History of Mental Illness By Stacy Clark



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History of Mental Illness

  • By Stacy Clark


Classical Understandings

  • Early Greek Literature & Mythology

    • Homer: Iliad- Ajax
    • Gods blamed for the “sacred disease”
    • Healing: prayers, sacrifices to Asklepios, god of healing
  • Drama

    • Aeschylus, Sophocles, Euripides
    • Madness often results as “Psychic civil war becomes endemic to the human condition” and introspection begins to dominate drama
    • Medea
  • Greco-Roman custom

    • Violence, cannibalism, grief seen as markers
    • No asylums; family responsibility for care
    • Fear of contagion from evil spirits (keres)
    • Cure for hysteria (“wandering uterus”): marriage
  • Idea of “melancholy genius”

    • Plato, Aristotle


Early Medicalization

  • Hippocrates (ca. 460-357 BC): natural explanation for epilepsy

  • “naturalization of madness”

    • “…the sacred disease appears to me to be no more divine nor more sacred than other diseases, but has a natural cause from which it originates like other afflictions. Men regard its nature and cause as divine from ignorance and wonder, because it is not like other diseases.”
    • Mania and melancholia: excitement/depression
    • Humoral theory (usually choler, black bile)
    • Melancholy madness sometimes seen as genius (i.e. modern ideas of bipolar creativity)
  • Plato

    • Timaeus, 375 B.C.E: Physiological cause of madness, therefore
    • possibility of treatment by medical means
    • Also, concept of “madness as a transcendental divine fire with
    • the power to inspire”


“Naturalistic Notions”

  • Galen!!

    • Mania: disease of yellow bile (the heart)
    • “hot” disease called for cooling treatment
  • Soranus

    • Mental illness caused by: “continual sleeplessness, excesses of venery, anger, grief, anxiety, or superstitious fear, a shock or blow, intense straining of the senses and the mind in study, business, or other ambitious pursuits”
  • Arataeus of Cappadocia (contemporary of Galen, 150-200 C.E.)

    • Descriptions of mental disorders (depression, mania, melancholy, bipolar disorders) and epilepsy
    • “one believes himself a sparrow; … or they believe themselves a grain of mustard, and tremble continuously for fear of being eaten by a hen.”
    • Criticized Dionysian frenzies as disgraceful
  • Greek ideas dominated medical thought for centuries, providing basis for medieval European and Islamic thought



Biblical Examples

    • Madness as divine punishment: Deuteronomy 6:5, “The Lord will smite thee with madness”
    • King Nebuchadnezzar
    • New Testament examples of Jesus healing demonic possession


Non-Western Antiquity

  • Hinduism

    • Goddess Grahi (“she who seizes”)
  • India

    • Dog-demon
  • Mesopotamia and Babylon

    • Spirit invasion, the evil eye, demonic power, breaking of taboos led to mental disorder
    • “If at the time of his possession his mind is awake, the demon can be driven out; if at the time of his possession is not so aware, the demon cannot be driven out.” ~Assyrian text, 350 B.C.E.


Early Christianity: “Holy Madness” vs. Diabolic Possession

    • Supernatural forces battled for possession, leading to despair, anguish, etc
    • “Madness of the Cross”- “ecstatic revelations of
    • saints and mystics”
    • But cause usually diabolic, spread by heretics,
    • witchcraft
    • Anatomy of Melancholy (1621): Richard Burton (Oxford): sick people particularly susceptible to Devil, “true author of despair and suicide”
    • Religious Treatments
      • Spiritual treatment for unclean spirits: masses, exorcism, pilgrimages (Catholicism)
      • Insane cared for in religious hospitals, houses
      • Prayer, counsel, Bible reading (Protestantism)


Madness as Heresy

    • Reformation and Counter-Reformation
      • Political purposes of diagnosis
      • “False doctrine and delusion formed two sides of the same coin: the mad were judged to be possessed, and religious adversaries were deemed out of their mind.”
    • Madness as Blaspheming against God
      • Mental anguish bringing sinners to acute spiritual crisis, leading (hopefully) to recovery
      • Conversion narrative of George Trosse (b.1631)
    • Witch Hunts
      • Late 15th cent, peak around 1650
      • Unusual speech and behavior sign of consorting with the Devil; satanic maleficium (malice)
      • Over 200,000 people (primarily women) executed
      • Led to popular and official skepticism of the doctrine of demonic possession


Skepticism of Witchcraft

  • Johannes Weyer (1515-1588): De Praestigiis Daemonum

    • witches to be “pitied and treated, not feared and punished”
      • Product of imaginations or hallucinogenic substances
      • Natural disasters as cause of “crimes”
      • Devil’s power somewhat limited by God
    • Dr. Edward Jorden (1569-1632): naturalistic explanation
      • Hysteria: “suffocation of the mother”
      • Womb bred “vapours” which unbalanced body, leading to
      • odd behavior attributed to possession
      • Relied on Galenic concepts
  • Biological explanation

      • Humoral theory: Obstructions, vapors as causes
    • Misogyny remained: Witches became hysterical women
    • Witch-hunting ultimately failed as tool of enforcing social order


  • Comparisons drawn between religious extremists and mentally ill

    • Result of 30 Years War (1618-48), English Civil Wars (1642-51)
      • Similar behavior: speaking in tongues, convulsions, “weeping and wailings”
      • Zeal a sign of mental instability
  • Renaissance anatomy and physiology

  • begin to displace Greek humoral theory

    • Vesalius, Harvey
    • Thomas Willis
      • Coined term “neurologie”
      • Excluded demonic possession from consideration
      • Biological explanation for mental illness


Enlightenment Europe

  • The rest of Europe retained beliefs in possession longer than England

    • by 1700, most of Europe believed in natural explanation
  • Elites scorned religious explanations in favor of natural causes

    • Religious beliefs became concern of psychopathology
    • Blame placed on Methodists for surviving popular belief in witchcraft/possession
  • Pathologization of religion in general

    • Mainly Enlightenment free-thinkers
    • Philosophes (Voltaire, Diderot) saw Christianity as function of “sick brains”
  • Doctors replace clergy as healers



Reason and Rationality

  • Rene Descartes (1594-1650)

    • Dualism: mind and body disconnect
    • Mental illness ascribed to problems between mind and body
    • Implied that “insanity, precisely like regular physical illnesses, must derive from the body”
  • Thomas Hobbes (1588-1679)

    • Materialistic worldview
      • “insanity was thus erroneous and thought caused by some defect in the body’s machinery”
  • John Locke (1632-1704):

    • insanity delusional; caused by faulty cognitive processes


  • Romantic ideas of madness for artists/ writers: Madness as creative genius or “melancholy malcontent”

    • Shakespeare: Hamlet, King Lear, Feste (12th Night)
    • Cervantes: Don Quixote
  • Famous writers/poets suffering from madness/mental breakdowns

    • Shelley, Byron, Rousseau, Pascal, Poe, Nijinsky, Sylvia Plath, Virginia Woolf
  • Parisian avant-garde society: true art from mental/physical sickness

    • Hashish, opium, absinthe crucial to this phase
    • Critique of bourgeois values


Medicalization of mental illness led to less romantic ideas about madness

  • Medicalization of mental illness led to less romantic ideas about madness

  • St. Mary of Bethlehem (Bedlam), mental hospital founded in 1247, open to public to

  • teach moral lessons about excess

  • George III (1788)- fodder for satirists



“Fashionable Melancholy”

  • Nervous diseases become fashionable

    • Seen as afflictions for privileged upper classes and “refined temperaments”
    • Hypochondria (male) & hysteria (female)
    • Victorian women develop stereotype of “depressive, hysterical, suicidal, and self-destructive behavior”


Institutionalization

  • Traditionally, insane cared for at home or in religious institutions such as Bedlam

  • Foucault: locking away of undesirables during the rise of absolutism; method of control, not cure

  • Possibly oversimplified argument

    • Russia lack of institutions until 1850s
    • Few institutions in Portugal and rural Europe
  • Porter argues institutionalization was a function of social changes, not government



  • Most institutions private

  • Medical oversight not required in England until after 1820s

  • Wide range of care; some helpful, others cruel

    • Genre of patient literature exposed abuses and neglect
  • Around 1800, increased optimism and personal care

    • Medicine, surgery, traditional methods downplayed in favor of personal cure regimens
  • Psychiatry develops as a method of therapy for patients

  • Previous therapies relatively barbaric: physical restraints, purging, bloodletting



  • Florence

    • Humanity of patients emphasized
  • Paris

    • Revolutionary ideals led to
    • improved standard of treatment
    • Pinel: “treatment must penetrate
    • to the psyche”
    • Mock trial of tailor
  • Reforms, Certification of Asylums in England, France, USA attempted to raise quality of care

    • 1770s-1830s


  • 19th century: huge increase in number, scale of asylums in Europe

    • England: 10,000 in 1800 to 100,000 in 1900
    • Italy: 8,000 in 1881 to 40,000 in 1907
    • Probably reactions to industrialization and urbanization
  • Non-restrictive therapy in England (Hill, Conolly 1830s)

  • “Work therapy” in France and Germany

  • Importance of classification and separation

    • Men from women, dangerous from safe, clean from dirty, etc.


  • During last third of 19th century, pessimism about lack of ability to cure patients replaces early optimism

    • Asylums expanded dramatically
    • Many patients remained in incurable states
    • Personal care and quality begins to deteriorate
      • “formal drills, financial stringency, and drug routines meant to pacify, sedate, and stupefy”
    • Underlying social and cultural factors
      • Economics, government paternalism, scientific secularism


  • Madness as physical disorder

      • Herman Boerhaave, Friedrich Hoffmann
    • End of humoral theory and focus on liquid
    • Solidist physiology: solid parts of body more important than liquids
    • Nervous system becomes site of inquiry
    • Somatic approach
  • John Locke (1632-1704)

    • Madness a flaw in mechanism where senses are turned into ideas
    • Very influential in Britain, France
  • Benjamin Rush (1745-1813)

    • “father of American psychiatry”
    • Mental disorders due to “vitiated blood”
    • Bloodletting as best cure


  • William Cullen (1710-1790)

    • Used Locke’s philosophical ideas, but returned to medical emphasis
    • Psychological aspect of disorder
    • Irritation of the nerves/excess in brain activity precipitated madness; insanity as a nervous disorder
    • Biological basis: “mental disorder grounded in neurophysiology”
  • By 1780, somatic system (of Boerhaave, etc.) out of date

    • Led to concern about the patient’s psyche
    • Case-history approach led to “systematic psychological observation”


  • Vincenzo Chiarugi (Florence, 1759-1820)

    • Senses and nervous systems of the body affected the mind
    • Therapy of “moral control,” doctor setting positive examples for patients
    • Mental illness acquired, not hereditary
    • Optimistic about cure
  • Philippe Pinel (Paris, 1745-1826)

    • Similar ideas
    • Evidence did not show structural abnormalities in autopsies of mentally ill brains; therefore, most were curable through therapy
    • Also optimistic about effectiveness of moral therapy
  • Jean-Etienne Dominique Esquirol (1772-1840)

    • Mental Maladies (1838) very influential
    • Cited biological basis of mental disorders, but focused on psychosocial triggers
    • Supporter of asylums; Briefly housed the Marquis de Sade


German Psychiatry

  • German Psychiatry

    • Unlike Britain and France, university and research-based
    • Contentious arguments between psychological and organic theorists
    • More investigative than therapeutic; focused more on diseases than patients
  • J.C.A. Heinroth (1773-1843)

    • Mental illness caused by sin
      • “not from the body but from the soul itself”
    • Insanity a voluntary rejection of divine gift of free will
  • Ernst von Feuchtersleben (Vienna, 1806-1849)

    • Psychiatry based on personality
    • “psychopathy” as disease of entire personality; modern concept of psychosis


  • Phrenology

    • Viennese anatomists Gall and Spurheim
    • “seat of the mind was the brain, whose configurations
    • both determined and displayed the personality”
    • Appearance of bumps on the head in specific areas
    • could determine psychological characteristics
  • “Medical Materialism” buttressed by theories such as

    • phrenology
    • Helped make psychiatry exclusive to sanctioned
    • physician-researchers
    • Maintained physical therapies such as bleeding, purging, sedatives
  • Wilhelm Griesinger (Berlin)

    • 1845: “mental illnesses are brain diseases”
    • Underlying abnormalities/brain irritation led to worsening (irreversible) conditions; natural slope of mental illness was deterioration
    • Somatic explanation spurred research and led to less stigmatization of patients
    • Tried to unite psychiatry and neurology in clinics; wanted to keep psychiatry united with medicine


Carl Wernicke (1848-1905)

  • Carl Wernicke (1848-1905)

    • “German neuropsychiatry at its apogee”
    • Interests in disorders of language and
    • speech, particularly stroke damage
      • Wernicke’s aphasia
    • Mapping of cerebral cortex
    • Manual of Brain Diseases (1881-3) important attempt to attribute symptoms in physical abnormalities of brain
    • Concept of dominance of cerebrum
  • Neurasthenia (George Beard, 1839-1883)

    • Nervous breakdown because of pressure of modern civilization
    • “nerve force” of individuals drained
    • Struck elite, just as earlier diagnoses of hysteria
    • Stereotypically American disease


German pessimism

  • German pessimism

    • “therapeutic nihilism born of experience bred a new herediterianism”
    • Asylums becoming crowded with (then untreatable) sufferers of tertiary syphilis
    • Alcoholism provided quintessential model
  • France picked up on pessimistic degenerative theories

    • Defeat by Prussia 1870, subsequent bloody Paris commune, bourgeois fears of social unrest provoked uneasy public mood
  • Marking of “inferior” members of society promoted misogyny, racism, eugenics

    • Physical characteristics of people and races
    • Sterilization and confinement of undesirables
      • In US before Nazi Germany


Psychiatry in Law

  • Psychiatry in Law

    • Britain
      • After 1799 trial of James Hadfield, defendants could be not guilty by reason of insanity
      • M’Naghten Rules established insanity defense as inability to tell right from wrong
    • France
      • “irresistible impulse” and temporary insanity (crime passionelle) enough to establish innocence
    • Disputes between law and psychiatry led to confusion, damaged opinion of psychiatry


Patient complaints

  • Patient complaints

    • Much literature exists complaining that the inmates of Bedlam were the sane ones; the doctors were crazy/cruel
    • Expression in art, essay, poetry
    • 1870s: attention to art produced by patients as way of diagnosis
    • Art therapy
    • Avant-garde artists, by virtue of similarity to patients’ work, called insane
      • Surrealists, Expressionists, Cubists
      • Cezanne


Emil Kraeplin (1856-1926)

  • Emil Kraeplin (1856-1926)

    • German, wanted to establish psychiatry as scientific, respected field
    • Dementia praecox: precursor of schizophrenia
    • Loaded language such as “atrophy of the emotions” suggested lack of humanity
  • Alois Alzheimer (1864-1915)

    • Senile dementia
    • Geriatric research
  • Nazi psychiatry

    • Lives of mentally ill not worth it
    • January 1940- September 1942: 70,723 mental patients gassed
    • Taken from lists of leading psychiatrists and psychologists


Freud (1856-1939)

  • Freud (1856-1939)

  • Materialist approach, dismissive of religion

    • Psychoanalysis
      • Oedipus Complex
      • Unconscious mind
      • Repression and neuroticism
      • Sexuality (esp. in children)
      • Ego, superego, id
      • Free association and dream interpretation
  • Carl Jung (1875-1961)

    • Feud with Freud
    • Collective unconscious
      • Lamarckian theory
    • Fascination with archetypes and myths
  • Alfred Adler (1870-1937)

    • Inferiority complex
    • Importance of social relations
    • Important in interwar treatment


US focus of psychoanalytic movement

  • US focus of psychoanalytic movement

  • Melanie Klein and Anna Freud

    • Disputes in field over relationships
    • between mothers and children
  • By 1950’s, psychoanalysis imbedded in American practice and society

    • Mental disorder not confined to bad cases
    • Ordinary people suffered from neuroses, complexes, etc
      • Alcoholism, adjustment problems, family problems, juvenile delinquency


Discovery of bacteria led to cures of syphilis, which caused mental illness

  • Discovery of bacteria led to cures of syphilis, which caused mental illness

  • 1920s: dubious trends

    • Electric shock therapy
    • Barbiturates and prolonged-sleep
    • Insulin coma (schizophrenia)
  • 1930s: psychosurgery

    • Leucotomy: separation of frontal lobes and rest of brain
    • Lobotomy
      • 18,000 by 1951
    • Often made patients submissive; some able to re-enter society
    • Well-meaning doctors, but criticized as overly aggressive
    • Methamphetamines came into use


1940s: penicillin!

  • 1940s: penicillin!

    • Led to rise of pharmacology
    • 1949: first psychotropic (mood-
    • influencing) drug introduced for
    • bipolar disorder
  • 1950s

    • Anti-psychotic and anti-depressant drugs
    • Many could leave asylums under medical regimens with new drugs
  • Valium introduced 1960s

  • Prozac 1987

    • Increased serotonin created “feel-good” sensation
    • Within 5 years, 8 million people tried


Karl Menninger

  • Karl Menninger

    • “Gone forever is the notion that the mentally ill person is an exception. It is now accepted that most people have some degree of mental illness at some time.” (1956)
  • More attention on milder cases

  • Anti-psychiatry movement,

  • 1960s and 1970s

    • Supported deinstitutionalization


Sources:

  • Roy Porter. Madness: A Brief History. Oxford, Oxford University Press, 2002.

  • Pictures: Wikipedia.org,

  • http://images.google.com/imgres?imgurl=http://www.gjpsy.uni-goettingen.de/gjp-madness-cover.jpg&imgrefurl=http://www.gjpsy.uni-goettingen.de/gjp-madness-download.htm&h=771&w=593&sz=54&hl=en&start=28&tbnid=OPHXHXdmYUr6wM:&tbnh=142&tbnw=109&prev=/images%3Fq%3Dmadness%26start%3D20%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Den%26sa%3DN

  • http://images.google.com/imgres?imgurl=http://www.bc.edu/bc_org/avp/cas/fnart/art/19th/painting/bell_madness.jpg&imgrefurl=http://sciowithbrio.wordpress.com/2007/06/01/10416/&h=477&w=409&sz=62&hl=en&start=71&tbnid=kKiIJ272cnYHDM:&tbnh=129&tbnw=111&prev=/images%3Fq%3Dmadness%26start%3D60%26gbv%3D2%26ndsp%3D20%26svnum%3D10%26hl%3Den%26sa%3DN




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