdays people seem very focused on proximate mechanisms (e.g., the brain) rather than less proximate mechanisms (e.g., how the environment causes the brain to be in its proximate state).

I guess... I'm not much convinced that there have been major treatment advances (for mental disorders) in the last 20 years. It is true that more medications have been developed and it is true that therapies have been subjected to empirical investigation and it is true that we have developed better neuroimaging techniques. I'm not sure how much this has led to 'advances' in treatment, however. We don't seem to understand the mechanisms of mental disorder any better than we did. When something seems to work (to provide some relief) we don't really have any idea how or why it works.

Ideas of 'humane (or 'moral') treatment for people with psychiatric conditions are very old indeed (from Pinel, I think). Ideas of 'moderate' living are also very old indeed (prescribed in ancient greece and in egypt and in the middle east and china etc). Ideas of sedating people so that they are more manageable in institutions... Not sure how much that constitutes an advance...

It is interesting to me that the WHO conducted 3 studies where it was found that 3/4 of people dx'd with schizophrenia in developing nations recovered completely whereas only 1/3 of people dx'd with schizophrenia in developed western nations recovered completely. Why on earth should this be the case? People in developing nations have less access to psychiatrists, to psychiatric medications, and more access to social supports and suffer from less social stigma. One might wonder how much western medicine has advanced our understanding and treatment of mental disorders after all...