HISTORY OF ABNORMAL PSYCHOLOGY
History of Psychology
Eric Snitchler

Kevin Harris

Abnormal Psychology Time Machine

 

An aspect of abnormal psychology that has been and continues to be debated is the cause of mental illness.Throughout history, people have developed a variety of theories to explain psychological disturbances.Generally, these theories have fallen on one of three general themes: mystical/supernatural, scientific/medical, or humanitarian.
Mystical explanations regard abnormal behavior as the result of possession by spirits.The scientific/medical approach considers natural causes, such as biological imbalances, faulty learning processes, or emotional stressors.Finally, the humanitarian approach tends to view abnormal behavior as the result of cruelty or poor living conditions.The differing etiological theories as well as advancing knowledge have had large impact on the treatment of those with psychological disorders and have influenced current theories in clinical psychology.
 

10000 B.C. – 3,000 B.C. --- Prehistoric Times 

As far as historians can ascertain, Paleolithic people saw no distinction between medicine, magic, and religion.Archeologists have uncovered skulls with holes drilled in them dating back as far as 8,000 B.C.Researchers have determined that, for some, bone healed near these holes indicating that the procedure may have been surgical and that the person survived.

 
 

Many theories have been developed as a means to explain the purpose behind this surgery, called trephining.Some anthropologists theorize that the holes may have been drilled into the skull as a means of releasing “evil spirits” that were trapped inside the head causing abnormal behavior.Other anthropologists believe that trephining was used to treat medical problems (e.g., removal of a tumor).However, the true purpose for trephining during the Stone Age remains unknown.Trephining continues to be practiced today among certain African tribes for the relief of head wounds.
 
 

For an idea of how you might have been treated if you had a mental illness in the Stone Age click here.

 

1800 B.C. – 1700 B.C. -- CODE OF HAMMURABI

In Mesopotamia, between 1795-1750 B.C., Hammurabi, King of Babylon, issued a structured code of laws, known as the Code of Hammurabi. The Code of Hammurabi was preserved on Cuneiform, a system of writing developed by the Sumerians, which consisted of writing onto wet clay with a wedge and then drying those clay tablets.This code is the first-known example an orderly body of laws created by a ruler. The code of laws includes legal procedures for physicians in the treatment of a variety of physical ailments such as payment for successful services rendered as well as punishment for a failed service to his patient (e.g., loss of the physician’s hands).
Mesopotamian diseases were viewed from a primarily mystical perspective and were blamed on spirits: gods, ghosts, etc.Each spirit was believed to cause a disease in any one part of the body.Some diseases were referred to as “Hand of …” signifying a divine cause whereas others were simply identified by names (e.g., bennu).

For an idea of how you might have been treated in Mesopotamia during the 1700's B.C. click here.
Hammurabi

     Hammurabi

 

800 B.C. --- 1000 A.D. GREEK AND ROMAN CIVILIZATION

During Greek and Roman civilizations, we see a much more scientific view of mental illness being developed with many concordant humanitarian treatments.However, theories regarding mystical explanations remained powerful and eventually toppled the scientific approach.
According to Homer (800 B.C.) mental illness was caused by God’s taking a mind away.In terms of treatment during the time that Homer is reputed to have existedAsclepius, an eminent physician, developed several forms of treatment.Later Asclepius was revered as a God of healing and numerous temples were created in his name.  For an idea of how you may have been treated during the 800's B.C. click here
The foundation of a systemic approach to psychological and physical disorders is considered to have begun with the early Greek philosophers.Hippocrates (460 – 377 B.C.) wrote numerous papers describing psychological disorders such as psychosis, mania, phobias, and paranoia.Hippocrates theorized that “four humours” or bodily fluids were responsible for both physical and mental health.The four important bodily fluids were: black bile, yellow bile, phlegm, and blood.
Hippocrates
Having too many of any of these fluids could account for changes in an individual’s personality and behavior.Hippocrates theorized that an excess of black bile would make a person "melancholic" (depressed), and an excess of yellow bile would cause a person to be "choleric" (anxious or irritable).Too much phlegm would result in a person being "phlegmatic" (indifferent).An excess of blood would cause a person to be "sanguine" (experience unstable mood shifts).It is important to note that Hippocrates saw no distinction between physical and psychological disorders.Hippocrates views dominated thinking regarding psychological disorders for the next 500 years.In addition however, Hippocrates views were challenged by supernatural theories and the concomitant cruel treatment of psychologically disturbed people.

To see what sort of "therapy" you might have received in Greek and Rome during 400 B.C. if you were mentally ill click here.

The next significant in advance in the scientific approach was made in the first century B.C. by a Greek physician living in Rome who introduced new and more humane ideas about psychological disorders.Asclepiades (129-40 B.C.) disagreed with Hippocrates that an imbalance of bodily substances caused psychological disorders.He believed that psychological disturbances could be the result of emotional problems and spoke out strongly against the incarceration of the mentally ill and bleeding (a treatment that continued for another 1500 years).Other important advances made by Aesclepiades were a distinction between acute and chronic psychological disorders and between hallucinations and delusions.Asclepiades also developed several original treatments including a “swinging bed” to relax the emotionally disturbed patient and music therapy.
Later, Aretaeus (50-130AD), a medical philosopher in Rome determined that manic and depressive episodes could occur in the same person with intervals of lucidity between.Aretaeus also rejected Hippocrates ideas regarding the four humours and believed in more humanitarian care for his patients.He also said that not all patients with mental illness were intellectually deficient.Therefore, we have evidence that there were some humanitarian treatments and viewpoints during the period of the Greek and Roman philosophers.
Unfortunately, in the years before Christ, the attitudes towards the “psychologically disturbed” began to shift towards more spiritual views and the advances of the Greek and Roman philosophers and physicians began to decline.Aulus Cornelius Celsus (25BC-50AD), who lived in Ancient Rome during the time of Jesus Christ believed that “a sort of force” should be applied to the insane to cause a sudden fear into the spirit forcing it to flee the body.His beliefs helped to reinforce the belief that some psychological disorders were caused by angry gods or spirits.Celsus beliefs and writings were later used as evidence to justify the burning of witches.His version of treatment also corresponded to exorcism as a form of treatment, which was often performed by a shaman, priest, or medicine man. A.C. Celse. Lithograph
Many years later Claudius Galen (131-200 A.D) developed a new system of medical knowledge based on the study of anatomy rather than on philosophical speculation.He was the first researcher to conduct experiments on animals in order to study the workings of the internal organs.He invented the use of the pulse for diagnosis and his books on anatomy were used until the 19th century.Galen was appointed to be physician of the gladiators in 157 A.D. and went to Rome in 162 A.D. to become a doctor to the emperor Marcus Aurelius.Unfortunately, Galen maintained Hippocrates beliefs in the four humours as the cause of mental disturbance.However, Galen also suggested that a failure to control one’s passions (i.e., anger) might cause a kind of madness.
Galen's Dissection of a Pig

300 A.D. -- 1500 A.D. The Middle (DARK) Ages


Following Galen and during the Middle Ages, almost no new scientific advances in the understanding of mental illness were made.The Middle Ages are marked by a resurgence of beliefs regarding spiritual causes for abnormal behavior.Individuals with psychological disorders were blamed for their illness because of moral weakness or for participating in forbidden practices with the devil, sorcerers, or other demons.These views resulted in a large stigma for having a mental illness.There were some beliefs in physical causes among some groups, primarily a continuation of Hippocrates theory of the four humours and a belief in mental illness as arising from the malfunction of the brain or its ventricles. 
Very few physicians spoke out against the treatment of the mentally ill suggesting that they be treated as sick people deserving of humane treatment.Those few who did speak out against the church faced professional and personal danger.More accurate views of mental illness appear to have been held by poets and writers who provide suggestions that highly stressful events may result in emotional disorders that could be treated with a “psychological approach.”
Ever wonder how you might have been treated during the beginning of the Middle Ages.  To get an idea click here.
Although religious thinking resulted in a strong belief in spiritual possession and brutal treatments for the mentally ill, Christian views also called for charity.Monasteries or poorhouses, which had been built to house people who could not pay their expenses, were built all over Europe and allowed the mentally ill shelter.Early in the conception of the monasteries, patients were treated with concern and were even issued arm badges so that they could be returned if their symptoms worsened.These poorhouses later became known as asylums with the most famous being 
the Hospital of St. Mary of Bethlehem in London.The hospital was originally created in 1247 for poor people, and by 1403 began to house people called “lunatics.”In the next few centuries, the inhumane and chaotic housing of the psychologically disturbed came to be known as “bedlam”, a derivative of the hospital’s name.The hospital quickly became overcrowded and the residents more uncontrollable and the hospital employed chains and punishment to control patients.Similar conditions were found at other asylums as they became overcrowded.
Ward at Bedlam
    A Female Ward in 1860

 
 

Click here to read a description of your treatment at the "bedlam"

“Witchhunts” began at the beginning of the Renaissance and were at their height in the 14th and 15 centuries in Europe.They became more widespread in America later, as evidenced by the Salem witch trials in 1692.Some historians believe that many psychologically ill were called witches.Witchhunts were justified by the publication of the Malleus Malifacarum (The Witch’s Hammer), an indictment of witches written by two Dominican monks in Germany in 1486.The book denounced witches as heretics and devils who must be destroyed in the interest of preserving Christianity.It consisted of three main sections: 1) arguments in support of the existence of witches and witchcraft and that by doubting their existence was to be a heretic; 2) a description of how witches could be identified; and 3) treatment for witches which was deportation, torture, and burning at the stake.Women, particularly poor, old women, as well as midwives, were the main targets of persecution and many historians argue that the mentally ill were not particularly targeted.  Click here if you want to know what kind of "treatment" you may receive during the 14th and 15th century if you were mentally ill. 
During the 16th century, while mystical beliefs predominated causal explanations for mental illness, there were some voices of reason starting to be heard.Jahann Weyer (1515-1588) wrote a book in 1563 called De Praestigiis Daemonum(The Deception of Demons) which attempted to discredit beliefs in demon possession causing abnormal behavior.He did not disagree entirely with the concept of demonic possession, but argued that natural causes may result in abnormal behavior.He also considered drug-induced symptoms of psychosis (e.g., hallucinations) and ultimately formed the basis for later humanitarian approaches for the treatment of individuals who were mentally ill.Weyer was also severely ridiculed for his beliefs by religious and political leaders and was accused of being a sorcerer.  Portrait Johannes Weyers
17th18th, and 19th century
During the 17th, 18th and early 19th centuries, people with mental illness continued to suffer from poor treatment. Most were left to wander in the wilderness while some were committed to institutions. Either way, it was not a good situation as conditions in asylums remained terrible. 
In 1766, Franz Anton Mesmer (1734-1815) received a doctorate in medicine from the University of Vienna. He hardly practiced medicine, and instead focused on the fascinating invisible forces (gravity, magnetism) proposed by Sir Isaac Newton. Mesmer believed that hysterical states (anesthesia, paralyses, blindness, deafness) were caused by an imbalance of a universal magnetic fluid in the body. He treated patients using various types of magnetic objects. Also, he felt his body was, like a magnet, capable of communicating with the magnetic fluid, which would bring about changes in the behavior of the subject. While his contemporaries thought of Mesmer as a quack, he did help many people overcome their hysteria. Though he believed the illnesses to be purely physical, he is generally considered one of the early practitioners of hypnotism. If you are curious about what it might have been like to be a patient of Mesmer’s,click here.

    Mesmer using his so-called 

     magnetic influence on a 

     subject.

 

As the general public’s awareness of the awful conditions in asylums such as Bedlam grew, improvements began to appear. In 1789 Vincenzo Chiarugi (1759-1820) introduced regulations at his mental hospital in Florence, Italy that increased standards for hygiene, recreation, and work opportunities. At nearly the same time, Jean-Baptiste Pussin, superintendent of "incurable" mental patients at La Bicetre hospital in Paris, France forbade staff to beat patients and released them from shackles. Philippe Pinel (1745-1826) continued these reforms upon becoming chief physician at La Bicetre’s ward for the mentally ill in 1793. Pinel is considered historically to be a primary figure in the movement for humanitarianism. However, he is credited for much of the work that Pussin did before he arrived at La Bicerte. Nonetheless, he emphasized keeping case histories of patients and developed the concept of "moral treatment", which involved treating patients with kindness and sensitivity. Pinel removed the chains of the people imprisoned at La Bicetre (symbolically celebrated in the painting) and he argued that they must be treated as sick human beings rather than evil beasts. Many patients who had been incarcerated for years were restored to health and eventually discharged from the hospital. 

Pinel symbolically frees the ill from their shackles. 

Following the lead and success of Pinel, a Quaker William Tuke (1732-1822) established the York Retreat House in rural England. The retreat enabled people with mental illness to rest peacefully, talk about their problems, and work.
Meanwhile in the United States in 1769, Benjamin Rush (1745-1813) was appointed professor of chemistry and medicine at the college of Philadelphia. Rush is considered the father of American psychiatry as he instituted a more scientific approach, and made many changes that improved the conditions for the mentally ill. The fact that he was a founding father, politician, and signed the Declaration of Independence gave him the power to institute reform. He put into action plans for better ventilation, separation from violent and non-violent patients, and arranged recreation and exercise programs for the sick. However, his methods of treatment were still inhumane and ineffective. He believed bloodletting, purging, and terrifying were beneficial. For more information on what it might be like to be treated by Rush, click here. Benjamin Rush’s Medical Inquiries and Observations upon Diseases of the Mind (1812) was the first work on psychiatry published in the United States.

                            Benjamin Rush

Between 1817 and 1828, following the examples of Pinel and Tuke, many institutions opened that devoted themselves exclusively to the treatment of the mentally ill. The first private mental hospital opened in the United States was the Asylum for the Relief of Persons Deprived of the Use of Their Reason in 1817 in what is now Philadelphia.

Even though there was great emphasis on moral treatment in the 19th century, drugs were also used quite often. While claiming to be moral, the chains were exchanged for powerful sedatives to control the aggressive patient. The most common drugs used were alcohol, cannabis, opium, and chloral hydrate. These treatments were not very successful as less than a third of the patients improved.

Moral treatment had nearly been abandoned and circumstances for most of the mentally ill in the United Sates, especially the poor, remained dreadful. In 1841, Dorthea Dix (1802-1877), a Boston schoolteacher, began a campaign to make the public aware of the plight of the mentally ill people. By 1880, she was successful in seeing that 32 psychiatric hospitals for the poor had opened
                                   Dorthea Dix
However, the staff of these public hospitals were taking in so many patients that couldn’t get into the private institutions, they were unable to provide the individual attention that was such a big part of moral treatment. More and more, these asylums were taken over by physicians who were more interested in experimenting with biological aspects of mental illness, rather than psychological well being and patient care.
Jean Martin Charcot (1825-1893) was an established neurologist who brought respectability to the study of hypnosis. Born in Paris, where he spent most of his life, he studied at a hospital that Pinel had converted from a prison. Charcot saw a connection between hypnosis and hysteria and argued that only patients with hysteria could be hypnotized. He went on to become a great clinician and a renowned teacher. Writers, philosophers, and even famous actors attended lectures. Sigmund Freud attended lectures on a grant for four months in 1885-1886. Charcot believed in brain localization as he related clinical symptoms to brain autopsies and developed the clinical anatomical method. 
Jean Marin Charcot

Charcot lectures on hypnotic states.

Emil Kraepelin (1856-1926) brought much needed order to the classification of mental disorders focusing on the biological aspects of mental illness. This approach resulted in closer alignment of psychiatry with medicine because many categories of mental illness were treated in disease terms. Two major groups Kraepelin focused on was dementia praecox (schizophrenia) and manic-depressive psychosis. He believed a chemical imbalance caused schizophrenia and a metabolism irregularity caused manic-depression. Kraepelin’s classification ideas laid the groundwork for today’s classification system

                                  Emil Kraepelin

 

In the united Kingdom in 1882, the Statistical Committee of the Royal Medico-psychological Association came up with a classification scheme that was revised many times but never adopted by its members. In Paris in 1889, the Congress of Mental Science adopted a classification system, but it was never actually used. Finally in the United States, the Association of Medical Superintendents of American Institutions for the Insane, which later became known as the American Psychiatric Association, adopted an idea similar to the British system. This system incorporated many of Emil Kraepelin’s ideas.
Sigmund Freud (1856-1939) began using psychoanalysis as a treatment for mental illness and developed a theory of mind that emphasized unconscious motivation. His concepts of development, personality, and structure of the mind were not new, but he assembled them and reassembled them in new and innovative ways. For more detailed information about Sigmund Freud's life and theories click here.  For information on being a patient of Freud’sclick here

                                     Sigmund Freud

Clifford Whittingham Beers (1876-1943), a Yale graduate, suffered a mental breakdown and was confined to an asylum from 1900-1903. After his recovery, he aroused new concern for mentally ill individuals when he published a study of his experience titled A Mind That Found Itself (1908). Beers was responsible for founding the National Committee for Mental Hygiene, which worked to prevent mental illness and ensure humane treatment.

                                         C.W. Beers