Plan

 Introduction

 French Classification
 Psychosis
 Neuroses
 Personnality disorders

 Some examples of psychiatric institutions in

the Arab world
 Conclusion
Plan

 French Classification
 Psychosis
 Neuroses
 Personnality disorders

 Some examples of psychiatric institutions in the

Arab world
 Conclusion
In the old days…
 Possessions, bewitchment, exorcisme, and
black magic, are terms used to describe the
insane people in the old days.
In the old days…
 It’s psychiatry which
transgressed the
roadblocks essentiel to
understand insane
people in the old days
along with their
mysteries and secrets.
In the old days…
 The history and evolution of « insanity »
cannot be understood away from the
historic evolution of scientific, social and
medical knowledge.
In the old days…
 During the antiquity, psychiatric issues
where not treated medically due to 2 major
reasons:
 Religious thinking: there are no psychiatric
problems but rather divine manifestations.

 Absence of differenciation between psychiatric

and somatic issues.
In the old days…
 Mental affections have been long regarded
as alienations in which there were demonic
and evil possessions.
Hippocrates (460 bc.)
 He was the first to differentiate and specify certain
mental disorders such as phrenitis, mania,
melancholy, and hysteria.

Femmes enceintes - Steve Gribben

Avicenne (Ibn Sina)  Avicenne was a Persian
(c. 980—1037) philosopher, doctor and
scientist. He contributed to
the evolution of psychology.
 Ibn Sina refuted the idea
of ​"Jinn" or demonic
possession in his book
"Qānūn al-Ṭobb".
 He talked about mental
disorders and then about
mania, melancholy and
epilepsy. He found that the
psyche influences the body,
the health and has an
impact on the vegetative life.
Abu Hamid Al-Ghazali  One of the greatest Islamic
(1058-1111 A.D.) philosophers, Al Ghazali discussed
the concept of self, and the reasons
for happiness and sadness.
 Al-Ghazali spoke about the five
external senses (hearing, vision,
taste, smell, touch) and then
internal senses (common sense,
imagination, reflection and
memory).
 He wrote: while the external
senses are related to specific
organs, the inner senses are
located in different regions of the
brain. He discovered that memory
is located at the end of the brain,
imagination is located in the frontal
lobe, and reflection in the middle
region.
In the old days…
 Life in psychiatric hospitals was
rhythmic. every transgression
was severely punished by
barbaric methods.

 For example, talking about

death to the patient to cause
them a shock.
Philippe Pinel (1745-1826)
 Develops treatments for mental alienation
which will become psychiatry.

 Classify the patients as calm

or agitated.

 Introduces the concept of

moral treatment.
In the old days…
 During the eighteenth century, the eminent
differentiation between reason and
unreason was completed.

 And we are starting to classify mental

illnesses.
Psychosis

 In the 19th century, the term "psychosis"

was used for the first time by an Austrian
doctor, Ernst von Feuchtersleben, as an
alternative to the terms "madness" and
"mania".
Etymology
 Psychosis: derived from the Greek term
"psyche" = spirit and "oses" = sick or
abnormal condition.

 Madness was then recognized as a disease

of the soul and then as a mental illness.
Psychosis vs. Neurosis
 It is the psychiatrist Emil Kraepelin (1816)
who established a clear differentiation
between psychotic disorders and neurotic
disorders.
Jean Bergeret
 One of those who described psychosis in
grouped structures:
 Manic-depressive psychosis;
 Paranoid disorder;
 Schizophrenia;
Plan
 Introduction

 Psychosis
 Neuroses
 Personnality disorders

 Some examples of psychiatric institutions in the

Arab world
 Conclusion
Classification
 The French classification of mental illnesses:

 Psychosis
 Neurosis
 Personality disorders
Classification
The French classification is later replaced by the
internationally recognized nomenclatures: DSM
and ICD.

Nevertheless, the French classification made us

understand the evolution of diseases and their
clinical pictures throughout history.
Plan
 Introduction

 Neurosis
 Personnality disorders

 Some examples of psychiatric institutions in the

Arab world
 Conclusion
Psychosis
 Manic-Depressive Psychosis(PMD)

 Schizophrenia

 Non-dissociative psychosis
Psychosis

 Schizophrenia

 Non-dissociative psychosis
Manic-Depressive Psychosis

 Mania and Melancholy: identified

in antiquity, but the close links
which unites them in the same
disease have been recognized by
Falret (1851) who describes it as
"the circular madness" and
Baillarger (1854) which describes it
as "the double form madness”.
Manic-Depressive Psychosis
 1895: Kraepelin brings together the mood
psychosis described previously into a single
disease:
"Manic-depressive madness"

Champs de blé aux corbeaux

Van Gogh
Manic-Depressive Psychosis
 The first division based on polarity, is
proposed by Leonhard (1959), Angst and
Perris:

 Bipolar psychosis: occurrence of manic and

melancholic seizures in the same subject.

 Unipolar Psychosis: Occurrence of One Type,

Recurrent Melancholy.
Manic-Depressive Psychosis
 The existence of sub-varieties within these two
groups left American authors to classify PMD in
a much broader setting of mood disorders.

 DSM-5 currently refers to mood disorders that

include:
 Bipolar and subgroup disorders
 Depressive and subgroup disorders
 NB: The mixed independent entity episode in the
DSM-IV is classified in the previous subgroups
Nowadays…
 Bipolar disorder includes mania, and the
unipolarity characterized by a recurrence of
major depression:

• Some authors recognize the unipolar manic entity

characterized by a recurrence of maniacal access
(discussed entity)

• This would be legitimate in a unique spectrum of

mood disorders
Bipolarity and Celebrities!
 Catherine Zeta Jones

Kurt Cobain
Marilyn Monroe
Psychosis
 Manic-Depressive Psychosis(PMD)

 Non-dissociative psychosis
Schizophrenia
 1906: Bleuler introduces the
term "Schizophrenia" for the first
time, from the Greek "I separate,
I split".

 Bleuler's term refers to "the early

dementia" of his master Kraepelin, a term
first mentioned in 1896.
Schizophrenia
 The term “Early dementia" is then sharply
criticized by Chaslin and Seglas, for whom
the schizophrenic deficit is not a dementia,
nor is juvenile or precocious, since we can
find schizophrenics having started at an
advanced age.
Schizophrenia
 In previous years, Schizophrenia group was
referred to as "dissociative psychosis" to
emphasize its clinical heterogeneity.
Schizophrenia
 However, we come back to DSM-5, the
brand new nomenclature, to clinical
homogeneity where we start speaking of
« The Schizophrenia "

Leonardo Di Caprio
Shutter Island,2010
Martin Scorsese
Schizophrenia
 Despite the lack of a rigorous definition,
clinicians recognize dissociative psychoses as:

"A set of disorders dominated by discordance, verbal

inconsistency, ambivalence, autism on one hand, delusions
and hallucinations on the other hand, with profound
emotional disturbances in the sense of detachment and the
strangeness of feelings, disorders that tend to evolve into a
deficit and dissociation of personality "(Henry Ey).
Schizophrenia and Celebrities
Edward Albert Einstein

Syd Barett, (Pink Floyd)

Psychosis
 Manic-Depressive Psychosis(PMD)

 Schizophrenia
Non-Dissociative psychosis
 These are the "chronic delusions" of the
French nosography, which constitute a set of
three diseases occurring at an older age than
that of Schizophrenia (over 35 years), defined
by delusional ideas that go back to more than
six months.
Non-Dissociative psychosis

 Other
Paranoia
 Mechanism of interpretative delusion.

 Divides into three major types according to

the theme of delusion:
 Passionate delusions;
 Delusions of interpretation;
 delusions of relationship of the sensitives.
Passionate delusion
Examples:
 Erotomania divided by Clérambault in 3
stages:
 Hope to be loved by an individual in general
superior hierarchically
 Frustration
 The Grieve against this object
of desire
Passionate delusion
Examples:
 Delusion of Jealousy:
 Essentially male pathology;
 Total conviction of spouse's infidelity;
 Interpretative mechanism;
 Presents a danger to the object of delusion.
Interpretation delusion
 Described by Serieux and Capgras in 1909
under the name of "reasoning madness".

 Ideas are multiple and diverse.

Interpretations centered on the fact that
everything the subject perceives must have
a persecutory meaning that he brings back
to himself.
Relationship delusions of the
sensitives
 Described by Kretschmer in 1919, on which
a basic ultra-sensitive personality has ideas
of persecution and reference.

 Often the delusional

person is depressed, but as
in all paranoid delusions,
can become persecuted -
persecutor.
Non-Dissociative psychosis
Others…
 Chronic Hallucinatory Psychosis (P.H.C.)
and Paraphrenia:

 Entities specific to French Psychiatry.

 Classified as Schizophrenia (US
classification).
P.H.C.
 Defined by De Clérambault as a chronic
delusional psychosis based on a syndrome
of mental automatism where there is a loss
of control by the subject on his psychic life
which now operates autonomously and
automatically with sensory hallucinations
imposed on the subject by the world
outside.

 Mechanism especially hallucinatory.

John Forbes Nash, Jr.
Paraphrenia
 Paraphrenic delusions are characterized by
a theme dominated by the fantastic register
and an imaginative delusional mechanism.
DSM-5
 The only change is that, some bizarre ideas
can be found in non-dissociative delusions
and is not necessarily part of the diagnosis
of schizophrenia.
Plan

 French classification
 psychosis

 Personnality disorders

 Some examples of psychiatric institutions

throughout history in the Arab world
 Conclusion
Neurosis

 Used by Cullen for the first

time in 1769, the term
Neurosis was repeated in the
nineteenth century to
designate diseases "without
organic lesion".
Neurosis
 Early twentieth century: Janet defines
neurosis as:
"A group of morbid disorders which is formed
by the most bizarre and disparate
phenomena, which we do not know how to
relate to each other".
Neurosis
 Freud stresses the importance
of psychological conflict which
is at the origin of neuroses, the
neurotic symptoms being the
expression of a psychological
conflict rooted in the subject's
childhood and constituting a
compromise between desire
and defense.
Neurosis
 There are four types of neuroses:
 Anxiety neurosis;
 Phobic neurosis;
 Obsessional neurosis;
 Hysterical neurosis.
 Anxiety neurosis
 Combines a chronic anxiety background
with paroxysmal anxiety attacks without
triggers found.

Angoisse, 2003
Gao XINGJIAN
Encre sur papier de riz.
Phobic neurosis
 Irritated and unreasonable fear of a so-
called "phobogenic" situation, but not of an
objectively dangerous nature.
Obsessional Neurosis
 "Madness of doubt" or ”delusion of touch".
 Association of a meticulous and idealistic
personality with obsessive thoughts leading
to rituals and compulsions.
Hysterical neurosis
 Associated with varying degrees of symptoms of
organic appearance, most often neurological, or
affecting other organs most often related to so-
called histrionic personality traits that combine
suggestibility, theatralism and exuberance.
Neurosis
 Nowadays, the concept of neurosis is
questioned and disappeared in the most
used international classifications.

 The term neurosis is replaced by the term

"disorders".
Neurosis
In the DSM-IV, neurotic diseases have been
replaced by the following entities:

• Generalized anxiety disorder • Conversion

• Panic disorder with or without
agoraphobia
• Social / specific phobia
• Obsessive Compulsive Disorder
• Post-traumatic stress disorder
• Somatoform disorders
• Hypochondries
• Dysmorphophobia, etc ...
 Neurosis
In the DSM-5, we see the following changes:

 Conversion Functional disorder with

neurological symptomatology

anxiety with somatic complaints

Hypochondria
anxietywithout somatic complaints

 Dysmorphophobia part of obsessive

compulsive disorder (OCD).
Neurosis
 In the DSM-5, we see the following changes:

 Agoraphobia: becomes a common denominator

that can be present with all anxiety disorders.

 Obsessive Compulsive Disorder: Becomes an entity

apart.
Plan

 Some examples of psychiatric institutions

throughout history in the Arab world

 Conclusion
Personnality disorders
 K. Jaspers defines personality as "the
particular way a man's tendencies and
feelings are manifested, the way he is
impressed by the situations in which he
finds himself and how he adapts to them".
Traits vs. Disorder
 The distinction between traits and
personality disorders is important:

 Trait represents a trend in the behavior

of an individual.
 Disorder indicates a limited and
stereotyped pathology with implications
for the behavior of the individual.
Traits vs. Disorders
 Ex: Paranoid personality

 Trait: susceptible, slightly megalomaniac

but functioning normally.

 Disorder: the idea of ​harm, greatness,

psychorigidity, doubt of others, with
aggressive reactions, preventing it from
functioning normally.
American Nomenclature -A

Paranoid personality where the

rigidity of thoughts dominates
(Adolf Hitler)

Schizoid personality with autistic

behavior
(Bill Gates)

Schizotypal personality with

bizarre manifestations and strange
behaviors (Nicolas Cage)
American Nomenclature -B

Narcissistic personality turned on

the ego
(Staline)

Antisocial personality with

maladjustment to the norms of
society (Saddam Hussein)
American Nomenclature -C

Histrionic personality with

emotional hyper-reactivity (Vivien
Leigh as Sara O'nara)

Borderline Personality with

Instability and Anxiety
(Lady D.)
American Nomenclature -C
Obsessive personality centered
on meticulousness (David
Beckham)

Avoidant personality characterized by

hypersensitivity to the judgment of others
and a general mode of social inhibition
(Brown Charlie Brown: cartoon character)

Dependent personality with

excessive need to be cared for
(Stephen Colbert)
 DSM-5 DSM VI ?
 4 characters currently maintained in the DSM-
5, will probably disappear in the next
nomenclature as promised by the authors of
the DSM-5:
 Paranoid
 Schizoid
 Histrionic
 Dependent
Plan
Psychiatric institutions throughout
history in the Arab world

 Bimaristan Al Majanin – Baghdad, Iraq – 982

 Kalawoon Hospital – Caire, Egypte – 1284
 Al Bimaristan Al Arghuni – Alep, Syrie – 1354
 Al Asfourieh – Hazmieh, Liban – 1900
 Deir El Salib – Jal El Dib, Liban – 1920
 Behman Hospital – Caire, Egypte – 1940
 Baghdad
Bimaristan Al Majaneen (982)

 Al Bemarstan Al
Uthhdie was a
hospital built in
982 by Uothid - Al
Dawla Al Bouihee.
 It is considered the
first psychiatric
hospital in the
world (Bemarstan
Al Majaneen).
 Cairo
Kalawoon Hospital (1284)

 The concept of mental illness in

Egypt has been present since
the time of the pharaohs, from
the Islamic period to the present
day.
 The papyri at the time of the
Pharaohs show that Soma and
Psyche are undifferentiated and
mental disorders are described
as symptoms of the heart and
uterus.
 Aleppo
Al-Bimaristan Al-Arghuni (1354)
 One of the most
fascinating
monuments is
located in Aleppo
(‫ )حلب‬in the century
of "Mamluk", it is the
psychiatric hospital
called Al-Bimaristan
Al-Arghuni ( ‫البيمارستان‬
‫)االرغوني‬.

 This institution offers help to the different mental patients

while the Europeans consider these same patients as
possessed by evil spirits.
 Aleppo
Al-Bimaristan Al-Arghuni (1354)

 Musicians and singers were

engaged to calm the
patients.
 Music therapy was
recommended in the
treatment of melancholy.
 In the same way, the
continuous sound of the
fountain beside the
patients' rooms was
intended to calm agitated
patients.
Hazmieh, Lebanon
Al Asfourieh (1900)

 Al Asfourieh was the first

psychiatric asylum in
Lebanon.
 Built in 1900 in Hazmieh
a few kilometers from
Beirut.
 Sold in 1973 to an
American firm to be
rebuilt elsewhere
(suspended project).
 Deir El Salib – Jal El Dib (1920)

 Father Jacques built the Convent of the Cross in 1920.

 In the 1930s, he began to receive the elderly, the poor,
and all those in need of help.
 In the fourties, the convent housed more than 1000
people including the mentally ill.
 In the fifties, Deir El Salib was officially recognized as a
psychiatric hospital.
Behman Hospital
Cairo – Egypt (1940)

 October 1940, the house

at the end of the hill in
Helwan becomes the
Behman Hospital.
 It was the first psychiatric
hospital in Egypt.
 For thirty years, Dr.
Behman has contributed
to the evolution of this
exemplary hospital with
an international
reputation.
Plan
 Introduction

 French Classification
 Psychosis
 Neuroses
 Personnality disorders

 Some examples of psychiatric institutions in

the Arab world
Conclusion
 Despite the fact that classifications limit our
interpersonal contact in psychiatry;

 Despite the fact that some classifications come

back after being banned;

 Despite the fact that they give us a transverse and

not longitudinal view of the patient;
Conclusion