Psychiatry - O. K. Napreyenko 2001

Propaedeutics of Psychiatry
History of Psychiatry

MAIN STAGES OF The Development of Psychiatry

The history of psychiatry is closely intertwined with the Selection/37.html">History of Human civilization.

The Pre-Scientific Period

The pre-scientific period of psychiatry dates back to ancient times and extends into the classical antiquity period. During this era, aggressive and dangerous mentally ill individuals were considered possessed by evil spirits; they were cast out, beaten, and stoned, whereas quiet and calm patients were revered, idolized, and cared for. In this manner, empirical observations regarding The behavior of the mentally ill began to accumulate, a legacy preserved in folklore, myths, and legends.

Psychiatry during the Era of Ancient Greek and Roman Medicine (6th Century BC – 3rd Century AD). This period witnessed The formation of medical guilds and a fundamental shift in the conceptualization of mental disorders. Pythagoras was the first to state that the brain is The Organ of mental activity and that Epilepsy is specifically linked to the disruption of its function. Emphasizing The Role of heredity, he noted: "We have a predisposition to both health and disease." Hippocrates synthesized disparate knowledge across various branches of medicine. According to him, the brain serves not only as an organ of cognition and adaptation to the external world, but also "from it we become mad." He delineated temperament types, traced their correlation with psychoses, formulated a humoral theory of mental activity, provided a detailed description of epilepsy under the name "the sacred disease," and highlighted The Significance of heredity.

The writings of Hippocrates underscored the role of alcoholism, somatic diseases, and psychological trauma in the onset of madness, and introduced psychiatric terms such as melancholy, mania, paranoia, and epilepsy—terminology that remains in use in modern psychiatry.

Aristotle concluded that intellectual disability sometimes ensues as a consequence of epilepsy and madness.

Psychiatry in the Middle Ages (4th–17th Centuries). With the fall of the Roman Empire, Greco-Roman medicine declined, ushering in the dark ages. Throughout this period, dangerous psychiatric patients were isolated from society and confined to cellars, crude huts, and even prisons.

In certain Western European countries for two centuries, beginning in the late 15th century—following the papal bull of Innocent VIII and the publication of the Malleus Maleficarum ("The Hammer of Witches"), which outlined Methods for identifying and exposing pacts with demons—large-scale witch-hunts were conducted. Through brutal torture, the Inquisition extracted "sincere" confessions from the unfortunate victims as proof of their guilt. Tens of thousands of people, a significant proportion of whom were mentally ill, were publicly burned alive. In the view of contemporary Catholics, madness was caused by the devil possessing an individual and dictating their behavior.

During the 15th and 16th centuries, primitive asylums for the confinement of the mentally ill began to be established. Kept in damp, dark basements, patients were shackled in chains and handcuffs and subjected to severe punishments. The primary objective was isolation rather than Treatment, a practice that persisted until the 17th and 18th centuries.

The Era of Psychiatric Reform. In 1792, the French physician Philippe Pinel (1745–1826) struck the chains from the mentally ill at Bicêtre and Salpêtrière, dismantled the prison-like regime, mandated humane treatment for patients, reorganized the hospitals, and established separate wards for calm and disturbed patients. He combined medical treatment with structured occupational therapy. These measures helped pacify patients' behavior and allowed psychoses to be studied in their natural state. Pinel’s reforms soon spread across France and other nations.

In 1801, Pinel published his Medical-Philosophical Treatise on Mental Alienation, in which he systematically categorized and described mental illnesses. Among the etiological factors of psychiatric disorders, he distinguished between predispositions (hereditary load, age, and constitutional traits) and precipitating factors (traumatic brain injury, infectious diseases, and alcoholism).

Pinel’s pupil and collaborator Jean-Étienne Esquirol (1772–1840) continued the reform movement and actively advocated for the rights of psychiatric patients. He integrated regular clinical rounds and formal case histories into hospital routines. Esquirol made a profound contribution to Clinical Psychiatry by publishing the two-volume manual On Mental Maladies (1838). He was the first to differentiate between illusions and hallucinations, as well as congenital and acquired intellectual disability, and introduced concepts such as remission and intermission.

Although Pinel unshackled the mentally ill, agitated patients were still restrained in straitjackets. In England during the 1840s, John Conolly established the "no-restraint" system, positing that any mechanical coercion inflicted upon a patient is fundamentally harmful, as it degrades the individual and impedes recovery. For patients experiencing acute agitation, he recommended brief periods of isolation rather than physical restraint.

In 1803, Johann Christian Reil coined the term "psychiatry" (from the Greek psyche — soul, spirit, mind, and iatrea — medical treatment).

The Era of Nosological Psychiatry

The foundation of the nosological approach in psychiatry (1834) was laid by Pyotr Butkovsky in his seminal work Mental Diseases.... Following in his footsteps, Karl Kahlbaum (1828–1899) introduced nosological criteria into psychiatry, proposing that psychoses be studied by analyzing their mental and somatic symptoms, clinical course, the sequential progression of manifestations, and ultimate outcomes. This analytical approach to the progression of psychosis was greatly advanced by Kahlbaum’s Introduction of METABOLISM/2.html">THE CONCEPT OF the symptom complex, or syndrome. Utilizing these criteria, Kahlbaum’s friend and colleague Ewald Hecker (1868) described hebephrenia as a distinct disorder, while Kahlbaum himself delineated catatonia (1874).

Later, building upon Kahlbaum’s criteria, Emil Kraepelin (1856–1926) classified manic-depressive psychosis and dementia praecox as distinct nosological entities in 1896. The latter condition was later renamed Schizophrenia by Eugen Bleuler in 1911. Kraepelin systematically organized mental disorders and authored the Textbook of Psychiatry, which went through eight editions and served as an essential reference for psychiatrists worldwide for decades. His colleague Korbinian Brodmann investigated the cytoarchitecture of the Cerebral Cortex AND mapped its distinct areas. Franz Nissl made substantial contributions to the neuropathology of mental illnesses, while Alois Alzheimer described the clinical and morphological features of presenile atrophic dementia, which was subsequently named after him.

The History of Psychiatry in Ukraine and Other Slavic Lands

Pre-Scientific Psychiatry

Prior to the Christianization of Kievan Rus, during the pagan era, the mentally ill were treated by sorcerers, volkhvs (pagan priests), and healers known as lechtsi (physicians). They utilized herbs, flowers, and roots combined with incantations and divination.

Following the adoption of Christianity in Kievan Rus in 988, the care of the mentally ill came under the purview of the Orthodox Church. Indigenous forms of early Orthodox charity were formalized by Prince Vladimir in 966 through a charter issued to the ecclesiastical hierarchy. This decree obligated the church to patronize and care for the elderly, pilgrims, and the destitute—a significant portion of whom were mentally ill. The charter provided for the establishment of almshouses and shelters attached to churches. To ensure their financial sustenance, Prince Vladimir instituted a church tithe.

From the mid-11th century, the era of monastic psychiatry began, lasting until the 18th century.

In the Principality of Kyiv, St. Theodosius of the Caves, and in Pereyaslav, St. Ephraim of Pereyaslav, elevated charity and the establishment of philanthropic institutions to unprecedented heights across all of Rus. The mentally afflicted (referred to as prichynni) were not confined in asylums and hospitals; instead, they were granted personal autonomy and the freedom of choice. They could receive treatment on an outpatient basis, as we would term it today. Within monasteries, they were tended to by healers, herbalists, and monks, whose primary therapeutic modalities consisted of medicinal herbs and prayer. Among the monastic healers of the Kiev Pechersk Lavra, St. Gregory the Wonderworker was renowned for "healing the possessed and possessing the gift of suggestion, bending the will of those whom he treated." Monk Lawrence likewise engaged in the spiritual healing of mental ailments.

The societal attitude of the Slavs toward the mentally ill and drunkards was aptly expressed by Theodosius of the Caves: "The possessed person suffers involuntarily and thus earns eternal life, whereas the drunkard willingly embraces his vice and thereby earns eternal torment." Legislative measures against drunkenness were also reflected in the Statute of Volodymyr Monomakh (1117).

In the 11th century, medical specialties began to diverge. The Izbornik of Sviatoslav categorizes all illnesses into "physical ailments" (somatic) and "mental ailments," attributing the ROOT cause of the latter to brain dysfunction. To diagnose mental disorders, this text recommended that physicians engage the patient in an open conversation while closely observing their behavior, posture, gait, and smile. Various treatises from this period describe epilepsy, post-typhoid psychosis, and reactive persecutory delusions. There are also accounts of delirium tremens, in which patients experienced terrifying hallucinations of the devil and other evil spirits. In 1263, a manuscript version of the 11th-century philosopher John of Bulgaria's medico-philosophical treatise Hexaemeron was translated, containing valuable insights into The Nervous system and mental illness.

The legal status of individuals with mental disabilities within the family, as well as the protection of their property, was outlined in 12 articles of the City Laws, which were incorporated into the Judicial Law of Prince Volodymyr, and later into the Sobornoye Ulozhenie of Tsar Alexei Mikhailovich (1669). These statutes stipulated, among other things, that children were obligated to care for their ailing parents, and parents, in turn, for their children; failure to fulfill this duty resulted in disinheritance. The mentally ill were legally barred from making gifts or testifying in court, and testators were required to possess a "sound mind, not merely a sound body." Furthermore, a "demoniac" who committed murder was exempt from the death penalty and sent to a monastery instead.

During the Middle Ages, mentally ill individuals in Slavic lands largely escaped the persecutions seen in Western Europe. Attempts to impose the ruthless eradication of witches, sorcerers, and heretics met strong resistance from the Christian Church, based on the principle that "Christian truth can be spread only through peaceful means." Slavs consistently viewed the mentally ill as unfortunates suffering under a heavy burden, deserving of refuge and compassion from their loved ones. Madness was perceived as an affliction caused by malevolent spirits, the devil, or the evil eye. Consequently, afflicted individuals were treated with humanity and care, ideally within the sanctuary of a monastery.

In the 17th and 18th centuries, the role of monasteries as asylums for the mentally ill began to decline. This shift occurred because the state increasingly favored the expansion of parish-based institutions over monastic hospitals and almshouses. Monasteries were primarily assigned the responsibility of detaining dangerous patients, "exercising supervision over them to prevent harm to themselves and others."

Following the introduction of the Provincial Reform of 1775, specialized asylums for the insane, headed by physicians, began to be established. This system of institutional psychiatric care eventually superseded the monastic model.

The Emergence of Scientific Psychiatry

The advancement of the science of mental illness was greatly propelled by the founding of universities. The pioneer of scientific psychiatry in Slavic lands, as well as the first university lecturer and professor of psychiatry, was P. O. Butkovsky from Kharkiv.

Petro Oleksandrovych Butkovsky (1801–1844), after graduating from the Greco-Latin College in Kharkiv and the St. Petersburg Medical-Surgical Academy, and serving as a military physician, successfully defended his dissertation Discourse on Mental Illnesses in 1830, earning his doctorate in medicine by late 1832. In 1834, he published his seminal work, Mental Illnesses, Presented in Accordance with the Principles of Current Psychiatric Doctrine in Their General, Particular, Theoretical, and Practical Aspects. This marked the first textbook on psychiatry published in the Russian Empire.

P. O. Butkovsky (1834) staunchly advocated materialist views and was the first to introduce a physiological perspective into psychiatry. For this, he faced severe criticism. Ironically, he was later unjustly ridiculed for alleged religious mysticism.

The author provided a detailed description of sensations, along with the afferent and efferent Functions of the Nervous System, and classified delusions into intellectual and sensory categories. He was the first to describe the state of catalepsy and highlight emotional disturbances associated with internal organ disorders. He concluded that the body (soma), brain, and mental processes are intrinsically interconnected. Furthermore, he described the "phenomenon of general or obscure sensation." Although I. M. Sechenov repeatedly analyzed this phenomenon in his later works, he failed to acknowledge Butkovsky's priority in this discovery. "Heart diseases," Petro Oleksandrovych wrote, "are accompanied by gloom, melancholy, fear, and sorrow." He also observed that severe forms of Pulmonary Tuberculosis are frequently accompanied by euphoria.

"Mental illness primarily affects the organ of the intellectual sphere—the brain," P. O. Butkovsky noted. He defined mental health as "the harmony of mental manifestations or that state of psychic life in which an individual freely commands all functions and actions of the soul." From this definition of mental health, he derived the concept of mental illness: "A mental illness is a state in which control over all or certain manifestations of psychic life is lost. In any mental affliction, the intellect, imagination, memory, emotional drive, and desires fall into internal disarray, disrupting the harmony of spiritual life."

Following William Cullen, P. O. Butkovsky detailed fantastic oneiric experiences accompanied by a loss of time perception and partial amnesia, characterized by "contradictory memories of moments of illness, akin to a vivid dream that cannot be recalled." He observed that in patients with rabies—which in its clinical course parallels paranoid schizophrenia—"feelings, thoughts, and inclinations manifest without coherence or order." This corresponds to the concept of intrapsychic ataxia described in 1909 by E. Stransky.

A renowned scientist was the first to note the favorable impact of somatic and infectious diseases on the course of psychoses. Somewhat later, Odesa psychiatrist A. S. Rosenblum (1876) described cases of recovery or significant improvement in patients suffering from various psychoses and general paralysis following typhoid fever, relapsing fever, and malaria.

He drew the scientific community's attention to borderline psychiatry by describing psychopathies under the name of the "Class of eccentrics." Unlike "the insane, their intellect and thinking remain unimpaired, and one cannot deny them sound judgment." Over time, E. Kraepelin (1915), in his Classification of psychopathies, identified a group of "eccentrics." P. O. Butkovsky (1834) introduced the nosological approach to psychiatry even earlier than K. Kahlbaum and defined criteria for distinguishing individual diseases.

In his "Mental Diseases," P. O. Butkovsky devoted a chapter to "diagnosing questionable mental illness" and clearly established the criteria for insanity: "A person deprived of reason cannot control themselves or properly exercise free self-determination." To detect "feigned madness," he proposed methods that have not lost their relevance today. These facts indicate that the foundations of forensic psychiatry were laid by P. O. Butkovsky.

P. O. Butkovsky advocated for a humane attitude toward the mentally ill and drew attention to the appalling conditions in which "these unfortunate sufferers" were kept. He provided a detailed Description of the layout and equipment of psychiatric hospitals. Despite the scientist's significant contribution to psychiatry, his name remained in obscurity for a long time.

Following the death of P. O. Butkovsky, the course of psychiatry at Kharkiv University was taught for over 30 years across various departments by professors who lacked proper training in the subject. The situation changed radically with the arrival of P. I. Kovalevsky.

P. I. Kovalevsky (1849–1923), after graduating from a theological seminary, completed the Faculty of Medicine at Kharkiv University. He was appointed as an assistant at the Department of Nervous and Mental Diseases. In 1877, he defended his doctoral dissertation on "Changes in Skin Sensitivity in Melancholics." At the same time, he was elected as a privatdozent and taught psychiatry for 15 years. P. I. Kovalevsky authored numerous works across various branches of clinical and forensic psychiatry, as well as on the problems of giftedness and madness. He developed an original classification of mental illnesses. As one of the pioneering researchers, he advocated for the role of Syphilis in the manifestation of neurosis-like disorders and epileptic seizures, and he studied the clinical manifestations, causes, and treatment methods of alcoholism.

The scientist penned a unique series of pathographical sketches based on genealogical, anatomical-physiological, and psychological characteristics, dedicated to prominent historical figures. These are profoundly psychological and pathopsychological studies distinguished by acute powers of observation.

With the establishment of gubernias, the construction of psychiatric hospitals began, creating an urgent need for textbooks on psychiatry and professional periodicals. In 1880, P. I. Kovalevsky published his textbook "Psychiatry" along with the monographs "Medico-Psychiatric Analyses" and "Primary Madness." From 1883 to 1899, the first psychiatric journal in Russia, "Archive of Psychiatry, Neurology, and Forensic Psychiatry," began publication in Kharkiv. The scientist also translated A number of monographs by prominent foreign psychiatrists.

In 1884, P. I. Kovalevsky received the title of professor and established an independent Department of Psychiatry at Kharkiv University. On his initiative, the 1st Congress of Russian Psychiatrists was held in 1887. Twelve doctoral dissertations were defended under the professor's supervision.

At St. Vladimir Kyiv University, the Faculty of Medicine was opened in 1842. Since then, lectures on psychiatry were delivered by Pokrovsky, and from 1855 by Ehrhardt, neither of whom had psychiatric training. The in-depth teaching of this discipline began with the arrival of I. O. Sikorsky.

After graduating from Kyiv University in 1869, Ivan Oleksiyovych Sikorsky (1842–1919) was retained at the Faculty of Medicine "to prepare for a professorship." He engaged in pathological anatomy and in 1872 defended his doctoral dissertation on "The Lymphatic vessels of the Lungs." The following year, I. O. Sikorsky was sent on a five-year research fellowship to the St. Petersburg Medico-Surgical Academy, where he worked in the fields of psychiatry and medical psychology under the supervision of Professor I. M. Balinsky.

From 1892, I. O. Sikorsky served as a full resident physician at the St. Petersburg Psychiatric Hospital. In early 1885, he returned to Kyiv University, where he was elected professor of the "Department of Systematic Clinical Doctrine of Mental Diseases." The scientist dedicated his research to general and medical psychology, child psychiatry, alcoholism, physiognomy, as well as mental hygiene and psychoprophylaxis.

I. O. Sikorsky assigned a major role to genetics in the development of mental illnesses. "Heredity consists in the biological transmission of ancestral traits to descendants. In this way, both normal and pathological Features of the Organism can be inherited."

In 1906, the scientist established a private therapeutic and pedagogical institute for "intellectually disabled and backward children." Various methods of rehabilitative treatment, primarily medical pedagogy, were widely employed there. At that time (1912), according to I. T. Yudin (1951), the Russian Empire had 34 private psychiatric clinics, including five in Kyiv, 4 in Kharkiv, 3 in Odesa, and one in Chernihiv.

Starting in 1896, I. O. Sikorsky published the journal Questions of Neuropsychiatric Medicine in Kyiv. The scientist's numerous publications were summarized and published in 1900 in the Collection of Scientific and Literary Articles across five volumes. I. O. Sikorsky's findings are set forth in his monographs General Psychology with Physiognomy (1904) and Fundamentals of Theoretical and Clinical Psychiatry with a Brief Outline of Forensic Psychology (1910).

Valentin Mykhailovych Hakkebush (1881–1931), upon graduating from Moscow University, returned to Ukraine and worked in the Poltava and Kharkiv psychiatric zemstvo hospitals. He took an active part in establishing the Kyiv Psychoneurological Institute and headed the Department of Psychiatry at the Kyiv Medical Institute. V. M. Hakkebush's scientific interests focused on The Study of organic psychoses of late life, TRAUMATIC BRAIN INJURIES, neuroses and psychopaths, as well as forensic and child psychiatry. He actively introduced experimental psychological methods into the examination of psychiatric patients. Co-authoring several works, he described a specific form of late-life mental pathology and published seven monographs, among them Course of Forensic Psychopathology (1928) and Environment and Childhood Hysteria.

Psychiatry began to be taught at the St. Petersburg Medico-Surgical Academy in 1835, though not at the highest level. Matters improved significantly with the arrival of I. M. Balinsky.

Ivan Mykhailovych Balinsky (1827–1902) was born into a family of Polish intellectuals. In 1846, he graduated from the St. Petersburg Medico-Surgical Academy, and in 1955 [sic], he defended his doctoral dissertation dedicated to the "Analysis of the historical Development of the fever concept." In 1857, he headed the newly organized independent Department of Psychiatry. Two years later, he published Compendium of Lectures on Psychiatry.

Through his efforts, a psychiatric clinic was established attached to the department, providing outpatient care to patients as well. He played an active role in planning psychiatric hospitals in Russia. I. M. Balinsky emphasized that without proper living conditions for psychiatric patients, "no method of treatment can be applied successfully." The period of his activity coincided with the introduction of trial by jury in Russia, where he proved to be a brilliant expert in psychiatry. I. M. Balinsky left no written scientific works, yet during his lectures, he introduced such concepts as "obsessive states" and "crystallization of delusions." Three doctoral dissertations were defended under his supervision. He passed away in 1902, leaving instructions for his tombstone to read: "Here lies Ivan Balinsky—friend and servant of the mentally ill."

I. M. Balinsky was succeeded by his student Ivan Pavlovych Merzheyevsky (1838–1908). It was under his tenure that active research work began at the clinic. He approached the study of psychiatric illnesses from a biological standpoint. In his doctoral dissertation titled Somatic Examination of the Insane (1867), I. P. Merzheyevsky demonstrated that metabolism increases during manic excitement. In the 1870s, he and his students laid the foundations of child psychiatry. Based on microscopic brain studies, I. M. Merzheyevsky concluded that brain development is delayed in macrocephaly, and he opposed the atavistic theory, according to which the brain in this condition resembles that of anthropoid apes. Under his supervision, dissertation research was conducted on psychoses in children, nervous system alterations caused by external harmful influences and Alcohol poisoning, as well as starvation. I. P. Merzheyevsky holds the priority in describing the degeneration of myelin nerve fibers, Changes in the ventricular ependyma, and Blood Vessels in progressive paralysis. The scientist's high academic authority led to his election as chairman of the First Congress of Psychiatrists of Russia. Over 16 years of heading the department, he established the St. Petersburg school of psychiatrists, supervised 26 dissertations, and published nearly 150 scientific papers. In 1893, I. P. Merzheyevsky retired, and the Department of Psychiatry at the Military-Surgical Academy was headed by his student, Professor V. M. Bekhterev.

Vladimir Mykhailovych Bekhterev (1857–1927), upon graduating from the St. Petersburg Military-Medical Academy, received the title of doctoral physician and remained to work in the Clinic for Mental and Nervous Diseases. In 1878, under the supervision of I. P. Merzheyevsky, he defended his dissertation, in which he argued that mental manifestations have definite objective causes. For several years, he studied The Nature of hypnosis and used it to treat patients. From 1885 to 1893, V. M. Bekhterev headed the Department of Psychiatry at Kazan University, where he established Russia's first psychophysiological laboratory. During this period, he continued to develop the Anatomical and physiological direction of psychiatry and neurology. The results of these studies were presented in the monograph Conduction Pathways of the Spinal Cord and Brain (1892) and in the fundamental work Fundamentals of The Doctrine of Brain Functions (1907). In the monograph Objective Psychology (1903), based on associative-motor Reflexes, he attempted to describe the anatomical and physiological substrate of all psychological and psychopathological concepts. He pointed out the correlation between the rising frequency of mental disorders, alcoholism, and suicides with severe socio-economic conditions. On issues of "alcohol policy," he was an advocate of extreme measures and favored a total ban on the consumption of strong alcoholic beverages. In 1910, he organized an anti-alcohol institute in St. Petersburg, founded nine scientific journals, and established a number of research institutions. V. M. Bekhterev published over 600 scientific papers. Most of them are dedicated to anatomical, physiological, and psychological problems, the systematics of mental illnesses, the Clinical Features of phobias, and obsessive ideas.

Viktor Khrysafovych Kandinsky (1849–1889) was a talented psychiatrist with a tragic fate. His brief career as a psychiatrist, which began in 1881, was highly productive in scientific terms. He provided unsurpassed descriptions of pseudohallucinations, manifestations of mental automatism, and oneiric disorders. He defined psychopathies as mental deformity, a disharmony of personality. V. Kh. Kandinsky was a proponent of the nosological approach in medicine. In 1892, he proposed a classification of Mental Illnesses and described ideophrenia (known today as schizophrenia) as an independent disorder. Being mentally ill himself, in his clinical studies he relied not only on observation and patient interviews but also on retrospective self-observation. The most significant of his works is the book On Pseudohallucinations (1890).

Psychiatry began to be taught at Moscow University in 1837, when professors of internal medicine were required to lecture on the subject. From 1869 onwards, psychiatry became a subject of study at the Department of Nervous and Mental Diseases, headed by Oleksiy Yakovych Kozhevnikov.

A significant contribution to the development of the Moscow school of psychiatry and the teaching of the subject was made by Sergei Sergeyevich Korsakov (1854–1900). In the 1880s, the symptomatological approach dominated psychiatry. In 1887, S. S. Korsakov defended his doctoral dissertation titled On Alcoholic Paralysis, in which he identified polyneurotic psychosis as a distinct nosological entity. In 1897, at the 12th International Medical Congress in Moscow, upon the proposal of Professor Jolly and with general approval, it was decided to name this illness Korsakov's psychosis. Over time, the amnestic syndrome observed in other conditions came to be known as Korsakov's syndrome.

Advancing the nosological approach, S. S. Korsakov identified a new nosological entity in 1891—dysnoia, the clinical picture of which corresponds to that of an exacerbation of schizophrenia. The scientist also worked within the anatomical and physiological framework. He published a Course of Psychiatry (1893) and numerous papers that were included in his Selected Works (1954).

S. S. Korsakov contributed to the Structure/175.html">Implementation of an organized, humane system of psychiatric care.

Following S. S. Korsakov's death, the department was headed by his student and follower Vladimir Petrovych Serbsky (1859–1917).

In 1890, he defended his dissertation titled Forms of Mental Disorders Described under the Name of Catatonia. V. P. Serbsky is one of the founders of forensic psychiatry. His most famous books are Course of Forensic Psychiatry (1907) and Textbook of Psychiatry (1912).

Petro Borysovych Gannushkin (1875–1933), a student of S. S. Korsakov, remained at the Department of Psychiatry after graduating from Moscow University and later headed it in 1918. In 1904, he defended his doctoral dissertation based on the monograph Acute Paranoia, in which he argued that paranoia exists not only as a separate disease but also as a paranoid syndrome that can occur in various conditions, including schizophrenia.

P. B. Gannushkin made an invaluable contribution to the development of adjunctive psychiatry, elaborating its aspects from the perspective of disease progression and the correlation between the "soil" (constitution) and mental disorder. He described paranoid, psychasthenic, and hysterical characterological traits. In his monograph The Clinic of Psychopathies: Their Statics, Dynamics, Systematics (1933), he provided diagnostic criteria and detailed clinical symptomatology of personality disorders. He actively promoted mental hygiene, social psychiatry, and outpatient and preventative care. He nurtured a constellation of talented psychiatrists. P. B. Gannushkin published 3 monographs, 22 articles, 19 Prefaces to monographs and collections, and nearly 100 reviews. He also organized the publication of the journal Modern Psychiatry.

Tychiy Ivanovych Yudin (1879–1949), after graduating from Moscow University, completed a clinical residency from 1904 to 1907 at the psychiatric clinic of the institute headed by V. P. Serbsky. Later, he worked as a psychiatrist in Kharkiv and Moscow psychiatric hospitals. In 1924, he was elected professor and HEAD of the Department at Kazan University, where he worked for eight years. From 1932 to 1945, T. I. Yudin returned to Kharkiv, initially heading the Ukrainian Psychoneurological Institute; when this institute was reorganized into the Ukrainian Psychoneurological Academy, he became its vice-president. In 1937, the academy was transformed into the Research Institute of Neurology and Psychiatry, headed by T. I. Yudin. From 1945 until the end of his life, he headed the Department of Psychiatry at the Moscow Medical Institute.

T. I. Yudin is a founder of the genetics of mental illnesses. In his monograph Psychopathic Constitutions (1926), he examined schizophrenia and manic-depressive psychosis from an evolutionary-genetic standpoint. He was the first to describe psychopathological manifestations within families, attributing them to underlying mutant Gene complexes.

The scientist defined the research strategy for pathogenetic markers in studying diseases with a hereditary predisposition, and laid the foundations of epidemiological genetics by determining the prevalence of schizophrenia in the population.

The Prevention of mental illnesses must be based on Medical-Genetic Counseling. T. I. Yudin (1936) emphasized: "The individual genes that make up schizophrenia are far too widespread in the population; therefore, the idea of sterilization as a method for improving the human race is genetically absurd."

The scientist demonstrated that mental illnesses begin with neurotic disorders, followed by personal—i.e., psychopathic—disorders, culminating in psychosis. T. I. Yudin was the first to establish the patterns of exogenous reactions. His authored works include the monographs Psychopathic Constitutions (1926) and Essays on the History of Domestic Psychiatry (1951).

The Modern Period of Psychiatry in Ukraine

Viktor Pavlovych Protopopov (1880–1957), upon graduating with honors from the Military-Medical Academy in St. Petersburg in 1906, was retained by V. M. Bekhterev at the Department of Psychiatry. In 1909, he defended his doctoral dissertation titled On Associative-Motor Reactions to Sound Stimuli, in which he substantiated a new method for studying conditioned reflexes in the motor sphere. Investigating somatic features in manic-depressive psychosis, he identified sympathicotonic disorders, which became known as Protopopov's triad (1920). To treat the manic phase of psychosis, he subsequently proposed lumbar novocaine blockade.

In 1923, V. P. Protopopov moved to Kharkiv, where he organized the Department of Psychiatry at the Medical Institute, as well as the Department of Psychiatry and Higher Nervous Activity at the Psychoneurological Personnel Institute. He was the organizer and director of the Ukrainian Research Institute of Clinical Psychiatry and Social Psychohygiene, which was later reformed into the Psychoneurological Academy. Furthermore, he actively engaged in the reorganization of Kharkiv's largest hospital ("Saburova Dacha"). From 1944 until the end of his life, V. P. Protopopov worked in Kyiv, where he established the Department of Psychiatry and Pathology of Higher Nervous Activity within the System of the Academy of Sciences of Ukraine, and was elected an academician. From 1945, he headed the Department of Psychiatry at the Kyiv Institute for Postgraduate Medical Education.

V. P. Protopopov adhered to two main scientific theses: 1) psychosis is a pathology of higher nervous activity; 2) psychosis is a disorder affecting not only the brain, but the entire organism. He formulated a coherent biochemical Concept of the Pathogenesis of schizophrenia.

Building upon the concept of nervous system weakness in schizophrenia, V. P. Protopopov developed the principles and methods of protective therapy, and substantiated and introduced Sleep therapy for schizophrenia patients. Based on data regarding the accumulation of toxic Protein metabolism products and somatic disorders in these patients, he proposed a complex of biological therapies for this condition. V. P. Protopopov made a significant contribution to the development of psychiatric care, striving to establish psychiatric services in every region. He published nearly 150 scientific papers and supervised 11 doctoral and 25 candidate dissertations.

Yevhen Oleksiyovych Popov (1899–1961) graduated from the Kharkiv Medical Institute and served as Deputy Director for Research at the Ukrainian Psychoneurological Institute. From 1938, he headed the Department of Psychiatry at the Kharkiv Institute for Advanced Medical Training, and from 1951, the Department of Psychiatry at the First Moscow Medical Institute. He became a corresponding member in 1946 and a full member of the USSR Academy of Medical Sciences in 1957. Ye. O. Popov's major works include "Delirium and Insomnia" (1934), "Materials on the Clinical presentation and Pathogenesis of Hallucinations" (1949), and "On The problem of the Pathogenesis of Schizophrenia" (1957), which demonstrate his wide scientific interests. Ye. O. Popov proposed the phase-inhibitory theory of hallucinations, the pharmacodynamic experiment method, and others.

Yakiv Pavlovych Frumkin (1902–1978), a student of P. B. Gannushkin, headed the Department of Psychiatry at the O. O. Bogomolets Kyiv Medical Institute from 1932 to 1975. He defended his doctoral dissertation on "Types of Epileptic Dementia" (1932). He focused on pressing issues in the theory and practice of clinical psychiatry, the methodology of psychiatric Diagnosis in epilepsy, schizophrenia, and infectious and mental pathology in the elderly. Ya. P. Frumkin authored over 150 scientific papers, in which he was the first to describe clinical concepts such as "undefined affect type" (in schizophrenia) and the "principle of correspondence." He detailed the Clinical forms of epilepsy and types of epileptic dementia, the Clinical presentation of arteriosclerotic hallucinosis, "trace mechanisms in psychopathological symptom formation," "acute psychopathic states," and the "Frumkin triad" (in schizophrenia). He published a number of monographs and textbooks, namely: "Psychiatric Terminology" (1939); "Brief Cytology/practical/136.html">Differential diagnosis OF Certain Forms of Mental Illness" (1951); "Educational Atlas of Psychiatry" (1963; co-authored with H. L. Voronkov); "Psychiatry: Tables and Diagrams" (1977; co-authored with H. L. Voronkov, I. D. Shevchuk); and "Trace Effects in the Clinic of Psychopathology" (1978, co-authored with S. M. Livshitz). Under Ya. P. Frumkin's supervision, 9 doctoral and 38 candidate dissertations were completed.

Yosyp Adamovych Polishchuk (1907–1978), from 1934 to 1941, combined the duties of a senior researcher at the Ukrainian Research Institute of Psychoneurology and an assistant at the Department of the Kharkiv Medical Institute. From 1944, he worked as an associate professor in the Department of Psychiatry at the Kyiv Institute for Advanced Medical Training. Following the death of V. P. Protopopov, Professor Yu. A. Polishchuk headed this department for 24 years. His scientific research focused on the biochemical, immunological, and GENETIC ASPECTS OF the Etiology, pathogenesis, and treatment of schizophrenia and manic-depressive psychosis.

In patients with schizophrenia, Yu. A. Polishchuk (1938) identified protein metabolism disorders leading to gestosis. To eliminate the latter, he proposed detoxification therapy using sodium hyposulfite and unithiol. He was the first (1956) to introduce the concept of hypoenergism for schizophrenia and hyperenergism for manic-depressive psychosis. He developed the hypothesis of polygenic inheritance of schizophrenia. From a biochemical perspective, he described syndromes such as: endogenous and exogenous intoxication types; impaired oxidation processes; alimentary deficiency; and impaired endocrine-vegetative regulation. For each of these syndromes, he also proposed methods for correcting Metabolic Disorders.

Yu. A. Polishchuk is the author of over 110 scientific papers. He wrote 4 monographs: "Biochemical Syndromes in Psychiatry" (1967), "Atlas for Experimental Study of Human Mental Activity" (1968), "Schizophrenia" (1979), and "Clinical Genetics in Psychiatry" (1981).

Heorhiy Leonidovych Voronkov (1923–1992) was a World War II veteran and participant in the Victory Parade on Red Square in Moscow. In 1953, he graduated from the Kyiv Medical Institute. From 1953 to 1992, he worked at this institute: initially as an assistant, then as an associate professor, and from 1975 to 1991 as Head of the Department of Psychiatry. For 18 years, he served as the Chief Psychiatrist and Chairman of the Problem Commission on Psychiatry of the Ministry of Health and the Academy of Medical Sciences. In 1972, he defended his doctoral dissertation on "The Problem of Onsets and Early Diagnosis of Epilepsies." He described risk factors for epilepsy (epileptic radicals) and a specific form of epilepsy known as cephalgolepsy. His research interests also included Other forms of psychosis, alcoholism, symptomatic mental disorders, and the Organization of Psychiatric care. He authored nearly 100 scientific papers, including "Educational Atlas of Psychiatry" (1962; co-authored with Ya. P. Frumkin); "Psychiatry: Tables and Diagrams" (1977; co-authored with Ya. P. Frumkin,

I. D. Shevchuk). Under his editorship, the "Handbook of a Psychiatrist" was published (1990). He was a laureate of the Academician V. P. Protopopov Prize (1990).

The 1950s marked the dawn of the psychopharmacotherapy era, heralded by the widespread introduction of psychoactive medications into clinical practice. This was preceded by the study of Neurotransmitters in schizophrenia, manic-depressive psychosis, and other mental illnesses. Since then, the clinical manifestations of schizophrenia, epilepsy, manic-depressive psychosis, and other mental conditions have evolved, a phenomenon termed pathomorphosis. Research aimed at deciphering The structure of genes responsible for psychoses has been actively pursued, which will facilitate the development of novel treatments.

In recent decades, alongside the aforementioned classical problems of psychiatry, priority has been given to studying the neuropsychiatric consequences of environmental hazards and reviving person-centered approaches (psychoanalytical, behavioral, etc.), the development of which had been halted in the 1930s for well-known reasons.

Review Questions

1. What contributions did Philippe Pinel and Jean-Étienne Esquirol make to the development of psychiatry?

2. What was THE CONTRIBUTION OF Karl Kahlbaum and Emil Kraepelin to the development of the nosological approach in psychiatry?

3. When and where did monastic psychiatry emerge, and what methods did it use to provide care for the mentally ill?

4. Who is considered the founder of psychiatry in Slavic countries, and what did he contribute to its development?

5. Name the Representatives of the Kharkiv and Kyiv schools of psychiatry In the second half of the 19th and the first half of the 20th centuries. Outline the Morphology/3.html">MAIN DIRECTIONS OF their scientific and practical activities.

6. Who is the founder of psychiatry in Russia, and what is his contribution to this field?

7. Name the main representatives of the St. Petersburg and Moscow schools of academic psychiatry in the second half of the 19th and early 20th centuries. Characterize their contribution to the development of this branch of medicine.

8. Name the leading representatives of contemporary psychiatry in Ukraine. Characterize the areas of their scientific research.