History & Systems of Psychology
Chapter 15 – Early Concepts of Mental Illness

What is “mental illness”?
Synonyms: “psychopathology,” “abnormal behavior”
Condition has always existed, terms used to describe it have varied over time
Former terms: mad, lunatic, maniac, insane

Definition of Mental Illness, cont.
Recurring themes through history:
behavior that is harmful to self or others
Unrealistic/false thoughts & perceptions (i.e., delusions or hallucinations)
Inappropriate or extreme emotions, rapid shifts in mood
Unpredictable or strange behavior

Early Explanations of Mental Illness
Three general categories of explanations:
Biological: medical model of MI; assumes caused by malfunction of brain, injury, toxins, stress, etc.
Psychological: MI caused by psych. events such as grief, anxiety, conflict, etc.
Supernatural: in primitive times ailments without obvious explanation attributed to supernatural forces; renewed in Middle Ages

Early Approaches to Treatment
Psychotherapy: any attempt to help a person with a mental disturbance; involves a sufferer, a helper, some form of ritualistic activity
Psychotherapy would take different forms depending on the model of MI used (biological, psychological, supernatural)
Influence of “natural law” – idea that became popular in the 18th century, saying we get what we deserve; therefore, if you are suffering, you need to change your ways

Approaches to Treatment, cont.
Psychological approach to treatment can involve a variety of techniques – catharsis, relaxation, support, coping skills, etc.
Supernatural approach to treatment involves removing the evil forces causing the distress through a variety of techniques
Magic rituals & incantations
Bleeding or trepanation
Exorcism

Approaches to Treatment, cont.
Biological approach to treatment fostered by Greeks, especially Hippocrates
Saw MI as having natural origin just like physical illness
Naturalistic treatments used, such as baths, fresh air, proper diet
Galen perpetuated this approach, expanded idea of humors as cause of MI
Ideas abandoned around time of fall of Roman Empire

Approaches to Treatment, cont.
Middle Ages – return to supernatural ideas of MI, supernatural approaches to treatment
Preferred form of treatment – exorcism
Ideas combination of Christian thought and pagan beliefs
Renaissance – abnormal behavior sign of sinfulness or witchcraft
witch hunts reached a peak approx. 1450-1750, supported by the church
Malleus Maleficarium (The Witches’ Hammer) published 1487 & used by the Inquisition
Around 100,000 executions, mostly women

Improvements in Treatment of MI
Even during witch hunts, some argued for natural explanations of MI and humane treatment
Idea gradually gained some acceptance, but MI still poorly understood, & people with MI treated poorly
“treatment” with bloodletting, shock through spinning or cold water, often housed in terrible conditions

Improvements in Treatment of MI
Phillippe Pinel (1745-1826) – French physician interested in treating the poor & the mentally ill
Argued for human treatment, instituted reforms at Bicetre Asylum: release from chains, improved food, stopped bloodletting and harsh treatment, stopped punishment & exorcism
Innovations such as occupational therapy & bathing, first to maintain case histories & stats, documented decreased death rate & increased cure rate

Improvements in Treatment of MI
Benjamin Rush (1745-1813) – American physician; friend of Jefferson & Adams, surgeon general under Washington, signed Declaration of Independence
Social reformer who opposed slavery, capital punishment, & inhumane treatment of prisoners; advocated education of women
Called first US psychiatrist, wrote book opposing treatment of MI like criminals or animals
Advocated abolishing chains & punishment, suggested fresh air & pleasant walks
Medical model of MI, thought bloodletting helpful

Improvements in Treatment of MI
Dorothea Lynde Dix (1802-1887) – schoolteacher who worked with MI in Boston prisons, shocked at conditions
1941 began 40-year campaign to reform treatment, responsible for widespread reforms in U.S.

Classification of Mental Illnesses
Emil Kraepelin (1856-1926) – attempted to classify mental disorders
1883 published list of mental disorders that was used until recent times
DSM descendant of Kraepelin’s work
Classification based on causes, involvement of brain & nervous system, symptoms, treatment
Disorders included mania, depression, dementia praecox (later called schizophrenia), paranoia, manic depression, neurosis, Alzheimer’s

Tension between Psychological & Medical Models of MI
With growth of natural science, principles of mechanism, determinism, & positivism were applied to people as well
Assumed by mid-19th century that cause of all illness, incl. MI, was physiological or chemical
Discouraged search for psychological causes (unconscious motivation, stress, frustration, anxiety, etc.)
Some believe psychologically caused problems are not “real”