Historical background

Psychiatry goes through phases in which one or other of these various physical, social, or psychological models is regarded as most influential in psychiatric causation generally. In the early and mid-twentieth century, the psychological theories stemming from psychoanalysis (Freud) were dominant, especially in the USA. Later, 'biological' psychiatry was dominant, following the discovery - all in the 1950s - of effective mood stabilizers, antidepressants, and antipsychotic drugs.

Social factors were to the fore in the 1960s and 1970s, at the time of deinstitutionalization and the 'anti-psychiatry' movement. However, ideas that psychiatric disability was mainly caused by social factors such as prejudice and 'stigma' have not been borne out.

Recently, psychological factors have staged something of a comeback, with the emergence of cognitive behavioural therapy; however, biological psychiatry, now emphasizing such factors such as 'receptors' and molecular genetics, remains influential.

The bio-psycho-social model, as originally derived for chronic pain patients, probably provides the most realistic overall model of causation, as we know enough to be sure that none of the above approaches is ever going to be capable alone of providing complete explanations.

This chapter outlines some general principles and research techniques. More detail regarding causation of individual disorders will be given in later chapters.

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