Brain Healers Through History, Part 1: The Bhagavad Gita to Griesinger

Steven Rourke  |  May 18, 2016

Slide 1

Methods to understand the brain—and to treat disorders that affect it—have arisen in a wide variety of forms across historical periods, cultures, geographies, and, more or less, wherever people congregate. In this three-part series, we sort through the historical record—from pre-Vedic India to modern-day Manhattan—to identify some of the most important brain healers, those who have helped illuminate the specialties relating to the brain and its health, as we know them today.

As with any cross-cultural sprint through history, this overview is guilty of blurring a few epistemological lines and bringing together an eclectic assortment of specialists—physicians, anatomists, philosophers, theologians, historians, artists, therapists, and “madhouse keepers”—who, though they may have been used to working in separate cubicles, have all contributed to our understanding and the well-being of the brain.

Slide 2

Krishna teaching Arjuna, from Bhagavad Gita (house decoration in Bishnupur, West Bengal, India).

Vedic and Pre-Vedic India

Perhaps the oldest surviving records of what we might consider mental illness and steps to heal the brain are from Vedic and pre-Vedic Southern Asia.

The Bhagavad Gita (c. 4000-3000 BCE) discusses the role of balance in physical and mental well-being, with healing based in methods to promote harmony by controlling the mind, emotions, and senses. It has been described as a “classical example of crisis intervention psychotherapy.”[1]

Much later down the road, other Indian scriptures, such as the Atharvaveda (c.1200 BCE), described mental illnesses that include conditions that we might now call schizophrenia and bipolar disease. The Ayurvedic texts Charaka Samhita and Sushruta Samhita stipulate that schizophrenia should only be treated by experts in mental health.[2]

Rich traditions of discourse relating to mental health are found in other Indian cultures and medical systems, including Siddha medicine—proof that mental illness has been on the record in the region for several thousand years.[2]

Image courtesy of Wikimedia Commons

Slide 3

Statue of Confucius at Confucian Temple in Shanghai, China.

Chinese Traditions

Equilibrium of the physical and psychological is a fundamental principle in much of East Asian thought. And for three millennia, Chinese philosophers and healthcare professionals have theorized about psychological well-being and sought to heal the brain.

Confucius (c. 551-479 BCE) described collective harmony—tolerance, understanding, compromise, and emotional restraint—as the root of mental health, which relies on the well-being of the community rather than the promotion of individual self-interest.[3] And the Huangdi Neijing (c. 200 BCE), a pillar of Chinese medicine, describes mental illness and symptoms of “disturbed affect and behavior.”[4]

The concept of mental health in Taoism, developed by Lao Tzu and Chuang Tzu in about 500 BCE, is based in self-transcendence and integration with the laws of nature rather than “self-development” and “social attainment.”[5] Hsun Tzu (c. 298-238 BCE) wrote of the mind collecting the “knowledge of the senses.”[6]

Image from Dreamstime

Slide 4

Pharaonic Egypt

Surviving papyri recount the extensive pharmacopeia and well-established medical beliefs in Pharaonic Egypt, which include theories of the role of the brain and how the mind affects health.

Imhotep (c. 3000 BCE), one of the first recorded physicians and vizier of the pharaoh Zoser, practiced “temple sleep”—a psychotherapeutic method seemingly related to the interpretation of dreams.[7]Stroke appears to be described in an inscription found in the tomb of vizier Weshptah (c. 2455 BCE).[8]

In the Edwin Smith Papyrus (c.1600 BCE), we find descriptions of brain anatomy, the effects of trauma on the brain, the role of nerves, and outcomes of medical and surgical interventions.[9,10] And one century later, the notion of the brain as the site of mental function and a description of depression and dementia are found in the Ebers Papyrus (c. 1500 BCE).[11]

Image from Dreamstime

Slide 5

Statue of Hippocrates, father of medicine.

The Greek Tradition

Building on the Egyptian framework, philosophers and early health practitioners in classical Greece helped shape the sphere of mental health with ideas founded on the interrelationship between mental and physical health, along with increasing knowledge of the brain.

Hippocrates (c. 460-370 BCE)—within the paradigm of a “healthy mind in a healthy body”—described mental care and art therapy interventions as one of the three components of care in what is perhaps the oldest classification of mental disorders.[12]

With his pioneering and systematic human dissections, Herophilos (c. 330-270 BCE)—often called the “father of anatomy”—helped contribute to the realm of brain healing through his descriptions of the nervous system and brain anatomy[13] and by calling the brain “the seat of the intellect.”[14]

Celebrated as one of the first anatomists of the brain, Galen (c.130-210 BCE) devoted much of his life to the anatomy and research of the brain through dissection and vivisection and was guided by his belief that the brain controlled the body.[15]

Another anatomist, Rufus of Ephesus (c. 80-150), helped further the understanding of the anatomy and functioning of the brain with the theory that the nerves, spinal cord, and brain—although separate anatomical structures—are composed of the same substance.[16]

Image from Alamy

Slide 6

Persian-born physician Rhazes (c. 865-925 CE) was first to describe measles and smallpox; to observe pupillary reaction to light; to publish a text on children’s diseases. He represented Arabic medicine at its best.

Early Islamic Tradition

The Islamic Golden age was rich in examinations of the psyche, human nature, and psychological thought.[17]

The Persian philosopher and physician Abu Bakr Muhammad ibn Zakariya al Razi (c. 854-925 CE)—also known as Rhazes—treated mental health patients, practicing a form of what we might now call psychotherapy. Rhazes stressed the importance of self-esteem and positive thinking in his theory of “sound mind, healthy body,” and he rejected the mind-body dichotomy popular in the medical tradition of the ancient Greeks.[18]

Also in the realm of mental health, the authoritative Ibn Sina or Avicenna (c. 980-1037) is considered a pioneer for his consideration of the psychosomatic causes of disease. His vast opus—notably, the Canon of Medicine—addresses a profusion of medical phenomena, including the role of psychological well-being and how health can be maintained by physical and mental activities.[19]

Not to be overlooked, the two oldest known mental health hospitals operated during this period, in Baghdad (8th century CE) and Cairo (9th century CE).[20]

Image courtesy of National Institutes of Health

Slide 7

Augustine of Hippo (c. 354-430) and the Middle Ages

Augustine of Hippo was perhaps one of the last to contribute to the sphere of brain healing before the dark millennia of the Middle Ages descended on Europe.

With an academic background grounded in the study of the Greek philosophers, and deeply rooted in theology (as befits a future saint), he conceived of the mind as the interface between the divine and the terrestrial, believing that memory was the root of psychological functioning.[21] Augustine of Hippo is considered by some to be one of the West’s first psychologists.

Image from Dreamstime

Slide 8

Mondino de’ Liuzzi (1270-1326): Common Sense Lies in the Brain

Mondino de’ Liuzzi was an anatomist and physician who helped reinstate the practice of direct anatomical observation through human dissection as Europe began to emerge from the Middle Ages.[22] He is known as “the restorer of anatomy.”[23]

Growing up in his father’s pharmacy in Bologna, Mondino was exposed to the profession of healing at a young age and continued his medical education at the University of Bologna.

At a time characterized by the power of the church, Mondino’s public dissections, starting in around 1315, were a courageous counter to official doctrine. In the absence of human dissection, anatomical understanding up until then relied heavily on the teachings of predecessors, such as Galen.

Mondino is also notable for his suggestion that common sense lies in the brain.[24,25] His contributions to neuroanatomy—perhaps limited in scope, owing to the church’s proclaiming it a sin to open the skull—included associating areas of the brain with specific functions: the choroid plexus with thinking; the lateral ventricles (which he divided into three) with fantasy (anterior), “special senses” (middle), and imagination (posterior); the third ventricle with cognition and prognostication; the fourth ventricle with memory.[23]

Anothomia, Mondino’s best known and most widely disseminated text, was an important reference book for two centuries.[23]

Image courtesy of National Institutes of Health

Slide 9

Leonardo da Vinci (1452-1519): Precise Anatomical Illustrations and Sublime Artistry

As the first great medical illustrator, with over 5000 surviving drawings, Leonardo da Vinci contributed significantly to our anatomical understanding of the eye, brain, and nervous system (and, of course, much else).

From an artistic and scientific perspective, da Vinci’s starting point was, naturally, rooted in the theories and culture of the early renaissance and influenced by his predecessors, including Galen, Avicenna, and Mondino de’ Liuzzi. It’s unsurprising, then, that some of the mistakes of these early anatomists—people (excluding de’ Liuzzi) whose knowledge of dissection was either second-hand or derived from animal models—crept into the early work of da Vinci.

But Leonardo da Vinci was at the vanguard of change during a period in which artists were maneuvering to understand anatomy through human dissection. At a time when art and medicine frequently overlapped, da Vinci practiced what he called the “science of painting” in his belief that “to draw is to understand.”[26]

As his career progressed, da Vinci refined our understanding of anatomy, making brilliant use of artistic innovations of the age, such as shading, perspective, proportion, and realism.[27]

da Vinci was also an innovator in dissection methodologies, for such practices as hot wax casting.[26,28] Given the poor conditions under which dissections took place—no refrigeration, no sanitation, and dubious origin of cadavers—and the remarkable quality of da Vinci’s illustrations, it’s fair to say that he must have been a gifted dissector.[29]

Beyond his artistry, da Vinci was also the first to describe the frontal sinus and meningeal vessels; contributed to neurophysiology; and provided original, mechanistic models of sensory physiology.[28]

Image from Dreamstime

Slide 10

Thomas Willis (1621-1675): Brain Anatomist, Philosopher, and Theologian

The English physician, anatomist, and philosopher Thomas Willis is best known for his description of the anastomotic system of arteries at the base of the brain—the circle of Willis.[30,31] His writings, particularly Cerebri Anatome (1664), provided advances in the knowledge of the brain. And for his pediatric cases—including studies of intracranial effusion, convulsion from shaking injury, cerebral abscess, and epilepsy—Willis has been dubbed the first pediatric neurologist.[32]

Departing from the purely anatomical, Willis’s studies combined philosophy, theology, politics, and medicine, providing the vehicle for his reflections on 17th-century Restoration England. Willis believed that the study of anatomy could “unlock the secret places of man’s mind and look into the living and breathing chapel of the deity.”[30] He described the brain and nerves as an ordered system built by God and took to brain anatomy with conviction, filling the void in anatomical knowledge with a wealth of studies and experiments, while carrying out an active and successful medical practice.

Thomas Willis is also thought to have coined the term “neurologie.”[32]

Image courtesy of Wikimedia Commons

Slide 11

French psychiatrist Philippe Pinel (1745-1826) releasing lunatics from their chains at the Salpêtrière asylum in Paris in 1795.

Philippe Pinel (1745-1826): The Asylum Movement and Moral Treatment

From a lineage of “country doctors,” Philippe Pinel received his medical training in Toulouse and Montpellier but found himself excluded from practice in prerevolutionary Paris owing to the “provincial” provenance of his degree. He developed his outlook and skills while working as a medical writer and unlicensed physician in a private asylum, before the winds of change swept in his direction and he was appointed physician-in-chief of the Paris public asylum.[33]

An advocate for the humane treatment of patients, Pinel was influential in asylum reform and was one of the founders of the “moral treatment” movement, which called for patients to be treated as human beings (or, to be precise, like children) rather than purely criminals or animals. His theories departed from the commonly held notion of mental illness residing in demoniacal possession and instead underlined the role of social and psychological stresses, heredity, and physiological damage.[34] His Memoir on Madness (1794) has been described as a fundamental text in modern psychiatry.[35]

Pinel is celebrated as having “freed the mad from their chains”—though this may have been in part the initiative of his assistant, an ex-patient known as “Mr Poussin.”[33] Details, details. Pinel seems to have been happy to share the limelight, proclaiming the value of knowledge and skills acquired by the non-medically trained persons (“madhouse keepers”) who honed their skills on the job.

Image courtesy of Wikimedia Commons

Slide 12

Benjamin Rush (1746-1813): Man of the Enlightenment and Father of American Psychiatry

A leader of the American Enlightenment, signatory of the Declaration of Independence, participant in the Continental Congress, supporter of the American Revolution, and Surgeon General of the Continental Army, Dr Benjamin Rush is also considered one of the founders of American psychiatry.

From a humble background in rural Pennsylvania, Benjamin Rush received his first degree, aged 14, from the College of New Jersey (modern-day Princeton) before taking up medical training at the University of Edinburgh.[36,37] While in Europe, Rush—a humanist and progressive, and very much a man of his times—was exposed to leading thinkers and new approaches to medicine, politics, and philosophy.[36]

Rush’s career on returning from Europe was a heady combination of research, medical practice, teaching, social reform, and politics. He was influential in all the fields he tackled but focused on medicine—making significant contributions to the study of mental health—once politics lost its shine.

Rush advocated for the humanization of treatment in psychiatric institutions. For his brilliant mind, prolific research, and novel approaches—as well as the publication of his highly respected Medical Inquiries and Observations, Upon the Diseases of the Mind (1812)—he is remembered as the father of American psychiatry and a founder of American medicine (as well as “the Pennsylvania Hippocrates”).[36,37]

Image courtesy of National Institutes of Health

Slide 13

Johann Christian Reil (1759-1813): Originator of the Term “Psychiatry,” Founding Father of Neurology

Best known for creating the term “psychiatry,” Johann Christian Reil was an advocate for the mentally ill, reformer of medical education, physiologist, and founding father of neurology. From his base at the University of Halle (and, in later life, at Berlin University), Reil was a prolific academic, accomplished practitioner, and the city’s official physician.

Reil believed in society’s obligation to support the mentally ill. Published in 1803, his Rhapsodies on the Application of Psychic Treatment Methods to Mental Disturbances (a title that might work better in German) called for the humane treatment of these patients in carefully designed institutions. He also advocated specialized medical training, proposing that the treatment of diseases of the mind necessitated advanced study in psychiatric disorders.[38]

In his treatise On the Term of Medicine and Its Branches, Especially With Regard to the Rectification of the Topic in Psychiatry (1808), Reil was the first to describe “psychiatry,” which he conceived as one of the core specialties—alongside surgery and pharmacy—in his vision of medicine.[38,39]

Through his studies of the corona radiata, insula Reili, sulcus circularis Reili, trigonum lemnisci, and Johann Reil is recognized as a contributing founder of neurology. It’s also argued that many underpinnings of our conception of psychiatry date back to Reil.

Image courtesy of National Institutes of Health

Slide 14

Wilhelm Griesinger (1817-1868): First Biological Psychiatrist 

The German physician Wilhelm Griesinger is known as a founder of biological psychiatry, famously stating that “mental illness is rooted in the failure of the brain.”

His approach refuted two competing theories of the time—the moral and the somatic[40,41]—and he argued that mental illness lies in a combination of anatomy, physiology, psychology and social environment,[42] as outlined in Pathology and Therapy of Mental Disorders (1845). By distinguishing between “acute” and “chronic” mental illness, Griesinger differed with his contemporaries, who favored the “curable” vs “incurable” paradigm.[42]

Griesinger was an innovator in community-based care. Proposing the integration of acute patients into hospitals within towns and cities, he believed that short-term hospitalization could be effective if combined with active support systems. On the other hand, he argued that care for patients with chronic illness was best given in rural, specialized settings.[43]

Griesinger traveled widely—throughout Germany, in France, and Austria, as well as in Egypt where he was head of the medical school in Cairo. He had experience in pediatric psychiatry and was the head of Berlin’s psychiatric institute.[44]

Stay tuned for part 2 of this series.


Link original: http://www.medscape.com/features/slideshow/brain-healers-part-1#page=15

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