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
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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
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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
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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
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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
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• 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
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–
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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)
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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
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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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