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UNDERSTANDING PSYCHOPATHOLOGY

INTRODUCTION
Extraordinary People

Clifford Beers, A Mind That Found Itself

Clifford Beers was always an energetic child, moody, with little
selfcontrol. Still, he was intelligent and ambitious enough to do well in
school, and he graduated from college. However, Beers’s mood iness
increased with time, particularly after his brother Sam began to have
severe, convulsive seizures. In March 1890, as his brother lay dying in the
family home, Beers’s moodiness grew to despair, accompanied by deep
paranoia. He began contemplating suicide and eventually jumped out a
fourth-floor window, fortunately suffering only broken bones. Beers was
hospitalized, fi rst in a private mental hospital but later, when his family
ran out of money, in public mental hospitals. In the early 1900s, there
were no effective treatments for symptoms such as those Beers suffered.
He was given drugs that physicians thought might help, including
strychnine and arsenic tonics. He also was beaten, choked, put in a
straitjacket for up to 21 days, and locked away with no clothes for
long periods in dark, cold cells. Despite these experiences, Beers’s
symptoms ultimately subsided, and after spending 3 years in various
hospitals, he was declared recovered enough to be released.
These experiences inspired Beers to start a movement for the reform of
mental health treatment, which he called the mental hygiene
movement. After his release from the mental hospital, Beers wrote a
personal account of his time there, which was published in 1908 as A
Mind That Found Itself . This book forever changed how physicians and
the public viewed mental patients and hospitals (Nolen-Hoeksema, S.
2011).

The study of abnormal psychology is the

study of people, like Clifford Beers, who
suffer mental, emotional, and often physical

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pain, often referred to as psychopathology.

Sometimes the experiences of people with
psychopathology are as unusual. Sometimes,
however, people with psychopathology have
experiences that are familiar to many of us
but more extreme.
In this module, we explore the cases with
troubling psychological symptoms to
understand how they think, what they feel,
and how they behave. We investigate what is
known about the causes of and treatments
for various types of symptoms.
Thus, the purpose of this module is not
only to provide you with information, facts
and figures, theories, and research. It is
also to help you understand the experience
of people with psychological symptoms.

Lesson 1 Understanding Abnormal

Behavior: Its Key Concepts
Lesson 2 History of Mental Illness
Lesson 3 Research Methods in Abnormal
Psychology
Lesson 4 Models of Abnormality
Lesson 5 Clinical Assessments, Diagnosis
and Treatment

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MODULE I

UNDERSTANDING PSYCHOPATHOLOGY

Lesson 2

HISTORY OF
MENTAL ILLNESS

1. Prehistoric and Ancient Beliefs. Prehistoric cultures often held a

supernatural view of abnormal behavior and saw it as the work of evil
spirits, demons, gods, or witches who took control of the person. This form
of demonic possession often occurred when the person engaged in behavior
contrary to the religious teachings of the time. Treatment by cave dwellers
included a technique called trephination, in which a stone instrument
known as a trephine was used to remove part of the skull, creating an
opening. Through it, the evil spirits could escape thereby ending the
person’s mental affliction and returning them to normal behavior. Early
Greek, Hebrew, Egyptian, and Chinese cultures used a treatment method
called exorcism in which evil spirits were cast out through prayer, magic,
flogging, starvation, having the person ingest horrible tasting drinks, or
noise-making.
2. Greco-Roman Thought. Rejecting the idea of demonic possession, Greek
physician, Hippocrates (460-377 B.C.), said that mental disorders were
akin to physical disorders and had natural causes. Specifically, they arose
from brain pathology, or head trauma/brain dysfunction or disease, and
were also affected by heredity. Hippocrates classified mental disorders into
three main categories – melancholia, mania, and phrenitis (brain fever) and
gave detailed clinical descriptions of each. He also described four main
fluids or humors that directed normal brain functioning and personality –
blood which arose in the heart, black bile arising in the spleen, yellow bile
or choler from the liver, and phlegm from the brain. Mental disorders
occurred when the humors were in a state of imbalance such as an excess of
yellow bile causing frenzy and too much black bile causing melancholia or
depression.
Also important was Greek philosopher, Plato (429-347 B.C.), who
said that the mentally ill were not responsible for their own actions and so
should not be punished. Greek physician, Galen (A.D. 129-199) said mental
disorders had either physical or mental causes and included fear, shock,
alcoholism, head injuries, adolescence, and changes in menstruation.
In Rome, physician Asclepiades (124-40 BC) and philosopher Cicero
(106-43 BC) rejected Hippocrates’ idea of the four humors and instead
stated that melancholy arises from grief, fear, and rage; not excess black
bile. They practice the concept of “contrariis contrarius”, meaning opposite

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by opposite, and introduced contrasting stimuli to bring about balance in

the physical and mental domains. An example would be consuming a cold
drink while in a warm bath.

3. The Middle Ages – 500 AD to 1500 AD. Mental illness was yet again
explained as possession by the Devil and methods such as exorcism,
flogging, prayer, the touching of relics, chanting, visiting holy sites, and
holy water were used to rid the person of his influence. In extreme cases,
the afflicted were exposed to confinement, beatings, and even execution.
Scientific and medical explanations, such as those proposed by Hippocrates,
were discarded.
Group hysteria, or mass madness, was also seen in which large
numbers of people displayed similar symptoms and false beliefs. This
included the belief that one was possessed by wolves or other animals and
imitated their behavior, called lycanthropy, and a mania in which large
numbers of people had an uncontrollable desire to dance and jump, called
tarantism. The latter was believed to have been caused by the bite of the
wolf spider, now called the tarantula, and spread quickly from Italy to
Germany and other parts of Europe where it was called Saint Vitus’s dance.
Near the end of the Middle Ages, mystical explanations for mental
illness began to lose favor and science and medicine were called upon to
explain psychopathology.
4. The Renaissance – 14th to 16th centuries. The most noteworthy
development in the realm of philosophy during the Renaissance was the rise
of humanism, or the worldview that emphasizes human welfare and the
uniqueness of the individual. This helped continue the decline of
supernatural views of mental illness. In the mid to late 1500s, Johann
Weyer (1515-1588), a German physician, published his book, On the Deceits
of the Demons, that rebutted the Church’s witch-hunting handbook, the
Malleus Maleficarum, and argued that many accused of being witches and
subsequently imprisoned, tortured, and/or burned at the stake, were
mentally disturbed and not possessed by demons or the Devil himself. He
believed that like the body, the mind was susceptible to illness.
The number of asylums, or places of refuge for the mentally ill where
they could receive care, began to rise during the 16th century as the
government realized there were far too many people afflicted with mental
illness to be left in private homes. Hospitals and monasteries were
converted into asylums. In 1547, the Bethlem Hospital opened in London
with the sole purpose of confining those with mental disorders. Patients
were chained up, placed on public display, and often heard crying out in
pain. The asylum became a tourist attraction, with sightseers paying a
penny to view the more violent patients, and soon was called “Bedlam” by
local people; a term that today means “a state of uproar and confusion” .
5. Reform Movement – 18th to 19th centuries. The rise of the moral
treatment movement occurred in Europe in the late 18th century and then
in the United States in the early 19th century. Its earliest proponent was
Francis Pinel (1745-1826) who was assigned as the superintendent of la
Bicetre, a hospital for mentally ill men in Paris. Arguing that the mentally ill
were sick people, Pinel ordered that chains be removed, outside exercise be

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allowed, sunny and well-ventilated rooms replace dungeons, and patients be

extended kindness and support. This approach led to considerable
improvement for many of the patients, so much so, that several were
released.
Following Pinel’s lead in England, William Tuke (1732-1822), a
Quaker tea merchant, established a pleasant rural estate called the York
Retreat. The Quakers believed that all people should be accepted for who
they were and treated kindly. At the retreat, patients could work, rest, talk
out their problems, and pray (Raad & Makari, 2010). The work of Tuke and
others led to the passage of the Country Asylums Act of 1845 which required
that every county provide asylum to the mentally ill. This was even
extended to English colonies such as Canada, India, Australia, and the West
Indies as word of the maltreatment of patients at a facility in Kingston,
Jamaica spread, leading to an audit of colonial facilities and their policies.
Reform in the United States started with the figure largely considered
to be the father of American psychiatry, Benjamin Rush (1745-1813). Rush
advocated for the humane treatment of the mentally ill, showing them
respect, and even giving them small gifts from time to time.
Due to the rise of the moral treatment movement in both Europe and
the United States, asylums became habitable and places where those
afflicted with mental illness could recover. Its success was responsible for
its decline.
The moral treatment movement fell due to the rise of the mental
hygiene movement, which focused on the physical well-being of patients. Its
main proponent in the United States was Dorothea Dix (1802-1887), a New
Englander who observed the deplorable conditions suffered by the mentally
ill while teaching Sunday school to female prisoners. Over the next 40 years,
from 1841 to 1881, she motivated people and state legislators to do
something about this injustice and raised millions of dollars to build over 30
more appropriate mental hospitals and improve others. Her efforts even
extended beyond the U.S. to Canada and Scotland.
Finally, in 1908 Clifford Beers (1876-1943) published his book, A
Mind that Found Itself, in which he described his personal struggle with
bipolar disorder and the “cruel and inhumane treatment people with mental
illnesses received. He witnessed and experienced horrific abuse at the hands
of his caretakers. At one point during his institutionalization, he was placed
in a straightjacket for 21 consecutive nights.” His story aroused sympathy in
the public and led him to establish the National Committee for Mental
Hygiene, known today as Mental Health America, which provides education
about mental illness and the need to treat these people with dignity. Today,
MHA has over 200 affiliates in 41 states and employs 6,500 affiliate staff and
over 10,000 volunteers.
6. 20th – 21st Centuries. The decline of the moral treatment approach in
the late 19th century led to the rise of two competing perspectives – the
biological or somatogenic perspective and the psychological or psychogenic
perspective.
• Biological or Somatogenic Perspective. Recall that Greek physicians
Hippocrates and Galen said that mental disorders were akin to
physical disorders and had natural causes. Though the idea fell into
oblivion for several centuries it re-emerged in the late 19th century

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for two reasons. First, German psychiatrist, Emil Kraepelin (1856-

1926), discovered that symptoms occurred regularly in clusters which
he called syndromes. These syndromes represented a unique mental
disorder with its own cause, course, and prognosis. In 1883 he
published his textbook, Compendium der Psychiatrie (Textboook of
Psychiatry), and described a system for classifying mental disorders
that became the basis of the American Psychiatric Association’s
Diagnostic and Statistical Manual of Mental Disorders (DSM) that is
currently in its 5th edition (published in 2013).
Secondly, in 1825, the behavioral and cognitive symptoms of
advanced syphilis were identified to include a belief that everyone is
plotting against you or that you are God (a delusion of grandeur), and
were termed general paresis by French physician A.L.J. Bayle. In
1897, Viennese psychiatrist Richard von Krafft-Ebbing injected
patients suffering from general paresis with matter from syphilis
spores and noted that none of the patients developed symptoms of
syphilis, indicating they must have been previously exposed and were
now immune. This led to the conclusion that syphilis was the cause of
the general paresis. In 1906, August von Wassermann developed a
blood test for syphilis and in 1917 a cure was stumbled upon. Julius
von Wagner-Jauregg injected nine patients with blood from a soldier
afflicted with malaria. Three of patients fully recovered while three
others showed great improvement in their paretic symptoms. The
high fever caused by malaria burned out the syphilis bacteria.
Hospitals in the United States began incorporating this new cure for
paresis into their treatment approach by 1925.
The 1930s also saw the use of electric shock as a treatment
method, which was stumbled upon accidentally by Benjamin Franklin
while experimenting with electricity in the early 18th century. He
noticed that after suffering a severe shock his memories had changed
and in published work, suggested physicians study electric shock as a
treatment for melancholia.
• Psychological or Psychogenic Perspective. The psychological or
psychogenic perspective states that emotional or psychological
factors are the cause of mental disorders and represented a challenge
to the biological perspective. This perspective had a long history, but
did not gain favor until the work of Viennese physician Franz Anton
Mesmer (1734-1815). Influenced heavily by Newton’s theory of
gravity, he believed that the planets also affected the human body
through the force of animal magnetism and that all people had a
universal magnetic fluid that determined how healthy they were. He
demonstrated the usefulness of his approach when he cured Franzl
Oesterline, a 27-year old woman suffering from what he described as
a convulsive malady. He also successfully cured deafness, paralysis,
loss of bodily feeling, convulsions, menstrual difficulties, and
blindness.
A royal commission was formed to investigate his technique
but could not find any proof for his theory of animal magnetism.
Though he was able to cure patients when they touched his
“magnetized” tree, the result was the same when “non-magnetized”

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trees were touched. As such, Mesmer was deemed a charlatan and

forced to leave Paris. His technique was called mesmerism and today,
we know it as hypnosis.
The psychological perspective gained popularity after two
physicians practicing in the city of Nancy in France discovered that
they could induce the symptoms of hysteria in perfectly healthy
patients through hypnosis and then remove the symptoms in the same
way. The work of Hippolyte-Marie Bernheim (1840-1919) and
Ambroise-Auguste Liebault (1823-1904) came to be part of what
was called the Nancy School and showed that hysteria was nothing
more than a form of self-hypnosis. In Paris, this view was challenged
by Jean Charcot (1825-1893) who stated that hysteria was caused
by degenerative brain changes, reflecting the biological perspective.
He was proven wrong and eventually turned to their way of thinking.
The use of hypnosis to treat hysteria was also carried out by
fellow Frenchman Pierre Janet (1859-1947), and student of Charcot,
who believed that hysteria had psychological, not biological causes.
In Vienna, Josef Breuer (1842-1925) induced hypnosis and had
patients speak freely about past events that upset them. He called
this the cathartic method and our use of the word catharsis today
indicates a purging or release, in this case, of pent up emotion.
By the end of the 19th century, it had become evident that
mental disorders were caused by a combination of biological and
psychological factors and the investigation of how they develop
began. Sigmund Freud’s development of psychoanalysis followed on
the heels of the work of Bruner, and others who came before him.
7. Current Views/Trends.
Use of psychiatric drugs and deinstitutionalization. Beginning in
the 1950s, psychiatric or psychotropic drugs were used for the treatment of
mental illness and made an immediate impact. Though drugs alone cannot
cure mental illness, they can improve symptoms and increase the
effectiveness of treatments such as psychotherapy. Classes of psychiatric
drugs include antidepressants used to treat depression and anxiety, mood-
stabilizing medications to treat bipolar disorder, antipsychotic drugs to treat
schizophrenia, and anti-anxiety drugs to treat generalized anxiety disorder
or panic disorder
A result of the use of psychiatric drugs was deinstitutionalization, or
the release of patients from mental health facilities. This shifted resources
from inpatient to outpatient care and placed the spotlight back on the
biological or somatogenic perspective. When people with severe mental
illness do need inpatient care, it is typically in the form of short term
hospitalization.
Managed health care. Managed health care is a term used to describe
a type of health insurance in which the insurance company determines the
cost of services, providers a person may see, and the number of visits a
subscriber can have within a year. This is regulated through contracts with
providers and medical facilities. The plans pay the providers directly so
subscribers do not have to pay out-of-pocket or complete claim forms,
though most require co-pays paid directly to the provider at the time of
service. Exactly how much the plan costs depends on how flexible the

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subscriber wants it to be; the greater the flexibility, the greater the cost.
Managed health care takes three forms:
Multicultural psychology. As our society becomes increasingly
diverse, medical practitioners and psychologists alike have to take into
account the patient’s gender, age, race, ethnicity, socioeconomic (SES)
status, and culture and how these factors shape the individual’s thoughts,
feelings, and behaviors. Additionally, we need to understand how the
various groups, whether defined by race, culture, or gender, differ from one
another. This approach is called multicultural psychology.
In August 2002, the American Psychological Association’s (APA)
Council of Representatives put forth six guidelines based on the
understanding that “race and ethnicity can impact psychological practice
and interventions at all levels” and that there is a need for respect and
inclusiveness. They further state, “psychologists are in a position to provide
leadership as agents of prosocial change, advocacy, and social justice,
thereby promoting societal understanding, affirmation, and appreciation of
multiculturalism against the damaging effects of individual, institutional,
and societal racism, prejudice, and all forms of oppression based on
stereotyping and discrimination.”

THINK IT THROUGH!

For thousands of years, humans have tried to understand

and control abnormal behavior. Check your understanding
of these historical theories and match them to the treatments
used to “cure” abnormal behavior: (a) bloodletting; induced
vomiting; (b) patient placed in socially facilitative
environments; and (c) exorcism; burning at the stake.

1. Supernatural causes; evil demons took over the victims’

bodies and controlled their behaviors.

2. The humoral theory reflected the belief that normal

functioning of the brain required a balance of four bodily
fluids or humors.

3. Maladaptive behavior was caused by poor social

and cultural influences within the environment.

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References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of
Mental Disorders. (5th ed.-TR). American Psychiatric Publishing.

American Psychiatric Association. (2013). Diagnostic and statistical manual of

Mental Disorders. (5th ed.). American Psychiatric Publishing.

Barlow, D.H., Durand, V.M., Hofmann, S.G. (2018). Abnormal Psychology: An

Integrative Approach. (8th ed.). Cengage Learning Unlimited.

Bortolotti, L. (2017). Delusions in Context. Routledge Press.

https//www.taylorandfrancis.com

Comer, R. J., Comer, J.S. (2015). Abnormal Psychology. (9th ed.). Worth
Publishers,
Inc.

Demme, J. (1991). The Silence of the Lambs (Film). Strong Heart Productions.

DMMMSU Official Account. (2021). DMMMSU at a Glance (Video). Youtube.

https://www.youtube.com/watch?v=WqMAK9nsrB0

GMA Public Affairs.(2018). I-Witness: 'Bilanggo ng Isipan,' dokumentaryo ni Kara

David. Youtube. https://www.youtube.com/watch?v=VlvxuqYcO-g

GMA Public Affairs. (2017). Reporter's Notebook: Estado ng mental health sa

Pilipinas, sinuri. Youtube. https://www.youtube.com/watch?v=1a5TnnIKIks

Howard, R. (2002). A Beautiful Mind (Film). Dreamworks & Universal Pictures.

Jansson, A. (2021). From Melancholia to Depression: Disordered Mood in the

19th century Psychiatry. Palgrave MacMillan.
https://doi-org/10.1007/978-3-030-54802-5

Livesley, W. J., and Larstone, R. (2018). Handbook of Personality Disorders:

Theory, Research and Treatment. Guilford Press. www.guilford.com

Morrison, J.R. (2014). DSM-5 Made Easy: The Clinician’s Guide to Diagnosis. (1st
ed.) The Guilford Press.

Noxon, M. (2017). To the Bone (Film). Netflix.

Petire, D. (2007). Sybil (Film). Lorimar Productions.

Study.com. (2014). The Psychology of Abnormal Behavior: Understanding the

Criteria & Causes of Abnormal Behavior (Video). Youtube.
https://www.youtube.com/watch?v=prUFZIcgZiQ

Tomacder, G. (2020). Module in Abnormal Psychology (Psy 108). Don Mariano

Marcos Memorial State University-Mid La Union Campus.

Wimshurst, L. (2017). Abnormal Child Adolescent: A developmental Perspective.

Routledge, Inc. http//:www.taylorandfrancis.com

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