Preface to the First Monograph

The Fourth Psychiatric Revolution
At present, psychiatry is in the midst of a fourth revolution. The first revolution was the so-called Moral Treatment which involved theactivism of Phileppe Pinel (1745-1826) and William Tuke (1732-1819), as also the efforts of Dorothea Dix (1802-1887). This resulted in destigmatization of the lunatic label which had earlier meant treating the insane in a dehumanizing manner e.g.. chaining them to walls, displaying them for money etc. It resulted in the transition to custodial care and the opening of mental hospitals. The second psychiatric revolution was the Mental Hygiene Movement heralded by the eyeopening works of Elizabeth Packard (Modern Persecution or Insane Hospital Unveiled) and Clifford Beers (1876-1943; A Mind That Found Itself) which was furthered by, amongst others, pioneers like Adolf Meyer (1866-1950) and William James (1842-1910). This was followed by the third Psychiatric revolution, that of the Community Psychiatry Movement. This involved community participation, removal of restrictions, comprehensive set of services multi-disciplinary in nature, active consumer participation, mental health consultancy and preventive measures. This well intentioned grand movement had its problems, as all such grand movement must indeed have. It became the fountainsource of a fresh crop of difficulties related to transinstitutionalization in boarding and halfway houses, with increased rates of hospital admission, and the ‘revolving door syndrome’. Moreover, it lead to an ominous rise in contact between the criminal justice system and the mentally ill as they moved more freely in the community.

Today, we are in the midst of a silent by strong fourth revolution. Firstly, this revolution reiterates its strong linkage with the mainstream of medicine. Secondly, it bases itself on strong, empirical findings based on rigorous methodological studies, mainly biological. The major paradigm shift of contemporary psychiatry is towards methodological rigour on the one hand, and cautious forays in the neurosciences, adoption and genetic studies on the other ( from where, hopefully, significant leads in understanding the aetiology of major psychiatric disorders must arise). Diagnostic refinement is a necessary step in this direction, as is use of sophisticated technology to aid the process.

And yet, we know that psychiatry, its practitioners, and its patients, do not function in a vacuum. They interact with, and are influenced by, a wide range of complex, interlinked, social and interpersonal forces.These forces are often generated by people not directly connected with the medical speciality of psychiatry. They are the policy-planners, governments , political leaders, activists, social thinkers, NGOs, mass media, enlightened public opinion etc. They have marked influence on social thought and action, policy, funding and research. They influence people and societies often in more significant ways than the medical speciality of psychiatry considers healthy for society.

We may continue to function in a vacuum and wait for wisdom to dawn. Or, we may establish a dialogue with them and work for wisdom for happen.

The second option seems the more productive one.

No doubt, there are some psychiatrists comfortable with the biological label. There are others comfortable with the social one. Both these are needed, for they help to further robust enquiry in their respective fields. But what we also probably need is an integration, a synthesis of the mass of evidence that these two fields have produced. The inevitable conclusions drawn at our present state of knowledge based on such integration will give rise to pointers for further research as well as guidelines for policy-planners. Moreover, it will result in an awakened public opinion empowered with knowledge and evidence, its actions enlightened, and unlikely to be swayed or manipulated by unscrupulous forces.

The Mens Sana Monographs are meant to further attempts at such a Fourth Psychiatric Revolution, an Evidence-based, Integrated Movement in Psychiatry.

What is this monograph all about? When a war is waged, leaders and governments look at various dimensions. The deployment of troops is obviously important, as is the political fallout of such a decision. The economic implications are worked out, as are humanitarian and rehabilitative initiatives. Somewhere along the way, leaders have also to be aware of the psychiatric consequences of war (as also of terrorism), for there is a mass of data, both from the biological and sociological studies in psychiatry, which point to such a need. This monograph presents some of these evidences from recent studies.

Ajai R. Singh and Shakuntala A. Singh