“Lunatic,” “maniac,” “psychopath,” “crazy.” The many words for the mentally ill reflect the long history of gross misconceptions of mental illness that imbued them with the stigma it still bears and cast psychiatry in the role of “stepchild of medicine.” With discussion of mental health now at a fever pitch, heightened by the recent tragic struggles of beloved celebrities, the rising rates of mental disturbances and substance abuse in young people, and PTSD and suicide in the military, not to mention the social pathologies that accrue from untreated mental illness including homelessness, prisoners with mental illness and mass violence perpetrated by untreated persons with mental illness, the need for a deeper knowledge of mental illness, what mental health care can provide and greater public awareness, has never been greater. Despite its checkered history, the discipline of psychiatry has come a long way since the days of chaining patients in cold cells, “Snake Pit”–like asylums, coma therapies, ice pick lobotomies, preposterous theories like animal magnetism and orgones, and discriminatory diagnoses like homosexuality and schizophrenogenic mothers. In last half-century, psychiatry has transformed itself into a scientifically based discipline with clinical competence and effective treatments. Thanks to psychopharmacology, brain imaging, molecular genetics, neuroscience, and cognitive and social psychology, psychiatry now has empirically proven treatments in the forms of neuromodulation, psychotropic medications, psychotherapy and rehabilitation that can alleviate suffering and save lives.
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The heritage of Karl Jaspers remains highly relevant to at least three areas of psychiatric inquiry: the epistemology of psychiatry, the classification of mental disorders, and the exploration of subjective experiences in persons with schizophrenia. In the realm of epistemology, Jaspers foreruns the ongoing debate about the lack of a guiding philosophy in psychiatry, and the need to be aware of our conceptual assumptions in order to prevent their distorting effects. Related to this is the acknowledgement that an invariable feature of psychiatry is the coexistence of a variety of research methods, whose limitations need to be recognized, but none of which can be ignored. Extremely relevant to current debate is also Jaspers’ discussion of the relationship between psychopathology and neuroscience, and his critique of Griesinger’s maxim that “all mental illnesses are cerebral illnesses”. In the area of classification of mental disorders, of high relevance to current debate is Jaspers' conceptualization of “ideal types” as opposed to “disease entities”. In the area of exploration of subjective experiences in persons with schizophrenia, Jaspers’ characterization of the “activity of the self” and its disorders has given rise to a line of inquiry that has developed throughout the past century up to our days. Furthermore, his description of the genesis of delusions in schizophrenia remains highly relevant, and has clearly inspired the construct of “aberrant salience”. Finally, Jaspers’ emphasis on patients’ “working through the illness” resonates with the current notion that person-disorder interactions are crucial in the shaping of psychopathological symptoms.
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