[Changes of paradigms in psychiatry].

During the last centuries mental illnesses represented brain disorder. About hundred years ago--instead of gradually accumulating neurophysiological knowledge--the focus of attention shifted to investigation of abnormal mental states divorced from cerebral function. The advance of the brain research and psychopharmacology has been progressively narrowing the marked demarcation between organic and functional (psychogenic) syndromes. Till the end of the seventies the psychotic patients were treated in closed mental wards, the neurotics in open neurological ones in the common departments for neurology and psychiatry. The modernization of the mental care system started when psychiatry became independent of the neurology. The psychotherapy-despite of the international acknowledgement of the Hungarian psychoanalysts-has developed only in the last third of this century. The opposition of the biological and psychodynamic approaches theoretically refer to the presumed physical or mental origin, whereas mental function means the summation of variety of electrical and chemical events occurring in the brain. The asylums have gradually progressed to the open wards and therapeutic communities. Beside of the hospital treatment the outpatient care became a matter of primary importance, but the system of out-of-hospital alternatives, day-hospitals, halfway institutes, patient's homes, work places have been lacking. The modern psychiatric care system is moving forward the community in spite of its resistance. The psychiatric patients suffer not only from their mental symptoms and experienced disability, but mainly from the unfavorable attitudes of the immediate and social environment. The biological, psychological and sociological factors determine the origin, the treatment and the outcome of the mental disorders; neither of them can neglect without disadvantage of the other two.