History of psychiatry: what’s it got to do with dogs?

Blog post by dog behaviourist Laure-Anne Visele, The Hague, briefly outlining the history of psychiatry
Written in: August 2017.
Illustration credits at the end of the post.

About the author: certified dog trainer in The Hague

My name is Laure-Anne and I am the dog behaviour therapist at Canis bonus, and Head Trainer at OhMyDog! (dog training school) in The Hague.

I help people from The Hague, Rijswijk, Delft, Westland and region with their dog behaviour.

I have a degree in Zoology, am a certified dog training instructor, and have a Postgraduate in applied animal behaviour (Magna cum laude).

If you want dog-friendly and evidence-based tips, drop me a line briefly explaining the problem and I’ll tell you if I think I can help.

What does psychiatry have to do with dogs?

As a dog behaviourist, I need a finger in every behaviour pie:

1. Ethology: animal behaviour in their natural habitat,
2. Behaviourism: how animals (humans included) learn,
3. Comparative psychology: comparing human and canine behaviour disorders.

So I have basic knowledge of the signs of the major psychiatric conditions recognized in humans, particularly ones affecting fear, arousal and aggression regulation. So I practically jumped for joy when I found a tiny book on the history of psychiatry in an old bookstore. It fascinated me so much that I expanded the milestones written in the book into the combined list I compiled belowwith other psychiatry milestones. Here goes, welcome to my rough and ready psychiatry timeline.

A history of psychiatry

• 1550 BCE – Rough symptoms of clinical depression are described on the Ebers papyrus (Egypt), a classification of known diseases at the time.
• 872 – A hospital for the mentally ill is opened in Cairo, with Islam’s typical charitable attitude to the less fortunates. This is in stark contrast to Europe’s medieval ‘lunatic asylums’, where patients are believed to be under the influence of the devil and suffer base abuse. ‘Lunatics’ in Europe were often cared for by monasteries, and subjected to cruel treatment in the name of saving their souls.
• 1377 to 1676 – Bethlem – aka Bedlam – was founded in 1247 but only started acting accepting patients with symptoms of mental illness in the 1370’s. The dispensary since became synonymous with the worst abuse of psychiatric patients known to history, with harsh physical abuse and solitary confinement, believing these to be therapeutic. Aside from schizophrenic patients (‘lunatic’ patients), it also accommodated for epileptic (‘falling sickness’) patients, dementia sufferers and people with learning disabilities.

• 1530 – Jean Fernel (Catherine de Medicis’ attending physician), drafts the first classification of mental disorders in his Medicina universa. He sorts them along four major axes: mania, melancholy, dementia, and idiots.
• 1656 – Louis XIV (France) founds an institution for prostitutes and the mentally ill.
• 1777 – William Cullen coins the word neurosis. Used today to mean an episode of intense stress whilst retaining a sense of reality. As opposed to a psychosis.
• 1810 – The Code Napoleon (Napoleonic Constitution) absolves psychotic patients from criminal responsibility.
• 1818 – The word ‘Psychiatry’ is born. Coined by Dr. Johann Christian Heinroth, German medical doctor. Not to be confused by Oskar Heinroth, one of the founding fathers of ethology. At the time, only the most severely affected in-patients fell under the realm of psychiatry. They were treated with inhumane and mostly ineffective measures.
• 1828 – The Madhouse Act (UK) is the first attempt to regulate mental asylums and give a semblance of rights to psychiatric patients.
• 1848 – Phineas Gage, a US railway worker, suffers severe damage to his left frontal lobe in a work accident. Subsequently, obvious behaviour changes are observed including loss of social inhibitions, quickness to anger and lack of ethical consideration. Nowadays, his proclaimed dramatic changes of personality are debated (see here and here) but his case was historical in the dawn of the brain localisation period in neuroscience, where every function was believed to have but one discrete location in the brain.

• 1859 – Dr. Briquet (France) writes the ‘Traite clinique et therapeutique de l’hysterie‘, including taking a stab at aetiology. The book covers every affliction he equated to a neurosis, from vomitting, barking, catalepsy and mutism to hiccups.
• 1867 – First use of the word ‘depression’ by French poet Baudelaire. This will only be used in psychiatry from 1970, finally replacing the term ‘melancholy’
• 1870’s – Bromides were the sedatives of the day. This highly addictive compound was also prescribed to epileptics in the belief that it would lessen the sexual urges that were thought to be at the source of their mal.
• 1870’s: A silver-staining method invented by Camillo Golgi, combined with microscopy, reveal the anatomy of the neuron.

• 1887 – Elizabeth Cochran Seaman (pen name Nellie Bly) poses as mentally ill and stays for ten days undercover in a psychiatric institution in the US, revealing abject abuses leading to wide-ranging reforms.

• 1888 – Santiago Ramon y Cajal puts forward that neurons are the central functioning unit of the brain.
• 1893 – Emil Kraepelin’s describes the clinical signs of dementia praecox (precocious dementia): onset in late teens/early adulthood, chronic episodes, and loss of cognitive abilities. Today, these clinical signs are classified as schizophrenia.
• 1895 – Josef Breuer and Sigmund Freud publish their Studies on hysteria, famously discussing the case of Anna O (Bertha Pappenheim, a pioneer for the feminist cause).
• 1901 – Alois Alzheimer, German psychiatrist, documents his eponymous disease.
• 1903 – Barbiturates, highly addictive anti-convulsants, are introduced and subsequently widely prescribed as hypnotics (i.e. sleeping pills) and later as sedatives (i.e. relaxants). Barbiturates had a narrow therapeutic range, in the sense that excess dosage could quickly lead to a toxic response – read overdose. Barbiturates also cause some of the most dangerous drug withdrawal reactions. Despite all this, they continued to be widely prescribed until the 1970’s.
• 1905: PTSD-like symptoms labelled ‘battle shock’ in Russian soldiers. Later labelled ‘shell shock’ by British soldiers during WWI.

• 1905: Alfred Binet and Theodore Simon, French psychologists, develop the Binet-Simon scale to measure intelligence. This is the world’s first attempt at a standardized psychometric test.
• 1908: Eugine Bleuler, Swiss psychiatrist (and director of a Zurich mental institution), coins the term ‘schizophrenia’
• 1911 – First use of the word ‘autism’ by Eugene Bleuler, Swiss psychiatrist.
• 1920 – John Watson (and his graduate student, Rosalie Rayner), conducts the famous Little Albert experiment whereby he permanently traumatises a baby by producing a loud noise upon presenting a white rat in support of his claims of classical conditioning being applicable to humans. Little Albert famously suffered from a lifelong phobia of small animals.

• 1923 – Freud elaborates the school of psychotherapy and for the first time out-patients are treated. This marks a schism from biopsychiatry where patients are treated through dialog rather than medication. Freud’s patients are not as severely impaired as psychiatry’s traditional in-patients.
• 1924 – German neuropsychiatrist Hans Berger develops electroencephalography, using non-invasive electrodes to record voltage fluctuations in the brain.
• 1932 – Discovery by Manfred Sakel of insuline’s therapeutic effects on schizophrenic patients and thus birth of biological therapy: the idea that biological means could treat psychiatric conditions.
• 1936 – Nobel Prize in Physiology and Medicine to Henry Hallett Dale (British neuroscientist) and Otto Loewi (German pharmacologist) for their discovery of Acetylcholine, discovering the first’s neurotransmitter (a chemical produced by an activated neuron and causing a biological effect on the next neuron, where it is released). Acetylcholine regulates, among other things, muscle stimulation and, more psychiatrically relevant, REM sleep. ACh also plays a role in encoding new memories.
• 1938 – Invention of the eletroconvulsive therapy by Ugo Cerleti and Lucio Bini.

• 1944 – Methylphenidate (Ritalin) is synthesized by Swiss chemist Leandro Panizzon. It was famously originally used to treat his wife’s low blood pressure. His wife’s name? Rita! Yes, that’s where the name ‘Ritalin’ comes from.
• 1946 – Norepinephrine (aka noradrenaline), is isolated by Ulf von Euler (Swedish biologist who goes on to winning a Nobel Prize for his work on neurotransmitters in 1970). Norepinephrine regulates a mental (and neurological) state of alertness, increasing heart rate and blood pressure, for example. It is also important for forming memories. Norepinephrine is the precursor to epinephrine, aka adrenaline. Adrenaline is depleted by stress and replenished by exercise.
• 1948 – Lithium carbonate’s mood stabilising properties are demonstrated
• 1949 – Donald Hebb’s book, Organisation of behaviour – a neuropsychological theory – shares his discovery of the neuroanatomy of learning and memory. We now know that memories are encoded over neural networks.
• 1950 – Eugene Roberts and Jorge Awapara discover that GABA (gamma aminobutyric acid if you don’t mind), discovered in fungi in 1910, was also in fact a neurotransmitter. A GABA deficiency can lead to anxiety or even epilepsy. GABA is also involved in schizophrenia and sleep disorders. Famous substances activating GABA receptors are benzodizepines (with our famous Diazepam – Valium and Alprazolam – Xanax), alcohol and barbiturates (sometimes used for anesthesia but also recreationally). GABAergic drugs are used for their hypnotics, sedatives, tranquillizers (sedative-hypnotics) and anticonvulsants.
• 1950 – Rhone Polenc invents Chlorpromazine (better known as Thorazine), an antipsychotic still used today on some schizophrenic patients. This anti-psychotic drug kick-started the large de-institutionalisation movement that has led to today’s mental illness crisis in the US, whereby severely mentally ill people were left to their own fate as institution after institution shuts down.
• 1952 – Betty Twarog discovers serotonin is a neurotransmitter (in molluscs, initially). Serotonin is involved in the regulation of moods, notably the inhibition aggression and depressive states. Serotonergic drugs, including famous SSRI’s (serotonine reuptake inhibitors) like Fluoxetine (Prozac) are among the biggest selling drugs on the market. They are also the drug of choice for a flurry of canine behavioural conditions. Hallucinogenic drugs such as LSD or ecstasy, interestingly, are also serotonergic.
• 1952 – Arvid Carsson discovers dopamine. He eventually got a Nobel prize for his work (in 2000). Dopamine is the precursor to its famous neurotransmitter cousin, adrenaline (and of course noradrenaline). Dopamine is involved in Parkinson’s disease. This was discovered by rendering rabbits catatonic through the depletion of dopamine at their nerve terminals. Injecting dopamine restored their previous motor function. Dopamine is also involved in the so-called reward pathways and, as such, plays a major role in generating and maintaining addictions and compulsions.
• 1952 – Publication of DSM-I, the American Psychiatric Association’s first Diagnostic and Statistical Manual. It contained just 106 ‘character’ disorders (or “reactions”) viewed as weaknesses of character due to faults in upbringing. It did not so much contain formal diagnoses as theories.
• 1953 – Patient H.M. has parts of his hippocampus removed in an attempt to relieve him of his lifelong seizures. As a result, he develops near complete anterograde amnesia and loses the ability to create new memories. Experiments of his cognitive capacities revolutionised our understanding of memory and revealed two distinct mechanisms: declarative (that can be expressed with words) and procedural (automatic, classical conditioning, motor tasks) memory.
• 1954 – Methylphenidate (Ritalin) is recognized as a Central Nervous System stimulant (Meier et al, 1954).
• 1956 – Evidence of antidepressant properties of Iproniazid – previously used against tuberculosis. The birth of the world’s first anti-depressant (of the Mono Amine Oxydase inhibitor type).
• 1957 – First precise mention of ADHD-like symptoms as ‘hyperkinetic impulse disorder’. In 1957 also, Thorazine [!] is used on “hyperkinetic emotionally disturbed children”
• 1957 – Benzodiazepine’s hypnotic, muscle relaxant and anxiolytic properties are discovered by Laboratoires Laroche in the US.  Famous benzodiazepines are Diazepam (Valium) and Alprazolam (Xanax). Benzodiazepines are highly addictive – though not as much as barbiturates – but also highly effective at tacking phobias, panic, anxiety and insomnia. They are fast-acting, making them a drug of first-choice to curb predictable acute phobic episodes in dogs (like fireworks).

• 1961 – ‘Histoire de la folie a l’age classique’ is published, a scathing critique of psychiatry and its chemical straightjackets.
• 1963 – First study on Ritalin (methylphenidate) for ’emotionally disturbed children’ is published
• 1964 – The first draft of the Declaration of Helsinki is signed, an ethical code for human experimentation.
• 1968: DSM-II with 182 disorders and follows the structure of the broader International Classification of Diseases in an attempt to gain validation.
• 1969: John Bowlby’s attachment theory reveals the possible role of maternal deprivation in the development of some psychopathologies.
• 1970: The word ‘zoopsychatrie’ is coined. Roughly translated from French, it means veterinary behaviourism.
• 1973: Solomon Snyder and Candace Pert discover endorphins (endogenous morphine). Endorphins are a group of inhibitory neurotransmitters that generate feelings of pleasure, as well as having an analgaesic effect. They have a similar effect to opioids like heroine and opium. They depress the central nervous system depressant, they slow it down. They are believed to be involved in stress-related psychiatric disorders, severe depression, addiction disorders and schizophrenia.
• 1974:  Allan Baddeley and Graham Hitch propose the model of working memory replacing the short-term/long-term memory model. This sheds light on the cognitive skills involved in retrieving and storing the information required to perform a particular task, distinguishing between verbal and visuo-spatial stores, for example.
• 1975: The anti-Ritalin movement expands as several books are published, bringing the validity of the ADHD diagnosis into question.
• 1980: DSM-III: A radical change from the previous versions, with a marked departure from psychoanalysis to cognitive behavioural therapy terminology and a focus on measurable, observable symptoms. It bore 265 diagnostic categories. This more standardised version reflects psychology and psychiatry’s efforts to be recognised as valid scientific fields. Prior to DSM-III, the categories were so vague that they did not allow rigorous research. This led to a flurry of research into mental illnesses, which has greatly contributed in the destigmatisation of patients from weak and wilful to legitimate sufferers. A notable modern addition to the DSM-III: PTSD.
• 1977-1985 – Development of SSRI’s, facilitating the treatment of depression, but also panic attacks, anxiety disorders, obsessive disorders and phobias. Fluoxetine is one of the most widely used behavioural drug on dogs today.
• 1987: DSM-IIIR
• 1992: DSM-IV: 297 disorders. One major change from previous versions was the inclusion of the clinical significance criteria: the degree to which a sufferer is impeded from conducting a productive life is becoming a central diagnostic criterion. Concretely, it means that you can experience all the symptoms listed in a disorder but still not have the diagnostic. Perhaps disappointingly, the APA admits to the DSM-IV’s continued lack of internal consistency: “no definition adequately specifies precise boundaries for the concept of ‘mental disorder’… different situations call for different definitions”. It states that “there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder” (APA, 1994 and 2000).
• 1994: Peter Usherwood discovers that Glutamate (discovered in Tokyo as a food flavor in 1907 and present in the famous monosodium glutamate!) is a neurotransmitter. It is in fact the most common neurotransmitter, present in nearly half of our neurons. Glutamate is an excitatory neurotransmitter. It is released when we perceive danger. It is believed to be involved in a number of psychiatric disorders, including PTSD (post traumatic stress disorder), major depression, bipolar disorder, anxiety and schizophrenia.
• 2013: DSM-V: Quoting the number of discrete diagnoses in this edition is surprisingly controversial. The major changes in this version are an attempt to add biological correlates to the disorders (and famously failing to do so), and the merging of specific disorders into broader spectra (famously schizophrenia and autism, among others).

Where are we now?

Looking at the timeline, I am glad we live on this side of history. There’s still quite a bit to achieve before most human (and even more so, canine) psychiatric patients receive effective and humane treatments, are treated with dignity and understanding.

Today, many psychiatric patients still have to contend with much well-meaning but misguided advice from:

• The ones who believe ‘tough love’ is the way to recovery, dismissing our human/canine patients as people who just ‘need to toughen up, and a bit of discipline’.
• The medication detractors who find ‘It’s full of chemicals.’ and that our patients should just ‘use homeopathy/Reiki/quantum healing/…’  or simply do more sports.
• The ones who see mental health patients as being weak, wilfulness, stupid, dangerous.
• The skeptical doctors (/vets) who see behaviour/psycho- therapy as pseudoscience. The same doctors/vets who, while we fight to validate our profession with evidence, dispense unfounded behaviour advice because they saw it on National Geographic or once read a book about it…

Meanwhile some of our patients, human and canine alike, face:

1. Confinement,
2. Only partially effective medication with crippling unacceptable side effects
3. The majority of first responders (police/dog shelters or doctors/vets), woefully under-trained in dealing with agitated or psychotic patients, frequently resort to violence when apprehending a patient.

So we still have a ways to go. I hope I can re-write the timeline in a few years and have some progress to report.

Illustration credits

• Bedlam: Engraving by T. Bowles, 1735. Downloaded 6 Aug 2017 from Wellcome Images, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom. More information about Wellcome Trust images (archive).
• Phineas Gage: Unknown author. PD-US license – downloaded 6 Aug 2017 from Wiki Commons.
• Vertical section of rabbit hippocampus: By Camillo Golgi – C. Sulla fina anatomia degli organi centrali del sistema nervoso. Reggio-Emilia: S. Calderini e Figlio; 1885. Reprinted in: On the fine structure of the pes Hippocampi major (with plates XIII–XXIII). Brain Research Bulletin, Vol. 54, No. 5, p. 482 (2001), Public Domain
• Nelly Bly: Artist: Nelly Bly, from Ten days in a Madhouse (book). Downloaded 6 Aug 2017 from Penn Edu. PD-US license
• Shell shock: Photograph taken by an Official War Photographer. Image from WWI, taken in an Australian Advanced Dressing Station near Ypres in 1917. The wounded soldier in the lower left of the photo has a dazed, shell-shocked stare. Permission details: PD-BRITISHGOV. HMSO has declared that the expiry of Crown Copyrights applies worldwide This artistic work created by the United Kingdom Government is in the public domain because It is a photograph created by the United Kingdom Government and taken prior to 1 June 1957.
• Little Albert: Photographer: John B Watson. Downloaded 6 Aug 2017 from Wiki Commons. PD-US license
• Electro convulsive therapy (Reeve041476): Bergonic chair used to induce seizure in psychiatric patient. Source: National Museum of Health and Medicine. Downloaded from Flickr on 6 August 2017. License: CC BY 2.0
• Xanax sculpture: Artist: Taolin. Downloaded from Flickr on 6 August 2017. CC BY 2.0 license.