History of Abnormal Psychology
6.14.2006
Purpose
Why should I care about the history of psychology?
Eating Disorders
Anorexia Nervosa
Refusal to maintain body weight of at least 85% ideal body weight, fear of gaining weight/being overweight, belief that s/he is overweight despite emaciation, shape and weight are very important to self-esteem, etc. Role of the media and Western ideal of thinness AN: cultural phenomenon?
Eating Disorders
Up to 12th century: possible cases of AN that were attributed to demonic possession and treated with exorcism 13th-16th centuries: “holy anorexia…involved food refusal resulting in emaciation overtly motivated by the belief that this reflected divine intervention” including St. Catherine of Sienna, St. Veronica, and possibly Mary Queen of Scots 17th-18th centuries: “miraculous maids…girls between the ages of 14 and 20 who engaged in self-starvation, modeling themselves explicitly after ascetic medieval saints” 19th century: “cases of extreme emaciation among females who actively refused to eat despite pangs of hunger and attributed [it] to a desire for attention and notoriety”
Connecting Treatment to Etiology
Attitudes about a disorder influence how we attempt to treat it. Consider how you would treat a mental disorder due to:
Weakness of character Sinfulness Heredity Physical environment Social environment
Historical Views of Abnormal Behavior
Demonology, Gods, & Magic
Abnormal behavior often attributed to possession
“Good” or “Bad” possession depended on the person’s symptoms Religious significance of being possessed
Treatment
Trephining allowed the evil spirit to escape the head Exorcisms used to cast demons out of the body
Hippocrates’ Early Medical Concepts
Hippocrates (460-377 B.C.)
"People believe that this disease is sacred simply because they don't know what causes it? But some day I believe they will, and the moment they figure out why people have epilepsy, it will cease to be considered divine."
Brain – central organ of intellectual activity Mental disorders – due to brain pathology Pointed out that head injuries could lead to sensory and motor disorders Emphasized the importance of heredity and predisposition
Mental disorders due to natural causes
Hippocrates’ Early Medical Concepts
Doctrine of the four humors
Blood (sanguis) - generally optimistic, cheerful, eventempered, but can be daydreamy to the point of not accomplishing anything and impulsive (mania Phlegm – consistent, relaxed, and observant, but can be apathetic and sluggish Yellow bile (choler) - a leader, but can be controlling, easily angered or bad tempered Black bile (melancholer) – kind, considerate, can be highly creative - - but also can be obsessed with tragedy and cruelty (depression)
Hippocrates’ Early Medical Concepts
Classification: Three categories
Mania Melancholia Phrenitis (Brain fever) Based on daily clinical observations and records of patients
Humane: “Walking is man's best medicine." Specific to diagnosis Recognized the importance of environment Hysteria due to “wandering uterus” Four humors
Treatment: “do no harm”
Misconceptions
Early Philosophical Conceptions
Plato
Diminished criminal responsibility for mentally ill Emphasized role of sociocultural factors Some supernatural influence on etiology
Largely Hippocratic in views Rejected the importance of frustration and conflict in etiology of mental disorders Described the role of consciousness – people strive to eliminate pain and attain pleasure (these ideas are similar to Freud’s conceptualization of mental illness)
Aristotle
Alexandria, Egypt
Center of Greek Culture Therapies used for mental patients
Pleasant surroundings Activities (dances, parties, walking in gardens, concerts) Dieting Massage Hydrotherapy Gymnastics Education Also used bleeding, purging, mechanical restraints
Later Greek and Roman thought
Galen (A.D. 130-200)
Follower of Hippocrates Used science to contribute to the field Elaborated on nervous system based on animal dissections Divided the causes of psychological illnesses into 2 categories
Physical: injuries to the head, adolescence, menstrual changes Mental: shock, fear, love
Roman medicine
Pragmatic approaches to medicine Wanted patients to be comfortable
Used physical therapy, warm baths, massage
Middle Ages: Europe
Mental disorders were prevalent Mass Madness
Often occurs in times of widespread fear and distress In the Middle Ages, mass madness was maintained by oppression, disease and famine Tarantism – uncontrollable dancing Lycanthropy – belief in possession by wolves Plague
Middle Ages: Europe Etiology and Treatment
Etiology of Mental Illnesses
Scientific approaches rarely used Saw a return of the belief that mental illness was due to supernatural causes such as superstition or rituals Left largely to the clergy and occurred primarily in monasteries Generally kind: prayer, holy water, ointments, exorcisms
Treatment of Mental Illness
Middle Ages in the Middle East Treatment and Classification
First mental hospital established in Baghdad in A.D. 792 Avicenna (Arabia: A.D. 980-1037)
“the prince of physicians” Wrote The Canon of Medicine
Classified and defined diseases and their causes Referred to hysteria, manic reactions, and melancholia Ahead of his time: He described the symptoms and complcations of diabetes and asserted the Tuberculosis was contagious, which was argued by Europeans…turns out he was right
Comparing mental health in Europe and China over time
Early Chinese medicine was based on natural causes: imbalance in Yin and Yang – treatment was aimed at restoring this balance During the second century, Chung Ching wrote on physical and mental illnesses based on his clinical observations. He believed that both physical and environmental influences affected mental illness and that treatment should target both. During the Chinese Middle Ages, medicine regressed to beliefs that mental illness was caused by supernatural rather than natural forces (ghosts and devils)
Reformation: Treatment - Establishment of Asylums
Places to warehouse troublesome people, used harsh tactics to control unruly or excited patients “Bedlam”: Monastery of St. Mary of Bethlehem in London commissioned by King Henry VIII (1547)
Deplorable conditions Violent patients put on display Harmless patients forced to beg
Resurgence of Scientific Inquiry in Europe
Johann Weyer (1515-1588)
“Founder of modern psychopathology” First physician to specialize in mental disorders His works were scorned by his peers and were banned by the church until the 20th Century Rebutted the Malleus Maleficarum
Age of Enlightenment: Humanitarian Reform – Key People
Pinel (Paris: 1745-1826)
Removed chains from patients and treated them kindly as an experiment – found it was successful!
Established the York Retreat, trained physicians and nurses in treating mental patients with humanity and kindness, and began to change public opinion Aroused worldwide awareness of inhumane treatment for the mentally ill and established 32 mental hospitals around the world
Tuke (England: 1732-1822)
Dix (America: 1802-1887)
Age of Enlightenment: Humanitarian Reform - Treatment
Treatment Philosophies
Moral Management – attempted to help satisfy a person’s social, occupational, and individual needs; emphasis placed on rehabilitating a person’s moral and spiritual self rather than curing the mental illness Mental Hygiene Movement – focused on the physical needs of patients, keeping them comfortable
Twentieth Century Treatment
Asylums viewed by public as eerie, strange, and frightening
Substantial growth in number of mental hospitals Lengthy stays Little effective treatment National Institute of Mental Health is organized DSM-I published Mary Jane Ward published The Snake Pit – call to provide more humane treatments for mental health patients Goffman published Asylums – detailed account of the neglect and maltreatment of mental health patients Hill-Burton Act is passed funding community mental health agencies Community Health Services Act of 1963
1946 – 1963: Changing views of mental health services
Twentieth Century Treatment
1970’s – Deinstitutionalization and Community Mental Health Care In the United States, it constituted a radical shift in social policy and the way mental health care was provided Replaced inpatient hospitals with community-based care, day treatment, and outreach programs Considered more humane and cost-effective
Twentieth Century Deinstitutionalization
Forces that initiated/shaped the movement
Miracle drugs
Tricyclics, lithium, etc. Anti-psychotics typically reduce the symptoms that are more “severe”
Reconceptualization of Mental Illness
Power of labeling
Sociocultural isolation Powerlessness/Helplessness Adjustment to institution lead to passivity and withdrawal Transferred the responsibility from the state to private institutions and the federal government
Recognition of Institutional Hazards
Economic Incentives
Twentieth Century Deinstitutionalization – Did it work?
Fewer patients spend time in inpatient hospitals Patients spend less time in inpatient hospitals More patients are re-hospitalized
Where are they instead?
Homeless Nursing homes Group homes Jail
Twentieth Century Deinstitutionalization – Why not?
Focus on medication More stigma than physical illness Little economic or social support for mental health programs
“Not in my backyard,” little job training or placement, shortterm housing, etc.
Deinstitutionalization paid more attention to negative rights than positive rights
Negative Rights (Autonomy, choice, independence, etc.) Positive Rights (Social responsibility norms, education, job training, etc.)
Contemporary Views Etiology
Psychoanalytic thought (Freud)
Role of the unconscious in avoiding pain Catharsis
Maladaptive cognitions and behaviors are developed and maintained through learning and conditioning Syphillis was found to caused paralysis and insanity The role of neurotransmitters Hippocrates (460-377 B.C.): Brain is the center of intellectual activity and mental disorders are the result of brain pathology
Cognitive/Behavioral Theories (Skinner/Pavlov)
Brain Pathology
Contemporary Views Etiology
Diathesis-Stress Model Genetics
Heritability of mental illnesses Environmental experiences that people with similar genetics share (eg. SES, education, religion, etc.) Environmental experiences that are individual (eg. peer interactions, disease, exposure to hormones or toxins, etc.)
Shared environmental influences
Non-shared environmental influences