History of Mental Health Discussion

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Chapter 2: Historical Perspectives

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Learning Objectives

Three characteristics commonly considered in defining abnormal behavior:

Cultural inappropriateness

Subjective distress

Psychological impairment

Do diseased brains cause abnormal behavior?

Abnormality does not generally lend itself to precise definition. The emphasis here will be on understanding the current diagnostic system for identifying mental disorders.

Do diseased brains cause abnormal behavior?

Do ideas, emotional conflicts, and upsetting experiences cause abnormal behavior?

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The Witch Trials of Salem (Slide 1 of 2)

In the summer and early fall of 1693, 17 women and 2 men were taken to Gallows Hill near Salem, Massachusetts and hanged as witches.

Principal accusers were a group of young girls.

Betty (9) and her cousin Abigail (11) were the first to show symptoms of a strange malady.

They sat motionlessly and stared fixedly at an invisible object.

They had convulsions—writhing and screaming.

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The Witch Trials of Salem (Slide 2 of 2)

Common pattern: One girl, in her fits and convulsions, claimed to see the spectral form of a villager tormenting her.

This was enough for a guilty verdict.

Rebecca Nurse (71) demonstrated her “witchcraft” when a group of girls imitated moves made at her trial.

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Models and Metaphors (Slide 1 of 2)

To understand new phenomena, we tend to apply ideas that are useful in another familiar domain.

As a science progresses, it moves through a series of models (paradigms) about how its subject matter should be viewed. A paradigm provides the following:

A viewing framework

Vocabulary to discuss

A “recipe” to conduct research

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Figure 2-1 Is it a Rabbit, or a Duck?

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Models and Metaphors (Slide 2 of 2)

Mature sciences, like physics, have moved through a series of paradigms, each one more powerful than its predecessor.

Psychology is a relatively new science in which no single ruling paradigm has yet emerged.

Competing viewpoints exist in psychology.

Each viewpoint offers a different model or metaphor to explain observations and predict events.

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Models and Metaphors for Abnormal Behaviors

Demonology

Spirit possession

Witchcraft

Naturalistic explanations

Organic view

Medical model

Psychological view

Understanding hysteria

Learning and behavior

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Early Demonology

Diverse people developed a remarkably similar theory or metaphor to explain abnormal behavior: possession by some god, spirit, or demon.

Exorcism is the practice of expelling demons from bodies they possess.

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Early Greek and Roman Views of Abnormal Behavior (Slide 1 of 2)

Not everyone subscribed to the prevailing belief in spirit possession.

Many physicians and philosophers held modern viewpoint, essentially modern in their denial of supernatural explanations for both physical and mental disorders.

Hippocrates, Galen, Asclepiades, Aretaeus

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Early Greek and Roman Views of Abnormal Behavior (Slide 2 of 2)

Hippocrates: behavioral abnormalities were sicknesses in the same sense as physical disorders.

Advocated medical approaches to treatment, such as moderate exercise and physical tranquility.

Galen: strongly influenced by the earlier work of Hippocrates; psychological abnormalities caused by imbalances of important bodily fluids called the four humors:

Yellow bile, black bile, blood, and phlegm

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The Middle Ages: Dance Manias

Episodes of mass madness in which groups of people dance in the streets

In Italy, similar episodes were called tarantism because they were believed to be caused by the bite of a tarantula.

In other parts of Europe, they were known as St. Vitus' dance after a 1518 episode in which dancers were sent to a chapel of St. Vitus.

In some areas, the dance mania became institutionalized as an annual ritual.

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The Middle Ages: Witchcraft

From the end of the 15th century and continuing for some 200 years, there was a widespread preoccupation with witches, their identification, and destruction.

Flogging, starving, immersion in hot water, and more refined forms of torture were used.

Initially, witches were thought to have signed a pact with the devil, but the distinction between voluntary and involuntary demonic possession became blurred over time.

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Voices of Reason

Johann Weyer (1515 - 1588)

Believed that many witches were mentally disturbed individuals who needed care and treatment

Reginald Scott (1538 - 1599)

Published The Discovery of Witchcraft (1584) in which he especially denied the role of demons in producing mental disorders

St. Vincent de Paul (1576 - 1660)

Argued that mental diseases were similar in kind to bodily disease

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Demonology Today: Alive and Well in the U.S.A.? (Slide 1 of 2)

Belief in occult phenomena, such as witchcraft and astrology, has enjoyed a revival that began in the second half of the twentieth century.

Over half of individuals in a random telephone survey of southern states believe that people are sometimes possessed by the devil (Rice, 2003).

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Demonology Today: Alive and Well in the U.S.A.? (Slide 2 of 2)

Ritualistic abuse by Satan worshipers became a popular explanation for multiple personality disorder (now, dissociative identity disorder) featured in many television programs and magazines in the 1970s and 1980s.

A 1992 FBI report concluded there is little or no evidence of allegations of Satanic ritualistic abuse.

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Humanitarian Reforms (Slide 1 of 2)

Although asylums usually began as havens where the mentally disturbed could find food, shelter, and some kindly attention; as time went by, they tended to become overcrowded, noisy, unsanitary repositories.

Living conditions at London asylum Bethlehem Hospital (opened in 1547) became so noisy and chaotic that the word bedlam was derived from its name.

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Humanitarian Reforms (Slide 2 of 2)

In the 18th and 19th centuries, several reformers began improving the care of the mentally disturbed.

Philippe Pinel (1745-1826), France

William Tuke (1732 – 1822), England

Dorothea Dix (1802-1887), United States

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The Organic View

Based on the belief that mental disorders have their origin in some biological malfunctioning transmitted through heredity or are caused by a disease, injury, lesion, or more subtle biochemical disturbance in the brain

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The Organic View: Rene Descartes

Philosopher Rene Descartes (1596-1650) proposed that humans and animals worked much as machines did.

Humans were different from the purely mechanistic animals, according to Descartes, because they have a soul and could act voluntarily.

Dualism: the separation of mind and body

Led to the scientific exploration of the mechanisms of the physical body

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The Organic View: Emil Kraepelin

Emil Kraepelin (1855-1926) created a classification system that continues to influence psychiatric thinking.

Kraepelin looked for individuals with patterns of symptoms (symptom complexes) which showed a similar onset, course, and outcome.

He combined symptom patterns into two major syntheses:

Manic-depressive psychosis

Dementia praecox

A third category was created which occurred more rarely and only had one symptom: paranoia

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Manic-Depressive Psychosis

Kraepelin linked mania (excited, elated reactions) with depression to form the manic-depressive category because the psychiatric records demonstrated the following:

Symptoms sometimes alternated with each other in the same person.

Both mania and melancholia showed an abrupt onset and a periodic course in which the person tended to show spontaneous recovery but a high likelihood of future recurrences.

In neither case was there progressive mental deterioration or physical symptoms such as paralysis.

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Dementia Praecox

Kraeplin created this category based on symptoms which had in two common characteristics:

Early onset, usually in adolescence or young adulthood (thus praecox or precocious)

A progressive downhill course toward an incurable dementia (mental incompetence)

While irreversible, the outcome was not death, but rather stabilization at a reduced level of mental and social capacity.

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The Organic View: Emil Kraepelin

Kraepelin's two major classifications accounted for about two-thirds of all the patients in mental hospitals at that time.

Established the possibility that categories of mental disorders reflected distinct disease processes.

The cause and cure of these types of disorders could proceed more rationally if they were investigated as organic diseases.

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The Organic View: An Example of Organic Causation

General paresis involved a symptom-complex, consisting of delusions of grandeur, dementia, and progressive paralysis. The paralysis and mental deterioration progressed rapidly to a fatal outcome.

In 1884, Fournier provided highly suggestive evidence that the symptoms of general paresis were related to and perhaps part of the sexually transmitted disease, syphilis.

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Organic Causation: General Paresis

Fournier found that 65% of patients with general paresis had a history of syphilis, compared with only 10% of patients with other mental disorders.

In 1897, Krafft-Ebing inoculated nine paretic patients, (who had denied having a prior syphilitic infection) with matter from syphilitic sores.

None of these patients developed symptoms of syphilis.

In 1905, Schaudinn identified a spirochete called Treponema pallidum, which was the cause of general paresis.

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Organic Cure: General Paresis

In 1917, malarial fever therapy was successfully used to treat syphilis, avoiding the development of general paresis.

In Vienna, Wagner-Juaregg used blood from a soldier with malaria to infect patients with general paresis.

The resulting malarial infection caused a high fever, which in turn, killed off the syphilis spirochete.

A much more effective therapy was developed decades later with the discovery of penicillin.

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Organic View: Current Status

After a century of organically oriented research, the foundation of the disease model of mental illness remains surprisingly incomplete.

With very few exceptions, there are no laboratory tests that can be conducted to detect the presence (or absence) of a mental disorder, or even any biochemical findings that are specific to particular disorders.

A precise physical cause has never been found for most DSM-V diagnoses.

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The Psychological View

The view that psychological events—personal experiences, beliefs, emotions, and ideas—might cause abnormal behavior developed along two very different lines of work:

The study of hysteria and hypnosis

The study of animal learning

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The Psychological View: Hysteria

Hysteria includes the following:

Uncontrolled emotional outbursts of weeping, laughter, or other inappropriate behaviors

Certain altered states of consciousness

A host of changeable bodily symptoms, such as paralyses, muscular contractions, and defects in hearing and vision

These symptoms have no identifiable organic basis.

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Healing by Suggestion: Anton Mesmer

Healing produced by permitting a flow of the magnetic fluid into or from the person by the "magnetizer" or healer

Developed a theatrical style of treatment which was discredited in 1784 by a group of scientific thinkers that said:

“Imagination without magnetism produces convulsions and that magnetism without imagination produces nothing."

Mesmerism became a popular term for procedures used to induce trances and other altered states of consciousness.

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The Scientific Study of Hysteria: Jean-Martin Charcot (Slide 1 of 3)

A puzzling but significant fact about hysteria was the almost unlimited variety of symptoms it encompassed:

Grande hysterie

Disturbances in sensory perception

Anesthesia, hemianesthesia, glove anesthesia, blindness, deafness

Hysterical pains

Paralysis

Abasia (inability to walk), selective defects

La belle indifférence

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The Scientific Study of Hysteria: Jean-Martin Charcot (Slide 2 of 3)

As a neurologist, Charcot recognized that many of the symptoms of hysteria differed from similar symptoms which arose from known organic causes.

Individuals with hysteria rarely hurt themselves when their symptoms overtook them.

There was a disappearance of the affliction under chloroform, but not in ordinary sleep.

Individuals with hysteria had normal reflexes, sudden onset, and occasionally, sudden disappearance.

No known organic lesion or disease process could produce the effects on the body.

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The Scientific Study of Hysteria: Jean-Martin Charcot (Slide 3 of 3)

Charcot wondered if hysterical symptoms could be produced through autosuggestion in a process similar to self-hypnosis.

He could put hysterical patients under hypnosis, produce new symptoms at will, and relieve the existing symptoms of at least some patients.

Others found hysterical symptoms could be induced through hypnosis in subjects with no previous history of hysteria.

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The Psychological View: Animal Learning

The second path of investigation which provided insight into the psychological causes of abnormal behavior was derived from animal experiments on how behavior was affected by experience.

Ivan Pavlov (1849 - 1936)

Edward Thorndike (1874 – 1949)

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Figure 2-2 Pavlov’s Conditioning Apparatus

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The Study of Animal Learning: Ivan Pavlov

In his work on digestion, Pavlov noted that his dogs soon came to salivate before meat powder was delivered into the mouth, apparently at the sight of the laboratory workers engaged in the study.

He undertook a series of experiments to understand the nature of this “psychic” reflex, and this work had a profound effect on psychology.

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The Study of Animal Learning: Pavlovian Conditioning (Slide 1 of 4)

Terminology:

Unconditioned stimulus (US): a stimulus that is naturally capable of eliciting the unconditioned response

Unconditioned response (UR): a response that occurs naturally or innately to an unconditioned stimulus

Conditioned stimulus (CS): an originally neutral stimulus that becomes capable of eliciting a conditioned response after repeated pairing with an unconditioned stimulus

Conditioned response (CR): a response that is elicited by a conditioned stimulus after repeated pairing with an unconditioned stimulus

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The Study of Animal Learning: Pavlovian Conditioning (Slide 2 of 4)

In Pavlov’s studies:

The meat powder was called the unconditioned stimulus (or US).

Salivation produced by the meat powder was called the unconditioned response (or UR).

The neutral stimulus (such as a bell or light) was called the conditioned stimulus (or CS).

The response of salivation to the conditioned stimulus was called the conditioned response (or CR).

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The Study of Animal Learning: Pavlovian Conditioning (Slide 3 of 4)

Learning is the acquisition of the association between the CS and the US.

Extinction is a process in which repeated presentations of the conditioned stimulus occur without the unconditioned stimulus. The association between the CS and US weakens.

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Figure 2-3 Typical Learning and Extinction Curve in a Conditioning Experiment

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The Study of Animal Learning: Pavlovian Conditioning (Slide 4 of 4)

Two other processes were evident as a result of conditioning:

Stimuli that were increasingly similar to the CS also exerted some control over the CR.

With continued conditioning, discrimination occurs, narrowing the range of controlling stimuli to those closest to the CS.

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Figure 2-4 Discrimination of (A) From (D) Produced “Neurosis”

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The Study of Animal Learning: Shenger-Krestovnikova (Slide 1 of 2)

Pavlov believed human behavior could be analyzed and explained in terms of innate and acquired (conditioned) reflexes.

Shenger-Krestovnikova, a student of Pavlov, created “symptoms of acute neurosis” in dogs in a discrimination experiment.

She trained dogs to salivate when presented with a circle drawn on a card.

She then found that the dogs also salivated if an ellipse, rather than a circle, was shown on the card (generalization).

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The Study of Animal Learning: Shenger-Krestovnikova (Slide 2 of 2)

The dogs were then trained to discriminate the circle from the ellipse by pairing food only with the circle, and then she refined the discrimination to more similar stimuli.

When faced with the discrimination between (A) and (D), Pavlov reported that one dog “began to squeal in its stand, kept wriggling about, tore off with its teeth the apparatus… a behaviour which never happened before. On being taken into the experimental room the dog now barked violently…”

In other words, the dog appeared to develop a neurosis.

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Figure 2-5 Thorndike’s “Puzzle Box”

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The Study of Animal Learning: Edward Thorndike (Slide 1 of 3)

Thorndike studied the process whereby animals escaped from a “puzzle box.”

Hungry cats learned by trial and error how to escape to get food.

Cats slowly became more adept at the required response, taking less and less time to get out of the puzzle box on succeeding trials.

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The Study of Animal Learning: Edward Thorndike (Slide 2 of 3)

In 1911. Thorndike formulated the "law of effect.”

When a behavior is followed by a satisfying consequence, it is more likely to be repeated; when followed by a punishing or annoying consequence, it is less likely to recur. In other words, whether a given behavior is strengthened or weakened depends upon its consequences or effects.

This learning process emphasized the consequence that followed the response.

This would come to be called instrumental learning, or operant conditioning, to distinguish it from classical, or Pavlovian, conditioning.

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The Study of Animal Learning: Edward Thorndike (Slide 3 of 3)

Thorndike viewed the law of effect as a process of selection:

The environment “selected” effective responses by the positive outcomes those responses produced.

Thorndike saw the similarity between Darwin’s concept of natural selection of physical attributes and his view of learning as environmental selection of behavior.

Since consequences changed behavior, neural connections in the brain were also changed, a foreshadowing of behavioral neuroscience.

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Chapter Summary (Slide 1 of 5)

Attempts to explain strange phenomena are usually couched in familiar metaphors.

Demon possession has been a popular, but scientifically unsupportable explanation for abnormal behavior in many times and places.

Some ancient Greeks and Romans, such as Hippocrates and Galen, proposed more naturalistic explanations, including the ideas that fluid imbalances or disordered brains caused disordered behavior.

FINAL THOUGHTS

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Chapter Summary (Slide 2 of 5)

In the late Middle Ages and afterward, many individuals, some of whom were probably suffering from mental disorder, were convicted and put to death as witches.

Some courageous individuals, including Johann Weyer and Reginald Scott, spoke against prevailing beliefs and argued that mental illnesses resulted from natural causes, not from demon possession.

FINAL THOUGHTS

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Chapter Summary (Slide 3 of 5)

Humanitarian reforms in the treatment of the mentally ill have waxed and waned throughout history. Especially important landmarks were the reforms instituted by Phillippe Pinel in Paris in 1792 and Dorothea Dix in the United States in the mid-19th century.

The organic view of abnormal behavior experienced a revival in the 19th century, especially in the work and writings of men such as Wilhelm Greisinger and Emil Kraepelin.

FINAL THOUGHTS

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Chapter Summary (Slide 4 of 5)

The discovery that a syphilitic infection produced the symptom pattern known as general paresis was particularly important in strengthening the organic view.

One psychological view of abnormal behavior arose largely from the study of hysteria, developing from the views of Anton Mesmer to the carefully documented work of Jean-Martin Charcot. Clinical observations strongly suggested that hysterical symptoms arose from strong emotional conflicts and the social context in which the person lived.

FINAL THOUGHTS

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Chapter Summary (Slide 5 of 5)

A second psychological perspective of abnormal behavior developed from laboratory studies on animal conditioning and learning. The work of Ivan Pavlov and Edward Thorndike set the stage for behavioral theories of how both normal and abnormal behavior can be acquired and modified through learning processes.

History of Mental Health Discussion

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