Chapter 2: Views of Abnormal Behaviour: then and now

Nota:

• Chinese, Egyptians, Hebrews and Greeks believed in "possession". They believed it was a punishment, involving withdrawal of God's protection and the abandonment of the person to the forces of evil. So, they practised/performed exorcism, which usually involved magic, prayer, incantation, noise-making and the use of horrible-tasting concoctions made from sheep's dung and wine.

Nota:

• The father of modern medicine denied possession as a cause of people's "strange behaviour". He insisted that mental disorders, like other diseases, had natural causes and appropriate treatments. He believed the brain  was the central organ of intellectual activity and that mental disorders were due to brain pathology. Hippocrates also emphasized the importance of heredity and predisposition and pointed out that injuries to the head could cause sensory and motor disorders. He classified the mental disorders into 3 categories: - mania - melancholia - phrenitis (brain fever)
• Explaining temperament or personality = the doctrine of the four humors The four essential fluids of the body - BLOOD (sanguis), PHLEGM, BILE (choler) and BLACK BILE (melancholer) A person's temperament was thought to be determined by which of the humors was dominant.
• Treatments! E.g. Melancholia Prescribed a regular and tranquil life, sobriety and abstinence from all excesses, a vegetable diet, celibacy, exercise short of fatigue, and bleeding if indicated. Sometimes he even removed the patient from their family.
• However, he believed that hysteria was restricted to women and was caused by the uterus wandering to various parts of the body, pining for children. He recommended marriage as the best remedy.

Nota:

• Plato (429-347 B.C.) studied individuals who committed a crime. He wrote that such person were in some "obvious" sense, not responsible for their acts and should not receive punishment in the same way as normal persons. Regarding treatment: He believed the should be provided with "hospital" care. However, he also thought mental disorders were in part divinely caused.

Nota:

• In Alexandria, Egypt, the temples dedicated to Saturn were used as sanatoria. Patients with mental problems were provided with constant activities including parties, dances, walks in the gardens, concerts. Different therapeutic measures were used - dieting, massage, hydrotherapy, gymnastics, hydrotherapy, but they also used bleeding, purging ans mechanical restraints.
• Asclepiades (124-40 B.C.)developed a theory of disease that was based on the flow of atoms through the pores in the body and developed treatments such as massage, special diets, bathing, exercise, listening to music and rest, and quiet to restore to the body.
• Galen (A.D. 130-200) performed dissections of animals. So, his main contributions were in the field of anatomy of the nervous system. Galen divided the causes of psychological disorders into physical and mental categories. Among the causes were injuries to the head, excessive use of alcohol, shock, fear, adolescence, menstrual changes, economic reversals, and disappointment in love.

Nota:

• One of the first developed civilisations in which medicine and attention to mental disorders were introduced (Soong, 2006). Even at early ages, Chinese medicine believed the causal of mental disorders was rather natural than supernatural. The concept of yin and yang, the human body, like the cosmos, is divided into positive and negative forces. If there is a imbalance between the forces, the result is an illness. So, they focused on restoring the balance.
• Chung Ching (2nd cent) based his theory on the idea that MD are caused by organ pathologies. He also suggested that stressful psychological conditions could also lead to organ pathologies, and similarly to Hippocrates, he believed in the utilization of drugs, as well as restoring the emotional balance through different activities.

Nota:

• The first mental hospital was established in Baghdad in A.D. 792, followed by others in Damascus and Aleppo. Mentally disturbed individuals received humane treatment (Avicenna 980-1037)!!! In contrast, during the Middle Ages in Europe, it was still assumed that MD are caused by supernatural power.
• Mass Madness (hysteria) Dancing manias ( epidemics of raving, jumping, dancing, convulsions) in the 10th cent; Italy, 13th cent, a.k.a tarantism (a disorder that included an uncontrollable impulse to dance that was often attributed to the bite of the southern European tarantula or wolf spider. Later in Germany - Saint Vitus's dance.
• Lycanthropy - people believed to be possessed by wolves and imitated their behaviour. e.g. In 1541 a man believed he was a wolf, but his skin was smooth because his hairs were under his skin. To cure him of his delusions, his extremities were removed, which resulted in his death.
• Nigeria, 1990: "Koro", "penis thieves" People believed that their genitalia were stolen, so that the "thieves" benefited magically.
• # Exorcism # 2001, a woman drowned her child in an exorcism performance, because she believed her daughter was possessed by a demon. More recently, an autistic child was killed in a church in an exorcism.
• # Witchcraft # Many people with mental issues were convicted of witchcraft and burned at stake. Even Robert Burton (1576-1640) in his classic work "The Anatomy of Melancholia" (1621) considered demonic possession a potential cause of MD.

Nota:

• Paracelsus (1490-1541) was a critic of demonic possessions. He insisted that the dancing mania was a mental disease rather than caused by a supernatural power. However, he believed in the astral influence ("lunatic", luna = moon)
• Johann Weyer (1515-1588) did not approve of torture, burning and imprisonment of people convicted of witchcraft. He published his work on the issue, which was banned by the Church until the 20th century. However, after that the clergy started to question their methods and St. Vincent de Paul (1576-1660) declared, with the risk of his life, that mental diseases are not much different than bodily diseases.

Nota:

• The first asylums were established for the sole purpose of removing the troublesome individuals from society. These people were not taken care of, they lived and died in filth and dirt.
• It is thought that the first asylum was built in Spain in 1409, but little is known about he treatment of patients. The first in the UK was St. Mary of Bethlem in London (1547), which had completely deplorable conditions, including exhibition to the public for one penny a look!!!

Nota:

• Pinel (1745-1826), France In 1792 suggested to remove the chains from some of the patients as an experiment. He thought that if the patients were provided with order and peace and were treated as sick people (and not as beasts), improvement would occur. He was absolutely right --> miraculous results
• Tuke's work in England (1732-1822) William Tuke established the York Retreat where patients stayed, worked and rested in a kindly, religious atmosphere.
• In 1841 Thomas Hitch trained nurses and put trained supervisors at the head of the nursing staff, which completely changed the public attitude towards people with MD. Shortly after that, Lunacy Inquiry Act was passed, which included the requirement of effective inspection of asylums and houses every 4 months to ensure proper diet and the elimination of the use of restraints.
• Benjamin Rush, "the founder of American psychiatry", (1745-1813) "the tranquilizing chair"
• The use of MORAL MANAGEMENT - wide-ranging method of treatment that focused on a patient's social, individual and occupational needs; emphasized the patients' moral and spiritual development and the rehabilitation of their "character". Treatment via manual labour and spiritual discussions.
• The rise of mental hygiene movement
• Benjamin Franklin's electric shock He proposed that melancholia can be treated with electricity, after he experienced an alteration of his memories due to severe shock. He was followed by Ingenhousz, who reported similarly alterations in his thinking following a shock he had received. It was not until the 20th cent though that Cerletti and Bini (1938) initiated electric shock as a treatment for depression.
• Dorothea Dix (1802 - 1887) and the mental hygiene movement Credited with establishing 32 mental hospitals!

Nota:

• - Continuous growth of asylums (thanks to Clifford Beers etc.); - In 1946 was published "The Snake Pit" by Mary Jane Ward; - 1946 The National Institutes of Mental Health was organized and provided active support for research and training through psychiatric residencies and clinical psychology training programs
• - 1961 Goffman published "Asylums" = inhumane treatment etc. - use of lithium in the treatment of manic depressive disorders and the introduction of phenothiazines for the treatment of schizophrenia.
• - 1950-1990s Deinstitutionalisation= from 500 000 to 100 000 mental hospital population (USA)

Nota:

• General Paresis and Syphilis - 1825, Bayle differentiated general paresis as a specific type of MD. - 1897 Viennese psychiatrist Kraft-Ebbing conducted experiments involving the inoculation of paretic patients with matter from syphilitic sores. The experiment established the relationship between GP and syphilis; - 1906, Wassermann devised a blood test for syphilis; - 1917, Wagner-Jauregg introduced the malarial fever treatment of syphilis and paresis. - Today - penicillin.

Nota:

• Emil Kraeplin (1856-1926) - a system of classifications of MD, the forerunner of today's DSM classification.

Nota:

• - Freud (1856-1939) - psychoanalysis, the study of hypnosis, esp in relation to hysteria. - Hypnosis, an induced state of relaxation in which a person is highly open to suggestion, first came into widespread use in late-eighteenth- and early-nineteenth-century France.
• MESMERISM - Mesmer developed the ideas of Paracelsus about the influence of the planets on the human body. -Used "animal magnetism" to treat all kinds of diseases.
• THE NANCY SCHOOL - The view that hysteria can be treated through hypnosis.
• THE BEGINNING OF PSYCHOANALYSIS - Freud worked with Breuer. They used hypnosis as a means of treating patients. The patients talked freely under hypnosis and after awakening, they felt emotional release, a.k.a catharsis. Also, they didn't see a relationship between their problems and their hysterical problems. This led to the idea of the UNCONSCIOUS. - Two of the methods Freud used: free association and dream analysis.

Nota:

• THE EARLY PSYCHOLOGY LABORATORIES -

1. Classical Conditioning
2. Operant Conditioning