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Evolution of Medicine

Life expectancy

Since 1850, life expectancy has more than doubled mostly due to infection control. Improvements in sewage management, clean water, access to medical help, vaccination, and anti-bacterial drugs that have transformed public health. 

The Covid 19 pandemic was a reminder of the danger of infectious disease. It pushed hospitals to the limit and resulted in 7M deaths world wide, inspite of lockdowns and the quickest vaccine development in history. Covid 19 significantly reduced life expectancy. 

Women live 6 years longer than men or  80yrs  vs 74yrs 

Men of height men of height 5'7" (170.2 cm ) or less lived 7.46 years longer than those of at least 6'1" (182.9 cm).

Cause of death 

The top 10 causes of death in 2019, before Covid, are: 

US                                     World




Alzheimer                    Digestive

Digestive                      Lower respiratory

Kidney                          Neonatal

Lower respiratory      Enteric infections

Diabetes                      Alzheimer 

Liver                             Diabetes

Illegal Drugs                Diarrheal 

The World causes of death show that infections and neo natal care are still an issue in poorer countries. The biggest issues are the same rich or poor; cardio vascular, cancer and respiratory. US has notably higher rates of  cancer, Alzheimer's and kidney disease. 

Barriers to progress

Between 1999 and 2016, there has been significant progress in preventing;                 

        heart disease by early detection, cholesterol mgmt. and routine bypass surgery

        stroke by blood pressure and arrythmia control

        lung infections by reducing smoking 


Becoming more prevalent are;


        accidents from risk taking in social media

        drug overdoses from the opioid explosion 

         lower respiratory  



         diabetes from more obesity


Total deaths from Cancer has not changed. 


The top 10 cancer killers are; lung, colon, pancreatic, breast, prostate, leukemia, non- Hodgkins, liver, bladder.

The cancers with improved survival are; colon, lung, breast, prostate, stomach, cervical. Most of these have routine early screening programs. 

The cancers with poorer survival are; liver, pancreatic, esophageal, bladder, kidney, brain, gall bladder. Early detection is a problem in these cancers. The most common and getting worse is pancreatic. By the time pancreatic cancer produces symptoms it usually has already mediatized and spread. 



Role of poverty 

The research by Alice Chen, Emily Oster, and Heidi Williams (2016)  “the observed higher US postneonatal mortality relative to Europe is due entirely, or almost entirely, to higher mortality among disadvantaged groups.”Not just the mortality of infants is higher in the US, but maternal mortality is also much higher. And while maternal mortality is falling in almost all countries in the world the death of mothers is becoming more common in the US.


The inequality in life expectancy is large in the US, the difference between the poorest 1% and the richest 1% in the US is 14.6 years, and getting worse. 

Changes in the mortality of the young have a much larger impact on average life expectancy.

The US has 2x higher health expenditure than UK  with 3 years worse life expectancy. When combined with the data showing lower 25% incomes having 7 years worse life expectancy the the higher 25%, the ineffectiveness of the US health care system is clear. 

Factors why UK has better life expectancy than US in  deaths per 100,000 are;

obesity                   Diff =  46 

opiod addiction    Diff = 11.3  

road accidents      Diff =  7, 

suicides                  Diff =  6,

homicides              Diff = 5.

The take aways for US residents are the importance of following all the screening protocols, regular exercise, avoid smoking and opiods, weight control. The biggest hidden dangers appears to be pancreatic cancer and Alzheimer's

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Cancer deaths.jpg

History of Medicine      

Traditional medicine in China and India focused on herbal medicines as natural drugs  Hippocrates formalized early medical ideas such as famous oath. Over time the understanding of anatomy and how the bodies functions interacted. 

Islamic medicine understood the value of clean practices long before Western medicine. The Tasrif, written by surgeon Abu Al-Qasim Al-Zahrawi, was translated into Latin; it became one of the most important medical texts in European universities during the Middle Ages and contained useful information on surgical techniques and spread of bacterial infection.

In the Middle Ages, religious concepts dominated over organized medicine.

The Renaissance brought an intense focus on scholarship to Christian Europe. A major effort to translate the Arabic and Greek scientific works into Latin emerged. Europeans gradually became experts not only in the ancient writings of the Romans and Greeks, but in the contemporary writings of Islamic scientists. During the later centuries of the Renaissance came an increase in experimental investigation, particularly in the field of dissection and body examination, thus advancing our knowledge of human anatomy.

At the University of Bologna, Julius Caesar Aranzi (Arantius) (1530–1589). He became Professor of Anatomy and Surgery   in 1556, where he established anatomy as a major branch of medicine for the first time. Aranzi combined anatomy with a description of pathological processes, based largely on his own research, Galen, and the work of his contemporary Italians. His books (in Latin) covered surgical techniques for many conditions, including hydrocephalusnasal, polypgoitre and tumours to phimosisasciteshaemorrhoidsanal abscess and fistulae.[134] 


Sanitary impact

In 1847 in Vienna, Ignaz Semmelweis (1818–1865), dramatically reduced the death rate of new mothers (due to childbed fever) by requiring physicians to clean their hands before attending childbirth, yet his principles were marginalized and attacked by professional peers.[161] At that time most people still believed that infections were caused by foul odors called miasmas.

A major breakthrough in epidemiology came with the introduction of statistical maps and graphs. They allowed careful analysis of seasonality issues in disease incidents, and the maps allowed public health officials to identify critical loci for the dissemination of disease. John Snow in London developed the methods. In 1849, he observed that the symptoms of cholera, which had already claimed around 500 lives within a month, were vomiting and diarrhoea. He concluded that the source of contamination must be through ingestion, rather than inhalation as was previously thought. It was this insight that resulted in the removal of The Pump On Broad Street, after which deaths from cholera plummeted. 

The breakthrough to professionalization based on knowledge of advanced medicine was led by Florence Nightingale in England, and her Nightingale Training School opened in 1860 and became a model. 

During the U.S. Civil War the Sanitary Commission collected enormous amounts of statistical data, and opened up the problems of storing information for fast access and mechanically searching for data patterns. The pioneer was John Shaw Billings (1838–1913). A senior surgeon in the war, Billings built the Library of the Surgeon General's Office (now the National Library of Medicine), the centerpiece of modern medical information systems.[172] Billings figured out how to mechanically analyze medical and demographic data by turning facts into numbers and punching the numbers onto cardboard cards that could be sorted and counted by machine. The applications were developed by his assistant Herman Hollerith; Hollerith invented the punch card and counter-sorter system that dominated statistical data manipulation until the 1970s. Hollerith's company became International Business Machines (IBM) in 1911.


Drug testing protocols have been refined into 3 Phases,  safety, efficacy, and  therapeutic,  by the CDC in the US. The therapeutic phase  is double blind, meaning that neither the patient or therapist know who has the drug and who has the placebo.  


Medical Microbiology

In 1860,  Frenchman Casimir Davaine to identify the pathogen of the deadly disease anthrax.  British surgeon Joseph Lister, however, took these findings seriously and subsequently introduced antisepsis to wound treatment in 1865. In 1881, the outbreak of a cholera epidemic in Alexandria, Egypt,  Pasteur and  Koch, wnet to investigate. Koch's group returned in 1883, having successfully discovered the cholera pathogen

In the 20th century, ongoing research concentrated on the nature of infectious diseases and their means of transmission. Increasing numbers of pathogenic organisms were discovered and classified. Some, such as the rickettsias, which cause diseases like typhus, are smaller than bacteria; some are larger, such as the protozoans that engender malaria and other tropical diseases. The smallest to be identified were the viruses, producers of many diseases, among them mumpsmeaslesGerman measles, and polio. In 1910 Peyton Rous showed that a virus could also cause a malignant tumour, a sarcoma in chickens.

Anti bacterials

In 1910, Ehrlich with his colleague Sahachiro Hata, he conducted tests on arsphenamine, once sold under the commercial name Salvarsan. Their success inaugurated the chemotherapeutic era, which was to revolutionize the treatment and control of infectious diseases. Salvarsan, a synthetic preparation containing arsenic, is lethal to the microorganism responsible for syphilis. Until the introduction of the antibiotic penicillin, Salvarsan or one of its modifications remained the standard treatment of syphilis and went far toward bringing this social and medical scourge under control.

Sulphonamide drugs.  In 1936 English physician Leonard Colebrook and colleagues provided overwhelming evidence of the efficacy of both Prontosil and sulfanilamide in streptococcal septicemia (bloodstream infection), thereby ushering in the sulfonamide era. 

In 1928, when Alexander Fleming noticed the inhibitory action of a stray mold on a plate culture of staphylococcus bacteria in his laboratory at St. Mary’s Hospital, London. The mold was a strain of Penicillium—P. notatum—  Ten years later Howard FloreyErnst Chain, and their colleagues at Oxford University   isolated penicillin in a form that was fairly pure (by standards then current) and demonstrated its potency and relative lack of toxicity. By then World War II had begun, and techniques to facilitate commercial production were developed in the United States. By 1944 adequate amounts were available to meet the extraordinary needs of wartime.

Penicillin  was not active against Mycobacterium tuberculosis. However, in 1944 Selman Waksman, Albert Schatz, and Elizabeth Bugie announced the discovery of streptomycin from cultures of a soil organism. Streptomycin, however, suffers from the great disadvantage that the tubercle bacillus tends to become resistant to it. Fortunately, other drugs became available to supplement it, the two most important being para-aminosalicylic acid (PAS) and isoniazid.  

Antibiotic resistance is seen as a growing problem. 


Dramatic though they undoubtedly were, the advances in chemotherapy still left one important area vulnerable, that of the viruses. It was in bringing viruses under control that advances in immunology—the study of immunity—played such a striking part. One of the paradoxes of medicine is that the first large-scale immunization against a viral disease was instituted and established long before viruses were discovered. The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox virus. Cowpox served as a natural vaccine until the modern smallpox vaccine emerged in the 20th century. When Edward Jenner introduced vaccination against the virus that causes smallpox, the identification of viruses was still 100 years in the future. It took almost another half century to discover an effective method of producing antiviral vaccines that were both safe and effective.

After 1883 Pasteur switched research direction, and introduced his third vaccine—rabies vaccine—the first vaccine for humans since Jenner's for smallpox.

In 1897 English bacteriologist Almroth Wright introduced a vaccine prepared from killed typhoid bacilli as a preventive of typhoid. Preliminary trials in the Indian army produced excellent results, and typhoid vaccination was adopted for the use of British troops serving in the South African War. Unfortunately, due to incomplete test protocols  it was often difficult to decide to what extent the decline in typhoid was attributable to improved sanitary conditions and to what extent it was due to greater use of the vaccine.

In the meantime, however, the process by which the body reacts against infectious organisms to generate immunity became better understood. In Paris, Élie Metchnikoff had already detected the role of white blood cells in the immune reaction, and Jules Bordet had identified antibodies in the blood serum. The mechanisms of antibody activity were used to devise diagnostic tests for a number of diseases. In 1906 August von Wassermann gave his name to the blood test for syphilis, and in 1908 Charles Mantoux developed a skin test for tuberculosis. At the same time, methods of producing effective substances for inoculation were improved, and immunization against bacterial diseases made rapid progress.

The first candidate polio vaccine, based on one serotype of a live but attenuated (weakened) virus, was developed by the virologist Hilary Koprowski. The prototype vaccine was given to an eight-year-old boy on 27 February 1950. leading to large-scale trials in the then Belgian Congo and the vaccination of seven million children in Poland a  between 1958 and 1960.[56]

The second polio virus vaccine was developed in 1952 by Jonas Salk at the University of Pittsburgh, The Salk vaccine, or inactivated poliovirus vaccine (IPV), is based on poliovirus grown in a type of monkey kidney tissue culture (vero cell line), which is chemically inactivated with formalin.[23] After two doses of inactivated poliovirus vaccine (given by injection), 90 percent or more of individuals develop protective antibody to all three serotypes of poliovirus, and at least 99 percent are immune to poliovirus following three doses.[1]

Subsequently, Albert Sabin developed another live, oral polio vaccine (OPV). It was produced by the repeated passage of the virus through nonhuman cells at sub-physiological temperatures. The attenuated poliovirus in the Sabin vaccine replicates very efficiently in the gut, the primary site of wild poliovirus infection and replication, but the vaccine strain is unable to replicate efficiently within nervous system tissue.   Three doses of live-attenuated oral vaccine produce protective antibody to all three poliovirus types in more than 95 percent of recipients. In 1958 ,it was selected, in competition, by the US National Institutes of Health.[56] Licensed in 1962, it rapidly became the only polio vaccine used worldwide.

In 1981, HIV was first detected and had a disastrous impact on sexual partners. 

HIV infects vital cells in the human immune system, such as helper T cells nmacrophages, and dendritic cells.[11]  Upon entry into the target cell, the viral RNA genome is converted (reverse transcribed) into double-stranded DNA by a virally encoded enzyme, reverse transcriptase, that is transported along with the viral genome in the virus particle.   When T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections, leading to the development of AIDS. 

By 2008, anti-viral cocktails, not vaccines, had made HIV a chronic not deadly disease. Most of the antiviral drugs now available are designed to help deal with HIVherpes viruses, the hepatitis B and C viruses, and influenza A and B viruses.[6]   One way of doing this is to develop  nucleoside analogues that look like the building blocks of RNA or DNA, but deactivate the enzymes that synthesize the RNA or DNA once the analogue is incorporated. This approach is more commonly associated with the inhibition of reverse transcriptase (RNA to DNA) than with "normal" transcriptase (DNA to RNA), and so works against HIV.

The first antiviral drug to be approved for treating HIV, zidovudine (AZT), is  a nucleoside analogue.

Over time understanding of the molecular biology of viruses improved. The virus particle has spikes on its surface that are responsible for breaking into healthy cells. Our immune system is triggered by these spike proteins. The idea is that a vaccine that produced the spike protien would activate an immune reaction without using the dangerous virus.  

Covid 19 emerged in 2021 as a dangerous coronavirus.  It was clear quickly that the virus was highly infectious (each person infects 6 others), compared to flu (each person infects 1.5 others).  Covid 19 infection is both symptom free for many and particularly dangerous in the unlucky oldies and those with pre-existing lung issues. Even with a lock down and mandatory masking, the hospitals got to the edge of being overwhelmed several times.  A vaccine that used a m-RNA string that produced the "spike" protein on the surface of the viral particle was developed quickly, tested to be >90% effective and deployed inside a year. It took 2 years for the world to start back to normal.  The most disappointing side effect was that vaccine became a political football, with the right fighting vaccination even though it caused the death of their followers.  US death count was over 1M at the end. 


Röntgen 1895 discovered X rays and could be used to see through bodies. The X ray became a universal diagnostic tool for bones and cartilidge. The early experimenters learnt the hard way about the dangers of X rays. 


English-born physicist John Wild (1914–2009) first used ultrasound to assess the thickness of bowel tissue as early as 1949; he has been described as the "father of medical ultrasound".[123] Subsequent advances took place concurrently in several countries but was not until 1961 when David Robinson and George Kossoff's work at the Australian Department of Health resulted in the first commercially practical water bath ultrasonic scanner.[124] In 1963 Meyerdirk & Wright launched production of the first commercial, hand-held, articulated arm, compound contact B-mode scanner, which made ultrasound generally available for medical use.


CT scanners use a rotating X-ray tube and a row of detectors placed in a gantry to measure X-ray attenuations by different tissues inside the body. The multiple X-ray measurements taken from different angles are then processed on a computer using tomographic reconstruction algorithms to produce tomographic (cross-sectional) images (virtual "slices") of a body. In October 1963, William H. Oldendorf received a U.S. patent for a "radiant energy apparatus for investigating selected areas of interior objects obscured by dense material".[191] The first commercially viable CT scanner was invented by Godfrey Hounsfield in 1972.  CT can deliver significant X ray exposure, so should be used care.

Contrast agents allow  contrast CT to visualize the arteries and veins throughout the body.[37] This ranges from arteries serving the brain to those bringing blood to the lungskidneysarms and legs. An example of this type of exam is CT pulmonary angiogram (CTPA) used to diagnose pulmonary embolism (PE). It employs computed tomography and an iodine-based contrast agent to obtain an image of the pulmonary arteries. Contrast agents can trigger allergic (anaphylactic) reactions.

In MRI  certain atomic nuclei are able to absorb radio frequency energy when placed in an external magnetic field; the resultant evolving spin polarization can induce a RF signal in a radio frequency coil and thereby be detected.  In clinical and research MRI, hydrogen atoms are most often used. Most MRI scans essentially map the location of water and fat in the body. Pulses of radio waves excite the nuclear spin energy transition, and magnetic field gradients localize the polarization in space. By varying the parameters of the pulse sequence, different contrasts may be generated between tissues based on the relaxation properties of the hydrogen atoms therein. Specific organs can be visualized such as  blood flow using  a paramagnetic contrast agent (gadolinium). MRI is much safer than CT, but cannot be used if magnetic metals are in the body. 

In 1973 at Stony Brook University, Paul Lauterbur in the journal Nature,[141] followed by the picture of a living animal, a clam, and in 1974 by the image of the thoracic cavity of a mouse.  Advances in semiconductor technology were crucial to the development of practical MRI, which requires a large amount of computational power. In 1980, Mallard at U Aberdeen built a full body MRI and the first clinically useful image of a patient's internal tissues using MRI, which identified a primary tumour in the patient's chest, an abnormal liver, and secondary cancer in his bones.This was made possible by the rapidly increasing number of transistors on a single integrated circuit chip.[144] Mansfield and Lauterbur were awarded the 2003 Nobel Prize in Physiology or Medicine for their "discoveries concerning magnetic resonance imaging". 


Crick and Watson discovered the molecular structure of DNA, and identify  the replication process. The foundation for sequencing proteins was first laid by the work of Frederick Sanger who by 1955 had completed the sequence of all the amino acids in insulin, a small protein secreted by the pancreas. This provided the first conclusive evidence that proteins were chemical entities with a specific molecular pattern.  Crick began developing a theory which argued that the arrangement of nucleotides in DNA determined the sequence of amino acids in proteins, which in turn helped determine the function of a protein. He published this theory in 1958.

Sanger process.  Takes the DNA string that starts with a "primer", make copy using a mixture of bases and labled sequence stoppers. The stopper randomly creates  a new copy at every point where a specific base occurs, producing a pool of segments. Measure the length of the segments, and create the DNA sequence. Works for up to 900 base pairs, or 900 process cycles. Length gives distance to next base, cycle number give relative position to last base. 

The "Next Generation Sequencing" uses a library of tagged sequences as the probe rather than a single base. Multiple tagged sequences can be detected in a single cycle. The overlapping probes are then assembled into a complete genome. 

Metabolic therapy

There are numerous biochemical process, managed by different organs, that regulate our bodies. Mis-regulation is a root cause of many serious conditions, for example, high blood pressure is a trigger for strokes. Mis-regulation of sugar in diabetes causes major long term damage. Drug treatments have been developed to manage many mis-regulation problems. 

Cancer treatment 

As infections largely disappeared as cause of death, people lived long enough for cancers to be the second leading cause of death. Fighting cancer is a combination of early detection when it is small and before it spreads. This allows a combination of surgery, radiation and chemotherapy to be effective. Recently DNA specific chemotherapy has further improved success rates. Radiation and chemotherapy are very challenging for the patient as the cancer cells are very similar to healthy cells, just with uncontrolled growth.  The treatment is typically designed to just poison the cancer without killing the patient. There has been notable progress on lung, colon, prostate, breast cancers. In 2020, liver and pancreatic are the  cancers that are still becoming more common. 

In 2016, scientists at the Washington University School of Medicine in St. Louis, MO, found that jumping genes are widespread in cancer and promote tumor growth by forcing cancer genes to remain switched on. They analyzed 7,769 tumor samples from 15 different types of cancer and found 129 jumping genes that can drive tumor growth through their influence on 106 different cancer genes. The jumping genes were functioning as “stealthy on-switches” in 3,864 of the tumors that the team analyzed. These tumors came from breast, colon, lung, skin, prostate, brain, and other types of cancer.

“If you,” says Ting Wang, who is a professor of medicine in the Department of Genetics, “perform typical genome sequencing, looking for genetic mutations driving cancer, you’re not going to find jumping genes.”


The oldest known surgical amputation was carried out in Borneo about 31,000 years ago.[10] The operation involved the removal of the distal third of the left lower leg. The person survived the operation and lived for another 6 to 9 years.  The next oldest known amputation was carried out about 7000 years ago on a farmer in France whose left forearm had been surgically removed.

In the 13th century in Europe skilled town craftsmen called barber-surgeons performed amputations and set broken bones while suffering lower status than university educated doctors. 

The discipline of surgery was put on a sound, scientific footing during the Age of Enlightenment in Europe (1715–89). An important figure in this regard was the Scottish surgical scientist (in London) John Hunter (1728–1793), generally regarded as the father of modern scientific surgery. Hunter greatly advanced   new methods for repairing damage to the Achilles tendon and a more effective method for applying ligature of the arteries in case of an aneurysm.[51] He was also one of the first to understand the importance of pathology, the danger of the spread of infection and how the problem of inflammation of the wound, bone lesions and even tuberculosis often undid any benefit that was gained from the intervention. He consequently adopted the position that all surgical procedures should be used only as a last resort.[52] Hunter's student Benjamin Bell (1749–1806) became the first scientific surgeon in Scotland, advocating the routine use of opium in post-operative recovery, and counseling surgeons to "save skin" to speed healing; his great-grandson Joseph Bell (1837–1911) became the inspiration for Arthur Conan Doyle's literary hero Sherlock Holmes.

The European way of modern pain control through anesthesia was discovered in the mid-19th century, however, such practices were common in the 16th century Bunyoro-Kitara kingdom of modern-day Uganda Africa where the Bunyoro physicians used banana wine as an anesthetic agent. Before the advent of anesthesia in Europe, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering.  War time amputation was famous for its speed. 

Beginning in the 1840s, European surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such as ether, first used by the American surgeon Crawford Long (1815–1878), and chloroform, discovered by James Young Simpson (1811–1870) and later pioneered in England by John Snow (1813–1858), physician to Queen Victoria, who in 1853 administered chloroform to her during childbirth. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.

Progress in anesthesia and technique have led to many complex procedures becoming routine. Some milestones; 

1952. The first successful open heart surgery using hypothermia.

1967: The first successful heart transplant by Christiaan Barnard.

​1967. The first successful coronary artery bypass surgery.

in 2020, heart bypass, heart valve repair, joint  replacement, ligament repair, to name a few are routine. Minimally invasive arthroscopic surgery have radically reduced recovery times. 


Founded in the 13th century, Bethlem Royal Hospital in London was one of the oldest lunatic asylums.[12]


In the late 17th century, privately run asylums for the insane began to proliferate and expand in size. Already in 1632 it was recorded that Bethlem Royal HospitalLondon had  "21 rooms wherein the poor distracted people lie, and above the stairs eight rooms more for servants and the poor to lie in".[14] Inmates who were deemed dangerous or disturbing were chained, but Bethlem was an otherwise open building for its inhabitants to roam around its confines and possibly throughout the general neighborhood in which the hospital was situated.[15] In 1676, Bethlem expanded into newly built premises at Moorfields with a capacity for 100 inmates. 

In 1621, Oxford University mathematician, astrologer, and scholar Robert Burton published one of the earliest treatises on mental illness, The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it. Burton thought that there was "no greater cause of melancholy than idleness, no better cure than business." Unlike English philosopher of science Francis Bacon, Burton argued that knowledge of the mind, not natural science, is humankind's greatest need.

In 1656, Louis XIV of France created a public system of hospitals for those with mental disorders, but as in England, no real treatment was applied.[19]


In 1713 the Bethel Hospital Norwich was opened, the first purpose-built asylum in England, founded by Mary Chapman

In 1890, Sigmund Freud proposed psychoanalysis as  a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. These have been discarded. Carl Jung started as a follower of Freud but parted ways with analytical psychology based on  individuation—the lifelong psychological process of differentiation of the self out of each individual's conscious and unconscious elements. Jung considered it to be the main task of human development. He created some of the best known psychological concepts, including synchronicityarchetypal phenomena, the collective unconscious, the psychological complex and extraversion and introversion.

Psychoanalysis continues to be practiced by psychiatrists, social workers, and other mental health professionals; however, its practice has declined. It has been largely replaced by the similar but broader psychodynamic psychotherapy in the mid-20th century.[82] Psychoanalytic approaches continue to be listed by the UK National Health Service as possibly helpful for depression.

Psychodynamic psychotherapy or psychoanalytic psychotherapy[1][2] is a form of psychological therapy. Its primary focus is to reveal the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress.


Human Biology


The human body's 12 systems work together to ensure that we stay alive, healthy, and thrive:

  • The cardiovascular (or circulatory) system transports blood, oxygen, and nutrients throughout the body.

  • The digestive system takes in and processes food, and expels waste.

  • The endocrine system produces hormones that regulate metabolism, growth and development, tissue function, sexual reproduction, sleep, and mood.

  • The immune system fights infection caused by pathogens, like bacteria and viruses.

  • The integumentary system   your skin! And it protects your soft and squishy interior from damage by external dirt, pathogens, and trauma.

  • The lymphatic system is part of the immune system and complementary to the circulatory system. It keeps body fluid levels in balance and defends against infections.

  • The muscular system facilitates movements of our bodies, from reaching for the remote control to smashing out an intense workout in the boxing ring.

  • The nervous system, which consists of your brain, the spinal cord, and all the nerves throughout your body, controls movement, balance, the five senses, thought processes, and awareness.

  • The reproductive system— allows us to make babies.

  • The respiratory system facilitates breathing; more specifically, the intake of oxygen and expulsion of carbon dioxide.

  • The skeletal system provides a strong and durable framework upon which all your meat hangs, while helping to protect your delicate internal organs.

  • The urinary system expels waste and extra water that the body doesn't need.



The Heart is the bodies pump and hardest working muscle. Atrium is responsible for filling the ventricle which does the real pumping. The left side supplies the lungs, the right the rest of the body. Problems include leaky valves, blocked arteries and  electrical problems. 

Blocked arteries delivering blood to the heart muscle can kill parts of the muscle leading to a "heart attack" which  are mostly fatal. The American College of Cardiology reports that the earliest documented case of coronary atherosclerosis  was in an Egyptian princess who lived between 1580 and 1550 B.C.  Today, lowering blood cholesterol (fats) and early detection with surgical intervention for valves and arteries, with arthroscopic becoming much more common. Once the muscle is damaged, blood thinners are used to reduce pump load.

Leaky valves are repaired or replaced with artificial, pig or human cadaver valves.

The cardiovascular center provides a rapid, neural mechanism for the regulation of blood pressure by managing cardiac output or by adjusting blood vessel diameter. Located in the medulla oblongata of the brain stem, it consists of three distinct regions:

  • The cardiac center stimulates cardiac output by increasing heart rate and contractility. These nerve impulses are transmitted over sympathetic cardiac nerves.

  • The cardiac center inhibits cardiac output by decreasing heart rate. These nerve impulses are transmitted over parasympathetic vagus nerves.

  • The vasomotor center regulates blood vessel diameter. Nerve impulses transmitted over sympathetic motor neurons called vasomotor nerves innervate smooth muscles in arterioles throughout the body to maintain vasomotor tone, a steady state of vasoconstriction appropriate to the region.

The cardiovascular center receives information about the state of the body through the following sources:

  • Baroreceptors are sensory neurons that monitor arterial blood pressure. Major baroreceptors are located in the carotid sinus (an enlarged area of the carotid artery just above its separation from the aorta), the aortic arch, and the right atrium.

  • Chemoreceptors are sensory neurons that monitor levels of CO 2 and O 2. These neurons alert the cardiovascular center when levels of O 2 drop or levels of CO 2 rise (which result in a drop in pH). Chemoreceptors are found in carotid bodies and aortic bodies located near the carotid sinus and aortic arch.

  • Higher brain regions, such as the cerebral cortex, hypothalamus, and limbic system, signal the cardiovascular center when conditions (stress, fight‐or‐flight response, hot or cold temperature) require adjustments to the blood pressure.

The kidneys provide a hormonal mechanism for the regulation of blood pressure by managing blood volume.

  • The renin‐angiotensin‐aldosterone system of the kidneys regulates blood volume. In response to rising blood pressure, the juxtaglomerular cells in the kidneys secrete renin into the blood. Renin converts the plasma protein angiotensinogen to angiotensin I, which in turn is converted to angiotensin II by enzymes from the lungs. Angiotensin II activates two mechanisms that raise blood pressure.

Various substances influence blood pressure. Some important examples follow:

  • Angiotensin II constricts blood vessels throughout the body (raising blood pressure by increasing resistance to blood flow). Constricted blood vessels reduce the amount of blood delivered to the kidneys, which decreases the kidneys' potential to excrete water (raising blood pressure by increasing blood volume).

  • Angiotensin II stimulates the adrenal cortex to secrete aldosterone, a hormone that reduces urine output by increasing retention of H 2O and Na + by the kidneys (raising blood pressure by increasing blood volume).

  • Epinephrine and norepinephrine, hormones secreted by the adrenal medulla, raise blood pressure by increasing heart rate and the contractility of the heart muscles and by causing vasoconstriction of arteries and veins. These hormones are secreted as part of the fight‐or‐flight response.

  • Antidiuretic hormone (ADH), a hormone produced by the hypothalamus and released by the posterior pituitary, raises blood pressure by stimulating the kidneys to retain H 2O (raising blood pressure by increasing blood volume).

  • Atrial natriuretic peptide (ANP), a hormone secreted by the atria of the heart, lowers blood pressure by causing vasodilation and by stimulating the kidneys to excrete more water and Na +(lowering blood pressure by reducing blood volume).

  • Nitric oxide (NO), secreted by endothelial cells, causes vasodilation.

  • Nicotine in tobacco raises blood pressure by stimulating sympathetic neurons to increase vasoconstriction and by stimulating the adrenal medulla to increase secretion of epinephrine and norepinephrine.

  • Alcohol lowers blood pressure by inhibiting the vasomotor center (causing vasodilation) and by inhibiting the release of ADH (increasing H 2O output, which decreases blood volume).


Blood pressure mis-regulation is a leading cause of strokes - blood clots that damage the lungs or brain. There are a number of drugs to reduce blood pressure; Diuretic, Beta-blockers (carvedilol) , ACE inhibitors, Angiotensin II receptor blockers (Valsartan), Calcium channel blockers, Alpha blockers, Alpha-2 Receptor Agonists, Combined alpha and beta-blockers, Central agonists, Peripheral adrenergic inhibitors, Vasodilators.


Electrical problems include atrial fibrillation, ventricle fibrillation, and  blocked signals within the heart. Ventricle fibrillation  or "cardiac arrest" is very serious which requires electro shock within 2 minutes. Atrial fibrillation is rarely immediately fatal, and is more common in large athletic males over 50, probably due to enlarged heart.  Can be source of blood clots that damage lungs or brain but  can be treated with drugs, or ablation to reconfigure conduction paths inside the heart.  Heart block requires a pacemaker fix. First pacemaker in 1958.


Enables the intake of oxygen and expulsion of carbon dioxide, so it is the primary path for airborne pollution and infections. Is damaged by particles and tar from smoking as trigger for COPD and lung cancer. At risk for loss of function from asthma, an immune overresponse. Embolism's from blood clots migrating from the heart can kill segments of the lungs. Susceptible to bacterial and viral infections causing pneumonia. The lungs are warm damp area with small cavities where bugs can thrive and are difficult to treat. Bacterial pneumonia is treated with antibiotics which are susceptible to becoming antibiotic resistant. 

Bacterial respiratory infections are generally more aggressive than viral. While having COPD makes you more susceptible to viral pneumonia, the infection is also not uncommon among those with a healthy immune system. Bacterial pneumonia is considered a sign of a compromised immune system; when your body doesn't adequately fight an infection, it can worsen rapidly

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue.[3] A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.[4]

Influenza affects both the upper and lower respiratory tracts.[citation needed]

Antibiotics are the first line treatment for pneumonia; however, they are neither effective nor indicated for parasitic or viral infections. Acute bronchitis typically resolves on its own with time.[citation needed]


I think it is important! Susceptible to catastrophic loss of function strokes from blood clots  interrupting blood flow.  Treatment with clot busting drugs within 4 hours is critical after scanning to eliminate any blood leaks that will be made much worse by clot busters.  If damage is mild, the brain can be retrained by mental exercises.   


If there is an aneurism, or weaknesses in blood vessel walls, a break can cause serious damage. Because the brain is a dense 3D structure of neurons, it is susceptible to inoperable cancer. 


In old age it is susceptible to growth abnormalities such as  Lewy bodies causing Parkinson's. Lewy bodies are the inclusion bodies – abnormal aggregations of protein – that develop inside nerve cells affected by Parkinson's disease. Alzheimer's. caused by  amyloid plaques and tau tangles.  Amyloid plaques are formed by mis folds of the protein especially abundant in neurons.   Multiple concussions cause Chronic traumatic encephalopathy, or CTE. Autopsies of deceased NFL players show a buildup of a protein called tau around the blood vessels. CTE is thought to cause areas of the brain to waste away (atrophy). 


Their research found that tau-induced “jumping genes” — which can relocate or copy themselves to other locations in the genome — form double-stranded RNA.  The researchers detected accumulation of double-stranded RNA in postmortem brain tissue from patients with Alzheimer’s disease and progressive supranuclear palsy and in brains of mouse and fruit fly models of tauopathy.

There is evidence of a genetic susceptibility to both Parkinson's and CTE.

Sex bits

Female sex bits include; breast, clitoris, ovaries, and uterus.

Breast is the 4th most common cancer, and equal first for women when accounting for the fact that only half the population is at risk. There is a significant genetic susceptibility, and it is one of the first where genetic typing directs the therapy. 

Ovarian, cervical  and uterine cancers are all common. but do not make the 10 worst list.  It is preferable to retain ovaries wherever possible as they provide female sex hormones, if they are lost then menopause happens immediately. 

Male sex bits include  penis, prostate, testicles. The prostate switches between semen and urine as needed. Testicles make semen and the male hormones responsible for the changes in voice box, and Adam's apple in puberty.   Prostate cancer is a significant killer, but does leave markers in blood that can be used for early detection. Testicular cancer is common. Erectile dysfunction is common, and is not helped by blood pressure med however Viagra has stiffened men's resolve.


The digestive tract consists of  stomach, intestines and liver. The stomach is responsible for breaking down food .The thick mucous-membrane lining of the walls is densely packed with small gastric glands; these secrete a mixture of enzymes and hydrochloric acid that partly digest proteins and fats., and the intestines for absorbing nutrients into the blood stream. The small intestine receives digestive enzymes from the pancreas and liver to continue to break down ingested food, and absorbs proteins  and sugars. The large intestines manages residues and the absorption of water and ions. Healthy intestines support a  "biome" of several bacteria. This biome can be disrupted by antibiotics being used to treat other infections. Replenishing the biome with healthy samples from donors is a solution. ​

The digestive system is the path of entry for water and food born infections such as cholera, hepatitis, typhoid and dysentery. These are dangerous diseases of poor sanitation that are still an issue in 3rd world countries and after natural disasters such as earthquakes. 


Diseases of the intestines include Celiac's, diverticulitis, inflammatory bowl, and irritable bowl.

Celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents it from absorbing some nutrients (malabsorption). In diverticulitis pockets form in the intestine walls that get inflamed and infected. Inflammatory bowl is an auto immune attack of the intestine lining. Irritable bowl is caused by excessive muscular contractions of the intestines. 

Colon cancer is the 2nd most common cancer,  early detection by routine colonoscopy has had a major impact on outcomes. 

The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. Liver is damaged by excess alcohol consumption. 

Endocrine system

The endocrine system[1] is a messenger system comprising feedback loops of the hormones released by internal glands of an organism directly into the circulatory system, regulating distant target organs.  In humans, the major endocrine glands are the thyroid glandparathyroid glandpituitary glandpineal gland, the testes (male), ovaries (female), and the adrenal glands. The hypothalamuspancreas, and thymus also function as endocrine glands, among other functions. Other organs, such as the kidneys, also have roles within the endocrine system by secreting certain hormones. The study of the endocrine system and its disorders is known as endocrinology.​

  • Posterior pituitary gland    Stores and secretes hormones such as antidiuretic hormone (ADH) which is synthesized by supraoptic nucleus of hypothalamus and oxytocin which is synthesized by paraventricular nucleus of hypothalamus. ADH functions to help the body to retain water; this is important in maintaining a homeostatic balance between blood solutions and water. Oxytocin functions to induce uterine contractions, stimulate lactation, and allows for ejaculation.[7][8]

  • Thyroid gland   regulates  levels of TSH, produced by the anterior pituitary gland, which further regulates the metabolic activity and rate of all cells, including cell growth and tissue differentiation.

  • Parathyroid gland   Secretes parathyroid hormone (PTH). PTH acts on bone, the kidneys, and the GI tract to increase calcium reabsorption and phosphate excretion. In addition, PTH stimulates the conversion of Vitamin D . 

  • Adrenal glands​   Produces adrenalin​.

  • Pancreas   The pancreas secrete hormones to maintain homeostatic blood sugar. Insulin is produced and excreted to lower blood sugar to normal levels, whereas glucagon increases blood glucose level.[9]

  • Thymus   regulates immune function T cell production along with bone marrow.

Pancreas is subject to auto immune attack in Diabetes Type 1, and control failure in Type 2. Pancreatic cancer is a growing problem because currently there is no early detection protocol. 

Thyroid is subject to auto-immune attack in Hashimoto's (hypo-) and Graves (hyper-) diseases.


The kidney participates in the control of the volume of various body fluids, fluid osmolalityacid–base balance, various electrolyte concentrations, and removal of toxins, including uric acid. They convert a precursor of vitamin D to its active form, calcitriol; and synthesize the hormones erythropoietin and renin.

Mis-regulation of uric acid is the root cause of gout. 

Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. The global estimated prevalence of CKD is 13.4%, and patients with kidney failure needing renal replacement therapy are estimated between 5 and 7 million.[3] Procedures used in the management of kidney disease include chemical and microscopic examination of the urine (urinalysis), measurement of kidney function by calculating the estimated glomerular filtration rate (eGFR) using the serum creatinine; and kidney biopsy and CT scan to evaluate for abnormal anatomy. Dialysis and kidney transplantation are used to treat kidney failure; one (or both sequentially) of these are almost always used when renal function drops below 15%. Nephrectomy is frequently used to cure renal cell carcinoma.

Motion Systems 

Bones in the skeleton provides the scaffold for organs. 

Joints between bones enable mobility. - arthritis, wear, bone spurs, gout

Cartlidge provides the friction free surfaces at the contact points between bones.

Ligaments link the bones in a joint, and limit range of motion

Tendons connect bones to muscles

Muscles expand and contract to enable motion 

Nerves send message to activate muscles

Bursa provides friction relief where tendons rub over bones

Inner ear provides balance. 

Common problems include;

  • Broken bones - immobilization to allow mending, support structure sometimes required

  • Damaged ligaments, tendons, muscles - ruptures require surgery. 

  • Cartilage wear in arthritis, most common cause of joint replacement.

  • Cartilage distortion, particular problem between vertebrae putting pressure on spinal column nerves

  • Inflamed bursa treated with rest and steroids

  • Muscles subject to wasting diseases and atrophy

  • Nerves -   autoimmune diseases   include: multiple sclerosisGuillain-Barré syndrome (a rare condition in which the immune system attacks the peripheral nerves), lupus, and inflammatory bowel disease.  

  • Muscle/nerve interface diseases such as Myasthenia gravis, ALS motor neuron disease.


We rely on eyes, nose, tongue, ears to experience our environment. 


Eyes are particularly important and delicate. Focusing problems have been fixed with glasses for centuries. Lenses become opaque from cataracts and  lens replacement has become routine. Damage to the optic nerve from excess pressure in the eye ball causes glaucoma, a leading cause of blindness. Diabetes can restrict blood flow to the retina. The retina can become detached from the eye surface. 


Skin keeps the insides from falling out. It has a remarkable capacity for self repair. Skin cancer is dangerous, managed by inspection and early intervention. Minimizing sun exposure is a key preventative. 

Lymphatic system

The lymphatic system, or lymphoid system, is an organ system in vertebrates that is part of the immune system, and complementary to the circulatory system. It consists of a large network of lymphatic vesselslymph nodes, lymphatic or lymphoid organs, and lymphoid tissues.[1][2] The vessels carry a clear fluid called lymph (the Latin word lympha refers to the deity of fresh water, "Lympha")[3] back towards the heart, for re-circulation.

Unlike the circulatory system that is a closed system, the lymphatic system is open. The human circulatory system processes an average of 20 litres of blood per day through capillary filtration, which removes plasma from the blood. Roughly 17 litres of the filtered blood is reabsorbed directly into the blood vessels, while the remaining three litres are left in the interstitial fluid. One of the main functions of the lymphatic system is to provide an accessory return route to the blood for the surplus three litres.[4]

The other main function is that of immune defense. The primary (or central) lymphoid organs generate lymphocytes . The thymus and the bone marrow constitute the primary lymphoid organs involved in the production of lymphocytes. A lymphocyte is a type of white blood cell (leukocyte) in the immune system of most vertebrates.[1] Lymphocytes include  T cells.  Lymphocytes make up between 18% and 42% of circulating white blood cells.

The lymph system is also a path for cancer cells to move around and metastasize to other organs.

Immune system

Upon detecting a pathogen, microphages (or white blood cells) will surround and immobilize it, literally consuming it with their bodies. Antibodies are the high-powered weaponry made by white blood cells to destroy the invaders. Vaccines are designed to trigger the bodies immune response and create the antibodies without the infection.  

The standard model of infections is SIR, and R0 is the measure of how easily the disease spreads - how many new people are infected by each infected person. Covid 19 was a highly contagious. 

Issues include, immune compromised, over stimulation such as allergies, auto-immune. 

Autoimmune disease by prevalence:

Immune over-reaction

Allergies, also known as allergic diseases, refer to a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment.[11] These diseases include hay feverfood allergiesatopic dermatitisallergic asthma, and anaphylaxis.[1] Symptoms may include red eyes, an itchy rashsneezingcoughing, a runny noseshortness of breath, or swelling.[12] Note: food intolerances and food poisoning are separate conditions.[3][4]

Common allergens include pollen and certain foods.[11] Metals and other substances may also cause such problems.[11] Food, insect stings, and medications are common causes of severe reactions.[2] Their development is due to both genetic and environmental factors.[2] The underlying mechanism involves immunoglobulin E antibodies (IgE), part of the body's immune system, binding to an allergen and then to a receptor on mast cells or basophils where it triggers the release of inflammatory chemicals such as histamine.[13] Diagnosis is typically based on a person's medical history.[3] Further testing of the skin or blood may be useful in certain cases.[3] Positive tests, however, may not necessarily mean there is a significant allergy to the substance in question.


A compromised immune system can be inherited as in the "boy in the bubble", develop as a disease as in common variable immunodeficiency disease, It also results from advanced or untreated HIV infection.  Cancer treatment from chemotherapy or X rays damages the immune system.  Transplant recipients must take drugs to suppress their immune system to avoid rejection. 



Medical issues come from external sources such as infections, pollution and accidents. Wear and tear with age are responsible for blocked arteries, worn joints etc. Abnormal cell growth is responsible for cancers, and brain damage in Alzhiemers, Parkinson's, and CTE. Mis-regulation causes blood pressure problems, gout, diabetes 2. Immune system failures include auto-immune where the body attacks healthy cells such as diabetes 1, Hashimoto's and Graves. Immune overreaction causes allergies. Immune system failure "immunocompromised" makes the unable to defend any infections. 

  • Flu has an R0 of 1.5 

  • Smallpox has an R0 of 3

  • Polio has an R0 of 4-6

  • Covid 19 has an R0 of 7

  • Mumps has an R0 of 10-12

  • Chickenpox has an R0 of 10-12

  • Pertussis has an R0  of 15-17

  • Measles has an R0  of 16-18

Mental disorder

A mental disorder, also referred to as a mental illness[5] or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning.[6] Such features may be persistent, relapsing and remitting, or occur as single episodes. Many disorders have been described, with signs and symptoms that vary widely between specific disorders.[7][8] Such disorders may be diagnosed by a mental health professional, usually a clinical psychologist or psychiatrist.

In 2019, common mental disorders in the US include 

Substance Abuse

The National Bureau of Economic Research reports that individuals with a history of mental illness are 25% more likely to consume alcohol, 69% more likely to consume cocaine, and 94% more likely to consume cigarettes.¹ When a person struggles with substance misuse and a mental illness, this is known as a dual diagnosis or co-occurring disorder.

Mood disorders, especially major depressive disorder (MDD) and bipolar disorder (BD), often coincide with substance use disorders (SUDs). Prevalence of substance use disorders in people with BD range from 20% to 70% and from 10% to 30% in persons with MDD. Alcohol use disorder is the most common SUD in individuals with BD, occurring in about 42%, and cannabis use disorder is the next most common, at about 20%.²

Depression is a mental illness frequently co-occurring with substance use. The relationship between the two disorders is bi-directional, meaning that people who misuse substances are more likely to suffer from depression, and vice versa. People who are depressed may drink or use drugs to lift their mood or escape from feelings of guilt or despair. But substances like alcohol, which is a depressant, can increase fatigue, affecting concentration, inhibitions, decision-making and reaction times. Alcohol misuse may lead to falling asleep at work or school.

Teen mental health

In high school, 50% sexually active, 2% gay, 7% lesbian.


Around 1 in 3 high school girls in the U.S. have seriously considered attempting suicide, according to new results from a Centers for Disease Control and Prevention survey from 2021, up from less than a fifth of teen girls in 2011. And more than half of teen girls, 57%, reported feeling "persistently sad or hopeless" — a record high number.

By contrast, 14% of high school boys told the 2021 survey that they had seriously considered attempting suicide, up from 13% in 2011.

In girls, frequent social-media use seemed to harm health when it led to either cyberbullying and/or inadequate sleep and exercise.

  • Girls enter  puberty earlier and so have less experience to manage.  

  • Girls have greater emotional sensitivity than boys

  • Girls place more importance on relationships than boys.

  • Girls are more likely than boys to have excessive empathy

  • Girls are more likely than boys to co-ruminate (share with friends)

Psychopath leaders

Unfortunately, leadership seems to self select psychopaths. Popular labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses. Psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent antisocial behavior, impaired empathy and remorse, and bolddisinhibited, and egotistical traits.[1][2][3]  

"Psychopaths are social predators who charm, manipulate, and ruthlessly plow their way through life, leaving a broad trail of broken hearts, shattered expectations, and empty wallets. Completely lacking in conscience and in feelings for others, they selfishly take what they want and do as they please, violating social norms and expectations without the slightest sense of guilt or regret." —Robert D. Hare, 1993,

Kevin Dutton, author of The Wisdom of Psychopaths, is a research psychologist at the Department of Experimental Psychology at the University of Oxford, with a specialty in psychopathy. He analyzed past and present leaders for their relative level of psychopathy. In an article for Scientific American, Dutton argues that psychopathy can be defined by three categories of characteristics, including fearless dominance, self-centered impulsivity, and coldheartedness.

Dutton generally considers a man a psychopath if he scores at least a 155 on his scale and a woman a psychopath if she scores at least a 139.5. President-elect Donald Trump scores a 171 on Dutton’s scale in part because of high scores in the perceived traits of fearless dominance and self-centered impulsivity (though Dutton has not examined Trump in person). But he’s by no means the only U.S. president who could be considered a psychopath. “Politics came out as a profession in which an official consignment of legalized, precision-engineered psychopathy would come in rather handy,” writes Dutton.

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 Anxiety disorder

An anxiety disorder is anxiety or fear that interferes with normal functioning may be classified as an anxiety disorder.[37] Commonly recognized categories include specific phobiasgeneralized anxiety disordersocial anxiety disorderpanic disorderagoraphobiaobsessive–compulsive disorder and post-traumatic stress disorder.

Mood disorder

Other affective (emotion/mood) processes can also become disordered. Mood disorder involving unusually intense and sustained sadness, melancholia, or despair is known as major depression (also known as unipolar or clinical depression).  Bipolar disorder (also known as manic depression) involves abnormally "high" or pressured mood states, known as mania or hypomania, alternating with normal or depressed moods.


Psychotic disorder

Patterns of belief, language use and perception of reality can become dysregulated (e.g., delusionsthought disorderhallucinations). Psychotic disorders in this domain include schizophrenia,  


The fundamental characteristics of a person that influence thoughts and behaviors across situations and time—may be considered disordered if judged to be abnormally rigid and maladaptive.  A number of different personality disorders are listed, including those sometimes classed as eccentric, such as paranoidschizoid and schizotypal personality disorders; types that have described as dramatic or emotional, such as antisocialborderlinehistrionic or narcissistic personality disorders; and those sometimes classed as fear-related, such as anxious-avoidantdependent, or obsessive–compulsive personality disorders.   If an inability to sufficiently adjust to life circumstances begins within three months of a particular event or situation, and ends within six months after the stressor stops or is eliminated, it may instead be classed as an adjustment disorder. T 

Eating disorder

Eating disorders involve disproportionate concern in matters of food and weight.[37] Categories of disorder in this area include anorexia nervosa, bulimia nervosaexercise bulimia or binge eating disorder.[44][45]

Sleep disorder

Sleep disorders are associated with disruption to normal sleep patterns. A common sleep disorder is insomnia,

Sexual disorders

Include dyspareunia and various kinds of paraphilia (sexual arousal to objects, situations, or individuals that are considered abnormal or harmful to the person or others).

Impulse control disorder:

People who are abnormally unable to resist certain urges or impulses that could be harmful to themselves or others, may be classified as having an impulse control disorder, and disorders such as kleptomania (stealing) or pyromania (fire-setting). Various behavioral addictions, such as gambling addiction, may be classed as a disorder. Obsessive–compulsive disorder can sometimes involve an inability to resist certain acts but is classed separately as being primarily an anxiety disorder.

Substance use disorder:

This disorder refers to the use of drugs (legal or illegal, including alcohol) that persists despite significant problems or harm related to its use. Substance dependence and substance abuse fall under this umbrella category in the DSM. Substance use disorder may be due to a pattern of compulsive and repetitive use of a drug that results in tolerance to its effects and withdrawal symptoms when use is reduced or stopped.

Dissociative disorder:

People with severe disturbances of their self-identity, memory, and general awareness of themselves and their surroundings may be classified as having these types of disorders,  (which was previously referred to as multiple personality disorder or "split personality").

Cognitive disorder:

These affect cognitive abilities, including learning and memory. This category includes delirium and mild and major neurocognitive disorder (previously termed dementia).

Developmental disorder:

These disorders initially occur in childhood. Some examples include autism spectrum disorder, oppositional defiant disorder and conduct disorder, and attention deficit hyperactivity disorder (ADHD), which may continue into adulthood. Conduct disorder, if continuing into adulthood, may be diagnosed as antisocial personality disorder (dissocial personality disorder in the ICD).

Dissocial personality disorder

People with dissocial personality disorder exhibit traits of impulsivity, high negative emotionality, low conscientiousness and associated behaviors, including irresponsible and exploitative behavior, recklessness and deceitfulness. Popular labels such as psychopath (or sociopath) do not appear in the DSM or ICD but are linked by some to these diagnoses. Psychopathy, sometimes considered synonymous with sociopathy, is characterized by persistent antisocial behavior, impaired empathy and remorse, and bolddisinhibited, and egotistical traits.[1][2][3] Different conceptions of psychopathy have been used throughout history that are only partly overlapping and may sometimes be contradictory.  Although no psychiatric or psychological organization has sanctioned a diagnosis titled "psychopathy", assessments of psychopathic characteristics are widely used in criminal justice settings in some nations and may have important consequences for individuals.[specify] The study of psychopathy is an active field of research. The term is also used by the general public, popular press, and in fictional portrayals.[11][12] While the term is often employed in common usage along with "crazy", "insane", and "mentally ill", there is a categorical difference between psychosis and psychopathy. 

Factitious disorders 

are diagnosed where symptoms are thought to be reported for personal gain. Symptoms are often deliberately produced or feigned, and may relate to either symptoms in the individual or in someone close to them, particularly people they care for.

Relational disorder,

where the diagnosis is of a relationship rather than on any one individual in that relationship. The relationship may be between children and their parents, between couples, or others. There already exists, under the category of psychosis, a diagnosis of shared psychotic disorder where two or more individuals share a particular delusion because of their close relationship with each other.


There are a number of uncommon psychiatric syndromes, which are often named after the person who first described them, such as Capgras syndromeDe Clerambault syndromeOthello syndromeGanser syndromeCotard delusion, and Ekbom syndrome, and additional disorders such as the Couvade syndrome and Geschwind syndrome.


There is also a wide range of psychotherapists (including family therapy), counselors, and public health professionals. In addition, there are peer support roles where personal experience of similar issues is the primary source of expertise. 

A major option for many mental disorders is psychotherapy. There are several main types. Cognitive behavioral therapy (CBT) is widely used and is based on modifying the patterns of thought and behavior associated with a particular disorder. Other psychotherapies include dialectic behavioral therapy (DBT) and interpersonal psychotherapy (IPT). Psychoanalysis, addressing underlying psychic conflicts and defenses, has been a dominant school of psychotherapy and is still in use. Systemic therapy or family therapy is sometimes used, addressing a network of significant others as well as an individual.

Some psychotherapies are based on a humanistic approach. There are many specific therapies used for particular disorders, which may be offshoots or hybrids of the above types. Mental health professionals often employ an eclectic or integrative approach. Much may depend on the therapeutic relationship, and there may be problems with trustconfidentiality and engagement.

A major option for many mental disorders is psychiatric medication and there are several main groups. Antidepressants are used for the treatment of clinical depression, as well as often for anxiety and a range of other disorders. Anxiolytics (including sedatives) are used for anxiety disorders and related problems such as insomnia. Mood stabilizers are used primarily in bipolar disorder. Antipsychotics are used for psychotic disorders, notably for positive symptoms in schizophrenia, and also increasingly for a range of other disorders. Stimulants are commonly used, notably for ADHD.[121]

Despite the different conventional names of the drug groups, there may be considerable overlap in the disorders for which they are actually indicated, and there may also be off-label use of medications. These medications in combination with non-pharmacological methods, such as cognitive-behavioral therapy (CBT) are seen to be most effective in treating mental disorders.


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