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HS-12-MentalIllness1week11.pptxContemporary Issues: Historical Framework of Contemporary Psychology
Unit 12
Mental Illness & Its Treatment
Early Ideas About Psychopathology
What was Freud reacting against ?
Ancient Ideas About Mental Illness
evil spirits caused mental disorders
to drive out the spirits
induced vomiting
Starvation
skull drilling
Trephining (10K – 5K BCE): hole chipped into skull
through opening, evil spirit(s)-- causing the psychopathology--would be
released and the individual would be cured
neolithic (3500 BC) ; patient survived
Egypt
1st known Mental Hospital (29th Century BCE)
Temple of Imhotep
1st ‘Psychiatrists’ (Temple Sleep)
dream interpreting to discover source of illness.
1st known Psychiatric Text (20th Century BCE)
Dealt with hysteria
Mental Illness = Physical Illness
opium to induce visions
rituals & prayers to specific gods
Later:
used recreation (concerts, dances, & painting)
Mind was subservient to Body
The chapter begins with a brief overview of historical trends in the treatment of psychopathology.
Early beliefs that evil spirits caused mental disorders led to efforts intended to drive out the spirits; sufferers endured such treatments as floggings, induced vomiting, starvation, and skull drilling.
Although the sixteenth century witnessed the creation of special hospitals for the insane, the inhumane conditions and barbaric treatments served to isolate patients from the rest of humanity rather than to improve their lives.
Reformers such as Philippe Pinel and Dorothea Dix advocated for—and achieved—institutional reform.
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Religious Views
Mesopotamia/Babylon (Cradle of Civilization)
Priests treated ‘Possession’ - magico-religious
Monothesim
Hebrews: punishment from God for sin
God also the ultimate healer so appeal to God for cure
Islam: possession by Jinn (sprits; good or evil)
supernatural intervention not necessarily malignant
Texts (10th Century): definitions, symptoms, & Tx
Psychiatric ward of Baghdad hospital
Wards didn’t exist in - fear of demonic possessions
Christian (4th Cent): Evil Spirits/Devil
Tx: torture & execution
15th century – Inquisition (300 yrs)
18th century – Tx: institutionalization (brutal jails)
Greeks
Thales: mental illness as natural event
Away from mystical causes
Source inside the sufferers themselves
Pythagoras: brain is source of mental disturbances.
biological humors: mental illnesses result of disequilibrium of basic harmonies
good-bad, love-hate, single-plural, and limited-unlimited
Hippocrates: brain as the seat of consciousness
mental illness = pathology in the brain
Mental Ill = disparity between dream content & reality
advocated exercise & tranquility
in some cases, bloodletting to reestablish humoral balance
STILL: most Greek medicine men continued to support magico-religious demonology as a cause of mental illness
The Enlightenment
1600s: Restraint; Sedated with opium
“Enlightened” reform: ‘Moral Treatment’
removing inmates' chains
housing them in a pleasant environment
decent food
therapeutic use of occupational tasks
Phillipe Pinel (1745-1826) in France
“Moral Treatment”
Treat people like patients not animals
Listen to complaints
Case Histories (dramatic rise in cure rates)
His assistant Poussin, a former inmate, had many of the ideas
William Tuke (1732-1822) in England
Businessman & Quaker
York Retreat for the care of the insane in 1796
Similar moral treatment strategy in farm setting
Early Amer. Treatment
Samuel Willard (1748-1801)
first hospital for mental illness in the USA (Uxbridge, MA)
Cold water immersion (used in England)
i.e., Shock Tx
Better than 1600s “Asylums” in Christian Europe
Better than family care where shame & stigma
Pt. often abused & restrained or abandoned &
left to a life of begging and vagrancy.
Benjamin Rush (1745-1813)
father of American psychiatry
Medical model – disease
Observations and Inquiries upon the Diseases of the Mind (1812)
Believed Vascular Inflammation of Brain was cause
Bloodletting
The “tranquilizer chair” – controls flow of blood to brain
Reforming Asylums
Dorothea Dix (1802-1887)
Born in Maine, parents alcoholic & father abusive
At 14 she lived with great aunt in Worcester for 4 years
Ran a school for 6-8yo girls (not allowed in public schools)
1822-36 School in Boston
Ill; doc suggest Europe
Met with reformers (mostly in England). Returned 1841
Taught Sunday School class for woman inmates; found mentally ill, developmentally delayed & criminals all mixed together in unheated, unfurnished, and foul-smelling quarters
Brought to Courts & won (1884)
Method toured places where mentally were housed and exposed poor care, neglect, and abuse
Over time, resulted in creation of 47 mental hospitals
Clifford Beers (1876-1943)
Wrote of asylum conditions after experiencing them
The Mind That Found Itself (1908) - autobio
Started mental hygiene movement (Mental Health America)
The Kirkbride Plan “building-as-cure”
Thomas Kirkbride (1809–1883) proposed a system of state mental hospitals based on the Moral Treatment philosophy
He was superintendent of the Pennsylvania Hospital for the Insane
Founded precursor of American Psychiatric Association
Building: a special apparatus for the care of lunacy
sunlight & fresh air
privacy & comfort
Attractive grounds
Dorothea Dix testified to NJ Legislature in 1844
people with mental illness were being housed in county jails, private homes, and the basements of public buildings
New Jersey State Lunatic Asylum 1st based on Kirkbride Plan
Today it is Trenton Psychiatric Hospital
Several Dozen built: 1877 Worcester State Hospital
Out of favor by 1900s
Diagnosing Mental Illness
Emil Kraepelin (1856-1926) (Contemporary of Freud)
Medical degree (neuropath), but also studied with Wundt
Compendium der Psychiatrie 1883
Psych is branch of medicine; Mental disease is biological
Classification scheme for mental illness
Psychiatrie (1899, 6th ed)
Based on clinical syndrome vs symptoms
common patterns of symptoms
2 main (13 in all)
Manic-depressive psychosis (mood disorder)
Fluctuates, recoverable
Dementia praecox (thinking disorder)
progressive, neurodegen, no recovery
Basis for WHO & DSM
Supported ‘Moral Treatment” vs. Freud, etc.
Psychological Cause of Mental Illness
Emotional Factors More Important Than Biological Factors
Mesmerism and Hypnosis Franz Anton Mesmer (1734-1815)
Trance states had been around for long time - magic
Mesmer: Physician (U Vienna 1776)
Newton universal gravitation (late 1600)
Animal Magnetism (influences act on human body)
Poor health resulted from misaligned magnetic forces
Cure was to realign forces
Under his influence trance, then recovery and relief
1st magnify; then transmit own AM to patient via magnet
“Baquet” group mesmerism therapy
container filled with water, glass, and magnetized iron filings w/ iron rods protruding from it – Sub touched rods
First Vienna, then Paris
(Ben) Franklin Commission (1784)
Cure by magnetism but also if no magnetism - Charlatan
Missed: suggestion (placebo), not magnetism
Mesmerism and Hypnosis (continued)
In England (1785)
Demonstrated effects on pain reduction (amputations)
Renamed by Braid (1843) neurypnology (sleep of the nervous system – neuro + hypnology)
Liebeult & Bernheim (France)
School of Nancy
Suggestibility as a normally distributed trait
Hypnosis: natural curative process via mental suggestion
For highly suggestible patients cures
Jean Charcot (1825-1893)
Salpêtrière Hospital in Paris (Grand Hypnotism)
Hypnosis and hysteria same underlying pathology
i,e, both neuro, not psych
Only hysterics could be hypnotized
Hypnosis could be used to diagnose hysteria
Not seen as a cure
Sigmund Freud (1856-1939) Psychoanalysis
Freudian myth – two elements
Completely at odds with everyone else
Absolute originality
Maintained by
Destroying papers twice (1885, 1907)
Total Control
Picking loyal follower as biographer (Jones, British Psych)
Self Promotion - Freud (1917):
3 great shocks to the collective Ego:
Copernicus (15th cent.) Earth NOT center of universe
Charles Darwin (19th century)
Freud (20th century) The Unconscious
Psych Environment For Freud
1895: 1st Book: On the origins of psychoanalysis
Wundt 63 yo
Titchener 28 yo (Cornell x 2 yrs) Structuralism just beginning
Functionalism just beginning
No Behaviorism (Watson was 17 yo)
No Gestalt Psych (Wertheimer was 15 yo)
Freud Died in 1939 (so 44 years later)
Wundtian Psych, Structuralism & Functionalism Over
Gestalt Psych moving from Germany to US
Behaviorism dominant in US
Common To All (pre-Freud)
Psychology Was Academic
Science/Lab Based: Wundt as major influence
MAJOR FOCUS: Sensation, Perception, Learning
Psychoanalysis:
Not Academic
Not Science/Lab Based
MEDICAL ORIGINS: Medicine & Psychiatry
Different:
Goals:
Subject Matter: Psychopath & Abnormal Behavior
Unconscious
Methods: Clinical Observation (vs lab experiments)
Freud’s Unique Contribution
Unconscious
Wundt & Titchener rejected UC
cannot use Introspection
cannot reduce to basic sensory elements
Functionalism: exclusive focus on Consciousness
James admitted the notion of UC process
Angell’s 1904 text – 2 pages to UC
Woodworth’s 1924 text - few brief comments
Watson’s Behaviorism rejected both UC & C
UC is simply what Sub hasn’t yet verbalized
Antecedents to Freud’s UC
Leibniotz (early 18th Cent)
Monads: individual elements of reality (not atoms); not solely matter/physics
Range from UC (petite perception) to C (apperceptions)
Friedrich Herbart (19th Cent):
refined with threshold concept
< threshold = UC; > threshold = C
< Thresh due to inhibition
Gustav Fechner (19th Cent): also threshold
Iceberg metaphor (not inhibition)
Influenced Freud (he quoted Fechner)
General Zeitgeist Of 1880s
UC very much a part of
several popular books
Dr. Jekyll & Mr. Hyde 1889
Freud (continued)
MD Vienna (1881)
Desired a career in research
Poor pay, wanted to marry so clinical practice
Influenced by materialistic Zeitgeist
Mentor Ernst Brücke (colleague of Helmholtz)
all living things are dynamic & regulated by laws of chemistry and physics
psychodynamics.
Six months with Charcot (Hypnosis)
Prepping for medical practice
Meynert Psychiatric clinic encounters hysteria
Decided to become a neurologist
Meynert
disturbances in brain development predispose for psychiatric illness
certain psychoses are reversible.
Anna O Case
Studies on Hysteria by Freud and Breuer (1895)
Anna O – a pseudonym for Bertha Pappenheim
Founder: “Jüdischer Frauenbund” (League of Jewish Women)
Under care of Joseph Breuer (1842-1925)
Wide range of hysteric symptoms:
cough, paralysis of the extremities, disturbances of vision, hearing, and speech, hallucination, and loss of consciousness
During episode; she would mutter words
Talking cure (under hypnosis)
under hypnosis, told her words she said when she was “absent”
Stopped hypnosis but continued ‘free-association’
Seemingly eliminated Sx by talking through them to their source
Father’s illness
Freud’s insight
Hysterics “suffer from reminiscences”
Hysteric symptoms symbolically related to cause
1895, with Breuer Studies on Hysteria
Included Anna O. and other cases
Darwinian influence
Behavior not always rational
Sexual motivation for behavior
Methods for accessing unconscious
Hypnosis: tried but rejected
Free Association
Dream Analysis
Seduction hypothesis
Hysteria is result of sexual abuse
Abandoned, after self analysis, in favor of “imagined seduction”
Led to Oedipal complex & focus on sexual motivation
Creating Psychoanalysis
First decade of 20th century
Highly productive
Interpretation of Dreams (1900)
The Psychopathology of Everyday Life (1901)
Three Essays on Sexuality (1905)
Wit and Its Relation to the Unconscious (1905)
Invited by Hall to Clark’s 20th anniversary celebration
Series of lectures (1909)
For Freud international recognition
For American psychologists
Not sure what to make of Freud
Hall a big fan though
James less so
Psychoanalysis (continued)
Beyond the Pleasure Principle (1920)
Thanatos added to Eros
The Ego and the Id (1923)
Id, Ego, Superego structure introduced
Anxiety and defense
Anxiety: aversive inner state
Objective, neurotic (ID runs free), and moral anxiety
Humans reduce anxiety (tension) through defense mechanisms
Anna Freud’s influence on theory of defense mechanisms
Anna made comprehensive list
Repression and others
Sublimation: The only “successful” defense
Anna never left father
Oedipal: sublimated Id into psychological creativity which advanced Freudian theory, her father's greatest love
Psychoanalysis
The Theory Evolves
Freud’s followers loyalty then dissent
1o issue: universality of sexual motivation
Alfred Adler (1870-1937)
Emphasized social factors over biological (sex)
Individual psychology (later influenced Maslow)
Main concept inferiority complex
Carl Jung (1875-1961)
Freud’s adopted eldest son, crown prince and successor
Word association task (to access the unconscious)
Sent to Freud 1906; relation lasted till 1913
Presented at Clark conference (1909)
Analytical psychology
Collective Unconscious
Psychoanalysis
Freud’s Followers
Psychoanalysis in America
Not well received in academic circles
Tried to examine Freudian concepts empirically or to translate them into other terms (e.g., behavioral)
Psychoanalysts argued that critics were being critical because of unresolved unconscious issues
Popular with the public and the psychiatric community
Psychoanalysis was “smuggled” into America by Viennese and Berlin exiles (fleeing rise of Nazi)
American psych a mixed bag of medicine, science, & flimflam
Issue: Psychoanalysis a method, not yet a discipline
Post WWII: Freud fits the modern sensibility
Acceptable to talk about SEX
WW II; Freud explored the underworld of dark things
Evaluating Freud
Contributions
Importance of Unconscious
We’re not always aware of reasons for our behavior
Importance of childhood
In some cases, mental illness can be helped with non-medical strategies (i.e., psychoanalysis)
Criticisms
Overly dogmatic
e.g., excessive emphasis on sex
Biased interpretations of cases
Limited number of cases
Fit the data to his theory (should be the reverse)
1960s
political radicalism, postmodernism, feminism
Anxiety – psychopharmacology remedies
Does Freud still matter?
Jerome Bruner
“His theory provides a dramatic, indeed, a tragic view of the human condition.”
"The imagery of the theory, moreover, has an immediate resonance with the dialectic of experience … it fits the human plight…”
“Finally, the image of man presented was thoroughly secular… the image has found a ready home in the rising, liberal intellectual middle class…”
Mar. 29, 1999
TIME 100: Scientists & Thinkers
Does Freud still matter?
Eric Kandel:
Much of what we do is unconscious.
dreams have psychological meaning
infants are active, thinking individuals who have sensual as well as painful experiences
listening carefully to a patient, you can get a lot of insight into what the unconscious is talking about.
3/27/06
Eric Kandel Unconscious Decision Making
