Principles and Practice of Geriatric Psychiatry - Hardcover

Hardcover

ISBN 10: 0471981974 ISBN 13: 9780471981978

Publisher: Wiley–Blackwell, 2002

Synopsis

As the global population ages, all disorders related to ageing are of greater interest to researchers, but none more so than mental disorders. Consequently, geriatric psychiatry has emerged in the last two decades as an important clinical and scientific discipline. The 2nd Edition of this very successful book brings the reader up-to-date on the most recent advances in this area as well as a diverse range of other fields. Drawing on the knowledge of leading international experts the book encompasses the range of scientific and clinical disciplines relevant to mental health in old age, from neuroscience and molecular pathology, psychology and sociology, to community care, management and organisation. * A comprehensive, well-respected reference work, essential for everyone working in this relatively new specialty. * Covers the whole range of mental illness in old age in detail with chapters on normal mental and cognitive ageing. * Includes UK and US approaches to care as well as sampling the problem of ageing in a number of other countries.

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Review

"...a very useful reference resource..." -- International Psychogeriatrics, Vol.16, No.3, 2004

"...overall high quality...I thoroughly recommend to individuals and departments..." -- British Journal of Psychiatry, March 2003

Excerpt. © Reprinted by permission. All rights reserved.

Chapter 1 – A Conceptual History in the Nineteenth Century
G. E. Berrios
Department of Psychiatry, Addenbrooke's Hospital, Cambridge, UK

The history of geriatric psychiatry can be written from two viewpoints. The "externalist" approach focuses on the social and political variables that have controlled attitudes towards abnor-mal behaviour in old age, and on the professionalization of those charged with the care of the mentally infirm elderly. The "internalist" approach - to be followed in this chapter - concen-trates on the origin of the scientific language of psychogeriatrics. An adequate historical account should include information on theories of ageing, both physical and mental, brain sclerosis and the formation of a viable concept of mental illness. On the first rubric much research has been done; far less work exists on the other two. On psychogeriatric care before the nineteenth century there is very little: this may simply reflect a historical reality.

VIEWS ON AGEING BEFORE THE NINETEENTH CENTURY
Like most other aspects of human life, ageing has also been portrayed in terms of metaphors. Classical views, following the nature - nurture controversy, conceived of ageing as resulting from either internal instructions or from the buffeting of foreign factors.

The "wear and tear" view happened to be popular during the early nineteenth century, the period on which this chapter will concentrate. It was based, as it had always been, on the ageless observation that all natural objects, whether animate or not, are subject to the ravages of time. Surprisingly enough, the "wear and tear" view has not always generated an understanding attitude. In fact, across times and cultures great ambiguity has existed in regard to the treatment of old folk. Fortunately, a realistic acceptance seems to have predominated although there is plenty of evidence of hostility. The Hebrew tradition, and indeed its Christian offshoot, encouraged much reverence towards the wisdom and value of old age. But even in societies which have made great play of this view, veneration has been reserved for those in positions of power or influence. Little is known about attitudes towards elderly women or old men in humbler stations.

So, it can be concluded that, all in all, a view seems to have predominated that ageing was undesirable and that the identifica-tion of wear factors was important to devising ways of prolonging life.

A second ambiguity can be detected in these earlier writings. It concerns the extent to which the ageing process necessarily involves the human mind. Whilst it was a palpable fact that all human frames decayed, not everyone accepted that this had necessarily to affect the soul or mind. Extant descriptions of the psychological changes brought about by old age suggest that people were aware that the mind also underwent a decline. However, theory and religion encouraged the view that the spirit could or did escape wear and tear, and that human beings grew ever more wise and useful, thanks to the accumulation of experience and knowledge. This belief must have been available in all those societies that felt the need to create adequate spaces for all manner of intellectual and/or sociopolitical gerontocracies. Some seem even to have separated chronological age and functional age in order to justify such concessions. From the point of view of the history of psychogeriatrics, it would be useful to know to what extent this belief was undermined by the occasional case of dementia amongst those elderly in positions of power. Historical evidence seems to show that these situations were neither more nor less perturbing than mental illness occurring at other periods of life. Indeed, fail-safe devices seem to have been available in these societies to cope with the upheavals created by such occurrences.

Men like Buffon, Darwin and Goethe reshaped ideas on ageing during the eighteenth century. Buffon wrote: "All changes and dies in Nature. As soon as it reaches its point of perfection it begins to decay. At first this is subtle and it takes years for one to realise that major changes have in fact taken place" (p. 106). Buffon put this down to an "ossification" process similar to that affecting trees: "this cause of death is common to animals and vegetables. Oaks die as their core becomes so hard that they can no longer feed. They trap humidity, and this eventually makes them rot away" (p.111).

Erasmus Darwin's views resulted from the application of yet another metaphor, namely, that ageing results from a breakdown of "communication" between man and his environment. Darwin suggested that such breakdown followed a loss of irritability (a property of nerve fibres) and a decreased response to sensation:

"It seems our bodies by long habit cease to obey the stimulus of the aliment, which support us... three causes may conspire to render our nerves less excitable: 1 - If a stimulus be greater than natural, it produces too great an exertion of the stimulated organ, and in consequence exhausts the spirit of animation; and the moving organ ceases to act, even though the stimulus is continued. 2 - If excitations weaker than natural be applied, so as not to excite the organ into action, they may be gradually increased, without exciting the organ into action, which will thus acquire a habit of disobedience to the stimulus. 3 - When irritative motions continue to be produced in consequence of stimulus, but are not succeeded by sensation..." (p. 365).

VIEWS ON AGEING DURING THE NINETEENTH CENTURY

In 1807 Sir John Sinclair published a major compendium on ageing and longevity which included references to most pre--nineteenth century sources. It was, in a way, the last grand glance to the past. Soon afterwards work started by those who, like Leon Rostan (1791-1866), based their claims on empirical findings. Rostan, one of the most original members of the Paris school, published in 1819 his Recherches sur le Ramollissement du Cerveau, where the view commenced...

Edition details

• Publisher: Wiley–Blackwell
• Publication date: 2002
• Language: English
• ISBN 10: 0471981974
• ISBN 13: 9780471981978
• Binding: Hardcover
• Edition number: 2
• Number of pages: 832
• Editor: Copeland John R. M., Abou–Saleh Mohammed T., Blazer Dan G.