Chapter 6 Clinical Research and Psychology at the End of the 19th and Beginning of the 20th Century

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1 Chapter 6 Clinical Research and Psychology at the End of the 19th and Beginning of the 20th Century PSK301-History of Psychology Assoc. Prof. Okan Cem Çırakoğlu okanc@baskent.edu.tr

2 What People Know About Mental Illness Madness Neurosis Hysteria Eating disorders Affective disorders Substance- Related problems

3 Madness Insanity or lunacy Gross excessiveness or overwhelming deficiency of certain features Aggressive, violent behavior and dramatic emotional outburst Profound lack of will, desire or emotion

4 Madness Specific descriptions Philippe Pinel (1801) - France John Haslam (1810) - England Individuals with mostly withdrawn behavior: Diminished speech No interest in joyful activities Lack of emotional attachment Disorganized thinking Poor personal hygiene Hallucinations and bizarre ideas Karl Kahlbaum ( )- catatonia

5 Dr. Philippe Pinel in the courtyard of the Salpêriere Hospital in Paris

6 Neurosis Persistent, overhelming anxiety and avoidant behavior They aware of of their problems Usually acknowledge the oddness of their symptoms by the end of 19th century Anxiety neurosis Phobias (esp. Agoraphobia) Neurasthenia (persistent feeling of weakness, general lowering physical and mental tone)

7 Affective Disorders From ancient times to present in many civilization, mood disorders attracted attention China, Babylon, India, Greece... Remember the case of Girolamo Cardano (phobias, anxiety, sleep disturbances...) Robert Burton s Anatomy of Melancholy (1621) Entirely dedicated to depressive symptoms

8 Affective Disorders Certain mood states were recognized as abnormal if The symptoms had to be profoundly different from normal mood fluctiations The fluctuations had to be frequent and long-lasting Mood problems were associated witt the functions of liver, spleen and gallblader Benjamin Rush ( ) Tristimania (prolonged sadness) Karl Kahlbaum ( ) Cyclic insanity or cyclothimia (fluctuations of mood from mild depression to mild euphoria) Henry Maudsley ( ) Affective Disorder 20th Century Mood Disorders

9 Terminology Referring to Mental Illness in the 19 th Century

10 Popular Beliefs about Mental Illness Mental illness became a special explanatory category for those individuals whose behavior was out of ordinary and difficult to explain by understandable causes Having a mental illness often meant being an outcast. Across cultures the public maintained an overall negative perception of mental illness. People had broad expectations that some forms of mental illness were curable.

11 Social Climate and Psychopathology A significant increase of incidences of mental illness at the end of 19th century. Sex, drugs and alienation Changing perceptions of mental illness Reluctance to care mental patients at home Utilitarianism and hedonism Mental illness is something that prevents people from joy and happiness

12 Social Climate and Psychopathology Medicalization of Abnormal and Deviant Behavior Institutionalization of treatment Turf battles among professionals Psychiatry vs. Psychology Licensing Professional competition

13 Understanding Mental Illness Classifications of Mental Illness Emil Kraepelin ( ) offered an early scientific classification (1883) of mental illness, which included 15 categories or groups Contributed to the development of medical model of classification of mental illness

15 Approaches to Mental Illness Clinical-pathological method. The supporters of this method compared clinical observations of a patient s abnormal symptoms with the reliable data about brain pathology, most likely obtained during an autopsy on the patient s brain.

16 The Case of Phineas Gage

18 Studying the Nervous System Nervous Fatigue. In the 19th century, ideas about exhaustion of the nervous system as a cause of abnormal psychological symptoms also became fashionable. An individual experiencing persistent stress is at risk of developing a nervous illness. Hence, any measures that soothe the body should change the psychological symptoms as well. In Europe, recreational centers near mineral water resorts became major attractions.

19 Turning to Heredity The Hereditary Approach. Many researchers turned their attention to hereditary factors of mental illness, especially its serious forms. Their assumption was that certain forms of mental illness ran through generations. Prominent French physician, Benedict-Augustin Morel ( ) coined the term degeneration, referring to a generational regress in physical and psychological traits.

20 Looking at Social and Psychological Causes An early representative of the Social approach was Jean-Philippe Esquirol ( ). He believed that dramatic or difficult events in an individual s life could trigger distressful psychological symptoms. Introducing statistical methods to clinical studies, he proposed that the most frequent cause of mental illness was emotional. He even classified causes of emotional abnormalities such as extreme anger, excessive love, and financial worries.

22 Early Attempts at Treatment It was widely recognized in the early 20th century that medical doctors trained in the fields of behavioral and neurological problems should play a major role in diagnosis and treatment of mental illness. Psychologists gradually accepted the assisting role, helping physicians in gathering information about the symptoms of psychological dysfunctions, their dynamics, and outcomes.

24 Early Attempts at Treatment Physicians were relatively free to choose any method of treatment and study its effectiveness. Curiosity guided many experimental procedures. Cold baths Laxatives Bloodletting Physical labor Opium Orderliness Morphine

25 Early Attempts at Treatment Moral Therapy. It was generally assumed that some forms of mental illness result from serious misfortunes in a patient s life. Therefore, to return to a normal mental state, the patient should experience compassion and trust. Gradually, through learning and hope, he or she could restore the lost qualities of good behavior.

26 Early Attempts at Treatment In the United States, human rights advocate Dorothea L. Dix ( ) led a campaign to create civilized conditions of individuals living in mental asylums. She traveled across the United States to inspect the facilities in which mental patients were kept. She reported about the inhumane conditions in which the afflicted spent their lives abandoned by their family members. In part because of her advocacy, the federal government in 1855 funded the Government Hospital for the Insane located in Washington, D.C. The asylum was the first large mental facility of this kind in the United States.

27 Lightner Witmer and Early Clinical Psychology Lightner Witmer ( ) founded one of the world s first psychological clinics at the University of Pennsylvania in 1896, at a time when psychology research labs were opening in several schools across the United States. He was also interested in research, but above all he wanted to develop a new field of psychology dedicated to helping people in need. In an 1896 article, Witmer described the symptoms that today are labeled as autistic disorder. Witmer performed several professional roles at once, a practice common today. He had to provide direct services in clinical settings and in private practice; he had teaching responsibilities; he supervised treatment by other professionals. He also had to do administrative work and research.

28 Early Attempts at Treatment Very few ideas in psychology achieved such resonance and created so much controversy as the views and practices of Emmanuel Church Healing Movement. It was a social movement and therapeutic practice that turned the attention of millions of people to psychology and its practical applications. What was the method of treatment? People learned how to gain access to their psychological problems through the power of scientific knowledge and religious faith.

History of psychiatry & psychology. Prof. Kultegin Ogel

History of psychiatry & psychology Prof. Kultegin Ogel ogelk@ogelk.net Ancient times Starting in the 5th century BC, mental disorders, especially those with psychotic traits, were considered supernatural