History of Psychopathology

History of Psychopathology

PSY 5310: Advanced Abnormal Psychology

Historical Perspective

Historical Perspective on Abnormality

• Historically there is a movement from supernatural to

natural explanations

• As we will see, many present-day misconceptions are

rooted in historical perceptions - many of which are myths

Historical Perspective on Abnormality

• For example: Cartesian Dualism is making a comeback,

together with neo-reductionism

Trephination

• Evidence from prehistoric times;

first clear-cut evidence from 8500

years ago

• Believed to be attempts to treat

psychopathology (‘insanity’)

• Q: Up until when was this practice

used?

• A: Early 20th century!

Ancient Greece

• Hippocrates (460-377 BC)

• The Father of Modern Medicine

• Mental illnesses are illnesses of the body

• Observed many patients (was interested in their dreams)

• Four Humors: Blood, phlegm, yellow bile, and black bile

• Four categories of abnormal behavior: Epilepsy, Mania, Melancholia, and Brain fever.

Ancient Greece

• Plato (423-347 BC)

• Mental illness is caused by weakness of the rational mind over impulses and desires.

• Treatment: Rational discussion – to strengthen the rational mind

• ‘Insane’ individuals are not responsible for crimes and should not be punished

Later Greek and Roman Thought

• Galen (130-200 AD)

• An influential Greek physician active in Rome

• Two types of psychological disorders

– Physical: Head injuries, excess alcohol consumption,

or changes in menstrual cycle

– Psychological: Shock, fear, financial problems, and ‘broken

heart’…

Later Greek and Roman thought

• Promising times…

• Medicine developed rapidly

• Temples were built to be used as humanitarian places to heal

• Pleasant environment was emphasized

• Treatment: diet, massage, exercise, education; but also, bleeding, and purging agents…

• But the next 1000 years put an end to this progressive humanitarian approach…

The Middle Ages (400-1400 AD)

Middle Ages (400-1400 AD)

• In Europe – Superstitions, exorcism, very cruel

‘treatments’

• Exorcism – Emphasis on the pride of the devil and the

need to insult, curse, and offend the ‘devil inside’

Middle Ages (400-1400 AD)

• Mass madness/psychosis –

– Tarantism : A dancing mania

believed to be caused

by a spider bite

Witch Hunting

• 15th and 16th centuries AD

• Mainly females accused of

deviating from Christianity and of dealing

with the devil that granted them superpowers

• Video evidence

The Renaissance Period (14-16th Century)

• The rebirth of scientific thinking

• (Saint) Teresa from Avila – A Spanish nun was one of

the first critics of the idea of possessions.

• Hysterical nuns are not possessed they are “ill-like”

• The first asylums – subhuman conditions

• Cruel treatment to convince patients to choose the path of

reason

Phillippe Pinel (1745-1826)

• Recognized as the person who made the first step towards the taking over of asylums by physicians

• Proponent of “moral treatment”

• Pinel’s experiment - 1792

Dorothea Dix (1802-1887)

• Started a small revolution out of Boston

• Was very active in establishing dozens of humane asylums

• Initially a success…that later failed miserably...

• Such an environment in itself does not significantly improve major

psychopathologies – These require treatment

The Modern Perspective

The Modern Perspective

• Psychoanalytic perspective

• Behavioral Perspective

• Cognitive Perspective

• Present day – Third wave approaches

The Modern Perspective

• By the end of 19th century – focus on the brain as the

cause of mental illness

• Emil Kraepelin (1856-1926) – Considered to be the father

of Biological Psychiatry

• New system for classification of mental disorders

• Based on scientific investigations,

psychopharmacology and genetic studies

The Roots of the

Psychoanalytic Perspective

• Franz Mesmer (1734-1815)

• A magnetic fluid in the body impacts health

• The technique: ‘Mesmerism’ to treat Animal Magnetism

• Had a weird way of putting people in a trans

• Was determined a charlatan

• But his ideas laid the ground for hypnosis as a treatment of hysteria

Roots of the

Psychoanalytic Perspective

• Jean Charcot (1825-1893) – A French neurologist

• The first to establish the connection between

hysteria and hypnosis

• Mentored Sigmund Freud in his clinic

The Psychoanalytic Perspective

• Sigmund Freud (1856-1939)

• Topographic model

(id, ego, superego)

• Sexual drive

• Unconscious

• Importance of catharsis

The Psychoanalytic Perspective

• Psychosexual Stages

– Oral : first 18 months

– Anal : 18 months – 3

– Phallic : 3 – 6 years

– Latency : 6 – 12 years

– Genital : 6 onwards

Defense Mechanisms

RegressionRetreating to a behavior of an earlier developmental period to prevent anxiety and satisfy current needs

Denial Refusing to perceive or accept reality

DisplacementDischarging unacceptable feelings against someone or something other than the true target of these feelings

Rationalization Inventing an acceptable motive to explain unacceptably motivated behavior

IntellectualizationAdopting a cold, distanced perspective on a matter that actually creates strong, troubled unpleasant feelings

Projection Attributing one’s own unacceptable motives or desires to someone else

Reaction formation

Adopting a set of attitudes and behaviors that are the opposite of one’s true dispositions

IdentificationAdopting the ideas, values, and tendencies of someone in a superior position in order to elevate self-worth

Sublimation Translating wishes and needs into socially acceptable behavior

The Behavioral Perspective

• Ivan Pavlov (1849-1936)

• Classic conditioning

The Behavioral Perspective

• John Watson (1878-1959)

• Rejected both the biological and

psychoanalytic paradigms

• Blank Slate

• Later B.F. Skinner (1904-1990) and

E. L. Thorndike (1874-1949) advanced

the idea of Operant Conditioning

The Behavioral Perspective

The Cognitive Perspective

• Albert Ellis (1913-2007): Rational vs irrational beliefs, emotional factors, reconstructions of beliefs as means therapy (REBT)

• Albert Bandura (1925-): Beliefs, social learning

• Aaron Beck (1921-): Automatic thoughts are distorted by affect; The father of Cognitive Behavioral Therapy

Third-Wave Approaches

• Focus on people’s ability to understand and regulate their emotions

• Incorporates techniques from behavioral, cognitive therapy with Zen Buddhism

• Dialectical Behavior Therapy (DBT)- Difficulties in managing

negative emotions and in controlling impulsive behaviors

• Acceptance and Commitment Therapy (ACT) - Avoidance is the heart of all problems

Humanistic Approaches

• Humanistic theories: Based on the assumption that humans have an innate capacity for goodness and for living a full life

• Carl Rogers - Individuals naturally move toward personal growth, self-acceptance, and self-actualization– Self-actualization: Fulfillment of ones potential for love,

creativity, and meaning

– Client-centered therapy: Therapist communicates a genuineness in his or her role as helper

Family Systems Theory Salvador Minuchin

• Views the family as a complex interpersonal system, with its own

hierarchy and rules that govern family members’ behavior

• Removing the Identified patient

• Views a family member’s psychological disorder as an indication

of a dysfunctional family system

• Family systems therapy: Believes that an individual’s problems

are always rooted in interpersonal systems, particularly family

systems

Past, Future, Present…

• From Daemons to Freud, from Mesmerism to CBT

• Where are we standing currently?

• How do we perceive mental illness today?

• Do we know what mental illness is?

• How do we treat mental illness today?

• Do we know what to do with severely ‘ill’ patients?