Early History of Clinical Psychology

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1 Early History of Clinical Psychology Early man widely believed that mental illness was the result of supernatural phenomena such as spiritual or demonic possession, sorcery, the evil eye, or an angry deity and so responded with equally mystical, and sometimes brutal, treatments.

2 Trephining: surgical intervention in which a hole is drilled or scraped into the human skull, exposing the dura mater in order to treat health problems related to intracranial diseases.

3 Hippocrates ( BC) humoral theory, proposed a triad of mental disorders termed melancholia, mania and phrenitis (an acute mental disorder accompanied by fever). He also spoke of other disorders such as phobia. He believed that disease was the product of environmental factors, diet and living habits, not a punishment inflicted by the gods, and that the appropriate treatment depended on which bodily fluid, or humour, had caused the problem

4 Greek Era Plato ( BC) argued that there were two types of mental illness: "divinely inspired" mental illness that gave the person prophetic powers, and a second type that was caused by a physical disease.

5 16 th to 18 th Century Some mentally disturbed people may have been victims of the witchhunts that spread in waves in early modern Europe. Those judged insane were increasingly admitted to local workhouses, poorhouses and jails.

6 St. Mary of Bethlehem Hospital Harsh treatment and restraint in chains was seen as therapeutic, helping suppress the animal passions.

7 People paid to visit old Bedlam and to see the sight. 1814: 96 people each paid a penny to visit.

8 Benjamin Rush The gyrator, based on the principle of centrifugal action to increase cerebral circulation.

9 Sigmund Freud Sigmund Freud was born on 6 May, Parents favored him over his siblings ~ they sacrificed everything to give him a proper education. Graduated with honors from high school. Freud enrolled at the University of Vienna in 1873, where it took him three years longer than normal to complete his medical studies.

10 Medical school In 1876, he published his first paper about eel testicles In 1874, the concept of "psychodynamics" was proposed with the publication of Lectures on Physiology by German physiologist Ernst Wilhelm von Brücke (in coordination with physicist Hermann von Helmholtz) the living organism is a dynamic system to which the laws of chemistry and physics apply. In 1879, Freud interrupted his studies to complete his one year of obligatory military service, and in 1881 he received his M.D. with a thesis on the spinal cord of lower fish species".

11 Joseph Breuer - catharsis

12 From 1884 onwards, he began to experiment with cocaine, using it on himself. Freud felt that cocaine would work as a panacea for many disorders and wrote a well-received paper, "On Coca," explaining its virtues Ernst von Fleischl s death

13 1886 becomes Privatdozent U of Vienna Paris - Jean-Martin Charcot - hypnosis 1886 opened his own medical practice, specializing in neurology. On Male Hysteria - etiological role of trauma

14 Wilhelm Fliess Berlin. Ear Nose and Throat Specialist. Male (23) and female (28) Life cycles. Linked to mucus lining of the nose. Humans are basically bisexual. Death of Emma Eckstein.

15 The Seduction Theory April 21, Freud presented a paper before the Society for Psychiatry and Neurology in Vienna, entitled "The Aetiology of Hysteria. Using a sample of 18 patients from his practice, he concluded that all of them had been the victims of unwanted sexual assaults by various caretakers. The cause of the patient s distress lay in a trauma inflicted by an actor in the child s social environment. The source of internal psychic pain lay in an act inflicted upon the child from outside. This led to his well known seduction theory abandoned the Seduction theory

16 In 1981, J.M. Masson was fired from his position as Projects Director of the Sigmund Freud Archives, shortly after suggesting in a talk in New Haven that a key theory Freud had developed in 1895 and later repudiated - the so-called seduction theory - may have been valid after all. This talk scandalized the Freudian orthodoxy, as reported in Time, Newsweek, and The New York Times. Here for the first time are the letters from Freud, long kept from public view, which stirred this controversy. On the basis of these letters and other new information Masson discovered at the Archives and elsewhere in Europe, he has written a devastating and highly controversial expose of the origins of psychoanalysis. In 1895, Sigmund Freud formulated what was perhaps his most profound theory: that emotional disturbances in adults stem from actual from actual early traumatic experiences, the knowledge of which has been repressed. But Freud eventually renounced this theory in favor of a new view, that his women patients had "fantasized" their early memories of rape and seduction - a view on which the whole budding science of psychoanalysis would be based. Masson makes available previously unpublished letters from Freud's closest friend, Wilhelm Fliess, which reveal that Freud had grave doubts about abandoning the "seduction theory." Masson discovered that not only had Freud read the contemporary literature documenting the high incidence of sexual abuse of children, he had in all likelihood witnessed autopsies of children who had been raped and murdered. That Freud abandoned his seduction theory, Masson argues, was a failure of courage rather than a clinical or theoretical insight. As a result, most psychiatrists and psychoanalysts have in effect been reluctant to trust the memories of their patients, women in particular, about the traumas they experienced in childhood. Like Freud, they see such traumas as fantasy rather than reality. This cover-up of the truth, Masson asserts, has poisoned the entire profession. From

17 ANNA O (Bertha Pappenheim) -patient of Josef Breuer (collaborator with Freud) -Free Association (chimney sweeping) -Transference "Breuer told Freud that she was deranged; he hoped she would die to end her suffering". She later recovered over time and led a productive life.

18 Freud's background in neurophysiology included an understanding of late 19th Century thermodynamics and, in particular, the principle of conservation of energy. Since Freud viewed the impulses of the psyche as bursts of energy, it was clear to him that the Ego could not simply destroy these impulses but that it must, in some way, convert them or send them elsewhere. Thus, Freud used a term "sublimation" which Nietzsche had already used in a similar context. Repression requires sublimation; that is, the energy must be channeled elsewhere. (e.g., one channel for energy is self-directed aggression --- guilt and self-hate.)

19 Freud tried to trace movement of psychic energy from excitation to discharge, something that Helmholtz was examining. Psychic energy arises from two sources, excitation from the external world and excitation from bodily tissues. Freud generally used the terms "instinct" and "libido" when referring to psychic energy arising from bodily tissue. Treatment: Bottled up energy must be released to reduce tension (cathartic release).

20

21 Breuer later distanced himself from Freud, because, Freud is given to absolute and exclusive formulations: this is a psychical need which leads to excessive generalization. There may in addition be a desire d épater le bourgeois [to shock the bourgeois].... I confess that the plunging into sexuality in theory and practice is not to my taste

22

23 Communication Style His analyses of cases were like detective stories in which he succeeded in tracking down the guilty one - - the unconscious emotional motive -- with an original way of interpreting the patient s associations, dreams, and symptoms. And it seemed all pretty exact, scientific.

24 What Have we kept from Freud???? - what is still relevant today.

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