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004 - chapter 2 - historical & contemporary views0001

004 - chapter 2 - historical & contemporary views0001

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Published by: Joseph Eulo on Jan 29, 2009
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Demonology, Gods, and Magic
Hippocrates' Early Medical Concepts
Early Philosophical Conceptions of
Consciousness and Mental Discovery
Later Greekand Roman Thought
Abnormalityduring the Middle Ages
Changing Attitudestoward Mental Health in the
Early TwentiethCentury
Mental HospitalCare in theTwentiethCentury
Biological Discoveries: Establishing the Link
between the Brain and Mental Disorder
The Development ofa Classification System
Causation Views: Establishing the Psychological
Basis of Mental Disorder
The Evolution of the Psychological Research
Tradition: Experimental Psychology
The Resurgence of Scientific Questioning in
The Establishment of Early Asylums and Shrines
Humanitarian Reform
Nineteenth-Century Views of the Causesand
Treatment of Mental Disorders
Interpreting Historical Events
Historical and
Contemporary Views of
Abnormal Behavior

ur historical efforts to understand abnormal psychologyinclude both humor and tragedy. In this chapter, we will highlight some views of psychopathology, and some of the treatments administered, from ancient times to the twenty-first century. In a broad sense, we will see a progression of beliefs from what we now consider superstition to those based on scientific awareness-from

a focus on supernatural explanations toa knowledge of natural causes. The course of this evolution has often been markedby periods of advancement or unique individual contributions, followed by longyears of

inactivity orunproductive backward steps.

The earliest treatment of mental disorders was that prac- ticed by Stone Age cave dwellers some half amillion years ago. For certain forms of mental disorders(probably those in which the individual complained of severe headaches and developed convulsive attacks), the early shaman, or medicine man, treated thedisorder by meansof an opera- tion now called "trephining."This operation was per- formed with crude stone instruments and consistedof chipping away one area of the skull in the form of a circle until the skull was cut through. This opening, called a

"trephine:'presumably permitted the evil spirit that was
thought to be causingall the trouble to escape-and

may incidentally have relieved a certain amount of pressure on the brain. In some cases, trephined skulls of primitive peo- ple show healing around the opening, indicating that the patient survived the operation andlived for many years afterward (Arnott, Finger,& Smith, 2003; Selling, 1943).

Although human life appeared on earth some 3 mil-
lion or more years ago, written records extendback only a

few thousand years. Thus our knowledge of our early ancestors islimited. Two Egyptian papyri dating from the sixteenth centuryB.C. provide someclues to the earliest treatments of diseases and behavior disorders(Okasha& Okasha, 2000). The Edwin Smith papyrus(named after its nineteenth-century

discoverer) contains detailed descrip- tions of the treatment of wounds and other surgical oper- ations. In it, the brain isdescribed-possibly

for the first
time in history-and

the writing clearly shows thatthe brain was recognized as the site of mentalfunctions. The Ebers papyrus offers another perspective on treatment. It covers internal medicine and the circulatory system but relies more on incantations and magic for explaining and curing diseases that had unknown causes. Although surgi- cal techniques may have been used, they were probably coupled with prayers and thelike that reflectedthe prevail- ing view of the origin of behaviordisorders.

Demonology, Gods, and Magic
References to abnormal behavior in early writings show
that the Chinese, Egyptians, Hebrews, and Greeks often

attributed such behavior to a demon or god who had taken possession of a person. Whether the"possession" was assumed to involve good spirits or evil spirits usually

depended on the affected individual's symptoms. If a per-
son's speech or behavior appeared to have a religious or
mysticalsignificance, it was usually thought that he or she
waspossessed by a good spirit or god. Such people were
often treatedwithconsiderable awe and respect, for people
believed they hadsupernaturalpowers.

Most possessions, however, were considered to be the work of an angry god or an evil spirit, particularly when a personbecame excited or overactive and engaged in behavior contrary to religious teachings. Among the ancient Hebrews, for example, such possessions were

thought to represent the wrath and punishment of God.
Mosesisquoted in the Bible as saying,"The Lord shall
smite thee with madness:' Apparently thispunishment was
thought to involve the withdrawalof God's protection and
the abandonment of the person to the forces of evil.In

such cases, every effort was made to ridthe person of the evil spirit. Jesus reportedly cured a man with an "unclean spirit" by transferring the devils that plaguedhim to a herd of swine, which, in turn, became possessed and"ran vio-

lently down a steep place into the sea" (Mark 5:1-13).

Theprimary type of treatment for demonic posses- sion was exorcism, which included various techniques for casting an evil spirit out of an afflicted person. These tech-

niques variedbut typically included magic, prayer, incan-
tation, noisemaking, and the use of horrible-tasting
concoctionsmade from sheep's dung and wine.
Hippocrates' Early Medical Concepts

The Greektemples of healing ushered in the Golden Age of Greece under the Athenian leader Pericles(461-429B.C.). This period saw considerable progress in the understand-

ing andtreatment of mental disorders, in spite of the fact
Hippocrates' (460-377B.C.) belief that mental diseasewas the
result of natural causesand brain pathology wasrevolutionaryfor
its time.
that Greeks of the timeconsidered the human bodysacred,
so littlecould belearned of human anatomy or physiology.
Duringthis period theGreek physician Hippocrates
(460-377B.C.),often referred to asthe father of modern
medicine, received his training and made substantial con-
tributions tothe field.
Hippocrates denied that deities and demons intervened
inthe development of illnessesand insisted that mental dis-

orders, likeotherdiseases,had natural causes and appropri- ate treatments.He believed that thebrain was the central organ of intellectual activity and that mental disorders were

due to brain pathology. He also emphasized the importance
of heredity and predisposition and pointed out that injuries
to the head could cause sensory and motor disorders.
Hippocrates classifiedall mental disorders into three
general categories-mania,
melancholia, and phrenitis
(brain fever)-and

gave detailedclinical descriptions of the specific disorders included ineach category. He relied heavily on clinical observation, and his descriptions, which

werebased ondaily clinicalrecordsof his patients, were
surprisingly thorough.
Maher and Maher(1994) pointed out that the best
known ofthe earlier paradigms for explaining personality
or temperament is the doctrine of the four humors, associ-
ated with thename ofHippocrates and later with the
Roman physician Galen. The four elements of the material

worldwere thought to be earth, air, fire, and water, which had attributes of heat, cold, moistness,and dryness. These elements combined to form the four essential fluids of the body-blood

(sanguis), phlegm,bile (choler),and black

bile(melancholer). The fluids combined in different pro- portions within different individuals, and a person's tem- perament was determined by which of the humors was dominant. From thisview came one of the earliest and longest-lasting typologies of human behavior: the san- guine, the phlegmatic, the choleric, and the melancholic. Each of these"types" brought with ita set of personality attributes. For example, the person of sanguine tempera- mentwas optimistic, cheerful, and unafraid.

Hippocrates considered dreams to be importantin understandinga patient's personality. On this point, he was a harbinger of a basic concept of modern psychody- namic psychotherapy. The treatments advocated by Hip- pocrates were far in advance of the exorcistic practices then prevalent.

For the treatment
of melancholia

Developments inThinking2.1 on p. 30), forexample, he prescribeda regular and tranquil life, sobriety andabsti- nence from allexcesses, a vegetable diet, celibacy, exercise

short of fatigue, and bleeding if indicated.He also recog-
nized the importance of the environment
removed his patients from their families.
Hippocrates' emphasis on the natural causes of dis-
eases,on clinical observation,and on brain pathology as
the root of mental disorders was truly revolutionary. Like
his contemporaries,
however, Hippocrates
had little
knowledge of physiology. He believed that hysteria (the
appearanceofphysical illnessin the absence oforganic

pathology) was restricted to women and was caused by the uterus wandering tovarious parts of the body, pining for children. For this "disease," Hippocrates recommended marriage as the best remedy.

Early Philosophical Conceptions of
Consciousness and Mental Discovery
The Greek philosopher Plato(429-347B.C.) studied men-
tally disturbed individuals who hadcommitted criminal
acts and how to deal with them. Hewrote thatsuch per-
sonswere,in some "obvious" sense,not responsible for
their acts andshould not receive punishment in the same
way asnormal persons: "[S]omeone maycommit an act
when mad or afflicted with disease.... [Ifso,] let him pay
simplyfor the damage; and let him be exempt from other
punishment" (Plato, n.d.). Plato also made provisionfor
mental cases to be cared for in the community.

Platoviewed psychological phenomena as responses of the whole organism, reflecting its internalstate and nat- ural appetites.InThe Republic, Plato emphasized the impor- tanceof individual differences in intellectualand other

abilities, and took into account socioculturalinfluences
inshaping thinking and behavior. Hisideas regarding

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