History of Mental Illness
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Transcript History of Mental Illness
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 (164251)
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
• 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 selfdestructive 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
– Led to dehumanization; positive aspects of mental illness
forgotten
• 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
–
–
–
Unlike Britain and France, university and researchbased
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)
– “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
– “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
– 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
– 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)
– 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)
• 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
• 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
• 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!
– Led to rise of pharmacology
– 1949: first psychotropic (moodinfluencing) 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
– “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,
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