Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_205_библиотеки_им_акад_М_И_Перельмана

As more biologically focused psychopharmacological treatments emerged in the late 1950s and early 1960s, a shift to a more biopsychosocial understanding of mental disorder etiology began (Engel 1980). By the time of DSM-II in 1968, the term reaction was dropped from almost all of these disorders and more elaborative descriptions were added, including manic-depressive illness, circular type; manic-depressive ill­ness, depressed type; other major affective illness; involutional melancholia; psycho­sis with childbirth; psychotic depressive reaction; and depressive neurosis (American Psychiatric Association 1968). In this DSM edition, however, the conceptual approach to psychoses and neuroses remained essentially the same. Also in DSM-II, cyclothymic personality remained in the personality disorder section with an added parenthetical descriptor (affective personality). The psychoses were split between organic brain syn­dromes and “functional psychoses.” The former included disorders in which clear eti­ological factors, such as Alzheimer’s disease, strokes, infections, nutritional deficien­cies, or substance exposure, were involved. The functional psychoses—those not at­tributed to physical conditions—included manic-depressive illness (manic, depressed, and circular types) and involutional melancholia (affective psychosis). Anxiety was considered to be the chief characteristic of all of the neuroses that could be expressed directly, or controlled unconsciously and automatically (by psychological defense mechanisms). In the case of depressive neurosis, there was no gross distortion or fal sification of external reality (e.g., delusions or hallucinations); this diagnosis was con­sidered to be “an excessive reaction of depression due to an internal conflict or to an identifiable event such as the loss of a love object or cherished possession” (American Psychiatric Association 1968, p. 40).