Historical Views of Abnormal Behavior Chapter 2 Historical

Historical Views of Abnormal Behavior Chapter 2

Historical Views of Abnormal Behavior • The history concerning how abnormal behavior was treated is generally unknown. • Two Egyptian papyrus dating back to the 16 th century B. C. provide some clues to the earliest treatments of disease and behavioral disorders. • The Edwin Smith papyrus contains detailed descriptions of the treatment of wounds and other surgical operations. The brain is described, possibly for the first time in history. • The brain was mentioned as the site of mental functions. • The Ebers papyrus offers another perspective on treatment. It covers internal medicine and the circulatory system, but relies more on incantations and magic for explaining how to cure diseases.

Demonology, Gods, and Magic • The Chinese, Egyptians, Hebrews, and Greeks attributed abnormal behavior to a demon or god who had taken possession of a person. • Depending upon how the person acted decided whethere were good or bad spirits within the person. • Most possessions were considered to be the work of an angry god or spirit. • People often thought that if they did something bad that they would no longer get god’s protection and might begin acting “mad”. • Every effort was made to get rid of the evil spirit within the person. These efforts included magic, prayer, incantation, noisemaking and the use of horrible containing concoctions made of sheep dung and wine.

Hippocrates’ Early Medical Concepts • The Greek temples of healing brought in the golden age of Greece, which was led by Pericles who was an Athenian. • Pericles noted that he saw significant progress with diagnosing and treating mental illnesses. The Greeks considered the human body sacred. • During this period, the physician Hippocrates (460 -377 B. C. ) was thought of as the father of modern medicine. • Hippocrates noted that demons and spirits had nothing to do with mental illness and there were natural causes and treatments that could help people. Hippocrates understood that the brain was responsible given mental illness. He noted that injuries to the head could cause sensory and motor delays.

Hippocrates’ Early Medical Concepts • Hippocrates said that all mental illness fit into three categories: mania, melancholia, and phrenitis (brain fever). He relied on clinical observation and his descriptions, which were based on daily clinical records of his patients and were thorough. • It was known that Hippocrates and the Roman physician Galen explained personality and temperament as the four humors. The four elements of the material world were Earth, wind, air, and water. This had attributes of heat, cold, moistness, and dryness. These elements combined to form four essential fluids – blood, phlegm, bile, and black bile. • It was believed that these fluids combined in different proportions within different individuals and a person’s temperament was determined by these fluids. • Hippocrates believed that dreams were very important in an understanding of a patient’s personality.

Hippocrates’ Early Medical Concepts • The treatment for melancholia was a regular and tranquil life, sobriety, and abstinence from all excesses, a vegetarian diet, celibacy, exercise short of fatigue, and bleeding if indicated. He would often remove patients from their families. • Hippocrates had very little knowledge of physiology. He believed that hysteria was restricted to women and was caused by the uterus wandering to different locations within the body, pining for children. Hippocrates believed that “marriage” was the best medicine.

Early Philosophical Conceptions of Consciousness • The Greek philosopher Plato studied mentally disturbed individuals who had committed criminal acts and how to deal with them. He believed that such persons were not responsible for their acts and should not receive punishment in the same way as normal persons. • Plato also made provision for mental cases to be cared for within the community. • Plato wrote in “The Republic” that there were individual differences in intellectual and other abilities and took into account sociocultural influences in shaping thinking and behavior. • Plato wanted hospital care for individuals who developed beliefs that ran counter to those of the broader social order. Plato thought that mental disorders were divinely caused. Aristotle (who was a student of Plato) wrote on mental disorders. He wrote about consciousness. He believed that “thinking” would eliminate pain and help to attain pleasure. • Aristotle believed that there were disturbances “within the bile”. He thought that very hot bile brought about amourous desires, verbal influences, and suicidal tendencies.

Later Greek and Roman Thoughts • Hippocrates work was continued in Alexandria, Egypt in 332 B. C. due to the city’s founding by Alexander the Great. • Medical practices progressed to a higher level. Pleasant surroundings were considered to be healing. Mental patients were provided with constant activities including parties, dances, walks in the garden, rowing along the Nile, and physical concerts. • Physicians also pushed for patients to diet, have massage, take part in hydrotherapy, gymnastics, and education. They also used bleeding, purging, and mechanical restraints.

Later Greek and Roman Thoughts • Asclepiades (c. 124 -40 B. C. ) was a Greek physician that developed a theory of disease that was based on the flow of atoms through the pores of the body and developed treatments such as massage, special diets, bathing, exercise, listening to music, and resting in order to restore the body. • The Greek physician Galen (A. D. 130 -200) made some original theory concerning the anatomy and the nervous system. He did not contribute much to the idea of mental illness. Galen dissected animals. Human dissection was not allowed. • Galen felt that psychological changes could be categorized by: injuries to the head, excessive use of alcohol, shock, fear, adolescence, menstrual changes, economic reversals, and disappointment in love. • Physicians often used “opposite by opposite”, for example patients were asked to take a hot bath while drinking a cold glass of wine.

Early Views of Mental Disorders in China • China was one of the oldest civilizations that medicine was used with other treatments. The Chinese sought natural causes and not supernatural causes. The body was divided into positive and negative forces and if the two forces were balanced, the result was physical and mental health. The treatments focused on restoring balance. • Chung Ching (was the Hippocrates of China) and wrote two books about physical and mental disorders. He also gained his knowledge by clinical observation and believed that there were organ pathologies. His treatments used drugs and emotional supporting activities.

Views of Abnormality During the Middle Ages • During the Middle Ages (500 -1500 A. D), the most scientific aspects of the West survived in the Islamic countries of the Middle East. • The first mental hospital was established in Baghdad in 792 A. D. In these hospitals, the patients were given humane treatment. • One of the most popular people in this area was Avicenna from Persia called the “prince of physicians”. He is also the author of “The Cannon of Medicine”, which was one of the most widely studied text within that time. In his text, he referred to hysteria, epilepsy, manic reactions, and melancholia. • During this time in Europe, the Middle Ages thought everything was impacted by superstition.

Mass Madness • In the later half of the Middle Ages, there were groups of people that were affected by mass hysteria. Dancing manias (epidemics of raving, jumping, dancing, and convulsions) were reported within the 10 th century. • One episode happened in the 13 th century and was known as tarantism – a disorder that included an incredible desire to dance that was attributed to the bite of the southern European tarantula or the wolf spider. This later spread to Germany and the rest of Europe and was known as Saint Vitus’s dance.

Views of Abnormality During the Middle Ages • Isolated rural areas were also afflicted with outbreaks of lycanthropy – a condition in which people believed themselves to be possessed by wolves and imitated their behavior. • There was one patient that claimed to be a wolf and to cure him of his extremities, they amputated his limbs and he ended up dying. • Mass madness reached a peak during the 14 th and 15 th centuries when there was social oppression, famine, and disease. Europe was ravaged by Black Death. It killed millions. • Mass hysteria has happened in modern day. In April of 1983, there was a mass hysteria with the girls of the West Bank, Palestine. Arab leaders thought that the girls had been poisoned by the Israelies. Psychological factors played a role in this case.

Views of Abnormality During the Middle Ages • In 1990, many men in Nigeria had mass hysteria because they thought their genitals had vanished. This fear is called koro. Most of these individuals believed that their genitals disappeared because of supernatural reasons.

Exorcism and Witchcraft • In the Middle Ages, the clergy had to take care of the mentally ill. During this time, the mentally ill were taken care of pretty well. Treatment included prayer, holy water, oils, the breath or spittle of priests, the touching of relics, visits to holy places, and mild forms of exorcism. • In some monasteries and shrines, exorcisms were performed by the gentle “laying on of hands”. Today, there are still exorcisms performed on some children for afflictions that are simply psychological problems. There have been deaths because of exorcisms done on children. • In the past, many mentally ill people were accused of being witches or practicing witchcraft. Generally, women that have been accused of witchcraft are often outspoken with a bad temper and sharp tongue.

Exorcism and Witchcraft • There are two types of demonically possessed people: • 1) those that were physically possessed were considered crazy. • 2) those that were spiritually possessed were considered to be witches.

Toward Humanitarian Approaches • During the late Middle Ages and early Renaissance, scientific questioning re-emerged. This movement was known as humanism. • This was the period that the superstitions of the past were questioned. • Paracelsus (1490 -1541), a Swiss physician, was an early critic of possession and superstition. He believed that possession was a form of disease. His treatment was bodily magnets. He also believed in astral influences. He believed that the moon caused changes within the brain. • Johann Weyer (1515 -1588) who wrote under the name of Joannus Wierus, was so disturbed by the imprisonment, torture, and burning of people accused of witchcraft that he made a careful study of the entire problem. He published his book in 1583, which was called, “On the Deceits of the Demons” which refuted a witch hunting handbook published in 1486. Most people protested his work, violently. This man was far ahead of his time.

The Establishment of Early Asylums • In the 16 th century, special institutions called asylums-sanctuaries or places of refuge meant solely for the care of the mentally ill – grew in number. • Asylums were a way of removing trouble-some individuals that could not take care of themselves. Most early asylums were referred to as “madhouses”. Many patients died because of filth and cruelty. • The first asylum was established in Spain in 1409. In 1547, the monastery of St. Mary of Bethlem in London was officially made into an asylum by Henry VIII. The violent patients could be looked at for one penny a look. The more harmless patients were forced to beg on the streets for money. • The Lunatics’ Tower was constructed in Vienna in 1784. The doctors and keepers of this institution stayed in the rooms whereas the patients were confined to the spaces between the walls. The patients were put on exhibit for a small fee. The inmates were treated more like beasts than like patients. • The early treatments of those with mental illness found that patients needed to choose a healthy mind over insanity. The treatment techniques were aggressive, aimed at restoring a balance between the body and mind. These were designed to intimidate the patients. • The treatments included: powerful drugs, water treatments, bleeding and blistering, electric shocks and physical restraints.

Humanitarian Reform • Philippe Pinel (1745 -1826) was a humanitarian that made a great impact in the lives of the mentally ill. In 1792, Pinel was placed in charge of the La Bicetre in Paris. • Pinel received permission to remove the chains of the patients as part of his experiment. He believed with kindness and compassion that patients would get better. He provided patients rooms with the sun. Some of the patients that he had freed had been in dungeons for more than 30 years. The filth, noise, and abuse were replaced by order and peace. • Paperwork shows that Pinel forbid the workers from beating the patients.

Tuke’s Work in England • William Tuke (1732 -1822) established the York retreat, a pleasant country house where mental patients lived, worked, and rested in a kind and religious environment. • Tuke was a Quaker and the Quakers believed in treating all people (even the insane) with kindness and acceptance. This Quaker retreat has continued to provide effective care for over 200 years. After asylums, huge mental hospitals were created that were often crowded and the treatment was less than adequate. • In 1841, Samuel Hitch introduced nurses and trained supervisors at the head of the nursing staffs. This improved the care of the patients. • In 1842, the Lunacy Inquiry Act was passed, which included the requirement of asylums and houses every four months to ensure proper diet and use of restraints. • In 1845, the Country Asylums Act was created and dictated that all counties had to provide an asylum for the mentally ill. Although they tried to stop ill treatment of patients, “tanking” was still used to control patients. This meant dunking the patient under water until they were close to death.

Rush and Moral Management in America • Benjamin Rush was the founder of American psychiatry and also signed the Declaration of Independence. He wrote the first American treatise on psychiatry. He wrote, “Medical Inquiries and Observations upon Diseases of the Mind” and was the first American to create a course in psychiatry. • The use of moral management – a wide ranging treatment method that focused on a patient’s social, individual, and occupational needs. These patients were provided spiritual discussions as well as physical labor. They did very well considering that many of them probably had syphilis, a disease of the central nervous system. • In 1876, the “cure” rate for the Bedlam hospital was 45. 7%. Moral management was almost given up because of prejudice against immigrants.

Rush and Moral Management within America • One of the big reasons why moral management was almost given up was because of the rise of the mental hygiene movement. This focused mainly on the physical wellbeing of the patient. Although the comfort level of the patients improved, the patients received almost no help for their mental illnesses. The idea was to keep a patient comfortable until a biological cure came along. • The discharge rate went down during this time.

Benjamin Franklin’s Early Discovery of the Potential Curative Effects of Electric Shock • Benjamin Franklin’s early experimentation with electricity was also used with electroshock. He proposed using electroshock therapy for those with depression. He realized that severe shock had altered his memories. • Another physician noted that his memories were altered after he received an electrical shock. This physician also called for experiments using mentally ill patients. It was in the middle of the 18 th century that electric shock was associated with amnesia.

Dix and the Mental Hygiene Movement • Dorothea Dix (from New England) became a champion of the poor and forgotten in prisons and mental institutions. She pushed for humane treatments of psychiatric patients. She was forced out of teaching because of reoccurring TB. She taught in a women’s prison for awhile. • In a “Memorial” submitted to the U. S. Congress in 1848 she talked about the deplorable conditions she saw. Due to Dix, millions of dollars were raised to build suitable hospitals. She established 32 mental hospitals. • Dix finished her career by organizing the nursing forces of the Northern armies during the Civil War.

The Military and the Mentally Ill • Mental health treatment was helped by military medicine. The first mental health facility for treating mentally disordered war casualties was opened by the Confederate Army in the American Civil War. • Between the Civil War and WWI, psychiatrists worked with the military to deem whether or not someone was mentally fit for services. The mental health professionals noted that alcoholism was rampant with soldiers.

19 th Century Views of the Causes and Treatment of Mental Disorders • Even into the 19 th century, the only treatments offered were blood letting, purging, drugging, and it was not very effective. • At this time, depression was thought to be the effect of nervous exhaustion. They thought that the body’s energies were depleted.

Changing Attitudes Toward Mental Health in the Early 20 th Century • In the early 20 th century, psychiatrists did very little to effectively educate the public about mental health and insanity. People were often scared of the asylum within their communities. • Clifford Beers (1876 -1943) wrote a book called, “A Mind that Found Itself” and it was published in 1908. Beers told of his mental collapse and wrote about how awful the treatment was that he received from three different institutions. The straight-jacket was used to quiet excited patients. Beers experienced the straight-jacket and wrote about it. His writings were found to be enlightening by William James.

Mental Hospital Care within the 21 st Century • During the early 21 st century, the number of asylums grew in number. They now housed the severely mentally ill including: schizophrenia, major depression, organic mental disorders, tertiary syphilis, paresis, and severe alcoholism. • By 1940, the public mental hospitals housed over 400, 000 patients. 90% of these were in large state funded hospitals. • In 1946, Mary Jane Ward published a very influential book called, “The Snake Pit”. She brought attention to the plight of mental hospitals and overcrowding.

Mental Hospital Care within the 21 st Century • In 1946, the National Institute of Mental Health was organized and provided active support for research and training through psychiatric residencies and clinical psychology training programs. In the 1950’s and 1960’s, many professionals were concerned with the conditions of the mental hospitals. • Improving conditions became even more important after the publication of, “Asylums” by the sociologist Erving Goffman. It was during the last decade that some drug treatment was developed. As an example, they used lithium to treat manic depressive disorder. There was also the introduction of phenothiazines for the treatment of schizophrenia. • In the next couple of decades, psychiatric facilities were closed as drugs became better and psychiatrists wanted these patients returned to their communities. This movement was called deinstitutionalization. Many individuals worried that these people were becoming dependent upon these institutions.

Mental Hospital Care within the 21 st Century • Chronic mentally ill patients feel that they have been abandoned by the healthcare facilities. Many of the people living on the streets have mental illnesses and are homeless. • Mental hospitals have been replaced with community-based care, day treatment hospitals, and outreach. Closing psychiatric facilities has not improved individuals with severe mental illness.

Biological Discoveries: Establishing the Link Between the Brain and Mental Disorder • A major discovery came with the discovery of organic factors underlying general paresis – syphilis of the brain. This produced paralysis and insanity and caused death within 2 -5 years as a result of brain deterioration. • The discovery of a cure for general paresis began in 1825, when a French physician A. L. J. Bayle differentiated general paresis as a specific type of mental disorder. • In 1897, the Viennese psychiatrist Richard von Kraft-Ebbing conducted experiments involving the inoculation of paretic patients with matter from syphilis sores. None of the patients developed secondary symptoms of syphilis. • In 1906, August von Wassermann devised a blood test for syphilis. It tested to see if there was a deadly bacteria in the bloodstream. This could be diagnosed before the serious symptoms occurred. • In 1917, Julius von Wagner-Jauregg, chief of the psychiatry clinic of the University of Vienna introduced a malaria fever treatment of syphilis and paresis because he knew the high fever associated with malaria killed off the bacteria. He took the blood of a malaria induced soldier and put it into syphilis patients. There was improvement in three and a cure in three. Today, there is penicillin as an effective, simpler treatment.

Brain Pathology as a Causal Factor • In the early part of the 18 th century, knowledge of anatomy, physiology, neuroscience, and chemistry increased rapidly. Scientists felt that diseased body organs were the cause of physical ailments. • Albrecht von Haller said it was important to dissect the brain of those that were insane. In the future, metallic poisoning was found. The mental deterioration of Alzheimers was eventually found by Alois Alzheimer. • Henry Cotton believed that he could remove the portion of the disease that was causing the mental illness. He used surgical tools to remove teeth, tonsils, parts of the brain, colon, testicles, or ovaries. • Walter Freeman performed lobotomies on individuals with severe mental disorders. He used an ice pick to sever the neural connections in the brain after entering through the patient’s eye sockets. These were ineffective and inappropriate. Henry Cotton

The Development of a Classification System • Emil Kraepelin (1856 -1926) helped to develop the early biological viewpoint. He emphasized brain pathology in mental disorders. His system of classifications of mental disorders became what eventually became known as the DSM-IV-TR and now the DSM-5. • Kraepelin believed that the symptoms of mental disorders were as simple as those of the measles.

Development of the Psychological Basis of Mental Disorder • The first steps taken for better understanding the psychology of mental disorders was accomplished by Sigmund Freud developed his comprehensive theory of psychopathology that emphasized the inner dynamics of unconscious motives. The methods he used to study and treat patients came to be called psychoanalysis. He also introduced hypnosis.

Mesmerism • Franz Anton Mesmer, an Austrian physician, developed the ideas of Paracelsus. He believed the planets had an influence on the body. He believed the planets affected the universal magnet fluid in the body, which determined health and disease. • Mesmer believed that people could take their own magnet fluid and influence others magnetic influence. • In 1778, he gained a following in Paris. He opened a clinic where he treated people with “animal magnetism”. Patients were seated around a tub containing various chemicals, and iron rods protruding from the tub were applied to the affected areas of the body. He would do this with music. Mesmer went around his patients and either touched them with a wand or with his hand. Eventually, Mesmer was seen as a charlatan by his peers including Benjamin Franklin. After an experiment where the people proved that it was his patients that thought they had been cured, Mesmer was kicked out of Paris. • There was a group of Mesmerists within the United States that tried to prove its validity, especially during surgery. It did not last long.

The Nancy School • Ambrose August Liebeault, a French physician, was one of the first to use hypnosis successfully in his practice. • Bernheim became interested in the link between hysteria and hypnosis. Bernheim had treated a patient for four years that had not gotten better, but was cured with Liebeault. The two got together and came up with two main concepts of hypnosis: • 1) the phenomena observed in hysteria – such as paralysis of the arm, inability to hear, and anesthetics where a person could not feel a pin prick could be produced in normal results by means of hypnosis. • 2) the same symptoms could be removed by means of hypnosis. Hysteria was a sort of self-hypnosis. The physicians that followed this route of treatment came to be known as the Nancy School. • Soon, it was shown that there were psychological factors involved in mental disorders.

The Beginnings of Psychoanalysis • In 1885, Freud studied under Charcot and learned of the ideas of hypnosis due to Liebeault and Bernheim. He became convinced that hypnosis could bring out unconscious desires. • Josef Breuer along with Freud had patients talk about their emotional trauma in hypnosis and noticed that they were much better after they awoke. This came to be known as catharsis. Generally, patients did not see a connection between their hysteria and their deep-seated emotion. • It was this change that brought about the discovery of the unconscious – the portion of the mind that contains experiences of which a person is unaware. Freud found that by having patients say whatever was on their mind, patients could eventually overcome inner obstacles to remembering and would discuss their problems freely. • Freud used Free Association – which meant having patients talk freely about themselves, thereby providing information about their feelings and emotions. • Freud also used dream analysis – having patients record and describe their dreams. His methods were introduced to American scientists in 1909. Freud brought quite a bit of controversy to American when he spoke at Clark University.

The Evolution of the Psychological Research Tradition: Experimental Psychology • Abnormal behavior was definitely influenced by experimental psychologists including: Wilhelm Wundt and William James. In 1879, Wilhelm Wundt created the first laboratory studying human phenomenon at the University of Leipzig. • Many future clinical specialists followed Wundt’s scientific methods, which made experiments less biased. Wundt studied the individual differences given human processing. • In 1896, Lightner Witmer established combined research with application and established the first American psychological clinic at the University of Pennsylvania. He looked at mentally deficient children in terms of research and therapy. He became the founder of clinical psychology. • In 1909, William Healy was the first to study juvenile delinquency. He saw it as an after-effect of urbanization. In this, he showed that there were societal issues that could affect mental illness.

The Behavioral Perspective • Behaviorism evolved out of experimental psychology. It believed that the study of subjective experience – through the techniques of free association and dream analysis – did not provide acceptable scientific data because the observations were not open to verification by other scientists. Behaviorists believed that directly observable behavior was what should be studied. • The Behavioral Perspective – is organized around a central theme, the role of learning in human behavior. • Classical conditioning – a form of learning in which a neutral stimulus is paired with an unconditioned stimulus that naturally illicited an unconditioned behavior. After repeated pairings, the neutral stimulus becomes a conditioned stimulus that elicits a conditioned response. This began with the findings of Ivan Pavlov demonstrated that dogs would gradually begin to salivate in response to a nonfood stimulus such as a bell after the stimulus had been regularly accompanied by food.

The Behavioral Perspective • Behaviorism – the study of overt behavior rather than the study of theoretical mental constructs. • John B. Watson (a behaviorist) believed that he could condition any child to become whatever an adult wished. He stated that abnormal behavior had been an unfortunate outcome of a bad childhood. Watson brought much emphasis on the social world and its influence in abnormal behavior.

Operant Conditioning • E. L. Thorndike and B. F. Skinner were exploring a different type of conditioning, one in which the consequences of behavior influence behavior. This will determine whether or not the behavior will be repeated or not. • Skinner believed that an animal’s behavior could be shaped or changed by the reward or influence given to the animal.